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Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.
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Cavernous transformation of the portal vein (CTPV) is considered a rare condition. However, with the development of radiological technology, an increasing number of patients have been diagnosed with CTPV, thus causing wide attention in clinical practice. This article elaborates on the research advances in CTPV from etiology to treatment, discusses the etiology of portal vein thrombosis and the mechanism by which portal vein thrombosis leads to CTPV, and summarizes the clinical manifestations of CTPV and the main methods of diagnosing this disease. Besides, this article analyses various methods in treating CTPV, and believes that surgical shunts are still the most extensively used method in treating CTPV.
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ObjectiveTo investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors.MethodsFrom January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. ResultsPancreatic tumors (5/8) and retroperitoneal tumors(3/8)were the primary etiology,andthe main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain.Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence.ConclusionRegional portal hypertension caused by malignant tumor was relatively rare,aggressive resection of multi-viscera combined with devascularization was an effective therapy.
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Objective To explore the clinical significance and operational methods during extended radical excision for pancreatic cancer combined with portal vein ( PV )/superior mesentery vein ( SMV ) resection,and to investigate the management of iatrogenic arterial injury. Methods Clinical date of 242 patients with pancreatic cancer undergoing extended radical excision were retrospectively analyzed. All cases were divided into three groups, patients with PV/SMV resection were in group A (n = 51 ), patients with iatrogenic arterial injury during operation were in group B(n =5) ,patients without resection of vessels werein group C (n = 186 ). Operating time、volume of intraoperative blood transfusion, time of vascular interruption、the mean hospitalization,postoperative complications and postoperative survival analysis among three groups were compared with each other. Results Operating time in group A、B and C were (442. 85 ± 102. 32 ) min, ( 348. 62 ± 92. 31 ) min and ( 315.00 ± 83.43 ) min respectively, volume of intraoperative blood transfusion were ( 1430. 83 ± 1092. 43 ) ml、( 1420. 22 ± 794. 41 ) ml and ( 928. 19 ±571.57) ml respectively,operating time and volume of intraoperative blood transfusion were of significantly difference(P <0. 05) among the 3 groups,there was no significant difference in the mean hospitalization and postoperative complications. The postoperative median survival period was 18.4 months for patients of pancreatic adenocarcinoma with PV/SMV resection, the postoperative median survival period was 16. 1 months without PV/SMV resection, there was no significant difference between these by postoperative survival analysis. In the 51 cases with vessel resection,7 cases underwent partial resection of the vascular wall,44 cases underwent segmental resection, reconstruction of the portal vein was performed by end-to-end anastomosis in 38 patients, stent graft in 6 cases, the mean length of the PV/SMV resection was (2. 92 ±1.35 ) cm; latrngenic arterial injury occurred during operation in 5 patients ( 1 in hepatic artery, 1 in superior mesenteric artery, 3 in celiac think), the artery was reconstructed by end-to-end anastomosis in 4 cases,repair in 1 case. Conclusions Active and reasonable operation for pancreatic cancer with PV/SMV resection is important for improving the rate of surgical resection and the quality of life. Because of complex topography,iatrogenic vascular injury may happened frequently.
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Objective To evaluate the safety and rationality of total/near total bilateral thyroidectomy(TBT) for patients with bilateral multinodular goiter(BMG). Methods From January 2003 to December 2006,311 BMG cases were preoperatively divided into two groups, 130 cases in group A underwent TBT, and 181 cases in group B were treated with subtotal/partial bilateral thyroidectomy. Results There were 6 and 2 eases in group A and group B respectively diagnosed by intraoperative frozen biopsy as BMG, but identified as papillary carcinoma by final pathology. Hence the 6 cases in group A avoided reoporation, while the 2 cases in group B underwent a resection of the remnant gland. Transient hoarseness developed in 3 (2.42%, 3/124) and 3 (1.68%, 3/179) eases in group A and group B respectively (P =0.48). Transient hypocalcemia developed in 11 (8.87% ,11/124) and 9(5.03% ,9/179) cases in group A and group B respectively(P =0.16). There was no postoperative goiter recurrence in group A, but recurrence developed in 12 cases (6.70%,12/179) in group B(P=0.02). Conclusions Total bilateral thyroidectomy is safe and rational for the management of bilateral thyroid goiter.
