Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.013
Fu Xu, T. Min, Sun Shiquan, He Jian, Z. Tie, Chou Yudong, Mao Liang
Objective To investigate the clinical efficacy of hepatic venous drainage guided hepatectomy (HVDGH) for hepatocellular carcinoma. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients with hepatocellular carcinoma who were admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medicine School from October 2015 to January 2018 were collected. There were 9 males and 1 female, aged from 35 to 68 years, with an average age of 57 years. Three-dimensional reconstruction of liver, hepatic vasculature, and carcinoma was performed in the 10 patients to evaluate the anatomy and variation of hepatic vasculature, and the spatial relationship between carcinoma and hepatic vasculature. Patients were performed right HVDGH, middle HVDGH, left and middle HVDGH, according to their conditions. Observation indicators: (1) preoperative three-dimensional reconstruction and planning; (2) surgical and postoperative conditions; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients up to May 2018. Measurement data with normal distribution were described as average (range), and count data were described as absolute numbers. Results (1) Preoperative three-dimensional reconstruction and planning: of the 10 patients, 3 had the tumor located at S4 of the liver, 1 had the tumor located at S4 and S8 of the liver, 1 had the tumor located at S5, S6, and S7 of the liver, 4 had the tumor located at S6 and S7 of the liver, 1 had the tumor located at S6, S7, and S8 of the liver. All the 10 patients had tumor close to the main hepatic vein with a distance <5 mm, including 6 with the tumor adjacent to the right hepatic vein, 1 adjacent to the middle hepatic vein, and 3 adjacent to the left hepatic vein and the middle hepatic vein. The tumor diameter was 7.3 cm (range, 4.0-13.5 cm). The residual liver volume/standard liver volume (RLV/SLV) of 10 patients undergoing hepatic vein-preserving hepatectomy was 36.2% (range, 22.0%-46.0%), of which 7 had RLV/SLV less than 40.0%. The RLV/SLV of 10 patients undergoing HVDGH was 51.9% (range, 40.0%-61.0%). (2) Surgical and postoperative conditions: all the 10 patients underwent HVDGH successfully, including 6 with tumor adjacent to right hepatic vein undergoing right HVDGH, 1 with tumor adjacent to middle hepatic vein undergoing middle HVDGH, 3 with tumor adjacent to left and middle hepatic vein undergoing left and middle HVDGH. The operation time, volume of intraoperative blood loss, and the distance between surgical margin and carcinoma were 350 minutes (range, 240-470 minutes), 525 mL (range, 200-1 000 mL), and 8.3 mm (range, 5.0-20.0 mm). There was no postoperative complication such as hemorrhage, liver failure, or biliary fistula in 10 patients. The duration of postoperative hospital stay was 13 days (range, 11-21 days). (3) Follow-up: 10 patients were followed up for 4
{"title":"Clinical efficacy of hepatic vein drainage guided hepatectomy for hepatocellular carcinoma","authors":"Fu Xu, T. Min, Sun Shiquan, He Jian, Z. Tie, Chou Yudong, Mao Liang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.013","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of hepatic venous drainage guided hepatectomy (HVDGH) for hepatocellular carcinoma. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients with hepatocellular carcinoma who were admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medicine School from October 2015 to January 2018 were collected. There were 9 males and 1 female, aged from 35 to 68 years, with an average age of 57 years. Three-dimensional reconstruction of liver, hepatic vasculature, and carcinoma was performed in the 10 patients to evaluate the anatomy and variation of hepatic vasculature, and the spatial relationship between carcinoma and hepatic vasculature. Patients were performed right HVDGH, middle HVDGH, left and middle HVDGH, according to their conditions. Observation indicators: (1) preoperative three-dimensional reconstruction and planning; (2) surgical and postoperative conditions; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients up to May 2018. Measurement data with normal distribution were described as average (range), and count data were described as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Preoperative three-dimensional reconstruction and planning: of the 10 patients, 3 had the tumor located at S4 of the liver, 1 had the tumor located at S4 and S8 of the liver, 1 had the tumor located at S5, S6, and S7 of the liver, 4 had the tumor located at S6 and S7 of the liver, 1 had the tumor located at S6, S7, and S8 of the liver. All the 10 patients had tumor close to the main hepatic vein with a distance <5 mm, including 6 with the tumor adjacent to the right hepatic vein, 1 adjacent to the middle hepatic vein, and 3 adjacent to the left hepatic vein and the middle hepatic vein. The tumor diameter was 7.3 cm (range, 4.0-13.5 cm). The residual liver volume/standard liver volume (RLV/SLV) of 10 patients undergoing hepatic vein-preserving hepatectomy was 36.2% (range, 22.0%-46.0%), of