ABSTRACT
The clinical data of 15 patients with duodenal trauma who were admitted to Shanxi Bethune Hospital from January 2012 to June 2019 were retrospectively analyzed. There were 13 patients with blunt injury and 2 with penetrating injury. The surgical procedure was selected by patient′s condition and extent of injury combined with the clinical symptoms, imaging examination and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS). All patients were followed up through outpatient examination and telephone interview till February 2020. Ten patients were diagnosed as duodenal trauma by CT scan before operation, and 5 patients were diagnosed during the operation. According to the AAST-OIS, 1 patient was with grade Ⅰ injury, 6 in grade Ⅱ, 5 in grade Ⅲ, 2 in grade Ⅳ and 1 in grade Ⅴ. All 15 patients received surgical treatment, including 1 with simple suture, 5 with break suture and duodenal diverticularization, 6 with break suture and biliary drainage (3 with hepatocystic duct drainage and 3 with cholecystostomy), 2 with pancreaticoduodenectomy. Postoperative complications occurred in 3 patients with Clavien system classification of Ⅲ b, Ⅱ and Ⅱ. One patient with duodenal stricture and severe abdominal infection was cured after gastrectomy and Billroth Ⅱ gastrojejunostomy 6 months after operation, and 2 cases with duodenal fistula were cured after conservative treatment. One patient who underwent pancreaticoduodenectomy was followed up for 6 months in the outpatient department, and 14 patients were followed up for 6-24 months. For emergency abdominal trauma patients with suspected duodenal injury, surgical exploration should be carried out actively. The site and range of intestinal wall injury should be considered in order to select a reasonable operation. Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery. Early postoperative enteral nutrition support is one of the key measures for successful wound healing.
ABSTRACT
Objective To analyze the related factors of postoperative complications in elderly patients with colorectal cancer (≥80 years old) and to explore its prevention and treatment strategies. Methods A total of 86 patients with advanced colorectal cancer in Shanxi Dayi Hospital from January 2012 to January 2018 were selected, which were divided into the laparosopic group (35 cases) and the open group (51 cases) according to the operation methods. The clinical data, surgical methods, postoperative complications and related factors of the patients were retrospectively analyzed. Results The amount of bleeding, postoperative anal exhaust time and hospitalization time in the laparoscopic group were less than those in the open group, and the differences were statistically significant (t= 2.107, 3.631, 7.563, all P< 0.05). There was no significant difference in operative time between the laparoscopic group and the open group (t= 2.306, P>0.05). There was no significant difference in the number of postoperative complications for the patients whether cardiovascular and cerebrovascular diseases, diabetes and lung diseases were involved between the two groups (all P>0.05). The number of poor wound healing in the body mass index (BMI) ≥28 kg/m2 group (8 cases, 25.0 ％) was more than that in the BMI < 28 kg/m2 group (3 cases, 5.6 ％), and the difference was statistically significant (χ2= 5.179, P= 0.023). There was no statistical difference in the number of other complications between BMI ≥ 28 kg/m2 group and BMI < 28 kg/m2 group (all P> 0.05). The number of postoperative anastomotic fistula, pulmonary infection and poor wound healing in the laparoscopic group were all lower than those in the open group, and the differences were statistically significant (all P< 0.05). There were no statistically significant differences in postoperative cardiovascular and cerebrovascular accidents between the laparoscopic group and the open group (P= 0.543). Conclusions The elderly patients with colorectal cancer should attach great importance to perioperative diagnosis and treatment, so that preoperativecomplications can be effectively treated and controlled. Besides, it is necessary to give preference to laparoscopic surgery in the prevention of postoperative complications for elderly patients with colorectal cancer.