Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.10.002
Jianan Ren
Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made. Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage, laparotomy or open abdominal therapy could be considered according to the sepsis severity. Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction. Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function. Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function. Once the treatment failure is made, the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus. The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage. Key words: Infection; Intra-abdominal infection; Source control measures; Percutaneous abscess drainage; Open abdominal therapy
{"title":"Decision making in the source control of intra-abdominal infection","authors":"Jianan Ren","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.002","url":null,"abstract":"Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made. Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage, laparotomy or open abdominal therapy could be considered according to the sepsis severity. Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction. Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function. Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function. Once the treatment failure is made, the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus. The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage. \u0000 \u0000 \u0000Key words: \u0000Infection; Intra-abdominal infection; Source control measures; Percutaneous abscess drainage; Open abdominal therapy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"903-907"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42537198","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.1673-9752.2019.10.009
Liu Zhaoli, Dong Wang, Zhao Ziwen, Dalyue Li, L. Yun, Dongsheng Wang
Objective To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer. Methods The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Results Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P 0.05). The incidence of system complications was 17.8%(8/45) in t
{"title":"Effects of stage I opening and stage II opening of prophylactic ileostomy on postoperative recovery in low rectal cancer: a prospective study","authors":"Liu Zhaoli, Dong Wang, Zhao Ziwen, Dalyue Li, L. Yun, Dongsheng Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.009","url":null,"abstract":"Objective \u0000To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer. \u0000 \u0000 \u0000Methods \u0000The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. \u0000 \u0000 \u0000Results \u0000Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P 0.05). The incidence of system complications was 17.8%(8/45) in t","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"940-945"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43762564","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}
Objective To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. Methods The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. Results (1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphata
{"title":"Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis","authors":"Hongying He, Guangtao Li, Qingli Li, Xiaochen Ma, Yangfan Zhang, Lucou Chen, F. Fang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.013","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphata","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"966-978"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43076270","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.1673-9752.2019.10.018
Fan Xiao, Xiaoyu Guo, Gang-ping Wang
Pancreatic cancer is a highly malignant tumor of the digestive system, also known as "the king of cancer" . Its incidence is increasing year by year worldwide. At present, there is still a lack of effective screening methods for pancreatic cancer, and the early symptoms are not obvious. Most pancreatic cancer is diagnosed in the late stage, and the best time for surgery has been lost, and patients often have poor response to radiotherapy, chemotherapy and targeted therapy, so the prognosis is very poor. The occurrence and development of pancreatic cancer are closely related to genetic background, environmental factors, basic diseases and living habits. So far, although certain risk