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Objective To explore the curative effect and prevention of complications of emergency laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods The clinical data of 1 278 patients with acute cholecystitis who were treated with emergency laparoscopic cholecystectomy from July 2004 to July 2010 in our haspital were collected and analyzed retrospectively.Among these patients,471 cases had mild acute cholecystitis,720 cases had acute suppurative cholecystitis and 87 cases had acute gangrenous cholecystitis.The impaction of stones in the neck of gallbladder was present in 823 cases.The impaction of stones in the cystic duct was present in 157 cases.In 96 cases emergency operation was performed within 48 hours after the synptoms occurred,in 799 cases operation was performed from 48 to 72 hours,and in 383 cases operation was undertaken after 72 hours.Results The mean operation time was 40min(20-90 min) and the mean blood loss was 80ml(20-300 mL).Early postoperative fever(38.0～39.5℃) developed in 375 cases.Temporary jaundice was found in 108 cases.Bile leakage occurred in 17 cases.No LC cases were converted to open cholecystectomy.No cases were complicated with bile duct injury and there was no mortality.Conclusions Emergency laparoscopic cholecystectomy for acute cholecystitis is difficult.The probable complication rate is quite high.Severe complications can be avoided with skillful surgical technique and rich operative experience.Acute cholecystitis is not a contraindication for emergency laparoscopic cholecystectomy.
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Objective To study the effect of recombinant antibody HBsAg-Fab of hepatitis B virus(HBV) to block hepatitis B reinfection after liver transplantation.Methods The functional efficiency of antibody Fab in blocking hepatitis B reinfection after LT was analysis and studied by vitro infection test,complement toxicity assay and virus infection test,calculated the antibody absorption rate and cell death rate and cell infection rate,Results When the group with and the group without recombinant antibody Fab were compared,the antibody absorption rate,cell death rate and cell infection rate between the 2 groups showed sigificant defference(P
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Objective To explore the prophylaxis and treatment strategies for psychic syndrome in patients after piggyback liver transplantation.Methods The data on the etiology,treatment outcome and prognosis of psychic syndrome occurring in 45 of 235 patients who had piggyback liver transplantation were retrospectively analyzed.Results The incidence of psychic syndrome complication was 19.1%(45/235),22 cases presented as mania(48.9%),5 cases as tristimania(11.1%),3 cases as hallucinosis(6.7%),1 case as suicidal tendency(2.2%),1 case as metamorphopsia(2.2%),8 cases as angst insomnia(17.8%),2 cases as maladjusted disturbance(4.4%),3 cases as affective disturbance(6.7%),and the majority presented as delirious alienation.All the cases were cured,except 1 case of coma,who was confirmed by CT to have intracranial hemorrage,died after failure of resuscitation.Conclusions The incidence of psychic syndrome in patients after piggyback liver transplantation is relatively high.However,most cases have mild symptoms and the prognosis is fine.When the patients have psychogenic symptoms,the prognosis of patients can be improved by some symptomatic treatment strategies directed to their different clinical manifestations.
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Objective To explore the effect of exposure of the recurrent laryngcal nerve(RLN) in prevention of RLN injury during thyorid surgery.Methods The clinical data of 810 cases of thyroid operation in which the RLN was exposed in 252 cases(group A) and was unexposed in 558 cases(group B) were analyzed.Results Although the extent of thyroid resection was greater in group A than in group B,the rate of RLN injury in group A(1.19 %) was significantly lower than that of group B(3.05 %,P
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Objective To study the choice of initial operative approach for thyroid nodule and the necessity of reoperation after local excision of differentiated thyroid cancer.Methods Clinical data of 138 patients with differentiated thyroid cancer after local tumor excision had reoperation at our hospital during a period of four year were retrospectively reviewed.All the reoperations were bilateral thyroidectomy and cervical lymph node excision.Results There were 76.8% patients with residual cancer in thyroid and cervical lymph node.There were 23 patients(16.7%) with recurrent laryngeal nerve injury that included 22 cases with unilateral and 1 case with bilateral injury after the initial operation,and 19 of the 23 patients with recurrent laryngeal nerve injury recovered after nerve repair.After thyroid reoperation,3 cases(2.2%) had recurrent laryngeal nerve injury,2 cases(1.4%) had partial parathyroid gland injury,2 cases(1.4%) had superior laryngeal nerve injury,but there were no cases of esophageal injury or postoperative bleeding.Conclusions The incidence of residual cancer is high after local excision for differentiated thyroid cancer,therefore,reoperation with bilateral thyroidectomy and cervical lymph node excision is necessary.
