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Objective@#To improve the awareness of emergency biliary obstruction (BO) disease, and to further improve the diagnosis and treatment ability of BO patients.@*Methods@#Data of the etiology, clinical manifestations, imaging data, laboratory tests, and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.@*Results@#Common bile duct stones were the most common cause of BO patients (63.49%), followed by cholangiocarcinoma (19.05%); the most common clinical manifestations of BO patients were jaundice (90.48%), abdominal pain (87.30%), and fever (53.97%); the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P<0.05), but there was no significant difference between CT and MRCP (P=1.000); compared with benign group, hemoglobin and albumin in malignant group were significantly lower, while total bilirubin and direct bilirubin were higher, with statistically significant difference (P<0.05). Most patients in BO patients improved after treatment, and the mortality rate of BO patients was 3.17%(2/63) at the end of emergency visit.@*Conclusions@#Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients. The most common clinical manifestations of patients with emergency BO are jaundice, abdominal pain, and fever. Better than abdominal ultrasound, CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients. Anemia, hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients. Most patients can temporarily get better at the end of emergency visit.
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Objective To improve the awareness of emergency biliary obstruction (BO) disease,and to further improve the diagnosis and treatment ability of BO patients.Methods Data of the etiology,clinical manifestations,imaging data,laboratory tests,and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.Results Common bile duct stones were the most common cause of BO patients (63.49％),followed by cholangiocarcinoma (19.05％);the most common clinical manifestations of BO patients were jaundice (90.48％),abdominal pain (87.30％),and fever (53.97％);the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P ＜ 0.05),but there was no significant difference between CT and MRCP (P =1.000);compared with benign group,hemoglobin and albumin in malignant group were significantly lower,while total bilirubin and direct bilirubin were higher,with statistically significant difference (P ＜ 0.05).Most patients in BO patients improved after treatment,and the mortality rate of BO patients was 3.17％ (2/63) at the end of emergency visit.Conclusions Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients.The most common clinical manifestations of patients with emergency BO are jaundice,abdominal pain,and fever.Better than abdominal ultrasound,CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients.Anemia,hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients.Most patients can temporarily get better at the end of emergency visit.
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Objective To analyze the effect of Xuebijing injection on inflammatory response in patients after hepatobiliary and pancreatic surgeries, and to evaluate its safety and clinical value. Methods A retrospective cohort study was conducted. 708 patients received hepatobiliary and pancreatic surgeries of Nanfang Hospital, Southern Medical University from January 2015 to September 2017 were enrolled and divided into Xuebijing treatment group and conventional treatment group according to whether they were treated with Xuebijing injection or not. The inflammatory response indexes included white blood cell count (WBC), neutrophil (NE), C-reactive protein (CRP), body temperature, which were compared between the two groups at 1, 3, and 5 days after operation. The incidence of adverse reactions, the length of postoperative hospital stays and hospitalization costs were compared. Results A total of 209 patients were prescribed with Xuebijing injection, and 499 patients were allocated into conventional treatment group. The two groups were stratified by liver, biliary and pancreatic surgery types, and further 1:1 propensity score matching was performed. After propensity score match, 189 patients were included in each group, with 101, 46, and 42 patients undergoing liver, biliary, and pancreas surgery, respectively. There were no significant differences in baseline data such as gender, age and inflammatory response indexes before surgery between the two groups. In both groups, the WBC and NE showed a gradual decline after operation, CRP were increased gradually and then decreased after 3 days. Compared with the conventional treatment group, Xuebijing treatment group showed obvious anti-inflammatory effect from 3 days after operation [WBC (×109/L): 10.1±4.0 vs. 11.0±3.5, NE: 0.71±0.10 vs. 0.76±0.12, CRP (mg/L): 73.1±38.7 vs. 82.2±41.8, all P < 0.05]. On the 5th day, it still showed a strong anti-inflammatory trend [WBC (×109/L): 7.0±2.8 vs. 7.9±2.6, NE: 0.62±0.10 vs. 0.68±0.12, CRP (mg/L): 43.4±31.0 vs. 50.9±25.3, all P < 0.05]. The cases of postoperative fever in the Xuebijing treatment group were significantly less than that in the conventional treatment group (cases:98 vs. 119, χ2＝4.711, P＝0.029). There was no significant different in the total incidence of adverse drug reactions such as rash, nausea and vomiting (5.0% vs. 3.2%), the length of postoperative hospital stays [days: 9.3 (6.1, 13.5) vs. 9.1 (5.5, 13.3)] and hospitalization costs [wanyuan: 5.8 (3.6, 9.5) vs. 5.7 (3.5, 9.8)] between Xuebijing treatment group and conventional treatment group (all P > 0.05). Conclusions Xuebijing injection has a good anti-inflammatory effect on patients undergoing hepatobiliary and pancreatic surgeries. Xuebijing injection has good safety and can be applied to the prevention and treatment of excessive inflammatory reaction after hepatobiliary and pancreatic surgeries.
