RESUMEN
Severe acute pancreatitis presents high rate of postoperative complications and results in higher mortality.The main postoperative complications include bleeding,digestive tract fistula,residual infection in the abdominal cavity and retroperitoneum.Along with further deep understanding of the disease and the great changesof treatment,we have new insight for preventing and dealing with the postoperative complications.The damage control surgery combined with minimally invasive surgery concept and individual therapic mode make great effect for the management of postoperative complications.In this review,we focus on the therapies for postoperative complications of severe acute pancreatitis.
RESUMEN
Objective To summarize nursing experience of digestive tract fistula after orthotopic liver transplantation (OLT). Methods From January 2000 to December 2010,1173 patients received liver transplantation,among whom 61 recipients got digestive tract fistula during early stage after operation.The clinical data and major nursing measures of 61 patients were studied retrospectively. Results The incidence rate of digestive tract fistula after OLT was 5.20％.The incidence rate of bile leakage,gastric fistula,duodenal fistula,jejunal fistula,ileal fistula and transverse colon fistula were 3.90％,0.42％,0.08％,0.34％,0.08％ and 0.34％,respectively.The onset time of digestive tract fistula was from 3 to 24 days post transplantation,and atypical symptoms such as fever,abdominal pain,abdominal distention,weakened enterocinesia and even septic shock were presented.And the rising or descending of white blood cells counts,rising of level of transaminase and total bilirubin in laboratory examination were simultaneously presented.Four patients died of bile leakage,and other seven patients died of intestinal fistula throughout conservative or operative treatment.The rest of 50 were discharged healthily. Conclusions The morbidity of digestive tract fistula after OLT is low,but its mortality rate is high.It is necessary to closely observe patients' condition and confirm diagnosis in early stage,in order to promote the healing of digestive tract fistula after OLT.At the same time,psychological,basic and dietary nursing should be given in order to enhance the survival rate and quality of life of patients.
RESUMEN
Objective To investigate the effects of nutritional support on the hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection. Methods Twenty-nine patients with digestive tract fistula complicated with severe abdominal infection were administered parenteral nutrition (PN) for 4 to 8 days, and then followed by enteral nutrition (EN) or EN + PN. The body weight, serum albumin, transferrin, prealbumin, fibronectin were monitored before and on the 10th and 28th day after nutritional support. Results The levels of serum prealbumin and fibronectin were increased significantly on the 10th day after nutritional support (t = 3.72, 3.52, P <0.01). The body weight, the levels of serum albumin, transferrin, prealbumin and fibronectin were significantly higher than those before nutritional support (t=3.97, 6.57, 7.09, 3.51, 3.58, P<0.01). Conclusion Nutritional support is effective in alleviating hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection.