Preoperative antiplatelet drugs on the hemorrhage and allogenic blood transfusion condition after coronary artery bypass graft surgery

Aim of the study was to observe and evaluate the postoperative hemorrhage and allogenic blood transfusion condition in patients who were exposed to different levels of clopidogrel and aspirin beforeon-pump coronary artery bypass graft surgery [CABG]. A total of 180 patients underwent on-pump CABG at our hospital were enrolled and divided into treatment group, discontinuation group and control group based on their preoperative use of clopidogrel and aspirin, with 60 patients in each group. And the postoperative hemorrhage and allogenic blood transfusion condition were observed and evaluated. Compared with the control group, the postoperative total drainage and the occurrence of major bleeding were significantly higher in the treatment group [p<0.05]. The transfusion volume and infusion rates of packed red blood cells and fresh frozen plasma and the total blood transfusion rate were decreased progressively in accordance with the treatment group, discontinuation group and control group. The transfusion volume and infusion rates of packed red blood cells and fresh frozen plasma, and the total blood transfusion rate were significantly higher in the treatment group when compared with the control group [p<0.05]. And the total blood transfusion rate was significantly higher in the treatment group when compared with the discontinuation group [p<0.05]. The postoperative hemorrhage and allogenic blood transfusion rate would be significantly up-regulated when patients were exposed to clopidogrel and aspirin in the week before on-pump CABG

Clinical research on video-assisted thoracoscopic iodine tincture pleurodesis for treating malignant pleural effusion / 中国肿瘤临床

Objective: To observe the therapeutic effect of video-assisted thoracoscopic surgery (VATS) with iodine tincture pleurodesis on malignant pleural effusion (MPE). Methods:Clinical data from 47 MPE cases were retrospectively analyzed. Based on different treatments, the 47 cases were divided into Groups A (n. 25) and B (n. 22), which used iodine tincture and talc powder as a hard-ener, respectively. Provided that all cases were conclusively diagnosed as MPE, and the patients underwent VATS pleural biopsy and pleurodesis, Groups A and B were comparable. The authors then compared the postoperative effectiveness rates (both complete and par-tial remissions), the volume of chest drainage, the incidence of adverse reactions, and the drainage time of the chest tube between the two groups. Results:Difficulty in breathing was proven to be less severe among all cases after the operation, and none of the patients suffered from acute lung injuries. After the operation, Group A exhibited an effectiveness rate of 96.0%, whereas Group B presented a rate of 95.5%, which indicates that no significant difference was found between the two groups (P>0.05). The total incidence of adverse reactions was 32.0%in Group A and 63.6%in Group B, with a significant difference between the two (P<0.05). Conclusion:VATS io-dine tincture pleurodesis has been proven to be as therapeutically effectual as talc pleurodesis and has resulted in fewer adverse reac-tions. This finding suggests that VATS iodine tincture pleurodesis has a promising potential in clinical practice because of its definite cu-rative effect, simple management, high security, fewer adverse reactions, and reasonable cost.

Diagnosis and treatment analysis of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history / 中国基层医药

Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%( wound infection 37.1%, pneumonia 22.2%), which was significantly higher than 11.8%of patients without intestinal necrosis (wound infection 5.9%,pneumonia 5.9%)(χ2 =3.861,3.861,all P<0.05).Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .

Evaluation of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy / 国际外科学杂志

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.

Pre-operative evaluation of three-dimensional spiral CT cholangiography in patients with bile duct obstruction / 国际外科学杂志

ObjectiveTo study the preoperative evaluation of three-dimensional spiral CTcholangiography(SCTC) in patients with bile duct obstruction.MethodsA retrospective analysis was performed for 60patients with bile duct obstruction from May 2008 to April 2011,who were treated with endoscopic retrograde cholangiopancreatography( ERCP),then SCTC was performed through endoscopic nasobiliary drainage( EN-BD) tube,and the bile duct tree image of SCTC of bile duct obstruction was evaluated.ResultsIn 60 cases of bile duct obstruction who performed three-dimensional SCTC,the left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,cholecyst bile duct was visible in 80％ patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enters into the common bile duct.ConclusionThree-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values in judging the structure of the bile duct tree and the shape of cholecyst bile duct during operation.

