The clinical analysis of a step-up approach for severe acute pancreatitis: report of 121 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and clinical value of the step-up approach for severe acute pancreatitis (SAP).</p><p><b>METHODS</b>Clinical data of 121 SAP patients admitted between January 2002 and December 2011 were retrospectively analyzed. Fifty-eight patients (37 males and 21 females, aged from 20 to 72 years, mean 47.6 years) in the group of direct open necrosectomy from January 2002 to December 2006 were performed laparotomy through removal of all necrotic tissue. Sixty-three patients (42 males and 21 females, aged from 19 to 78 years, mean 46.2 years) of step-up approach from January 2007 to December 2011 underwent percutaneous catheter drainage through retroperitoneum or omental bursa guided by B-type ultrasonography for the first therapy, and then, according to the pathogenetic condition, if necessary, followed by a small incisional necrosectomy along the drainage tube. The two groups were compared for the rates of postoperative complications, death, transfusion and length of stay, medical costs.</p><p><b>RESULTS</b>The rates of total postoperative complications, organ dysfunction, alimentary tract fistula and incisional hernia in step-up approach group were significantly lower than those of direct open necrosectomy group (31.7% vs. 62.1%, 14.3% vs. 37.5%, 6.3% vs. 19.0%, 9.5% vs. 29.3%; χ(2) = 4.43 to 11.17, P = 0.001 to 0.035). The other complications had no significant differences between the two groups (P > 0.05). Patients in step-up approach group had a lower rates of transfusion (44.4% vs. 70.7%, χ(2) = 8.488, P = 0.004), fewer medical costs of transfusion and hospital stay, compared with those in direct open necrosectomy group ((2525 ± 4573) yuan vs. (4770 ± 6867) yuan, t = 2.131, P = 0.035; (171 213 ± 50 917) yuan vs. (237 874 ± 67 832) yuan, t = 2.496, P = 0.014). There were no significant differences of length of stay and mortality between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Step-up approach for SAP which can reduce the rates of postoperative complications, transfusion and medical costs has significant feasibility and great clinical value.</p>

Experience of the surgical comprehensive treatment on severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the experience of the surgical comprehensive treatment of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>From July 1999 to December 2009, a total of 506 patients suffered SAP were admitted with a mean APACHE II score 12.8 ± 4.6. There were 270 male and 236 female, aged from 16 to 89 years, mean age 43 years. SAP patients were treated by the SAP treatment team which consisted of pancreatic specialized and multidisciplinary doctors. Two hundreds and thirty-four cases (46.2%) received non-operative treatment and 272 cases (53.8%) received surgical intervention.</p><p><b>RESULTS</b>In 506 cases, 445 patients were cured and 52 patients died (31 died in early stage, 21 died in later stage), 9 cases discharged automatically. The overall incidence of complication, overall mortality and overall curative rate were 29.4% (149/506), 10.3% (52/506) and 87.9% (445/506), respectively. The incidences of complication in non-operative group and in surgical intervention group were 27.8% (65/234) and 30.9% (84/272), respectively (P > 0.05). The mortality in non-operative group and in surgical intervention group were 9.4% (22/234) and 11.0% (30/272), respectively (P > 0.05). The curative rates in non-operative group and in surgical intervention group were 90.6% (212/234) and 85.7% (233/272), respectively (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients should be treated in ICU in the early phase of the disease when APACHE II score > 10. Pancreatic specialized and multidisciplinary team treatment, appropriate choice of timing, indication and procedure of surgical intervention and details of drainage are vital to the prognosis of SAP.</p>

