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Objective:To evaluate the efficacy of transgastric combined with percutaneous endoscopic treatment for infected pancreatic necrosis (IPN).Methods:Clinical data of 19 IPN patients who received transgastric combined with percutaneous endoscopy at the Gastroenterology Intensive Care Unit of Nanjing Drum Tower Hospital from August 2015 to August 2020 were retrospectively studied. The clinical efficacy and the procedure-related complications were analyzed.Results:The mean procedure of endoscopic transmural drainage (ETD) was 1.1±0.3 times. During ETD procedure, lumen-apposing metal stents (LAMS) were placed in 9 patients, metal coated stents in 2 patients, double pigtail plastic stents in 7 patients, and only a nasal cyst drainage tube in 1 patient. All 19 patients received 12-14 F drainage catheters for drainage during the first percutaneous catheter drainage (PCD) treatment with the mean number of catheters of 1.8±1.2. Double cannulas was subsequently replaced in 3 of them for continuous drainage, and a percutaneous metal coated stent was replaced in 1 patient. The culture results of drainage fluid were 11 cases of gram-negative bacilli and gram-positive cocci, 4 cases of gram-positive cocci, 1 case of gram-positive bacilli, 3 cases of gram-negative bacilli. Among 19 patients, 4 cases had concurrent fungal infections. The mean number of debridement was 3.1±1.8 times, 2 cases of which were treated with endoscopic transluminal necrosectomy combined with percutaneous endoscopic necrosectomy. The mean procedure per patient was 6.1±2.4 times. Bleeding occurred in 1 case (5.3%) after the operation. But the bleeding was successfully stopped after endoscopic hemostasis. No serious complications such as gastrointestinal fistula, perforation or pancreatic fistula occurred. One patient died due to sepsis, and 18 other patients showed significant absorption of IPN after the treatment. None of the 19 patients were transferred to laparotomy.Conclusion:Transgastric combined with percutaneous endoscopic approach is safe and effective for IPN.
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Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the elderly patients (80 years or older) with choledocholithiasis.Methods:A retrospective study was conducted on 742 cases of choledocholithiasis who underwent ERCP at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2014 to December 2017. The patients were divided into two groups: 196 patients aged 80 or above (the very elderly group) and 546 patients aged 60 or below (the non-elderly group). The baseline data including gender, number and size of stones of the two groups were matched using the 1∶1 propensity score matching, and the covariate equalization samples between the two groups were obtained and 196 pairs of patients were successfully matched. The treatment success rate, complication incidence, hospitalization time and cost were analyzed.Results:Comorbidities in patients of the elderly group were significantly more than those in the non-elderly group [93.4% (183/196) VS 76.5% (150/196), P<0.001]. The success rates of treatment were 96.4% (189/196) and 96.9% (190/196), respectively ( P=0.778). The incidence of postoperative complications were 8.7% (17/196) in the elderly group and 6.6% (13/196) in the non-elderly group ( P=0.447). The mean hospitalization time and the mean hospitalization cost of the elderly group and the non-elderly group were 8.20 days, 23 624.06 Yuan and 8.03 days, 22 249.64 Yuan, respectively (all P>0.05). Conclusion:ERCP is effective and safe, and can be used as the first choice for senile patients with choledocholithiasis.
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The paper first offers a comprehensive analysis of the existing social understanding of medical errors and then discusses from the angles of humanistic factors and cognitive theories the concepts of operational errors, decisional errors and latent errors, error occurrence mechanisms, system related error occurrence, and ways of designing a safety system that can prevent error occurrence. The paper sets forth 8 aspects that ought to be stressed in the safety design of a patient care system: ①attaching great importance to medical safety; ②discovering errors in a timely manner; ③reducing reliance on memories; ④using force and restraint; ⑤avoiding over reliance on human vigilance; ⑥simplifying and standardizing key procedures; ⑦designing system buffer and recovery functions; ⑧establishing non punitive reporting systems.
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Medical safety is one of the most important subjects in hospital management and hospital culture of safety is a new concept recently introduced into hospital safety control, The paper explains the concept and connotation of hospital culture of safety, sets forth its six basic elements, and expounds its relationship with medical safety. It is pointed out that it is imperative to properly handle the relationships between the leaders as well as the staff members and medical safety, safety and efficiency, the system as well as individuals and punishment, reporting and concealment, cooperation and exchanges, etc. It is also important to take initiatives in creating learning organizations and in the process of creating, gaining and passing on knowledge, readjust personal behaviors, guarantee medical safety, reduce medical risks, and enhance hospital culture of safety.