Asian Case Reports in Surgery
ISSN / EISSN : 2169-253X / 2169-2548
Published by: Hans Publishers (10.12677)
Total articles ≅ 58
Latest articles in this journal
Asian Case Reports in Surgery, Volume 10, pp 51-55; https://doi.org/10.12677/acrs.2021.103008
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.
Asian Case Reports in Surgery, Volume 10, pp 7-12; https://doi.org/10.12677/acrs.2021.102002
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.
Asian Case Reports in Surgery, Volume 10, pp 13-22; https://doi.org/10.12677/acrs.2021.102003
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.
Asian Case Reports in Surgery, Volume 10, pp 23-28; https://doi.org/10.12677/acrs.2021.102004
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.
Asian Case Reports in Surgery, Volume 10, pp 34-43; https://doi.org/10.12677/acrs.2021.102006
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.
Asian Case Reports in Surgery, Volume 10, pp 29-33; https://doi.org/10.12677/acrs.2021.102005
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。
Asian Case Reports in Surgery, Volume 10, pp 1-6; https://doi.org/10.12677/acrs.2021.101001
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.
Asian Case Reports in Surgery, Volume 10, pp 57-64; https://doi.org/10.12677/acrs.2021.104009
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.
Asian Case Reports in Surgery, Volume 10, pp 45-50; https://doi.org/10.12677/acrs.2021.103007
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.
Asian Case Reports in Surgery, Volume 09, pp 1-6; https://doi.org/10.12677/acrs.2020.91001
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.