ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.
ObjectiveTo investigate predictive value of amylase level in intraperitoneal drainage fluid after pancreaticoduodenectomy (PD) for grade B and C pancreatic fistula (PF).MethodThe clinical data of 106 patients underwent PD in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2018 were retrospectively analyzed.ResultsTwenty-four cases (22.6%) had the PF after the PD, in which of 18 cases of grade A, 4 cases of grade B, and 2 cases of grade C. The age, tumor diameter, pancreatic texture, and main pancreatic duct diameter were associated with the PF after the PD by the univariate analysis (P<0.050), the main pancreatic duct diameter (OR=4.856, P=0.004) was its independent risk factor. The amylase levels of intraperitoneal drainage fluid on day 5, 7, and 10 after the PD could better predict the occurrence of PF (AUC was 0.910, 0.951, 0.948, respectively), especially which on day 10 after the PD could better predict the occurrence of grade B and C PF (AUC was 0.938).ConclusionElevated amylase levels in peritoneal drainage fluid on day 5, 7, and 10 after PD have better diagnostic effects on PF, especially which on day 10 after PD has a better diagnostic effect on grade B and C PF.
目的：比較肝膽手術后兩種腹腔引流管的應用效果。方法：將我院2005年5月～2007年3月間行肝臟手術病人106例隨機分為實驗組(57例)和對照組（49例），實驗組采用自制雙套管持續負壓沖洗引流，對照組采用傳統的單腔腹腔引流管引流，分析、比較兩組引流的療效。結果：采用雙套管負壓沖洗引流的病人發生引流管堵塞3例，隔下感染及積液4例，采用傳統的單腔腹腔引流管引流的病人發生引流管堵塞12例，隔下感染及積液15例，差異有統計學意義（Ｐ＜0.05）。結論：肝臟手術后應用雙套管持續負壓沖洗引流在防止引流管堵塞、隔下感染療效優于傳統的單腔腹腔引流管引流。
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.
目的 探討腸外瘺并腹腔感染的診治。方法 回顧性分析我院2002年1月至2007年12月期間收治的86例腸外瘺并腹腔感染患者的臨床資料。結果 所有腸瘺多在術后1~2周發生，經口服或引流管注入60%泛影葡胺60～100 ml造影后明確診斷，均行腹腔引流液細菌培養，加強抗感染。20例患者行腹腔沖洗引流，62例在B型超聲定位下穿刺引流，4例急診行剖腹沖洗引流，其中2例行降結腸造瘺。2例合并糖尿病的患者因全身感染嚴重且反復發作，出現多器官功能衰竭，分別于術后第15 天和第28 天死亡。其余84例住院治療時間平均12 d，均順利出院。結論 對腸外瘺并腹腔感染的患者，早期徹底的腹腔沖洗及有效的腹腔和膿腫引流，是控制感染、治愈腸外瘺的關鍵。
目的:觀察持續腹腔引流治療頑固性腹水的療效。方法:將頑固性腹水患者74例分為兩組,治療組38例,采用腹腔置管,持續腹腔引流腹水,3000mL/天;對照組36例,以常規補充白蛋白、限鈉、限水、利尿治療為主,比較兩組的療效。觀察治療組治療前后患者尿量、腹圍和體重變化,并比較治療組與對照組在肝、腎功能及電解質的變化及總體療效。結果:治療組療效優于對照組(Plt;0.05),與治療前比較,治療組治療后尿量、腹圍、體重有明顯改變(Plt;0.01), 肝、腎功能及電解質與對照組比較無明顯變化(Pgt;0.05)。結論:持續腹腔引流治療頑固性腹水經濟適用,不良反應少,患者依從性好。
【Abstract】ObjectiveTo study the therapeutic effects of indwelling catheters in patients with severe acute pancreatitis (SAP). MethodsThe clinical data of 113 patients with severe acute pancreatitis admitted to our hospital from Aug. 2002 to May 2004 were collected. The patients were divided into the indwelling catheter group (45 cases) and the control group (68 cases).The APACHEⅡscores and therapeutic results were compared. The drainage and intraabdominal pressure (IPA) were monitored. Results The APACHEⅡscores on day 2 and day 5 after therapy in indwelling catheter group were significantly decreased compared with the control group(P=0.000).The average hospital stay and cyst morbidity of the indwelling catheter group were significantly decreased compared with those of the control group(P=0.000). The mortality rate was lower in the indwelling catheter group, but there was no statistical difference between these two groups(Pgt;0.05). The IAP was positively correlative with the drainage volume, hospital day and APACHEⅡscores(r=0.552, r=0.748, r=0.923，P=0.000). ConclusionThe indwelling catheter is an important treatment in patients with SAP.