目的 探讨B超引导下穿刺置管引流技术在重症急性胰腺炎治疗中的应用价值。方法 36例重症急性胰腺炎患者均行腹腔穿刺置管引流，其中经皮肝胆管（胆囊）穿刺置管引流（PTCD）23例，腹膜后积液（脓肿）穿刺置管冲洗引流16例，配合常规内科治疗，取得满意效果。结果 所有患者穿刺置管过程顺利，均未出现与穿刺相关的并发症如气胸、血胸、腹腔内出血、穿刺部位感染等。所有患者在禁食、胃肠减压、抗生素、生长抑素、制酸、维持水电解质酸碱平衡及肠内外营养支持治疗的基础上辅以超声引导下穿刺置管引流，仅1例暴发性胰腺炎患者发生脓腔内大出血导致多器官衰竭而死亡，其余35例均治愈，无中转开腹手术，患者腹痛、腹胀、腹部压痛等主要症状和体征缓解时间为（4.4±1.3）d（1～7d），尿淀粉酶恢复正常时间为（3.1±1.5）d（2～8d）,住院时间为（23.4±7.3）d（16～55d）。结论 B超引导下穿刺置管引流术操作简单、创伤轻微，在重症急性胰腺炎治疗中有重要价值。
ObjectiveTo study clinical value of perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of fast track surgery (FTS). MethodsThe clinical data of 268 patients were analyzed retrospectively, who underwent laparoscopic cholecystectomy in the Department of General Surgery, the 2nd Hospital of Baiyin City from July 2013 to July 2015. All these patients were divided into FTS group and traditional group according to the chronological order, 133 patients in the traditional group were performed traditional perioperative analgesia before August 31, 2014, and 135 patients in the FTS group were performed perioperative multimodal analgesia method based on the concept of FTS after September 1, 2014. The data of both groups were collected and analyzed, including point of numerical rating scale, intestinal function recovery time, intake food time, ambulation time, drainage tube duration, postoperative hospital stay, postoperative sleep time at 72 h, and complications. Results①The points of numerical rating scale at 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h in the FTS group were significantly lower than those in the traditional group (P < 0.01).②Compared with the traditional group, the intestinal function recovery time, intake food time, ambulation time, drainage tube duration, and postoperative hospital stay were obviously shorter, the postoperative sleep time at 72 h was obviously longer in the FTS group.③The incidence of nausea and vomiting in the FTS group was significantly lower than that in the traditional group (P < 0.01), the incidences of the other complications such as acid reflux, urinary retention, and breathing difficulty had no significant differences between these two groups (P > 0.05). The satisfaction rate of postoperative analgesic effect in the FTS group was significantly higher than that in the traditional group (P < 0.01). ConclusionsPerioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of FTS is safe and effective. It could achieve painless effect of laparoscopic cholecystectomy.
ObjectiveTo explore the reliability and safety of diagnosis and treatment for cholecystocolonic fistula during laparoscopic cholecystectomy. MethodsData of patients with cholecystocolonic fistula in department of general surgery, Gansu provincial hospital from Jan 2002 to Dec 2015 were analyzed retrospectively. There were 112 cases diagnosed by routine intraoperative cholangiography from 11 472 laparoscopic cholecystectomy patients, including 33 males and 79 females, age from 58 to 84 years〔(67.4±12.6) years〕. ResultsOne hundred and twelve cases of cholecystocolonic fistula were diagnosed by routine intraoperative cholangiography in laparoscopic cholecystectomy. There were 105 cases of cholecystocolonic fistula performed laparoscopic cholecystectomy and colon repair, and 7 cases performed colostomy, no surgical complications occurred. Seventy cases were followed-up for 6-27 months〔(16.4±5.3)months〕after operation, no long-term complications occurred. ConclusionsThere is a lack of specific symptoms and special diagnosis for cholecystocolonic fistula before operation. Intraoperative cholangiography is a only objective method for diagnosis, and treatment of cholecystocolonic fistula by laparoscopic cholecystectomy and colon repair or colostomy is safe and reliable based on experienced laparoscopic skill.
