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Objective:To study the effect of internal drainage tube and T tube in laparoscopic common bile duct exploration.Methods:The data of 103 patients who underwent laparoscopic common bile duct exploration for the treatment of choledocholithiasis from January 2016 to April 2021 in Dongguan Kanghua Hospital were analyzed, including 50 males and 53 females, aged (50.3±17.2) years old, the age range was 15 to 90 years old. A total of 103 patients were randomly divided into T tube group ( n=60), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal+ T tube drainage, and self-dropping stent group ( n=43), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal + placed with self-dropping stent. The operation time, intraoperative blood loss, postoperative drainage, postoperative hospital stay and incidence of postoperative complications were compared between the two groups. Results:The operation time of self-dropping stent group was (107.2±26.1) min, intraoperative blood loss 10(5, 10) ml, and postoperative hospital stay (6.5±3.5) d, which were better than those of T tube group (143.5±52.7) min, 10(10, 20) ml, (8.8±3.8) d, the differences were statistically significant (both P<0.05). There were no significant difference in postoperative drainage volume and postoperative complications between the two groups (both P>0.05). Conclusion:The internal drainage tube in laparoscopic common bile duct exploration is a safe and reliable surgical method for the treatment of choledocholithiasis, which can significantly shorten the hospitalization time of patients.
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Objective: To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst. Methods: Between March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group (arthroscopic cystectomy combined with internal drainage group, n=28) and control group (arthroscopic internal drainage group, n=28). Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups ( P>0.05). The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation. Results: Patients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis, and the middle back of calf tenderness of the trial group were all longer than those in the control group ( P<0.05), the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group ( P<0.05). Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant ( P=0.236). According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation. There was no significant difference between 2 groups ( Z=-1.872, P=0.078). Nine cases (34.62%) of the trial group and 13 cases (48.15%) of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm. The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups ( χ2=2.293, P=0.852). Conclusion: Compared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.
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Objective To analyze the different procedures and their clinical effects on treatment for pan-creatic pseudocyst( PPC) .Methods The management and outcome of 78 patients with PPC from Jan.2002 to Jun.2012 were retrospectively analyzed.Results 20 patients underwent conservative treatment and the pseudo-cysts absorbed spontaneously during follow up.Invasive procedures were performed in 58 cases, including percu-taneous catheter drainage in 3 cases with 1 postoperative pancreatic leakage and 1 postoperative pancreatic ab-scess;PPC external drainage in 5 cases with 2 postoperative pancreatic leakage and 1 postoperative bleeding;pancreatic pseudocyst stomach anastomosis in 15 cases with 1 postoperative gastrointestinal bleeding;Roux-en-Y cystjejunostomy in 29 cases with 2 gastrointestinal bleeding;cystduodenostomy in 2 cases;pancreatic pseudocyst excision in 2 cases with 1 postoperative pancreatic leakage; and laparoscopic cystogastrostomy in 2 cases.Con-clusions At present, there are various treatment options for pancreatic pseudocyst and it is necessary to choose treatment strategy according to patient's condition.Internal drainage is still the primary option of surgical proce-dures in treatment for pancreatic pseudocyst.
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Objective To review the experience of aortic root internal drainage in the operation of type A aortic dissection.Methods This was a prospective and observational study.Clinical data were available from 20 cases of type A aortic dissection patients (A group) from March 2003 to March 2008,and anothcr 36 cases of type A aortic dissection patients (B group) from March 2008 to May 2013.All of patients received the operation of replacement of ascending aortic aneurysm and aortic arch replacement and descending aortic stented elephant trunk implantation in our hospital.The additional inside drainage were made between the aortic root aneurysm sac and right atrial appendage in B group.Perioperative and postoperative data including the operation time,the amount of bleeding,cardiopulmonary bypass time,the amount of red cell transfusion,number of postoperative cases re-operated for hemostasis,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications,and postoperative mortality rate were analyzed retrospectively.The data was analyzed using SPSS version10.0 software.The chi-square test was used for constituent ratios,whilest was applied to analysis of differences in above variables betweens two groups.Results There were significant differences in the amount of bleeding during surgery,cardiopulmonary bypass time,the amount of red cell transfusion,rate of postoperative re-operation,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications and postoperative mortality between the two groups (x2/t =2.658,2.381,2.265,3.056,6.862,2.896,2.316,7.215,7.668,P =0.012,0.034,0.007,0.016,0.013,0.032,0.008,0.008,respectively).Conclusions The method of aortic root internal drainage in the operation of type A aortic dissection could reduce the amount of bleeding and improve the success rate of operation.
