Objective To understand etiology and available treatment of postoperative peritoneal adhesion. Method Domestic and overseas literatures in recent years about research progress of peritoneal adhesion were reviewed. Results As to the previous research, the operation was the main cause of peritoneal adhesion by the injury, inflammatory reaction, and hypoxia, which further affected the changes of the peritoneal microenvironment through the release of inflammatory cells, inflammatory mediators, cytokines, etc., then disturbed the balance of deposition and dissolution of fibrin and promoted the formation of extracellular matrix and microangiogenesis, resulted in peritoneal adhesion. The main treatment measures were optimizing surgical procedure and improving surgical technique, preventing fibrinolysis and promoting fiber protein degradation, some drug therapies involved molecules and genes, using biologic barrier treatment with drug barrier and mechanical barrier, and some other adjuvant therapies. Conclusions Pathogenesis of peritoneal adhesion is complex and poorly understood currently. There is no effective clinical treatment and intervention for this disease. Research on aspects of cell and molecular of abdominal cavity microenvironment will be beneficial to precise treatment of peritoneal adhesion, and combined medication of multiple targets and multiple links and related interventions are expected to apply for peritoneal adhesion in future.
Objective To explore prognostic factors of unplanned reoperation in Department of General Surgery. Methods The clinical data of 85 patients with unplanned reoperations who treated in the Northern District of the Shanghai Ninth People’s Hospital from January 2014 to May 2017 were retrospectively collected. The risk factors such as preoperative basic information, surgical related information, and postoperative information for death of unplanned reoperations were analyzed. Results There were 72 cured patients and 12 deaths in the 85 patients. The univariate analysis results showed that the age was older (P<0.05), the operative time was longer (P<0.05) in the patients with death as compared with the cured patients; the with basic diseases, selective operation, high grade of ASA, preoperative hemoglobin <90 g/L, admission to ICU after unplanned reoperations, postoperative complications, and multiple reoperations were correlated with the mortality of unplanned reoperations (P<0.05). The multivariate analysis results showed that the elderly patients, preoperative hemoglobin <90 g/L, and postoperative complications were the independent prognostic factors (P<0.05). The satisfaction of patients at discharge in the death group was significantly lower than that in the survival group (P<0.05). Conclusion Ederly patient, preoperative hemoglobin <90 g/L, and postoperative complications are independent prognostic factors of unplanned reoperations in Department of General Surgery.
Objective To explore the influencing factors of palliation efficacy in malignant obstructive jaundice. Methods Clinical data of 107 patients with malignant obstructive jaundice who treated in Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from March 2014 to December 2017, were retrospectively collected to analyze the influencing factors of palliation efficacy in 1 week and1 month after operation. Results Multivariate analysis results showed that, hilar obstruction and preoperative albumin level were influencing factors of palliation efficacy in 1 week after operation (P<0.05), patients with hepatic portal obstruction, and low preoperative albumin level had poor effect; hilar obstruction, preoperative albumin and total bilirubin level were influencing factors of palliation efficacy in 1 month after operation (P<0.05), patients with hepatic portal obstruction, low preoperative albumin level, and high total bilirubin level had poor effect. Conclusions The obstruction location, preoperative albumin level, and total bilirubin level are the independent influencing factors of palliation efficacy which played an important role in prognostic assessment.