factors have been identified, such as smoking, obesity, alcohol, chronic pancreatitis, type 2 diabetes mellitus, and family history, the cause of pancreatic cancer is still not very clear. In recent years, more and more studies have shown that in addition to the already recognized risk factors for pancreatic cancer, there is a certain relationship between digestive microecological disorders and the progression of pancreatic cancer. The authors review the research status of digestive system microecology and pancreatic cancer, in order to understand the role of digestive system microecology disorders in the occurrence and development of pancreatic cancer, thus providing a new way to effectively improve the prognosis of pancreatic cancer. Key words: Pancreatic neoplasms; Pancreatic can-cer; Digestive system microecology; Helicobacter pylori; Hepatitis virus; Oral microbiota
{"title":"Research status and development of digestive system microecology and pancreatic cancer","authors":"Fan Xiao, Xiaoyu Guo, Gang-ping Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.018","url":null,"abstract":"Pancreatic cancer is a highly malignant tumor of the digestive system, also known as \"the king of cancer\" . Its incidence is increasing year by year worldwide. At present, there is still a lack of effective screening methods for pancreatic cancer, and the early symptoms are not obvious. Most pancreatic cancer is diagnosed in the late stage, and the best time for surgery has been lost, and patients often have poor response to radiotherapy, chemotherapy and targeted therapy, so the prognosis is very poor. The occurrence and development of pancreatic cancer are closely related to genetic background, environmental factors, basic diseases and living habits. So far, although certain risk factors have been identified, such as smoking, obesity, alcohol, chronic pancreatitis, type 2 diabetes mellitus, and family history, the cause of pancreatic cancer is still not very clear. In recent years, more and more studies have shown that in addition to the already recognized risk factors for pancreatic cancer, there is a certain relationship between digestive microecological disorders and the progression of pancreatic cancer. The authors review the research status of digestive system microecology and pancreatic cancer, in order to understand the role of digestive system microecology disorders in the occurrence and development of pancreatic cancer, thus providing a new way to effectively improve the prognosis of pancreatic cancer. \u0000 \u0000 \u0000Key words: \u0000Pancreatic neoplasms; Pancreatic can-cer; Digestive system microecology; Helicobacter pylori; Hepatitis virus; Oral microbiota","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1001-1004"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43235188","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.1673-9752.2019.10.011
H. Guan, Qiang Huang, Chen-hai Liu, Xian-sheng Lin, Ji Yang, Sanwei Chen
Objective To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy. Methods Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including "肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I2. Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10. Results (1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P 0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis. Conclusions Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality. Key words: Liver neoplasms; Cholelithiasis; Hepatectomy; Nutritio
目的系统评价免疫营养支持在肝切除术围手术期的临床疗效。方法采用CNKI、CBM、万方数据库、VIP数据库、PubMed（Medline）、Embase、Web of science、science Direct、Cochrane Center等数据库对1996年1月至2018年3月的文献进行检索，检索词为“肝切除术，免疫营养，肝切除、肝切除、免疫营养、免疫增强营养”。随机对照试验肝切除术围手术期免疫营养支持与常规营养支持的疗效比较。免疫营养组患者在肝切除术围术期接受免疫营养支持，常规营养组在肝切除手术围术期给予常规营养支持。结果指标：术后并发症的总体发生率、术后感染性并发症的发生率、手术后肝衰竭的发生率，围手术期死亡率、住院时间和住院费用。两位研究人员分别进行了文献筛选、数据提取和方法学质量评估。计数数据表示为风险比（RR）和95%置信区间（CI）。测量数据表示为平均差（MD）或加权平均差（WMD）和95%置信区间。采用I2分析纳入研究的异质性。如果纳入的研究数量≥10，则使用漏斗图测试潜在的发表偏倚；如果纳入的试验数量<10，则使用最大研究数量的漏斗图测试结果测量的潜在发表偏倚。结果（1）文献检索：荟萃分析共纳入12项随机对照试验，总样本量为1136例，其中免疫营养组和常规营养组分别为568例。（2） Meta分析结果：免疫营养组术后并发症的总体发生率、术后感染性并发症的发生率、肝功能衰竭的发生率均较低，和住院时间（RR=0.57，0.49，0.30，MD=-3.28，95%CI：0.46-0.71，0.37-0.65，0.12-0.74，-4.45至-2.11，P 0.05），表明发表偏倚对Meta分析结果影响不大。结论肝切除术围手术期免疫营养支持是安全可行的。与常规营养支持相比，免疫营养支持可以显著降低术后并发症的总体发生率、术后感染性并发症的发生率、肝功能衰竭的发生率，并在不增加术后死亡率的情况下缩短住院时间。关键词：肝肿瘤；胆结石；肝切除术；营养支持；免疫营养；围手术期；并发症；随机对照试验；荟萃分析；安全；功效
