ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
Objective To observe the effectiveness of vacuum seal ing drainage (VSD) combined with anti-takenskin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 andJune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method.The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-takenskin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size,preoperative albumin index, or injury time between 2 groups (P gt; 0.05). In test group, the redundant stump skin was usedto prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome deal ing after amputation,which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, andconventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSDdevice was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times ofdressing change, and the hospital ization days in test group were significantly better than those in control group [ 90.0% vs.63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 ± 0.5) times vs. (8.0 ± 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively](P lt; 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and twopointdiscrimination of wound in test group were better than those in control group, showing significant differences (P lt; 0.05).No obvious swelling occurred at the residual limbs in 2 groups. The limb pain incidence and the residual limb length were betterin test group than those in control group (P lt; 0.05). Whereas, no significant difference was found in the shape of the residual limbs between 2 groups (P gt; 0.05). In comparison with the contralateral limbs, the muscle had disuse atrophy and decreasedstrength in residual limbs of 2 groups. There was significant difference in the muscle strength between normal and affected limbs(P lt; 0.05), but no significant difference was found in affected limbs between 2 groups (P gt; 0.05). Conclusion Comparedwith direct anti-taken skin graft on amputation wound, the wound could be closed primarily by using the VSD combined withanti-taken skin graft. At the same time it could achieve better wound drainage, reduce infection rate, promote good adhesion ofwound, improve skin survival rate, and are beneficial to lower the amputation level, so it is an ideal way to deal with amputationwound in the phase I.
【Abstract】ObjectiveTo study the effect of bile reinfusion on immunologic function of erythrocyte in patients with obstructive jaundice after external drainage of biliary tract.MethodsPatients with obstructive jaundice who had received biliary tract external drainage were randomly divided into bile reinfusion group (n=24) and simple external drainage group (n=27). Patients without jaundice,who received cholecystectomy in the same period with the above ones,were selected randomly as control group(n=25). In external drainage groups patients’ bile was collected daily, and was filtered through gauze, and then, pumped back into the patients’ duodenum or jejunum after being heated to 38 ℃-40 ℃. The bile reinfusion could be started after the intestinal function recovered postoperatively. The changes of C3bRRT, ICRT, RFER and RFIR were observed before and after operation. The data were analysed through SPSS8.0.ResultsPreoperative C3bRRT and RFER levels in patients with obstructive jaundice were lower than those without jaundice significantly, and Preoperative ICRT and RFIR levels in patients with obstructive jaundice were higher than those without jaundice significantly. C3bRRT levels in bile reifusion group was higher obviously than those in simple drainage group (P＜0.05) on the 14th postoperative day. ConclusionImmunologic function of erythrocyte in patients with obstructive jaundice is inhibited, and bile reinfusion after biliary tract external drainage can be helpful to the recovery of immunologic function of erythrocyte.
ObjectiveTo analyze effect of percutaneous transhepatic choledochus drainage (PTCD) for hilar cholangiocarcinoma. MethodsClinical data of 67 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2005 to Dec. 2010 were retrospectively analyzed. ResultsOf the 67 cases, 30 cases were performed PTCD, 20 cases were performed radical surgery after PTCD, and 17 cases were performed palliative surgery after PTCD. There were 59 cases who were followed-up for 3-30 months, and the median time was 9.3 months. The median survival time of patients who underwent PTCD, radical surgery, and palliative surgery were 10.2, 21.4, and 8.9 months respectively. The survival of patients who underwent radical surgery was better than those of underwent PTCD (χ2=13.6, P=0.000 4) and palliative surgery (χ2=15.2, P=0.003 8), and survival of patients who underwent PTCD was better than patients underwent palliative surgery (χ2=5.3, P=0.040 1). ConclusionsPTCD is contribute to preoperative diagnosis and evaluation, in addition, it can reduce unnecessary surgical exploration, guarantee the safety of the radical surgery, and provide follow-up care for palliative operation channel which is favorable for local internal radiation therapy.
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.
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.
Objective To investigate the curative effect of facility negative pressure closed drainage on wounds in earthquake. Methods We retrospectively analyzed the data of 35 patients treated by facility negative pressure closed drainage after debridement in earthquake. The same category patients treated by conventional therapy as the control group. Results Time of facility negative pressure closed drainage was 6-12 days, average 7.5±1.8 days. The woundswere all cured. The wounds closure were performed with skin grafting in 24, with secondary suturing in 4, with regionalflap transposition in 5, and with cross leg flap in 2. There were significant differences in time of secondary closure, timesof dressing and the total time of hospitalization between two groups (Plt;0.01). And there was a significant difference incurative effect of skin grafting between two groups (Plt;0.05). Conclusion Facility negative pressure closed drainage on treating wounds in earthquake is a simple, safe method, and has significant curative effect.
