ABSTRACT
Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease.
ABSTRACT
Superior mesenteric vein (SMV) thrombosis is a relatively rare disease. Most patients may be successfully treated with anti-coagulation alone. However, bowel stricture may develop due to intestinal ischemia which may require surgical treatment. This report describes a rare case of small bowel stricture occurring one month after successful treatment of SMV thrombosis. After segmental resection of strictured bowel, the patient's post-operative course was uneventful.
ABSTRACT
Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.
ABSTRACT
Objective To analyze risk factor of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Methods A retrospective population-based cohort study was carried out on 13878 patients undergoing LC from Apr 1994 to Dec 2003. Patients were divided into BDI group and non-BDI group. Factors with statistically significant differences between groups in anivariable analysis were selected to construct a multivariate logistic regression mode. Result Among 13878 LC procedures 38 BDI (0.27%) were identified. Factors which were of significant differences between groups in anivariable analysis includ diameter of common bile duct(?~2=5.92, P
ABSTRACT
Objective To observe the incidence of residual gallbladder in patients undergone cholecystectomy through laparotomy (OC),mini-incision laparotomy cholecystectomy (MC) or laparoscopic cholecystectomy (LC),and to explore the causes,diagnosis,prevention and treatment of residual gallbladder.Methods The clinical data of 241 patients undergone laparotomy cholecystectomy (OC group),231 patients undergone mini-incision laparotomy cholecystectomy (MC group) and 290 patients undergone laparoscopic cholecystectomy (LC group) were retrospectively analyzed,and the incidence of residual gallbladder was compared among the three groups.Results Residual gallbladder was found in 32 patients after the surgical procedures,with 4 in OC group (1.7%),13 in MC group (5.6%) and 15 in LC group (5.2%),respectively.Statistical analysis showed that the incidence of residual gallbladder was lower in OC group than in MC and LC group (P0.05).Multivariate analysis showed that severity of inflammation before the operation,operative methods and operator's experience were correlated with the incidence of residual gallbladder.All the 32 cases were diagnosed by ultrasonography,computed tomography (CT),magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).24 patients were cured with surgical procedure,and the symptoms disappeared during a follow-up period of 6 months to 9 years;other 8 cases were treated with conservative management and the results were unsatisfactory.The pathological examination showed no tumor or malignant change in the excised specimen.Conclusions Residual gallbladder is not a negligible complication of cholecystectomy.Effective control of inflammation of the gallbladder,selection of a proper time and procedure of operation,and the operation done by an experienced surgeon can reduce the incidence of residual gallbladder,and reoperation is the effective treatment for it.