which 7 had RLV/SLV less than 40.0%. The RLV/SLV of 10 patients undergoing HVDGH was 51.9% (range, 40.0%-61.0%). (2) Surgical and postoperative conditions: all the 10 patients underwent HVDGH successfully, including 6 with tumor adjacent to right hepatic vein undergoing right HVDGH, 1 with tumor adjacent to middle hepatic vein undergoing middle HVDGH, 3 with tumor adjacent to left and middle hepatic vein undergoing left and middle HVDGH. The operation time, volume of intraoperative blood loss, and the distance between surgical margin and carcinoma were 350 minutes (range, 240-470 minutes), 525 mL (range, 200-1 000 mL), and 8.3 mm (range, 5.0-20.0 mm). There was no postoperative complication such as hemorrhage, liver failure, or biliary fistula in 10 patients. The duration of postoperative hospital stay was 13 days (range, 11-21 days). (3) Follow-up: 10 patients were followed up for 4","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1069-1074"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43240444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.011
Chengbing Chu, Jie Chen, Yingmo Shen, Su-jun Liu, Shuo Yang, Jing Liu, Jin-xin Cao
Objective To analyze the risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Methods The retrospective case-control study was conducted. The clinical data of 679 patients who underwent inguinal hernia free tension repair between January 2015 and September 2018 in Beijing Chao-Yang Hospital of Capital Medical University were collected. There were 646 males and 33 females, aged (65±12)years, with a range from 28 to 94 years. Observation indicators: (1) surgical situations of inguinal hernia free tension repair; (2) follow-up; (3) enterocutaneous fistula and its treatment; (4) risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Follow-up by outpatient examination and telephone interview was performed to detect the postoperative enterocutaneous fistula up to June 2019. Measurement data with normal distribution were represented as Mean±SD. Count data were described as absolute numbers. Univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model, respectively. Results (1) Surgical situations of inguinal hernia free tension repair: 679 patients underwent inguinal hernia free tension repair. Of 679 patients, 215 underwent plug repair or mesh-plug repair, including 9 cases undergoing Plug repair only, 50 undergoing Millikan procedure, and 156 undergoing Rutkow procedure, other 464 underwent non-plug surgery, including 181 undergoing Lichtenstein procedure, 53 undergoing transinguinal preperitoneal hernia repair (TIPP), and 230 undergoing transabdominal preperitoneal patch repair (TAPP) and total extraperitoneal inguinal hernia repair (TEP). Polypropylene mesh or plug were used in all 679 cases. The operation time and volume of intraoperative blood loss were (61±14)minutes and (10±7)mL. There were 580 of 679 patients treated with prophylactic antibiotics. (2) Follow-up: 679 patients were followed up for 15-86 months, with a median time of 51 months. There were 12 male patients with postoperative enterocutaneous fistula, aged (69±8)years, with a range from 57 to 79 years, twelve patients with enterocutaneous fistula developed symptoms within the time of (42±25)months. (3) Enterocutaneous fistula and its treatment: of 12 patients with enterocutaneous fistula, 11 underwent plug repair or mesh-plug repair, and 1 undergwent TAPP(enterocutaneous fistula secondary to invasion of preperitoneal patch to intestines). The fistulas were located at inguinal region, with a diameter of 0.5-1.0 cm. In the 12 patients, of the 5 patients with sigmoid fistula, 4 underwent intestinal resection around the fistula, 1 underwent distal bowel closure and proximal colostomy. Six patients had enteric fistula, including 5 secondary to invasion of plug to intestines and 1 due to preperitoneal patch in TAPP, and they underwent resection of intestines with fistula combined with side-to-side intestial anastomosis, or laparoscopic sut
{"title":"Analysis of risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair","authors":"Chengbing Chu, Jie Chen, Yingmo Shen, Su-jun Liu, Shuo Yang, Jing Liu, Jin-xin Cao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.011","url":null,"abstract":"Objective \u0000To analyze the risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinical data of 679 patients who underwent inguinal hernia free tension repair between January 2015 and September 2018 in Beijing Chao-Yang Hospital of Capital Medical University were collected. There were 646 males and 33 females, aged (65±12)years, with a range from 28 to 94 years. Observation indicators: (1) surgical situations of inguinal hernia free tension repair; (2) follow-up; (3) enterocutaneous fistula and its treatment; (4) risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Follow-up by outpatient examination and telephone interview was performed to detect the postoperative enterocutaneous fistula up to June 2019. Measurement data with normal distribution were represented as Mean±SD. Count data were described as absolute