Study on combined therapy of hyperlipidemic severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the principle and measures of combined treatment of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP).</p><p><b>METHODS</b>The clinical data of 54 patients with HL-SAP including two phases from January 1996 to December 2000 and from January 2001 to August 2006 were analyzed retrospectively. In the first phase, 25 patients were performed by routine methods to decrease triglyceride, or additional operative treatments. In the second phase, 29 cases were treated by multiple ways of non-operative combined therapy, or additional operative treatments mainly by minimally invasive procedures.</p><p><b>RESULTS</b>Among 54 cases with HL-SAP, 33 cases (61.1%) received non-operative therapy and 21 cases (38.9%) received surgical intervention. Overall mortality was 18.5% (10/54). In the first phase of 25 cases, the mortality in non-operative group and surgical intervention group was 21.4% (3/14) and 36.3% (4/11), respectively. In the second phase of 29 cases, the mortality in non-operative group and surgical intervention group was 10.5% (2/19) and 10.0% (1/10), respectively. The overall curative rate, morbidity, overall mortality, content of triglyceride at the fourth day after onset, APACHE II score at the fourth day after onset and average stay were obviously improved in the second phase compared with the first phase (P < 0.05).</p><p><b>CONCLUSIONS</b>According to individualized therapy principles, treatment for HL-SAP should emphasis on multiple ways of non-operative combined therapy and appropriate choices of the timing, indication in surgical intervention. And the choice of operative procedure should follow the principle of minimally invasive surgery. Meanwhile, pay more attention to monitoring and controlling the level of triglyceride post-discharge for the patients with the history of HL-SAP.</p>

The importance of nonrecurrent laryngeal nerve in thyroid surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the anatomic variation of nonrecurrent laryngeal nerve (NRLN) and its surgical identification and prevention during thyroidectomy.</p><p><b>METHODS</b>The database of 5 NRLN cases was analyzed to investigate the difference of operative maneuvers and procedures.</p><p><b>RESULTS</b>All 5 NRLN were located in the right side. Two cases were found have vocal cord paralysis and 1 case recovered in 3 cases who have NRLN injures.</p><p><b>CONCLUSIONS</b>Any transverse bond should not be cut between vascular and laryngeal except middle thyroid vein. Recurrent laryngeal nerve (RLN) should be dissected during thyroid excision. Cervical pneumogastric nerve should be systematic dissected to detect whether RNLN is exist, if RLN is not exist in the same side.</p>

Experience in resection of hilar cholangiocarcinoma: a report of 54 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in ameliorating curative resection rate and major postoperative complication rate for treatment of hilar cholangiocarcinoma.</p><p><b>METHODS</b>Respective analysis was made on the clinical data of 54 consecutive cases who underwent resection of hilar cholangiocarcinoma from Jan. 1998 to Dec. 2004.</p><p><b>RESULTS</b>In this group 54 cases received tumor resection with a resection rate of 63.5%. Combined partial hepatectomy was performed in 14 patients, while combined pancreaticoduodenectomy (Whipple) in 3 patients, and combined resection of portal vein in 2 patients and combined resection of hepatic artery in 2 patients. Thirty patients had curative resection. The curative resection rate was greatly increased from 27.0% (before 2001) to 41.7% (after 2001) in this group with well controlled perioperative mortality and postoperative complications rate (e.g. hepatic failure and major infection). The gross 1-, 2-, and 3-year survival rates for the whole group were 67.4%, 28.1% and 13.5% respectively. The 1-, 2-, and 3-year survival rates for curative resection were 87%, 36% and 24% respectively. The 1-, 2-year survival rates for palliative resection were 42% and 18%.</p><p><b>CONCLUSIONS</b>Enhanced surgical technique resulted in better clinical outcomes.</p>

Surgical treatment of acute obstructing colorectal cancer: a report of 297 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate surgical treatment of obstructing colorectal cancer.</p><p><b>METHODS</b>From July 1993 to July 2003, clinical data of 297 cases undergoing emergency operation for obstructing colorectal cancer were analyzed retrospectively. There were 103 cases with right-sided lesion and 194 cases with left- sided lesion.</p><p><b>RESULTS</b>All patients received emergency operation. Stage i tumor resection and anastomosis were performed in 126 patients including 98 cases with right- sided lesion and 28 with left- sided lesion, total or subtotal colectomy in 108,Hartmann operation in 36,Dixon operation in 9, ileocolic anastomosis in 11,and colostomy in 7 cases. Postoperative complications occurred in 53 cases (17.8% ) including incision infection, intraperitoneal infection and intestinal fistula. There were 17 perioperative deaths. Two hundred and eighty cases healed (94.3% ).</p><p><b>CONCLUSION</b>Stage i tumor resection and anastomosis and total or subtotal colectomy are feasible and safe surgical procedures for obstructing colorectal cancers.</p>