Prognostic analysis of continuous lumbar cistern external drainage after aneurysmal subarachnoid hemorrhage / 国际外科学杂志

Objective:To analyze the influencing factors, prevention and treatment strategy of short-term poor prognosis of continuous lumbar cistern external drainage after aneurysms subarachnoid hemorrhage (aSAH).Methods:Used retrospective research method, the clinical data of 300 patients with aSAH combined with continuous lumbar cistern external drainage treated in Sanya Central Hospital (Hainan Third People′s Hospital) from March 2019 to March 2021 were selected as the training set. In addition, the clinical data of 144 patients with aSAH with continuous lumbar cistern external drainage treated in Sanya Central Hospital (Hainan Third People′s Hospital) from March 2017 to May 2019 were selected as the verification set. According to the results of postoperative follow-up, the patients in the training set were divided into two groups: good prognosis group ( n=208) and poor prognosis group ( n=92). The demographic characteristics, past history, Hunt-Hess grade, modified Fisher grade, location of responsible aneurysm, postoperative complications, bone flap decompression and lumbar cistern drainage were compared between the two groups. The independent risk factors for prognosis of aSAH patients undergoing continuous lumbar cistern external drainage were screened by Cox proportional hazard regression model, and these factors were included and XGboost model was established. The prediction model was validated internally and externally in the training set and verification set: AUROC(C-index) was used to verify the model differentiation; GiViTI calibration band and Hosmer-Lemeshow test were used to verify the model calibration; DCA curve was used to verify the clinical validity of the model. Results:Hunt-Hess grade, modified Fisher grade, drainage duration, average daily drainage volume, shunt-dependent hydrocephalus, aneurysm rebleeding, cerebral vasospasm and delayed cerebral ischemia were independent risk factors for poor prognosis in patients with aSAH who underwent continuous lumbar cistern external drainage( P<0.05). The XGboost model was successfully established by incorporating the above independent risk factors, and the internal and external verification of the XGboost model was carried out in the training set and verification set, respectively, the area under the curve of receiver operating characteristic was 0.882(95% CI: 0.820-0.955) and 0.878(95% CI: 0.774-0.928) respectively, and the model differentiation was good; the 80%-90% confidence interval of the GiViTI calibration curve did not cross the 45° angle bisector ( P>0.05). In the Hosmer-Lemeshow goodness-of-fit test, the P value were 0.581 and 0.716, respectively. The threshold probability value in the DCA curve was 30.4%. The clinical net benefit rate of the training set and verification set were 31% and 34%, respectively, indicating that the prediction model was clinically effective. Conclusions:The independent risk factors for poor prognosis of aSAH patients undergoing continuous lumbar cistern drainage are Hunt-Hess grade, modified Fisher grade, cerebral vasospasm, delayed cerebral ischemia and shunt-dependent hydrocephalus. The XGboost model constructed in this study can effectively predict the prognosis of patients with aSAH undergoing continuous lumbar cistern drainage, and provide reference for the formulation of follow-up treatment plans.

Pancreatic duct stenting and postoperative pancreatic fistula after pancreaticoduodenectomy / 中华普通外科杂志

Objective@#To study the correlation between pancreatic duct stent placement and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy.@*Methods@#We performed a retrospective review on 298 patients who underwent pancreaticoduodenectomy from Jan 2011 to Dec 2016. Patients were divided into none stent group, external stent group and internal stent group according to the placement and drainage of the pancreatic duct stent.@*Results@#There were 60 cases in none stent group, 103 cases in external stent group and 135 cases in internal stent group. Altogether there were 52 cases suffering from biochemical pancreatic fistula, 52 cases of grade B fistula and 9 cases of grade C pancreatic fistula. There were three factors with statistical significance: 1, the operative method (χ2=20.947, P=0.000), 2, the diameter of main pancreatic duct (χ2=8.662, P=0.013), and 3, the intraoperative blood loss (χ2=14.03, P=0.001). There were no statistical significance difference between no stenting group and external/ internal stent group in the incidence of pancreatic fistula (P>0.05). The difference between internal stent group and external stent group was of statistical significance (χ2=9.948, P=0.019). The incidence of clinically relevant pancreatic fistula in external stent group was lower than the internal stent group (14.5% vs. 26.6%)(χ2=9.777, P=0.002).@*Conclusions@#The pancreatic duct stenting is not a risk factor for pancreatic fistula. The external drainage of pancreatic juice is associated with a lower incidence of pancreatic fistula compared to the internal drainage.

