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Results in Journal Asian Case Reports in Surgery: 58

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杜 飞
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 57-64; https://doi.org/10.12677/acrs.2021.104009

Abstract:
Objective: To explore the multidisciplinary treatment for complications after pancreaticoduodenectomy. Methods: The clinical data of the patient after pancreaticoduodenectomy treated in the Eighth Affiliated Hospital of Sun Yat-sen University in March 2021 was analyzed retrospectively. The patient presented pancreatic leakage, chylous leakage, incisional dehiscence and infection, multi-drug resistance and infection combined with infectious shock after surgery. Results: The patient underwent pancreaticoduodenectomy in another hospital. After active anti-infective therapy, incisional negative pressure drainage and enteral and parenteral nutritional support, assisted by enzyme inhibition, supplementing human albumin, and correction of water-electrolyte and acid-base imbalance in our hospital, the patient was finally cured and discharged. Conclusion: The treatment of complications after pancreaticoduodenectomy is difficult and needs multidisciplinary cooperation.
施 猛
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 51-55; https://doi.org/10.12677/acrs.2021.103008

Abstract:
目的:探讨小肠异物致嵌顿性股疝穿孔的临床特点、诊断及治疗。方法:回顾性分析南昌大学第二附属医院胃肠外科2021年2月收治的一名小肠异物致嵌顿性股疝穿孔患者的临床资料。结果:术前盆腔CT提示左侧腹股沟管扩大,部分小肠疝入,其内可见一高密度影。腹腔镜探查发现左股静脉内侧股管处可见小肠肠管疝入,牵拉肠管可见肠管卡压处有长约3 cm鱼刺刺破肠管,嵌顿处肠管可见一圈发黑,术中诊断为“左侧嵌顿性股疝”,予以行“腹腔镜左侧股疝补片修补术 + 小肠部分切除术”,术后恢复顺利,痊愈出院。结论:小肠异物致嵌顿性股疝穿孔,临床上极为少见,术前诊断及术中及时发现异物极为重要,需引起广大临床医师的重视。 Objective: To investigate the clinical features, diagnosis and treatment of enteric foreign bodies with incarcerated femoral hernia. Methods: The clinical data of a patient with intestinal foreign body with incarcerated femoral hernia admitted in Department of gastrointestinal surgery, Second Affiliated Hospital of Nanchang University in February 2021 were analyzed retrospectively. Results: Preoperative pelvic CT showed that the left inguinal canal was enlarged, part of the small intestine was herniated, and a high-density shadow could be seen in it. Laparoscopic exploration found that there was a small intestinal hernia in the femoral tube of the left femoral vein, a fish bone about 3 cm long punctured the intestinal tube at the compression of the intestinal tube at the traction, and a circle of blackening at the incarcerated intestinal tube. During the operation, it was diagnosed as “left incarcerated femoral hernia”, and “laparoscopic left femoral hernia patch repair + partial small bowel resection” was performed. The postoperative recovery was smooth and the patient was discharged. Conclusion: Intestinal foreign body with incarcerated femoral hernia is very rare in clinical practice. Preoperative diagnosis and intraoperative discovery of foreign bodies are very important, which should be paid attention to by clinicians.
孔 哲
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 45-50; https://doi.org/10.12677/acrs.2021.103007

Abstract:
目的:明确肝内胆管细胞癌合并淋巴结转移的患者行淋巴结清扫术的安全性以及可能获益。方法:分析1例原发性肝内胆管细胞癌合并巨大的肝门部淋巴结转移的中老年男性患者的临床表现、影像学表现、手术情况、术后并发症以及随访情况。结果:此例患者手术时间为315分钟,术中出血500 ml,术后住院时间8天,无术后主要并发症,该患者病理为中–低分化胆管细胞癌,肿瘤大小5 × 3.5 × 3 cm,8、12、13组淋巴结转移癌并融合肿块,目前随访8个月未见肿瘤复发。结论:肝内胆管细胞癌合并淋巴结转移的患者行淋巴结清扫术,手术风险可控,可能延长患者的无病生存期。 Objective: To determine the safety and potential benefit of lymph node dissection in patients with intrahepatic cholangiocellular carcinoma with lymph node metastasis. Methods: A case of primary intrahepatic cholangiocarcinoma with large hilar lymph node metastasis was analyzed, including the clinical manifestations, imaging manifestations, surgical status, postoperative complications and follow-up. Results: The operation time of this patient was 315 minutes, the intraoperative hemorrhage was 500 ml, the postoperative hospital stay was 8 days, and no major postoperative complications were observed. The patient was pathologically identified as moderately to poorly differentiated cholangiocarcinoma with tumor size of 5 × 3.5 × 3 cm, lymph node metastasis and mass fusion in group 8, 12, and 13, and no tumor recurrence was observed during 8 months of follow-up. Conclusion: Lymph node dissection in patients with intrahepatic cholangiocellular carcinoma with lymph node metastasis can control the risk of operation and may prolong the disease-free survival of patients.
谢 于
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 34-43; https://doi.org/10.12677/acrs.2021.102006

Abstract:
中肝切除是肝脏手术中间较困难的一种方式,通常中肝切除指S4、S5+8或S4+5+8段的切除,鲜有合并S7段的中肝切除。在合并S7段的扩大中肝切除时,需要保留S6段有独立且完整的回流静脉。本文报道1例肝肿瘤侵犯S4+5+8段、S7段、RHV、中肝静脉(middle hepatic vein, MHV),且S6段回心血流在根部有癌栓浸润患者,行保留肝脏S2、S3、S6段,联合下腔静脉癌栓取出并部分IVC切除,同时将保留的S6肝静脉与IVC再次吻合的手术经过。 Mesohepatectomy is a difficult method in liver surgery. Generally, mesohepatectomy refers to the resection of S4, S5+8 or S4+5+8 segments, but rarely combines with S7 segment hepatectomy. In the mesohepatectomy combined with S7 segment, it is necessary to keep an independent and complete draining vein for S6 segment. This article reports a case of hepatocarcinoma invading S4+5+8 segment, S7 segment, RHV, middle hepatic vein (MHV), and one of draining vein for S6 segment which flows into inferior RHV is filled with tumor thrombus. In this patient we performed extended mesohepatectomy, removed the IVC tumor thrombus and partial IVC, and re-anastomosed the remaining S6 hepatic vein to IVC.
四裘 五
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 29-33; https://doi.org/10.12677/acrs.2021.102005

Abstract:
通过对比研究脑室外引流联合腰大池引流(EVD-LP)和单纯脑室外引流(EVD)治疗重度自发性脑室出血患者的疗效,为自发性脑室出血患者的治疗提供参考。前瞻性分析收治的重度自发性脑室出血患者52例,按治疗方法分为EVD治疗组(13例)和EVD-LP治疗组(39例),EVD治疗组将脑室型颅内压探头放在积血脑室内,引流并监测“颅内压”的变化。EVD-LP诊疗组在EVD治疗组基础上,待复查头部CT显示第三脑室、第四脑室及室间孔及中脑导水管无完全性梗阻性积血后,置入腰大池外引流管引流,比较分析两组患者脑室引流管留置时间、血肿清除时间和术后患者1个月、3个月的日常生活能力(ADL)量表评分来评价患者预后情况。结果显示,EVD-LP组患者无严重并发症出现,两组在良好预后人数(χ2 = 1.926, P > 0.05)、引流管留置时间(χ2 = 0.188, P > 0.05)、脑室内血肿完全清除时间(χ2 = 1.067, P > 0.05)无统计学差异,EVD-LP组患者的3月后良好(ADL 1~3分)预后率82%显著高于EVD组54%。本研究表明,EVD-LP治疗重度自发性脑室出血安全有效,无严重并发症出现,能显著提高患者3月良好预后率。
岳徐 春
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 23-28; https://doi.org/10.12677/acrs.2021.102004

Abstract:
家族性腺瘤性息肉病伴发腹腔内硬纤维瘤在临床上极为罕见,且其早期临床表现多不明显,常常不易被早期发现、早期诊断,从而不能获得及时的治疗。因此,提高临床医师对此症的认识、有意识地做好二级预防有着非常重要的临床意义。 Familial adenomatous polyposis accompanied by intra-abdominal desmoid tumors is very rare in clinical practice, and its early clinical manifestations are mostly not obvious, thus it is often difficult to be detected and diagnosed early, so that timely treatment can hardly be obtained. Therefore, it is of great clinical significance to improve clinicians’ understanding of this disease and consciously do a good job in secondary prevention.
全阳 德
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 13-22; https://doi.org/10.12677/acrs.2021.102003

Abstract:
目的:通过对乳腺癌组织测序发现novel-miR-9在癌组织中呈现低表达。深入研究novel-miR-9对乳腺癌的调控机制及其生物学功能理论机制。方法:运用cck-8以及EdU实验检测novel-miR-9对人乳腺癌细胞增殖的影响;应用生物信息学分析预测novel-miR-9靶基因以及与乳腺癌相关基因;用Venny2.1.0绘制韦恩图得到靶基因集合;对靶基因集合进行GO功能注释分析,找出与细胞增殖相关基因;分析其基因在乳腺癌表达量;并对其进行蛋白交互作用,GO功能注释分析和KEGG Pathway分析。结果:novel-miR-9在人乳腺癌细胞呈低表达(P Objective: to study the low expression of novel-miR-9 in breast cancer by sequencing. For the further study of novel-miR-9 regulation mechanism of breast cancer and its biological function theory mechanism. Methods: cck-8 and EdU experiments were used to detect the effect of novel-miR-9 on human breast cancer cell proliferation; application of bioinformatics analysis to predict novel-miR-9 target genes and breast cancer related genes; a set of target genes was obtained by drawing Wayne map with Venny2.1.0; GO functional annotation analysis of target gene sets, Identification of genes related to cell proliferation; to analyze the expression of its gene in breast cancer; and protein interaction, GO function annotation analysis and KEGG Pathway analysis. Results: novel-miR-9 low expression in human breast cancer cells (P < 0.001); inhibition of breast cancer cell proliferation (P < 0.001); through Venny map and GO function annotation analysis and protein interaction analysis to identify 26 genes related to cell proliferation and found that the interaction relationship is more complex; GO analysis found that target genes may be involved in cell proliferation, signal reception and other biological processes; KEGG Pathway analysis found that its target genes are most enriched in PI3K-Akt, Ras, cancer, cancer microRNA and other signaling pathways. Conclusions: novel-miR-9 regulation is involved in many important biological processes, provided clues for the follow-up study.
珍武 珍
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 7-12; https://doi.org/10.12677/acrs.2021.102002

Abstract:
目的:探讨经内镜阑尾支架内引流治疗阑尾周围脓肿的临床价值及安全性。方法:收集2017年4月~2018年10月内蒙古医科大学乌海市中医院微创中心收治的27例阑尾周围脓肿患者,经内镜阑尾支架内引流治疗,动态观察患者引流治疗前及治疗后1、3、5天体温、血白细胞(white blood cell, WBC)、C反应蛋白(C-reaction protein, CRP)、脓肿大小变化,统计患者腹痛缓解及消失的时间、术后住院时间及医疗费用。结果:所选病例经内镜给予生理盐水反复冲洗后,置入阑尾支架(10Fr塑料支架),对其中9例发现阑尾粪石性梗阻患者,经内镜使用取石网篮取石成功后,予以支架置入。术后患者腹痛缓解明显,体温、WBC及CRP均下降明显,住院时间短。随访2年,1例患者复发阑尾炎,行腹腔镜下阑尾切除术后痊愈。结论:结肠镜下治疗阑尾周围脓肿是安全、有效的,合并阑尾腔内梗阻的患者同时解除阑尾腔梗阻效果更加明显。 Objective: To investigate the clinical application value and safety of treatment for patients about endoscopic appendiceal stent drainage in the treatment of periappendiceal abscess. Methods: To collected cases from April 2017 to October 2018, 27 patients who suffer from a disease. The disease is called periappendiceal abscess, which is a complication of acute appendicitis that occurs without treatment. The pathogenesis of the disease is the formation of inflammatory pus around the appendix, followed by the surrounding omentum surrounding the pus, the formation of abscess around the appendix. These cases admitted to research group, were chosen by the minimally invasive surgery center of Wuhai Hospital of traditional Chinese medicine of Inner Mongolia Medical University, were treated with endoscopic appendiceal stent drainage. The changes of related indexes after operation were observed dynamically. Those indexes include temperature changes, white blood cell (WBC) count, C-reaction protein (CRP) changes and abscess size were dynamically observed before and 1, 3 and 5 days after treatment that the cases periappendiceal abscess treated by endoscopic appendiceal stent internal drainage, and the time when abdominal pain begin to ease and disappear completely, duration of hospital stay after treatment, and the total cost of the medical procedure. Results: The selected cases were rinsed repeatedly with sterile water for in-jection by endoscopy, and then the stent (10Fr plastic stent) was inserted along the opening of the appendix. Among them, 9 patients were found the fecaliths is confined to the appendix cavity which causes poor drainage of the appendix. The fecaliths were successfully removed by endoscopic lithotripsy basket in the process of the treatment, and then the stent was placed along the opening of the appendix. After operation, the patients felt abdominal pain was significantly and rapidly relieved. The change of body temperature was monitored, which was found that the body temperature dropped quickly and then returned to normal. Inflammatory markers such as WBC and CRP decreased significantly. The length of hospital stay was short. The abdominal abscess was significantly reduced by B-ultrasonography after surgery 5 days. All 27 patients were followed-up for two years. One of all the patients who received the treatment that endoscopic appendiceal stent drainage in the treatment of periappendiceal abscess case, who had acute appendicitis again, then cured after underwent laparoscopic appendectomy. Conclusion: Periappendiceal abscess treated by endoscopic appendiceal stent internal drainage is safe and effective. And the results are even better and more significant in patients with obstruction of appendiceal cavity.
民刘 立
Published: 1 January 2021
Asian Case Reports in Surgery, Volume 10, pp 1-6; https://doi.org/10.12677/acrs.2021.101001

Abstract:
新型冠状病毒(COVID-19)肺炎疫情爆发以来,全国各地医务人员众志成城,打响了一场轰轰烈烈的疫情阻击战,取得了举世瞩目的决定性抗疫胜利。由于疫情目前仍然在全世界肆虐,因此积极做好疫情防控成为常态化工作。作为非定点医院、非隔离病区的普通外科,如何在常态化防疫情况下,既要做好防护工作、又要及时救治急危重患者的生命,是时代赋予我们的一项迫切任务。本文通过介绍COVID-19疫情期间一例罕见老年急性胆道脓性血栓梗阻的诊治过程,强化术前检查的针对性和特殊性,分析急诊手术的必要性和紧迫性,总结该例患者抢救成功的经验,同时探讨疫情期间急诊手术的防护要点和注意事项,以期为常态化防疫期间的普通外科手术决策提供借鉴。 Since the outbreak of coronavirus disease 2019 (COVID-19) pneumonia, the medical staff all over the country joined hands and launched a vigorous fight against the epidemic, and achieved the world's attention to the stage victory. As the epidemic continues to rampant around the world, ac-tively doing a good job in epidemic prevention and control become the normalization work. Under the condition of normalized epidemic prevention, as a department of a non designated hospital in the rear of the epidemic situation, General surgery is facing on an urgent task entrusted by the times of how to effectively prevent nosocomial infection and avoid the occurrence of clustered epidemic events, and actively carry out emergency surgical treatment for critically-ill patients. This paper introduces the diagnosis and treatment process of a rare elderly patient with acute biliary pyogenic thrombosis obstruction during the outbreak of COVID-19, strengthens the pertinence and particularity of preoperative examination, analyzes the necessity and urgency of emergency operation, summarizes the successful rescue experience of the patient, and discusses the key points and precautions of emergency operation, so as to provide reference for emergency treatment and effective epidemic protection of general surgery during the normalized COVID-19 epidemic.
军姚 明
Published: 1 January 2020
Asian Case Reports in Surgery, Volume 09, pp 1-6; https://doi.org/10.12677/acrs.2020.91001

Abstract:
目的:探讨改良腹腔镜经腹膜前腹股沟斜疝修补术(Transabdominal Preperitoneal Prosthesis, TAPP)的临床疗效,为TAPP提供更简便的术式,以期在临床上推广。方法:分析2017年3月至2019年9月聊城大学第二附属医院东昌府人民医院200例成人男性单侧腹股沟斜疝手术患者的临床资料,按照术式不同分为两组,每组100例,分为改良TAPP组和TAPP组,分别分析两组患者的手术指标、复发情况及术式学习曲线等情况。结果:改良TAPP组手术时间、术中失血量和住院时间均少于TAPP组,差异具有统计学意义(P Objective: To explore the effect of the modified transabdominal preperitoneal prosthesis (TAPP), and to provide a more convenient surgical method for the TAPP, with a view to promoting it in clini-cal practice. Methods: The clinical data of 200 adult male patients with inguinal hernia admitted at the Second Affiliated Hospital of Liaocheng University and Dongchangfu People’s Hospital from March 2017 to September 2019 were analyzed, and they were divided into the modified TAPP group and the TAPP group according to the different operation method, with 100 cases in each group. The operation indicators, recurrence rate and the operation learning curve of the two groups were monitored respectively. Results: The operation time of the modified TAPP group was shorter than that of the TAPP group, the blood loss was less than that of the TAPP group, and the hospital stay was less than that of the TAPP group, the difference was statistically significant (P < 0.05). The frequency of analgesic use, pain score and treatment cost in the modified TAPP group were lower than that of the TAPP group, with statistically significant difference (P < 0.05). The incidence of subabdominal vascular injury, spermaduct injury and other side injuries in the modified TAPP group were lower than that of the TAPP group, with statistically significant difference (P < 0.05). The learning curve of the modified TAPP group was significantly lower than that of the TAPP group, with statistically significant difference (P < 0.001). Conclusion: The modified TAPP surgery for in-guinal hernia can significantly shorten the operation time and reduce the incidence of side injuries, with better effect and more security.
景张 胜
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 41-47; https://doi.org/10.12677/acrs.2019.84006

