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1.
Chinese Critical Care Medicine ; (12): 654-658, 2021.
Article in Chinese | WPRIM | ID: wpr-909378

ABSTRACT

Objective:To investigate the predictive value of heparin binding protein (HBP) for sepsis.Methods:From June 2019 to December 2020, 188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled. The patients were divided into non-sepsis group (87 patients) and sepsis group (101 patients) according to Sepsis-3 criteria. Gender, age, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), HBP, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score, modified early warning score (MEWS) and patients' recent medication history were recorded, the differences in the above indicators between the two groups were compared. The risk factors of sepsis were analyzed by Logistic regression. Spearman correlation analysis was used to analyze the correlation between HBP, PCT, CRP and SOFA score to evaluate the predictive value of HBP, PCT and CRP for the severity of septic organ failure. Receiver operating characteristic curve (ROC curve) were drawn to evaluate the diagnostic value of HBP, PCT and CRP for sepsis.Results:Compared with the non-sepsis group, the sepsis group had significantly higher levels of HBP, PCT, CRP, WBC, SOFA score, qSOFA score, and MEWS [HBP (μg/L): 55.46 (24.57, 78.49) vs. 5.90 (5.90, 9.01), PCT (μg/L): 6.83 (1.75, 30.64) vs. 0.23 (0.12, 0.75), CRP (mg/L): 67.35 (26.23, 123.23) vs. 4.45 (2.62, 47.22), WBC (×10 9/L): 11.84 (7.18, 16.06) vs. 6.58 (5.47, 8.99), SOFA score: 6 (4, 8) vs. 0 (0, 0), qSOFA score: 2 (1, 3) vs. 0 (0, 1), MEWS: 4 (3, 6) vs. 1 (0, 2)], the length of hospital stay was significantly prolonged [days: 10 (4, 17) vs. 0 (0, 7)], and the mortality was significantly increased [29.7% (30/101)vs. 4.6% (4/87)], with statistical significance (all P < 0.05). Correlation analysis showed that HBP, PCT and CRP were significantly positively correlated with SOFA score ( r values were 0.60, 0.33, and 0.38, respectively, all P < 0.01), among which HBP had the strongest correlation, CRP was the second, and PCT was the weakest. Logistic regression analysis showed that HBP, PCT and CRP levels were independent risk factors for sepsis [odds ratio ( OR) were 1.015, 1.094, 1.067, 95% confidence intervals (95% CI) were 1.007-1.022, 1.041-1.150, 1.043-1.093, all P < 0.01]. ROC curve analysis showed that HBP, PCT and CRP all had some diagnostic value for sepsis [the area under ROC curve (AUC) were 0.92, 0.87, 0.80, 95% CI were 0.88-0.97, 0.82-0.92, 0.74-0.87, respectively, all P < 0.01]. Among them, the diagnostic efficacy of HBP was higher when the cut-off value was ≥15.11 μg/L, its sensitivity and specificity were 86.14% and 89.66%, respectively, which were higher than the sensitivity (81.19%) and specificity (80.46%) when the PCT cut-off value was≥ 1.17 μg/L. However, CRP had the best sensitivity of 94.06% for the diagnosis of sepsis but lacked of specificity (63.22%). Conclusion:HBP can be used as a biological indicator for predicting sepsis and can assess the severity of organ failure in septic patients.

