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Objective To promote the recognition and effect of treatment of the iatrogenic injury in the end of common bile.Methods The clinical data of 12 cases of the iatrogenic injury in the end of common bile duct were retrospectively analyzed.Of the 12 patients with an age ranging from 45-65,6were mate and 6 female.All the 12 patients had the bile leakage after choledocholithotomy in combination with exploration.The injury was found during operation and managed immediately in 6 cases.In other 6 cases,there were fever and right upper local retroperitonitits and delayed diagnosis of the injury.Results Nine cases were cured and 3 died(mortality=25%).Conclusion Timely finding and management of the injury during operation are important.Meanwhile,postoperative finding and early management can promote the survival of patients.The delayed treatment will result in high mortality.
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ObjectiveTo evaluate the effect of different operative methods for treating rebleeding in patients with portal hypertension(PHT). MethodsThe clinical data of 66 patients with postoperative ebleeding out of 373 PHT cases during the last 30 years was retrospectively analyzed. Their first operations were splenectomy, portoazygous devascularization, various non-selective shunt and combined operation(devascularization combined with shunt), of which, the rebleeding rate were 26.67 %, 17.86 %, 14.58 % and 4.35 %, respectively. Among 55 cases receiving re-operation, there were 42 with distal esophago-fundusectomy, 11 mesocaval shunt(MCS)and 2 re-devascularization. The other 11 cases received nonoperative therapy. ResultsThe mortality, mean follow-up time, rebleeding rate and encephalopathy rate were 9.52% (4/42), 11 years,9.52% (4/42)and 14.29% (6/42)in distal esophago-fundusectomy group;0,7.5 years,0 and 9.09% (1/11)in MCS group. All 2 cases in re-devascularization group died within one postoperative month. All 11 cases in non-operative group were with portal hypertension gastropathy(PHG). ConelusionCombined operation may effectively reduce postoperative rebleeding rate in PHT cases and MCS is a relatively ideal method for treating rebleeding.
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Objectives:To evaluate the effect of early enteral nutrition(EEN) on the structure and function of the gut, the bacterial and endotoxin translocation. Methods:SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and trypsin into the pancreas via pancreatic duct.15 dogs were divided into PN group and EEN group.Systemic plasma endotoxin levels was quantified.Both portal and systemic blood sample were obtained before and 1?4?7 d following SAP,and cultured for aerobic as well as anaerobic bacterial growth.Specimens of tissue from mesentery lymph nodes,lung and pulmonary portal nodes and pancreas were removed,weighed and homogenized at the 7th day. Results:The levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and cycle blood and distant organs were significantly reduced the protein and DNA content of the small intestine and colon increased,and the height of the villi and the thickness of mucosa and whole bowel wall of the intestinel and colon improved in EEN group as compared with those in PN group. Conclusions:We conclude that EEN can improve gut metabolism,decrease the extent of mucosal atrophy,and assist in the maintenance of the mucosal barrier function.It is effective touse EEN in severe acute pancreatitis.