Abstract:
Objective: To explore the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of emphysematous pyelonephritis. Methods: The clinical data of 2 cases of emphysematous pyelo-nephritis and related literatures were reviewed. The clinical characteristics, diagnosis and treat-ment methods were discussed through literature review. Results: Emphysematous pyelonephritis is relatively rare and has no typical clinical manifestations. CT is the best choice of diagnosis. Anti-biotics should be used as soon as possible once the diagnosis was confirmed. If the patient’s condi-tion has no improvement, percutaneous nephrectomy and nephrectomy should be considered.
平陈 安
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 23-29; https://doi.org/10.12677/acrs.2019.82004

Abstract:
目的:探讨在同期三镜下,经肝内胆管至胆总管顺行推进法逐级导管肝管扩张会师术(LHSCD)治疗肝左外叶和肝右后叶肝胆管结石、合并肝胆管梗阻或肝胆管狭窄的临床应用体会。方法:回顾性分析成都市第二人民医院2005年12月至2019年4月期间,符合入选标准的43例患者的临床资料。结果:本组43例行LCBDE和LHSCD,行肝左外叶切除术40例、行肝右后叶切除术3例,行LC腹腔检查21例。逐级导管经左肝管会师和经胆总管扩张乳头并留置鼻胆管34.8% (15/43),经左肝管会师和推挤左肝管结石出总管切口并留置鼻胆管9.3% (4/43),经左肝管会师和经胆总管扩张乳头、内镜乳头小切开并留置鼻胆管7.0% (3/43),经左肝管会师、左肝管整形、肝圆韧带修补缺损并留置鼻胆管7.0% (3/43);逐级导管经右肝管会师并留置鼻胆管4.7% (2/43)。经左肝管会师和经胆总管扩张乳头、内镜乳头小切开并留置乳头部T管双导管20.9% (9/43),经左肝管会师和推挤左肝管结石出总管切口、内镜乳头小切开并留置乳头部T管双导管7.0% (3/43),经左肝管会师、留置乳头部T管双导管4.7% (2/43),经左肝管会师、左肝管整形、肝圆韧带修补缺损并留置左肝内胆管T管双导管2.3% (1/43);经右肝管会师并留置乳头部T管双导管2.3% (1/43)。术后左肝内胆管残石2例(4.7%),胆汁漏4例(9.3%),轻度胰腺炎1例(2.3%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无围手术期再次手术和死亡患者。术后总并发症发生率为16.3% (7/43)。结论:对本医院有限病例进行初步研究发现,只要病例选择合适,在同期三镜下,采用LHSCD治疗肝左外叶和肝右后叶肝胆管结石、合并肝胆管梗阻或肝胆管狭窄是可行、有效和安全的。 Objective: To explore the experiment of clinical application of laparoscopic hepatic duct step by step dilatable catheter dilatation and realignment of three endoscopes at the same time through intrahepatic bile duct to common bile duct consequent propulsive guidance technology (LHSCD) for the treatment of the intrahepatic bile duct of the left hepatic lateral lobe and the right back hepatic lobe and common bile duct stones with obstruction and stenosis of the hepatic bile duct. Methods: The clinical data of 43 cases which met the inclusion criteria were retrospectively researched from December 2005 to April 2019 in the Second People,s Hospital of Chengdu. Results: In this group, 43 cases were treated with LCBDE and LHSCD, 40 cases with left lateral hepatic lobectomy, 3 case with right posterior hepatic lobectomy, and 21 cases with LC by laparoscopy. Through step by step dilatable catheter realignment expanded left hepatic duct and duodenal papilla, indwelling nasobiliary was in 34.8% (15/43); step by step dilatable catheter realignment expanded left hepatic duct and push the stones into the common hepatic duct, indwelling nasobiliary was in 9.3% (4/43); step by step dilatable catheter realignment expanded left hepatic duct and duodenal papilla, duodenoscopic papillary sphincterotomy of small incision, indwelling nasobiliary was in 7.0% (3/43); step by step dilatable catheter realignment expanded left hepatic duct, left hepatic duct plastic surgery, and the liver round ligament repairing the defect, indwelling nasobiliary was in 7.0% (3/43); step by step dilatable catheter realignment expanded right hepatic duct, indwelling nasobiliary was in 4.7% (2/43). Through step by step dilatable catheter realignment expanded left hepatic duct and duodenal papilla, and the small incision of papillary sphincterotomy, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 20.9% (9/43); step by step dilatable catheter realignment expanded left hepatic duct and push the stones into the common hepatic duct, and the small incision of papillary sphincterotomy, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 7.0% (3/43); step by step dilatable catheter realignment expanded left hepatic duct, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 4.7% (2/43); step by step dilatable catheter realignment expanded left hepatic duct, left hepatic duct plastic surgery, and the liver round ligament repairing the defect, indwelling T tube + double biliary catheter drainage of left hepatic duct was in 2.3% (1/43); step by step dilatable catheter realignment expanded right hepatic duct, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 2.3% (1/43). Residual stone of the left medial lobe hepatic duct was occurred in two cases (4.7%). Bile leakage was occurred in four cases (9.3%). The slight pancreatitis was occurred in one case (2.3%). No cases had perforation of intestine and bile duct, bleeding, severe pancreatitis. There is no perioperative reoperation and death. Total postoperative complication formation rate was in 16.3% (7/43). Conclusion: A preliminary study of the limited cases in our hospital found that under the three endoscopy over the same period, using the LHSCD is feasible, effective and safe for the treatment of hepatolithiasis, hepatobiliary duct obstruction or hepatobiliary duct stenosis of the left hepatic lateral lobe and the right back hepatic lobe as long as the appropriate cases are selected.
平陈 安
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 31-39; https://doi.org/10.12677/acrs.2019.83005

