ABSTRACT
Objective:To analyze the clinicopathological features of intraabdominal bronchogenic cyst.Methods:The clinical data of 8 patients with intraabdominal bronchogenic cyst admitted in 3 Grade-A tertiary hospitals in Yunnan province between 2014 and 2023 were retrospectively analyzed. The clinical and pathological features, diagnosis, treatment and prognosis of intraabdominal bronchogenic cyst were reviewed.Results:There were 1 male and 7 females with an mean age of 45±12 years (21-65 years). Two patients presented with abdominal pain and 5 asymptomatic patients were found during physical examination. The cysts were located in retroperitoneum in 4 cases, located between the pancreas tail, spleen and the posterior wall of the stomach in 2 cases, located in the posterior wall of the stomach in 1 case, and located close to left adrenal gland in 1 case. Two patients had elevated tumor markers, while tumor markers in the remaining 6 cases were normal. Seven cases underwent laparoscopic complete cyst resection and 1 case had open surgical resection. The wall of most cysts were lined with respiratory epithelium and composed of goblet cells or pseudostratified ciliated columnar epithelium. The wall of cysts was composed of fibrous connective tissue or smooth muscle bundles, and the cavity contained serous mucous glands. Two cases showed cartilage tissue and one showed the infiltration of large number of inflammatory cells. The mean follow-up time was 31±32 months (range 5-107 months), and no recurrence or metastasis was found during the follow-up.Conclusions:Abdominal bronchogenic cyst is often found in adulthood, and most cases are symptomatic and found during physical examination. The diagnosis mainly depends on pathological examination, and tumor markers are not specific for its diagnosis. Surgery is the best way for treatment.
ABSTRACT
Splenic hilar lymph node (LN) is the difficulty and focus of perigastric LN dissection during radical gastrectomy for advanced proximal gastric cancer (APGC). Although the new edition of Japanese Gastric Cancer Treatment Guidelines excluded the splenic hilar LN from the D2 lymphadenectomy in patients with APGC, there are still few high-level evidences. Meanwhile, the guideline recommends that splenectomy is still necessary for patients with APGC involving the greater curvature. With the support of increasing evidences, the spleen-preserving splenic hilar LN dissection has been recognized by more and more scholars. Additionally, the technique of laparoscopy provides a new method for splenic hilar LN dissection. Our center proposed a new technique named Huang′s three-step maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy, which not only reduces the difficulty of operation, but also makes the technique easier to popularize and with a significance of minimally invasive effect. During the clinical practice, the dissection of LNs behind the splenic portal vessels is also one of the controversies. Therefore, the difficult technique of splenic hilar LN dissection not only requires us to make a technical exploration, but also requires us to explore precise indications, in order to avoid unnecessary operation in patients who do not require dissection of the No.10 LNs and to avoid missing the opportunity for radical surgery in high-risk patients because of the difficult techniques.
ABSTRACT
As tumors originated from mesenchymal tissue, gastrointestinal stromal tumors (GIST) has its own typical history. For the idea of treatment for GIST at different historical periods, the role and value of surgery for the treatment of GIST keep changing. Laparoscopy and endoscopy will have the role they deserved. With the understanding of pathogenesis of GIST, targeted chemotherapy will be more and more accurate and individualized. How to improve the overall therapeutic effect of GIST, especially for the patients with the high risk and drug-resistance, is the dilemma and challenges for the surgeons.
ABSTRACT
Splenic hilar lymph node (LN) is the difficulty and focus of perigastric LN dissection during radical gastrectomy for advanced proximal gastric cancer (APGC).Although the new edition of Japanese Gastric Cancer Treatment Guidelines excluded the splenic hilar LN from the D2 lymphadenectomy in patients with APGC,there are still few high-level evidences.Meanwhile,the guideline recommends that splenectomy is still necessary for patients with APGC involving the greater curvature.With the support of increasing evidences,the spleenpreserving splenic hilar LN dissection has been recognized by more and more scholars.Additionally,the technique of laparoscopy provides a new method for splenic hilar LN dissection.Our center proposed a new technique named Huang's three-step maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy,which not only reduces the difficulty of operation,but also makes the technique easier to popularize and with a significance of minimally invasive effect.During the clinical practice,the dissection of LNs behind the splenic portal vessels is also one of the controversies.Therefore,the difficult technique of splenic hilar LN dissection not only requires us to make a technical exploration,but also requires us to explore precise indications,in order to avoid unnecessary operation in patients who do not require dissection of the No.10 LNs and to avoid missing the opportunity for radical surgery in high-risk patients because of the difficult techniques.
