Several unusual manifestations such as white bile draining in common bile duct (14 cases) and casual massive bleeding (2 cases ) during and following hepatobiliary and pancreatic operations is reported. These manifestations were in fact signs of hepatic insufficiency. The manners of manifestations of hepatic insufficiency and their treatment are discussed, with a stress that liver-protective treatment and nutritional support are the fundamental modalities.
ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.
Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.
Objective To compare the efficacy of 6-epsilon-aminocaproic acid （EACA） with aprotinin on reducing postoperative bleeding in cardiac valve replacement procedures, and to investigate its influence on the possible thromboembolism and the renal function. Methods Seventy-nine patients who underwent cardiac valve replacement were randomly divided into two groups： EACA group （n = 39） and aprotinin group （n = 40）, which were given EACA and aprotinin separately in operations. The volumes of drainage to body surface area （BSA）, blood transfusion were recorded during 24 h after operations. The concentrations of serum D-dimer and α2-antiplasmin （a2- AP） were measured before, during operation and at 72h post-operatively. The serum creatinine levels before operation and at the 72 h after operation were also measured. Results The volume ratio of drainage to BSA in EACA group was significantly higher than that in the aprotinin group at 24 h after operation （P = 0. 019）. However, there was no significant difference in the volumes of blood transfusion between two groups （P〉0. 05）. Also no statistical difference in the concentrations of D-dimer and a2-AP were found between two groups whether preoperatively or at 72h post-operatively （P= 0. 960,0. 485）, D-dimer and a2-AP of the aprotinin group were higher than those in the EACA group after aortic off-clamping （P = 0. 001,0. 000）. There was no statistically difference of △CrCl72 in both groups （P〉0. 05）. No patient with thrombosis or thromboembolism was detected in two groups.Conclusion Although the efficacy of EACA in reducing postoperative bleeding in cardiac valve replacement can not compare favorably with that of aprotinin, the blood transfusion volume would not increase when EACA is used introoperatively. Proper usage of EACA will not cause thrombosis and renal damage.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
Objective To systematically review the correlation of activated partial thromboplastin time (APTT) and prognosis after ECMO treatment. Methods The PubMed, EMbase, MEDLINE, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the correlation of APTT and prognosis after ECMO treatment from database inception to April 11th, 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 22 studies, involving 2 913 patients were included. The level of APTT in the bleeding group was higher than that in the non-bleeding group during ECMO support treatment (MD=10.34, 95%CI 1.32 to 19.37, P=0.02). The APTT level in the thrombus group was lower than that in the non-thrombus group (MD=?3.58, 95%CI ?5.89 to ?1.27, P=0.002). The level of APTT in the death group was significantly higher than that in the survival group (MD=8.97, 95%CI 5.89 to 12.06, P<0.00001). Conclusion The APTT level of ECMO patients is closely related to the prognosis of bleeding, thrombosis and death. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
ObjectiveTo investigate the current situation of randomized controlled trials (RCTs) of thrombin like enzyme research and the ability to provide a reliable basis for the clinical practice.
MethodsRCTs identified from four Chinese databases up to the year 2012 were assessed according to international standard, including SinoMed (1978-2012), CNKI (1979-2012), Wanfang Data (1986-2012), and VIP (1989-2012).
ResultsA total of 2358 articles were searched and 53 RCTs were identified. The results showed that the quality of these articles was not high enough to meet the needs of clinical practice in China.
ConclusionIn China, current quantity and quality of RCTs of thrombin like enzyme can not meet the need of clinical practice. In order to improve the prevention and treatment of hemorrhagic diseases, and surgical bleeding, especially for patients lacking clotting factor, more high-quality RCTs are required.
Objective To investigate the effect of rivaroxaban on the risk of bleeding after total knee arthroplasty (TKA). Methods A total of 119 cases undergoing primary TKA because of knee osteoarthritis between June 2009 and May 2011, were randomly divided into the rivaroxaban group (59 cases) and the control group (60 cases). There was no significant difference in gender, age, height, weight, side, disease duration, and grade of osteoarthritis between 2 groups (P gt; 0.05). Thepreoperative preparation and operative procedure of 2 groups were concordant. At 1-14 days after TKA, rivaroxaban 10 mg/d were taken orally in the rivaroxaban group, and placebo were given in the control group. The blood routine examination was performed before operation and at 2 days postoperatively; the total blood loss and hemoglobin (HGB) decrease were calculated according to the formula; the blood loss, postoperative wound drainage, and wound exudate after extubation were recorded to calculate the dominant amount of blood loss; and the bleeding events were recorded within 35 days postoperatively. Results The total blood loss and HGB decrease were (1 198.34 ± 222.06) mL and (33.29 ± 4.99) g/L in the rivaroxaban group and were (1 124.43 ± 261.01) mL and (31.57 ± 6.17) g/L in the control group, showing no significant difference (P gt; 0.05); the postoperative dominant blood loss in the rivaroxaban group [(456.22 ± 133.12) mL] was significantly higher than that in the control group [(354.53 ± 96.71) mL] (t=4.773, P=0.000). The bleeding events occurred in 3 cases (5.1%) of the rivaroxaban group and in 1 case (1.7%) of the control group, showing no significant difference (χ2=1.070, P=0.301). Conclusion Rivaroxaban has some effects on the risk of bleeding after TKA. In general, rivaroxaban is safe.
Objective To evaluate the hemostatic effect of selective artery embolization in treatment for traumatic hepatic rupture bleeding. Methods The clinical data of 63 patients with traumatic hepatic rupture treated in this hospital from Jan. 2004 to Jun. 2011 were analyzed retrospectively. With Seldinger technique， a catheter was introduced into the liver artery via the right femoral artery for angiography. Once the bleeding site was identified， microcatheter was placed into the hemorrhagic vessels to control the bleeding with polyvinyl alcohol or gelatin sponges. Results The hepatic arteriography was successfully performed in 63 cases， the results showed hepatic left-artery bleeding in 8 cases， hepatic right-artery bleeding in 39 cases， and hepatic left- and right-artery bleeding in 10 cases. Fifty-seven cases received selective arterial embolization and successful hemostasia， including one embolization in 36 cases， two embolizations in 11 cases， and more than two embolizations in 10 cases. Six patients without obvious hemorrhage didn’t receive selective arterial embolization. There was no bleeding again case and no dead case. The hemoglobin and hematocrit returned to normal in one week after embolization. No hemorrhage or other complications happened during follow-up for 0.5 to 1 year. Conclusion The selective arterial embolization is an effective， safe and minimally invasive method for hemostasia of patients with traumatic hepatic rupture.