Laparoscopic cholecystectomy for the treatment of patients with cholelithiasts concurrent with choledocholithiasis / 国际外科学杂志

Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.

Three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for prevention of biliary duct injury / 国际外科学杂志

Objective To study the preventive effect of biliary duct injury(BDI)of three-dimensional spiral CT cholangiography(SCTC)before laparoscopic cholecystectomy(LC).Methods A retrospective analysis was carried out for 30 patients suffering from cholelithiasts concurrent with choledocholithiasis from July 2007 to June 2009.EAndoscopic sphincterotomy(EST),then three-dimensional SCTC was carried out through endoscop-ic nasobiliary drainage(ENBD)before IX,and the preventive effect of BDI was evaluated.Results The visibility of intra-hepatic bile duct,the hepatic bile duct and the common bile duct were 100% the visibility of chol-ecyst bile duct was 73% ,and three-dimensional SCTC can tell the position of cholecyst duct,BDI was not happened in all these patients.Conclusion Three-dimensional SCTC before LC can decrease the possibility of BDI.

Immune nutrition in the treatment of acute pancreatitis / 国际外科学杂志

Acute pancreatitis can lead to dysfunction of gut mucosa barrier, translocation of intestinal bacteria, damage of immune function. Immune nutrition substances such as glutamine, arginine, -3 polyun-saturated fatty acids (-3 PUFAs),dietary fiber (DF) can prevent dysfunction of gut mucosa barrier and translocation of intestinal bacteria, enhance the immune function, promote the recovery of acute pancreatitis. The article reviewed domestic and. overseas documents to on the contribution of immune function to acute pancreatitis.

Treatment of cholecystolithiasis and calculus of common bile with endoscope and laparoscope / 中国综合临床

Objective To explore the clinical effect of treatment for cholecystolithiasis and calculus of com-mon bile with duodenoscope and laparoscope. Methods 48 cases of patients with cholecystolithiasis and calculus of common bile duct were analysed, of whom 30 cases were treated by traditional operation, and 18 cases were treated by duodenoscope and laparoscope. The operation time, stay-in-hospital time after operation, the gastrointestinal function recovery time after operation, the degree of pain were compared. Results The cost of duodenoscope and laparoscope was higher than that of traditional operation group, but the other parameters were better ( P < 0.05 ). Conclusion Treating cholecystolithiasis and calculus of common bile duct with duodenoscope and laparoscope is safe, less traumatic and the patients may recover faster than routine treatment.

The causes of postoperative complications of mesh plug hernia repair / 国际外科学杂志

Objective To analyze the causes of postoperative complications of Mesh plug hernia repair of inguinal hernia. Methods The 332 ingunial hernia patients from June 2002 to May 2007 who underwent Mesh plug repair were summarized retrospectivdy. the causes of postoperative complications were analyzed. Results All the patients were followed up 15～60 months.there were 3 cases of durative pain,1 case of recurring,16 cases of scrotal edema,20 cases of urinary retention. Condusion Anatomizing carefully during operation is the key to decrease the postoperative complications of Mesh plus hernia repair.

Prevention of biliary duct injury in laparoscopic cholecystectomy / 国际外科学杂志

Objective To explore how to prevent biliary duct injury during laparoscopic cholecystectomy.Methods The clinical data of 484 cases of laparoscopic cholecystectomy from December 2002 to December 2007 were retrospectively analyzed,and the experiences of preventing biliary duct injury were summarized.Results No biliary duct injury case was found but 26 cases were converted to laparotomy during operation and 20 cases were placed drainage tube.Conclusion Familiar with the anatomy of bile duct,careful handling of the Calot's triangle are the keys to prevent biliary duct injury in LC.