numbers. Univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model, respectively. \u0000 \u0000 \u0000Results \u0000(1) Surgical situations of inguinal hernia free tension repair: 679 patients underwent inguinal hernia free tension repair. Of 679 patients, 215 underwent plug repair or mesh-plug repair, including 9 cases undergoing Plug repair only, 50 undergoing Millikan procedure, and 156 undergoing Rutkow procedure, other 464 underwent non-plug surgery, including 181 undergoing Lichtenstein procedure, 53 undergoing transinguinal preperitoneal hernia repair (TIPP), and 230 undergoing transabdominal preperitoneal patch repair (TAPP) and total extraperitoneal inguinal hernia repair (TEP). Polypropylene mesh or plug were used in all 679 cases. The operation time and volume of intraoperative blood loss were (61±14)minutes and (10±7)mL. There were 580 of 679 patients treated with prophylactic antibiotics. (2) Follow-up: 679 patients were followed up for 15-86 months, with a median time of 51 months. There were 12 male patients with postoperative enterocutaneous fistula, aged (69±8)years, with a range from 57 to 79 years, twelve patients with enterocutaneous fistula developed symptoms within the time of (42±25)months. (3) Enterocutaneous fistula and its treatment: of 12 patients with enterocutaneous fistula, 11 underwent plug repair or mesh-plug repair, and 1 undergwent TAPP(enterocutaneous fistula secondary to invasion of preperitoneal patch to intestines). The fistulas were located at inguinal region, with a diameter of 0.5-1.0 cm. In the 12 patients, of the 5 patients with sigmoid fistula, 4 underwent intestinal resection around the fistula, 1 underwent distal bowel closure and proximal colostomy. Six patients had enteric fistula, including 5 secondary to invasion of plug to intestines and 1 due to preperitoneal patch in TAPP, and they underwent resection of intestines with fistula combined with side-to-side intestial anastomosis, or laparoscopic sut","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1054-1059"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43525380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.009
Lisheng Wu, Jianwei Yu
Objective To investigate the choice of surgical methods for recurrent inguinal hernia and their corresponding clinical efficacy. Methods The retrospective cross-sectional study was conducted. The clinical data of 98 patients with recurrent inguinal hernia who were admitted to the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) between January 2015 and December 2017 were collected. There were 90 males and 8 females, aged (62±16)years, with a range from 18 to 84 years. According to the previous surgical approaches of patients and the interference degree to the preperitoneal space, size of the defects, type of recurrent inguinal hernia, and the surgeon′s mastery of laparoscopic hernia repair technology, corresponding surgical methods for recurrent inguinal hernia were selected. Observation indicators: (1) conditions of recurrent inguinal hernia; (2) conditions of reoperation; (3) follow-up. Follow-up using outpatient examiantion, telephone interview, and website APP was performed to detect the conditions of recurrent hernia and complications at 3-7 days, 1 month, 3 months, 6 months, and 12 months after operation up to December 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers. Results (1) Conditions of recurrence inguinal hernia: the time to recurrence of inguinal hernia in 98 patients was 1.5 years (0.5 years, 4.0 years), ranging from 1 day to 40.0 years after operation. Five patients had recurrence more than 3 times. There were 47 cases classified as type R1, 21 cases as type R2, and 30 cases as type R3 according to Campanelli classification of recurrent hernias. Seventy-five of 98 patients were treated by anterior approach, including 26 undergoing Bassini repair, 16 undergoing Lichenstein repair, 11 undergoing Shouldice repair, 9 undergoing McVay repair, 5 undergoing Rutkow repair, 4 undergoing simple high ligation, and 4 undergoing Millikan repair. The time to postoperative recurrence was 3.0 years (0.7 year, 10.0 years). Twenty-three patients had been treated by posterior approach, including 2 undergoing reinforced preperitoneal Kugel repair combined with anterior approach, 1 undergoing Gilbert repair, and 1 undergoing Stoppa repair, with the time to postoperative recurrence of (3.2±1.6)years, 11 undergoing laparoscopic totally extraperitoneal prosthesis (TEP) and 8 undergoing laparoscopic transabdominal preperitoneal hernia repair (TAPP), with the time to postoperative recurrence of (1.5±0.9)years. (2) Conditions of reoperation: of the 75 patients firstly being treated by anterior approach, 62 underwent TAPP for reoperation, 9 underwent Kugel repair, and 4 underwent TEP, and the operation time was (66±25)minutes, (61±19)minutes, (70±26)minutes, respectively. Local anesthesia was used in 1 case with Kugel operation and general ane
