Search

Effect of Tension Suture on Healing Quality of Incision after Abdominal Surgery: A Meta-Analysis

ObjectiveTo investigate the effect of tension suture on healing quality of incision after abdominal surgery, and to provide a theoretical basis for reducing post-operative wound complications. MethodLiteratures on the tension suture in the application of abdominal incision were searched from January 2005 to January 2015, and then a Meta-analysis was carried out based on the data obtained from CBM, CNKI, and WanFang database. ResultsEight articles involving 2 001 patients with abdominal surgery, including 1 044 cases in tension suture group, and 957 cases in the conventional suture group, were incorporated. The Meta analysis results showed that, the technique of tension suture could reduce the incidence of post-operative wound infection (OR=0.40, 95% CI: 0.28-0.57, P<0.05), fat liquefaction (OR=0.51, 95% CI: 0.37-0.69, P<0.05), incisional hernia (OR=0.11, 95% CI: 0.04-0.34, P<0.05), wound dehiscence (OR=0.13, 95% CI: 0.07-0.25, P<0.05), and second stage surgery (OR=0.16, 95% CI: 0.09-0.30, P<0.05). But, it would also augment the risk of post-operative skin incision necrosis (OR=15.14, 95% CI: 2.79-82.08, P<0.05). On the other hand, the method of tension suture had no effect on the subcutaneous hemorrhage in the incision area (OR=0.58, 95% CI: 0.30-1.13, P>0.05). ConclusionsCompared with conventional suture, tension suture can reduce the hazard of wound infection, fat liquefaction, incisional hernia, wound dehiscence, and reoperation after abdominal surgery. In contrast, it can also increase the risk of post-operative skin incision necrosis.

Laparoscopic Cholecystectomy after Upper Abdominal Surgery

目的 探讨上腹部手术后腹腔镜胆囊切除术(LC)的可能性及手术方法与技巧。方法 回顾性分析我院2005～2009年期间对有上腹部手术史行LC的23例患者的临床资料。结果 23例患者中慢性结石性胆囊炎18例，胆囊息肉5例。既往均有上腹部手术史，其中胃大部切除术后19例,胃平滑肌瘤切除术后2例,脾破裂修补术后2例。采用闭合法穿刺建立气腹，分离粘连，暴露胆囊全貌及Calot三角，顺行或逆行切除胆囊。23例中LC成功21例; 因粘连致密，胆囊管无法辨认，中转开腹2例。手术时间45～140 min，平均67 min。全组无明显出血、内脏损伤、胆管损伤、胆汁漏等并发症发生。结论 部分上腹部手术后胆囊良性疾病行LC术可行。

Clinical Research on Nonoperative Treatment for Incomplete Adhesive Small Bowel Obstruction after Laparotomy

ObjectiveTo study the application value of mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations in treatment for incomplete adhesive intestinal obstruction after laparotomy. MethodsOne hundred and twentyeight patients diagnosed incomplete adhesive intestinal obstruction admitted to this hospital from March 2005 to May 2008 were randomly divided into trial group and control group. For the control group, the tradition therapy including fasting, gastrointestinal decompression, fluid replacement therapy, and enema with soap and water were used for treatment. For the trial group, the mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations were injected into stomach by the nasogastric tube on the basis of traditional treatment used for the control group. Some indicators including the successful rate of nonoperative treatment, the time that obstructive symptoms resolved and returned to normal exhaust and defecation and normal diet, and recurrence rate were compared between two groups. ResultsThe successful rate of nonoperative treatmentin in the trial group were significantly higher than that in the control group 〔92.1% (70/76) versus 69.2% (36/52), Plt;0.01〕. The average time that recovered to normal exhaust and defecation in the trial group and the control group was 32.5 d and 47.8 d, respectively. The average time that recovered to normal diet in the trial group and the control group was 3.2 d and 5.3 d, respectively. The time that recovered to normal exhaust and defecation, and diet in the trial group were significantly shorter than those in the control group (Plt;0.01). The recurrence rate had no significant difference between two groups (Pgt;0.05). ConclusionThe mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations improve recovery of intestinal function and reduce surgical intervention rate.

腹腔引流管拔除困难的原因分析及处理方法（附22例报道）

目的探讨腹腔引流管拔除困难的原因及临床处理方法。 方法回顾性分析笔者所在医院2003年7月至2015年5月期间22例腹部手术后腹腔引流管拔除困难患者的临床资料，总结分析其原因及处理方法。结果本组患者中引流管拔除时间为术后4～7 d者6例，7～10 d者16例。引流管拔除困难的原因1例为固定引流管的缝线从引流管穿过，4例为腹壁戳孔偏小，2例为引流管扭曲，9例为组织嵌入引流管内口或引流管侧孔（其中5例为纤维条索，4例为大网膜），6例无法确定原因。5例通过持续均匀用力牵引拔除，1例拆除缝合固定线拔除，8例通过旋转、来回牵拉或推送引流管拔除，8例应用持续重力牵引法拔除，无并发副损伤。 结论灵活应用各种方法来处理难以拔除的引流管，持续重力牵引法适宜于常规方法不能拔除的引流管。减少不必要的引流管放置，放置引流管时注意其细节和及时拔除引流管可避免引流管的拔除困难。

Effect of Preoperative Anxiety on Postoperative Pain and Analgesics Requirements in Patients Undergoing Abdominal Surgery

