Application of damage control surgery in serious pediatric abdominal surgery / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Damage control surgery (DCS) deals with the complex surgical problems by stages. This study investigated the application of DCS in serious pediatric abdominal surgery.</p><p><b>METHODS</b>The clinical data of 49 children with serious abdominal diseases (age: 4 months to 10 years) were retrospectively studied. Of them, 32 children underwent damage control surgery (DCS) and 17 children underwent conventional operation. The preoperative critical severity score (CSS), postoperative temperature, blood pH and prothrombin time (PT), and the treatment outcome were compared between the DCS and the conventional operation groups.</p><p><b>RESULTS</b>No significant difference was found in the preoperative CSS between the two groups. There were significant differences in postoperative blood pH and PT values between the two groups (p<0.05). As for postoperative temperature, there was no statistical difference between the two groups, yet the tendency of temperature recovery in the DCS group was milder than that in the conventional operation group. Twenty-seven children (84.4%) were successfully cured in the DCS group, while 9 children (52.9%) in the conventional operation group (p<0.05).</p><p><b>CONCLUSIONS</b>The curative effect of DCS surpasses the conventional operation in children with serious abdominal diseases, suggesting that DCS is of value in the management of serious pediatric abdominal diseases.</p>

Laparoscopic partial gastrectomy: Analysis of 18 procedures / 中南大学学报(医学版)

OBJECTIVE@#To explore the laparoscopic partial gastrectomy and the indications.@*METHODS@#Eighteen patients who underwent laparoscopic partial gastrectomy from August 2005 to May 2006 were analyzed retrospectively.@*RESULTS@#Sixteen patients (including 6 with gastric cancer, 9 with duodenal ulcer, and 1 with gastric multiple polyps) underwent laparoscopic partial gastrectomy. The other two patients underwent an open surgical procedure (1 patient with the tumor size large than 6 cm, and the other patient with bleeding after loosening one clip). The rate of intraoperative subcutaneous emphysema was 5.88% (1/17), and no death occurred. The operation time was (285+/-30)min on average, the estimated blood loss was (130+/-50)mL, and the hospitalization was (11+/-4)d. One case of obstruction of distal loop happened after the surgery, and the rate was 6.25% (1/16). The patients were followed up for 1 approximately 9 months postoperatively. Trocar puncture-site metastases occurred in one patient.@*CONCLUSION@#Laparoscopic partial gastrectomy is safe and feasible with skillful laparoscopic technique and with restricted indications, and the surgical outcome may be similar to that of the open surgery.

Highly-selective regional vascular exclusion for large liver tumor resection / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the highly-selective regional vascular exclusion in the risk hepatectomy for liver tumor.@*METHODS@#Short hepatic veins were ligated and divided followed by the dissection, and isolation of the inflow and outflow vessels of the tumor-bearing lobe, which were completely devascularized after the occlusion of these vessels. The blood loss volume, postoperative recovering situation of the liver function and the incidence of complication were observed in 68 cases.@*RESULTS@#Main hepatic veins were dissected and isolated exo-hepatically in 65 cases. In the other 3 cases, the main hepatic veins were blocked by Satin skin clamp applied longitudely along the inferior vena cava. Hepatic pedicle was routinely excluded.The amount of blood loss was from 400 to 1200 (600+/-200) mL and 26 (65%) cases didn't receive transfusion.There was no operative mortality and liver function failure. Surgical complications included subphrenic abscess in 2 cases and bile leakage in 2 cases, which were cured conservatively.@*CONCLUSION@#Highly-selective regional exclusion of hepatic blood flow during the risk hepatectomy is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.