{"title":"Selection of surgical methods for recurrent inguinal hernia and corresponding clinical efficacy","authors":"Lisheng Wu, Jianwei Yu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.009","url":null,"abstract":"Objective \u0000To investigate the choice of surgical methods for recurrent inguinal hernia and their corresponding clinical efficacy. \u0000 \u0000 \u0000Methods \u0000The retrospective cross-sectional study was conducted. The clinical data of 98 patients with recurrent inguinal hernia who were admitted to the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) between January 2015 and December 2017 were collected. There were 90 males and 8 females, aged (62±16)years, with a range from 18 to 84 years. According to the previous surgical approaches of patients and the interference degree to the preperitoneal space, size of the defects, type of recurrent inguinal hernia, and the surgeon′s mastery of laparoscopic hernia repair technology, corresponding surgical methods for recurrent inguinal hernia were selected. Observation indicators: (1) conditions of recurrent inguinal hernia; (2) conditions of reoperation; (3) follow-up. Follow-up using outpatient examiantion, telephone interview, and website APP was performed to detect the conditions of recurrent hernia and complications at 3-7 days, 1 month, 3 months, 6 months, and 12 months after operation up to December 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Conditions of recurrence inguinal hernia: the time to recurrence of inguinal hernia in 98 patients was 1.5 years (0.5 years, 4.0 years), ranging from 1 day to 40.0 years after operation. Five patients had recurrence more than 3 times. There were 47 cases classified as type R1, 21 cases as type R2, and 30 cases as type R3 according to Campanelli classification of recurrent hernias. Seventy-five of 98 patients were treated by anterior approach, including 26 undergoing Bassini repair, 16 undergoing Lichenstein repair, 11 undergoing Shouldice repair, 9 undergoing McVay repair, 5 undergoing Rutkow repair, 4 undergoing simple high ligation, and 4 undergoing Millikan repair. The time to postoperative recurrence was 3.0 years (0.7 year, 10.0 years). Twenty-three patients had been treated by posterior approach, including 2 undergoing reinforced preperitoneal Kugel repair combined with anterior approach, 1 undergoing Gilbert repair, and 1 undergoing Stoppa repair, with the time to postoperative recurrence of (3.2±1.6)years, 11 undergoing laparoscopic totally extraperitoneal prosthesis (TEP) and 8 undergoing laparoscopic transabdominal preperitoneal hernia repair (TAPP), with the time to postoperative recurrence of (1.5±0.9)years. (2) Conditions of reoperation: of the 75 patients firstly being treated by anterior approach, 62 underwent TAPP for reoperation, 9 underwent Kugel repair, and 4 underwent TEP, and the operation time was (66±25)minutes, (61±19)minutes, (70±26)minutes, respectively. Local anesthesia was used in 1 case with Kugel operation and general ane","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1043-1047"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48800610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.002
Heguang Huang
Inguinal hernia repair is a clinically common procedure to treat abdominal external hernia. More than 20 million hernias are estimated to be repaired every year around the world. With the continuous development of patch materials and endoscopy technology, various repair materials and surgical methods emerge in an endless stream. However, recurrence is always one of the inevitable complications after operation, and it has become the main cause of reoperation for patients. Recurrent inguinal hernia can be cured by surgical treatment. Due to that it is a complex disease with diverse clinical manifestations, difficult management and many complications, how to master the timing and technique of operation correctly, prevent postoperative complications, deal with the original patch, and give humanistic care has become the focus of attention of hernia surgeons. The author has discussed the reoperation of recurrent inguinal hernia in this paper. Key words: Hernia; Inguinal hernia; Recurrent hernia; Reoperation; Operation timing; Surgical procedure; Complications
{"title":"Discussion on the reoperation of recurrent inguinal hernia","authors":"Heguang Huang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.002","url":null,"abstract":"Inguinal hernia repair is a clinically common procedure to treat abdominal external hernia. More than 20 million hernias are estimated to be repaired every year around the world. With the continuous development of patch materials and endoscopy technology, various repair materials and surgical methods emerge in an endless stream. However, recurrence is always one of the inevitable complications after operation, and it has become the main cause of reoperation for patients. Recurrent inguinal hernia can be cured by surgical treatment. Due to that it is a complex disease with diverse clinical manifestations, difficult management and many complications, how to master the timing and technique of operation correctly, prevent postoperative complications, deal with the original patch, and give humanistic care has become the focus of attention of hernia surgeons. The author has discussed the reoperation of recurrent inguinal hernia in this paper. \u0000 \u0000 \u0000Key words: \u0000Hernia; Inguinal hernia; Recurrent hernia; Reoperation; Operation timing; Surgical procedure; Complications","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1010-1014"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45759196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.006
