Related factors affecting the occurrence of severe pancreatic fistula after radical gastrectomy / 中国基层医药

Objective:To investigate the related factors that affect the occurrence of severe pancreatic fistula after radical gastrectomy.Methods:The clinical data of 460 patients undergoing radical gastrectomy in The People's Hospital of Shouguang from January 2015 to January 2021 were retrospectively analyzed. These patients were divided into severe pancreatic fistula group ( n = 24) and non-severe pancreatic fistula group ( n = 436) according to whether they developed severe pancreatic fistula after surgery. Preoperative clinical data, surgical data, and abdominal drainage fluid amylase level in the first postoperative days were compared. The receiver operating characteristics (ROC) curve was used to calculate the cutoff value of abdominal drainage fluid amylase level on the 1 st and 3 rd days of developing severe pancreatic fistula after radical gastrectomy. The incidence of pancreatic fistula was compared between different amylase level groups. Multivariate logistic regression was performed to analyze the independent risk factors of severe pancreatic fistula after surgery. Results:There were significant differences in body mass index, operative time, intraoperative blood loss, peritoneal drainage fluid amylase level on the 1 st and 3 rd days after surgery, and the number of cases undergoing splenectomy between the two groups (all P < 0.05). The cutoff values of amylase level in peritoneal drainage fluid (D-AMY) on the 1 st and 3 rd days after surgery were 2 156 IU/L and 596 IU/L respectively, which had high sensitivity and specificity. On the 1 st and 3 rd days after surgery, the incidence of pancreatic fistula in the high-level amylase group was significantly higher than that in the low-level amylase group [26.2% (16/61) vs. 0.8% (3/334), χ2 = 62.82, P < 0.05). Multivariate logistic analysis showed that obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery were independent risk factors for severe pancreatic fistula, and the differences were statistically significant (all P < 0.05). Conclusion:Obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery are independent risk factors affecting the occurrence of severe pancreatic fistula. D-AMY (> 2 156 IU/L) on the 1 st day and D-AMY (> 596 IU/L) on the 3 rd day in the early postoperative days can be used as cutoff values to predict the occurrence of severe pancreatic fistula after radical gastrectomy.

Clinical significance of monitoring drainage fluid parathyroid hormone after thyroid surgery / 中华内分泌外科杂志

Objective To explore the clinical significance of monitoring drainage fluid parathyroid hormone (dPTH) for estimating the in situ reserves and function of the parathyroid by analyzing the change of serum calcium,serum parathyroid hormone(sPTH) and dPTH after thyroid surgery.Methods According to the operative method,the total of 144 patients with thyroid disease were divided into five groups:unilateral lobectomy,unilateral lobectomy plus isthmectomy with unilateral lymph node dissection,total thyroidectomy,total thyroidectomy with unilateral lymph node dissection,and total thyroidectomy with bilateral lymph node dissection group.The blood calcium,sPTH and dPTH level of patients were tested before operation and on the 1st,2nd,3rd and 4th day after operation.The depression of serum calcium,hypocalcemia and hypoparathyroidism were observed after operation.The serum calcium,serum PTH and dPTH level were summarized and analyzed statistically in order to evaluate the in situ reserves and postoperative function of the parathyroid.Results Among the 114 cases,the decline of serum calcium level mostly happened on the 2nd day after operation(70 cases,61.4％).There were 36 patients with hypocalcemia (31.58％) and 34 patients with hypoparathyroidism (29.82％).Serum calcium level increased gradually in all of the patients.Although sPTH level swung,it had a rising trend on the whole.The level of serum calcium and sPTH was positively correlated.The level of dPTH was discrete and decreased along with time.The decline level of dPTH among different groups had statistical difference.Conclusions It is a promising method to evaluate the in situ reserves and function of the parathyroid by monitoring the level and changes of dPTH after thyroid surgery,and it is of value for preventive calcium supplementation after thyroid surgery.