{"title":"Clinical efficacy of immunonutrition support in perioperative period of hepatectomy: a Meta analysis","authors":"H. Guan, Qiang Huang, Chen-hai Liu, Xian-sheng Lin, Ji Yang, Sanwei Chen","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.011","url":null,"abstract":"Objective \u0000To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy. \u0000 \u0000 \u0000Methods \u0000Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including \"肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition\" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I2. Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10. \u0000 \u0000 \u0000Results \u0000(1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P 0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis. \u0000 \u0000 \u0000Conclusions \u0000Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality. \u0000 \u0000 \u0000Key words: \u0000Liver neoplasms; Cholelithiasis; Hepatectomy; Nutritio","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"951-959"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43684139","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.1673-9752.2019.010.003
Guohao Wu
Nutritional therapy is one of the most important treatment measures for surgical critically ill patients, and it is also a difficult point in clinical nutritional support practice. In recent years, nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice. Many large-scale, multi-center clinical studies have been completed worldwide. Consensus has been formed on many hot issues and relevant guidelines have been issued. Based on the latest evidence-based medicine achievements, the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years. Key words: Critical illness; Surgery; Nutritional support; Parenteral nutrition; Enteral nutrition
{"title":"Hotspot issues and countermeasures in nutritional support treatment for critically ill surgical patients","authors":"Guohao Wu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.010.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.010.003","url":null,"abstract":"Nutritional therapy is one of the most important treatment measures for surgical critically ill patients, and it is also a difficult point in clinical nutritional support practice. In recent years, nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice. Many large-scale, multi-center clinical studies have been completed worldwide. Consensus has been formed on many hot issues and relevant guidelines have been issued. Based on the latest evidence-based medicine achievements, the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years. \u0000 \u0000 \u0000Key words: \u0000Critical illness; Surgery; Nutritional support; Parenteral nutrition; Enteral nutrition","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"908-911"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48820047","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.1673-9752.2019.10.012
T. Shan, Yigang Chen, B. Hong, C. Gu, Hong Zhou
Objective To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA. Results (1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×109/L to (10.2±0.9)×109/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×109/L to (13.0±1.3)×109/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P 0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured af
{"title":"Application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer","authors":"T. Shan, Yigang Chen, B. Hong, C. Gu, Hong Zhou","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.012","url":null,"abstract":"Objective \u0000To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer. \u0000 \u0000 \u0000Methods \u0000The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA. \u0000 \u0000 \u0000Results \u0000(1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×109/L to (10.2±0.9)×109/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×109/L to (13.0±1.3)×109/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P 0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured af","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"960-965"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45323523","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.1673-9752.2019.10.008
Zipeng Xu, Wenwen Yu, Wen-Jie Wang, Shimeng Xiong, T. Cao, Jianping Yu, Hong-tao Li, Hong-Bin Liu