ObjectiveTo analyze therapeutic effect of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis (GM).MethodsThe clinical data of 120 patients with GM from January 2018 to December 2018 in the Renmin Hospital of Wuhan University were analyzed. Sixty patients were treated with the ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage (control group), and the other 60 patients were treated with the metronidazole solution combined with dexamethasone on the basis of the control group (observation group). The therapeutic period, total effective rate, postoperative appearance of breast, and recurrence rate were analyzed. While the pathogenic bacteria was analyzed by the microbial culture and the pathogen gene detection.ResultsThere were no significant differences in the baseline data between the two groups (P>0.05). The ultrasound-guided vacuum-assisted rotary excisions were successfully performed in all 120 patients. The therapeutic period of the observation group was shorter than that of the control group (t=–3.633, P<0.001). The total effective rate and rate of excellent and good of postoperative breast appearance had no significant differences between the two groups (total effective rate: 96.7% versus 90.0%, χ2=1.922, P=0.166; rate of excellent and good of postoperative breast appearance: 96.7% versus 88.3%, χ2=1.205, P=0.272). The recurrence rate of the observation group was lower than that of the control group (χ2=5.175, P=0.023). The positive rates of bacteria were 25.8% and 58.8% in the 120 cases by the microbial culture and 52 cases by the pathogen gene detection, respectively, which had a statistical difference (χ2=16.974, P<0.001), the same conclusions were obtained in the observation group and the control group (χ2=6.691, P=0.010; χ2=9.379, P=0.002).ConclusionsUltrasound-guided vacuum-assisted rotary excision with tube irrigation drainage is well applied in treatment of GM. It could maintain a good shape of breast. Use of metronidazole solution combined with dexamethasone after surgery could shorten therapeutic period and reduce recurrence rate.
Three types of intestinal loops were used to reestablish the internal drainage of bile in 17 cases. The leeway derived from the peristaltic cycle of the intestinal loop for gastrointestinal reflux pressure, the cholangeitis after operation from reflux following choladocho-intestinal anastomosis could be avoided, and, naturally it had changed the traditional method of purèly blockade of the reflux, thus the result from treatment was far more satisfactory.
Objective To study the effect of sodium hyaluronate hydrogel in treating residual cavity on body surface after abscess drainage so as to provide new method to speed up the heal ing of residual cavity after body surface abscess drainageand reduce the frequency of dressing change and cl inic nursing workload. Methods From June 2007 to March 2008, 60 outpatients with body surface abscess drainage were randomly divided into hydrogel group (group A, 30 cases) and the control group (group B, 30 cases). In group A, there were 16 males and 14 females aged (49.5 ± 6.1) years, the disease course was (3.8 ± 0.6) days, and the volume of residual cavity was (4.19 ± 1.31) mL. In group B, there were 18 males and 12 females aged (50.2 ± 7.6) years, the disease course was (4.3 ± 0.5) days, and the volume of residual cavity was (4.04 ± 1.22) mL. There was no significant difference between two groups in gender, age, disease course and volume of residual cavity (P gt; 0.05). Residual cavity was smeared with 1 mL/cm2 sodium hyaluronate hydrogel in group A and drained by sal ine gauze in group B, the dressing was changed every two to three days. Residual cavity volume was recorded every four days, and the residual cavity volume, the frequency of out-patient dressing and the heal ing time residual of cavity were compared. Results The volume of residual cavity was (3.11 ± 1.12), (1.75 ± 0.95) and (0.55 ± 0.56) mL in group A, and was (3.39 ± 1.12), (2.64 ± 0.99) and (1.81 ± 0.81) mL in group B at 4, 8 and 12 days after treatment respectively, showing no significant differences at 4 days (P gt; 0. 05), but significant difference at 8 and 12 days (P lt; 0.01). Residual cavity heal ing time was (12.70 ± 2.78) days in group A and (20.27 ± 3.89) days in group B, and the frequency of dressing change was 5.53 ± 1.33 in group A and 9.13 ± 1.81 in group B, indicating significant differences between two groups (P lt; 0.01). Conclusion Sodium hyaluronate hydrogel can promote residual cavity heal ing, reduce the frequency of dressing change of out-patient and decrease the cl inic nursing care workload.