Surgical management of pyloric stenosis induced by gastrointestinal chemical burn in children / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of surgical management for pyloric stenosis induced by gastrointestinal chemical burn in children.</p><p><b>METHODS</b>Clinical data of 11 children with pyloric stenosis induced by gastrointestinal chemical burn were analyzed retrospectively. After the failure of medicine, intervention of low balloon expansion and stent placement, they underwent pylorectomy and gastroduodenostomy. The body weight, height, serum albumin, hemoglobin, transferrin were compared between 1 day before and 3 months after operation.</p><p><b>RESULTS</b>There were 10 males and 1 female with a mean age of 4.5 years old. The main cause of serious pyloric stenosis was the wrong intake of hydrochloric acid. Lesions involved the esophagus and stomach in the early stage, and 4 weeks later, the lesion mainly involved the pylorus, which resulted in scarring pyloric stenosis and complete pyloric obstruction. Pylorectomy and gastroduodenostomy was successfully performed. The mean operative time was (134±26) min. The estimated blood loss was (5±2) ml. The postoperative length of stay was (10±3) d. There were no surgical complications. During the follow-up of 3 months, all the patients resumed regular diet. The height, body weight, and intelligence appeared to be normal. They showed significant improvement in weight, serum albumin, globulin, hemoglobin, transferrin at 3 months after the surgery(P<0.05). Six months after surgery, the anastomosis was shown to be nornal in barium follow through exam with no signs of stricture of ulcer.</p><p><b>CONCLUSION</b>Pylorectomy and gastroduodenostomy is an effective management for pyloric stenosis induced by gastrointestinal chemical burn in children, whose short-term efficacy is good.</p>

Early-stage bacterial infection following orthotopic liver transplantation in patients over 60 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the pathogenic characteristics of bacterial infection and analyze the risk factors after orthotopic liver transplantation (OLT) in patients over 60 years of age.</p><p><b>METHODS</b>A retrospective study of 69 patients that were over 60 years of age and underwent OLT was carried out. Descriptive statistics and risk factor analysis were performed with SPSS 11.0.</p><p><b>RESULTS</b>Thirty-eight patients developed bacterial infection (55.1%) after OLT, and thirty recipients suffered from mixed bacterial infection (79.0%). Multi-location infection was most commonly seen (68.4%). Nine patients died of bacterial infection. The primary pathogenic germs included enterococcus, methicillin-resistant coagulase negative staphylococcus, c maltophilia. The risk factors related to bacterial infection included preoperative malnutrition, long anhepatic phase, use of ventilator and duration of ICU stay.</p><p><b>CONCLUSIONS</b>The old patients that have undergone OLT are susceptible to bacterial infection. Bacterial infections are associated with high rate of mortality and multidrug resistance. Eliminating various risk factors can reduce the incidence of bacterial infection.</p>

Orthotopic liver transplantation in patients over 60 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the outcome and relative problems of patients over 60 years old underwent orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Data of patients over 60 years old (>or= 60 years old group, n = 59) patients recipients who were 18 to 59 years old (< 60 years old group, n = 500) were reviewed retrospectively.</p><p><b>RESULTS</b>Overall patients survival at 1 year was not significantly different among >or= 60 years old group (66%) and < 60 years group (76%). There were no differences in the operation time, the quantity of blood lost during operation, the days of hospitalization and the incidence of hepatic artery thrombosis between the two groups. The incidence rate of acute rejection reaction in >or= 60 years old group was lower. Both the duration of staying in intensive care unit and the time of using ventilator in >or= 60 years old group were longer than the other group. Moreover, the incidence rates of infection and intracerebral hemorrhage were higher in >or= 60 years old group, which were the primary causes of death in this group.</p><p><b>CONCLUSION</b>Even though the complications were higher, recipients over 60 years old underwent OLT have more excellent 1 year survival.</p>

Combined total hepatectomy, orthotopic liver transplantation and pancreatoduodenectomy for unresectable hilar bile duct carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and outcome of combined hepatectomy, orthotopic liver transplantation and Whipple's pancreatoduodenectomy for radical excision of cholangiocarcinoma.</p><p><b>METHODS</b>A 35-year-old female patient with unresectable cholangiocarcinoma underwent curative radical operation, which includes hepatectomy, orthotopic liver transplantation and pancreaticoduodenectomy of hilar bile duct carcinoma; immunosuppression followed an induction protocol with FK506 and steroids. Lamivudine and HBIg were used to prevent hepatitis B virus from infection again.</p><p><b>RESULTS</b>Pathologic examination revealed low differentiated cholangiocarcinoma and immunohistochemistry stains demonstrated positive expression of cytokeratin 9 and 17, carcinoembryonic antigen and the hepatocyte protein was negative. Neither the margins of resection nor the periductal lymph nodes were involved. The liver showed evidence of cholestasis and metastasis nod. The patient was hospitalized 32 days and came back to the previous work. He has been followed up for more than 14 months up to now and is currently alive without any evidence of recurrent cancer.</p><p><b>CONCLUSIONS</b>For some selected unresectable Klatskin's tumors, combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation was justified. The radical methods maybe provide long-time survival and curative effect. Nevertheless, because of possible tumor recurrence and ethical controversy, the combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation procedure has to be applied only with caution and indications.</p>