Abstract:
目的:探讨在同期三镜下,经胆总管至十二指肠顺行推进法逐级导管乳头扩张会师术(LPSCD)治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄的临床应用体会。方法:回顾性分析成都市第二人民医院2008年7月至2019年4月期间,符合入选标准的205例患者的临床资料。结果:本组205例行腹腔镜胆囊切除术、胆总管探查胆管镜取石术,必要时行冲击波或液电碎石术。十二指肠镜窥视、逐级导管扩张乳头行鼻胆管引流50.2% (103/205),行T管双导管引流19.0% (39/205);十二指肠镜乳头微切开、逐级导管扩张乳头行鼻胆管引流5.9% (12/205),行T管双导管引流0.5% (1/205);十二指肠镜乳头小切开、逐级导管扩张乳头行鼻胆管引流8.8% (18/205),行T管双导管引流2.4% (5/205);十二指肠镜乳头中切开、逐级导管扩张乳头行鼻胆管引流3.4% (7/205),行T管双导管引流3.4% (7/205);因胆总管残石放弃鼻胆管引流和T管双导管引流各1例,于腹腔镜下留置T形管1.0% (2/205);因胆总管末端狭窄未解除放弃鼻胆管引流4例和T管双导管引流3例,于腹腔镜下留置T形管3.4% (7/205);因腹腔镜下取石失败放弃鼻胆管引流3例和T管双导管引流1例,中转为开腹胆总管探查取石T管引流术2.0% (4/205)。鼻胆管引流术后残石1例(0.5%),胆汁漏8例(3.9%),轻型胰腺炎2例(1.0%);T管双导管引流术后胆汁漏1例(0.5%),轻症胰腺炎2例(1.0%),经T管瘘道拔除T管双导管无失败病例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无围手术期再手术和死亡。术后总并发症发生率为6.8% (14/205)。结论:对本医院有限病例进行初步研究发现,只要病例选择合适,在同期三镜下,采用LPSCD治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄是可行、有效和安全的;此方法可以尽量保护十二指肠乳头的解剖完整性或生理功能。 Objective: To explore the experiment of clinical application of laparoscopic duodenal papilla step by step dilatable catheter dilatation and realignment of three endoscopes at the same time through common bile duct to duodenal lumen of transabdominal consequent propulsive guidance technology (LPSCD) for the treatment of the gall bladder stones, common bile duct stones, and combination of duodenal papilla obstruction or stenosis during the course of laparoscopic common bile duct exploration (LCBDE). Methods: The clinical data of 205 patients who met the inclusion criteria of extrahepatic bile duct stones with obstruction and stenosis of papillary undergoing LPSCD were retrospectively analyzed from July 2008 to April 2019 in the Second Hospital of Chengdu City. Results: In this group, 205 patients underwent laparoscopic cholecystectomy and choledocholithotomy for common bile duct exploration, and shock wave or electrohydraulic lith-otripsy was performed when necessary. Take a peek at the duodenoscopy, stepwise catheter dila-tion of the duodenal papilla, nasobiliary drainage 50.2% (103/205), and T tube + double biliary catheter drainage 19.0% (39/205); duodenoscopic papillotomy of micro dissection, stepwise ductal expansion of the papilla, nasobiliary drainage 5.9% (12/205), and T tube + double biliary catheter drainage 0.5% (1/205); duodenoscopic papillotomy of small incision, stepwise ductal dilatation of the papilla, nasobiliary drainage 8.8% (18/205), and T tube + double biliary catheter drainage 2.4% (5/205); duodenoscopic papillotomy of median incision, stepwise ductal dilatation of the papilla, nasobiliary drainage 3.4% (7/205), and T tube + double biliary catheter drainage 3.4% (7/205); one case was given up for nasobiliary drainage and one case for double-catheter T tube drainage due to common bile duct residual stone, and the t-tube was placed under laparoscope 1.0% (2/205); four cases of nasobiliary drainage and three cases of double t-tube drainage were abandoned due to terminal bile duct stenosis; the t-tube was indurated under laparoscope with 3.4% (7/205); due to the failure of laparoscopic lithotomy, three cases of nasobiliary drainage and one case of T tube double catheter drainage were abandoned, and all of them were converted to laparotomy for common bile duct exploration and lithotomy with T tube drainage of 2.0% (4/205). It is found the residual stone after nasobiliary drainage in one case (0.5%), bile leakage in eight cases (3.9%), and slight pancreatitis in two cases (1.0%). It is found the bile leakage after T tube + double biliary catheter drainage in one case (0.5%), and slight pancreatitis in two cases (1.0%). There were no failed cases through the T tube fistula pull T tube + double biliary catheter drainage. None of the cases had a perforation of intestine and bile duct, bleeding, severe pancreatitis, perioperative reoperation or death. The total postoperative complication rate was 6.8% (14/205). Conclusion: Based on the limited number of cases in our hospital the preliminary research result is, if suitable patients are selected, LPSCD of three endoscopes at the same time for treatment of gall bladder stones, common bile duct stones, and combination of duodenal papilla obstruction or stenosis is feasible, effective and safe. This method can protect the anatomical integrity or physiological function of duodenal papilla as much as possible.
李 敏
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 15-22; https://doi.org/10.12677/acrs.2019.82003