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Objective To outline the surgical experience of liver transplantation in children receiving left lateral lobe (segments II, III). Methods From March 1 to September. 1, 2004, 11 cases of pediatric liver transplantation were performed in Medical School of Hannover including 10 cases of split liver transplantation and 1 case of living related liver transplantation, and the clinical data of those cases were collected and analyzed. The average age and weight of these patients was 48.6 months (5-82 months) and 14.3 kg (6.9-23.8 kg) respectively, and 8 children had the previous abdominal surgical history. Results The average weight of the left lateral graft procured was 276.2 g (198-373 g), and the average cold ischemia time, anhepatic phase and operation time was 679 min (183-1290 min), 69 min (44-88 min) and 252 min (155-335 min) respectively. Six children received temporal closure of abdominal wall after liver transplantation. One child developed the perforation of stomach 15 days after operation, and compression of hepatic artery due to limited abdominal capacity occurred in 2 children within 24 h postoperatively. No complications including outflow obstruction of hepatic vein, hepatic artery thrombosis, primary graft nonfunction, graft necrosis and bile leakage from the cutting surface happened. Conclusion The left lateral lobe liver transplantation in children has been widely used with promising results. Resection of ill liver under controlling of inferior vena cava, simultaneous reperfusion of hepatic artery and portal vein and application of temporal abdominal wall closure had unique advantage, and thus, would be worth adopting.
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Objective To explore the universal pathologic changes as well as the characteristic features of post-transplant hepatitis C caused by different HCV genotypes and study the relationship between pathologic change with HCV genotypes.Methods Fifty cases of HCV-related post-transplant hepatitis C with confirmative serum HCV RNA positivity and HBV DNA negativity between January 2001 to April 2002 were collected from Starzl transplant institute, Pittsburgh university. Liver biopsy from all cases was obtained at the same time. The parameters of histology activity index (HAI), hepatic fibrosis stage (HFS), liver steatosis (LS) and rejection were evaluated. The data were analyzed by SAS 6.12 statistical software using Wilcoxon method.Results Several HCV genotypes or subgenotypes such as 1a, 1b, 2, 3a and 4 were separated at this group. Although there was no statistical difference in HAI, HFS between individual genotype groups, there was significant difference in LS. More severe steatosis was found in HCV 3a and HCV 2 groups other than in HCV 1, HCV 4 groups ( P
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ObjectiveTo investigate the protective role of Lazaroid U 74389G pretreatment against graft warm ischemia reperfusion injury of rat liver transplantation from non heart beating donors.MethodsRat liver transplantation was carried out in 4 groups (N 45, N 60, tN 45 and tN 60), according to pretreatment with U 74389 G or not, and the non heart beating time of 45 or 60 minutes before donor liver was harvested.Survival rates, liver functions, MDA values and graft pathologies were compared between the groups.ResultsThe one week survival rates of group N 45, N 60, tN 45 and tN 60 were 25%(2/8), 0(0/8), 58%(7/12) and 33%(4/12) respectively.U 74389G pretreatment not only significantly increased survival rate of rat liver transplantation from non heart beating donors, but also improved liver functions and graft pathologies, as well as decreased MDA expression.Conclusions U 74389G pretreatment could attenuate ischemia reperfusion injury on donor livers and increase the survival rates in rat liver transplantation from non heart beating donors.
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Objective To investigate the relationship between donor liver warm ischemia and postoperative cytokine expression in liver transplantation from non-heart-beating donors.Methods Rat orthotopic liver transplantation was performed in three groups (HB, NHBD-30 and NHBD-60) according to the non-heart-beating time of 0, 30 or 60 minutes before donor liver was harvested. The serum values of TNF-?, IL-6 and CINC in each group after transplantation were determined.Results Over time of warm ischemia to which the donor liver was exposed, the concentrations of TNF-?, IL-6 and CINC elevated with significant difference among those three groups. TNF-?, IL-6 and CINC reached its peak value at 3 hours, 6 hours and 6 hours after transplantation respectively.ConclusionsKG1 In liver transplantation from non-heart-beating donors, the upregulation of TNF-?, IL-6 and CINC was associated with warm ischemia injury.