ABSTRACT
<p><b>OBJECTIVE</b>To explore clinical outcomes of buttress plating in treating posterior Pilon fracture by amodified posteromedial approach.</p><p><b>METHODS</b>From July 2014 to January 2015, 10 patients with posterior Pilon fracture were respectively analyzed, including 7 females and 3 males, aged from 31 to 54 years old. One patient were type , 3 patients were type IIand 6 patients were type III according to classification of Pilon fracture by YU Guang-rong. All patients were treated by buttress plating through amodified posteromedial approach. Postoperative complications, fracture healing and reduction were observed, AOFAS score were used to evaluate function recovery at 1 year after operation.</p><p><b>RESULTS</b>All patients were followed up for 12 to 18 months with an average of(14.1±3.2) months. All incisions were primarily healed at stage I without wound complication, neurovascular injuries or musculus flexor contracture. According to Burwell-Charnley imaging scoring, 8 patients got anatomical reduction and 2 patients got moderate reduction. All fracture got healing from 12 to 16 weeks with an average of(13.2±1.8) weeks. According to AOFAS score at 1 year after operation, 8 got excellent results and 2 moderate. All patients returned to work at about(4.7±1.4) months (ranged from 3 to 6 months) after operation.</p><p><b>CONCLUSIONS</b>Buttress plating using a modified posteromedial approach in treating posterior Pilon fractures is an effective method, has less complications, and could recovery early weight-bearing functional exercise.</p>
ABSTRACT
Total en bloc spondylectomy is a surgical technique cutting off tumors of spine and its satellite. Previous studies have shown that this technique could reduce postoperative recurrence rate of spinal tumor, but surgical indications are not unified. Wide application of spinal tumor surgical staging and life expectancy system make it more clear for surgery. However, it is difficult to carry out extensive operation for the characteristics of more bleeding, great difficulty and high risk. As for continuous improvement of TES technology, application of endoscopy and appearance of 3D printing artificial vertebral body could push the operation becoming mature.
ABSTRACT
<p><b>OBJECTIVE</b>To explore clinical effect of meta plate with cannulated screw fixation in treating Letenneur III lateral Hoffa fracture through posterolateral approach.</p><p><b>METHODS</b>From June 2012 to June 2016, 12 patients with Letenneur III lateral Hoffa fracture were treated with meta plate and cannulated screw fixation through posterolateral approach, including 8 males and 4 females;aged from 22 to 66 years with an average of 42 years old;and 5 cases on left side, 7 cases on right side. Preoperative and postoperative X-ray and CT were taken before and after operation to assess location of fracture and fracture healing. Letenneur scoring standard was used to evaluate clinical effects. All patients were treated with meta plate combined with cannulated screws.</p><p><b>RESULTS</b>All incisions healed at stage I. The fractures were healed from 11 to 32 weeks with an average of 17.2 weeks. No internal fixation loosening, displacement and necrosis of femoral condyle and deep vein thrombosis of lower extremity occurred. All patients were followed up from 8 to 24 months with an average of 12.8 months. At the latest follow-up, 7 cases got excellent results, 4 good and 1 moderate according to Letenneur scoring standard.</p><p><b>CONCLUSIONS</b>Posterlateral approach is easy to expose, meta plate fixation with cannulated screws has advantages of strong internal fixation, high fracture healing rate, early knee joint function exercise and good recovery of joint function.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Plates , Bone Screws , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Methods , Fracture Healing , Recovery of FunctionABSTRACT
Giant cell tumors(GCT) of bone is benign bone tumors with aggressive and osteolytic activity. As traditional treatment of GCT, removal of bone graft is disease with high local recurrence rate, and could reduce local recurrence by auxiliary means. Different surgical methods such as prosthesis replacement, wide resection and En-bloc resection could be selected for different parts of giant cell tumor of bone, based on the lesion location, size, extent of invasion, recurrence rate. For patients with special region of GCT of bone with removed incompletely and high surgical risk expected, arterial embolism could be performed. The application of bisphosphonates and denosumab are mainly used in treating recurrent, refractory, special parts, metastatic giant cell tumor of bone will bring new hope of treatment for giant cell tumor of bone, due to lower the recurrence rate. Chemotherapy is mainly used in the treatment of metastasis and malignant bone tumor. Radiotherapy for recurrent or unresectable bone giant cell tumor can control tumor progression, but there is the possibility of malignancy. While long-term follow-up studies and long-term results of applications of bisphosphonates and denosumab are lacking, new methods and development of new drugs are still be needed to treat patients with giant cell tumor of bone and also bring about more hope.
