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Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. Intraoperative neuro-monitoring(IONM) is a technology for identifying the integrity of nerves during operation by electrophysiological means, which included the intermitted IONM and the continuous IONM.This paper aims to compare the superiorities and defects of both IONM methods and summarize the current state and progress of IONM.
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The protection of recurrent laryngeal nerve in thyroidectomy has been a research topic for clinicians. High-risk thyroidectomy is an operation with high rate of recurrent laryngeal nerve injury which including thyroid reoperation, giant goiter surgery, substernal goiter surgery, dorsal thyroid tumor surgey and thyroid malignancy surgery and so on. The application value of three kinds of laryngeal recurrent nerve protection techniques during high-risk thyroidectomy will be reviewed in this article, such as visualization alone, intraoperative nerve monitoring and continuous intraoperative nerve monitoring.
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Objective To observe the change of perioperati ve endotoxin (ET) level and renal function in obstructive jaundice (OJ) patient and the effect of sodium cholate,lactulose, and anisodamine.Methods Forty-eight OJ patients were randomly divided in to control group(n=15), sodium cholate treatment group(n=11), lactul ose treatment group (n=10) and a anisodamine treatment group(n=12), 21 patients with cholecystolithiasis served as non-jaundiced control group. The levels of plasma ET and endogenous creatinine clearance rate (Ccr) were determi ned in all the cases.Results Compar ed with non-jaundiced control group, plasma ET level increased significantly an d Ccr significantly decreased in OJ group (P
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Objective: To study the plasma endotoxin(ET)on renal damage and clinical interference of anisodamine in patients with obstractive jaundice(OJ).Methods: Thirty patients with OJ were randomly divided into general treatment group(A group) and anisodamine treatment (B jroup).The level of plasma ET and endogenous creatinine clearance rate(Ccr) were determined at perioperative period,other 21 cases of chronic choelithiasis without jaundice were employed to serve as the control.Results: (1)The plasma ET level of peripheral blood was increased significantly and Ccr level was decreased markedly in both A and B group than in the control at lst day of hospitalization(P
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0.05) while the level was significantly higher in the former 4 groups than in the control (P
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Objective:To study the role of rennin and angiotension Ⅱ in the developement of acute pancreatitis in rats.Methods:Forth-two Sprague-Dawley rats were divided into two groups randomly-control group,and acute pancreatitis group.Acute pancreatitis model was reproduced by closed duodenal loop technique.Plasma amylase.Plasma renin activity and angiotesion Ⅱ level were measured,pancreatic histopathology was examined with light microscopy. Results:In acute pancreatitis group,pancreatitis histopathology developed from edematous to bleeding and necrotizing pancreatitis,plasma amylase,plasma renin activity,and angiotesion Ⅱ level were increased as acute pancreatitis developed,but after 10h,the angiotesion Ⅱ level was increased sequentially and plasma renin activity was increased unsignificantly.Conclusion:Renin and angiotension Ⅱ played the important role in the developement of experimental acute pancreatitis.
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Objective:To observe the change of blood endotoxin level after external biliary drainage with bile extracorporeal bypass in patients with malignant obstructive jaundice.Methods:The external biliary drainages with bile extracorporeal bypass were undergone in 14 patients with malignant obstructive jaundice,peripheral blood endotoxin levels were measured in perioperative period, other 15 cases internal biliary drainage and 20 cases external biliary drainage as contrast.Results:The changes of endotoxin level were not significant in external biliary drainage group,however,the endotoxin level was decreased signficantly in internal biliary drainage or external biliary drainage with bile extracorporeal bypass at postoperation.Conclusion:The external biliary drainage with bile extracorporeal bypass can decrease postoperative blood endotoxin level in patients with malignant obstructive jaundice.
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Objective To summarize the experiences and lessons drawn from iatrogenic bile duct injury. Methods The clinical records of 52 patients with iatrogenic bile duct injuries were studied retrospectively. Results The injuries of 48 cases were resulted from extrahepatic bile duct operation,2 cases from partial gastrectomy and 2 cases from hepatectomy.The locations of injuries were at the juncture of common hepatic duct and common bile duct in 34 cases, the common hepatic duct in 6 cases ,the common bile duct in 6 cases ,the juncture of left and right hepatic duct in 4 cases,and the left and right hepatic duct each in 1 case respectively.Complete bile duct injuries were seen in 30 cases,and partial injuries in 22 cases .All patients were treated by operation. 8 cases were immediately discovered at the time of the initial operation and direct repair or end to end anastomosis with T tube stent was done in 5 of the cases,direct insertion of T tube drain in 1 case and Roux en Y hepaticojejunostomy in 1 case, all with good results;and in the another, a choledo choduodenostomy was performed,but re operation by Roux en Y hepaticojejunostomy was done 3 years later,due to stricture of the anastomosis.For the 44 cases in which the bile duct injury was detected after the initial operation, Roux en Y hepaticojunostomy was done in 31 cases,hepaticoduodenostomy in 8 cases, drainage of common bile duct in 2 cases,plastic repair of common bile duct defect with jejunal flap in 1 case, hepaticojejunostomy (Longmire) in 1 case,and removal of stitches between the anterior and posterior wall of the common bile duct in 1 case.In the whole series,4 patients died,and 41 of 48 surviving patients were followed up.The excellent result rate was 82.9%,and 7 cases with poor results were cured by reoperation with Roux en Y cholangiojejunal anastomosis 2 months to 5 years after operation. Conclusions The key to improvenment of treatment results of iatrogenic bile duct injury is awareness of its acurrence,early diagnosis , and eraly repair of the bile duct.The method of surgical therapy depends on the location and type of injury,and the time of detection after the injury.Roux en Y cholangiojejunal anastomosis gives the best results.
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Objective To study the relationship of plasma endotoxin (ET) level and renal function damage in patients with obstructive jaundice(OJ). Method The level of plasma ET、creatinine (Cr) or blood urea nitrogen ( BUN ) and endogenous creatinine clearance rate (Ccr ) were determined before and after operation in 30 patients with OJ(OJ group), and 21 cases of chronic cholelithiasis without jaundice (control group). Results The plasma ET level of peripheral blood was increased more significantly (P