ABSTRACT
Objective To investigate the clinical effectiveness of fast track surgery ( FTS) nursing during laparoscopic cone-shaped resection of renal tumor. Methods Forty patients who was planned to accept laparoscopic cone-shaped renal tumor resection was divided into either FTS group ( n=20 ) or control group ( n=20 ) according to odd-even number of their admission IDs. The control group was given routine perioperative nursing procedure, and the FTS group was given FTS nursing. Results The operation time, intraoperative blood loss and incidence of complications had no statistical significance between the two groups (P>0. 05). As compared to the control group, patients in the FTS group experienced a shorter anal exhaust time [(30. 3 ± 11. 7) h vs. (43. 0 ± 15. 5) h, t= -2. 924, P=0. 006], shorter post-operative fasting time [(26. 6 ± 12. 1) h vs. (56. 1 ± 18. 1) h, t= -6. 059, P=0. 000], earlier ambulation [(33. 6 ± 16. 8) h vs. (66. 9 ± 28. 6) h, t= -4. 490, P=0. 000], shorter urethral catheterization [(40. 2 ± 18. 5) h vs. (83. 4 ± 39. 6) h, t= -4. 420, P=0. 000], shorter drainage time [(50. 3 ± 22. 5) h vs. (102. 9 ± 46. 0) h, t= -4. 594, P=0. 000], and shorter length of hospitalization [(5. 5 ± 1. 5) d vs. (9. 0 ± 2. 1) d, t= -5. 911, P=0. 000]. Conclusions FTS nursing procedure can reduce the rate of post-operative complications and shorten hospitalization stay. It can not only guarantee the efficacy of surgical treatment but also help the patient to achieve the goal of fast rehabilitation, being worthy of extensive application.
ABSTRACT
ObjectiveTo investigate the diagnosis, treatment, and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy (LC). MethodsA retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis, selection of surgical procedures, and evaluation of treatment outcome were summarized. ResultsAmong these patients with Mirizzi syndrome, 8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification, 23 patients had type Ⅰ, 7 had type Ⅱ, 1 had type Ⅲ, and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC, and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end-to-end anastomosis, and the type Ⅳ patient underwent choledochoenterostomy. ConclusionMirizzi syndrome is difficult to diagnose, and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.