Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
ObjectiveTo explore the protective effects of abdominal paracentesis drainage (APD) on pancreatitis-associated liver injury in the early phase of severe acute pancreatitis (SAP). MethodsOne hundred and fourteen consecutive patients with SAP, admitted to the General Hospital of Western Theater Command from January 2015 to January 2021, were included in this retrospective study. The patients were divided into the APD group (n=61) and the non-APD group (n=53) based on whether they underwent APD treatment within 72 h of admission. The variables including baseline data, liverfunction tests, inflammation indexes, severity scores and other variables of the two groups were statistically analyzed. ResultsThe hospital mortality in the APD group was lower than that in the non-APD group (8.2% vs. 22.6%, P=0.031). These severity scores (including APACHE Ⅱ score, Ranson score and modified Marshall score) and inflammation indexes (including C-reactive protein, interleukin-6, interleukin-1 and tumor necrosis factor-α) in the APD group were all lower than those in the non-APD group (P＜0.05). In terms of liver function related indexes, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL) after treatment in both two groups were significantly lower than those before treatment (P＜0.05). The levels of ALT, AST, TBIL and DBIL after treatment in the APD group were lower than those in the non-APD group (P＜0.05), and the levels of prealbumin and albumin after treatment in the APD group were higher than those in the non-APD group (P＜0.05), but there were no significant differences in the levels of alkaline phosphatase, GGT and 5′ -nucleotidase after treatment in the two group (P＞0.05). ConclusionFor SAP patients with ascitic fluid, application of APD can attenuate liver injury and improve liver function in the early stage of SAP.
Objective
To investigate the efficacy and safety of abdominal indwelling catheterization for the patients with large-volume ascites.
Methods
A total of 84 patients with liver cirrhosis complicated with large-volume ascites admitted in the first affiliated hospital of Xi’an Jiaotong University from January 2015 to December 2015 were retrospectively analyzed. Patients were divided into two groups, one was the puncture group and another was the catheterization group. The efficacy and safety were evaluated.
Results
Forty-four patients were enrolled in catheterization group, whereas forty patients were enrolled in puncture group. Symptoms associated with ascites had been eased and patients’ qualities of life had been improved in 2 weeks in each group. The tube fell out rate was 27.3% for patients in catheterization group. There was no operation related complications such as death, bleeding and intestinal perforation occurred. Either Child B stage or Child C stage, the dynamic changes of liver function and renal function in catheterization group were comparable to those in puncture group. No adverse event such as catheterization-related or puncture-related infection was observed.
Conclusion
Abdominal catheterization is effective and safe in management of large amount of ascites complicated with cirrhosis, however, the high rate of tube-fell-out should be paid more attention.
ObjectiveTo systematically review the efficacy and safety of early abdominal paracentesis drainage (APD) in patients with severe acute pancreatitis (SAP). MethodsThe PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials and cohort studies on the management of SAP via early APD from inception to December 10, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software and Stata 17.0 software. ResultsEighteen studies were included, with a total sample size of 2 685 patients. The meta-analysis showed that early APD could decrease mortality (OR=0.49, 95%CI 0.35 to 0.69, P<0.01) and the incidences of multiple organ failure (OR=0.56, 95%CI 0.45 to 0.71, P<0.01), ARDS (OR=0.54, 95%CI 0.41 to 0.71, P<0.01), and infectious complications (OR=0.72, 95%CI 0.57 to 0.92, P<0.01) and also reduce the need for further interventions and the total cost incurred during hospitalization, reduce the length of hospital stay, and reduce the number of days spent in the intensive care unit. However, there were no significant differences in the incidence of pneumonia, bacteremia, and sepsis between the two groups. ConclusionThe treatment of SAP via early APD, which has high clinical value, could decrease the incidence of multiple organ failure, improve the prognosis of patients, and reduce the associated mortality rate. Moreover, APD does not increase the risk of infection-related complications. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective
To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection.
Methods
The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized.
Results
After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge.
Conclusions
Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
