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To investigate the incidence of postoperative abnormal liver function test (aLFT) for the children with heart surgery, and to analyze the clinical characteristics and risk factors. Methods: A total of 143 children younger than 18 years old who underwent heart surgery in 2017 were enrolled in this study. The liver function were examined one day preoperation and consecutive 5 days after operation. The clinical data of perioperative period were recorded and the risk factors for aLFT were analyzed. Results: There were 43/143 (30%) cases had aLFT, including 5/143 (3.5%) acute liver injury (ALI). In the 6 liver function tests, total bilirubin, and glutamic-oxalacetic aminotransferase and glutamic-pyruvic aminotransferase increased to the peak at the first day and the second day after operation, respectively, and albumin declined to the lowest level at the fourth day after operation. aLFT happened most common at the first day after operation(22/43, 51.2%). The patients in the aLFT(+) group had smaller body size, more proportion of the risk adjustment for congenital heart sugery-1 (RACHS-1) score ≥ 3 and cyanosis, longer cardiopulmonary bypass (CPB) time, higher postoperative cardiac troponin (cTnI) value, higher inotropic score (IS), more transfusion, and longer mechanical ventilation time than those in the aLFT(-) group. The aLFT(+) group had longer ICU and hospital time, higher morbidity and mortality than those in the aLFT(-) group (P<0.05). Logistic regression showed that RACHS-1≥3, cyanosis, CPB time, cTnI, IS, transfusion, and mechanical ventilation time were the risk factors for aLFT. Multiple factor analysis showed the mechanical ventilation time was an independent risk factor for aLFT (P<0.05). Conclusion: aLFT is common in children after congenital heart operation, which could deteriorate to poor outcome. The mechanical ventilation time is an independent risk factor for aLFT.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Cardiac Surgical Procedures , Heart Defects, Congenital , General Surgery , Liver , Wounds and Injuries , Pathology , Logistic Models , Postoperative Complications , Respiration, Artificial , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.
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Objective To investigate the possible mechanism of pancreaticobiliary maljunction(PBM) on development of congenital choledochal cyst(CCC).Methods Tweenty-one patients with choledochal cysts initially diagnosed by ultrasonography,then underwent ERCP.The concentrations of amylase(AMS) and C-reactive protein(CRP) in bile removed through selective biliary catheterization was analyzed.Results Each of 21 cases of PBM(including 13 cases of C-P type and 8 cases of P-C type) had significantly higher concentrations of AMS and CRP compared with control group(P
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Objective To evaluate the therapeutic effect of segmental hepatectomy for intrahepatic bile duct stones.Methods In this study, 414 patients suffering from intrahepatic bile duct stones underwent hepatectomy from Jan 1981 to Dec 2001. Stones distribution, operation modality,postoperative complication and therapeutic effect were evaluated. Results Postoperative complications occurred in 72 cases(17.4%), mortality was 0.7%. A follow up of 2 to 22 years was achieved in 305 patients (73.7%), with excellent or good result in 88.9%, residual stone in 15.7%,and stone recurrence in 4.6%.Conclusion Appropriate use of hepatectomy is effective for the treatment of intrahepatic bile duct stones.
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0.05).(2)Serum ALT,AST and LDH:After reperfusion,the values of ALT,AST,and LDH in IP group were significantly lower than those in I-R group(P
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Objective To evaluate the effect of multiple adhesion molecules ICAM-1、CD_ 44 V6、CD_ 28 、E-cad and CEA in organic selection of gastric carcinomatous metastasis.Methods Eighty-four gastric carcinoma cases(32 cases without metastases,52 cases with transfer to liver、marrow、lymphonode、lung、kidney or belly cavity),were take operation sample or tissue under gastroscopy,being made cells single by primary culture,then were detected the expression of 5 kinds of adhesion molecules by ABC immunohistochemistry,positive rate was recorded.Results ICAM-1 had high expression in cases with marrow or lung metastasis,while low expression in cases with lymphonode metastasis.CD_ 44 v6 had high expression in cases with lymphnode or liver metastasis.CD_ 28 had high expression in cases with liver、lung or kidney metastasis.E-cad had high expression in cases with marrow metastasis,while low expression in cases with other metastasis.CEA had especially high expression in cases with liver、belly cavity or lymphnode metastasis.Conclusion High or low expression of adhesion molecules ICAM-1、CD_ 44 V6、CD_ 28 、E-cad and CEA plays a certain role in organic selection of gastric carcinomatous metastasis.
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Objective To study the role of nitiric oxide (NO) in the liver ischemic precondition (IP) in rats. Methods 131 rats were randomly assigned to ischemia/reperfusion (I/R)group, IP group and sham-operation(S) group. The plasma NO, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the pathological change of liver and rat mortality were observed at 2 hours, 24 hours and 1 week after operation. Results (1) The plasma NO level grew soon after operation in group IP, and was significantly higher than that in group S in all three time points (P0.05), and higher at 1 week (P
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Objective To investigate the timing of operation and the selection of surgical procedure for acute biliary pancreatitis.Methods The clinical data of 247 cases of acute biliary pancreatitis were retrospectively analysed.Results Among 10 non-operation patients,4 died;12 patients underwent emergency operation,5 had postoperative complications and 2 patients died after operation.169 patients underwent delayed operation after effective conservative therapy and 1 patient had postoperative complication;56 patients underwent(selective) operation without any postoperative complication or death.Conclusions Early emergency operation should be performed for relief of biliary obstruction in acute biliary obstructive pancreatitis.The patients with acute non-obstructive biliary pancreatitis should undergo conservative therapy at first and then,after(pancreatitis) has been controlled,delayed operation or selective operation to treat the biliary pathologic condition should be performed.
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Objective To explore the expression of apoptosis regulating genes C jun and bcl X L after normothermic liver ischemic preconditioning and its clinical significance. Methods 16 cases of liver cancer were randomly divided into ischemic reperfusion(IR) group and ischemic preconditioning (IP) group (8 cases in each). The samples of venous blood were drawn before IR or IP procedure and 30 minute after reperfusion for testing ALT, AST and LDH. Meanwhile, samples of liver tissue were taken for study of hepatocellular apoptosis, expressions of C-jun mRNA、 Bcl-X L mRNA and PCNA and morphologic changes. Results The levels of ALT、 AST、 LDH and AI in IR group were significantly higher than those in IP group (P
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Objective To investigate the relationship between peripapillary duodenal diverticulum and obstructive jaundice,and the diagnosis and treatment for this clinical entity.Methods The clinical data of 25 cases of obstructive jaundice caused by peripapillary diverticulum were retrospectively reviewed.Results All cases were diagnosed definitively by endoscopic retrograde cholangiopancreatography(ERCP).20 cases underwent choledochostomy with T-tube drainage and subtotal gastrectomy (Billroth II) and recovered,and 5 cases were cured by nonoperative therapy and discharged asymptomatically,but followup showed they had recurrent attacks of symptoms.Conclusions Obstructive jaundice caused by peripapillary diverticulum can be definitively diagnosed by ERCP,and should be treated by choledochostomy,T tube drainage and subtotal gastrectomy(Billroth II),which is a simple,rational,safe and effective surgical procedure.