1.Diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction
Junmin WEI ; Hongyuan CUI ; Qing HE
Chinese Journal of Digestive Surgery 2009;8(3):181-183
Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.
2.Effects of Steep Meridian Clear Corneal Incisions on Corneal Astigmatism in Phacoemulsification Surgery
Xiaoyong CHEN ; Hongyuan CAI ; Wei WANG
Chinese Journal of Minimally Invasive Surgery 2017;17(3):252-255
Objective To evaluate effects of steep meridian clear corneal incisions on corneal anterior surface and total astigmatism in phacoemulsification surgery . Methods Clinical data of 56 cases of phacoemulsification surgery with steep meridian clear corneal incisions from August to December 2015 were analyzed in this retrospective study .Corneal anterior surface and total astigmatism were measured with the Pentacam 3D anterior segment measurement and analysis system at the time before surgery and 1 month and 3 months after surgery .The polar coordinate analysis was used to evaluate effects of steep meridian incisions on corneal astigmatism . Results All the operations were accomplished successfully with smooth recovery .The corneal anterior surface and total astigmatism reduced significantly after 1 month and 3 months in astigmatic polar value AKP ( +0) (P<0.05), but no significant difference was found in AKP(+45) (P>0.05).No significant differences were detected between both corneal anterior surface and total astigmatism in AKP(+0) or AKP(+45) between 1 month and 3 months after surgery. Conclusion Steep meridian incision performed on the preoperative steeper meridian of keratometric astigmatism may reduce corneal total astigmatism .
3.Retrospective analysis of correlation between electrolyte changes after elective abdominal operation and postoperative complications
Xianglong CAO ; Mingwei ZHU ; Hongyuan CUI ; Qi AN ; Junmin WEI
Chinese Journal of Clinical Nutrition 2013;21(6):362-366
Objective To investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1% ; sodium,6.4% ; chloride,27.6% ; calcium,61.7% ; magnesium,16.3% ; and phosphorus,71%.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7% and the postoperative infection rate was 17.19%.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.
4.Effect of hypocaloric enteral nutrition on acute severe traumatic brain injury
Wei CHEN ; Yao LI ; Fenfen WANG ; Yu ZHANG ; Hongyuan FU
Chinese Journal of Trauma 2016;32(2):124-127
Objective To evaluate the clinical efficacy of hypocaloric enteral nutrition in patients with acute severe traumatic brain injury (TBI).Methods A total of 100 patients with severe TBI [Glasgow Coma Scale (GCS) 3-8 points] were enrolled and randomly divided into hypocaloric enteral nutrition group (hypocaloric group, 41.86-62.79 kJ · kg-1 · d-1) and traditional caloric enteral nutrition group (traditional caloric group, 104.65-125.58 kJ · kg-1 · d-1) ,50 patients per group.The enteral nutrition was given at 24-72 hours postoperatively.The changes of total serum protein (TP), serum-albumin (ALB), plasma hemoglobin (Hb), fasting blood glucose (Glu) and major gastrointestinal tract complications were observed and compared at 7 and 14 days after enteral nutrition support.Results Levels of TP, ALB and Hb were lowered in both groups at 7 and 14 days after nutritional support but showed no statistical difference (P > 0.05).Glu was (6.37 ± 1.02) mmol/L in hypocaloric calorie group, significantly lower than (7.35 ± 1.70) mmol/L in traditional caloric group at day 7 after nutritional support (P < 0.05).At 7 and 14 days after nutrition support, nausea, regurgitation, vomiting and complication incidence showed no significant difference between hypocaloric calorie group and traditional caloric group after nutritional support (P > 0.05), but abdominal distension, diarrhea and stomach retention rate in hypocaloric group were significantly lower than those in traditional caloric group (P < 0.05).Conclusion Hypocaloric enteral nutrition can significantly reduce the stress hyperglycemia, abdominal distention, diarrhea, gastric retention and other gastrointestinal symptoms in patients with acute severe TBI.
5.Hemostatic effects and safety of hemocoagulase agkistrodon in elderly patients undergoing laparoscopic cholecystectomy
Hua LV ; Mingwei ZHU ; Hongyuan CUI ; Yannan LIU ; Jifang MEN ; Lei LI ; Junmin WEI
Chinese Journal of Geriatrics 2013;(4):393-396
Objective To evaluate the hemostatic effect of hemocoagulase agkistrodon in elderly patients undergoing laparoscopic cholecystectomy and to analyze its influence on coagulation function and its safety.Methods A prospective,randomized,double blind and controlled research was conducted in 60 patients aged over 65 years.Patients were divided into 2 groups:the study group and the control group (n =30 each group).Patients in the study group were injected with 2 U hemocoagulase agkistrodon intravenously 20 minutes before operation and with 1 U hemocoagulase agkistrodon 4 hours after operation.Patients in the control group were injected with physiological saline instead of hemocoagulase agkistrodon.The intraoperative intraperitoneal hemorrhage and intraperitoneal drainage at 24 hours after operation were recorded.The changes in bemagglutination and safety were observed.Results 59 cases were finished in this study and 1 case was eliminated.The volume of intraoperative hemorrhage was less in the study group than in the control group [(53.6±68.1) g vs.(88.1±79.7) g,t =2.08,P=0.038].There was no significant difference in the volume of intraperitoneal drainage at 24 hours after operation between the study group and the control group [(71.7±113.3) g vs.(89.0±104.7) g,t =1.69,P=0.075].The hemoagglutinationindexes were similar between two groups and no thrombosis occurred.There was no significant difference in the time of hospital stay between the study group and the control group [(5.2±1.4) days vs.(5.3±1.7) days,t=0.52,P=0.61].No adverse event was reported.Conclusions Hemocoagulase agkistrodon has relatively good hemostatic effects and safety for the elderly patients undergoing laparoscopic cholecystectomy.