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Objective To identify the independent risk factors of surgical site infections (SSIs) for patients with cholelithiasis after biliary tract surgery.Methods 712 patients were enrolled from April 2010 to April 2015 in this study and their clinical data were retrospectively analyzed.There were 106 patients who developed SSIs.The risk factors of SSIs and their three subtypes (superficial incisional SSIs,deep incisional SSIs,and organ/space SSIs) were analyzed.The total hospitalization cost,length of hospitalization and patients who stayed over 30 days in hospital were compared between the group of patients with and without SSIs.Results Univariate analysis showed that SSIs were associated with diabetes,emergency operation,bile duct re-exploration,hepatectomy,positive bile bacteria culture,porta hepatis clamping,Ⅱ-Ⅳ grades of cholelithiasis,ASA Grade 3,BMI ＞ 30,hepatic function Grade B and protein level ＜ 30 g/L on hospital admission (all P ＜ 0.05).The results also indicated that superficial incisional SSIs,deep incisional SSIs and organ/space SSIs were correlated with emergency operation,bile duct re-exploration,hepatectomy,operation time,porta hepatis clamping,smoking,ASA score and protein level on hospital admission (all P ＜ 0.05).The total hospitalization expense,length of hospital stay and the number of patients hospitalized for over 30 days in the SSIs Group were significantly more than the non-SSIs Group (all P ＜ 0.05).Bile duct re-exploration,hepatectomy,positive bile bacteria culture and Ⅱ-Ⅳ grades of cholelithiasis were independent risk factors of SSIs on multivariate unconditional logistical regression analysis (all P ＜ 0.05).Conclusions Multiple factors in the perioperative period were involved in SSIs after bile duct surgery.Bile duct te-exploration,hepatectomy,positive bile bacteria culture and Ⅱ-Ⅳ grades of cholelithiasis were independent risk factors of SSIs.
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Objective To compare the function and influence of magnetic resonance cholangiopancreatography (MRCP) and T tube cholangiography before pulling out T tube after biliary tract surgery. Methods Clinical data from 248 patients with T tube drainage after biliary tract surgery bewteen January 2009 and June 2011 were retrospectively analyzed.Among them, the T tube cholangiography group was 195 cases, and MRCP group was 53 cases.Analyzed the function, the toxic side reaction and effect of prolonged hospitalization time of T tube cholangiography group and MRCP group,and discussed the diagnostic effect of MRCP before pulling out T tube after biliary tract surgery.Results Two groups of patients got distinct and integrated image of the bile ducts all.Compared with T tube cholangiography group, all 53 cases patients of MRCP group got accurate of diagnosis results, no fake positive results and adverse reaction occurred, and no prolonged hospitalization. Conclusion MRCP can replace T tube cholangiography as a means of diagnosis before removal of T tube.
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Objective To explore and analyse the causes of reoperation after biliary duct operation, so as to decrease the reoperation rate of biliary tract. Methods Clinical data of 71 patients who underwent reoperation of biliary duct diseases in our hospital between January 2005 to September 2010 were analysed,and the causes of biliary duct reoperation were summarized and analysed. Results The main cause of reoperation was recurrent or retained bile stone (76.1%,54/71), noncalculous stenosis of biliary tract ( 15.5 %, 11/71 ),biliary tract obstruction due to tumor (4.2%,3/71), and other factors (4.2%,3/71).Conclusion Recurrent or retained bile duct stone were the main cause for biliary reoperation, but noncalculous stenosis of biliary tract and biliary tract obstruction due to tumor could not be ignored. The initial rational operative method, approporiate operation time and the thoroughness of operation are the key factors to decrease bile duct reoperations.
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Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver trans-plant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur-ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenie bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation (P>0. 05). Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further en-hance the curative effect.
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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