【摘要】 目的 研究全身麻醉腹部手术患者术前焦虑对术后疼痛、镇痛药用量及对术后镇痛满意度的影响。 方法 选取2009年8月-2010年4月68例ASAⅠ～Ⅱ级，拟行气管插管全身麻醉的腹部手术患者，术前采用状态-特质焦虑量表和抑郁评分量表进行焦虑程度的测评，术后观察VAS疼痛评分、总的镇痛药用量以及患者对镇痛的满意度，分析术前焦虑与术后VAS评分、镇痛药用量及镇痛满意度的相关性。 结果 68例受试者术前STAI为50±13，BDI为16±13，术后VAS评分为4.0±2.1，术后24 h镇痛药芬太尼的用量为（0.80±0.21） mg；术后镇痛药用量、患者镇痛满意度评分与术前STAI明显相关（r=0.68和r=-0.88，Plt;0.01）。术后VAS评分与术前STAI及BDI也有一定的相关（r=0.35和r=0.3）。 结论 术前焦虑程度可以影响腹部手术患者对镇痛治疗的满意度， 显著增加镇痛药用量。【Abstract】 Objective To investigate the effect of preoperative anxiety on postoperative pain, amount of analgesics and satisfaction of postoperative pain relief for patients undergoing abdominal surgery with general anesthesia. Methods A total of 68 patients undergoing abdominal surgery with general anesthesia from August 2009 to April 2010 were selected (ASA I-II). Preoperational anxiety levels were evaluated using State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) and postoperative VAS pain score, the total amount of analgesics used and satisfaction of pain relief were observed. The relationship between preoperative anxiety and post-operative VAS score, and total amount of analgesics used and satisfaction of pain relief were analyzed. Results The mean STAI and BDI of 68 samples were 50±13 and 16±13, respectively; the mean postoperative VAS was 4.0±2.1, and the mean amount of analgesics fentanyl used in 24 hours after the operation was (0.80±0.21) mg; the amount of post-operative analgesics used and the satisfaction of pain relief of the patients were found to be highly related to pre-operative STAI (r=0.68, -0.88; Plt;0.01). Post-operative VAS score was also related to preoperational STAI and BDI (r=0.35, 0.3). Conclusion Preoperative anxiety is closely related to the postoperative analgesics and satisfaction of pain relief for patients who had abdominal operation. Severe preoperative anxiety can significantly increase the amount of postoperative analgesics used and dissatisfaction of pain relief.

Nutritional Support for Functional Delayed Gastric Emptying after Abdominal Operation

【摘要】目的 探讨腹部手术后功能性胃排空障碍的营养支持。方法 对我院1997年1月至2004年2月收治的27例腹部手术后胃排空障碍患者的临床资料进行回顾性分析。结果 单纯肠内营养支持8例（29.6%），肠内、肠外联合营养支持10例（37.0%），单纯肠外营养支持9例（33.3%），分别于术后平均15、20及23 d恢复胃动力。结论 肠内营养在功能性胃排空障碍的治疗中具有重要作用。

上腹部手术后并发的心律失常

Comparison of Patient-controlled Intravenous and Epidural Analgesia on Postoperative Complications after Abdominal and Thoracic Surgery: A Meta-Analysis

Objective　To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods　A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results　Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions　Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.

几丁糖预防腹部术后肠粘连的疗效观察

目的 观察几丁糖预防腹部术后肠粘连的效果。 方法 2000 年1 月－ 2008 年12 月，收治再次剖腹手术患者127 例，其中69 例前次术中应用几丁糖（应用组），男41 例，女28 例，年龄13 ～ 82 岁。前次手术原因：胃肠、胆道及胰腺部癌30 例，弥漫性腹膜炎21 例，外伤性血腹8 例，粘连性肠梗阻及腹茧症6 例，大肠破裂4 例。58 例前次术中未应用几丁糖（对照组），男34 例，女24 例，年龄15 ～ 84 岁。前次手术原因：胃肠、胆道及胰腺部癌24 例，弥漫性腹膜炎18 例，外伤性血腹7 例，粘连性肠梗阻及腹茧症6 例，大肠破裂3 例。两组患者再次手术距前次手术时间为3 个月～ 9年。 结果 根据Phillips 和仲剑平分级标准评定粘连程度：应用组获0 级61 例，Ⅰ级6 例，Ⅱ级2 例；对照组获Ⅰ级5 例，Ⅱ级27 例，Ⅲ级16 例，Ⅳ级10 例；两组比较差异有统计学意义（P lt; 0.01）。 结论 几丁糖是一种预防术后肠粘连的较理想生物材料。

Clinical Diagnosis and Treatment of Abdominal Postsurgical Gastroparesis Syndrome

目的 总结腹部手术后胃瘫综合征（PGS）的病因、诊断及治疗方法。方法回顾性分析我院2003年1月至2009年3月期间行腹部手术后发生胃瘫的30例患者的临床资料。结果 PGS发生于术后5～10 d，通过临床表现、上消化道造影及胃镜检查明确诊断。全组均经营养支持、药物治疗等保守治疗后治愈，治愈时间14～62 d，平均25 d。结论 PGS是由多种因素导致的,上消化道造影及胃镜检查是诊断PGS的可靠方法,保守治疗为其主要治疗手段，应尽量避免再次手术。