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Objective To provide the evidence for clinical medication safety by the investigation of the risk factors of linezolid-related thrombocytopenia in cancer patients in the department of hepatobiliary surgery. Methods Patients who received linezolid for anti-infective treatment from January 2017 to December 2021 were selected. The patients were divided into thrombocytopenia group and non-thrombocytopenia group according to whether thrombocytopenia occurred or not after administration of linezolid. The general data and laboratory indicators of the two groups were compared, and the risk factors of linezolid-related thrombocytopenia were screened by multivariate logistic regression analysis. Results A total of 104 patients were included in the study, including 84 patients who underwent surgery and 20 patients who did not. The incidence of linezolid-related thrombocytopenia was 24.0%. There were significant differences in gender, age, duration of linezolid use, platelet count, white blood cell count, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin, creatinine, estimated glomerular filtration rate between the two groups (P<0.05); logistic regression analysis suggested that age ≥60 years (OR=7.093; P=0.017), duration of linezolid use ≥12 days (OR=4.399; P=0.035), baseline platelet count ≤200×109/L (OR=8.470; P=0.004), baseline AST≥50 U/L (OR=15.465; P<0.001), and baseline white blood cell count ≥11×109/L (OR=11.436; P=0.001) were the risk factors for linezolid-related thrombocytopenia in cancer patients. Conclusion During the treatment of linezolid in cancer patients, attention should be paid to the adverse reactions of thrombocytopenia in the patients, especially those with old age, long-term treatment, low baseline platelets, poor baseline liver function, and high baseline white blood cell counts.
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Objective:To carry out evidence-based nursing practice of nutritional management of patients in the perioperative period of hepatobiliary surgery, formulate review indicators based on the best evidence, analyze obstacles, and provide reference for the application of evidence in clinical practice.Methods:According to the "6S" evidence model, the search was conducted on Cochrane Library, Joanna Briggs Institute evidence-based Health Care Center Database, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, the British Journal of Medicine, PubMed, SinoMed, CNKI and Wanfang Database from the date of database construction to September 30, 2021. Through systematic search, evaluation and summary of evidence, the evidence-based nursing review plan for perioperative patients in hepatobiliary surgery was determined and the status review was conducted. Influencing factors were analyzed, and action strategies were formulated.Results:A total of 14 pieces of best evidence were included in this study, and 16 review indicators were formulated, of which the implementation rate of one indicator was 85%, and the implementation rate of the other indicators was 0-55%. The main obstacles include the following: the lack of relevant knowledge at the medical and nursing level; the resistance of medical staff caused by the increasing clinical work, the lack of systems, procedures, quantitative tools, and instruments and equipment; insufficient leadership, etc.Conclusions:There is a big gap between evidence-based nursing evidence and clinical practice. It should be combined with the judgment of clinical professionals and the results of the baseline review to analyze the obstacles and formulate action strategies to promote the effective transformation of evidence.
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Objective:To analyze the effect of problem-based learning (PBL) combined with case-based learning (CBL) and clinical pathway (CP) teaching methods in standardized residency training in department of hepatobiliary surgery.Methods:A total of 64 residents who received the standardized residency training in the Department of Hepatobiliary Surgery in Shaanxi Provincial People's Hospital from July 2018 to July 2019 were selected and divided into the observation group and the control group. The control group used PBL + CBL teaching methods, while the observation group adopted PBL + CBL + CP teaching methods. The after-department examination scores and the teaching cognition scores of the two groups were compared. SPSS 15.0 was used for t-test and Chi-square test. Results:The after-department examination scores of the two groups were compared. Compared with the control group, the examination scores of professional theories, case analysis and operation skills in the observation group were significantly higher, and the difference was statistically significant ( t = 6.98, 7.85, 7.01, P < 0.05). In terms of recognition of teaching, the observation group was significantly higher than the control group, and the difference was statistically significant ( t = 9.14, P < 0.05). Conclusion:The PBL + CBL + CP teaching is conducive to the comprehensive and systematic mastery of knowledge and the rapid establishment of scientific clinical thinking. It has a strong scientific and systematic nature and is worthy of promotion.
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Objective:To investigate the effect of homogeneous management combined with staged teaching on physicians receiving standardized training of hepatobiliary surgery.Methods:A total of 46 physicians who received standardized training in Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, from January to March 2020 were selected as control group and were given conventional teaching, and 50 physicians who received standardized training from April to June 2020 were selected as observation group and were given homogeneous management combined with staged teaching. The two groups were compared in terms of professional level, clinical ability, and the degree of satisfaction with teaching before and after teaching. SPSS 24.0 was used to perform the independent samples t-test, the paired t-test, the chi-square test, and the rank sum test. Results:After teaching, both groups had significant increases in the scores of theoretical examination and operation skill examination, and compared with the control group, the observation group had significantly higher scores of theoretical examination (94.57±3.28 vs. 90.32±2.12) and operation skill examination (94.37±4.18 vs. 91.25±3.46). After teaching, both groups had significant increases in the scores of clinical consultation, physical examination, humanistic concern, clinical diagnosis, communication ability, organizational ability, and overall evaluation, and the observation group had significantly higher scores of the above seven aspects than the control group (6.98±0.94/6.45±0.14/6.95±0.88/6.65±0.93/6.53±0.26/6.84±0.92/6.58±0.35 vs. 6.13±0.31/6.21±0.76/6.21±0.42/6.18±0.35/6.32±0.61/6.33±0.24/6.25±0.71). The observation group had a significantly higher overall satisfaction rate than the control group [94.00% (47/50) vs. 78.26% (36/46)].Conclusion:In the standardized training and teaching of hepatobiliary surgery, homogeneous management combined with staged teaching can improve the professional level and clinical ability of physicians and enhance the degree of satisfaction with teaching.
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Objective:To investigate the application effect of problem-based learning (PBL) in the teaching of professional postgraduate students in hepatobiliary surgery.Methods:A total of 60 professional postgraduate students in the same grade who were accepted by Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, were selected as research subjects. The students were randomly divided into PBL teaching group and lecture-based learning (LBL) teaching group, and the training effect was compared between the two groups. SPSS 25.0 software was used for t test and chi-square test. Results:Compared with the LBL group, the PBL group had significantly higher scores of written examination [(90.3±4.5) vs. (85.2±7.1), P<0.05] and skill examination [(92.3±4.9) vs. (86.3±7.9), P<0.05] and significantly better comprehensive abilities such as scientific research ability, clinical ability, organizing ability, literature review, collaboration and cooperation, and language expression [(85.0±7.5) vs. (73.0±9.1), P<0.05], as well as a significantly higher overall evaluation score [(90.2±3.2) vs. (83.3±3.9), P<0.05]. The PBL group also had a higher degree of satisfaction than the LBL group (83.3% vs. 56.7%). Conclusion:Application of PBL in the teaching of professional postgraduate students can improve the quality of teaching.
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INTRODUCTION@#Fluorescence imaging (FI) with indocyanine green (ICG) is increasingly implemented as an intraoperative navigation tool in hepatobiliary surgery to identify hepatic tumours. This is useful in minimally invasive hepatectomy, where gross inspection and palpation are limited. This study aimed to evaluate the feasibility, safety and optimal timing of using ICG for tumour localisation in patients undergoing hepatic resection.@*METHODS@#From 2015 to 2018, a prospective multicentre study was conducted to evaluate feasibility and safety of ICG in tumour localisation following preoperative administration of ICG either on Day 0-3 or Day 4-7.@*RESULTS@#Among 32 patients, a total of 46 lesions were resected: 23 were hepatocellular carcinomas (HCCs), 12 were colorectal liver metastases (CRLM) and 11 were benign lesions. ICG FI identified 38 (82.6%) lesions prior to resection. The majority of HCCs were homogeneous fluorescing lesions (56.6%), while CLRM were homogeneous (41.7%) or rim-enhancing (33.3%). The majority (75.0%) of the lesions not detected by ICG FI were in cirrhotic livers. Most (84.1%) of ICG-positive lesions detected were < 1 cm deep, and half of the lesions ≥ 1 cm in depth were not detected. In cirrhotic patients with malignant lesions, those given ICG on preoperative Day 0-3 and Day 4-7 had detection rates of 66.7% and 91.7%, respectively. There were no adverse events.@*CONCLUSION@#ICG FI is a safe and feasible method to assist tumour localisation in liver surgery. Different tumours appear to display characteristic fluorescent patterns. There may be no disadvantage of administering ICG closer to the operative date if it is more convenient, except in patients with liver cirrhosis.