Abstract:
男性患儿,维吾尔族,出生时发现三条腿畸形,在当地医院明确诊断:先天性畸形(臀部寄生胎)、单侧腹股沟型隐睾、动脉导管未闭、先天性肛门畸形、肠未特指先天畸形、右中腿先天性髌骨缺如、中腿马蹄足内翻足、右腿足四肢偏短(海豹肢畸形)、腹壁疝。2018年3月8日来我院就诊。3月19日进行了手术:全麻下行中间腿,半骨盆切除,中间下肢足移植术,隐睾下降固定术,腹壁疝修补术,手术历时10小时,术中出血约120 ml。术后患者恢复好,于2018年4月10日康复出院。考虑患者为低龄、少数民族、多发先天畸形,围手术期护理具有鲜明的特殊性和低龄患儿围手术期的共同点,具有较强的临床和社会意义。 Male children, Uygur, was found three leg deformities at birth, which is confirmed in the local hospital: congenital malformation (hip parasite), unilateral inguinal cryptorchidism, patent ductus arteriosus, congenital anal malformation, congenital malformation of specified intestine, right middle leg congenital tibia absence, middle leg horseshoe foot varus, short right leg, feet and limbs (sea seal limb deformity), abdominal wall sputum. They came to our hospital on March 8, 2018. On March 19, the kid undergo surgeries: general anesthesia descended middle leg, half pelvic resection, middle lower limb foot transplantation, cryptorchidism reduction, abdominal wall hernia repair; operation lasted 10 hours, and intraoperative bleeding is about 120 ml. The patient recovered well after surgery and was discharged from hospital on April 10, 2018. Considering patients with low age, ethnic minorities, and multiple congenital malformations, perioperative care has distinctive features and commonalities in the perioperative period of younger children, with strong clinical and social significance.
博延 敏
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 9-14; https://doi.org/10.12677/acrs.2019.82002

Abstract:
目的:探讨程序性死亡配体-1 (Programmed cell death-ligand 1, PD-L1)及程序性死亡受体-1 (Pro-grammed cell death-1, PD-1)在前列腺癌中的表达水平,及其与前列腺癌临床病理特征的相关性。方法:收集2014年2月至2018年10月在中山大学附属第五医院泌尿外科进行前列腺癌根治术,并经术后病理确诊的前列腺癌组织63例,另取癌旁2 cm外前列腺组织为正常对照组。用免疫组化法检测PD-L1和PD-1在前列腺癌及正常前列腺组织中的表达情况,并分析二者的表达与前列腺癌临床病理特征的关系。结果:63例前列腺癌组织中,PD-L1和PD-1的阳性表达均明显增高,而正常前列腺组织中未检测到PD-L1和PD-1表达(P = 0.000);有淋巴结转移的前列腺癌组织中PD-L1和PD-1的表达明显高于无淋巴结转移组(PD-L1:75.00% vs 35.29%;PD-1:66.67% vs 33.33%,均PObjective: To explore the expressions of programmed cell death-ligand 1 (PD-L1) and programmed cell death-1 (PD-1) in prostate cancer (PCa), and the correlation between PD-L1/PD-1 expressions with the clinical pathological features of PCa. Methods: Data of 63 patients who underwent radical prostatectomy in Department of Urology, the Fifth Affiliated Hospital of Sun Yat-sen University with PCa diagnosed by postoperative pathology from February 2014 to October 2018 were collected. We took normal prostate tissue 2 cm away from prostate cancer as a control group. The expressions of PD-L1 and PD-1 in PCa and normal prostate tissues were detected by immunohistochemistry, and the correlation between them with the clinical pathological features of PCa was analyzed. Results: The positive expressions of PD-L1 and PD-1 were significantly increased in 63 PCa tissues, while the expression of PD-L1 and PD-1 was not detected in normal prostate tissues (P = 0.000). The expressions of PD-L1 and PD-1 in lymph node metastasis group were significantly higher than those without lymph node metastasis (PD-L1: 75.00% vs 35.29%; PD-1: 66.67% vs 33.33%, P < 0.05). The expressions of PD-L1 and PD-1 in the bone metastasis group were also higher than that in the non-bone metastasis group (PD-L1: 75.00% vs 38.18%; PD-1: 75.00% vs 34.55%, P < 0.05). Conclusion: The high expressions of PD-L1 and PD-1 in PCa are closely related to local or distant metastasis of patients, and may be involved in immune escape of PCa.
平陈 安
Published: 1 January 2019
Asian Case Reports in Surgery, Volume 08, pp 1-7; https://doi.org/10.12677/acrs.2019.81001