Xiaobin Li, Mengwei Wu, Rui Liu, Hongwei Yuan, Yimin Song
Objective To investigate the clinical efficacy of Lichtenstein surgery for cirrhosis ascites complicated with inguinal hernia (hernia ring diameter <3.0 cm). Methods The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients who underwent Lichtenstein surgery for cirrhosis ascites complicated with inguinal hernia in the Peking Union Medical College Hosptal of Chinese Academy of Medical Science between January 2010 and January 2018 were collected. There were 42 males and 8 females, aged from 45 to 73 years, with an average age of 66 years. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was conducted through outpatient examination and telephone interview to detect the hernia recurrence and survival of patients at 3, 6 months after operation and once every 6 months after 6 months up to January 2019. Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers and/or percentages. Results (1) Surgical and postoperative situations: 50 patients underwent operation successfully. The operation time and duration of postoperative hospital stay were (52±7)minutes and (4.0±1.8)days. Among the 50 patients, 1 case of postoperative wound fat liquefaction occurred and was healed after dressing change, 8 cases of scrotal edema effusion occurred and were recovered after being treated with suction, 3 cases of pain in groin area occurred and were relieved after symptomatic treatment, and 4 cases of urinary retention occurred and were cured after urethral catheterization and exercise of bladder. (2) Follow-up: 48 of the 50 patients were followed up, with a follow-up rate of 96%(48/50). The 48 patients was followed up for 12-36 months with a median time of 33 months. During the follow-up, 1 case of inguinal hernia recurred and 2 cases died of complications related to cirrhosis. Conclusion Lichtenstein surgery is safe and feasible for the cirrhosis ascites complicated with inguinal hernia (hernia ring diameter <3 cm). Key words: Hernia; Inguinal hernia; Hernia repair; Liver cirrhosis; Ascites
{"title":"Clinical efficacy of Lichtenstein surgery for cirrhosis ascites complicated with inguinal hernia","authors":"Xiaobin Li, Mengwei Wu, Rui Liu, Hongwei Yuan, Yimin Song","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.006","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of Lichtenstein surgery for cirrhosis ascites complicated with inguinal hernia (hernia ring diameter <3.0 cm). \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients who underwent Lichtenstein surgery for cirrhosis ascites complicated with inguinal hernia in the Peking Union Medical College Hosptal of Chinese Academy of Medical Science between January 2010 and January 2018 were collected. There were 42 males and 8 females, aged from 45 to 73 years, with an average age of 66 years. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was conducted through outpatient examination and telephone interview to detect the hernia recurrence and survival of patients at 3, 6 months after operation and once every 6 months after 6 months up to January 2019. Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers and/or percentages. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative situations: 50 patients underwent operation successfully. The operation time and duration of postoperative hospital stay were (52±7)minutes and (4.0±1.8)days. Among the 50 patients, 1 case of postoperative wound fat liquefaction occurred and was healed after dressing change, 8 cases of scrotal edema effusion occurred and were recovered after being treated with suction, 3 cases of pain in groin area occurred and were relieved after symptomatic treatment, and 4 cases of urinary retention occurred and were cured after urethral catheterization and exercise of bladder. (2) Follow-up: 48 of the 50 patients were followed up, with a follow-up rate of 96%(48/50). The 48 patients was followed up for 12-36 months with a median time of 33 months. During the follow-up, 1 case of inguinal hernia recurred and 2 cases died of complications related to cirrhosis. \u0000 \u0000 \u0000Conclusion \u0000Lichtenstein surgery is safe and feasible for the cirrhosis ascites complicated with inguinal hernia (hernia ring diameter <3 cm). \u0000 \u0000 \u0000Key words: \u0000Hernia; Inguinal hernia; Hernia repair; Liver cirrhosis; Ascites","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1027-1031"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43973916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.003
Shuang Chen