Prediction of the parathyroid gland function and prognosis after thyroid surgery by monitoring drainage fluid and serum parathyroid hormone and serum calcium / 中华内分泌外科杂志

Objective To explore the dynamic variation rule of drainage fluid parathyroid hormone ( dPTH) , serum parathyroid hormone ( PTH) and serum calcium after thyroidectomy .According to the variation rule, the survival , function and prognosis of the parathyroid which retained at the original place can be predicted . Methods From Apr.2012 to Aug.2012, 90 patients who underwent thyroidectomy in Thyroid Surgery Center of the First Affiliated Hospital of Kunming Medical University were chosen as the research object .All of the objects'operations were performed by the same surgeon team and they were divided into four groups according to different surgical methods ( group A:bilateral thyroidectomy group , group B:bilateral thyroidectomy and central neck dis-section group , group C: bilateral thyroidectomy and functional neck dissection group , and group D: unilateral thyroidectomy group ) .Parathyroid retention situation during operation and the occurrence of hypocalcaemia after operation were recorded .Blood samples were taken between 7am and 8am in the 4 consecutive days after opera-tion to detect serum calcium and serum parathyroid hormone .All of the 90 patients had the drainage tube and their drainage fluid were taken for testing dPTH .The levels of serum calcium , PTH and dPTH were analyzed by statistical analysis of repetitive measure analysis of variance ( ANOVA) .Results The mean postoperative maxi-mum serum calcium was in group D and the minimum was in group C .There was no obvious difference in terms of serum calcium between group A and group B .However , the serum calcium showed an upward trend in each group.The mean postoperative maximum PTH was in group D and the difference has statistical significance com -pared to the other 3 surgical methods.The minimum was in group B and group C .However, it showed an upward trend with time in each group .The difference of dPTH in each group had no statistical significance and it showed a downward trend in all the 4 groups.Low serum calcium and hypocalcaemia occurred to 22 cases and 13 cases respectively after operation .The low serum calcium cases in each group were 12, 3, 4 and 2 respectively and hy-pocalcaemia cases in each group were 4, 3, 1 and 1 respectively.Conclusions By monitoring dPTH, PTH and serum calcium after thyroidectomy , the survival and function of parathyroid retained at the original place can be e-valuated comprehensively .Furthermore, it also helps to estimate prognosis .dPTH at a high level after operation is a direct evidence that parathyroid retained at the original place survives .Low PTH and high dPTH after thyroid-ectomy illustrates the operation just affects the way that PTH secreted into blood and the parathyroid retained at the original place can still secrete large amount of PTH .PTH will return to normal gradually with reconstruction and healing of microcirculation around parathyroid .Persistent low serum PTH after operation , low dPTH after 24 hours and the early advent of hypocalcaemia suggest the parathyroid retained at the original place was injured seri -ously and its blood supply was damaged obviously and more than one parathyroid were affected .Secretion function of parathyroid will remarkably decrease .

The clinical significance of CK-19 mRNA expression in the axillary drainage fluid of rectal cancer patients with real-time RT-PCR detection / 中国综合临床

Objective To detect CK-19 mRNA expression by quantitative real-time RT-PCR in axillary drainage fluid of rectal cancer and investigate its clinical significance.Methods Axillary drainage fluids were collected from 59 patients with rectal cancer and 15 patients with benign abdominal lesion from Sep.2010 to Dec.2010.Level of CK-19 mRNA in axillary drainage fluid was detected using specific primers by real-time RTPCR.The data were statistically analyzed to investigate the relationships between CK-19 mRNA level and tumor invasion,lymph node status,tumor stage and tumor differentiation level.Results The positive rate of CK-19 mRNA expression in patients with rectal cancer was 67.8％,which was significantly higher than that in patients with benign abdominal lesion.The expression of CK-19 mRNA was significantly correlated with the depth of tumor invasion,lymphnode status,tumor stage and histopathological differentiation( P ＜ 0.05 or P ＜ 0.01 ).Ck129 mRNA expression was associated with the pathological level,the higher of the lymph node translation level,the higher expression in the axillary drainage fluid after rectal cancer surgery (r =0.674,P =0.021 ).The lower of the lymph node differentiation level,the higher expression in the axillary drainage fluid after rectal cancer surgery (r =-0.741,P =0.014).Conclusion Quantitative detection of CK-19 mRNA in axillary drainage fluid of rectal cancer by RT-PCR could enhance the diagnostic sensibility of colorectal cancer micrometastases.RT-PCR assay is suitable for predicting peritoneal micrometastasis of rectal cancer,which is a reference for postoperative treatment and prognosis prediction.

