ABSTRACT
Objective To analyze and compare the postoperative complications and perioperative data of laparotomy surgery and combined laparoscopy and choledochoscopy surgery for non-severe acute cholangitis.Methods Retrospective analyzed the clinical data of 134 patients,with non-severe acute cholangitis at First Affiliated Hospital of He'nan University from June 2015 to May 2017.The patients were divided into combined group (76 cases) and traditional group (58 cases) according to operation mode,and the postoperative complications and perioperative data including amount of bleeding,postoperative exhaust time,operative time,incision length,length of stay and extubation time of T-tube were compared.The measurement data were expressed by (-x ± s),and the t test was used between the groups.Comparison of count data were analyzed using the chi-square test.Results The amount of bleeding,postoperative exhaust time,incision length and length of stay were respectively (48.90 ± 16.23) ml,(1.94 ± 0.45) d,(4.53 ±1.97) cm,(7.81 ±2.23) d in the combined group and were significantly less than those in the traditional group (98.53 ± 17.34) ml,(2.42 ± 0.56) d,(8.34 ± 2.05) cm,(12.27 ± 1.56) d,with statistically significant diffbrences between the two groups (t =7.173,8.242,12.847,8.242;P =0.000,0.000,0.004,0.021).The operative time of the combined group was (157.75 ± 17.34) min,and that of the traditional group was (138.43 ±23.84) min,but there was no significant difference between the two groups (t =13.661,P =0.069).The extubation time of T-tube in the combined group and the traditional group was (29.78 ± 1.54) d and (22.54 ± 0.96) d,respectively.The differences between the two groups were statistically significant (t =3.435,P =0.043).Postoperative complications occurred in 16 out of all 134 patients,and bile leakage,residual stones and incision infection were the top three complications.The incidence of postoperative complications in the combined group and the traditional group was 5.26％ (4/76)and 20.69％ (12/58),respectively.The differences between the two groups were statistically significant (x2 =7.445,P =0.006).Conclusion The incidence of complications of calculous non-severe acute cholangitis combined laparoscopy and choledochoscopy is lower than traditional surgical operations,and more conforms to the enhanced recovery after surgery,and the postoperative recovery is faster than that of the traditional group.
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Objective To investigate the diagnosis and treatment of congenital mesenteric hiatal hernia in aduls.Methods The retrospective cross-sectional study was conducted.The clinical data of 11 adult patients with congenital mesenteric hiatal hernia who were admitted to the First Affiliated Hospital of Henan University from January 1999 to January 2016 were collected.All patients underwent abdominal X-ray and ultrasound examinations.Patients diagnosed as with intestinal obstruction or suspected intra-abdominal hernias underwent abdominal CT examination,and then were finally confirmed during surgery.Patients diagnosed as with mesenteric hiatal hernia received necrotic tissues resection and tissue repair (small intestine resection and anastomosis) if there was necrosis of hernia contents,and closing mesenteric hiatus.Patients without small intestine necrosis received closure of mesenteric hiatus after retraction of the hernia contents.Observation indicators:(1) clinical manifestations,(2) imaging findings,(3) treatment,(4) pathological examination,(5) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to March 2017.Results (1) Clinical manifestations:all 11 patients were acute onset,with incentives of satiation,postprandial exercise and diarrhea.The time from onset to admission was 2.0-30.0 hours,with an average time of 9.8 hours.The main symptoms included abdominal pain,nausea and vomiting,exhaust reduction and other intestinal obstruction performances.Eleven patients received physical examination,and 10 showed abdominal bulge,including 9 with intestinal type.Eleven patients had abdominal tenderness,and 9 combined with rebound tenderness.Abdominal percussion of 11 patients showed hyperresonant without shifting dullness,and active,muted and fading bowel sounds were detected in 1,3 and 7 patients,respectively.(2) Imaging examination:of 11 patients receiving abdominal X-ray examination,2 had intestinal loop and 4 had the intestinal obstruction performances such as typical gas-liquid plane.Abdominal ultrasound examination of 11 patients showed no specific findings due to abdominal intestinal gas,and 10 with peritoneal effusion.Of 11 patients,1 didn't receive abdominal CT scan due to preoperatively misdiagnose with acute appendicitis and 10 underwent abdominal CT scan.Nine patients were diagnosed with intestinal torsion by abdominal CT scan and then underwent enhanced CT scan,and 8 with small mesenteric vascular torsion and swirling sign were diagnosed with small intestine torsion and partial necrosis of small intestine.(3) Treatment:1 patient preoperatively misdiagnosed with acute appendicitis was converted to exploratory laparotomy,and 10 patients underwent exploratory laparotomy due to complete intestinal obstruction or progressive increase in symptoms.Intraoperative exploration showed that intestinal mesenteric hiatus and colon mesenteric hiatus were respectively in 8 and 3 patients,and hiatuses were round or oval,with a diameter of 2.0-8.0 cm and an average of 4.4 cm.Hernia contents were small intestine.The partial small intestine in 10 patients were resected and then mesenteric hiatus was closed due to necrosis of the small intestine,with removal length of 110-250 cm and an average of 176 cm,and length of remaining small intestine was 80-230 cm,with an average of 159 cm.The hernia into small intestine in 1 patient without complete necrosis was retracted to abdominal cavity after symptomatic treatment,and closing mesenteric hiatus.Eleven patients were cured and out of hospital after operation,without nosocomial complications.(4) Pathological examination:small intestine ischemic necrosis was detected in 10 patients after partial small intestine resection.(5) Follow-up situations:all patients were followed up for 12-24 months,without malnutrition,short bowel syndrome and other complications.Conclusions Without history of abdominal trauma or surgery,with incentives of the satiation,postprandial exercise and diarrhea,abnormal retroperitoneal small intestine shadow and small intestinal torsion diagnosed by CT scan and absent intestine sign by enhanced CT scan can be helpful to diagnose congenital mesenteric hiatal hernia in adults and small intestinal necrosis.Surgery is the only effective method in the treatment of congenital mesenteric hiatal hernia in adults.
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Objective To explore the multislice CT (MSCT) volumetric representation (VR), curved surface reconstruction (CPR) in diagnosis of ribs and rib cartilage of the clinical value of minor fractures.Methods The X-ray films,axial CT,VR,CPR image performance of 112 cases of clinical suspected ribs and costal cartilage minor fractures were retrospective analyzed.The sensitivity, specificity, positive rate and accuracy,negative rate,missed diagnosis and misdiagnosis rate and the diagnostic value in the diagnosis of rib and rib cartilage minor fractures of four examination method were compared and analyzed.Results VR, CPR examination can clearly display the ribs and rib cartilage minor fractures, the diagnostic sensitivity (94.25％, 98.85％), specificity (88.00％, 96.00％), positive rate (96.47％, 98.85 ％) and accuracy (92.85％, 98.21％) of VR and CPR were higher than X-ray and axial CT examination(82.14％ and 88.51％ ,80.00％ and 84.00％, 94.50％ and 96.25％,82.14％ and 87.50％).And the diagnostic value of CPR inspection(the area under the curve) was 0.974, obviously higher than that of X ray film, axial CT, VR, and the difference was statistically significant (0.814,0.863,0.911;P＜0.05).Conclusion MSCT of VR and CPR examination in the diagnosis of rib in minor fractures and rib cartilage has very important clinical value.