Transabdominal preperitoneal hernioplasty (TAPP) is an effective laparoscopic inguinal hernia repair procedure, and it is also the basis of current robotic assisted hernioplasty. Focusing on the future, the authors put forward new ideas and methods on how to achieve the development from standardization to intelligence, and to realize the artificial intelligence surgery. Using the concepts of point, line, and surface of geometric perspective can realize visualization and descriptiveness of techniques. At the same time, the procedure of TAPP is thoroughly explained and understood through the time axis and the spatial axis. Besides, the authors also present discussion and insights on the normative nature of TAPP methods, in order to realize normalization and standardization. Key words: Hernia; Inguinal hernia; Transabdominal preperitoneal hernioplasty; Technique; Laparoscopy
{"title":"Technical tips on transabdominal preperitoneal hernioplasty","authors":"Shuang Chen","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.003","url":null,"abstract":"Transabdominal preperitoneal hernioplasty (TAPP) is an effective laparoscopic inguinal hernia repair procedure, and it is also the basis of current robotic assisted hernioplasty. Focusing on the future, the authors put forward new ideas and methods on how to achieve the development from standardization to intelligence, and to realize the artificial intelligence surgery. Using the concepts of point, line, and surface of geometric perspective can realize visualization and descriptiveness of techniques. At the same time, the procedure of TAPP is thoroughly explained and understood through the time axis and the spatial axis. Besides, the authors also present discussion and insights on the normative nature of TAPP methods, in order to realize normalization and standardization. \u0000 \u0000 \u0000Key words: \u0000Hernia; Inguinal hernia; Transabdominal preperitoneal hernioplasty; Technique; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1015-1017"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42003175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.10.005
Chang Liu, Yanyan Dong, Zeyu Li
Intra-abdominal infections (IAIs) are common in the clinical practice, which include a variety of patholo-gical conditions. Severe IAIs can lead to sepsis, secondary organ dysfunction, and threaten the lives of patients. Patients with IAIs are under a high metabolic reaction, and often have gastrointestinal dysfunction, manifesting as impaired intestinal mucosal barrier function, out of control in intestinal flora regulation, and continuous loss of nutrients. The body is in a malnutrition condition, and body resistance severely declines, which further aggravates disease progression. Intestinal micro-ecology is the largest and most complex ecosystem in the human body. In the case of coexistence of many bacteria, the synergy and antagonism between different strains maintain the balance of digestive tract microecology. Intestinal flora and nutritional status under IAIs have their particularity. Understanding the mechanism of intestinal flora abnormalities under IAIs, reasonable and effective nutritional support treatment and management is essential for improving the prognosis of patients with IAIs. Key words: Critical illnes; Infection; Intra-abdominal infections; Intestinal flora; Nutritional support
{"title":"Intestinal flora as the potential target for nutritional support treatment in abdominal infection and its clinical significance","authors":"Chang Liu, Yanyan Dong, Zeyu Li","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.005","url":null,"abstract":"Intra-abdominal infections (IAIs) are common in the clinical practice, which include a variety of patholo-gical conditions. Severe IAIs can lead to sepsis, secondary organ dysfunction, and threaten the lives of patients. Patients with IAIs are under a high metabolic reaction, and often have gastrointestinal dysfunction, manifesting as impaired intestinal mucosal barrier function, out of control in intestinal flora regulation, and continuous loss of nutrients. The body is in a malnutrition condition, and body resistance severely declines, which further aggravates disease progression. Intestinal micro-ecology is the largest and most complex ecosystem in the human body. In the case of coexistence of many bacteria, the synergy and antagonism between different strains maintain the balance of digestive tract microecology. Intestinal flora and nutritional status under IAIs have their particularity. Understanding the mechanism of intestinal flora abnormalities under IAIs, reasonable and effective nutritional support treatment and management is essential for improving the prognosis of patients with IAIs. \u0000 \u0000 \u0000Key words: \u0000Critical illnes; Infection; Intra-abdominal infections; Intestinal flora; Nutritional support","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"916-919"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47030849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.10.014
Jing Yuan, Shoulong Dong, Yuxiao Chen, Tingyuan Li, Chuang He, Liangshan Li, Lin Chen, C. Yao, Xuequan Huang
