Objective To determine the effect of video-assisted retroperitoneal debridement in treatment of infected necrotizing pancreatitis.Methods The clinical data of patients with infected necrotizing pancreatitis was retrospectively analyzed.Heart rate,mean arterial pressure,body temperature and indicators for inflammatory response including level of WBC,CRP and procalcitonin before and after VARD treatment were compared.Results After VARD treatment,the heart rate (preoperative vs.postoperative 8 h,108 ± 22/min vs.95 ± 17/min),mean arterial pressure (preoperative vs.postoperative 12 h,66 ± 18 mmHg vs.79 ± 19 mmHg) and body temperature(preoperative vs.postoperative 24 h,38.3 ± 1.7 ℃ vs.37.3 ± 1.3 ℃) improved significantly (all P ＜ 0.05).Level of WBC [preoperative vs.postoperative 48 h,(13.8 ±6.6) × 109/L vs.(10.1 ±5.2) × 109/L],CRP(preoperative vs.postoperative 48 h,145 ± 88 mg/L vs.95 ± 4 mg/L) and procalcitonin (preoperative vs.postoperative 48 h,1.4 ± 0.7 μg/L vs.0.9 ± 0.4 μg/L) also decreased significantly(all P ＜ 0.05).Conclusions VARD therapy can significantly reduce systemic inflammation and improve the general condition of infected necrotizing pancreatitis patients.

Objective To evaluate the surgery timing for adhesive small bowel obstruction (ASBO).Methods A retrospective analysis was made on the clinical data of ASBO patients admitted to our hospital between January 2003 and December 2012 who received surgical treatment.According to surgery timing,patients were divided into three groups,early surgery group (＜ 36 h),mid-term surgery group (36-72 h) and late surgery group (≥ 72 h).The mortality,surgical site infection (SSI) rate and systemic infection rate were compared between groups.Result In this study,33,56 and 27 patients received early,middle and late surgery,respectively.The SSI rate in early surgery group was significantly lower than that in middle (6％ vs.25％,x2 =5.05,P =0.025) and late surgery group(6％ vs.30％,x2 =5.94,P =0.015).Though of not significant difference,the mortality and systemic infection rate in early surgery group were also lower than both middle and late surgery groups.Conclusions Early surgery might reduce the postoperative infectious complications and improve the outcome of patients with ASBO.

Objective To assess the value of primary resection and anastomosis with intraoperative colonic defecation in the patients with obstructive left colonic cancer. Methods From January 2000 to January 2008, 39 patients undergoing emergency laparotomy for left colonic cancers with complete obstruction were analyzed retrospectively. Results The patients were 25 males and 14 females, with a median age of 68.5 years (range: 57～78 years). The primary tumors were located at splenic flexure (3/7.7%), descending colon (8/20.5%), sigmoid colon (15/38.5%), boundary of sigmoid colon and rectum (8/20.5%), and superior segment of rectum (5/12.8%). Primary resection and anastomosis with intraoperative colonic de-fection were performed in 18 patients with left hemicolectomy, 13 patients with sigmoid colectomy and 8 pa-tients with anterior resection. Early complications included wound infection in 4 patients (wound disruption in 1 patient) and pulmonary infection in 5 patients. One patient complicated with anastomotic leakage and intra-abdominal abscess died of tumor metastasis after reoperation. Another one died of respiratory failure secondary to pulmonary infection. Morbidity and mortality was 25.6% and 5.1% respectively. Conclusion Primary resection with intraoperative colonic defecation can be applied to patients with malignant colonic complete obstruction with good operative results.