Subject(s)
Humans , Bone Neoplasms , Drug Therapy , General Surgery , Denosumab , Therapeutic Uses , Diphosphonates , Therapeutic Uses , Giant Cell Tumor of Bone , Drug Therapy , General Surgery , Neoplasm Recurrence, Local , Treatment OutcomeABSTRACT
Splenic hilar lymph node must be dissected in D2 dissection for advanced upper gastric cancer.With the advances of surgical technology and updated treatment concept,spleen-preserving splenic hilar lymph node dissection has been widely accepted and gradually carried out by surgeons.However,laparoscopic spleen-preserving splenic hilar lymph node dissection has become a technical difficulty of laparoscopic surgery for gastric cancer due to complex anatomy of splenic hilar vessels and exposed difficulty in splenic hilar region,especially in obese patients.Surgeons not only have skillful laparoscopic techniques but also know anatomic characteristics of splenic hilar vascular well,and reasonable surgical approach and programmed surgical procedures can guarantee successful laparoscopic spleen-preserving splenic hilar lymph node dissection.Meanwhile,with the development of laparoscopic spleen-preserving splenic hilar lymph node dissection,there is also some disputes about lymph node dissection.
ABSTRACT
Objective Evaluation of the effect ofYidanshu capsule combined with pancreatic duct jejunum anastomosis (Frey procedure) for elderly chronic pancreatitis with pancreatic duct dilatation.Methods A total of 84 patients with dysphagia after stroke who met the inclusion criteria were divided into 2 groups, 42 in each. Both groups were treated with frey procedure, and the observation group addedYidanshu capsule. Izbicki grading system was used to evaluate patients' clinical symptoms, the EORTC-QLQ-C30 scoring system to evaluate patients' quality of life. The serum levels of inflammatory cytokines was also used to evaluate the clinical efficacy. Results The total effective rate of observation group was 92.8% (39/42), and the control group was 76.2% (32/42). The difference was statistically significant (Z=3.561,P=3.561). After treatment, abdominal pain (0.4 ± 0.1 vs. 1.3 ± 0.2,t=3.672), nausea and vomiting (0.3 ± 0.0vs. 1.0 ± 0.1,t=4.001), Abdominal distension (1.2 ± 0.1vs. 2.0 ± 0.2,t=3.752), weak (0.4 ± 0.1vs. 1.4 ± 0.1,t=4.282) scores in the observation group were significantly lower than the control group (P<0.05). The role function (87.4 ± 9.1vs.70.6 ± 7.0,t=3.459), the body function (70.5 ± 7.2vs. 61.5 ± 6.2,t=4.316), emotional function (79.1 ± 7.7vs. 65.8 ± 6.3,t=3.671), social function (80.3 ± 8.1vs. 69.1 ± 6.2,t=3.773) scores in the observation group were significantly higher than the control group (P<0.05). The serum TNF-α (0.71 ± 0.13 ng/mlvs. 1.02 ± 0.15 ng/ml,t=3.652), IL-8 (1.94 ± 0.1 ng/mlvs. 4.51 ± 0.54 ng/ml,t=3.367), hs-CRP (1.01 ± 0.14 mg/Lvs.2.15 ± 0.29 mg/L,t=3.701) levels in the observation group were significantly lower than the control group (P<0.05).Conclusions TheYidanshu capsule combined with pancreatic duct jejunum anastomosis can improve the clinical curative effect of elderly patients with chronic pancreatitis with pancreatic duct expansion, relieve the clinical symptoms and inflammation, and improve the quality of life.