Objective To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine. Methods The experimental study was conducted. A total of 18 swines of either gender, aged (6.8+ 0.8)months with a range of 5.5-8.0 months, were collected from Animal Laboratory Center of Army Medical University. were randomly divided into 15 in experimental group and 3 in control group. The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse, and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation, and at 3, 7, 14, and 28 days after ablation. The liver tissues were taken for histopathological examination. The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst, and was performed enhanced CT examination at 3 days after ablation. Liver tissues were taken for histopathological examination. Observation indicators: (1) comparison of muscle contraction of siwnes between two groups; (2) imaging performance on enhanced CT after IRE ablation in the experimental group; (3) hepatic histopathological findings after IRE ablation in the experimental group; (4) comparison of apoptotic index in the ablation zone between two groups. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed by the independent sample t test. Results (1) Comparison of muscle contraction between two groups: swines in both groups underwent ablation successfully. The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5)m/s2 in the experimental group and in the control group, respectively, showing statistically significant difference between the two groups (t=-163.50, P<0.05). (2) Imaging performance on enhanced CT after IRE ablation in the experimental group: the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone. There was no obvious abnormality in the ablation zone and its adjacent large vessels. No serious complications occurred after the ablation. The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time, and the ablation zone was gradually replaced by normal liver tissue. The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17)cm immediately after ablation, (1.75±0.19)cm at the 3 days after ablation, (1.32±0.22)cm at the 7 days after ablation, (0.65±0.14)cm at the 14 days after ablation, (0.28±0.10)cm at the 28 days after ablation, respectively. (3) Hepatic histopathological findings after IRE ablation in the experimental group: the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen, arranged
{"title":"Analysis of safety and efficacy of irreversible electroporation hepatic ablation with high-frequency bipolar pulse in swine","authors":"Jing Yuan, Shoulong Dong, Yuxiao Chen, Tingyuan Li, Chuang He, Liangshan Li, Lin Chen, C. Yao, Xuequan Huang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.014","url":null,"abstract":"Objective \u0000To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine. \u0000 \u0000 \u0000Methods \u0000The experimental study was conducted. A total of 18 swines of either gender, aged (6.8+ 0.8)months with a range of 5.5-8.0 months, were collected from Animal Laboratory Center of Army Medical University. were randomly divided into 15 in experimental group and 3 in control group. The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse, and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation, and at 3, 7, 14, and 28 days after ablation. The liver tissues were taken for histopathological examination. The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst, and was performed enhanced CT examination at 3 days after ablation. Liver tissues were taken for histopathological examination. Observation indicators: (1) comparison of muscle contraction of siwnes between two groups; (2) imaging performance on enhanced CT after IRE ablation in the experimental group; (3) hepatic histopathological findings after IRE ablation in the experimental group; (4) comparison of apoptotic index in the ablation zone between two groups. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed by the independent sample t test. \u0000 \u0000 \u0000Results \u0000(1) Comparison of muscle contraction between two groups: swines in both groups underwent ablation successfully. The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5)m/s2 in the experimental group and in the control group, respectively, showing statistically significant difference between the two groups (t=-163.50, P<0.05). (2) Imaging performance on enhanced CT after IRE ablation in the experimental group: the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone. There was no obvious abnormality in the ablation zone and its adjacent large vessels. No serious complications occurred after the ablation. The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time, and the ablation zone was gradually replaced by normal liver tissue. The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17)cm immediately after ablation, (1.75±0.19)cm at the 3 days after ablation, (1.32±0.22)cm at the 7 days after ablation, (0.65±0.14)cm at the 14 days after ablation, (0.28±0.10)cm at the 28 days after ablation, respectively. (3) Hepatic histopathological findings after IRE ablation in the experimental group: the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen, arranged","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"979-985"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45446063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.10.010