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Objective To explore the cause and prevention of skin flap necrosis after radical operation for breast cancer and reduce the incidence of skin flap necrosis.Methods The data of 158 patients with breast cancer who had surgical treatment were analysed.The data included the thickness of the skin flap,tension of the skin flap,and the mode of the operation and their relation with necrosis of the skin flap.Results Among the 158 operated cases,32 cases(20.25%) had skin flap necrosis.The incidence of the flap necrosis in the thick skin flap group was lower than in the thin skin flap group(10.87%vs28.95%,P
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Objective To analyze the clinical significance of modified thyroidectomy by trans-isthmus approach.Methods The clinical data of 5 751 patients who underwent thyroidectomy from Jan.1996 to Jan.2006 were retrospectively analyzed.All cases were divided into two groups.The modified operation group(n=3288) was treated by trans-isthmus thyroidectomy.Another group(n=2463) was treated by routine approach.The operation time,bleeding volume,and complications were observed and compared.Results In modified operation group,the mean operation time,bleeding volume,temporary injury of recurrent laryngeal nerve,tracheal discomfort,and hypocalcemia were significantly decreased than those in routine approach group(P
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Objective To investigate the arterial blood supply of the pancreas head and provide a theoretical basis for the gastroduodenal artery reconstruction in pancreatic transplantation(PT).Methods Photograms of digital subtraction artery(DSA)which performing on 300 patients were analyzed to recognize the aberrations of arterial blood supply of pancreatic head.Results In 300 DSA photograms,the gastroduodenal artery(GD.a)was identified in 131 cases,and the anterior superior pancreaicduodenal artery(ASPD.a)and posterior superior pancreaicduodenal artery(PSPD.a)in 79 cases.The rate of aberrant origin of pancreatic transverse artery(PT.a)from GD.a was 12.98℅.There are some minor sources of blood supply to the pancreas head from GD.a.The rate of absence of an ASPD.a-AIPD.a anastomosis and PSPD.a-PIPD.a anastomosis was 15.19℅and 24.05℅,respectively.Conclusions The reconstruction of gastroduodenal artery can ensure a complete blood supply to the pancreatic head and duodenum in PT.
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Objective To study the effect of exposure of recurrent laryngeal nerve(RLN) in prevention of RLN injury during thyroid surgery under general anesthesia.Methods The clinical data of 389 patients who underwent thyroid operations under general anesthesia were retrospectively reviewed.The RLN was exposed in 163 cases and was not exposed in 226 cases.Results Two cases(1.10%) suffered from temporary RLN injury in exposure group and 12 cases(5.30%) suffered from RLN injury in non-exposure group(temporary nerve injury in 7 cases and permanent nerve injury in 5 cases)(P
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Objective To investigate the clinical significance of the treatment of intrahepatic bile duct stones with fiber choledochoscope combined with intraoperative ultrasound.Methods The clinical data of 185 cases with intrahepatic bile duct stone were analysed retrospectively,included 96 cases with stone removal by fiber choledochoscope intra-and post-operatively(choledochoscope group),and 89 cases with stone removal by fiber choledochoscope combined with intraoperative ultrasound(combined group).Results The rateo of bile duct retained stones in choledochoscope group(9.38%) was higher than that in combined group(2.08%)(P=0.041),and the rate of bile duct recurrent stones in choledochoscope group(12.34%) was higher than that in combined group(3.61%)(P=0.036).There was no significant differences between the two groups in the occarrence of cholangitis(P=0.087),but 3 cases of severe cholangitis required re-operation in choledochoscope group.Conclusions Fiber choledochoscope combined with intraoperative ultrasound can decrease the rate of bile duct retained stones and bile duct recurrent stones,and can improve the therapeutic effect.
