ABSTRACT
Objective@#To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF.@*Methods@#A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration.@*Results@#A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ2=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ2=5.460, P=0.019), multiple ECF (χ2=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ2=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ2=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ2=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ2=179.699, P<0.001), sepsis (χ2=211.851, P<0.001), hemorrhage (χ2=85.300, P<0.001), pulmonary infection (χ2=60.096, P<0.001), catheter-associated infection (χ2=10.617, P=0.001) and malnutrition (χ2=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015).@*Conclusions@#The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.
ABSTRACT
Objective:To compare the clinical effect of domestic and imported omeprazole injection in the treatment of peptic ulcer bleeding.Methods:According to the random sequence generated by the computer,118 patients who were treated in digestive department of our hospital from April 2013 to May 2015 were randomly divided into 2 groups,59 cases in each group.The control group was given treatment of imported drug losec,while the study group was given treatment of domestic drug aoxikang,and two groups were treated continuously for 7 days.The incidences of gastrointestinal reactions,dizziness and palpitations,the average treatment time,and clinical therapeutic effects were compared,in addition,the costs of treatment in the two groups were analyzed.Results:There were no significant differences in the incidences of gastrointestinal reactions,dizziness and palpitations and the average treatment time between the study group and the control group (P＞0.05).There was no significant difference between the two groups in the treatment effect after rank sum test (P＞0.05).The total effective rates (96.61％ vs 94.91％) were equivalent,the differences were not statistically significant (P＞0.05),but the costs of using domestic drugs were lower than that of imported drugs.Conclusion:The clinical curative effects of domestic aoxikang and imported losec in treatment of peptic ulcer bleeding have no significant difference,which can have a good therapeutic effect,but the economy of aoxikang is more better.
ABSTRACT
Objective To evaluate the safety and efficacy of endoscopic intraductal radiofrequency ablation combined with biliary metal stent and biliary metal stent only for the treatment of biliary malignant tumor.Methods Data of 48 patients with biliary malignant tumor were reviewed.All patients were examined by ERCP for the range of obstruction.Twenty-four patients received combined therapy (combination group),while 24 others received stent placement only (control group).In the combination group,stenotic segments were treated with intraductal radiofrequency ablation,then metal stents were placed into the biliary duct.In the control group,only metal stents were placed.Changes of serum total bilirubin (TB),surgical complications,days of stent patency and median survival time were studied.Results In the combination group,TB level [median (min-max)] was 238.15 μmol/L (22.10-410.70 μmol/L) before treatment and it decreased to 113.40 μmol/L (9.80-243.70 μmol/L) after,while in the control group it was 239.70 μmol/L(112.30-558.50 μmol/L) before and 121.10 μmol/L (52.10-329.30 μmol/L) after respectively,significantly different in both groups (P＜0.05).The time of stent patency was 156 days (44-530 days) in the combination group and 110 days (14-462 days) in the control group (P＜0.05).The median survival time was 173 days (44-550 days) and 133 days (14-490 days) respectively(P＜0.05).Conclusion The combination therapy of endoscopic intraductal radiofrequency ablation with biliary stent is safe and feasible for biliary malignant tumor.It can prolong the duration of stent patency and median survival time as well as improve postoperative survival quality.
ABSTRACT
Objective To investigate the impact of pancreatic duct stenting as a preventive measure for post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation.Methods Clinical data of 64 patients with biliary tract disease from January 2008 to December 2015 was prospective analyzed. All the patients were randomly divided into observation group and control group. Patients in observation group received pancreatic stent placement, while patients in control group was not received pancreatic stent placement and nasal duct. Postoperative monitoring items included abdominal pain, blood amylase. Then record and compare the incidence of acute pancreatitis, pancreatitis severity rating, abdominal pain score, Ranson score, amylase recovery time between the two groups.Results Observation group had ifve cases of PEP, the rate was 15.6 %, including mild four cases (12.5 %), medium one case (3.1 %); the control group had 13 cases of PEP, the rate was 40.6 %, including mild six cases (18.8 %), medium four cases (12.5 %), severe three cases (9.4 %). PEP observation group was signiifcantly lower than the control group (P < 0.05). Mild, medium and severe PEP were lower than the control group, in which the severe PEP was signiifcantly lower than the control group (P < 0.05). Ranson score of the observation group was (1.2 ± 0.4), significantly lower than the control group (2.5 ± 1.2) (P < 0.05); the observation group amylase average recovery time was (3.0 ± 0.6) d, it is also signiifcantly lower than the control group (5.8 ± 1.4) d (P < 0.01). No bleeding and perforation complications occurred.Conclusion Pancreatic stenting can effectively prevent the incidence of PEP, reduce postoperative pain, improve patient recovery.