2.
Chinese Journal of Surgery ; (12): 757-762, 2019.
Article in Chinese | WPRIM | ID: wpr-796556

ABSTRACT

Objective@#To evaluate the accuracy of endoscopic titanium clip localization combined with CT three-dimensional reconstruction for the control of incision margin in early gastric cancer under laparoscopy.@*Methods@#A prospective analysis was made for gastric cancer whose lesions were located in the middle of the stomach and T stage was 1 to 2 from October 2017 to January 2019 at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital. Totally 25 patients were eventually enrolled in the study. There were 17 males and 8 females aging of (63.6±7.2) years (range: 48 to 77 years). All cases were treated with titanium clip localization under endoscope combined with CT three-dimensional(3D) reconstruction to construct a virtual panorama of gastric cavity and lesions, and to design surgical margins. Laparoscopic surgical resection was performed according to the surgical margins designed before operation. The distance from the gastric angle to the origin of the minor curvature of the incisional margin, the distance from the gastric angle to the the center of lesion and the distance of the upper incision margin were measured under three-dimensional CT reconstruction and under actual specimen. Paired t test was used to compare the three distances measured by two methods.@*Results@#The measured distances from the gastric angle to the center of the lesion and the proximal incisional margin under 3D reconstruction CT were according to the measured values of actual specimens ((2.67±1.38) cm vs. (2.83±1.56) cm, t=1.51, P=0.14; (5.23±0.60) cm vs. 5 cm, t=1.93, P=0.07); the measured distances from the gastric angle to the origin of the minor curvature of the incisional margin under CT 3D reconstruction were different with the measured values of solid specimens ((5.94±0.94) cm vs. (6.37±0.90) cm, t=3.52, P=0.00).@*Conclusion@#The method of titanium clip localization combined with CT 3D reconstruction can provide a feasible laparoscopic localization method and incision edge solution for T1 to T2 gastric central cancer.

3.
Chinese Journal of Surgery ; (12): 212-216, 2018.
Article in Chinese | WPRIM | ID: wpr-809853

ABSTRACT

Objective@#To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma.@*Methods@#Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017.@*Results@#All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis.@*Conclusion@#Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.

4.
Chinese Journal of Surgery ; (12): 822-827, 2018.
Article in Chinese | WPRIM | ID: wpr-807610

ABSTRACT

Objective@#To summarize the incidence and characteristics of postoperative complications after laparoscopic pancreaticoduodenectomy(LPD), and to share our experience on management of complications.@*Methods@#The clinical data of 320 LPD performed by a single team in Sir Run Run Shaw Hospital and Zhejiang Provincial People′s Hospital between September 2012 and September 2017 were retrospectively analyzed, among which there were 196 males and 124 females with age of (60.2±11.6) years old.There were 306 patients who underwent standard LPD, and 14 patients who underwent extended LPD. The patients were divided into 2 groups of former 160 LPD and later 160 LPD according to the time order. By analyzing the differences of clinical outcomes between the two groups, especially focusing on the incidence of postoperative complications.The experience on management of complications was concluded. The prior surgical history of latter group was significantly higher than the former group(30.0%(48/160)vs. 18.8%(30/160), χ2=5.49, P=0.019), and the rest of baseline characteristics remained the comparable (P>0.05). For resectable lesions, LPD was performed by "No back" approach, following the principle of "From distal to cephalad, from ventral to dorsal, and from left to right" . As for the borderline resectable patients, LPD was performed by "Easy first" strategy. Student t test, χ2 test or Fisher test was used to analyzed the data between the two groups respectively.@*Results@#Of 320 LPD patients, 306 cases underwent standard LPD, 14 cases underwent LPD with resection of other organs.There were 278 LPD cases who followed "No back" approach, and 42 cases who followed "Easy first" strategy because of difficulty in creating the retro-pancreatic tunnel. And the overall morbidity was 32.2%(103/320) with reoperation rate of 5.3%(17/320). The perioperative mortality was 0.6%(2/320). The operation time of latter group was ((346.6±48.8)minutes), which was shorter than that of former group((358.0±54.4)minutes)(t=1.97, P=0.048). The blood loss of former and latter group remained comparable((207.9±135.8)ml vs.(189.6±121.4)ml, P=0.205). However, in subgroup analysis, the patients with blood loss less <200 ml of latter group decreased significantly from 59.4%(95/160) to 47.5%(76/160)(χ2=4.53, P=0.033). The overall morbidity of latter group was 28.8%(46/160), indicated a decrease from 35.6%(57/160) of former group without significant difference(P=0.188). Moreover, Grade A/B/C pancreatic fistula rate, Grade A/C bile leakage rate, Grade B/C postoperative hemorrhage rate of the later group tended to decrease, although they also didn′t reach a significant difference. However, the abdominal infection rate decreased significantly(χ2=3.93, P=0.047). The length of hospital stay remained comparable(P=0.156).@*Conclusions@#The most common complications after LPD were postoperative hemorrhage and pancreatic fistula. With specialized team and accumulated experience, the morbidity can decrease progressively by analyzing the leading cause and improving the technical skills.