ABSTRACT
Objective Evaluation of the effect ofYidanshu capsule combined with pancreatic duct jejunum anastomosis (Frey procedure) for elderly chronic pancreatitis with pancreatic duct dilatation.Methods A total of 84 patients with dysphagia after stroke who met the inclusion criteria were divided into 2 groups, 42 in each. Both groups were treated with frey procedure, and the observation group addedYidanshu capsule. Izbicki grading system was used to evaluate patients' clinical symptoms, the EORTC-QLQ-C30 scoring system to evaluate patients' quality of life. The serum levels of inflammatory cytokines was also used to evaluate the clinical efficacy. Results The total effective rate of observation group was 92.8% (39/42), and the control group was 76.2% (32/42). The difference was statistically significant (Z=3.561,P=3.561). After treatment, abdominal pain (0.4 ± 0.1 vs. 1.3 ± 0.2,t=3.672), nausea and vomiting (0.3 ± 0.0vs. 1.0 ± 0.1,t=4.001), Abdominal distension (1.2 ± 0.1vs. 2.0 ± 0.2,t=3.752), weak (0.4 ± 0.1vs. 1.4 ± 0.1,t=4.282) scores in the observation group were significantly lower than the control group (P<0.05). The role function (87.4 ± 9.1vs.70.6 ± 7.0,t=3.459), the body function (70.5 ± 7.2vs. 61.5 ± 6.2,t=4.316), emotional function (79.1 ± 7.7vs. 65.8 ± 6.3,t=3.671), social function (80.3 ± 8.1vs. 69.1 ± 6.2,t=3.773) scores in the observation group were significantly higher than the control group (P<0.05). The serum TNF-α (0.71 ± 0.13 ng/mlvs. 1.02 ± 0.15 ng/ml,t=3.652), IL-8 (1.94 ± 0.1 ng/mlvs. 4.51 ± 0.54 ng/ml,t=3.367), hs-CRP (1.01 ± 0.14 mg/Lvs.2.15 ± 0.29 mg/L,t=3.701) levels in the observation group were significantly lower than the control group (P<0.05).Conclusions TheYidanshu capsule combined with pancreatic duct jejunum anastomosis can improve the clinical curative effect of elderly patients with chronic pancreatitis with pancreatic duct expansion, relieve the clinical symptoms and inflammation, and improve the quality of life.
ABSTRACT
Although the function of the anterolateral stabilizing structures of the knee in the anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take the anterolateral structure into consideration when performing an ACL reconstruction. Anatomic ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have paid attention to the anterolateral aspects of the knee, especially the anterolateral ligament. We don't know the best time to perform ACL and ALL reconstruction. And we lack the evidence to prove which technique is the best one. So we look forward to more random controlled trial.
