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Objective To investigate the effect of section of pancreatic envelope combined with vacuum sealing drainage under laparoscopy on inflammatory mediators of patients with early severe acute pancreatitis (SAP). Methods Forty-two SAP patients were admitted to Foshan Hospital of Traditional Chinese Medicine in Guangdong Province from January 2008 to December 2016. That 22 patients underwent pancreatic membrane incision and vacuum sealing drainage under laparoscopy was in the experimental group, and that 20 patients underwent the routine pancreatic membrane incision and double tube drainage was in the control group. The venous blood was collected, the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured before and after operation for 1, 3, 7 and 14 days, and the clinical therapeutic effects were observed in the two groups. Results With the prolongation of therapy, the levels of CRP, IL-6 and TNF-α were decreased continuously in both groups, the degrees of decrease of above indexes in experimental group were more significant than those in the control group, and the differences in these indexes between the two groups were statistically significant [CRP (mg/L): 1 day was 203.80±25.12 vs. 271.79±60.41, 3 day was 117.26±19.70 vs. 174.53±42.37; IL-6 (ng/L): 1 day was 40.63±3.38 vs. 57.10±11.46, 3 days was 23.14±3.51 vs. 46.87±10.69; TNF-α (ng/L): 1 day was 23.91±10.42 vs. 36.73±15.90, 3 days was 19.13±8.34 vs. 32.58±15.81, all P < 0.05]. There were no statistical significant differences in the levels of above indexes on 7 days and 14 days after treatment between the two groups (all P > 0.05). The therapeutic efficacy of the experimental group was significantly higher than that of the control group [95.45% (21/22) vs. 90.0% (18/20), P < 0.05]. Conclusion Under laparoscopy, pancreatic envelope incision combined with vacuum sealing drainage performed for early SAP patients can control the body inflammation more rapidly, reduce complications and shorten the disease course.
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Objective To evaluate perioperative portal hemodynamic alterations in cirrhotic patients undergoing subtotal splenectomy,podicled spleen remnant retroperitoneal transplantation plus lower esophagus transection in the treatment of portal hypertension.Method Forty patients with cirrhotic portal hypertension were randomly allocated into 2 groups:splenic transplantation group (n = 20),in which patients underwent subtotal splenectomy with pedicled remnant spleen retroperitoneal transplantation and cardia-esophageal devascularization and transection,and control group (n = 20),in which splenectomy and cardia-esophageal devascularization and transection were performed.The cross section area,blood velocity and flow and collateral circulation of portal parameters were comparatively evaluated by 3D DEC MRA,and the size of remnant spleen,blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed.Results At 6-month after operation,the disappearance of esophageal-gastric varices in two groups was similar,and the cross section areas of main portal vein (MPV) in two groups all decreased postoperatively,in study group it was (1.81±0.73) cm~2 vs.(1.20±0.52) cm~2,P ＜ 0.01;in control group it was (1.78±0.52) cm~2 vs.(1.30±0.12) cm~2,p ＜0.01.The mean blood velocity of MPV decreased postoperatively,in study group it was (9.86±0.10) cm/s vs.(7.06±1.92) cm/s,P ＜0.01;In control group it was (10.0 ±0.6)cm/s vs.(8.2±2.4) cm/s,P ＜0.01.The mean blood flow velocity of MPV in study group was lower postoperatively than that in control group(P＜0.01).The mean blood flow volume of MPV decreased postoperatively from (15.0±1.9) ml/s to (10.5 ±2.7)ml/s,P ＜0.01 in study group;and from (14.9±2.1) ml/s to (11.6±2.1) ml/s,P ＜ 0.01 in control group.The mean blood flow volume of MPV in study group was lower postoperatively than that in control group(P＜0.05).A significant collateral formation was observed around the retroperitoneally translocated pedicled remnant spleen.Conclusions Compared with splenectomy,subtotal splenectomy,retroperitoneal translocation of the pedicled remnant speen helps to preserve splenic function as well as to increase retroperitoneal collateral formation which is conducive to further decreasing the portal veinous pressure.
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Objective To evaluate the efficacy of splenic autotransplantation plus lower esophagus transaction for the treatment of portal hypertension(PTH).Methods Thirty patients were divided into study group(15 cases)and control group(15 cases).Patients in study group Underwent splenic autotransplantation after splenectomy and cardia-esophageal devascularization plus lower esophagus transaction,and those in control group had all except splenic autotransplantation.The cross section area,blood velocity,blood flow of MPV(main portal vein)and changes of cardia-esophageal varices were evaluated by 3D DCE MRA at 1 week before operation and 6 months after,and blood flow and collateral circulation of transplanted spleen in the retroperitoneal space were assessed.Results In both groups,the cross section areas(cm2),mean blood velocity(cm/s)and mean blood flow(ml/s)of MPV decreased postoperatively(P＜0.05).The postoperative cross section areas(cm2)and mean blood velocity(cm/s) of MPV in study group were smaller than that in control group(P＜0.05).Esophageal and fundal variceal veins disappeared or improved equally in both groups.There was no difference in the postoperative and preoperative liver function between the two groups(P＞0.05).In study group,the planted spleen grew well in the retroperitoneal space,and with a formation of extensive collateral circulation.The postoperative serum hyaluronic acid decreased in this group(t=2.929,P＜0.05).Conclusion Splenic autotransplantation after splenectomy plus lower esophagus transection was effective for the treatment of PHT without adverse impact on liver function.