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Objective The purpose of this study was to determine how to preserve the remaining pancreatic body and tail in the pancreatectomy. Methods In seven cases of pancreatectomy, three of them were the rupture of pancreatojejunal anastomosis, and four of them were the pancreatectomy for tumor in the pancreatic neck or body. During operations, a bridge internal drainages was used to drain the pancreatic juice into the adjacent jejunum. After the operations, the supportive treatment, continuous irrigation of peritoneal cavity and pancreatic enzyme inhibition were used. Results In all seven patients, the remaining pancreatic body and tail were successfully preserved. The endocrine functions of these patients recovered to nearly normal level and patients were discharged. Conclusions In preserving the remaining pancreatic body or tail, the bridge internal drainage has its advantage of convenience. It effectively preserves the exocrine of pancreas as well as its endocrine
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Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.
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The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare.
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MortalityABSTRACT
Traditionally, early appendectomy has been the cornerstone of therapy for acute appendicitis. However, once appendiceal perforation and abscess formation occurs, the optimal means of treatment and the timing of operation is controversial. Recently, it was reported that radiologically guided percutaneous abscess drainage and antibiotic therapy, as an initial nonoperative management, was effective and safe. Recent experience with endoscopic transmural drainage of pancreatic pseudocysts or even pancreatic abscesses prompted us to use the similar technique for the primary treatment of peri-appendiceal abscess. We report a case of peri-appendiceal abscess complicating acute appendicitis which was successfully treated by colonoscopic transmural internal drainage.
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Abscess , Appendectomy , Appendicitis , Colonoscopy , Drainage , Pancreatic PseudocystABSTRACT
Objective To evaluate the effect of operation method in surgical treatment of pancreatic cyst. Method Retrospectively stastical analysis on 118 cases of pancreatic cyst was carried out.Result Thirty-one cases underwent external drainage,54 cases were subjected to internal drainage,and 33 cases to resection.Con- clusion For a genuine cyst,it is better to have it reacted.External drainage is only indicated for pseudocysts in emergent situations such as infection,hemorrhage or rupture,but is often accompanied with multiple complica- tions.Internal drainage is indicated for unresectable cysts and is superior to the external one,but it has some com- plications too.Resection of the pancreatic body and tail is the first choice for cysts located there,and it shows a good and thorough therapeutic effect with seldom recurrence.
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BACKGROUND: The optimal management of periampullary Ca. stage III remains controversial. METHODS: A total of 103 patients treated in a 5-ear period at Kwangju Christian Hospital, 54 patients with a curative operation and 49 patients with internal drainage, were retrospectively studied. RESULTS: There was no significant difference in the 30-ay mortality rate between patients with a curative operation and those with internal drainage, 4% versus 6% respectively. There was a difference between a curative operation and the internal drainage procedure in the early morbidity rate (16.7% versus 8%) and the late morbidity rate (9.3% versus 32.7%). The mean survival was more favorable for those with a curative operation than for those with the internal drainage procedure for periampullary Ca. stage III (pancreatic Ca.: 11.6 months versus 4.7 months, CBD Ca.: 12.6 month versus 5.4 months, and Ampulla of Vater Ca.: 16.5 months versus 5.6 months). The 6-onth and the 12-onth survival rates of the curative-operation group were 80% and 55% for pancreatic Ca., 100% and 80% for CBD Ca., and 90% and 80% for Ampulla of Vater Ca.. The 3-onth and the 6-onth survival rates of the internal drainage group were 70% and 30% for pancreatic Ca., 85% and 40% for CBD Ca., and 75% and 45% for Ampulla of Vater Ca. CONCLUSION: The mean survival duration was more favorable for those with a curative operation than for those with an internal drainage procedure for periampullary Ca. stage III. Therefore, if there is no evidence of distant metastasis, a radial resection is the treatment of choice for a patient with a carcinoma of the periampullary Ca.