目的探讨保留肝动脉血供的肝血流阻断对肝切除术失血量和肝功能的影响。 方法回顾性分析了2007年9月至2012年12月期间上海交通大学医学院附属第三人民医院118例行肝切除术患者的临床资料，其中68例行保留肝动脉血供的肝血流阻断（保留组），50例采用Pringl法行肝门阻断（阻断组），比较2组的手术失血量、接受输血病例的比例、手术并发症以及术后肝功能恢复情况。 结果全组无围手术期死亡病例。保留组患者的平均手术时间、术中失血量、接受输血患者的比例、术后肠道功能恢复时间以及术后并发症发生率与阻断组相比差异均无统计学意义（P＞0.05）；术后第1天及第5天，谷丙转氨酶及谷草转氨酶水平保留组明显低于阻断组（P＜0.05）。 结论保留肝动脉血供的肝血流阻断法能有效控制肝断面出血，明显保护了肝脏功能，且并未延长手术时间。
ObjectiveTo explore the risk factors of intraabdominal complications (IACs), pancreatic fistula (PF), and operative death after pancreatoduodenectomy (PD), and to provide a theoretical basis in reducing the rates of them. MethodsClinical data of 78 patients who underwent standard PD surgery in The Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. ResultsThere were 29 cases suffered IACs (13 cases of PF included), and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in patients with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancreatic duct stenting, and without employment of somatostatin (P < 0.05), no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting (OR=1.867, P=0.000), soft texture of remnant stump (OR=1.356, P=0.046), and diameter of main pancreatic duct less than 3 mm (OR=2.874, P=0.015) suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting (OR=1.672, P=0.030), soft texture of remnant stump (OR=1.946, P=0.042), and diameter of main pancreatic duct less than 3 mm (OR=1.782, P=0.002);no independent factor was found to have relationship with operative death. ConclusionsSoft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.
ObjectiveTo understand research progress of animal model of esophageal achalasia and discuss its pathogenesis briefly.Method Literatures about research progress of animal model of esophageal achalasia were reviewed. ResultsThe models of esophageal achalasia could been made in several ways, such as the obstruction model, the classic denervation model, and the increasingly popular gene model. These models were all based on the theory of the corresponding causes, with the processing of different factors, then completed the preparation of animal model. Conclusionsanimal model of esophageal achalasia goes through three stages: obstruction model, denervation model, and gene model. gene model of esophageal achalasia based on congenital theory could help us understand this disease better and make an ideal animal model, which could provide a reliable evidence for etiology study.
ObjectiveTo summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease. MethodRelated literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease. ResultsGastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect. ConclusionPathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.
Objective To observe effect of self-designed drug-loaded nanofilm in preventing postoperative peritoneal cavity adhesion during cholecystectomy in New Zealand white rabbit. Methods The 40 New Zealand white rabbits were randomly divided into blank control group, chitosan group, nanofilm group, and drug-loaded nanofilm group using random number table, the peritoneal cavity adhesions after cholecystectomy at different time (on day 7, 14, 21, and 28) were observed among these 4 groups. Results The adhesion of gallbladder forssa was serious in the blank control group and the adhesion situation had obviously improved among the other three groups, furthermore, the adhesion of the drug-loaded nanofilm group was the slightest. The adhesion score was significantly decreased in the chitosan group, the nanofilm group, or the drug-loaded nanofilm group as compared with the blank control group (P<0.05), which in the drug-loaded nanofilm group was significantly decreased as compared with the chitosan group (P<0.05) or the nanofilm group (P<0.05), which had no significant difference between the chitosan group and the nanofilm group (P>0.05). The nanofilm was degraded on day 14 after surgery and basically completely degraded on day 28 after surgery. The nanofilm degradation points had no significant differences between the nanofilm group and the drug-loaded nanofilm group at different time (P>0.05). Conclusions Drug-loaded nanofilm could prevent postoperative peritoneal cavity adhesion from physical barrier and drug therapy. It provides a new idea for prevention of peritoneal cavity adhesion after general surgery and research and development of new material to prevent peritoneal cavity adhesion in future.
Objective To evaluate the diagnostic value of all diagnostic tests for detecting armazide resistance in mycobacterium tuberculosis. Methods We searched PUBMED, EMBASE, CBM, CSJD and CJFD. QUADAS items were used to evaluate the quality of included studies. Meta-disc software was used to handle data from included studies. Results Twelve studies were included. Meta-analyses showed that the summary sensitivity and summary specificity of nitrate reductase assay were 92% and 99%, and those of BACTEC MGIT 960 system were 93% and 96%, respectively. The SROC of nitrate reductase assay and BACTEC MGIT 960 system were 0.9836 and 0.9862, respectively. Conclusion We recommend that proportion method can be replaced by nitrate reductase assay as a screening test for detecting armazide resistance in mycobacterium tuberculosis, and BACTEC 460 can be replaced by BACTEC MGIT 960 system as a final diagnostic test for detecting armazide resistance in mycobacterium tuberculosis.