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Objective To investigate the clinical effects of endoscopic sphincterotomy (EST) or endoscopic retro-grade cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) combined with la-paroscopic treatment of gallbladder and common bile duct stones. Methods 80 patients suffered cholecystolithiasis with choledocholithiasis were selected from June 2013 to June 2015. According to surgical method, patients were di-vided into EST + LC group (38 cases) and LCBDE + LC + ERCP group (42 cases). Clinical data, treatment effects, postoperative complications rate related indicators of liver function were compared between the two groups. Results The maximum diameter of stones, diameter of common bile duct and the number of stones in LCBDE + LC + ERCP group were significantly longer and larger than EST + LC group, the differences were statistically significant ( 0.05). Postoperative complication rate of ERCP + LC + LCBDE was 21.42 %(9/42), and postoperative compli-cation rate of EST+ LC was 26.32 % (9/42), the difference between the two groups were not clear ( > 0.05). The serum direct bilirubin, alanine aminotransferase and aspartate aminotransferase in the two groups were increased slightly after one day of operation, and those indexes returned to normal levels after three days of operation. Conclusion The operation methods of LCBDE+LC+ERCP and EST+ LC are both effective treatment for compli-cated choledocholithiasis. The success rate of LCBDE+LC+ERCP is higher, the operative time is shorter, which is good for larger stones.
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Objective To analyze the influencing factors of deep vein thrombosis (DVT ) in the patients with abdominal trau‐ma .Methods A total of 200 cases of patients with abdominal trauma in our hospital from June 2014 to June 2015 were selected and performed the color Doppler ultrasonography for determining whether DVT occurring .The clinical data were retrospectively ana‐lyzed .The influencing factors of DVT occurrence in the patients with abdominal trauma were analyzed .Results Among 200 cases of abdominal trauma ,56 cases appeared the symptoms and signs of muscular pressing pain ,swelling pain ,positive Homans sign ,su‐perficial varicose and skin temperature decrease within 7 d after abdominal trauma ,60 cases were diagnosed as DVT by color Doppler ultrasonography .The multivariate Logistic regression analysis results showed that advanced age ,high cholesterol level ,high D‐dimer level ,high blood urea nitrogen level ,complicating hypertension ,complicating diabetes ,complicating hyperlipidemia ,surgical history at preoperative 1 month ,lower abdominal trauma ,high score of trauma ,bedridden time more than 3 d and infection were the independent risk factors of DVT occurrence in abdominal trauma patients (P<0 .05) .Conclusion Clinic should perform the color Doppler ultrasound screening in the abdominal trauma patients with risk factors of DVT ,which is conducive to early discovery and early treatment of DVT .
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Objective To investigate the clinical value of damage control resuscitation ( DCR) in the treatment of severe multiple injuries combined with traumatic hemorrhagic shock. Methods A retrospective analysis was done on 27 patients with severe multiple injuries combined with traumatic hemorrhagic shock treated by DCR. Another 32 patients treated with traditional aggressive/normotensive fluid resuscitation were used as control. Lactic acid clearance time, coagulation, diffuse intravascular coagulation (DIC) morbidity, and mortality were observed and compared between two groups. Results Compared with traditional aggressive/normotensive fluid resuscitation, DCR had better curative effect, shorter clearance time of lactic acid, more rapid recovery of blood coagulation function and lower incidence of DIC morbidity and lower mortality for patients with severe multiple injuries combined with traumatic hemorrhagic shock. Conclusions In the treatment of severe multiple injuries combined with traumatic hemorrhagic shock, the use of DCR can remarkably improve the survival rate of patients and also provide a new way for resuscitation and rescue of other types of shock patients.