Objective To assess the value of primary resection and anastomosis without intraoperative irrigation in the patients with obstructive left colonic cancer. Method Between January 2000 and January 2008, 93patients underwent primary resection and anastomosis for colonic cancers were analyzed retrospectively. Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) was performed in 43 patients with obstructive left colonic caner and traditional left-sided colectomy in 50 cases without obstruction. Both groups of patients were comparable in terms of gender, nutritional status, underlaying disease, tumor location and stage, etc ( P = 0.83,0.13,0.29,0.51,0.38). The average age of the patients with colonic obstruction was significant older than that of the cases without obstruction (61.2 ± 8.6 vs. 58.1 ±7.8, P =0.010).The operative results were compared between patients with obstructive colonic cancer and cases without obstruction.Results The mean hospital stay of the primary anastomosis group and traditional left-sided colectomy group were (16.6±7.8) d and (12.4±5.4) d respectively, and the former was significant longer than the latter (P =0.002). The costs of hospitalization in the two groups were (50192.8 ± 39727.4) RMB and (46489.3 ±29543.1)RMB respectively (P = 0.04) . The morbidity and mortality in the two groups were 25.6% (11/43) vs. 18%(9/50) (P =0.375) and 2.3% (1/43) vs. 2.0% (1/50) (P =0.714) respectively, and there were no significant difference between the two groups. Conclusions Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) compares favorably with traditional left-sided colectomy in safety and efficiency for left colonic cancer with obstruction.

Objective To evaluate the preliminary outcome of stable vitiligo treatment with ReCell(R )technique.Methods Six patients with stable vitiligo were treated with ReCell(R ) technique.In each patient,a thin razor-thickness cutaneous biopsy was harvested from uninvolved area near the vitiligo patches.It was then processed through the ReCell(R ) system and 1 ml autologous epidermal cell suspension was obtained.The lesion area was dermabraded using a diamond fraise wheel to the dermoepidermal junction.The cell suspension was then sprayed on the wound and covered with non-adhering dressings.Results The patients were followed up for 6 months.5 patients presented with repigmentaion in the treated area.There was no significant response in one patient who was diagnosed as systematic vitiligo.Conclusions The ReCell(R ) technique is an alternative treatment for stable vitiligo patients.The clinical outcome will be satisfactory when appropriate patients are selected.

Objective To validate the accuracy of the determinant-based classification (DBC) for the severity of acute pancreatitis (AP).Methods Retrospective analysis the clinical data of 243 patients with acute pancreatitis who admitted to our hospital between January 2012 and December 2013.Length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality was assessed,respectively in subgroup of mild,moderate,severe and critical acute pancreatitis according to DBC.Results Pancreatic or peripancreatic necrosis was present in 65 of the patients (26.7％).Transient and persistent organ failures were present in 26 patients (10.7％) and 9 patients (3.7％),respectively.On the basis of the DBC,178 (73.3％),35 (14.4％),21 (8.6％),and 9 (3.7％) patients were determined to have mild,moderate,severe,or critical AP,respectively.The different categories of severity for DBC system were associated with statistically significant and clinically relevant differences in length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality.Conclusions The DBC accurately classify the severity of AP in subgroups of patients.

Objective To determine risk factors for postoperative infectious complications for small bowel obstruction.Methods Retrospective analysis the clinical data from small bowel obstruction patients who admittedto our hospital between January 2006 and December 2012 who receiving surgical treatment.The independent risk factors for infective complications were detected by logistic analysis.Results One hundred and fifty-four patients received surgery for small bowel obstruction with infection rate 27.9％.Logistic analysis revealed that older people(≥65 years) (OR 6.71,95％ CI 3.15-16.33),intraoperative bowel rupture (OR 2.71,95％ CI 1.19-7.25),delay surgery(≥72 h)(OR 11.33,95％CI4.62-20.20) and operation time(≥180 min) (OR 2.90,95％ CI 1.26-9.83) were the independent risk factors for postoperative infective complications.Conclusions Postoperative infections were the common complications after surgery for small bowel obstruction.Early surgery,intraoperative soft operation to prevent bowel rupture may be effective measures to reduce postoperative infection.