5.
Chinese Journal of Surgery ; (12): 354-358, 2017.
Article in Chinese | WPRIM | ID: wpr-808635

ABSTRACT

Objective@#To summary the experience of 233 cases of laparoscopic pancreaticoduodenectomy (LPD) performed by a single surgical team.@*Methods@#Data of patients undergoing LPD from September 2012 to October 2016 were reviewed. There were 145 males and 88 females with the mean age of(60.3±13.0)years old, ranging from 19 to 92 years old, and the mean body mass index of (22.8±3.5)kg/m2, ranging from 16.3 to 36.8 kg/m2. There were 195 patients with clinical manifestation and 54 patients who had the history of abdominal surgery.@*Results@#LPD were performed on 233 patients by same surgical team consecutively. The mean operative time was(368.0±57.4)minutes. Mean blood loss was(203.8±138.6)ml. The postoperative morbidity rate was 33.5%, with 6.9% of grade B or C pancreatic fistula and 9.9% of bleeding. The reoperation rate was 5.6%. The mortality during 30 days after operation was 0.9%. Mean postoperative hospital stay was (18.1±11.2)days. Mean tumor size was (3.9±2.4)cm, and the mean number of lymph nodes harvested was 21.3±11.9.One hundred and sixty-three patients were diagnosed as malignant tumor, including pancreatic adenocarcinoma(n=84), cholangiocarcinoma(n=17), ampullary adenocarcinoma(n=55), duodenal adenocarcinoma(n=5), gastric cancer(n=1)and duel cancer (n=1) located in distal stomach and duodenum.@*Conclusion@#The key point to make laparoscopic pancreaticduodenectomy a routine safe procedure is to operate the procedure under skilled hands in selected patients via suitable surgical approaches.

6.
Article in Chinese | WPRIM | ID: wpr-341487

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of laparoscopic gastrectomy for gastric stump cancer.</p><p><b>METHODS</b>Clinical and follow-up data of 7 patients who underwent laparoscopic gastrectomy for gastric stump cancer in our department from January 2008 to July 2015 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 5 male and 2 female patients, with a mean age of (62.1±10.7) years. Initial gastrectomy was performed for gastric cancer in 3 patients and peptic ulceration in 4. The initial surgery was B-II( gastrojejunostomy in 6 patients and Roux-en-Y gastrojejunostomy in 1. Duration between primary gastrectomy and occurrence of gastric stump cancer was ranged from 6-30 years for peptic ulceration, and from 11-15 years for gastric cancer. During the operation, adhesiolysis and exploration to locate the tumor were performed. Following total remnant gastrectomy and lymphadenectomy, intracorporeal anastomosis was accomplished by Roux-en-Y reconstruction. The methods of intracorporeal esophagojejunostomy were end-to-side approach using a circular stapler in 1 patient, side-to-side approach using an endoscopic linear staple in 2 patients, and hand-sewn technique in 4 patients. The operation time was (247.1±17.5) minutes and the intraoperative blood loss was (100.0±30.8) ml without transfusion. The number of retrieved lymph node was 19.1±4.8. The first flatus time, diet resumption time, postoperative hospital stay were (3.3±1.5) days, (3.7±0.8) days, (9.4±2.6) days, respectively. One patient experienced gastrointestinal bleeding that was managed conservatively and ultimately cured. Seven patients were followed up till January 2016. After follow-up from 6 to 38 months, 1 patient died of peritoneal metastasis 17 months after surgery, and 1 patient died of Alzheimer's disease 19 months after surgery. The other 5 patients were still alive without metastasis or recurrence.</p><p><b>CONCLUSION</b>Laparoscopic gastrectomy for gastric stump cancer is feasible and safe.</p>


