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The diagaosis and treatment of postoperative acute cholecystis

Dongwen WANG ; Qingjiu MA ; Qiwen XU ; Jun SONG ; Deming GAO

Chinese Journal of Practical Surgery.2001;21(4):218-219.

Objective To investigate the causes,diagnosis and treatment of postoperative acute cholecystitis. Methods Clinical data of 9 cases with postoperaive acute cholecystitis were analyzed retrospectively. Results7 cases was confirmed by ultrasonography, 1 case was confirmed by CT, and 1 case died of gallbladder perforation, no operative mortality in emergency cholecystectomy. Conclusion The prevalent etiology is biliary stasis. Early diagnosis and treatment is the key point to decrease the death rate.

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The diagnosis and treatment of the sharp injury in the back.

Shi CHENG ; Zhiqiang ZHONG ; Ruotian WANG ; Yiezhi ZHAO ; Zhihong LI ; Ming JIANG ; Huisheng YUAN ; Dongbo FAN

Chinese Journal of Practical Surgery.2001;21(4):216-217.

Objective To improve the level of diagnosis and treatment of the sharp injury in the back. Methods 47 cases which were treated from Jan 1991 to May 2000 were reviewed. ResultsAmong 37 cases who underwent the exploration, 5 cases died. Among 10 cases who underwent conservative treatment, 2 cases died. ConclusionThe condition of sharp injury in the back is very complicated,it is easy to be misdiagnosed, the mortality is high. Saving should be equalled with the diagnosis and treatment. The application of wound exploration, abdominal puncture, ultrasound examination and X-ray checking is valuable to the diagnosis. The patients with operation indications should be operated at once,while the others should be observed for some time to prevent the delayed clinical manifestation.

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Application of enteral nutrition and parenteral nutrition support in critically ill surgical patients.

Min WU ; Tieou YU ; Yinan LI ; Ping KANG ; Bin FANG ; Weibiao WEN

Chinese Journal of Practical Surgery.2001;21(4):213-215.

Objectives To evaluate the effects of enteral nutrition(EN)and parenteral nutrition(PN)support in critically ill surgical patients. Methods 80 patients who could not eat were randomized into two groups:one group receivedEN,the other group received PN. The nutrition parameters including nitrogen balance, serum levels of albumin, prealbumin, transferrin and retinal-binding protein,immunity function parameters including immunoglobulin A, immunoglobulin G,immunoglobulin M,and natural kill cell activity, and patients'tolerability parameters including glutamic-oxalacetic transaminase, glutarmic-pyruvic transaminase, blood urea nitrogen and creatinine,and plasma glucose were compared. Results After 10 days'therapy,the two groups all turned from negative nitrogen balance to positive nitrogen balance. The nutrition parameters and immunity function parameters increased significantly in both groups and the latter in group EN increased more. For tolerability parameters, blood sugar in group PN increased obviously and no change in EN group. ConclusionsBoth EN and PN play a rde in nutrition support and elevation of immunity function. Patients tolerate well. EN has better effects on elevation of immunity function and patients tolerate better compared with PN.

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Nosocomial infections in the surgical intensive care unit—retrospective analysis of five years.

Juan CHEN ; Fen LILI ; Xiangdong GUAN ; Lan LOU ; Minying CHEN ; Changjie CAI ; Zhongzhen LI ; Huiming YI

Chinese Journal of Practical Surgery.2001;21(4):209-212.