Objective To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection. Methods The prospective study was conducted. The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People′s Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected. All patients were randomly divided into two groups by the envelope method with double-blind technique, including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group. Observation indicators: (1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups; (2) postoperative conditions in the two groups; (3) follow-up. Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and intra-group comparison and comparison between groups were analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results Sixty-two patients were screened for eligibility, including 38 males and 24 females, aged (54±14)years, with the range of 22-81 years. There were 30 in the eco-immune group and 32 in the control group. (1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups: before treatment, the percentages of CD3+, CD4+, CD8+, ratio of CD4+ /CD8+, count of natural killer (NK) cells, levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61%±12%, 34%±5%, 28%±5%, 1.25±0.34, 17.26%±2.74%, (2.4±0.3)ng/L, and (1.7±0.5)g/L, versus 59%±11%, 33%±5%, 27%±4%, 1.27±0.36, 16.96%±2.99%, (2.5±0.5)ng/L, (1.8±0.5)g/L for the control group, respectively, there were no significant differences between the two groups (t=-0.563, -0.354, -0.987, 0.327, -0.462, 0.887, 0.991, P>0.05). After 7 days of treatment, the above indices for the eco-immune group were 62%±8%, 37%±6%, 27%±8%, 1.45±0.32, 22.63%±7.25%, (2.2±0.4)ng/L, and (2.3±0.4)g/L, versus 58%±8%, 32%±4%, 27%±6%, 1.26±0.22, 16.26%±2.10%, (2.7±0.6)ng/L, and (2.0±0.4)g/L for the control group, respectively, there were significant differences in the percentages of CD3+, CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA (t=-2.393, -4.336, -3.074, -5.338, 4.010, -3.155, P 0.05). In the eco-immune group, the percentage of CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t=-2.899, -2.739, -4.385, 2.157, -5.788, P 0.05). In the control group, the percentage of CD8+ and leve
{"title":"Application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection: a prospective analysis","authors":"Zipeng Xu, Wenwen Yu, Wen-Jie Wang, Shimeng Xiong, T. Cao, Jianping Yu, Hong-tao Li, Hong-Bin Liu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.008","url":null,"abstract":"Objective \u0000To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection. \u0000 \u0000 \u0000Methods \u0000The prospective study was conducted. The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People′s Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected. All patients were randomly divided into two groups by the envelope method with double-blind technique, including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group. Observation indicators: (1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups; (2) postoperative conditions in the two groups; (3) follow-up. Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and intra-group comparison and comparison between groups were analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. \u0000 \u0000 \u0000Results \u0000Sixty-two patients were screened for eligibility, including 38 males and 24 females, aged (54±14)years, with the range of 22-81 years. There were 30 in the eco-immune group and 32 in the control group. (1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups: before treatment, the percentages of CD3+, CD4+, CD8+, ratio of CD4+ /CD8+, count of natural killer (NK) cells, levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61%±12%, 34%±5%, 28%±5%, 1.25±0.34, 17.26%±2.74%, (2.4±0.3)ng/L, and (1.7±0.5)g/L, versus 59%±11%, 33%±5%, 27%±4%, 1.27±0.36, 16.96%±2.99%, (2.5±0.5)ng/L, (1.8±0.5)g/L for the control group, respectively, there were no significant differences between the two groups (t=-0.563, -0.354, -0.987, 0.327, -0.462, 0.887, 0.991, P>0.05). After 7 days of treatment, the above indices for the eco-immune group were 62%±8%, 37%±6%, 27%±8%, 1.45±0.32, 22.63%±7.25%, (2.2±0.4)ng/L, and (2.3±0.4)g/L, versus 58%±8%, 32%±4%, 27%±6%, 1.26±0.22, 16.26%±2.10%, (2.7±0.6)ng/L, and (2.0±0.4)g/L for the control group, respectively, there were significant differences in the percentages of CD3+, CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA (t=-2.393, -4.336, -3.074, -5.338, 4.010, -3.155, P 0.05). In the eco-immune group, the percentage of CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t=-2.899, -2.739, -4.385, 2.157, -5.788, P 0.05). In the control group, the percentage of CD8+ and leve","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"934-939"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47642409","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.1673-9752.2019.10.016
