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Objective To make a comparison between the outcome of modified Soave procedure and laparotomy on Hirschsprung disease(HD)in children.Method Chose the 21 eases who underwent transanal modified Soave procedure(modified Soave procedure group)and 25 eases had done by laparotomy (laparotomy group)from January 2001 to January 2007,clinical data of two groups were compared.Results Modified Soave procedure group showed lower level of IL-6 and CRP[(10.7±1.6)ng/L,(27.7±4.1)mg/L]on 48 h postoperation than laparotomy group[(22.0±2.3)ng/L,(73.7±15.0)mg/L](P ＜ 0.01).The mean operative time,hospital stay,the mean time of anal aerofluxus and the cost of hospitalization in modified Soave procedure group were much shorter than those in laparotomy group(P＜ 0.01).While the complication rate of two groups had no statistical difference.Moreover,there were no significant difference of rectal high pressure zone length and resting anal canal pressure between two groups at 1 year after operation.Conclusion Transanal modified Soave procedure for HD is a minimal invasive surgery,especially in young patients with short-segment type and common type of HD.
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Objective To evaluate the diagnosis, treatment and prognosis of primary duodenal carcinoma. Methods The clinical data of 41 cases with primary duodenal carcinoma admired during 2000-2007 were analyzed retrospectively. Results Clinical manifestation was not specific, including abdominal pain, abdominal distention, jaundice, bowel obstruction or bleeding. The correct diagnosis rate of endoscopy, duodenography, ultrasound and CT was 86%, 90%, 20% and 33% respectively. 23 cases underwent pancreaticoduodenectomy, 6 cases received segmental duodenectomy, 9 cases received bypass operation and 3 cases underwent biopsy. Overall postoperative 5-year survival rate was 18%. Univariate analysis revealed that the operation types, tumor histology, depth of tumor invatian, lymphatic invasion correlated with prognosis. Multivariate analysis showed that only the operative types, depth of tumor invasion and lymphatic invasion were independent prognostic factors. Conclusions Duodenography and endoscopy are major methods for diagnosis of primary duodenal carcinoma. Pancreaticoduodenectomy is the choice of therapy for primary duodenal carcinoma.
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Objective To evaluate the clinical effect of splenic internal jugular shunt for Budd Chiari Syndrome (BCS). Methods A retrospective analysis was made on the clinical data of 21 patients of BCS who underwent this operation. Results There was no death in 21 patients receiving this operation, The average post operative reduction of FPP was 0.97Kpa.2 suffered postoperative lung infection . Abdominal incision infection occurred in one patient. Tweenty cases were followed up for one month to forty five months. Lower extremity varicose veins and abdomen wall varicose veins basically disappeared a month postoperatively; ascites vanished completely 3 months postoperatively,and lower limb ulcer healed 6 months postoperatively. Seventeen patients followed by CDFI showed that no thrombus was found in their artificial vessel. Barium meal studies in 12 cases displayed that oesophageal varicose veins had basically disappeared during the follow up period. Conclusions Splenic jugular shunt bridged by artifical vessel is safe,effective and less traumatic for patients with type III and some patients with type II Budd Chiari syndrome. It is currently the best choice for treatment of BCS.
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Objective To explore the methods for early diagnosis and treatment of blunt pancreatic injury.Methods The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed.Results The conformity diagnosis rate of CT was 79.3%.Four cases received nonoperative treatment including 3 cases of grade I and 1 of grade II injury.A total of 28 cases with blunt pancreatic injury underwent operation: 5 grade I and 7 grade II cases underwent debridement and drainage;among the patients with grade Ⅲ injury,4 underwent distal pancreatectomy in combination with splenectomy,and 2 pancreatectomy with spleen preservation;amongst the 5 patients with grade Ⅳ injury,4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy;of the 5 patients with grade Ⅴ injury,1 case was operated on using duodenorrhaphy and diverticulization,2 underwent the Whipple′s procedare and 2 had damage control surgery.Three patients died of multiple organ failure,and complications occurred in 19(76.0%).Pancreatic fistula and pancreatic pseudocysts were the main complications.Conclusions In the absence of major pancreatic ductal injury,and the clinical conditions were stable,pancreatic injuries can be treated with nonoperative management.Operative treatment is suitable for severe blunt pancreatic injury.Appropriate operation,based on patient condition and the classification of pancrecatic trauma,is the key to increase the cure rate and decrease mortality rate.