Application progress of enhanced recovery after surgery in perioperative anesthesia management / 局解手术学杂志

Enhanced recovery after surgery is the path of perioperative multi-modal management.It is coordinated by anesthesiologists, surgeons, nursing staff, nutritionists and rehabilitation physician to reduce the perioperative stress response of patients.Maintenance of the body and organ functions before and after surgery to achieve early rehabilitation.Enhanced recovery after surgery integrates a series of interventions during the perioperative period to maintain physiological function and promote postoperative recovery.Its core goal is to reduce trauma and stress, to reduce pain and complications of patient, shorten hospital stay and reduce hospitalization costs.The ultimate goal is to accelerate patients recovery. so it is the direction of perioperative medical development. As an indispensable part of anesthesia management,the professionalism and ability of anesthesiologists will be critical to accelerating the success of rehabilitation surgery.

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review / 中华创伤杂志(英文版)

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular stent-graft treatment has emerged as an alternative for patients with type B aortic dissection (AD), either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type B AD.</p><p><b>METHODS</b>From May 2002 to July 2007, 67 patients with type B AD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase (AAD group) and 35 patients in the chronic phase (CAD group). The patients were followed up from 1 to 65 months (average, 17 +/- 16 months). The immediate and follow-up clinical outcomes were documented and compared between the 2 groups.</p><p><b>RESULTS</b>Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion (15.6% vs 0, P = 0.02) and visceral/leg ischemia (21.9% vs 2.9%, P = 0.02). Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group (21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P = 0.02 and P = 0.02). Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P = 0.42 by Log-rank test). But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection (96.2% vs 73.9%; P = 0.02 by Log-rank test).</p><p><b>CONCLUSIONS</b>Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B AD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.</p>

The relationship between Oddi's sphincter and bile duct pigment gallstone / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone.</p><p><b>METHODS</b>One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope.</p><p><b>RESULTS</b>Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder.</p><p><b>CONCLUSIONS</b>The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.</p>