In recent years, damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. The "damage control" concept also has been shown to increase overall survival and is likely to modify the management of critically ill patients suffering from gastrointestinal disease. In these patients the "lethal triad" of hypothermia, acidosis, and coagulopathy acts as a vicious cycle that often can not be interrupted and marks the limit of the patient's ability to cope with the physiological consequences of traditional and extensive surgical procedures. The principles of damage control are to control bleeding, obstruction, and/or infection until the physiologic derangement has been restored and the patient could undergo a prolonged operation for definitive repair. This approach is unfolded in three phases. During the initial operation, the surgeon carries out only the absolute minimum necessary to improve patient's condition and to control bleeding, obstruction, and/or infection. The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, definitive operation is performed.
Acidosis ; therapy ; Blood Coagulation Disorders ; therapy ; Critical Care ; Gastrointestinal Tract ; surgery ; Humans ; Hypothermia ; therapy ; Perioperative Care

Humans ; Intestinal Diseases ; classification ; therapy

Digestive System Surgical Procedures ; methods ; rehabilitation ; Humans

In addition to the operation technique and procedure selection, the dysfunction of important organs such as heart, lung, kidney and liver plays an important role in restricting the recovery of patients and the prognosis of gastrointestinal surgery. For patients complicated by one or more organs dysfunction after operation, who have no response to conventional therapies, extracorporeal life support/replacement should be used as early as possible. The extracorporeal organ support provides more time for rescue, and relieves injured organs to "rest" and accelerates recovery, which improves the survival of critically ill patients who suffered after gastrointestinal surgery. Nowadays, the safety and efficiency of the extracorporeal life support/replacement, including heart, lung, kidney, liver and intestine, are developing quickly, and easy to achieve, however, limitations still exist. With the development of nanotechnology and bioartificial membranes, an open and total extracorporeal life support system, which can simultaneously supports heart, lung, kidney, liver, intestine and brain, will be produced in the future, further improving the survival of critically ill patients.
Critical Illness ; Digestive System Surgical Procedures ; Extracorporeal Membrane Oxygenation ; Humans ; Life Support Care

Severe acute pancreatitis (SAP) can induce intra-abdominal hypertension, which has an adverse effect on the function of urinary, circulatory, digestive and neurological system, and finally leads to abdominal compartment syndrome (ACS) if patients were not timely treated. This article focuses on the close relationship between SAP and ACS, which included the definition, classification, pathogenesis of ACS and its pathophysiologic effects on other important organs. The different types and indications of surgical interventions of ACS were discussed in detail. For SAP patients complicated with ACS, urgent open abdomen is important to decrease the abdominal pressure and to prevent the incidence of multi-organ dysfunction syndrome. Complications after open abdomen, such as intestine fistula,abdominal sepsis, intestinal dysfunction and abdominal deficit,should be managed prudently.

Refractory constipations are mostly mixed constipations. Surgery is only reserved as the last option when conservative treatments have failed. Colectomy or stapbed transanal rectal resection (STARR) represents the procedure of choice in patients with pure slow transmit constipation (STC) or obstructive defecation syndrome (ODS). However, its clinical outcome is unsatisfactory. Jinling procedure, a new surgical innovation for mixed constipation, aims to correct the coexistence of STC and ODS in severe refractory constipation. It combines subtotal colectomy and side to side cecorectal anastomosis, which shows a promising clinical outcome in over 500 refractory constipation patients. In our department, there is no significant difference in operation time, mortality and complications between the laparoscopic assisted and open Jinling procedures. Jinling procedure is also appropriate for secondary Hirschsprung's disease. Stoma is described in the treatment of some adult constipation patients, which has not been supported by the evidence-based medicine at present. Anastomosis leakage is a severe complication after constipation surgery. Fecal diversion is indicated once it happened. Colon irrigation may be used in patients who failed after surgery or children who refused definitive operation. It has showed a good short-term functional recovery but becomes invalid after a long-term follow-up.
Adult ; Colectomy ; Constipation ; surgery ; Defecation ; Humans ; Laparoscopy ; Treatment Outcome

The prestigious Japanese novelist Watanabe Junichi gave a vivid account of the fierce conflict between the progress of modern medical science and traditional Japanese culture,by describing a medical case of heart transplant in his novel of Weiss Kreuz(Baiyan).The hidden mental ideas of the characters are also explored and analyzed,from which we could peer out the ethical culture in Japanese organ transplant.

Sepsis is a complicated pathophysiological disorder arising from a systemic inflammatory response to infection.Because of high morbidity,high mortality and high cost of treatment, sepsis has caused global attention and become a hot spot in pediatric intensive medical research.Increasing number of studies have shown a close correlation between the occurrence of multiple organ dysfunction syndrome and mitochondrial dysfunction in sepsis.A major feature in sepsis is dysfunction of mitochondrial oxidative phosphorylation.This review discusses the dysfunction of mitochondrial respiratory chain in sepsis.

Standardized nutritional support therapy can improve the nutrition status and surgical tolerance as well as reducing postoperative complications.The enteral nutritional support therapy is recommended as the first choice,while supplementary parenteral nutrition will be applied to the patients when enteral nutritional support therapy cannot achieve target supplement for more than 3 days.Enhanced recovery after surgery (ERAS) focuses on the optimization of preoperative managements,which also greatly update the strategy of nutritional support therapy.Risk assessment of nutrition in patients with surgery and correction of preoperative malnutrition are becoming important parts of ERAS.Preoperative nutritional support therapy not only emphasizes the energy supplement,but also regulates pathophysiologic changes of patients with surgery.It has been regarded as a mandatory method to enhance postoperative recovery and optimize preoperative managements.

Objective To investigate the relationship of hemrrheology changes and in resistance to microangiopathy in type 2 diabetes.Methods 102 type diabetes cincluding 52 with microangio pathy and 50 without microangio pathy and 50 healthy objects were observed.Hemrrheology and fasting serum glucose,insulin were determined.The insulin sensitivity indes(IAI)were calculated in all objects.Results The results showed that the viscosity in both type diabetes groupes were significantly higher than those of heathy objects and the insulin sensitivity indes were significantly lower than those of heathy objects P