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The famous professor,Masatoshi Makuuchi was known as "the king of the liver surgery".Authors concluded main contributions of Masatoshi Makuuchi by reviewing literatures.(1) He was the first to use intraoperative ultrasonography during liver operations.Furthermore,he pioneered anatomical hepatectomy and ultrasound guided transhepatic cholangiography and cholangial drainage.(2) He was the first to adopted preoperative selective portal vein embolization (PVE) and hemihepatic blood flow occlusion.(3) He performed the first adult-toadult living donor liver transplantation (A-ALDLT) worldwide and established the well-known formula to predict standard liver volume.(4) The more laudable achievement is promoting these advanced concepts and techniques to the world,training a large group of contemporary hepatobiliary surgeons and benefiting a great number of patients.Masatoshi Makuuchi is a well-deserved master and a good example for contemporary hepatobiliary surgeons to follow.
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Objective To investigate the feasibility and realistic significance of different teaching methods in professional and scientific degree graduate students.Methods Twenty six graduate students (scientific 12,professional 14) were randomly selected as research object from Sep.2014 to Apr.2017,and the relationship between clinical or research outcome and type of degree,clinical or experiment time were analyzed.Results The experiment time of scientific degree graduate students was significantly longer than that of professional degree graduate students [(21.0 ± 1.6) vs.(11.0 ± 3.5) months],and professional degree graduate students paid more attention to clinical work,there was statistic difference between the two groups [(20.0 ±2.1) vs.(12.0 ±2.4) months,both P＜0.05].The qualification rate of basic clinical manipulation in the professional group was higher than that in the scientific group (85.7％ vs.75.0％,P ＜ 0.05).Conclusion Different type of teaching methods based on the type of student degree were feasible and proper for graduate students in surgery,and the terminal object of our teaching should be focus on the resolution of clinical problems.
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<p><b>INTRODUCTION</b>Experience with robot-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HPB) surgery remains limited worldwide. In this study, we report our early experience with RAL HPB surgery in Singapore.</p><p><b>METHODS</b>A retrospective review of the first 20 consecutive patients who underwent RAL HPB surgery at a single institution over a 34-month period from February 2013 to November 2015 was conducted. The 20 cases were performed by three principal surgeons, of which 17 (85.0%) were performed by a single surgeon.</p><p><b>RESULTS</b>The median age of patients was 56 (range 22-75) years and median tumour size was 4.0 (range 1.2-7.5) cm. The surgeries performed included left-sided pancreatectomies (n = 10), hepatectomies (n = 7), triple bypass with bile duct exploration for obstructing pancreatic head cancer with choledocholithiasis (n = 1), cholecystectomy for Mirizzi's syndrome (n = 1) and gastric resection for gastrointestinal stromal tumour (n = 1). The median operation time was 445 (range 80-825) minutes and median blood loss was 350 (range 0-1,200) mL. There was only 1 (5%) open conversion. There were 2 (10.0%) major morbidities (> Grade II on the Clavien-Dindo classification) and no 30-day/in-hospital mortalities. There was no reoperation for postoperative complications. The median postoperative stay was 5.5 (range 3-22) days.</p><p><b>CONCLUSION</b>Our initial experience confirms the feasibility and safety of RAL HPB surgery.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Conductos Biliares , Cirugía General , Colecistectomía , Hepatectomía , Laparoscopía , Tempo Operativo , Páncreas , Cirugía General , Pancreatectomía , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados , SingapurRESUMEN
BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
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Humanos , Dolor Abdominal , Conductos Biliares , Bilis , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica , Colestasis , Conducto Colédoco , Anomalías Congénitas , Constricción Patológica , Conducto Cístico , Diagnóstico , Drenaje , Conducto Hepático Común , Hígado , Registros Médicos , Atención al Paciente , Estudios Retrospectivos , Esfinterotomía Endoscópica , StentsRESUMEN
Objective To explore the clinical application of the special use of antibacterial drugs in Department of hepatobiliary surgery by analyzing the typical cases of the use of antibiotics.Methods This paper analyzes and comments on the typical cases of the use of special antibiotics in Department of hepatobiliary surgery.Results Department of hepatobiliary surgery the special use level of antibacterial drugs,should be based on the pathogenic characteristics of drug resistance and drug sensitivity test results and timely adjustment of antimicrobialtherapy,severe infection should be given sufficient medicines in a timely manner,should adjust the antibiotics dose according to liver and kidney function,drug dose attention to drugs with narrow therapeutic index,combined medication,caution should be avoided unnecessary repeat medication.Conclusion Through the analysis of the typical cases of the special use of antibiotics in Department of hepatobiliary surgery,it can promote the rational use of antibiotics.
