Diagnosis and Treatment of Acute Intestinal Perforation in Patients with Colorectal Carcinoma / 中国医师杂志

Objective To investigate the clinical characteristics, diagnosis and treatment of acute intestinal perforation in the patients with colorectal carcinoma. Methods The clinical data of 38 colorectal carcinomas complicated with acute intestinal perforation treated in our hospital during 19 years were analyzed retrospectively. Results Acute intestinal perforation was common in old patients with colorectal carcinoma (mean age 62 years).The primary lesions were mostly located in left-side colon and superior rectum(27/38,71.1%). The perforation in the proximal colon of tumor and cecum accounted for 81.6%(31/38), and in tumor site accounted for 18.4%(7/38). The correct rate of preoperative diagnosis was only 15.8%(6/38). The postoperative complications were common and severe. The perioperative mortality was 42.1%(16/38). All the causes of death were multiple organ function deficiency. There were close relations between perioperative mortality and operation time. The postoperative recurrent rate was 41.2%(7/17). Five-year survival rate was 23.5%(4/17). Conclusion Early diagnosis, early operation and active prevention and treatment of multiple organ function deficiency were key to decrease the mortality of the colorectal carcinoma patients with acute intestinal perforation.

Diagnosis and treatment of blunt pancreatic injury / 中国普通外科杂志

Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.

Study of perioperative enteral immunonutrition in patients with gastrointestinal cancer / 中国现代普通外科进展

Objective:To evaluate the effects of perioperatively administrated enteral immunonutrition in gastrointestinal cancer patients on immune and inflammatory responses,nutrition states and postoperative morbidity.Methods:Sixty patients with gastrointestinal cancer were divided randomly into two groups.Two groups perioperatively(from preoperative day 5 to postoperative day 7) received an supplemented diet with arginine,RNA,and ?-3fatty acids(immunonutrition group;n=30) or an isoenergetic and isonitrogenous standard diet (standard-nutrition group;n=30).All variables of immune and inflammatory responses,nutrition states and postoperative morbidity were measured on preoperative day 5 and postoperative day 1,4 and 8.Results:On postoperative day 4 and 8,most immune variables and prealbumin in the immuno-group were significantly higher than those in the standard-group(P0.05),and inflammatory variables as CRP in the immunonutrition group were significantly lower than those in the standard group.In the immunonutrition group,there were significantly fewer patients who experienced postoperative complications and shorter days of hospital stay compared with standard group(P0.05).Conclusion:The perioperative administration of enteral immunonutrition in gastrointestinal cancer patients can significantly modulate the postoperative immunosuppressive and inflammatory responses at the early postoperative day,can significantly decrease the occurrence of infectious and overall postoperative complications as well as the length of hospital stay.