ABSTRACT
<p><b>OBJECTIVE</b>To study the influence of hepatitis B virus (HBV) replication and expressions of different viral genes on CDC37 level in hepatocytes.</p><p><b>METHODS</b>We amplified and cloned 6 HBV genes (P, preS1, preS2, S, C and X) into pCMV expression vectors, which were transfected in Huh7 and HepG2 hepatoma cell lines, and CDC37 expression level in the cells was detected using Western blotting. Wealso cloned the promoter sequence of CDC37 into pGL3 vector, and co-transfected pGL3 with pCMV recombinant plasmids into Huh7 and HepG2 cells and the fluorescent signals were detected. To study the influence of HBV replication on CDC37 expression, we constructed 1.28-copy overlength genomes of HBV genotypes B, C, D and CD recombinant. The overlength HBV genomes were transformed into Adeasier-1 cells for recombination and into 293 cells for packaging. Huh7 and HepG2 cell lines infected with the packaged HBV recombinant adenoviruses were examined for CDC37 expression with Western blotting.</p><p><b>RESULTS</b>Western blotting showed that the expression of different HBV genes did not obviously affect the protein level of CDC37 in the hepatocytes. The protein expression of HBV genes had no effect on the activity of CDC37 promoter. Huh7 and HepG2 cells infected with 1.28-copy HBV replicon showed no significant changes in the expression level of CDC37.</p><p><b>CONCLUSION</b>HBV replication and its gene expression have no effect on the level of CDC37 in hepatocytes in vitro.</p>
Subject(s)
Humans , Adenoviridae , Cell Cycle Proteins , Metabolism , Chaperonins , Metabolism , Gene Expression Regulation, Viral , Genetic Vectors , Hep G2 Cells , Hepatitis B virus , Genetics , Physiology , Hepatocytes , Virology , Transfection , Virus ReplicationABSTRACT
Objective To evaluate the safety and efficacy of pancreatic duct precutting by arciform knife combined with needle knife in difficult cannulation of ERCP.Methods The clinical data of 38 patients who were treated with pancreatic duct precutting by arciform knife combined with needle knife in our hospital from June 2005 to May 2012 were retrospectively reviewed.Results The success rate of ERCP was 86.8％ (33/38) without any complications of bleeding or perforation,while 4 cases were presented with hyperamylasemia after ERCP,4 with pancreatitis and 1 with cholangitis who all got recovered after 5 days with conservative treatment.Conclusion The application of pancreatic duct precutting by arciform knife combined with needle knife can improve the success rate of ERCP and is a kind of effective operation technique.
ABSTRACT
Objective To analyze the clinical manifestations and treatment for toxic megacolon induced by drastic cathartics inpatients with an unknown history of ulcerative colitis. Methods The clinical data of 5 patients with toxic megacolon induced by ulcerative colitis with initial onset type from June 2003 to October 2008 were analyzed retrospectively. Results In 5 cases, the first symptom was abdominal pain and distention. After taking cathartics, these 5 cases were complicated with toxic megaeolon and 2 cases suffering from intestinal perforation. Four female patients suffered from transient unconsciousness, in which 3 patients were found with cerebral lacunal infarction identified by magnetic field diffusion-weighted imaging. All 5 cases underwent exploration, colectomy and ostomy, one patient died perioperatively, anastomotic fistula and anastomotic constriction developed in one each cases. Conclusions The most common clinical manifestations of toxic megacolon induced by ulcerative colitis are abdominaigia, abdominal distention. Emergency therapeutic strategy consists of partial culectomy and ostomy.