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Objective:To explore the effect of continuous quality improvement for enhancing the ability of application and management of nurses of hepatobiliary surgery for physiological monitor.Methods: The data of clinical work were researched by using retrospective analysis, and they were divided into quality improvement group(n=40) and routine management group(n=40) according to different management method. The score of examination, satisficing of patient for physical monitor, false alarm situation and processing time between the two groups were researched and analyzed.Results: The score of examinations both of theory and operation of quality improvement group were significantly higher than those of routine management group (t=4.303,t=3.182,P<0.05), respectively. The reasonable storing rate, understanding rate of whereabouts and satisficing of maintenance about physical monitor of quality improvement group (92.5%, 100.0% and 87.5%) were significantly higher than those of routine management group(32.5%, 40.0% and 52.5%) (x2=5.02,x2=7.38,x2=9.35,P<0.05), respectively. The false alarm rate of quality improvement group (10.0%) was significantly lower than that of routine management group (35.0%) (x2=11.14,P<0.05). And the processing time of false alarm of quality improvement group was significantly shorter than that of routine management group (t=2.776,P<0.05).Conclusion: The method of continuous quality improvement can effectively enhance the ability of application and management level of the nurses of hepatobiliary surgery for physical monitor.
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The precise surgical treatment for hepatobiliary diseases has been a challenging topic in hepatobiliary surgery for a long time.A perfect preoperative plan can help the surgeon make R0 resection of the lesion and preserve the healthy tissue as much as possible.In addition,all of these depend on the application of different imaging modalities,especially three-dimensional reconstruction technique.But some limitations of 3D reconstruction should be noted:different surgeons may have different views for one object because of different observation points;or it cannot be used for intraoperative re-orientation and so on.3D printed model can overcome some disadvantages of 3D reconstruction.This paper reviewed related literature that reported the usage of 3D printed model in hepatobiliary surgery.
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We introduced Case based learning into traditional bilingual teaching, dividing the hepatobiliary surgery teaching into four phases: preview, introduction, group discussion and estimation after class . Through the classroom organization analysis of common cases of liver and gallbladder surgery, we took students as the main body, teacher as the guide, to complete the bilingual teaching. Auxiliary case based learning used in bilingual teaching of liver and gallbladder surgery practice is beneficial to improving the quality of bilingual teaching, and helps to cultivate the students' clinical thinking. However, there are still some deficiencies of the case aided bilingual teaching, which needs continuous improvement.
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Improving the special nursing ability is an important guarantee to carry out the clinical work for specialized nurse, so it is necessary to receive special hierarchical training.According to the length of employment and position, all nurse staff in the Department of Hepatobiliary Surgery ,Children's Hospital of Chongqing Medical University were classified, and the training schedule was made according to the level of personnel development to implement specialist training and operational skills training and assessment.And then examination was administrated;individualized guidance was got across to everyone according to the outcome of examination.Before and after the hierarchical training,analysis of doctors' and patients' satisfaction for nursing work, nursing theory, nursing service quality was carried out.The aim of this study is to verify the positive role of hierarchical training mode in promoting individual nursing ability and improve the level of nursing team, to provide experience and reference for nursing managers.
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Hemobilia é rara e potencialmente fatal. A suspeita de sangramento em trato biliar é maior em casos recentes de trauma hepático ou cirurgia hepatobiliar. Ruptura de pseudoaneurisma de artéria hepática é causa comum de hemobilia. Relatamos 3 casos de hemobilia em indivíduos jovens, acometidos por trauma abdominal, que evoluíram com ruptura de pseudoaneurisma e necessidade de embolização angiográfica de vaso sangrante.
Hemobilia is rare and potentially fatal. Suspect bleeding in the biliary tract is higher in recent cases of liver trauma or hepatobiliary surgery. Rupture of hepatic artery pseudoaneurysm is a common cause of hemobilia. We report 3 cases of hemobilia in young individuals suffering from abdominal trauma, who developed pseudoaneurysm rupture and need for angiographic embolization of bleeding vessel.