ABSTRACT
Objective:To discuss the therapy for ureteral endometriosis.Methods:The clinical data of 25 cases of histopathologically confirmed ureteral endometriosis during 2001 -2015 were retrospectively analyxed.Results:In the 25 cases,all the patients took urinary ultrasound for examination before sur-gery,of whom 21 (84%)were examined by CT and 5 (20%)by MRI.Three (12%)cases underwent preoperative KUB and intravenous pyelogram (IVP)examination.Four (16%)cases were examined by retrograde pyelography before surgery.Eight (32%)of them took cystoscope for examination and 11 (44%)took preoperative radionuclide renal dynamic imaging examination.All of these cases were affec-ted with unilateral ureter,13 (52%)in the right and 12 (48%)in the left.The ureter lesions were at the upper part in 21 (84%)cases and at the middle part in 4 (16%)cases.In these cases,11 (44%) received partial ureteral resection and end-to-end ureteral anastomosis,10 (40%)received partial ure-teral resection and ureterocystoneostomy,3 (12%)received retroperitoneal laparoscopic nephroureterec-tomy,and 1 (4%)received endoscopic resection of ureteral endometriosis lesion.All of these cases were confirmed with ureteral endometriosis by post-surgery pathology results,with the expression of CA125 and ER in the glandular tissue and expression of PR in the mesenchymal tissue inside the ureteral muscle de-tected by immunohistochemistry.Four (16%)cases took postoperative adjuvant hormonal therapy.And no recurrence was found among 16 (64%)cases with the successful follow-up which ranged from 3 to 76 months and the median follow up was 28 months.Fifteen cases were submitted to the follow-up by urinary ultrasound (93.8%)and 5 (31.3%)underwent CT for examination.All the cases relieved from hydro-nephrosis,and symptoms of 10 (63.5 )cases disappeared.The cases with double-J stent all had the stent removed within 3 to 6 weeks.Conclusion:Surgical procedures should be considered as the main therapy for ureteral endometriosis.We recommend ureterolysis for patients with mild ureteral obstruction and hydronephrosis.As for those with moderate and severe ureteral obstruction and hydronephrosis,we recommend partial ureteral resection.When the situation comes to patients with little renal function of the affected side,the recommended management is nephroureterectomy.
ABSTRACT
Pancreatic adenosquamous carcinoma is a rare exocrine pancreatic cancer,and surgical treatment is the only promising method in survival time extension and life quality enhancement.In July 2013,1 patient with pancreatic adenosquamous carcinoma and sarcomatoid change was admitted to the Shaoxing People's Hospital.A cauda pancreatis cystic nidus was detected by computed tomography 1 year ago,and no any other clinical symptoms were detected.The left upper quadrant of the patient was glutted and unwell,and the levels of CA19-9 and CA125 were 3 630 kU/L and 645 kU/L,respectively.The results of computed tomography and magnetic resonance imaging showed that a huge cystic and solid tumor was located between the cauda pancreatis,the stomach and the spleen;the tumor was mainly cystic and rooted in the tail of the pancreas;the spleen,stomach and surrounding tissues were infiltrated by the tumor.The results of postoperative pathological examination showed that the tumor was pancreatic adenocarcinoma with squamous epithelial differentiation and sarcomatoid change;the invasive squamous carcinoma dominated stomach wall,and the sarcomatoid change dominated spleen and lymph nodes with partial squamous epithelial differentiation and surrounding lymph nodes metastases.Although the surgical resection was complete and the postoperative thymosin injection and traditional Chinese medicine were implemented,tumor recurred at postoperative month 5,and the patient was dead due to cachexia and pernicious anemia at postoperative month 8.The prognosis of patients with pancreatic adenosquamous carcinoma is poor,early detection and surgery are key points for curative effect enhancement.
ABSTRACT
Objective To evaluate surgical therapies for chronic pancreatitis.Method The clinical data of 229 patients admitted for chronic pancreatitis during March 2009 to November 2013 in our hospital was retrospectively analyzed,different operation method and their clinical outcome were compared.Results Drainage operations or resection operations were made to all these 229 patients according to different types.57 patients underwent longitudinal pancreaticojejunostomy (LPJ procedure).118 patients received local resection of the head of pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure in 105 cases,Berne procedure in 6 cases,Beger procedure in 7 cases).7 patients received pancreaticoduodenectomy,21 patients received distal pancreas resection,26 patients received other procedures.Post-operative pain relief rate was 89.3％,overall morbidity was 19.6％.Conclusions In cases of chronic pancreatitis,different surgical types are adopted according to their individual indications.Operation in accordance with pathological types guarantees clinical outcome.
