目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.
Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.
ObjectiveTo investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.MethodThe clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.ResultsThe time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).ConclusionIn strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.
目的 探讨和对比无针缝合器与传统的二期针线缝合和蝶形胶布拉拢对感染切口的闭合疗效。方法 对49例肝胆术后切口感染患者，待感染切口引流物明显减少、创面有健康肉芽生长时，应用立辰无针缝合器逐步闭合切口。另81例肝胆术后切口感染患者分别采用蝶形胶布拉拢或二期传统针线缝合，对比3组患者切口自换药开始至切口拆线的愈合时间。结果 无针缝合治疗组的愈合时间为（23.0±6.5）d，明显短于蝶形胶布拉拢组的（31.0±10.4）d和二期传统针线缝合组的（34.0±14.1）d（P＜0.05）。蝶形胶布拉拢组与二期传统针线缝合组愈合时间差异无统计学意义（P＞0.05）。结论 采用无针缝合器治疗感染切口可在引流换药的同时逐步闭合切口，促进其早期愈合。
ObjectiveTo systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. MethodsA comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. ResultsSeven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). ConclusionCurrent evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.
ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.