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Humanos , Masculino , Adolescente , Adulto , Adulto Joven , Rotura , Hemobilia , Sistema Biliar , Aneurisma Falso , Diagnóstico Diferencial , Embolización Terapéutica , Hemobilia/etiología , Hemorragia Gastrointestinal/cirugía , Arteria HepáticaRESUMEN
It is to difficult to diagnose and treat hepatobiliary surgical diseases since its diverse clinical manifestations,which increases the difficulty of clinical internship.Taking clinical cases as teaching material,case-based learning was combined with teaching theme and was conducted by means of discussion and question and answer between teachers and students.Students can know about concepts or theories related to teaching theme.Case-based learning in internship can consolidate basic knowledge of hepatobiliary surgery,cultivate clinical scientific thinking and is helpful in analyzing and resolving problems of hepatobiliary surgical diseases.
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Objective To explore the feasibility and clinical value of the trans-umbilical single-port laparoscopic operation with routine apparatus in treatment of hepatobiliary diseases. Methods From Mar 2010 to Sep 2012, 415 patients with hepatobiliary disease, splenic disease, abdominal cavity disease or combine hysteromyoma were performed by trans-umbilical single-port laparoscopic operation with routine apparatus. The clinical data of 415 cases were analyzed respectively.Result All patients except one patients who was added one port for hysterectomy, were performed successfully trans-umbilical single-port laparoscopic operation with routine apparatus without conversion to laparotomy or conventional laparoscopic surgery. Conclusions The trans-umbilical single-port laparoscopic operation with routine apparatus is safe and effective in treatment of hepatobiliary diseases. Limited by the anatomy position, the trans-umbilical single-port laparoscopic operation with routine apparatus can cure most hepatobiliary diseases. So the operator must have the experience both in single-port laparoscopic operation and traditional laparoscopic operation. With the improvement of rotatable equipment, the practical procedure is expected to be generalized in the future.
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Objective To identify the researchers' productivity,the citation states and the grant patterns of the Chinese Journal of Hepatobiliary Surgery through citation analysis.Methods Articles published in the Chinese Journal of Hepatobiliary Surgery between 2009 to 2012 were collected from the Chinese Science Citation Database.These articles were analyzed with statistics and bibliometrics.The indicators included cooperation degree,core authors,distribution of grant,authors' origin and citation states.Results Of the 1321 papers which were published by the journal during the study period,505 papers were cited 923 times.Of the 1111 first authors,957 (86.14％) published one paper only.There were 154 core authors (13.86％ of first authors),and they published 364 papers (27.55％).There were 14 high-productivity institutes,which published 299 papers (22.63％).According to the geographical distribution,Beijing ranked first with 190 (14.38％) papers.The second was Shanghai with 156 (11.81％),the third was Jiangshu province with 134 (10.14％),the fourth was Zhejiang province with 132 (9.99％),and the fifth was Guangdong province with 101 (7.65 ％) papers.1262 papers were completed by collaborate teams of more than one author.The cooperative rate was 95.53％ and the cooperative degree was 4.67.361 papers were funded by 553 supporting foundations.Conclusions The authors of the Chinese Journal of Hepatobiliary Surgery were geographically widely distributed.Some were core authors with high-productivity.They were highly cited and with good cooperation degree.Beijing,Shanghai,Jiangshu,Zhejiang and Guangdong provinces play important roles in research on hepatobiliary surgery.
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Translational medicine is an emerging medical research pattern,its connotation includes a two-way process with effective translation of the latest basic research results into the available clinical medical technologies and products,and give the feedback of the clinical medical problems to the laboratory.It's a kind of bidirectional research,namely Bench to Bedside and Bedside to Bench.Translational medicine is one of the medical science frontiers.In recent years,scientists around the world pay high attention to the clinical translational applications of research results of hepatobiliary surgery,and relevant research and regulations formulation have started under the leadership of government.Actually,translational medicine plays an important role in the success of hepatobiliary surgery in liver transplantation era till now.China is expected to be at the forefront in hepatobiliary surgery and translational medicine in the world in the near future.Chinese surgical circles should have the whole world in view,set in the worldwide development in translational medicine,accelerate the dissemination of ideas in-depth to improve the technology and curative effect.