6.Prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors
Guodong YE ; Mingwei ZHU ; Hongyuan CUI ; Danian TANG ; Qi AN ; Jifang MEN ; Junmin WEI
Chinese Journal of Clinical Nutrition 2011;19(6):364-367
ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1% (81/269) ; more specifically,37.5% (21/56) among geriatric patients ( ≥80 years) and 17.6% (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3% (103/269) ; more specifically,57.1% (32/56) among the geriatric patients and 29.3% (72/245) among the other age groups (P <0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3%,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.
7.Clinical outcome of the combined nutritional support for colorectal cancer patients at nutritional risk: a retrospective study of 60 cases
Danian TANG ; Mingwei ZHU ; Jianhua SUN ; Qi AN ; Hongyuan CUI ; Jifang MEN ; Junmin WEI
Chinese Journal of Clinical Nutrition 2011;19(6):355-359
ObjectiveTo explore the clinical outcome of the combined nutrition support for colorectal cancer patients.MethodsTwo research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.ResultsThere were no significant difference in body weight and plasma albumin between these two arms ( P > 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 % ),infectious complications (10.0% ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33%,30%,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.
8.Liver transplantation in an adult patient with situs inversus
Jiangchun QIAO ; Danian TANG ; Yannan LIU ; Mingwei ZHU ; Xiuwen HE ; Hongyuan CUI ; Junmin WEI
Chinese Journal of Hepatobiliary Surgery 2012;18(5):334-336
ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.
9.Comparison of the benefits of combined nutrition support with enteral nutrition and parenteral nutrition versus sole parenteral nutrition support for elderly patients after pancreaticoduodenectomy
Hongyuan CUI ; Mingwei ZHU ; Junmin WEI ; Bin HUA ; Jingyong XU ; Jifang MEN
Chinese Journal of Clinical Nutrition 2010;18(3):153-157
Objective To compare the benefits of the combined nutrition support with enteral nutrition (EN)and parenteral nutrition(PN)versus sole PN for elder patients after pancreaticoduodenectomy.Methods The clinical data of 48 consecutive elderly patients who underwent Whipple operations in Beijing Hospital were retrospectively analyzed.Patients were divided into PN+EN group(n=25)and sole PN group(n=23)according to the nutrition support modes.Demographic data as well as data on liver function,endotoxin levels,and post-operative complications were recorded.Mortality,length of hospital stay,and total costs of post-operative management were compared between two groups.Results Endotoxin level increased on the 1stpost-operative day(POD 1) in two groups,but there is not significant difference,and then gradually decreased in beth two groups;however,the decrease rate(compared with the POD 1 level)was significantly higher in PN+EN group than in PN group on POD 7 and 14(P<0.01).The levels of alanine transaminase,aspartate aminotransferase,total bilirubin,and direct bilirubin increased on POD 1 in both groups,but there is not significant difference,and then gradually decreased;however,the decrease rates(compared with the levels on POD 1)were also significantly higher in PN+EN group than in PN group(P<0.05)on POD 14.Infective complication rate in group PN+EN(2/25,8.0%)was significantly lower than that in group PN(6/23,26.0%)(P<0.05).Total complication rate,post-operative hospital stay,and total costs were similar between these both groups.Conclusions PN+EN can effectively reduce endotoxemia and post-operative infective complications and improve liver function without increasing costs.Therefore,it is feasible for elderly patients after pancreaticoduodenectomy.
10.Effects of L-carnitine on the plasma lipid profile and liver function in elderly patients receiving total parenteral nutrition after abdominal operations
Peng LI ; Mingwei ZHU ; Hongyuan CUI ; Shuping TAN ; Guodong YE ; Jifang MEN ; Junmin WEI
Chinese Journal of Clinical Nutrition 2010;18(3):145-148
Objective To explore the effects of L-carnitine on the plasma lipid profile and liver function in elderly patients receiving total parenteral nutrition after abdominal operations.Methods In this prospective blinded randomized controlled trial,24 eligible elderly patients were given 6-day total parenteral nutrition.They were further equally divided into L-carnitine group(administered with L-carnitine 50 mg/kg)and control group(without L-carnitine).The changes of lipid profile and liver function and the clinical outcomes were recorded and compared.Results The plasma triglyeride levels were lower in L-carnitine group than in control group on the 4th and 7th post-operative day,but there were not significant difference(P>0.05);There was a significant difference between the two groups in the change of the 4th post-operative day and pre-operative day(P<0.05).However,the liver function indicators were not significantly different between these two groups.Conclusion Administration of L-carnitine during total parenteral nutrition can improve the triglyeride metabolism in elderly patients after abdominal operations and may benefit the recovery of liver function.