Objective
To investigate the clinical value of " O”continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage (PTCD) in pancreaticoduodenectomy (PD).
Methods
The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed.
Results
All patients completed the " O” continuous biliary-enteric anastomosis combined with PTCD without perioperative death. ① The preoperative indwelling time of PTCD tube was (13.24±3.39) d, total bilirubin (TBIL) was (363.67±12.26) μmol/L on admission and (155.59±17.63) μmol/L on preoperative after PTCD, respectively. ② The operative time was (231.46±18.69) min, the intraoperative blood loss was (158.30±31.33) mL, the diameter of the hepatic ductal segment was (1.3±0.2) cm, and the duration of the " O” continuous biliary-enteric anastomosis was (7.31±1.52) min. ③ After surgery, the indwelling time of PTCD tube was (8.13±1.49) d, the hospitalization time was (27.31±5.49) d. Biliary leakage occurred in 1 case, pancreatic fistula occurred in 5 cases (3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula), abdominal infection occurred in 2 cases, pneumonia occurred in 3 cases, wound infection occurred in 2 cases. No postoperative biliary-enteric anastomosis stenosis, biliary tract infection, and intra-abdominal hemorrhage occurred. There was no laparotomy patients in this group and all patients were discharged. ④ All patients were followed-up for 180 days after surgery. No death, bile leakage, biliary-enteric anastomotic stenosis, biliary tract infection, pancreatic fistula, gastro-intestinal leakage, and abdominal infection occurred. One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment.
Conclusions
The preoperative PTCD can improve the preoperative liver function and increase the security of PD. " O” continuous biliary-enteric anastomosis is simple, safe, feasible, and has the function of preventing biliary-enteric anastomosis stenosis. For severe jaundice patients with blood TBIL >170 μmol/L, the " O” continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
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.
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
ObjectiveTo investigate the anatomical characteristics of breast lymphatic drainage in patients with breast cancer after injecting methylene blue and indocyanine green (ICG) into the intradermis of the areola.MethodsOne hundred and eighty-six patients with stage 0–Ⅱ breast cancer were collected. The sentinel lymph node (SLN) biopsy was performed by injecting methylene blue and ICG. At the same time, the number of sentinel lymphatic channel (SLC), origin angle, direction, and consistency were also studied.ResultsA total of 308 SLCs were successfully showed in the 186 patients and 679 SLNs were detected. The 95.8% (295/308) of SLCs and 93.1% (632/679) of SLNs were showed by combination in the methylene blue and ICG. The 46.8% (87/186) of patients had 1 SLC, the 40.9% (76/186) of patients had 2 SLCs, the 12.4% (23/186) of patients had 3 SLCs. The 82.8% (255/308) of SLCs flowed from the outer upper edge of the areola, the 3.2% (10/308) of SLCs flowed from the outer lower edge of the areola, the 14.0% (43/308) of SLCs flowed from the inner upper edge of the areola. The 89.9% (277/308) of the SLCs flowed mainly through the 0°—60° interval in the outer upper quadrant, 10.1% (31/308) of the SLCs flowed through the 61°—90° interval in the outer upper quadrant.ConclusionsThe consistency of SLC and SLN stained by the two tracers is good. The number of SLC is 1–3. The SLCs flow mainly through the 0°—60° interval in the outer upper quadrant of the breast, then flow into in the axilla and don’t flow into the internal mammary lymph nodes. The deep superficial lymphatic channels under the skin and the penetrating lymphatic channels can not be showed by ICG, but the SLN can be showed by it.
ObjectiveTo explore the effect of mediastinal drainage tube placed after the esophageal cancer resection with intrathoracic anastomosis on postoperative complications such as anastomotic fistula. MethodsLiterature on the application of mediastinal drainage tubes in esophageal cancer surgery published in databases such as PubMed, EMbase, CNKI, China Biomedical Literature Database, VIP, and Wanfang were searched using English or Chinese, from the establishment of the databases to December 31, 2023. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included retrospective studies, the Cochrane Handbook bias risk tool was used to assess the bias risk of randomized controlled trials (RCT), and Review Manager 5.4 software was used for meta-analysis. ResultsA total of 19 retrospective studies and 8 RCT involving 6320 patients were included, with 3257 patients in the observation group (mediastinal drainage tube+closed thoracic drainage tube) and 3063 patients in the control group (closed thoracic drainage tube or single mediastinal drainage tube). The NOS score of the included literature was≥6 points, and one RCT had a low risk of bias and the other RCT had a moderate risk of bias . Meta-analysis results showed that compared with the control group, the observation group had fewer postoperative lung complications [OR=0.44, 95%CI (0.36, 0.53), P<0.001], fewer postoperative cardiac complications [OR=0.40, 95%CI (0.33, 0.49), P<0.001], earlier average diagnosis time of anastomotic fistula [MD=?3.33, 95%CI (?3.95, ?2.71), P<0.001], lower inflammation indicators [body temperature: MD=?1.15, 95%CI (?1.36, ?0.93), P<0.001; white cell count: MD=?5.62, 95%CI (?7.29, ?3.96), P<0.001], and shorter postoperative hospital stay [MD=?15.13, 95%CI (?18.69, ?11.56), P<0.001]. However, there was no statistically significant difference in the incidence of postoperative anastomotic fistula between the two groups [OR=0.85, 95%CI (0.70, 1.05), P=0.13]. ConclusionPlacing a mediastinal drainage tube cannot reduce the incidence of anastomotic fistula, but it can effectively reduce the incidence of postoperative respiratory and circulatory system complications in patients and improve patients’ prognosis. It can early detect teh anastomotic fistula and fully drain digestive fluid to promote rapid healing of the fistula, alleviate the infection symptoms of postoperative anastomotic fistula, and shorten the hospital stay.