Abstract:
目的:探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、逐级扩张导管、乳头小切开、防滑脱鼻胆管(LCPND)治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄的临床应用体会。方法:回顾性分析成都市第二人民医院2010年12月至2018年12月期间,符合入选标准的105例患者的临床资料。结果:105例在腹腔镜下行胆囊切除术、胆总管探查胆管镜下取石术,必要时,在胆管镜下行冲击波或液电碎石术。采用逐级导管扩张乳头、十二指肠镜下乳头小切开并留置鼻胆管72.4% (76/105),逐级导管扩张乳头、十二指肠镜下乳头切开和取石并留置鼻胆管13.3% (14/105),逐级导管扩张乳头失败而改为十二指肠镜下乳头切开或取石并留置鼻胆管7.6% (8/105),因逐级导管扩张乳头和十二指肠镜下切开乳头均失败而中转为腹腔镜胆总管探查取石并留置T形管1.0% (1/105),因腹腔镜下取石失败而中转为开腹胆总管探查取石、逐级导管扩张乳头、十二指肠镜下乳头切开并留置鼻胆管1.9% (2/105),因腹腔镜下取石失败而中转为开腹胆总管探查取石并留置T形管3.8% (4/105)。一期缝合术后无残石,胆汁漏5例(4.8%),轻症胰腺炎2例(1.9%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无围手术期再手术和死亡病例。术后总并发症发生率为6.7%(7/105)。结论:对本医院有限病例进行初步研究发现,只要病例选择合适,LCPND治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄是可行、有效和安全的。 Objective: To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, duodenoscopy, step by step dilatable catheter, the small incision of papillary sphincterotomy and antislip nasobiliary drainage (LCPND) of the corresponding period in treatment of extrahepatic bile duct stones with obstruction and stenosis of papillary during the course of therapeutic laparoscopy. Methods: The clinical data of 105 cases of extrahepatic bile duct stones with obstruction and steno-sis of papillary undergoing LCPND were analyzed retrospectively from December 2010 to December 2018 in the Second People’s Hospital of Chengdu. Results: It was in 105 cases removed the gallbladder and exploration of common bile duct by laparoscopy, to remove gallstones through the duct incision with choledochoscopy and shockwave lithotripsy. Step by step dilatable catheter ex-panded duodenal papilla, the small incision of papillary sphincterotomy and indwelling nasobiliary was in 72.4% (76/105); step by step dilatable catheter expanded duodenal papilla, through papil-lary sphincterotomy to remove gallstones and indwelling nasobiliary in 13.3% (14/105); the ex-panded papillary failed and was replaced by endoscopic papillotomy or lithotomy and indwelling nasobiliary in 7.6% (8/105); due to the failure of dilating papillary and endoscopic papillotomy, it was transferred to laparoscopic choledocholithiasis and retained T shape tube drainage in 1.0% (1/105); it was shifted to open CBD exploration for the stone removal, step by step dilatable cathe-ter expanded duodenal papilla, the papillary sphincterotomy and indwelling nasobiliary in 1.9% (2/105); it was shifted to open CBD exploration for the stone removal and indwelling T shape tube drainage in 3.8% (4/105). It had not residual stones after the balloon nasobiliary drainage, bile leakage in five cases (4.8%), and two patients (1.9%) had a slight pancreatitis. No cases had perfo-ration of intestine and bile duct, bleeding, severe pancreatitis. No perioperative reoperation and death. Total postoperative complication formation rate was 6.7% (7/105). Conclusion: From pre-liminary results of limited cases in our hospital, if patients are suitable, LCPND in treatment of ex-trahepatic bile duct stones with obstruction and stenosis of papillary is safe and effective.
平陈 安
Published: 1 January 2018
Asian Case Reports in Surgery, Volume 07, pp 31-37; https://doi.org/10.12677/acrs.2018.74005

Abstract:
Objective: To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, duodenoscopy, step by step dilatable catheter, the small incision of papillary sphincterotomy, T tube + double biliary catheter bundling and supporting drainage (LCTBS) of the corresponding period for the treatment of the left lateral lobe hepatic duct and common bile duct stones during the course of therapeutic laparoscopy. Methods: The clinical data of 15 cases of the left lateral lobe hepatic duct and common bile duct stones undergoing LCTBS were analyzed retrospectively from December 2005 to September 2018 in the Second People’s Hospital of Chengdu. Results: It was in 15 cases removed the left hepatic lateral lobe and exploration of common bile duct, in 7 cases re-moved the gallbladder by laparoscopy. Through step by step dilatable catheter expanded left he-patic duct and duodenal papilla, the small incision of papillary sphincterotomy, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 73.3% (11/15). Through step by step dilatable catheter expanded duodenal papilla, the small incision of papillary sphincterotomy, in-dwelling T tube + double biliary catheter drainage of duodenal papilla was in 20.0% (3/15). Through step by step dilatable catheter expanded left hepatic duct, left hepatic duct plastic surgery, the liver round ligament repairing the defect, indwelling T tube and double biliary catheter drainage of left hepatic duct was in 6.7% (1/15). Residual stone of the left medial lobe hepatic duct occurred in one case (6.7%). Bile leakage occurred in one case (6.7%). No cases had perforation of intestine and bile duct, bleeding, acute pancreatitis. No perioperative reoperation and death. Total postoperative complication formation rate was 13.3% (2/15). Conclusion: From preliminary results of limited cases in our hospital, if patients are suitable, LCTBS for treatment of the left lateral lobe hepatic duct stones and common bile duct stones is safe and effective.
畅黄 书
Published: 1 January 2018
Asian Case Reports in Surgery, Volume 07, pp 17-30; https://doi.org/10.12677/acrs.2018.73004

Abstract:
[目的] 评价机器人辅助腹腔镜前列腺癌根治术(RARP)与标准腹腔镜前列腺癌根治术(LRP)治疗局限性前列腺癌的临床疗效。[方法] 检索EMBASE、MEDLINE、PubMed、Cochrane图书馆,并选择有关LRP与RARP临床疗效的随机对照研究(RCTs)和非随机对照研究(包括前瞻和回顾性研究),应用系统评价软件Rev Man5.3进行Meta分析。[结果] 通过文献检索共纳入24个研究,包括2个RCTs、7个前瞻性和15个回顾性研究。Meta分析表明:两组在手术时间、导尿管留置时间、住院时间和总体并发症发生率方面无统计学差异(P > 0.05)。但在失血量、输血率、术后3、6、12月的控尿和勃起功能恢复方面,RARP组明显优于LRP组(P [Objective] The goal of this study was to perform a systemic review and meta-analysis to evaluate the perioperative and functional outcomes between laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP). [Methods] A literature search of EMBASE, MEDLINE, PubMed, and Cochrane Library databases was conducted. We selected randomized controlled trials (RCTs) and non-randomized comparative studies (including prospective and retrospective studies) comparing perioperative and functional outcomes of both LRP and RARP, and meta-analysis was applied using the Review Manager 5.3 software. [Results] Twenty-four studies were identified in the literature search, including 2 RCTs, 7 prospective studies, and 15 retrospective studies. LRP and RARP showed similarity in the operative time, catheterization duration, in-hospital stay, and overall complication rate (P > 0.05). However, blood loss and transfusion rate were lower in RARP (P < 0.05). Moreover, RARP was associated with significantly improved outcomes for continence and potency rates to those of LRP at 3, 6, and 12 months postoperatively (P < 0.05). [Conclusion] RARP was associated with lower blood loss and transfusion rate and much greater functional outcomes in contrast to LRP.
李 波
Published: 1 January 2018
Asian Case Reports in Surgery, Volume 07, pp 10-16; https://doi.org/10.12677/acrs.2018.72003

