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Objective To increase curative rate of nonoperation treatment for adult blunt splenic trauma.Methods Data of 141 patients with blunt splenic trauma treated in our hospital from March 2010 to October 2014 were retrospectively analyzed in accordance with the spleen injury degree classification issued by the Spleen Surgery Group of Chinese Society of Surgery in 2000.According to the treatment within 6 hours of injury,these patients were divided into operative and nonoperative management groups.Results The proportion of non operation was 69.5％ (98/141) and the success rate was 89.8％ (88/98).43 cases were in operation group:34 cases in grade Ⅲ,9 cases with grade Ⅳ,3 cases died; 98 cases were in non operation group:including 32 cases of grade Ⅰ,50 cases of grade Ⅱ,15 cases of grade llⅢ,1 case with grade Ⅳ.10 cases failed non operation treatment including 1 case with grade Ⅰ complicated by pancreatic and intestinal injury causing peritonitis during the period of observation,1 case of grade Ⅱ complicated by contusion of the liver and secondary bleeding on day 3 after the trauma,7 cases of grade Ⅲ,were converted to surgery because of multiple organ injury and rebleeding secondary to pulmonary complications,and 1 case of grade Ⅳ with multiple organ injury and shock being immediately converted to surgery.In overall there were 2 deaths in nonsurgery group,1 case with grade Ⅲ and 1 case with grade Ⅳ.Condusions Nonoperative treatment of blunt splenic trauma is safe and feasible in grade up to]Ⅱ blund splenic trauma patients.
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Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Methods The clinical data of 42 patients with Mirizzi syndrome with non-circumferential defect of bile duct who were repaired using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap were analyzed.The defect in the bile duct were repaired using gallbladder pedicle flap in 30 patients,umbilical venous flap in 8 patients and omental flap in 4 patients.Results All patients were operated successfully.There was no operative mortality.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 d.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9-12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed up for 1-5 years,and had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome is effective.This surgical treatment is a good choice.
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Objective To investigate the current status of treatment on traumatic ruptured spleen in a regional medical center in Tianjin,China.Method Logistic analysis of 16 impact ffactors of treatment decision on 147 patients with traumatic ruptured spleen.Results The type of trauma,pulse rate at admission,result of abdominal puncture and CT grade were related to treatment decision making.Splenectomy was carried out in 89 patients (60.54％) which accounted for 89.90％ of all surgical procedures.Splenectomy was carried out in 50.85％ of patients with CT grade 1 or 2 (or 85.71％ of grade 1 and 2 surgery),and 100％ of CT grade 3 or 4.Spleen preservation surgery was carried out in 7 patients with CT grade 1 or 2.Conclusion Splenectomy was carried out in most cases in this study.It is necessary to investigate the treatment of splenic trauma in regional medical centers,and to develop more reliable surgical techniques to carry out more spleen-preservation surgery ffor CT grade 1 or 2 ruptured spleen.
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Objective To investigate the factor that related to neoplasm from the clinicopathologic character of gallbladder polyps, and identify the reciprocal effectiveness of these factors. Method Three hundred and forty-seven patients who were underwent operation with gallbladder polypoid lesions were reviewed. Results Logistic regression analysis showed, only 5 parameters were significant for the prediction of neoplastic lesions, including age of the patient (P =0.015), the number of polyps (P=0.018), the maximal diameter (P=0.000), echo property (P=0.000), as well as the position of polyps (P=0.030),of which the maximal diameter was the best one to predict the neoplasm polyps. Further analysis with HOC curve showed that 0.925 cm, the diameter of polyps, was the critical point to calculate the polyp was neoplasm or not. Conclusions Age of the patient , the number of polyps , the maximaldiameter, the position of polyps, and echo property are independent factors in predicting gallbladder neoplastic lesions. The size of the polyps is the most significant one among the factors to predict gallbladder neoplasm with its critical point of 0.925 cm.
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Objective To compare the effects of laparoscopic cholecystectomy and laparoscopic common bile duct exploration combined choledochoscopic exploration( method A)and duodenoscopic sphincterotomy combined with laparoscopic cholecystectomy( method B) in treating choledocholithiasis with cholecystohthia-sis. Methods A retrospective study was adopted to analyze by statistical methods comparatively the clinical data of 114 patients, concerning operation time, blood lost, odynolysis rate, conversion rate,calculi residual rate ,complication rate ,hospitalization time and cost, et al. 68 cases were treated by method A,and 72 ca-ses were treated by method B. Results There were statistical differences in calculi residual rate, a conver-sion rate, apart complication rates and hospitalization cost between two groups, but there was no statistical difference in other index. Conclusion The two methods for choledocholithiasis and cholecystohthiasis has advantage and shortcoming respectively. The treatment for patients must be individualized by MRCP/USG, actual state of illness, and so on.
