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Objective@#To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers.@*Results@#(1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was determined by ultrasound, vascular plastic surgery was perfomed to avoid stenosis. (3) Follow-up: 10 patients were followed up for 6-12 months, with a median follow-up time of 8 months. One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery, and was not removed stones by choledochoscope. The patient had no recurrent symptoms after T-tube removal. The other 9 patients had no residual stones.@*Conclusion@#RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis, and the surgical treatment can be safe and effective.
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Objective To investigate the application value of real-time virtual sonography (RVS)in the diagnosis and treatment of complicated hepatolithiasis.Methods The retrospective and descriptive study was conducted.The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People's Hospital between October 2017 and March 2018 were collected.There were 3 males and 7 females,aged from 40 to 69 years,with an average age of 57 years.Patients received abdominal color Doppler ultrasound examination,magnetic resonance cholangiopancreatography,and upper abdominal spiral computed tomography (CT) thinly scanning +enhanced examination.Data of CT examination were imported into RVS.RVS was used to locate hepatolithiasis,relationship between stones and vessels,anatomy of bile ducts and vessels in hepatic hilus.Surgical methods included RVS-guided hilar cholangiotomy,biliary stricturoplasty,bilateral hepatojejunostomy,hepatic segmentectomy (lobectomy),and hepatolithotomy.Observation indicators:(1) surgical and postoperative situations;(2) typical case analysis;(3) follow-up.Follow-up using outpatient examination was performed to detect residual stones up to June 2019.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results (1) Surgical and postoperative situations:10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis,with successful match in RVS (difference between CT images and ultrosound images ＜ 2 mm).No residual stone was identified by choledochoscope during operation.The operation time and volume of intraoperative blood loss were 285 minutes (range,210-360 minutes) and 200 mL (range,100-600 mL),respectively.No blood transfusion was needed during the operations.The duration of hospital stay was 20.5 days (range,14.0-29.0 days).There was no perioperative death.One patient had postoperative biliary leakage and abdominal infection,and was cured after conservative treatment.(2) Typical case analysis:the tenth patient,female,60 years old,was diagnosed with complicated hepatolithiasis,and was prepared to undergo hepatolithotomy + quadrate lobectomy and hilar cholangioplasty+bilateral hepatojejunostomy.Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein,and stones and important vessels were marked on the images.After accurate positioning,a curette was used to remove the stones.Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed.After the stones were removed,the intrahepatic bile duct and hilar bile duct merged.The left end of the bile duct split was confirmed by real-time ultrasound.After location of portal vein was determined by ultrasound,vascular plastic surgery was perfomed to avoid stenosis.(3) Follow-up:10 patients were followed up for 6-12 months,with a median followup time of 8 months.One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery,and was not removed stones by choledochoscope.The patient had no recurrent symptoms after T-tube removal.The other 9 patients had no residual stones.Conclusion RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis,and the surgical treatment can be safe and effective.
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Objective To investigate the curative effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage in the treatment of severe pneumonia patients undergoing mechanical ventilation (MV).Methods A prospective randomized controlled trial was conducted. 286 severe pneumonia patients undergoing MV admitted to intensive care unit (ICU) of Hunan People's Hospital from January 2014 to July 2016 were enrolled, and they were divided into control group and observation group according to random number table, with 143 patients in each group. Patients in both groups received sensitive antibiotics for anti-infection, etiological treatment, and calefacient and humidifying treatment. The patients in the control group received bronchoalveolar lavage with fiberoptic bronchoscopy, and those in the observation group received bronchoalveolar lavage combined with vibration sputum drainage. The parameters of respiratory function and inflammation before and after treatment, curative effect, and prognosis were compared between the two groups.Results ① There were no significant differences in respiratory function parameters between the two groups before treatment, 2 hours after treatment, the parameters were improved in both groups. Moreover, oxygenation index (PaO2/FiO2) in observation group was significantly higher than that of control group [mmHg (1 mmHg = 0.133 kPa): 379.1±20.2 vs. 351.8±24.7], and arterial partial pressure of carbon dioxide (PaCO2) and airway resistance (Raw) were significantly lower than those of the control group[PaCO2 (mmHg): 36.5±5.8 vs. 45.3±6.9, Raw (cmH2O, 1 cmH2O = 0.098 kPa): 12.9±0.6 vs. 13.1±0.8, allP 0.05].Conclusion Compared with bronchoalveolar lavage with fiberoptic bronchoscopy alone, the treatment of bronchoalveolar lavage combined with vibration sputum drainage is more effective in sputum excretion for severe pneumonia patients undergoing MV, which could improve the respiratory function, reduce infection, shorten the duration of MV and the length of ICU stay, and improve the recovery.
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Objective To investigate the indication and value of metallic stent in the management of patients with malignant obstructive jaundice(OJ). Method The clinical data of 15 patients with malignant OJ treated in our hospital were analysed retrospectively. All the 15 patients were treated with metallic stent including cholangiocarcinoma in 8 cases, carcinoma of gallbladder in 3 cases, pancreatic carcinoma in 2 cases, porta hepatis metastasis of gastric carcinoma after radical gastrectomy in 2 cases. Result All the patients' jaundice disappeared 11-38 days after the stent placement. No severe complications or death occurred in this series. One patient had cholimia 5 days after the stent placement, which was cured by non-operative method. All cases were followed up periodically, the survival time was 30-384 days(averag 180.5 days). Conclusions Installing stent of Titanium-Nickel metallic alloy for the patient with unresectable malignant OJ is an ideal palliative therapy which is simple and less discomfortable.and less complications.The effect of reducing jaundice is satisfactory. This method may offer a new alternative method in the management of malignant OJ.
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Objective To explore the expression and significance of DPC 4/Smad 4 and nm23-H1/NDPK in human pancreatic carcinoma. Methods The expressions of DPC 4/Smad 4 and nm23/NDPK were detected by immunohistochemical method in 34 pancreatic carcinoma tissues and 34 chronic pancreatitis tissues. Results The positive rate of DPC 4/Smad 4 expression was significantly higher in the chronic pancreatitis than in the pancreatic carcinoma(P
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Objective To investigate if there is a synergism of kansui root and low molecular weight heparin(LMWH) in combined treatment of SAP in rats.Methods SD rats were randomly divided into 5 groups:Sham group(A group),severe acute pancreatitis group(B group),kansui root treatment group(C group),LMWH treatment group(D group),combined treatment group(E group).The serum TNF-?,IL-6 level and the ratio of TXB2/6-keto-PGF1? in pancreatic tissue,and the histological examination were evaluated.Results The values of TNF-??IL-6 and the ratio of TXB2/6-keto-PGF1? in C,D,E group were significantly lower than those in B group at the time point of 6,12,24h.But there were no significant differences in C,D,E group at all the time points.The histological examination showed that the pancreas was normal in group A;the pathological changes were milder in C,D,E group than that in B group.Conclusions Combined treatment of kansui root and LMWH was effective in SAP,but there was no synergism,and also no side effects.