Objective To evaluate the prevalence of NI in the SICU at our hospital. Methods 181 NI patients in the SICU were retrospectively analysed during Jan 1996～Dec 2000.Results The average NI rate was 9.81%. The major sites of NI were respiratory tract(36.96 %),thoracic/abdominal cavity(25.47 %)and bloodstream infections(9.32 %).The difference in major pathogens of infections in different sites reached statistical significance. For respiratory tract, thoracic/abdominal cavity and bloodstream infections,bacteria were the most common pathogens. Fungi were the moat frequent isolate from urine and stool. Mixed infection proportion was 52.25 %. The most common pathogens were Enterococci, Methicillin resistant Staphylococci、 Pseudomonas Aecruginosa、Escherichia Coli、Candida Albicans and Candida Tropicalis. Conclusions The most common pathogens of NI in SICU are different in different infection sites. The pathogens were complicated and most strains are antibiotics resistant. So it is important to establish NI control and to understand the changes of pathogens so as to prevent the infection.

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Long-term effect of combined portoazygous devuscularization and shunt for treatment of portal hypertension.

Shuguang ZHANG ; Changle RUAN ; Zhenhai YU ; Guangxing LI ; Zhaoting LI

Chinese Journal of Practical Surgery.2001;21(3):147-148.

ObjectiveTo evaluate the therapeutic effect of combined portoazygous devascularization and shunt on portal hypertension. MethodsThe data of 56 cases of portal hypertension treated with portoazygous devascularization and shunt from April 1987 to April 1999 was summarized. ResultsThere was no death in 54 patients receiving selective operation;of 2 cases receiving emergency operation, one died. Among 49 followed-up cases, there was one rebleeding,2 hepatic encephalopathy, and one died of liver failure 4 years after opeation. The mean portal pressure before and after operation was(3.42±0.46) kPa and (2.50±0.35) kPa, respectively. ConclusionCombined portoazygons devascularization and shunt not only decreases portal pressure but preserve hepatic blood flow to some extent.

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Combined devascularization and mesocaval shunt for treatment of portal hypertension: analysis of 100 cases.

Yingjian ZHENG ; Hongqi ZOU

Chinese Journal of Practical Surgery.2001;21(3):145-146.

ObjectiveTo study the hemodynamic changes in combined portoazygous devascularization and mesocaval shunt for treating portal hypertension and the effect of this operation. Methods100 cases of portal hypertension who received this combined operation from 1980 to 1995 were analyzed retrospectively. ResultsFree portal pressure(FPP)after shunt decreased to 1.92 kPa,which decreased portal pressure and preserved with (2.46 ± 0.30)kPa to maintain a good inflow to the liver and the encephalopathy rate was lowered. There was no death, and the effect was satisfactory. 5～15 years follow-up of 89 cases showed no rebleeding,with only 5% of encephalopathy and 15% of total mortality. Among them, 13 cases of Child C died of late-stage hepatopathy, such as liver failure, liver cancer and hepatorenal syndrome,with 94.5% of 5-year survival rate and 68.5% of 10-year survival rate. ConclusionThis combined operation is characterized by complete devascularization of sustaining varices and distal partial shunt with logical diameter. A perfect combination of both shunt and devascularization, it's one of the best choices currently available for treating portal hypertension in China.

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Surgical treatment of postoperative rebleeding in portal hypertension.

Yu WANG ; Qi ZHENG ; Qingtian LIN

Chinese Journal of Practical Surgery.2001;21(3):142-144.

ObjectiveTo evaluate the effect of different operative methods for treating rebleeding in patients with portal hypertension(PHT). MethodsThe clinical data of 66 patients with postoperative ebleeding out of 373 PHT cases during the last 30 years was retrospectively analyzed. Their first operations were splenectomy, portoazygous devascularization, various non-selective shunt and combined operation(devascularization combined with shunt), of which, the rebleeding rate were 26.67 %, 17.86 %, 14.58 % and 4.35 %, respectively. Among 55 cases receiving re-operation, there were 42 with distal esophago-fundusectomy, 11 mesocaval shunt(MCS)and 2 re-devascularization. The other 11 cases received nonoperative therapy. ResultsThe mortality, mean follow-up time, rebleeding rate and encephalopathy rate were 9.52% (4/42), 11 years,9.52% (4/42)and 14.29% (6/42)in distal esophago-fundusectomy group;0,7.5 years,0 and 9.09% (1/11)in MCS group. All 2 cases in re-devascularization group died within one postoperative month. All 11 cases in non-operative group were with portal hypertension gastropathy(PHG). ConelusionCombined operation may effectively reduce postoperative rebleeding rate in PHT cases and MCS is a relatively ideal method for treating rebleeding.