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Objective To study the prevention and management of early post-cholecystectomy jaundice.Methods The dinical data of 43 cases of jaundice occurring within one week after simple open cholecystectomy in 11 226 cases were retrospectively analyzed.Results The incidence of jaundice at one week after operation was 0.38% in simple open cholecystectomy,among them,medical jaundice accounted for 18 cases,and surgical jaundice for 25cases.Ultrasound,ERCP,MRCP,liver enzyme profile and reoperation confirmed the folowing: Extra-hepatic bile duct or the right hepatic duct was ligated in 9 cases,common bile duct residual stone in 6,partial gallbladder or gallbladder duct stone in 4,biliary leak in 4,cholangitic hepatitis in 4,hepatitis B or posthepatitis cirrhosis in 5,icterus after blood transfusion in 2,hemobilia in 2,ligation of right branch of hepatic artery in 2,and icterus of unknown causes in 5 cases.Reoperation was done in 8 cases,with one mortality.Conclusions Detailed case history,adequate examination before operation,and careful operative technique are the essential prerequisites to prevent early post-cholecystectomy jaundice.Early post-cholecystectomy jaundice should be treated according to the different causes.
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Objective To explore the operation methods,intraoperative treatment,measures for prevention and treatment of complications of laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods Two hundred and serenty-two patients with acute cholecystitis from March 2003 to April 2007 were analyzed retrospectively.We performed total laparoscopic cholecystectomy in 260 cases and subtotal laparoscopic cholecystectomy with cholecystomucoclasis of remnant gallbladder in 12 cases.Results None of 272 cases was converted to open operation.There was no mortality,and no bile duct injury or major bleeding.Conclusions Laparoscopic cholecystectomy is a safe and effective method for acute cholecystitis and it has the advantages of minimal trauma,quick recovery and less blood loss.
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Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.
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Objective To study the causes of reoperation after biliary duct operation, in order to decreasing the rate of biliary tract reoperation. Methods The clinical data of 828 patients who underwent reoperation of biliary duct diseases in Nankai hospital between 1990-1999 were evalated, and the causes of biliary duct reoperation were classified and analysed.Results The most common cause for reoperation was recurrent or retained bile stone(65.10% ), bile stone companied by stenosis of the sphincter of oddi (33.82%), simple stenosis of sphincter of Oddi ( 9.54%), traumatic stricture of bile duct and stricture of bilioenteric anastomosis( 10.39%), bile duct obstruction due to tumor (6.52%), and other less important factors. Conclusions Recurrent or retained bile duct stone was the main cause for biliary reoperation,and stenosis of the sphincter of Oddi was the next important factor for reoperations.Thoroughness of the initial operation and rationality of operative procedure are the chief factors to decrease bile duct reoperations.
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Objective To explore the relation of recurrent laryngeal nerve damage with the mode of surgery and exposure of the nerve in thyroidectomies.Methods We retrospectively reviewed the clinical data of 2142 thyroidectomy patients.There were 540 unilateral and 1602 bilateral procedures with 3744 nerves at risk of injury.Among them,1986 nerves were explored and indentified,and 1758 nerves were not exposed.Results The overall incidence of recurrent laryngeal nerve injury was 0.93%(20/2142),and with an incidence of 0.37%(8/2142)for permanent damage.The injury incidence in the nerves exposure and non-exposure groups was 0.30% and 0.80%,respectively,the difference was significant between the two groups(P0.05).Conclusions The occurrence of recurrent laryngel nerve injury can be reduced or avoided by its careful exposure and identification during thyroid operation.