Abstract:
目的:观察腰椎间孔镜术中应用复方倍它米松对保护脊髓功能,促进术后神经功能恢复的作用及其风险研究。方法:对2013年12月至2014年12月接受经皮椎间孔镜下髓核摘除术的60例单节段脱出型腰椎间盘突出症患者进行前瞻性随机对照研究,男31例,女29例;年龄19~71岁,平均40.0 (间盘突出)岁;L3/4共9例,L4/5共31例,L5/S1共20例。按随机数字表中随机数的奇数和偶数随机分为A组和B组,每组30例。A组为单纯经皮椎间孔镜下髓核摘除术,B组行经皮椎间孔镜下髓核摘除术后明胶海绵浸润1 mL复方倍他米松覆盖于出口根及硬膜囊腹侧,术前、术后即刻、术后1 d、术后3 d、术后30 d及术后90 d随访时采用视觉模拟评分法(Visual Analogue Scale, VAS评分)及腰椎功能障碍指数(Oswestry Disability Index, ODI评分)评估患者术后腰腿痛程度。结果:因失访、需要其它复杂治疗等原因3例被排除,其余57例病人中,A组28例,B组29例。术后即刻、第1、3 d VAS疼痛评分:AA组(3.01 1.06)分,(2.83 0.87)分,(2.04 0.46)分;B组:(2.13 0.84)分,(1.75 0.68)分,(1.07 0.24)分,两组比较差异有统计学意义(p 0.05)。结论:经皮腰椎间孔镜术中应用复方倍它米松可有效改善椎间孔镜下髓核摘除术后神经根刺激症状,但术后30 d后恢复效果与应用复方倍它米松无关,同时应用复方倍它米松也没有增加感染等并发症的风险。 Objective: To observe the effect of compound betamethasone on the protection of spinal cord function and the recovery of neurological function after lumbar intervertebral fluoroscopy. Methods: A prospective randomized controlled study was conducted in 60 patients with single-segment prolapse of lumbar disc herniation who underwent percutaneous lumbarectomy from December 2013 to December 2014. There were 31 males and 29 females in patients with lumbar disc herniation: aged 19 to 71 years, mean (40.0 ± 11.4) years; L3/4 in 9 cases, L4/5 in 31 cases, L5/S1 in 20 cases. The patients were randomly divided into group A and group B, with 30 patients in each group. Group A was treated with pure percutaneous nucleus pulposus, and group B was treated with 1 mL compound betamethasone after percutaneous lumbar intervertebral foraminectomy. The visual analogue scale (VAS score) and Oswestry Disability index (ODI score) were performed at preoperative, postoperative immediately, 1 day, 3 days, 30 days and 90 days after operation to assess the degree of postoperative low back pain. Results: Due to loss of visits, the need for other complex treatment and other reasons, 3 cases were excluded, with the remaining 57 patients, A group of 28 cases, B group of 29 cases. At postoperative immediately, 1 day, 3 days after operation, VAS score in group A was (3.01 ± 1.06), (2.83 ± 0.87), (2.04 ± 0.46), respectively. Meanwhile, in group B that was (2.13 ± 0.84), (1.75 ± 0.68), (1.07 ± 0.24), respectively. The difference between the two groups was statistically significant (p 0.05).
江 帆
Published: 1 January 2018
Asian Case Reports in Surgery, Volume 07, pp 5-9; https://doi.org/10.12677/acrs.2018.72002

Abstract:
目的:对比双侧全膝关节置换(total knee arthroplasty, TKA)术中运用关节腔周围注射鸡尾酒与股神经阻滞的镇痛效果。方法:选取2015年1月至2017年10月,我院收治的20例行双侧TKA的患者(40膝),其中男6例,女14例;年龄50~78岁,平均63岁。对双膝随机进行镇痛,一侧使用膝关节腔鸡尾酒注射,一侧使用股神经阻滞,术后常规镇痛,肌注帕瑞昔布钠(40 mg,2次/天),2天后改为口服塞来昔布(0.2 g,2次/天),记录术后72 h内疼痛视觉模拟评分(visual analogue scale, VAS) (1~10分)、手术时间、出血量、出院时膝关节活动度、住院时间等指标,并运用t检验及χ2检验统计分析。结果:20例40膝例均获6周随访,术后24 h VAS评分:试验组(3.0 ± 1.2)分,小于对照组的(4.4 ± 1.5)分,差异有统计学意义(P Objective: To compare the analgesic effect of intra-articular injection of cocktail and femoral nerve block on total knee arthroplasty (TKA). Methods: From January 2015 to October 2017, 20 patients with bilateral TKA (40 knees) were selected from our hospital, including 6 males and 14 females, aged 50~78 years, with an average age of 63 years. Randomized analgesia on both knees, one side of the knee cavity cocktail injection, femoral nerve block on one side, routine postoperative analgesia, intramuscular parecoxib sodium (40 mg twice daily), and oral celecoxib after 2 days (0.2 g, 2 times/day), record visual analogue scale (VAS) (1~10 points), operation time, and output within 72 hours after operation were used. Blood volume, knee joint mobility, length of hospital stay, and other indicators were measured using the t-test and χ2 test. Results: 20 cases of 40 knees cases were followed up for 6 weeks. The VAS score after 24 h of treatment group was (3 + 1.2) points, less than control group (4.4 + 1.5), which had statistically significant difference (P < 0.05); the joint activity of experimental group 1 week after operation was in the range of (100˚ + 8˚) and control group of (90˚ + 10˚), whose difference was statistically significant (P < 0.05); there was no statistical significance between operation time, bleeding volume, and joint activity range at postoperative 6 weeks. Conclusion: TKA has better analgesic effect after the operation of the intraarticular injection of cocktail, and it does not prolong the operation time, and the early joint activity is greater after the operation.
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