Pancreatic duct stenting and postoperative pancreatic fistula after pancreaticoduodenectomy / 中华普通外科杂志

Objective To study the correlation between pancreatic duct stent placement and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy.Methods We performed a retrospective review on 298 patients who underwent pancreaticoduodenectomy from Jan 2011 to Dec 2016.Patients were divided into none stent group,external stent group and internal stent group according to the placement and drainage of the pancreatic duct stent.Results There were 60 cases in none stent group,103 cases in external stent group and 135 cases in internal stent group.Altogether there were 52 cases suffering from biochemical pancreatic fistula,52 cases of grade B fistula and 9 cases of grade C pancreatic fistula.There were three factors with statistical significance:1,the operative method (x2 =20.947,P =0.000),2,the diameter of main pancreatic duct (x2 =8.662,P =0.013),and 3,the intraoperative blood loss (x2 =14.03,P =0.001).There were no statistical significance difference between no stenting group and external/ internal stent group in the incidence of pancreatic fistula (P ＞ 0.05).The difference between internal stent group and external stent group was of statistical significance (x2 =9.948,P =0.019).The incidence of clinically relevant pancreatic fistula in external stent group was lower than the internal stent group (14.5％ vs.26.6％)(x2 =9.777,P =0.002).Conclusions The pancreatic duct stenting is not a risk factor for pancreatic fistula.The external drainage of pancreatic juice is associated with a lower incidence of pancreatic fistula compared to the internal drainage.

Clinical study of continuous external drainage combined with intrathecal infusion of urokinase in prevention and treatment of cerebral vasospasm after aneurysm / 中国生化药物杂志

Objective To explore the persistent cerebrospinal fluid drainage and intrathecal injection of urokinase in prevention and treatment of cerebral vasospasm after aneurysm surgery.Methods The effect of prevention and treatment of cerebral vasospasm after aneurysm surgery in 40 patients, using the method combined with intrathecal injection of urine kinase for persistent cerebrospinal fluid drainage, and classified as the observation group;the other 40 cases patients with persistent cerebrospinal fluid drainage intervention, and classified as the control group, two groups of patients were in Shandong Provincial Hospital from January 2016 to January 2017.Results The incidence of rebleeding in two groups had no significant difference in observation of cerebral vasospasm in patients with the incidence was significantly lower than the control group, the observation The incidence of cerebral vasospasm group was 15.0%, 37.5% in the control group, compared two groups of patients with the prognosis, the obvious observation group of patients with good prognosis, comparison between groups showed significantly(P<0.05).Conclusion Persistent cerebrospinal fluid drainage and intrathecal injection of urokinase on the clinical study of postoperative cerebral vasospasm aneurysm found the simple, compared with continuous drainage of cerebrospinal fluid, can improve the clinical condition of patients, and promote the recovery of patients, reduce cerebral vascular spasm, so it is worthy of reference.

Clinical analysis of 24 cases of external pancreaticfistula patients treated by fistulectomy and Roux-en-Y pancreatojejunostomy / 临床外科杂志

Objective To evaluate the surgical management of pancreatic fistula caused by pan-creatic trauma and pancreatitis through surgical drainage. Methods A series of 45 patients with pancreat-ic fistula undergoing Roux-en-Y surgery with or without fistulectomy from 2004 to 2014 was analyzed. Pa-tients were divided into two groups:patients in group A(n=21)underwent external drainage of pancreatic secretion by Roux-en-Y surgery,and patients in group B(n= 24)underwent Roux-en-Y surgery with fistu-lectomy. The surgery was performed at 4~6 months after formation of the fistula,and somatostatin was used postoperatively. Results Patients in group A developed more severe side effects than patients in group B, including chronic abdominal pain(6/21 vs. 1/24),pancreatic leakage(8/21 vs. 2/24),digestive bleeding (5/21 vs. 5/24)and incision infection(9/21 vs. 3/24). Conclusion Resection of the fistula plus Roux-en-Y surgery can significantly reduce the incidence of surgical complications,which is a safe and efficient management for pancreatic fistula.

Evaluation of the effect of evidence-based nursing on improvement of nursing requirement of patients with ureter external drainage and inner stent drainage after urological operation / 中国实用护理杂志

Objective To study the effect of evidence-based nursing on improving the nursing requirement of patients with ureter external drainage and inner stent drainage after urological operation. Methods 62 patients in department of urinary surgery from June 2009 to October 2011 were selected as research object,and they were randomly divided into the control group and the observation group with 31 cases in each group,the two groups adopted routine nursing mode and evidence-based nursing mode respectively.Then the nursing requirement and nursing effect before and three and five days after nursing were compared between two groups. Results All the patients existed needs of related knowledge guidance,unhealthy emotion adjustment and social support,and the needs of patients between ureter external drainage and inner stent drainage showed no significant differences,improvement level of each items of the observation group after nursing were all better than those of the control group. Conclusions The patients with ureter external drainage or inner stent drainage have needs of related knowledge guidance,unhealthy emotion adjustment and social support,and the evidence-based nursing mode can effectively improve the patients'demand situations of these items.