ObjectiveTo discuss the treatment methods and outcome of hilar cholangiocarcinoma. MethodsFrom January 2002 to December 2008, 81 cases of hilar cholangiocarcinoma were retrospectively analyzed. ResultsAmong 81 patients, there were 55 males and 26 females, ages were from 38 to 72 years with an average age 57.5 years. In BismuthCorlette classification, 5 cases were type Ⅰ, 15 cases type Ⅱ, 14 cases type Ⅲa, 14 cases type Ⅲb, 33 cases type Ⅳ, according to the preoperative results of MRCP, but the classification of 15 cases were not consistent to the preoperative results (5 cases type Ⅱ, 8 cases type Ⅲ, 2 cases type Ⅳ) according to the results of intraoperative exploration. The rates of complications of radical operation, palliative operation, internal biliary drainage, and external biliary drainage were 54.5%(12/22), 58.8%(10/17), 23.8%(5/21), and 66.7%(14/21), respectively. The rate of complications of internal biliary drainage was lower than that of the other three methods (Plt;0.01), there were no significant differences among the other three methods. The 1, 2, 3, and 5year survival rates of 22 patients with radical operation, 17 patients with palliative operation, 21 patients with internal biliary drainage, 21 patients with external biliary drainage were 75.0%, 60.0%, 38.3%, 2.6%; 72.7%, 26.5%, 4.2%, 0; 50.5%, 15.8%, 2.2%, 0; 30.6%, 8.5%, 0, 0, respectively. The median survival time was 29.5 months, 13.8 months, 10.5 months, and 8.3 months, respectively. Survival rate of radical operation was higher than that of palliative operation (χ2=14.20, P=0.000 3), palliative operation was higher than that of internal biliary drainage (χ2=4.50, P=0.040 5), and internal biliary drainage was higher than that of external biliary drainage (χ2=4.45, P=0.040 1). ConclusionsThe BismuthCorlette classification is a guide to the required surgery, but the results of intraoperative exploration decides the final classification and operative method. Radical resection is the main related factors influencing the therapy efficacy of hilar cholangiocarcinona. Basinstyle anastomosis and T type supportingtube is the first choice of palliative operation. External drainage, to the full, is avoided.
Objective
To observe and evaluate the efficacy of continuous drainage with intravenous catheter in the treatment of breast abscess infected by methicillin resistant staphylococcus aureus (MRSA) and to explore the best treatment methods.
Methods
Sixty cases of breast abscess infected by MRSA were retrospectively analyzed. The patients were divided into continuous drainage group and puncture drainage group according to the treatment. Continuous drainage with 14G intravenous catheter and intermittent aspiration with 20 mL syringe were performed to treat the breast abscesses in the continuous drainage group (n=36) and puncture drainage group (n=24), respectively. Meanwhile, sensitive antibiotics were used according to the results of susceptibility test. The therapeutic effects of the 2 groups were compared.
Results
There were no significant differences in baseline data between continuous drainage group and puncture drainage group (P>0.05). There was no significant differences of cure rate between the two groups (P=0.717). Compared with the puncture drainage group, the continuous drainage group showed shorter period of time to heal the breast abscess (P=0.001), shorter period of time to control the ache (P=0.038), less punctures (P<0.001) and more daily volume of drainage (P<0.001). No significant differences were found in the period of time to control the fever between the two groups (P=0.127).
Conclusions
Continuous drainage with intravenous catheter can shorten the course of disease, reduce the suffering of patients, reduce the difficulty of hospital infection prevention and control. It’s an ideal choice for the treatment of breast abscess infected by MRSA.
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.
Objective To investigate the venous drainage in retrograde island flaps by fluorescence tracing technique and to observe the pathway of venous drainage. Methods The 0.1mL venous blood was collected from the marginal ear vein of every rabbit (n=20), respectively, and erythrocytes were separated by centrifugation and then were labeled with FITC. Positive rate and fluorescence intensity of FITC-labeled RBC were detected by flow cytometry. RBC morphous was observed under the inverted fluorescence microscope. Saphenous retrograde island fasciocutaneous flap and antegrade islandfasciocutaneous flap (4.0 cm × 3.0 cm in size with vascular pedicle length of 3.0 cm) were successfully establ ished in hind l imbs of 20 New Zealand white rabbits．One hind l imb of each rabbit was randomly assigned as the experimental group and the contralateral side was assigned as the control. The same flap was establ ished in the control group without any fluorescence tracer. According to retrograde or antegrade flaps, the experimental group was divided into 2 groups with 10 rabbits in each group. And then, according to different pathways of tracer-giving, each group was divided into 2 subgroups of artery and vein, with 5 rabbits in each subgroup. The labeled erythrocytes (5 μL) were injected into artery or vein and then flaps were cut down 5 seconds later. The flaps were immediately frozen and chipped (5-7 μm). Consecutive three frozen sections were made and two of them were stained with HE and GENMED, respectively, but the third one was squashed without staining. All frozen sections were observed under the microscope. Results Positive rate of FITC-labeled RBC was beyond 99% and fluorescence intensity was more than or equal to 103. FITC-labeled RBC showed steady green fluorescence under the inverted fluorescence microscope. Fluorescence appeared in all experimental groups, but none was found in the control groups. In antegrade island flap group, fluorescence appeared mainly in lumen of vein, wall of vein and inner membrane and outer membrane of artery. In retrograde island flap group, fluorescence distributed principally in inner membrane and outer membrane of artery and wall of vein. Conclusion The fluorescence tracing is appl icable to the research of venous drainage. Venous drainage in the antegrade island flaps is mainly through lumen of vein, wall of vein and inner membrane and outer membrane of artery. While, venous drainage in retrograde island flaps is principally through inner membrane and outer membrane of artery and wall of vein.