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Objective:To investigate the effects of chronic anger stress on rats' aging process and the mechanism of the neuroendocrine-immune network. Methods:After the aging and brain aging rats induced by D-galactose(D-gal) were stimulated by anger, observation of the effects of chronic anger stress on the rats' spatial learning and memory was made, the contents of norepinephrine(NE), 5-hydroxytryptamine(5-HT)in brain tissue and serum, the levels of adrenocorticotropic hormone (CORT) in serum were assayed, the spleen index was measured. Results:Compared with the D-gal group, in the D-gal group stimulated by anger, the rats' ability of spatial learning and memory declined, the contents of NE in brain tissue and serum increased, the contents of 5-HT declined, the levels of CORT in serum increased, and the spleen index declined. Conclusion: The rats' aging and brain aging were aggravated and the aging process were accelerated by chronic anger stress. The possible mechanism were the sustained excitability of the HPA axis and SAS, disturbances of neuroendocrine system and immunological function repression.
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Objective To reassess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and to investigate the correlation between them.Methods Of 65 cases of acute pancreatitis,the hospitalization days,fevering days and entire complications (including local and systemic complications)were regarded as clinical endpoints.CT criteria included Balthazar's plain CT scan score,necrosis score,CT severity index(CTSI) and London's PSI score.Clinical criteria included Ranson and APACHE Ⅱscore.Using analysis of variance,t-test and multiple linear regression analysis,the correlation between each criteria and the three clinical endpoints was examined as well as the relation between CT and clinical criteria.The power of each criteria and combination of CT and clinical criteria in predicting entire complications of AP was assessed and compared by using ROC analysis.Results The mean scores of PSI,Ranson and APACHE Ⅱamong three groups classified according to entire complications were significantly different.Except Balthazar's plain CT scan criteria,each criteria's mean scores in group with local complications was signifiantly higher than that in group without and entire complications was significantly more in sever group than that in mild group.Mean hospitalization days and fevering days were significantly longer in sever group than that in mild group with Ranson Score.PSI and Ranson score had linear correlation with fevering days,and Ranson score had linear correlation with hospitalization days.In CT criteria,a linear correlation was only found between PSI and Ranson score.ROC analysis showed the Az of Ranson score was the largest,and there was no increase in the Az when CT criteria were added to clinical criteria.Conclusion The predictive value of Ranson score and PSI are superior to that of others.Clinical criteria is superior in predicting systemic complications,whereas CT is superior in predicting local complications.There is no improvement in predicting entire complications of AP when CT criteria are added to clinical criteria.The findings of plain CT scan is found to be some laggard compared with that of clinic.CT scan and short follow-up are important in the evaluation of AP.
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Objective: Gallbladder polyps are frequently discovered in the past decade. Ifthe polyps are oenign,without concomitant stone and the gallbladder has a good function, it is not an absolutely indication for cholecystectomy. For this reason percutaneous endoscopio polypectomy of the gallbladden polyps were developed and applied. Methods: Among those who underwent peroutaneous endosoopic polypectomy of the gallbladder, 85 patients with gallblaeder polyps were studied. Under the epidural anesthesia, cholecystoscope was introduced into the gallbladder. The polyps were coagulated by self-made miorowave ceagulator and then resected for histopathelogical evaluation. The preserved gallbladders were followed up to evaluate the effioacy of this minimally invasive therapy. Results: All precedures were eventful with mean operation time of 1h to 1. 5h. Sixty seven patients were followed-up for a mean of 5.5 yeah (2～9 years) and showed all patients to be symptom free and in 64 cases the gallbladder function was found to be well preserved without recurrence of polyps and occurrenca of gallstones on ultraSound. Conclusion: The procedure reposed is a reliable, simple,effective and minimally invasive technique to remove gallbledder polyps and to preserve gallbladder function for the patients who have the benign gallbladder polyps.
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Objective To investigate the risk factors that affect the perioperative mortality incholangiocarcinoma.Methods The clinical data of sixty two patients with cholangiocarcinoma who underwent operation were reviewed retrospectively.Logistic regression test was used in the perioperative mortality study.Before multivariate analysis,each parameter was evaluated with univariate analysis to define whether it was of statistical significance(P