Marsupialización externa: técnica eficaz del hamartoma hepático gigante en niños / Marsupialization and external drainage: Effective procedure for giant hamartoma of the liver in children

Introducción. El hamartoma hepático es una tumoración hepática benigna que surge del mesénquima de la tríada portal, formado por conductos biliares quísticos displásicos y precursores embrionarios periportales. Maresch fue el primero en describir esta entidad en 1903; inicialmente conocida como tumor mesenquial pseudoquístico, fibroadenoma biliar y tumor linfangiomatoso cavernoso, hasta que Edmondson en 1956 le dio el nombre de hamartoma, por su origen del mesénquima de la tríada portal. El tratamiento recomendado es la escisión total de la lesión, lo que no siempre es posible, por lo que otras posibilidades son la enucleación, marsupialización, escisión secuencial, drenaje percutáneo, embolización y trasplante hepático, entre otros. Casos clínicos. Dos pacientes lactantes y uno preescolar con una masa hepática fueron diagnosticados como tumor quístico hepático por ultrasonografía y tomografía axial computada (TAC) contrastada, confirmados por histopatología. Se manejaron con marsupialización y drenaje externo del quiste por 8 semanas sin resección de tejido hepático; se les realizó control tomográfico hasta evidenciar la desaparición de la lesión quística con sustitución por fibrosis periférica en el sitio del drenaje. A 2 años del último caso postquirúrgico, la evolución es excelente, con crecimiento y desarrollo normales, pruebas de función hepática y controles de TAC normales, sin evidencia de actividad tumoral. Conclusión. Los hamartomas gigantes en pediatría son un reto quirúrgico para el cirujano pediatra. La marsupialización externa es una alternativa para el manejo de este tipo de hamartomas hepáticos.

Introduction. Hamartoma of the liver is a benign tumor that develops from the portal triad. It is characterized by a cystic benign mass in the biliary tree. Maresch in 1903 made the first description of this entity as a mesenchymal tumor or biliary fibroadenoma. Edmondson in 1956 named this entity mesenchymal hamartoma. Treatment consists in radical excision of the lesion; this is not always possible and other options for treatment have been described such as enucleation, marsupialization, sequential resection, drainage, embolization and transplantation. Case reports. Three pediatric patients were diagnosed with a tumor-cyst like lesion in the liver by computed tomography and abdominal ultrasound. Diagnosis was confirmed by histopathology as benign hamartoma of the liver. Treatment consisted in marsupialization and external drainage. Eight weeks later, a computed tomography scan was performed in each case showing a complete resection of the lesion substituted by fibrosis. Conclusion. Mesenchymal hamartoma of the liver in children is a challenge for pediatric surgeons due to the high rate of complications after resection of the tumor. We propose this technique as an alternative for treatment.

Clinical study on operative effect of surgical treatment for hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To investigate the clinical effect of surgical treatment for hilar cholangio-carcinoma. Methods The clinical data of 89 patients with hilar cholangiocarcinoma surgically treated in our hospital were retrospectively analyzed. They were divided into 3 groups: radical resection(group A,n=23),palliative resection (group B,n=44) and external drainage operation (group C,n=22). Complications,operative mortality,survival rate and posttreatment quality of lire were compara-tively analyzed among the 3 groups. Results The rate of complications was significantly higher in group A than in group C (P<0.05). There was no marked difference in operative mortality between group A and group B (P>0.05). The 1-,2-and 3-year survival rates and scoring of quality of life were remarkably higher in group A than in other 2 groups (P<0. 001 and 0. 05). Conclusion Radical re-section of hilar cholangiocarcinoma can improve the long-term survival and significantly enhance quality of life of the patients after operation. For patients receiving unradical resection, palliative surgical man-agement can improve the long-term survival and enhance quality of life.

Perforated Afferent Loop Syndrome in a Patient with Recurrent Gastric Cancer: Non-Surgical Treatment with Percutaneous Transhepatic Duodenal Drainage and Endoscopic Stent

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.

Effect of Bile Reinfusion on Immunologic Function of Erythrocyte in Patients with Obstructive Jaundice after External Drainage of Biliary Tract / 中国普外基础与临床杂志

Objective To study the effect of bile reinfusion on immunologic function of erythrocyte in patients with obstructive jaundice after external drainage of biliary tract.Methods Patients with obstructive jaundice who had received biliary tract external drainage were randomly divided into bile reinfusion group ( n =24) and simple external drainage group ( n =27). Patients without jaundice,who received cholecystectomy in the same period with the above ones,were selected randomly as control group( n =25). In external drainage groups patients’ bile was collected daily, and was filtered through gauze, and then, pumped back into the patients’ duodenum or jejunum after being heated to 38 ℃-40 ℃. The bile reinfusion could be started after the intestinal function recovered postoperatively. The changes of C 3bRRT, ICRT, RFER and RFIR were observed before and after operation. The data were analysed through SPSS8.0.Results Preoperative C 3bRRT and RFER levels in patients with obstructive jaundice were lower than those without jaundice significantly, and Preoperative ICRT and RFIR levels in patients with obstructive jaundice were higher than those without jaundice significantly. C 3bRRT levels in bile reifusion group was higher obviously than those in simple drainage group ( P

Cerebellar Nocardiosis: Case Report

The authors report a extemely rare case of primary cerebellar nocardial abscess. Cerebral nocardiosis is arare disease and often fatal, and commonly spreaded from nocardiosis of lung or skin. Total excision of abscess and medication with sulfonamide is the treatment of choice. The patient was treated by continuous external dirainage with intermittent irrigation of abscess cavity by sulfonamide and given with sulfonamide for 10 months.