Subject(s)
Aged , Anastomosis, Roux-en-Y , Blood Loss, Surgical , Female , Gastrectomy , Gastric Bypass , Gastric Stump , Pathology , General Surgery , Humans , Laparoscopy , Length of Stay , Lymph Node Excision , Male , Middle Aged , Neoplasm Recurrence, Local , Operative Time , Retrospective Studies , Stomach Neoplasms , General Surgery , Surgical Stapling
7.
Chinese Journal of Surgery ; (12): 84-88, 2016.
Article in Chinese | WPRIM | ID: wpr-349228

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy(LPD).</p><p><b>METHODS</b>Data of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of (58.7±10.3) years and mean body mass index of (23.5±3.9)kg/m(2). Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery.</p><p><b>RESULTS</b>Of 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was (367±49) minutes. The mean blood loss was(193±126)ml. The rate of overall postoperative complications was 36.4%(24/66), with 4.5%(3/66) of B or C pancreatic fistula and 7.6% (5/66) of bleeding. The mean postoperative hospital stay was (18.9±12.1) days. Mean tumor size was (3.8±2.3) cm, and the mean number of lymph nodes harvested was (20.3±10.9). Forty-severn patients were diagnosed as pancreatic adenocarcinoma(n=18), cholangiocarcinoma(n=7), ampullary adenocarcinoma(n=21), and gastric cancer(n=1), respectively.</p><p><b>CONCLUSION</b>LPD is feasible and safe under the skilled hand.</p>


Subject(s)
Adenocarcinoma , General Surgery , Aged , Anastomosis, Surgical , Female , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Operative Time , Pancreatectomy , Pancreatic Fistula , Pathology , Pancreatic Neoplasms , General Surgery , Pancreaticoduodenectomy , Postoperative Complications
8.
Article in Chinese | WPRIM | ID: wpr-470239

ABSTRACT

Objective To explore the clinical efficacies of open and laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst.Methods The clinical data of 36 adult patients with congenital choledochal cysts who were admitted to the Sir Run Run Shaw Hospital from February 2008 to February 2015 were retrospectively analyzed.Twenty-four patients underwent common bile duct cyst resection + cholecystectomy +biliojejunal Roux-en-Y anastomosis (open surgery group),12 patients underwent laparoscopic common bile duct cyst resection + cholecystectomy + biliojejunal Roux-en-Y anastomosis (laparoscopy group).The intraoperative conditions,detection indexes and postoperative recovery indexes in the 2 groups were analyzed.The follow-up by regular outpatient examination and telephone interview were done up to March 2015.Non-normal distribution data were described as M(P25,P75).Comparison between groups was analyzed using the Mann-Whitney U test and Fisher exact probability.Measurement data with normal distribution were presented as (x) ± s and analyzed using t test.Count data were evaluated by the ratio and proportion.Results The operation time of the open surgery group and laparoscopy group were 238 minutes (191 minutes,283 minutes) and 270 minutes (225 minutes,326 minutes),with a significant difference between the 2 groups (Z =-1.360,P > 0.05).The volume of intraoperative blood loss in the open surgery group and laparoscopy group were 200 mL (113 mL,363 mL) and 75 mL(50 mL,138 mL),with a significant difference between the 2 groups (Z =-3.377,P <0.05).The level of C-reactive protein in the open surgery group and laparoscopy group were 94 mg/L (81 mg/L,104 mg/L) and 29 mg/L (21 mg/L,61 mg/L),with a significant difference between the 2 groups (Z =-4.296,P <0.05).The pain scores at postoperative day 3,time to anal exsufflation,time for fluid diet intake and duration of hospital stay of the open surgery group and laparoscopy group were 2.5 ± 0.9,(3.7 ± 1.0) days,(5.0 ± 1.6) days,(10.0 ± 2.7) days and 1.9 ±0.3,(2.6 ± 1.0) days,(3.6 ± 1.6) days,(7.8 ± 2.2) days,respectively,showing significant differences between the 2 groups (t =3.146,3.286,2.450,2.523,P < 0.05).Nine patients in the open surgery group and 3 patients in the laparoscopy group had the complications,with improvement of conditions after symptomatic treatment,showing no significant difference between the 2 groups (P > 0.05).All the 36 patients were followed up for a median time of 36 months (range,1-72 months) with good recovery,without long-term postoperative complications and re-operation.Conclusion Laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst is safe and feasible,with the advantages of less intraoperative bleeding,less surgical trauma,fast recovery compared with open surgery.