Amylase, lipase, and volume of drainage fluid in gastrectomy for the early detection of complications caused by pancreatic leakage / 대한외과학회지

PURPOSE: Pancreatic leakage is a serious complication of gastrectomy due to stomach cancer. Therefore, we analyzed amylase and lipase concentrations in blood and drainage fluid, and evaluated the volume of drainage fluid to discern their usefulness as markers for the early detection of serious pancreatic leakage requiring reoperation after gastrectomy. METHODS: From January 2001 to December 2007, we retrospectively analyzed data from 24,072 patient samples. We divided patients into two groups; 1) complications with pancreatic leakage (CG), and 2) no complications associated with pancreatic leakage (NCG). Values of amylase and lipase in the blood and drainage fluid, volume of the drainage fluid, and relationships among the volumes, amylase values, and lipase values in the drainage fluid were evaluated, respectively in the two groups. RESULTS: The mean amylase values of CG were significantly higher than those of NCG in blood and drainage fluid (P < 0.05). For lipase, statistically significant differences were observed in drainage fluid (P < 0.05). The mean volume (standard deviation) of the drained fluid through the tube between CG (n = 22) and NCG (n = 236) on postoperative day 1 were 368.41 (266.25) and 299.26 (300.28), respectively. There were no statistically significant differences between the groups (P = 0.298). There was a correlation between the amylase and lipase values in the drainage fluid (r = 0.812, P = 0.000). CONCLUSION: Among postoperative amylase and lipase values in blood and drainage fluid, and the volume of drainage fluid, the amylase in drainage fluid was better differentiated between CG and NCG than other markers. The volume of the drainage fluid did not differ significantly between groups.

Drainage Fluid Infection after Thoracic Operation:Microbiological Examination and Preventive Measures / 中华医院感染学杂志

0.05).In all 57 strains of germ cultured,50.9% were Gram-negative bacilli,40.3% were Gram-positive cocci,and the other 8.8% were fungi.Causes of infection included impaired immunity defense,mistake in aseptic procedure or unstrictness of skin sterilizing,inadequate drainage,etc.CONCLUSIONS Reasonable in choice of antibiotics,strictness in aseptic procedure,adequate drainage and good nursing help are the main preventive measures to prevnt drainage fluid infection after thoracic operation.

Bacteriological Investigation of Drainage Tube after Modified Radical Mastectomy and Counter measures / 中华医院感染学杂志

OBJECTIVE To evaluate the present condition of bacteriological infection caused by drainage tube after modified radical mastectomy(MRM) and the prevention measure.METHODS Atotal of152 patients with drainage tube after MRM during 2005-2007 were analyzed,bacteria culture of drainage fluid from breast wound or axillary wound were taken in 24 hours after operation.The bacteria or fungi were identified with ATB bacterial analysis apparatus.RESULTS Seventy specimens from 52 patients were positive(positive rate 34.2%).Of 70 strains,40 were Gram-positive cocci,24 were Gram-negative bacilli and the other 6 were fungi.The reasons of infection included subsided immunity defense system,drainage tube application,incorrect aseptic processing or disinfection procedure,and obstruction of drainage tube.CONCLUSIONS The important prevention measures of bacteria infection through drainage tube after MRM include maintenance of aseptic environment in operating room,strict aseptic processing,fluent drainage,and proper indwelling time of drainage tube.

Clinical Value of Intra-abdominal fluid Monitoring after Laparoscopic Splenectomy / 中国微创外科杂志

Objective To investigate the approaches and clinical value of intra-abdominal fluid monitoring after laparoscopic splenectomy (LS). Methods We collected the data of 63 cases of LS performed in the West China Hospital from November 2005 to August 2008,and analyzed the level of amylase in intra-abdominal fluid,changes of color,volume,and characteristics of the drainage fluid,as well as the results of germiculture and ultrasonography. Results Among the cases,post-LS complications were detected by intra-abdominal fluid monitoring in 4 cases early after the surgery. In the four cases,2 patients showed hemorrhagic fluid (over 40 ml/h),and then was found having postoperative bleeding in the splenogastric ligament by abdominal exploration in 12 hours. In the other 2 patients,ravidous drainage fluid was detected in 6 days after the operation,and increased levels of amylase (15 189 and 9206 U/L,respectively) was revealed while germiculture was negative; pancreatic fistula (PF) was then diagnosed and somatostatin was administered. Of the 2 patients who developed PF,intra-abdominal drainage was patent in 1,and the drainage tube was withdrawn in 20 days; for the other cases who had non-patent drainage,ultrasonography-guided percutaneous puncture catheter drainage was performed,and the drainage tube was taken out in 2 months. Conclusions LS is safe,reliable,and minimally invasive. Postoperative monitoring of intra-abdominal fluid is valuable for early detection of post-LS complications.