Objective To investigate the clinical features and surgical management of patients with blunt multiple severe injuries. Methods 165 patients whth the injury severity score (ISS) over 16 were reviewed between 1988 and 1998. Results 47 cases (28.5%) had 3 or more injury sites, and 63 cases had multiple intraabdominal organ trauma. Abdominal trauma was evaluated by abdominocentesis in 143 cases, by US in 65 and CT in 47. All had positive values over 90%. Missed diagnosis of intraabdominal injury occurred in 21 cases (12 7%). The total mortality rate was 17 6% (29 cases). The average ISS for the died was 41 6 and 24 8 for the survivors ( t =15 21, P

Objective To study the complications of small bowel tumors (SBT) and their diagnosis and treatment. Methods A retrospective study was carried out among 47 SBT patients suffering from complications of SBT during the last two decades. Results Thirty-three cases (70%) were of malignant tumors. Complications included bleeding in 17 cases, perforation in 8, intussusception in 11, bowel obstruction in 8, volvulus, internal hernia and volvulus plus intussusception in one each. Abdominal pain was the most common presenting sign and symptom (40 cases). The mean interval from the onset of signs and symptoms to exploration was 4.7 months for those with malignant SBT and 3.1 months for benign ones. Roentgenography was the mainstay for diagnosis. Ultrasound, CT and MRI were also helpful. Benign tumors were treated with segmental resection of the affected bowel. Out of 33 malignant SBT patients, curative resection was performed in 26 and palliative resection in 7. Two patients died postoperatively.Conclusions Most patients with SBT were not correctly diagnosed until complications popped up. Surgery remains as the therapy of choice. [

Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

Objective To study the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) in the treatment of pancreatic benign and borderline tumors.Methods The clinical data of 15 patients with preoperative diagnoses of pancreatic benign or borderline tumors who underwent LSPDP in the Jinhua Hospital,Zhejiang University from March 2013 to March 2017 were retrospectively analyzed.The diameter of tumors ranged from 2.6 to 6.8 cm,with an average of 4.4 cm.Results 15 patients were successfully treated with LSPDP.Twelve patients underwent splenic vessels preservation and 3 without splenic vessels preservation.The average operation time was 215 min (160 ～ 270 min).The mean intraoperative blood loss was 340 ml (180 ～700 ml),and the average postoperative hospital stay was 10.5 days (7 ～ 16 days).There was no patient with postoperative abdominal hemorrhage.Three patients developed postoperative pancreatic fistula and they were treated successfully with conservative therapy.Two patients developed splenic infarction,and the splenic infarction improved markedly after two months on CT.The pathological diagnoses showed 9 patients with serous cystadenoma,4 patients with mucinous cystadenoma,1 patient with a pancreatic neuroendocrine tumor and 1 patient with a solid pseudopapillary tumor.There was no recurrence on follow-up which ranged from 6 to 24 months.Conclusions Laparoscopic spleen-preserving distal pancreatectomy was safe and feasible in the treatment of pancreatic benign or borderline tumors.The Kimura procedure should be performed in preference to the Warshaw procedure.

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective:To study the feasibility and safety of combining liver suspension with 3D laparoscopy in resection of liver tumors in segments 7 and 8.Methods:The data of 26 patients who underwent liver tumor resection in segments 7 and 8 with 3D laparoscopy at Jinhua Hospital of Zhejiang University from January 2018 to December 2019 were retrospectively analyzed. There were 20 males and 6 females, with an average age of 58.7 years. All patients underwent liver tumor resection in segments 7 and 8 with liver suspension combining with 3D laparoscopy. The operative data was analysed.Results:For 25 patients underwent successful operations, and 1 patient was converted to open surgery. The mean operating time was 153 (65-350) min. The Pringle's maneuver was used in 15 patients. The mean blood loss was 155 (30-1 200) ml. Postoperative ascites developed in 4 patients (16.0%), and pleural effusion in 2 patients (8.0%). There was no bile leakage or incisional infection. The mean postoperative hospital stay was 6.2 (4-10) days.Conclusion:The liver suspension technique combing with 3D laparoscopy is safe and effective for resection of liver tumors in segments 7 and 8.

Objective: To study the feasibility of using a double purse-string bridging pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (TLPD). Methods: A database of 35 patients who underwent TLPD using a double purse-string bridging pancreaticojejunostomy from January 2016 to January 2019 in Jinhua Hospital of Zhejiang University was retrospectively reviewed. The perioperative outcomes were analyzed. Results: All the 35 patients underwent TLPD successfully. The surgery time was (370.2±33.5) min, and the time of constructing the pancreaticojejunostomy was (28.4±12.6) min. The hospital stay after surgery was (14.2±6.9) days. Five patients developed postoperative complications, including pancreatic fistula in 3 patients, bile leakage in 1 patient, gastroparesis (complicated with abdominal infection) in 1 patient, and abdominal infection in 3 patients (2 patients with pancreatic fistula, and 1 patient with gastroparesis). All the patients with complications responded well to conservative treatment. Conclusions A double purse-string bridging pancreaticojejunostomy was simple and widely applicable. It is safe and feasible in total laparoscopic pancreaticoduodenectomy and should be promoted in clinical practice.

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.