Objective:To compare the short-term result of one-stage resection and anastomosis for patients with acute complete obstruction of the right and left colonic carcinoma.Methods:The clinical data of 80 patients undergoing emergency one-stage resection and anastomosis of acute complete obstruction for left and right colonic carcinoma were retrospectively analyzed.Results:Thirty-seven patients were operated on for obstructive carcinoma of the right colon,the mortality was 5.4%(2/37),the rate of complication was 21.6%(8/37),the mean hospital stay and cost was(31.6?12.8)d and(52794.9?60804.3)Yuan RMB,respectively.Forty-three patients were operated on for obstructive carcinoma of the left colon.the mortality was 2.3%(1/43),the rate of complication was 25.6%(11/43),the mean hospital stay and cost was(29.6?14.8)d and(50 192.8 ?39 727.4) Yuan RMB respectively.There was one case of anastomotic leakage in both groups.There were no significant differences of mortality and the rate of complication of the two groups.Conclusions:One-stage resection and anastomosis of acute complete obstruction of left colonic carcinoma can be performed as safely as in those with acute obstruction of right.Intraoperative decompression should be considered seriously in left colonic obstruction prior to the anastomosis following colonic resection.

Objective:To study the clinical application of laparoscopic combined with multi-video debridement in treatment of complicated infectious pancreatic necrosis (CIPN).Methods:The clinical data of 34 patients with CIPN who were treated at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from August 2017 to December 2019 were retrospectively studied. Based on the different video methods used, these patients were divided into 3 groups: the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group. The number of operations, operation time, blood loss, postoperative complication rates, mortality rates and total length of hospital stay were compared.Results:There were 13 patients in the laparoscopic combined with intraoperative ultrasound group, with age of (56.4±13.4) years. There were 7 patients in the laparoscopic combined with choledochoscopy group, with age of (48.0±8.4) years. There were 14 patients in the laparoscopic group with age of (51.4±15.6) years. The number of operations of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (2.2±1.1), (1.6±0.8), (2.9±1.4), respectively. The number of operations of the laparoscopic combined with choledochoscopy group were significantly less than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). The operation time of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (70.5±22.9) min, (65.7±19.9) min, (51.5±15.4) min, respectively. The operation time of the laparoscopic combined with intraoperative ultrasound group was significantly longer than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). There were no differences in blood loss, postoperative complication rate, mortality rates and total lengths of hospital stay among the three groups ( P>0.05). Conclusion:Laparoscopic combined with multi-video debridement after making full use of the advantages of each of the video methods, can be used to improve treatment outcomes of patients with CIPN.

Objective:To evaluate the treatment efficiency using transnasal ileus catheter in elderly patients with mechanical small intestinal obstruction.Method:Ninety geriatric patients with mechanical small intestinal obstruction admitted to Xuanwu Hospital of Capital Medical University from Jan 2018 to Dec 2019 were divided into intestinal obstruction catheter group with transnasal ileus catheter insertion ( n=40) and nasogastric tube group ( n=50). Results:The transnasal ileus catheter retained for (91.0±33.5) h significantly shorter than that in nasogastric tube group ((149.3±82.3) h, t=3.323, P=0.002). Compared to nasogastric tube group, the exhaust time, defecation time, feeding time, time to gas-liquid level disappearance and time to contrast agent appearance in the colon in intestinal obstruction catheter group were significantly shorter [(55.9±40.9) h vs. (127.6±59.1) h, t=5.149; (69.8±42.3) h vs. (134.9±48.4) h, t=5.371; (104.3±35.1) h vs. (178.3±79.8) h, t=4.297; (106.2±36.6) h vs. (175.8±79.1) h, t=4.050 and (101.4±37.3) h vs.(172.4±72.9) h, t=4.407, all P<0.05]. In addition, the length of hospital stay was shorter and in hospital expenses were lower [(8.1±3.8) d vs. (11.6±6.7) d, t=2.248; (8 236±5 451)￥ vs. (15 320±9 582)￥, t=3.293, all P<0.05]. Conclusion:The use of transnasal ileus catheter was safe and effective to relieve the symptoms of mechanical small intestinal obstruction, hence improving the success rate of conservative treatment.