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Diagnosis and treatment of primary presacral tumor: analysis of 23 cases

Nan WU ; Yuanlian WAN

Chinese Journal of Practical Surgery.2001;21(3):156-157.

ObjectiveTo discuss the diagnosis and therapy of primary presacral tumor. Methods23 patients with primary presacral tumors underwent surgical treatment from 1983～1999 were studied retrospectively. ResultsIn respect to pathological type, congenital tumor was the most frequent one in 23 patients. Digital examination together with B ultrasound and CT examination were quite important in determining the extent and degree of tumor invasion. As for operative ways, transacral and transperineal approach were the most common choices to detect the tumor. Conclusion Complete and enbloc resection is the principal method in treating presacral tumor, whether the lesions are beign or malignant. Choices of operative way should be made accordial to tumor condition. Keep nerves and blood vessels from being injuried during operation.

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Study of surgical style of treating acute mesenteric venous thrombosis

Guanfeng YU ; Jiangao YAO ; Jun CHENG ; Yunfeng HONG ; Yuming WANG ; Qiyu ZHANG ; Hongqi SHI ; Xiaolei CHEN ; Xiaofeng DENG

Chinese Journal of Practical Surgery.2001;21(3):154-155.

Objective To explore the best therapeutic methods for acute mesenteric venous thromboses(AMVT)with different degrees of intestinal ischemic lesions. Methods 6 cases of acute abdomen were preoperatively diagnosed as AMVT with imaging. After laparotomy, patients were classified as congestive lesion(n=3)and necrotic lesion(n=3)according to the degree of intestinal sichemia and were treated with mesenteric thrombectomy and bowel resection, respeetively. All cases received heparin and urokinase perioperatively. Results Of the 3 patients receiving mesenteric thrombectomy, 2 were cured and the other one with ischemic ascending colon was cured after right hemicolectomy due to the complication of colic dynamic ileus and perforation 10 days after thrombectomy. The other 3 patients recovered after bowel resection. Follow-up from 8 months to 6 years showed no recurrence. Conclusion Combined with anti-coagulation therapy, thrombectomy and bowel resection are rational and effective protocol for congestive lesion and necrotic lesion, respectively in AMVT patients.

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Managiment of portal hypertension complicated with hyperthyroidism

Xinbao WANG ; Zhen YANG ; Dexu LI ; Dapeng LI ; Fazu QUI ; Xiaorong DENG

Chinese Journal of Practical Surgery.2001;21(3):152-153.

ObjectiveTo summarize the experience of managing portal hypertension( PHT) complicated with hyperthyroidism. Methods5 patients with hyperthyroidism complicated PHT were performed with splenectomy plus pericardial devascularization after preoperative management, and the experience of pre- and postoperative management was summarized. Results1 patient occurred postoperative thyroid crisis and was cured with tranquilizing, prenisone and sodium iodide;the other 4 went through perioperation safely. The preoperative WBC,RBC,Hb and Pt were(2.018±0.536)×109/L,(2.97±0.42)×1012/L,(87±15.6)g/L and (38.4±13.24)×109/L, respectively, which rose to (6.54±0.398)×109/L, (3.636±0.387)×1012/L, (108.6±9.633)g/L and (240.4±84.54)×109 /L, respectively after operation. WBC and platelets of all patients reached normal level postoperatively. ConclusionProper perioperative management ensures that patients with hyperthyroidism complicated PHT survive the splenectomy plus pericardial devascularization, which renders opportunity for treating hyperthyroidism with medicine or surgery.

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