ABSTRACT
Objective To investigate the feasibility and safety of reoperation of laparoscopic common bile duct exploration in the management of choledocholithiasis in patients with biliary surgical history. Methods Thirty-one patients with choledocholithiasis and biliary surgical history were performed by reoperation of laparoscopic common bile duct exploration between January 2012 and January 2014 in our hospital.The adhesion was disconnected under the laparoscopy, and then the common bile duct was opened to introduce an endoscope for stone removal.A T-tube was placed for drainage. Results The operations were successfully completed in all the 31 cases, without conversion to open surgery.The vital signs of those patients were smooth during the operation.The operation time was 65-125 min, with a mean of (118 ±21) min.The volume of blood loss was 10-75 ml during operations, with a mean of (39 ±19) ml.The patients could take food normally 24-48 h after operation, with a mean of (27 ±13) h.The drainage tubes were pulled out 48 -72 hours after operation.No severe complications, such as residual stones, bleeding, gastrointestinal leakage, or pancreatitis happened during hospitalization, except for 1 case of biliary leakage and 1 case of incision infection.The patients stayed in hospital for 6-9 days after operation, with a mean of (7.0 ±1.5) days.No biliary stricture or recurrence was found during a 3-24 months of follow-up (mean, 15.6 months) in 31 cases. Conclusion Reoperation of laparoscopic common bile duct exploration by experienced laparoscopic specialists for choledocholithiasis in patients with biliary surgical history is relatively safe and effective.
ABSTRACT
OBJECTIVE@#To summarize the clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures.@*METHOD@#We collected and retrospectively analyzed the clinical data of 212 cases of epistaxis hospitalized in our department, among which 23 cases were diagnosed as epistaxis in the posterior fornix of inferior meatus. They underwent nasal endoscopic exploration and coagulation surgery with one case under general anesthesia and the other 22 under local anesthesia. The bleeding from olfactory cleft, spheno-ethmoidal recess and the middle nasal meatus were excluded for all the patients during the surgery. After shifting the inferior turbinate inward by fracture, the active bleeding was found in the posterior fornix of inferior meatus, which was stopped immediately by bipolar coagulation. The areas of coagulation and nasal mucosa erosion were packed with nasopore after operation.@*RESULT@#For all the patients, bleeding spots were definitely located during the operation and successfully coagulated. None of them suffered from recurrent-bleeding within 1 week postoperatively. Followed up for 6 to 12 months, there was no epstaxis recurrence or nasal cavity adhesion at the bled side in all patients.@*CONCLUSION@#For intractable epistaxis patient, after excluding the bleeding in olfactory cleft, sphenoethmoidal recess and the middle nasal meatus, it should be considered that the bleeding might come from posterior fornix of inferior meatus. It is the key point to thoroughly expose the posterior fornix of inferior meatus by shifting the inferior turbinate inward by fracture and explore for the bleeding spot carefully.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Epistaxis , General Surgery , Follow-Up Studies , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To assess the survival of patients receiving high intensity focused ultrasound(HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma(PHCC) victims with HIFU application.Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007.Among them,101 patients were males and 86 were females(mean age: 47.7 years old,range: 19-79 years old).The average tumor size was 5.7 cm(range: 0.5-18.0 cm).Of these 187 patients,numbers according to Child-Pugh grade of A,B and C were 104,52 and 31,respectively.According to TNM system,45,111 and 31 patients were in stage Ⅱb,Ⅲa and Ⅲb respectively.Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival.Results Survival period was(17.3?2.5) months after HIFU treatment of PHCC.The overall survival rate of 3-month,6-month,1-year and 2-year were 79.1%,60.1%,35.7%,and 29.3%,respectively.It was significant that tumor number(P=0.02),size(P=0.04),AFP(P=0.04),Child-Pugh grade(P=0.00),TNM stage(P=0.01),tumor metastasis(P=0.03) before HIFU,and tumor recurrence after HIFU(P=0.02) and standard treatment(P=0.02) were prognostic factors by single factor analysis.The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol(P=0.000),and TNM stage(P=0.004) and Child-Pugh grade(P=0.009) before HIFU.Conclusion It is used for improving overall survival rate to found PHCC early,protect liver function,examine comprehensively before HIFU treatment,focus on standard treatment and auxiliary treatment.