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Objective: To explore the alternatives for T-tube placement in surgical treatment of bile duct stones.Methods: Fourty-nine patients with bile duct stones have been performed retrograde transhepatic biliary drainages(RTBD)since 1991.Among them,37 cases were placed the drainage tubes through the right hepatic lobes by retrograde punctures;the other 12 cases with intrahepatic stones were placed the drainage tubes through the intrahepatic bile duct stumps following partial hepatectomies.All the CBD exploration incisions were primarily closed.Results: (1)RTBD by retrograde puncture:Two postoperative complications(5.4%,pneumothorax and biliary hemorrhage)occured.Both cases were cured by medical therapy.The drainage tubes were removed on the 8th postoperative day.(2)RTBD through intrahepatic ducts:Four cases had residual stones(30%)which had been cleared up by combination of extraction and intraluminal lithotripsy.Nineteen cases(38.8%)had the gallbladders preserved.Postoperative cholangiographies showed that all the gallbladders were smooth and well-filled and the extrahepatic bile ducts were in normal shapes.Extrahepatic bile ducts and all the preserved gallbladders did not show any deformity and stone formation by ultrasonography during 6 months to 9 years'following-up.Conclusion: RTBD by retrograde puncture has the advantage of shorter period of bearing drainage tubes;RTBD through intrahepatic duct stump after partial hepatectomy makes it easier to extract postoperative residual stones.Both methods have no negative impacts on the anatomies of both the extrahepatic bile duct and the gallbladder.
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Objective To evaluate spleen autotransplantation with lower esophagus transection for the treatment of portal hypertension by three-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D-DCE MRA). Methods Twenty-eight patients were randomly divided into study group undergoing splenic autotransplantation and cardia-esophageal devascularization plus lower esophagus transection and control group without splenic transplantation. The cross section area, blood velocity and blood flow of main portal vein (MPV) were measured by 3D-DCE MRA, and the blood flow, collateral circulation of transplanted spleen were assessed. Results The cross section areas (cm ) of MPV of the two groups decreased postoperatively ( study group 1. 80 ? 0. 69 vs. 1. 20 ? 0. 73 , t = 13.96, P = 0. 00; control group 1. 78 ? 0. 43 vs. 1. 29 ? 0. 57, t = 11. 38, P = 0. 00). The mean blood velocity ( cm/s) of MPV decreased postoperatively (study group 9. 85 ? 0. 09 vs. 7. 06 ? 1. 98, t = 18. 98 , P = 0. 00; control group 10. 01 ?0. 43 vs. 8. 19 ?2. 44, t =22. 32, P =0. 00) in the two groups, and the mean blood velocity ' of MPV in study group was lower postoperatively than that in control group ( t = - 8. 02, P = 0. 00 ) . The mean blood flow (ml/s) of MPV decreased postoperatively (study group 15. 05 ? 2. 43 vs. 10. 52 ? 2. 55, 1 = 16.93, P=0. 00; control group 14. 81 ?2. 29 vs. 11.58 ?2. 96, t = 15. 90, P=0. 00) , and the mean blood flow of MPV in study group was lower postoperatively than that in control group (t = - 2. 73, P = 0. 02). Extensive collateral circulation developed around the transplanted spleen. Conclusions 3D-DCE MRA clearly shows the autotransplantated spleen and portal hemodynamics. It is an important non-invasive way to evaluate the result of the procedures.
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Objective To analyze the major causes of reoperation for abdominal injuries and explore the effective preventive measures so as to enhance operation quality for abdominal injuries. Methods The data of 33 patients undergoing relaparotomy for abdominal injuries during the last 10 years was analyzed retrospectively. Results There were 25 closed injuries and 8 stab penetrating injuries in this group. The causes of reoperation were mainly missed injuries in initial laprotomy 10 cases,inappropriate surgical procedures 8 cases, postoperative complications 13 cases, and negative relaparotomy 2 cases. In these 33 patients, 40 times of reoperation were performed, and among them 2 patients sustained 3 times of laparotomy respectively. Overall mortality rate was 12%(4/33). The main causes of death were MODS resulted from consumption coagulopathy and/or severe septic complication after reoperation. Conclusions The effective preventive steps to decrease the incidence of reoperation in patients with abdominal injuries include complete interventional exploration, right operational methods and sufficient drainage in initial laparotomy for a surgeon.