ObjectiveTo compare the effects of medical glue and stapling in the prevention of postoperative seroma for patients undergoing laparoscopic direct hernia repair. MethodsNinty-four patients were randomly by computer generated randomization number divided into two groups: medical glue group (medical glue was used to fix pseudo-direct hernia sac) and stapling group (staple was used to fix pseudo-direct hernia sac).The time of follow-up was two years.The operative time, length of hospital stay, the pain level on first day and 7th day after operation, postoperative complications (seroma, wound infection, wound bleeding), hospital costs, and hernia recurrence rate within 2 years were observed. ResultsThe medical glue group compared with the stapling group, the operative time was shorter〔(35±5.1) min vs.(41±7.5) min〕, hospitalization time was shorter〔(4±0.51) d vs.(5±0.83) d〕, lower postoperative pain score〔the first day: (5±0.52) scores vs.(6±0.33)scores; the 7th day: (3±0.67) scores vs.(4±0.53) scores〕, and lower cost in hospital〔(5 731±560.50) yuan vs.(8 715±534.33) yuan〕, there were significant difference (P < 0.05).The incidence of seroma and other complications after operation and postoperative 1-year and 2-year hernia recurrence rate showed no significant differences (P > 0.05). ConclusionsThe medical glue has good prevention effects on postoperative seroma for patients undergoing laparoscopic direct hernia surgery, with shorter operative time and lower cost.This method is suitable for all levels of hospitals
ObjectiveTo elucidate the clinical pattern of pulmonary lymph node metastasis and the significance of station No.12 and No. 13 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC). MethodsThirty-eight NSCLC patients underwent standard radical resection of pulmonary carcinoma and systemic lymphadenectomy between January 2015 and June 2015. There were 29 males and 9 females with a mean age of 61.1±15.4 years (ranged from 44 to 73 years). There were 20 patients of squamous carcinoma, 17 patients of adenocarcinoma and 1 patient of sarcomatoid carcinoma. All patients didn't receive radioor chemotherapy before the operation. All the lymph nodes in the surgical specimens were marked and sampled for pathology examination. ResultsWe obtained 652 lymph nodes in total (17.2 per patient). Seventy-eight lymph nodes of 24 patients showed lymphatic metastasis with a metastasis degree of 12.0% (78/652) and a metastasis rate of 63.2% (24/38). Among which there were 22 patients of N1 metastasis, 10 of N1+N2 and 2 of N2 skipping metastasis. Routine pathological examination of N1 metastasis demonstrated 12 patients of positive station No.12 and No.13 lymph nodes with the metastasis rate of 31.6%. The total amount of dissected lymph nodes was 95, among which there were 14 lymphatic metastasis with the metastasis rate of 14.7%. Four patients with nodal involvement in lymph node stations No.12 or No.13 were identified from 18 patients without mediastinal and intrapulmonary lymph node metastases confirmed by routine pathological examination. The detection rate was 22.2% (4/18) and the rate of N1 missed diagnosis was 33.3% (4/12). Univariate and multivariate analysis suggested that the metastasis degree of pulmonary lymph nodes of station No.12 and No.13 was associated with tumor differentiation grade (χ2=6.453,P=0.011), while it didn't show any significant differences as to pathology subtype (χ2=0.118, P=0.732), tumor size (χ2=0.930, P=0.759), or tumor classification (χ2=1.648, P=0.199). ConclusionPulmonary lymph node metastasis occupies an important place in the process of lung cancer metastasis. Patients with NSCLC especially those of poorly differentiated should be pathologically examined regularly in order to improve the accuracy of staging.
Objective To investigate safety and short-term effect of subtotal hepatectomy with caudate lobe as sole remnant liver in treatment of hepatolithiasis, and to analyze diagnosis and treatment process of bronchobiliary fistula after hepatectomy. Methods The clinical data of 1 patient with hepatolithiasis combined with liver atrophy-hypertrophy syndrome and caudate lobe with compensatory hypertrophy who was admitted to the Gansu Provincial People’s Hospital in August 2016 were analyzed retrospectively. The body surface area of the patient was 1.47 m2, the standard total liver volume was 1 040 cm3. According to the results of CT, the expected residual 1iver volume (caudate lobe volume) after the hepatectomy was 643 cm3, and the ratio of residual liver volume over the standard total liver was 61%. The patient received the subtotal hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage. The follow-up including the postoperative complications and recurrence of calculus was performed by the regular hospital check up till September 2017. Results The subtotal hepatectomy with caudate lobe as sole remnant liver was performed successfully. The operative time and intraoperative blood loss were 280 min and 3 000 mL, respectively. The peritoneal drainage tube was removed on the 8th postoperative day with a good recovery of liver function. The postoperative pathological examination showed that there were some intrahepatic bile duct pigment stones, the bile duct wall fibrous tissue hyperplasia combined with a focal liver cells hydropic degeneration, and no canceration. The patient was discharged on the 40th postoperative day. Two months later, the T tube cholangiography showed that the inferior extremity bile duct was unobstructed and there was no residual intra- and extra-hepatic stone. The liver function was normal, then the T tube was removed. After 6 months, the patient coughed and exhausted the bilious sputum, meanwhile the sputum culture showed that there were the Escherichia coli and Streptococcus viridans, then the bronchobiliary fistula was diagnosed. After the multidisciplinary discussion, the patient received the right thoracocentesis and double abdominal drainages around liver, meanwhile, combined with the anti-inflammatory, liver protection, intravenous nutrition support, etc., the bilious sputum was obviously reduced. So far, the patient had been followed up for one year, the patient's cough, and expectoration symptoms disappeared and his condition was stable. Conclusions Caudate lobe-sparing subtotal hepatectomy in treatment of hepatolithiasis is safe and feasible, but it is possible that bronchobiliary fistula is followed after operation, individual and multidisciplinary collaboration in treatment of bronchobiliary fistula caused by extensive hepatectomy is safe and feasible.