ABSTRACT
Objective To study and evaluate the clinical effect of emergency primary resection and anastomosis in the treatment of obstructive left hemicolon carcinoma and the value of preventing reoperation .Methods From February 1st 2013 to February 1st 2018, a total of 46 patients with obstructive left hemicolon cancer underwent surgical treatment were selected in the First Peopleˊs Hospital of Jinzhong.According to the random digital table method,46 patients with obstructive left colon cancer were randomly divided into two groups ,with 23 patients in each group.The control group received stage colon resection and anastomosis ,and the observation group received stage I resection and anastomosis.The operative condition ,postoperative recovery ,anastomotic leakage,therapeutic effect of intestinal obstruction, serum inflammatory cytokines and reoperation rate were compared between the two groups . Results There were no statistically significant differences in the number of lymph nodes dissection ,the amount of blood lost during operation and time of operation (all P＞0.05).The recovery time of anal exhaust [(2.34 ±0.86)d], the removal time of drainage tube[(4.36 ±1.52) d],the active time of getting out of bed [(3.81 ±1.17) d],the hospitalization time[(12.05 ±2.73)d] in the observation group were significantly shorter than those in the control group[(3.29 ±1.05)d,(6.17 ±1.84)d,(5.24 ±1.43)d,(15.76 ±3.69)d]( t＝3.357,3.637,3.712,3.876,all P＜0.05).The incidence rate of anastomotic fistula in the observation group was not significantly higher than that in the control group (P＞0.05),and there was no statistically significant difference in the total effective rate of intestinal obstruction treatment between the two groups ( P ＞0.05 ).The levels of serum inflammatory cytokines such as C－reactive protein,interleukin－6 and tumor necrosis factor －alpha in the two groups were significantly lower than those before operation ( all P＜0.05),but there were no statistically significant differences between the two groups before and after operation (all P＞0.05).The rates of reoperation in the observation group and control group were 8.70%and 4.35%,respectively,and there was no statistically significant difference between the two groups ( P＞0.05).Conclusion Stage I resection and anastomosis can be used to treat intestinal obstruction effectively ,dissect lymph nodes,suppress inflammatory reaction , it is safe and reliable, and do not increase the risk of reoperation. Compared with stage I resection and anastomosis ,it has more advantages in accelerating postoperative recovery ,which is beneficial to reduce the cost of treatment and reduce the economic burden of patients .
ABSTRACT
Objective@#To study and evaluate the clinical effect of emergency primary resection and anastomosis in the treatment of obstructive left hemicolon carcinoma and the value of preventing reoperation.@*Methods@#From February 1st 2013 to February 1st 2018, a total of 46 patients with obstructive left hemicolon cancer underwent surgical treatment were selected in the First People's Hospital of Jinzhong.According to the random digital table method, 46 patients with obstructive left colon cancer were randomly divided into two groups, with 23 patients in each group.The control group received stage colon resection and anastomosis, and the observation group received stage I resection and anastomosis.The operative condition, postoperative recovery, anastomotic leakage, therapeutic effect of intestinal obstruction, serum inflammatory cytokines and reoperation rate were compared between the two groups.@*Results@#There were no statistically significant differences in the number of lymph nodes dissection, the amount of blood lost during operation and time of operation (all P>0.05). The recovery time of anal exhaust[(2.34 ±0.86)d], the removal time of drainage tube[(4.36±1.52)d], the active time of getting out of bed [(3.81±1.17)d], the hospitalization time[(12.05 ±2.73)d] in the observation group were significantly shorter than those in the control group[(3.29±1.05)d, (6.17±1.84)d, (5.24±1.43)d, (15.76±3.69)d](t=3.357, 3.637, 3.712, 3.876, all P<0.05). The incidence rate of anastomotic fistula in the observation group was not significantly higher than that in the control group (P>0.05), and there was no statistically significant difference in the total effective rate of intestinal obstruction treatment between the two groups (P>0.05). The levels of serum inflammatory cytokines such as C-reactive protein, interleukin-6 and tumor necrosis factor-alpha in the two groups were significantly lower than those before operation(all P<0.05), but there were no statistically significant differences between the two groups before and after operation (all P>0.05). The rates of reoperation in the observation group and control group were 8.70% and 4.35%, respectively, and there was no statistically significant difference between the two groups (P>0.05).@*Conclusion@#Stage I resection and anastomosis can be used to treat intestinal obstruction effectively, dissect lymph nodes, suppress inflammatory reaction, it is safe and reliable, and do not increase the risk of reoperation.Compared with stage I resection and anastomosis, it has more advantages in accelerating postoperative recovery, which is beneficial to reduce the cost of treatment and reduce the economic burden of patients.
ABSTRACT
Objective To determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis(SAP). Method A retrospective analysis was conducted in 186 patients, who were hospitalized in the intensive care unit of Jinzhong First People's Hospital with SAP between March 2000and October 2009. SAP patients met the diagnostic criteria of SAP set by Surgery Society of Chinese Medical Association in 2006. The variables included age, gender, etiology of SAP, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CT Severity Index ( CTSI ), abdomen compartment syndrome (ACS) ,the number of organ failure and the number of death. The prevalence and mortality of organ failure were calculated. The above-mentioned variables were analyzed by unconditional multivariate logistic regression analysis to determine the independent risk factors for organ failure in SAP. Results Of 186 patients, 96had organ failure. In 96 patients with organ failure, 47 died. There was a significant association between the prevalence of organ failure and age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CTSI, ACS. An increase in age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis correlated with an increase in the number of organ failure. Age, the number of comorbidit, APACHE Ⅱ score,CECT pancreatic necrosis, CTSI and ACS went into the unconditional multivariate logistic regression equation. Conclusions Organ failure occurred in 51.6% of 186 patients with SAP. The mortality of SAP with organ failure is 49.0%. Age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis,CTSI and ACS are independent risk factors of organ failure.