ABSTRACT
Objective To analyze the surgical treatment of pancreatic duct stones.Methods The clinical data of 46 patients with pancreatic duct stones treated in our hospital from January 2008 to January 2013 were retrospectively analyzed.Results The most common symptoms were abdominal pain in 42 patients,diarrhea in 4 patients,diabetes in 6 patients,increased level of amylase in 4 patients,high level of CA19-9 in 9 patients and concomitant pancreatic cancer in 5 patients.4 patients had history of acute pancreatitis.All patients were diagnosed with pancreatic duct stones by preoperative imaging.The stones were located in the head of the pancreas in 21 cases,in pancreatic body and tail in 17 cases,and in the whole length of the pancreas in 8 cases.7 cases had single stone,28 cases had 2 to 3 stones,and 11 cases had more than three stones.21 cases had stones with a maximum diameter more than 1.0 cm,and 25 cases with a maximum diameter less than 1.0 cm.Pancreatic lithotomy plus pancreaticojejunostomy was performed in 33 cases,pancreatoduodenectomy in 8 and resection of the body and tail of pancreas plus splenectomy in 5 cases.6(13.0％) patients had postoperative complications,and there was no mortality.3(6.5％) patients had postoperative residual stones.39 cases were followed up with follow-up time ranging from 3 months to 57 months.Pain relief rate was 85.7％,Stone occurred in 2 (4.3％) patients.Conclusions Surgery is an important treatment for pancreatic duct stones,and treatments should be adopted based on the situations of individual patients.
ABSTRACT
Objective To investigate the clinical efficacy of surgery treatment of benign prostatic hyperplasia in elderly patients.Methods 60 elderly patients with prostatic hyperplasia aged 80 years and over were admitted in our hospital from January 2005 to January 2009.56 cases were treated with transurethral plasmakinetic resection of benign prostatic hyperplasia,and 4 cases were treated with suprapubic prostatic hyperplasia enucleation.IPSS score,residual urine volume and maximum urinary flow rate (Qmax) in all patients were compared between pre-and post-surgery.Results 60 cases of patients were operated successfully without significant intraoperative capsular perforation,ureteral orifice and urethral sphincter injury.IPSS scores and residualurine volume were significantly less after surgery than before surgery [(20.3 ± 3.7) vs.(11.5 ± 2.1),(85.1 ± 13.0) ml vs.(37.7±7.9) ml,t=16.02,24.14,both P＜0.05].The maximum flow rate Qmax was significantly higher after surgery than before surgery[(8.7 ± 2.1) ml/s vs.(14.9 ± 3.2) ml/s,t =12.55,P＜0.05].All patients were followed up for 6-12 months.No incontinence and recurrence of benign prostatic hyperplasia were found.Conclusions Transurethral plasmakinetic resection for treatment of benign prostatic hyperplasia is safe and effective in elderly patients,with a low recurrence rate,and is worthy of promoting.
ABSTRACT
Objective To investigate the surgical management of Crohn's disease complicated with duodenal fistula.Methods The clinical data of 1 012 patients with Crohn's disease who were admitted to the Nanjing General Hospital of Nanjing Military Connnand from January 2002 to January 2014 were retrospectively analyzed.Of the 1 012 patients,22 were complicated with duodenal fistula,including 12 with ileocolonic anastomosis-duodenal fistula,7 with colo-duodenal fistula,2 with sigmoido-duodenal fistula and 1 with duodeno-enteric fistula.All patients received duodenal fistula repair + resection of diseased intestine.Patients were followed up via out-patient examination,phone call and email till May 2014.The condition of patients before and after enteral nutrition support was compared using the t test.Non-normal data were analyzed using the Mann-Whitney u test.Results Two patients with abdominal infection and 1 with gastrointestinal bleeding received emergent operation,and the other 19 patients received enteral nutrition support prior to operation.Three patients received emergent colostomy.Two patients had fistula at the duodenal anastomosis,and 1 patient was cured by enteral nutrition support + drainage for 12 days and the other 1 received reoperation.The energies provided by enteral nutrition and enteral + parenteral nutrition were (25.3 ± 2.1) cal/g and (28.5 ± 3.2) cal/g,respectively,and the time for nutrition support was (31 ± 5)days.The level of C-reaction protein and Crohn's disease activity index were decreased from 25 mg/L and 207 ± 111 before treatment to 2 mg/L and 117 ± 71 after treatment,with significant difference (u =53.000,t =0.942,P ＜ 0.05).The levels of body mass index,albumin and blood sedimentation rate were (17.0 ± 2.1) kg/m2,(35 ± 5) g/L and 26 mm/h before treatment,and (17.9 ± 2.8) kg/m2,(38 ± 5) g/L and 23 mm/h after treatment,with no significant differences (t =0.482,1.170,u =67.500,P ＞ 0.05).One patient was cured by enternal nutrition.Five patients received intestinal stoma and the other 13 patients received intestinal anastomosis.Twenty-two patients were followed up with the median time of 13.4 months (range,4.0-37.0 months).One patient had recurrence of ileocolonic anastomosis-duodenal fistula and received reoperation,and complications were not observed in the other 21 patients.Conclusions Selective operation is recommended for patients with Crohn's disease complicated with duodenal fistula.Enteral nutrition support is the first choice during the interoperative management.Resection of diseased intestine combined with repair of duodenal fistula after alleviation of Crohn's disease and malnutrition could achieve satisfactorv effect.
