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Objective:To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+ LC) with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+ LC) in elderly patients with concomitant gallbladder and common bile duct (CBD) stones.Methods:This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January, 2014 and December, 2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University. There were 254 males and 238 females, aged (83.9±3.0) years. These patients were divided into two groups based on their operative methods: the one-stage group (LCBDE+ LC, n=186) and the two-stage group (ERCP+ LC, n=306). Differences in surgery, stones and hospitalization costs were compared between the two groups. Results:When compared with the ERCP+ LC group, the LCBDE+ LC group had significantly higher incidences of previous gastrectomy [21.5%(40/186) vs 4.2%(13/306)], multiple stones [77.4%(144/186) vs 49.3%(151/306)], larger stone diameter [13.7(6.4, 18.6)mm vs 10.9(5.7, 16.1) mm], and increased hospitalization expenditure [(2.37±0.31) Wanyuan vs (3.26±0.44) Wanyuan] (all P<0.05). However, the rates of residual stone [2.7%(5/186) vs 1.3%(4/306)], stone recurrence [2.2%(4/186) vs 5.2%(16/306)], postoperatively overall complications [3.2%(6/186) vs 1.3%(4/306)], and total hospital stay [(10.7±6.2) d vs (11.3±5.4) d] were not significantly different between the two groups (all P>0.05). Conclusions:Allowing for the similar safety and effectiveness, and lower hospitalization expenditure, LCBDE+ LC was a preferred choice for patients aged over 80 year, especially in patients who had previous gastrectomy, multiple large CBD stones, or who could not accept endoscopic procedures for treatment of CBD stones.
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Objective:To investigate the efficacy of early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of severe acute pancreatitis (SAP) .Methods:170 SAP patients admitted to Quzhou People’s Hospital from Jan. 2016 to Jun. 2020 were divided into the observation group and the control group, with 85 cases in each group, according to the random number table method. The control group received comprehensive medical treatment, while the observation group received early minimally invasive catheterization continuous abdominal lavage and drainage intervention based on the control group. The efficacy and complications after 1 week of treatment were evaluated. Besides, the intra-abdominal pressure (IAP) and acute physiology and chronic health II (APACHEII) were scored, liver and lung function indexes [oxygenation indexes, oxygen partial pressure (PaO 2) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) ], and inflammation indexes [C-reactive protein (CRP) , tumor necrosis factor-α (TNF-α) , macrophage inflammatory protein-1α (MIP-1α) ] were measured before and 1 week after the treatment. Results:The total effective rate of the treatment in the observation group was 91.77%, which was significantly higher than 77.65% in the control group ( P<0.05) . The level of IAP, APACHEII score, AST, ALT, CRP, TNF-α, MIP-1α of the two groups after 1 week of treatment decreased significantly compared with those before treatment, while the oxygenation index and PaO 2 increased significantly. The levels of IAP, APACHEII score, AST, ALT, CRP, TNF-α, and MIP-1α in the observation group were lower than those in the control group after 1 week of treatment, while the oxygenation index and PaO 2 in the observation group were higher than those in the control group, with statistically significant difference ( P<0.05) . The incidence rates of multiple organ dysfunction syndrome (MODS) , sepsis and systemic inflammatory response syndrome (SIRS) in the observation group were: 8.24%, 11.76% and 15.29%, significantly lower than 21.18%, 29.41% and 30.59% in the control group ( P<0.05) . Conclusion:Early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of SAP is safe and effective, which can significantly inhibit pro-inflammatory factors, and protect liver and lung function.
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This study was aimed to observe the therapeutic effect of qi-supplementing,blood-activating and phlegmresolving on chronic obstructive pulmonary disease (COPD) patients with blood stasis syndrome in the acute stage,and to evaluate the lung function improvement condition.Observation was also made on plasma fibrinogen and D-dimer,in order to provide references for traditional Chinese medicine (TCM) clinical treatment of COPD.A total of 174 acute COPD patients with blood stasis syndrome were selected from October 2015 to July 2017 in the Linqu County People's Hospital of Shandong Province.Patients were randomly divided into the control group and the study group.Conventional western medicine treatment was given to the control group.On the basis of routine western medicine treatment,the study group was treated with TCM qi-supplementing,blood-activating and phlegm-resolving method.The clinical efficacy,changes of lung function,plasma fibrinogen and D-dimer before and after treatment were observed in both groups.The results showed that the total efficacy of the study group was 95.4％,and the total efficacy of the control group was 79.3％.The difference was statistically significant (P ＜ 0.05).Pearson correlation study showed that plasma fibrinogen (r =-0.79,P ＜ 0.05) and D-dimer (r =-0.84,P ＜ 0.05) were negatively correlated with PaO2.Before treatment,there was no significant difference in lung function,plasma fibrinogen and D-dimer between two groups (P ＞ 0.05).After treatment,indicators of both groups were significantly improved,in which the improvement of the study group was more obvious.The difference between two groups was statistically significant (P ＜ 0.05).It was concluded that the expression levels of plasma fibrinogen and D-dimer were closely related to COPD.Qi-supplementing,blood-activating and phlegmresolving method can improve clinical symptoms,blood stasis status and lung function of COPD patients in the acute stage with remarkable curative effect.
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[Objective]To observe and evaluate the clinical effect of Jingtongping pills on the cervical spondylotic radiculopathy(CSR).[Method]Eighty patients with CSR were assigned into two groups,40 patients were treated with Jingtongping pills(as therapeutic group)and the others were treated with Jingfukang(as control group).The clinical curative effect and adverse effect were evaluated at the end of 3 weeks.[Result]There was statistical difference between two groups when effective powers assessed with disease curative effect standard(P0.05).There was no adverse reactions founded in two groups.[Conclusion]Jingtongping pills has a certain therapeutic value for CSR.