Shi Yunjie, L. Shuai, Jin Zhichao, Li Xiaoshuang, Zhao Quanquan, Chen Fu, Wang Hao
Objective To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Results (1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plo
{"title":"Comparison in preoperative evaluation effects of abdominal enhanced CT two-dimensional coronal imaging versus three-dimensional vascular reconstruction for critical blood vessels in right colon cancer","authors":"Shi Yunjie, L. Shuai, Jin Zhichao, Li Xiaoshuang, Zhao Quanquan, Chen Fu, Wang Hao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.016","url":null,"abstract":"Objective \u0000To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. \u0000 \u0000 \u0000Results \u0000(1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plo","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"992-997"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45131180","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.1673-9752.2019.10.007
P. Hui, P. Zhu, W. Liao, Tian Yang, Chao Li, Lianxin Liu, Ying-jian Liang
Objective To investigate the bacterial flora distribution and antimicrobial resistance of patients with pyogenic liver abscess (PLA) in multi-centers of China. Methods The retrospective and descriptive study was conducted. The clinical data of 897 patients with PLA at 3 medical centers in China from October 2007 to April 2018 were collected, including 656 cases in the First Hospital of Harbin Medical University, 109 cases in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and 132 cases in the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University. There were 582 males and 315 females, aged (59±11)years, with a range of 6-86 years. Observation indicators: (1) bacterial flora distribution; (2) bacterial resistance. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. Results (1) Bacterial flora distribution: among 897 patients, 733 cases of Klebsiella pneumoniae, 75 cases of Escherichia coli, 11 cases of Staphylococcus aureus, 10 cases of Streptococcus viridians, 9 cases of Klebsiella pneumoniae subsp. pneumoniae, 7 cases of β-emolytic streptococcus, 6 cases of Acinetobacter baumannii, 5 cases of Streptococcus intermadius, 5 cases of Enterococcus faecium, 3 cases of Alcaligenes xylosoxidans subsp. xylosoxidans, 2 cases of Proteus mirabilis, 2 cases of Streptococcus isthmus, 2 cases of Enterobacter cloacae subsp. cloacae, 1 case of Citrobacter koseri, 1 case of Proteus vulgaris, 1 case of Pasteurella pneumotropica, 1 case of Curobacter freudii, 1 case of Enterobacter amnigenus, 1 case of Stenotrophomonas maltophilia, 1 case of Acinetobacter lwoffii, 1 case of Streptococcus salivarius, 1 case of Streptococcus bacterium, 1 case of Enterococcus avium, 1 case of Enterococcus faecalis, 1 case of Klebsiella oxytoca, and 1 case of Staphylococcus epidermidis were cultured in the pus respectively. There were 12 cases of double bacterial infection, and 2 cases of multiple bacterial infections. (2) Bacterial resistance. ① Resistance of Klebsiella pneumoniae and Escherichia coli: the drug resistance rates of Klebsiella pneumoniae to ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 99.79%(474/475), 4.09%(7/171), 12.18%(82/673), 7.34%(49/668), 2.34%(4/171), 1.96%(11/562), 5.85%%(10/171), 0(0/562), 0.55%(4/733), 1.42%(9/635), 0(0/733), 2.46%(18/733), 0.55%(4/733), 0.27%(2/733), 1.36%(10/733), 0.14%(1/733), 0(0/733), 0.36%(2/562), 0.95%(7/733), 0.41%(3/733), 0(0/733), 0(0/562), 1.64%(12/733), 0.95%