Wei Zhou, J. Cui, S. Gou, T. Yin, J. Xiong, Chun-you Wang
Objective To investigate the clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy (MARPN) for infected pancreatic necrosis (IPN). Methods The retrospective cohort study was conducted. The clinical data of 61 patients with IPN who were admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2014 and December 2017 were collected. There were 39 males and 22 females, aged 36-67 years, with a median age of 49 years. Of 61 patients, 40 undergoing open surgery were allocated into open group, and 21 undergoing MARPN were allocated into MARPN group. All the patients underwent surgical treatments after standard non-surgical treatments according to the Guidelines for the diagnosis and treatment of severe acute pancreatitis (2014 edition). Observation indicators: (1) intraoperative and postoperative situations; (2) follow-up. Follow-up using telephone interview or outpatient examination was performed to detect weight loss, pathoglycemia, steatorrhea, intestinal obstruction, and pancreatic portal hypertension for one year after surgery up to December 2017. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was done using the chi-square test. Results (1) Intraoperative and postoperative situations: operation time, time to out-of-bed activity, time to initial food intake, cases with reoperation, cases with postoperative multiple organ dysfunction syndrome (MODS), incidence rate of postoperative complications, mortality, time to drainage-tube removal, duration of hospital stay, and hospital expenses were (77±20)minutes, (13.0±3.6)days, (9.0±2.7)days, 8, 9, 45.0%(18/40), 7.5%(3/40), (37.0±6.3)days, (49±8)days, (84 321±8 872)yuan in the open group, and (59±20)minutes, (2.7±0.9)days, (1.9±0.4)days, 6, 2, 19.0%(4/21), 0, (21.0±2.7)days, (39±6)days, (58 594±3 576)yuan in the MARPN group, respectively, showing no significant difference in the cases with reoperation (χ2=0.69, P>0.05) but significant differences in the other indices between the two groups (t=4.24, 9.61, 15.34, χ2=23.76, 4.02, 36.03, t=11.07, 5.93, 8.43, P 0.05). Conclusion MARPN for IPN is safe and reliable, with certain efficacy, which can effectively reduce incidence of postoperative complication, motality and shorten hospital stay. Key words: Pancreatitis; Infection; Retroperitoneal approach; Pancreatic necrosectomy
{"title":"Clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis","authors":"Wei Zhou, J. Cui, S. Gou, T. Yin, J. Xiong, Chun-you Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.010","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy (MARPN) for infected pancreatic necrosis (IPN). \u0000 \u0000 \u0000Methods \u0000The retrospective cohort study was conducted. The clinical data of 61 patients with IPN who were admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2014 and December 2017 were collected. There were 39 males and 22 females, aged 36-67 years, with a median age of 49 years. Of 61 patients, 40 undergoing open surgery were allocated into open group, and 21 undergoing MARPN were allocated into MARPN group. All the patients underwent surgical treatments after standard non-surgical treatments according to the Guidelines for the diagnosis and treatment of severe acute pancreatitis (2014 edition). Observation indicators: (1) intraoperative and postoperative situations; (2) follow-up. Follow-up using telephone interview or outpatient examination was performed to detect weight loss, pathoglycemia, steatorrhea, intestinal obstruction, and pancreatic portal hypertension for one year after surgery up to December 2017. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was done using the chi-square test. \u0000 \u0000 \u0000Results \u0000(1) Intraoperative and postoperative situations: operation time, time to out-of-bed activity, time to initial food intake, cases with reoperation, cases with postoperative multiple organ dysfunction syndrome (MODS), incidence rate of postoperative complications, mortality, time to drainage-tube removal, duration of hospital stay, and hospital expenses were (77±20)minutes, (13.0±3.6)days, (9.0±2.7)days, 8, 9, 45.0%(18/40), 7.5%(3/40), (37.0±6.3)days, (49±8)days, (84 321±8 872)yuan in the open group, and (59±20)minutes, (2.7±0.9)days, (1.9±0.4)days, 6, 2, 19.0%(4/21), 0, (21.0±2.7)days, (39±6)days, (58 594±3 576)yuan in the MARPN group, respectively, showing no significant difference in the cases with reoperation (χ2=0.69, P>0.05) but significant differences in the other indices between the two groups (t=4.24, 9.61, 15.34, χ2=23.76, 4.02, 36.03, t=11.07, 5.93, 8.43, P 0.05). \u0000 \u0000 \u0000Conclusion \u0000MARPN for IPN is safe and reliable, with certain efficacy, which can effectively reduce incidence of postoperative complication, motality and shorten hospital stay. \u0000 \u0000 \u0000Key words: \u0000Pancreatitis; Infection; Retroperitoneal approach; Pancreatic necrosectomy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"946-950"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42031460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：