Résumé
Objective To explore the early predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive disease and its significance for the decision of exploratory laparotomy.Methods This retrospective study enrolled 29 patients diagnosed with acute superior mesenteric artery embolism or thrombosis in Peking University People's Hospital between July 1995 and June 2015.Results 12 patients developed intestinal necrosis.Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (x2 =14.867,P =0.000).In univariate analysis,the early predictive factors for intestinal necrosis were D-Dimer ≥ 600 μg/L (x2 =11.455,P =0.002),INR≥1.2 (x2 =3.948,P =0.047),pH values ＜7.4 (x2 =8.191,P =0.004),BE ＜ -1.0 mmol/L (x2 =8.191,P =0.004),blood lactate ≥ 2.2 mmol/L(x2 =7.535,P =0.006),BUN ≥ 6 mmol/L (x2 =10.076,P =0.002),CK ≥ 80 U/L (x2 =8.191,P =0.004),LDH ≥ 210 U/L (x2 =13.079,P=0.000),AST ≥25 U/L (x2 =10.076,P =0.002),SIRS (x2 =10.076,P =0.002).Multivariate logistic regression analysis found no independent predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive diseases.Conclusion Intestinal necrosis in acute mesenteric arterial occlusive diseases indicates a poor prognosis.Coagulation abnormalities,liver or kidney dysfunction,metabolic acidosis and SIRS necessitates an immediate exploration.
Résumé
Balantidiosis is a disease infected with Balantidium coli,and swine is the main infection source. The infection of B. coli may cause diarrhea,extra intestinal infection and co?infection with other pathogens and even intestinal necrosis. Strength?ening the manure management of both human and livestock,paying attention to personal hygiene and labor protection,and time?ly treatment of the patients are the main measures to control balantidiosis.
Résumé
Objective To evaluate the validity and surgical outcome of emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicated with intestinal necrosis.Methods Clinical data of 58 patients diagnosed strangulated inguinal hernia and intestinal necrosis in our hospital from July 2011 to April 2014 were retrospectively analyzed.Of the 58 patients,33 were males and 25 were females,mean age of (64 ± 18) years (range 52-86).There were 28 strangulated inguinal and 30 femoral hernias undergoing emergency small bowel resection and tension-free mesh hernioplasty.Patients with intestinal perforations,preoperative peritonitis,inflammatory hernia and those who required colon resections were excluded from the study.Results The mean operative time was (92 ± 22) min (range,80-120 min).Average length of hospital stay was (8.6 ± 2.5) d (range,6-21 d).There were three postoperative c omplications (5.2％):one of subcutaneous hematoma,one of superficial surgical site infection and one of scrotal fluid collection,which were all cured by wound dressing,removal of infected prosthetic mesh,vacuum sealing drainage (VSD) and continuous irrigation,intravenous antibiotics and scrotal puncture.During a follow-up period of 6 to 32 months (mean 12 ± 6 months),there was no hernia recurrence.Conclusions Emergency one-stage intestinal resection and tension-free mesh hernioplasty for strangulated inguinal hernia complicated by intestinal necrosis is safe,feasible with a favourable outcome and low rate of postoperative complications.
Résumé
Objective To explore the operative indication,procedure and postoperative complication of infantile intussusception.Methods Clinical data of 316 infants suffering intussusception in the past 38 years(1971-2008)were reviewed.There were 186 male,130 female.One hundred and eishty-six patients (58.9%,186/316) were younger than 6 months,and 78.2%(247/316)had suffered for more than 3 days.The proportion of abdominal intermittent pain and vomiting was 96.8%(306/316)and 87.7%(277/316),respectively.IIeum-colon ascendens was 35.4%(112/316)and ileum-ileum-colon ascendens was 37.3%(118/316).The proportion of intestinal necrosis was 36.7%(116/316).Two hundred patients (63.3%,200/316) were operated with simplified reposition and 36.7%(116/316)Was operated with intestinal resection.Results One patient with appendiceal abscess was misdiagnosed as intussucseption.Three cases of intussusception had repositioned automatically during the operation.Eight cases underwent additional operation because of postoperative complication.Three hundred and seven cases were cured, 2 cases discharged voluntarily.Seven cases died.Conclusions Currently most of acute intussusception may be cured with non-operation.Operative indication should be performed strictly.Operative procedure should be chosen on the pathological changes and the status of health.The comphcation could be reduced by intensive perioperation care.