③ 其他革兰氏阳性菌耐药性：金黄色葡萄球菌对青霉素、氨苄青霉素、哌拉西林、头孢唑林、头孢呋辛、头孢噻肟、头孢他啶、头孢吡肟、头孢西丁、阿莫西林/克拉维甲酸、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦安、氨曲南、亚胺培南、美罗培南、庆大霉素、妥布霉素、阿米卡星、四环素、，替加环素、环丙沙星、左氧氟沙星、莫西沙星、甲氧苄啶-磺胺甲恶唑、利奈唑胺、红霉素、克林霉素、万古霉素、替考拉宁和利福平分别为2/6、6/8、4/5、4/5，4/5、4/5、4/5和4/5，2/5、2/5、3/5、3/8、3/5和3/5，0/8、0/8、3/8、3/11、0/8，0/8、2/6、3/3、1/3和0/3。绿色链球菌对青霉素、氨苄青霉素、头孢曲松、头孢哌酮/舒巴坦、庆大霉素、四环素、环丙沙星、左氧氟沙星、莫西沙星、利奈唑胺、红霉素、克林霉素、万古霉素、替考拉宁和利福平的耐药率分别为3/10、0/8、0/7、0/7，2/8、6/10、0/8、0/8，0/7，0/5，4/10、6/10，0/5、0/5和0/3。β-溶血性链球菌对抗菌药物的耐药率为0复杂细菌的耐药性。在12例双菌感染患者中，合并革兰氏阴性菌的肺炎克雷伯菌对头孢替坦、头孢西丁、氨苄青霉素/舒巴坦、美罗培南、厄他培南、妥布霉素、替加环素和甲氧苄啶-磺胺甲恶唑的耐药率为0。鲍曼不动杆菌对厄他培南、左氧氟沙星和甲氧苄啶-磺胺甲恶唑的耐药率为0。大肠杆菌对头孢他啶、头孢西丁、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、亚胺培南、美罗培南、厄他培南、妥布霉素、阿米卡星和替加环素的耐药率为0。佛罗里达柠檬酸杆菌对除左氧氟沙星和甲氧苄啶新冠恶唑外的其他抗生素敏感。在合并革兰氏阳性菌的大肠杆菌中，大肠杆菌对头孢替坦、头孢吡肟、头孢西丁、头孢哌酮/舒巴坦、美罗培南、妥布霉素和阿米卡星的耐药性为0。粪肠球菌对青霉素、氨苄青霉素、左氧氟沙星、莫西沙星、利奈唑胺、万古霉素和替考拉宁的耐药率为0。卡氏肠球菌对氨苄青霉素、四环素、左氧氟沙星、莫西沙星、利奈唑胺和红霉素的耐药率为0。人葡萄球菌亚种对左氧氟沙星、莫西沙星、利奈唑胺、万古霉素、替考拉宁和利福平的耐药性为0。粪肠球菌对四环素、利奈唑胺、万古霉素和替考拉宁的耐药性为0。在肺炎克雷伯菌+大肠杆菌+金黄色葡萄球菌亚种+铜绿假单胞菌+玻璃球蛋白多菌感染中，肺炎克雷伯菌对头孢曲松、头孢他啶、头孢替坦、头孢吡肟、头孢西丁、氨苄青霉素/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦安、氨曲南、亚胺培南、妥布霉素、阿米卡星、，左氧氟沙星为0。大肠杆菌对头孢他啶、头孢替坦、头孢吡肟、氨苄青霉素/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦安、氨曲南、亚胺培南和阿米卡星的耐药率为0。金黄色葡萄球菌亚种对头孢曲松、头孢他啶、头孢替坦、头孢吡肟、氨苄青霉素/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦安、氨曲南、亚胺培南、妥布霉素、阿米卡星、替加环素、莫西沙星、复方新诺明、替考拉宁、万古霉素、利奈唑胺、克林霉素的耐药率为0。铜绿假单胞菌对头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、亚胺培南、庆大霉素、妥布霉素、阿米卡星、环丙沙星和左氧氟沙星的耐药性为0。光滑结节病对5-氟胞嘧啶、氟康唑、伊曲康唑和伏立康唑的耐药率为0。在肺炎克雷伯菌+大肠杆菌+鲍曼不动杆菌的多重细菌感染中，肺炎克雷伯菌对头孢替坦、头孢吡肟、哌拉西林/他唑巴坦、亚胺培南、厄他培南、妥布霉素、环丙沙星和左氧氟沙星的耐药率为0。大肠杆菌对阿莫西林/克拉维酸、哌拉西林/他唑巴坦、亚胺培南、美罗培南的耐药率为0。鲍曼不动杆菌对磺胺甲恶唑的耐药率为0。结论肺炎克雷伯菌是PLA的主要致病菌，其次是大肠杆菌。肺炎克雷伯菌和大肠杆菌对美罗培南和替加环素敏感。肺炎克雷伯菌亚种。肺炎和其他革兰氏阴性菌对厄他培南敏感。金黄色葡萄球菌对利奈唑胺敏感。抗生素是在对患者进行药物敏感性测试后选择的。关键词：感染；化脓性肝脓肿；细菌分布；耐药性；药物敏感性；多中心研究
{"title":"Bacterial flora distribution and antimicrobial resistance of pyogenic liver abscess: a multicenter retrospective study (A report of 897 cases)","authors":"P. Hui, P. Zhu, W. Liao, Tian Yang, Chao Li, Lianxin Liu, Ying-jian Liang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.007","url":null,"abstract":"Objective \u0000To investigate the bacterial flora distribution and antimicrobial resistance of patients with pyogenic liver abscess (PLA) in multi-centers of China. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 897 patients with PLA at 3 medical centers in China from October 2007 to April 2018 were collected, including 656 cases in the First Hospital of Harbin Medical University, 109 cases in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and 132 cases in the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University. There were 582 males and 315 females, aged (59±11)years, with a range of 6-86 years. Observation indicators: (1) bacterial flora distribution; (2) bacterial resistance. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. \u0000 \u0000 \u0000Results \u0000(1) Bacterial flora distribution: among 897 patients, 733 cases of Klebsiella pneumoniae, 75 cases of Escherichia coli, 11 cases of Staphylococcus aureus, 10 cases of Streptococcus viridians, 9 cases of Klebsiella pneumoniae subsp. pneumoniae, 7 cases of β-emolytic streptococcus, 6 cases of Acinetobacter baumannii, 5 cases of Streptococcus intermadius, 5 cases of Enterococcus faecium, 3 cases of Alcaligenes xylosoxidans subsp. xylosoxidans, 2 cases of Proteus mirabilis, 2 cases of Streptococcus isthmus, 2 cases of Enterobacter cloacae subsp. cloacae, 1 case of Citrobacter koseri, 1 case of Proteus vulgaris, 1 case of Pasteurella pneumotropica, 1 case of Curobacter freudii, 1 case of Enterobacter amnigenus, 1 case of Stenotrophomonas maltophilia, 1 case of Acinetobacter lwoffii, 1 case of Streptococcus salivarius, 1 case of Streptococcus bacterium, 1 case of Enterococcus avium, 1 case of Enterococcus faecalis, 1 case of Klebsiella oxytoca, and 1 case of Staphylococcus epidermidis were cultured in the pus respectively. There were 12 cases of double bacterial infection, and 2 cases of multiple bacterial infections. (2) Bacterial resistance. ① Resistance of Klebsiella pneumoniae and Escherichia coli: the drug resistance rates of Klebsiella pneumoniae to ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 99.79%(474/475), 4.09%(7/171), 12.18%(82/673), 7.34%(49/668), 2.34%(4/171), 1.96%(11/562), 5.85%%(10/171), 0(0/562), 0.55%(4/733), 1.42%(9/635), 0(0/733), 2.46%(18/733), 0.55%(4/733), 0.27%(2/733), 1.36%(10/733), 0.14%(1/733), 0(0/733), 0.36%(2/562), 0.95%(7/733), 0.41%(3/733), 0(0/733), 0(0/562), 1.64%(12/733), 0.95%","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"924-933"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45222661","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}
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