ABSTRACT
Treatment for Crohn's disease usually involves medication,however,with chronic intestinal inflammation,damaged intestine become fibrotic and finally resulted in bowel obstruction,which need surgical management.In recent years,the basic research,diagnosis and treatment of Crohn's disease have made tremendous progress.Under the new treatment strategies and technical conditions,surgical technologies and concepts for bowel obstruction caused by Crohn's disease have been markedly changed.Surgeons should cooperate with clinicians from the departments of gastroenterology,endoscopy,imaging examination and pathology,and the indications and timing for surgical treatment should be strictly controlled.Damage control surgery,fast track surgery and laparoscopic surgical techniques have also been commonly used,which are effective for improving the efficacy of surgical treatment of bowel obstruction caused by Crohn's disease.
ABSTRACT
Objective To investigate the surgical procedure selection for chronic pancreatitis.Methods The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed.Thirty-eight patients were with or without pancreatic duct stone,and the dilation of the pancreatic duct was above 7 mm,44 patients were with common bile duct dilation,32 patients were with inflammatory mass in the head of the pancreas,and 3 patients were with splenomegaly and esophagogastric varices.Surgical procedures were selected according to the symptoms and results of imaging examination.The remission or recurrence of pain was judged according to the visual analog scales.Patients were followed up via out-patient examination,mail or phone call till December 2013.Results Choledochojejunostomy was done on 27 patients,Partington-Rochelle pancreaticojejunostomy on 24 patients,PartingtonRochelle pancreaticojejunostomy + choledochojejunostomy on 6 patients,pancreaticoduodenectomy on 7 patients,resection of the body and tail of the pancreas on 4 patients,Beger's procedure on 3 patients,splenectomy on 3 patients,Frey's procedure + fenestration of bile duct in the head of the pancreas on 3 patients,Frey's procedure on 2 patients,common bile duct exploration + T tube drainage on 1 patient.The remission rate of abdominal pain was 95.2％ (60/63).One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively.Three patients were complicated with abdominal infection,2 with pancreatic fistula,1 with biliary fistula and 1 with abdominal bleeding.All the complications were cured by conservative treatment.Seventy-nine patients were followed up,and the mean time of follow-up was 58.6 months (range,4-156 months).Thirty patients had recurrence or new onset of abdominal pain,and the recurrence rate was 38.0％ (30/79).Of the 32 patients with inflammatory mass in the head of the pancreas,17 received choledochojejunostomy,and the recurrence rate of abdominal pain was 9/17 ; the other 15 patients received pancreatoduodenectomy,Beger' procedure or Frey's procedure,and the recurrence rate of abdominal pain was 1/15.Of the 41 patients without inflammatory mass,10 received choledochojejunostomy,and the recurrence rate of abdominal pain was 7/10; 30 received PartingtonRochelle pancreaticojejunostomy,and the recurrence rate of abdominal pain was 33.3％ (10/30).Conclusions Complete drainage could relieve the symptoms for patients with pancreatic duct dilation.Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.