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Objective:To investigate the application value of extrathecal Glisson blood flow occlusion in the resection of primary liver cancer.Methods:74 patients with primary liver cancer who received treatment in Yuyao People's Hospital from January 2019 to January 2020 were included in this study. They were randomly assigned to undergo resection of the primary liver cancer with either extracorporeal Pringle maneuver (control group, n = 37) or extrathecal Glisson maneuver (observation group, n = 37). Surgery-related indexes, postoperative liver function and gastrointestinal function recovery, and complications were monitored in each group. Results:Blood flow occlusion time and hospital length of stay in the observation group were (25.10 ± 5.19) minutes and (12.45 ± 1.10) days, which were significantly shorter than those in the control group [(30.65 ± 8.54) minutes, (14.85 ± 1.28) days, t = 3.378, 8.650, both P < 0.05]. Volume of blood loss in the observation group was significantly less than that in the control group [(490.36 ± 120.19) mL vs. (655.58 ± 152.24) mL, t = 5.181, P < 0.05]. Intraoperative blood transfusion rate in the observation group was significantly lower than that in the control group [21.62% (8/37) vs. 45.95% (17/37), χ2 = 4.893, P < 0.05]. At 1, 3 and 7 days after surgery, aspartate aminotransferase level in the observation group was (240.36 ± 60.52) U/L, (145.69 ± 42.18) U/L and (60.13 ± 12.58) U/L, respectively, which was significantly lower than that in the control group [(350.21 ± 60.16) U/L, (212.53 ± 40.21) U/L, (103.65 ± 20.54) U/L, t = 7.930, 6.977 and 10.991, all P < 0.05]. At 1 and 7 days after surgery, alanine aminotransferase level in the observation group was (228.52 ± 65.28) U/L and (44.26 ± 12.85) U/L, respectively, which was significantly lower than that in the control group [(350.16 ± 68.58) U/L, (466.36 ± 40.29) U/L, t = 7.815 and 3.179, both P < 0.05]. At 1 and 7 days after surgery, total bilirubin level in the observation group was (28.58 ± 5.24) μmol/L and (20.30 ± 5.10) μmol/L, which was significantly lower than that in the control group [(43.32 ± 10.26) μmol/L, (26.08 ± 5.68) μmol/L, t = 7.783, 4.606, both P < 0.05]. At 1 day after surgery, albumin level in the observation group was significantly lower than that in the control group [(34.65 ± 2.42) g/L vs. (31.12 ± 2.23) g/L, t = 6.525, P < 0.05). The time to recovery of bowel sounds, the time to the first exhaust, and the time to defecation in the observation group were (14.28 ± 2.10) hours, (29.21 ± 5.10) hours, and (54.20 ± 5.69) hours, which were significantly shorter than those in the control group [(16.65 ± 2.16) hours, (33.25 ± 5.47) hours, (59.85 ± 5.87) hours, t = 4.783, 3.286 and 4.204, all P < 0.05]. The total incidence of postoperative complications in the observation group was significantly lower than that in the control group [13.51% (5/37) vs. 35.14% (13/37), χ2 = 4.698, P < 0.05]. Conclusion:Extrathecal Glisson maneuver for the resection of primary liver cancer exhibits better performance in the control of bleeding, reduction of postoperative complications, and acceleration of rehabilitation than extracorporeal Pringle maneuver.
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Objective To compare the efficacy of laparoscopic gallbladder bed dissection(LGBD)between retrograde plus anterograde and anterograde only manners.Methods All of 575 cases of laparoscopic cholecystectomy(LC)were randomly divided into two groups(group A and group B).Patients underwent LGBD with retrograde plus anterograde mannerin group A(297 cases)oronly with anterograde manner in group B(278 cases)respectively.The efficacy and safety were compared between two groups.Results The operative time were(10.0±3.7)min and(13.0±3.9)min in group A and group B respectively (P<0.05).There were 33 cases of bleeding volume more than 5 ml in group A with 85 cages in group B (P<0.05).Three cases of gallbladder rupture were found in group A compared with 10 cases in group B (P<0.05).Postoperative fluid collection in gallbladder bed occurred in 5 cases in group A compared with 19 cases in group B(P<0.05).The conversion rate was 3.70%(11/297)and 3.96%(11/278)in group A and group B respectively(P>0.05).One cage of abdominal fluid collection was observed in group A whichwas relieved after conservative therapy.No other complications occurred.Conclusions LGBD applying retrograde plus anterograde manner may shorten the operative time,decrease the bleeding during operation and minimize the postoperative complications.Surgeons might benefit from its advantage of easier manipulation.
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Objective: To evaluate feasibility of using European Nutritional Risk Screening 2002(NRS2002) for nutritional status assessment in primary hospital.Methods: 799 patients were enrolled in this study.697 patients who were according NRS request were assessed using NRS method in hospitalization day.The patient whose NRS scores were higher than 3 were justified under nutritional risk.102 patients who were not according NRS request were assessed by exeamining the serum albumin(ALB) in the next day.The patients whose serum ALB was lower than 35 g/L were justified malnutrition.Results: There were 697 patients could be evaluated by NRS method.Body Mass Index(BMI) was lower than 18.5 in 159(22.8%) cases and NRS scores were ≥3 in 240 cases(34.4 %) among 697 cases.Serum albumin was lower than 35 g/L in 31 (30.4%) cases among 102 cases who could not be evaluated by NRS method because of incapable of standing up(66/102,64.7%) and ascites or hydrothorax(17/102,16.7%) and concomitance of above-mentioned causes(11/102,10.8%) and coma(8/102,7.8%).Conclusion: Assessment of nutritional status of hospitalized patients in primary hospital using NRS2002 method is feasible.The patients who could not be evaluated by NRS 2002 method can be assessed by assaying serum ALB.
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Objective To study the skills of laparoscopy for hight difficulty eholecystectomy.Method Forty-eight cases of hight difficulty laparoscopic cholecystectomy from July 2005 to July 2007 were analyzed retrospectively. Result In 48 cases, 5 cases were converted to open surgery, 2 cases suffered in-cision infection, all the patients recovered. Conclusion According to the operating status and experience of the performer, Calot triangle dissection and judge good opportunity to change open surgery are the key faetora to the successful operation for difficult and complex laparoscopie cholecystectomy, which is safe and feasible.
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Objective To investigate the value in distinguishing benign and malignant vertebral fractures with MR diffusion-weighted imaging(DWI).Methods 31 patients with 58 vertebral fractures were underwent routine MRI scanning and echo-planar DWI(EPI/DWI).The materials were divided into benign group(n=32,20 cases),malignant group(n=18,8cases),tuberculosis group(n=8,3cases) and normal vertebral body group(n=31). Signal intensities on DWI were compared and apparent diffusion coeffient(ADC) values of normal and abnormal vertebral bodies were calculated. ADC values among the benign,malignant,tuberculosis vertebral bodies and normal ones were quantitatively analyzed and compared.Results The ADC values of benign,malingnant,tuberculosis and normal vertebral bodies were (1.44?0.41)?10 -3 mm2/s,(0.94?0.17)?10 -3 mm2/s,(0.98?0.13)?10 -3 mm2/s and(0.42?0.16)?10 -3 mm2/s ,respectively. The ADC values of the three abnormal groups were higher than normal group ( all P0.05). The sensitivity and specificity of ADC for the diagnosis of malignant lesion were 72.2% and 90.6% if the upper bound of 95% confidence interval was set as a differential level.Conclusion DWI provides an important supplement to the routine MRI in the differentiation of benign with malignant vertebral fractures.