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.
目的探讨晚期恶性梗阻性黄疸减黄、保肝的处理方式。方法回顾性分析我科2008年1月至2009年10月期间收治的80例恶性梗阻性黄疸患者，根据肿瘤部位、患者身体、经济条件等确定无法行根治性手术者，采用不同的减黄术式。结果本组80例患者中，9例行PTCD，42例行PTBS，29例行ERBD。并发症发生情况: PTBS组有15例，ERBD组6例，PTCD组2例。PTCD组的住院时间和住院费用明显低于PTBS组和ERBD组(Plt;0.05)。结论晚期恶性梗阻性黄疸，一经确诊，尽早处理，微创引流减黄是首选方式。
ObjectiveTo analyze the cause of complications for patients with advanced malignant biliary obstruc-tion treated with percutaneous transhepatic implantation of biliary stent (PTBS) and summarize the experiences of comp-lications of the treatment. MethodThe complications of 59 patients firstly treated with percutaneous transhepatic cholangial drainage (PTCD) then with PTBS in 156 cases of advanced malignant biliary obstruction from January 2010 to January 2013 in this hospital were analyzed retrospectively. ResultsFifty-nine cases of complications were occurred in 156 cases of advanced malignant biliary obstruction, the incidence was 37.8%, including biliary infection in 26 cases, bile duct bleeding in 17 cases, liver failure in 5 cases, renal failure in 4 cases, acute pancreatitis in 4 cases, stent displa-cement in 2 cases, bile duct perforation in 1 case.Three cases died in 59 patients with complications, 56 cases were improved after symptomatic treatment. ConclusionPTCD combined with PTBS is a safe and effective treatment of advanced malignant biliary obstruction, the reasonable perioperative management is very important to reduce the occurrence of complications.
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.
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 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 investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=−3.37, 95%CI −3.89 to −2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
目的 比较开腹、腹腔镜和经皮肝穿刺引流3种方法治疗细菌性肝脓肿的优劣性，为细菌性肝脓肿治疗方法的选择提供参考依据。方法 回顾性分析笔者所在医院2010年9月至2011年7月期间收治的39例细菌性肝脓肿患者的临床资料，根据其治疗方式将患者分为开腹组、腹腔镜组和经皮经肝穿刺引流组（穿刺组）3组，对3组的首次治愈者比例、1个月治愈者比例、发生并发症者比例、住院时间及住院费用进行比较。结果 开腹组、腹腔镜组和穿刺组首次治愈者比例分别为10/12、8/9及12/18，3组间差异有统计学意义（P＜0.05）； 1个月治愈者比例分别为11/12、9/9及17/18，3组间差异无统计学意义（P＞0.05）；发生并发症者比例分别为2/12、1/9及2/18，腹腔镜组和穿刺组之间的差异无统计学意义（P＞0.05），2组与开腹组相比差异均有统计学意义（P＜0.05）；住院时间分别为（15.4±4.5） d、（9.7±2.3） d及 （16.7±5.8） d （P＜0.05）；住院费用分别为（1.9±0.5）万元、（1.3±0.3）万元及（0.8±0.2）万元（P＜0.05）。结论 开腹组、腹腔镜组和穿刺组3种治疗方法各有利弊，个体化选择治疗方式是肝脓肿的治疗策略。