目的探討晚期惡性梗阻性黃疸減黃、保肝的處理方式。方法回顧性分析我科2008年1月至2009年10月期間收治的80例惡性梗阻性黃疸患者，根據腫瘤部位、患者身體、經濟條件等確定無法行根治性手術者，采用不同的減黃術式。結果本組80例患者中，9例行PTCD，42例行PTBS，29例行ERBD。并發癥發生情況: PTBS組有15例，ERBD組6例，PTCD組2例。PTCD組的住院時間和住院費用明顯低于PTBS組和ERBD組(Plt;0.05)。結論晚期惡性梗阻性黃疸，一經確診，盡早處理，微創引流減黃是首選方式。
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.
ObjectiveTo systematically review the efficacy and safety of early abdominal paracentesis drainage (APD) in patients with severe acute pancreatitis (SAP). MethodsThe PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials and cohort studies on the management of SAP via early APD from inception to December 10, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software and Stata 17.0 software. ResultsEighteen studies were included, with a total sample size of 2 685 patients. The meta-analysis showed that early APD could decrease mortality (OR=0.49, 95%CI 0.35 to 0.69, P<0.01) and the incidences of multiple organ failure (OR=0.56, 95%CI 0.45 to 0.71, P<0.01), ARDS (OR=0.54, 95%CI 0.41 to 0.71, P<0.01), and infectious complications (OR=0.72, 95%CI 0.57 to 0.92, P<0.01) and also reduce the need for further interventions and the total cost incurred during hospitalization, reduce the length of hospital stay, and reduce the number of days spent in the intensive care unit. However, there were no significant differences in the incidence of pneumonia, bacteremia, and sepsis between the two groups. ConclusionThe treatment of SAP via early APD, which has high clinical value, could decrease the incidence of multiple organ failure, improve the prognosis of patients, and reduce the associated mortality rate. Moreover, APD does not increase the risk of infection-related complications. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=?3.37, 95%CI ?3.89 to ?2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
目的 探討前列腺體積＞60 mL的前列腺增生癥患者的手術安全性，提高部分合并尿道狹窄前列腺增生癥患者的手術實施率。 方法 2009年3月－2010年3月，行恥骨上膀胱穿刺引流下經尿道前列腺電切術（TURP）治療前列腺增生58例。年齡54～93歲，平均72歲，病程8個月～12年，平均7.2年；前列腺體積35～128 mL，平均78 mL；國際前列腺癥狀評分24～35分，平均30.2分 ；最大尿流率1.2～4.8 mL/s，平均1.8 mL/s；殘余尿量84～210 mL，平均160 mL。術前無尿潴留28例。 結果 58例順利完成手術，其中2例伴包膜穿孔，9例前尿道狹窄者通過去外鞘電切鏡完成手術。所有患者切除前列腺組織體積18～86 mL，平均58 mL；術中沖洗液為5%葡萄糖液，用量18 600～42 500 mL，平均23 500 mL；手術時間45～185 min，平均70 min。術后病理檢查均示良性前列腺增生，術后住院時間3～8 d，平均5 d。術后患者最大尿流率為18～46 mL/s，平均32 mL/s。 結論 恥骨上膀胱穿刺引流能降低膀胱內壓，減少水、糖分吸收，增加手術安全性，提高了部分合并前尿道狹窄的前列腺增生患者的手術幾率。
目的探討經皮經肝膽管穿刺引流（PTCD）、經皮腹腔穿刺引流及Roux-en-Y膽管空腸吻合術序貫治療高位膽管損傷合并膽漏的療效。方法對我中心2004年5月至2009年5月期間收治的5例高位膽管損傷合并膽漏的患者，應用PTCD、經皮腹腔穿刺引流、Roux-en-Y膽管空腸吻合術序貫治療過程及療效進行回顧性分析。結果5例患者均獲痊愈，隨訪3~24個月，未發生膽管再次狹窄、膽管炎等并發癥。結論PTCD、經皮腹腔穿刺引流后，再進行Roux-en-Y膽管空腸吻合術是治療高位膽管損傷合并膽漏的首選方法。
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
目的 比較開腹、腹腔鏡和經皮肝穿刺引流3種方法治療細菌性肝膿腫的優劣性，為細菌性肝膿腫治療方法的選擇提供參考依據。方法 回顧性分析筆者所在醫院2010年9月至2011年7月期間收治的39例細菌性肝膿腫患者的臨床資料，根據其治療方式將患者分為開腹組、腹腔鏡組和經皮經肝穿刺引流組（穿刺組）3組，對3組的首次治愈者比例、1個月治愈者比例、發生并發癥者比例、住院時間及住院費用進行比較。結果 開腹組、腹腔鏡組和穿刺組首次治愈者比例分別為10/12、8/9及12/18，3組間差異有統計學意義（P＜0.05）； 1個月治愈者比例分別為11/12、9/9及17/18，3組間差異無統計學意義（P＞0.05）；發生并發癥者比例分別為2/12、1/9及2/18，腹腔鏡組和穿刺組之間的差異無統計學意義（P＞0.05），2組與開腹組相比差異均有統計學意義（P＜0.05）；住院時間分別為（15.4±4.5） d、（9.7±2.3） d及 （16.7±5.8） d （P＜0.05）；住院費用分別為（1.9±0.5）萬元、（1.3±0.3）萬元及（0.8±0.2）萬元（P＜0.05）。結論 開腹組、腹腔鏡組和穿刺組3種治療方法各有利弊，個體化選擇治療方式是肝膿腫的治療策略。
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.