9.
Chinese Journal of General Surgery ; (12): 1014-1019, 2012.
Article in Chinese | WPRIM | ID: wpr-430873

ABSTRACT

Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer by systematic review and meta-analysis.Methods The literature database before February,2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy(OTG) with a relevance of study goal.The inclusion and exclusion criteria were formulated.Aftera quality evaluation,the data was extracted.The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis.Results There are ten studies meeting the inclusion criteria for meta-analysis.The total sample size of these studies was 942 cases.Compared to OTG,LATG experienced longer operation time [weighted mean difference(WMD) =41.12 min,95% confidence interval(CI):20.62-61.63,P <0.01)],less blood loss(WMD =-198.36 ml,95% CI:-300.94--95.78,P < 0.01),earlier time to flatus(WMD =-0.80 days,95% CI:-1.17--0.42,P<0.01),shorter hospital stay(WMD =-4.02days,95% CI:-6.03--2.01,P < 0.01) and decrease in overall complications [relative risk (RR) =0.55,95% CI:0.40-0.76,P < 0.01)].The number of dissected lymph nodes,proximal or distal resection margin and mortality were similar between the two groups.Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss,less overall complications and quick recovery.

10.
Article in Chinese | WPRIM | ID: wpr-425732

ABSTRACT

ObjectiveTo evaluate the influence on left ventricular(LV) twist,and the relationship between LV twist and function in the rabbits with ventricular aneurysm formed after myocardial infarction by two-dimensional ultrasound speckle tracking imaging.MethodsTwenty-six healthy rabbits were divided into two groups,six as control group,twenty as experimental group.The model of myocardial infarction and ventricular aneurysm were established by ligaturing left anterior descending coronary artery and left circumflex artery.After four weeks,according to the pathological examination of whether ventricular aneurysm formed or not,the experimental group was divided into myocardial infarct group and ventricular aneurysm group.Echocardiography was performed to measure rotations (at the levels of mitral annulus and apex in LV short-axis view),LV twist,left ventricular cavity size and function.ResultsCompared with the myocardial infarct group,LV end-diastolic diameter(LVEDD) and LV end-diastolic volume(LVEDV) were larger in the ventricular aneurysm group,but LV ejection fraction (LVEF),LV fractional shortening (LVFS),apical rotation and LV twist were lower in the ventricular aneurysm group than the myocardial infarct group.Both apical rotation and LV twist had shown a great correlation with LVEF.The conclusion was also shown in the ROC curve that sensitivity and specificity of diagnosis cardiac dysfunction were 76.9% and 80.0% respectively when the apical rotation was 1.21°.Conclusions There was a closely relationship between the change of apical rotation and the LV systolic function.When the apical rotation dropped to 1.21°,an apparent decline of LV systolic function was implied.

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