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find Author "柴琛" 21 results
  • Advances in Clinical Diagnosis and Treatment of Iatrogenic Bile Duct Injury

    ObjectiveTo explore the cause, clinical diagnosis and treatment, and prevention strategies of iatrogenic bile duct injury (IBDI). MethodsBy means of literature retrieval, the clinical diagnosis and treatment measures of patients with IBDI were summarized. ResultsThe related risk factors of IBDI include man-made factors, the local anatomy variation factors, and pathological factors. According to the damage diagnosis time and local pathological state, the repair operations such as bile duct suture repair, biliary tract end to end anastomosis, bile duct jejunum Roux-en-Y anastomosis, bile duct jejunum Roux-en-Y anastomosis, and jejunal artificial valve forming, or liver resection, and liver transplantation were performed. Moreover, it was also available that biliary stent or papillary balloon dilation through ERCP for the bile duct distal stricture. ConclusionsIt is important that prevention of IBDI. Operation should pay attention to upper abdominal operation prior to the implementation of the correct understanding of IBDI. In case of IBDI, the reasonable repair operation mode should be choose according to the damage types and time, and it can significantly improve the treatment effect and quality of life of patients.

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  • Efficacy and Safety of Interstitial Chemotherapy with 5-Fluorouracil Sustained Release Agent in Radical Operation of Colorectal Cancer

    ObjectiveTo observe effect and safety of interstitial chemotherapy with 5-fluorouracil sustained release agent in radical operation of colorectal cancer. MethodsOne hundred and sixty patients with colorectal cancer from October 2011 to December 2013 were randomly divided into observation group and control group according to an incomplete random method, 78 cases of them were in the observation group and 82 cases of them were in the control group. All the patients were performed radical resection of colorectal cancer. The abdominal cavity and pelvic cavity were washed after surgery. 5-fluorouracil sustained release agent was implanted in the observation group patients for interstitial chemotherapy, the implant site was at the tumor resection area and the mesenteric artery. Routine chemotherapy was performed in these two groups after operation. The postoperative complications were observed. The postoperative local recurrence rate, liver metastasis rate, and 24-month survival rate were recorded. ResultsThe rates of abdominal complications and toxic effects had no significant differences between these two groups (P > 0.05). The rates of 12-month and 24-month local recurrence and the rate of liver metastasis in the observation group were significant lower than those in the control group[1.3% (1/78) versus 8.5% (7/82), x2=8.934, P=0.023; 5.2% (4/78) versus 23.2% (19/82), x2=14.834, P=0.004; 10.3% (8/78) versus 18.3% (15/82), x2=12.034, P=0.016]. The rate of 24-month survival in the observation group was significant higher than that in the control group[94.9% (74/78) versus 84.1% (69/82), x2=11.465, P=0.010]. ConclusionThe good safety of interstitial chemotherapy with 5-fluorouracil sustained release agent could effectively decrease local recurrence rate and liver metastasis rate of colorectal cancer after radical operation and improve survival time of patients.

    Release date:2016-10-02 04:54 Export PDF Favorites Scan
  • Advances in the treatment of pancreatic pseudo cyst

    Objective To summarize the treatment of pancreatic pseudo cyst in recent years. Methods Through the retrieval of relevant literatures, the progress in the treatment of pancreatic pseudo cyst in recent years were reviewed. Results Pancreatic pseudo cyst is a common complication of pancreatitis or pancreatic injury. Severe symptoms are often caused by large cysts or complications, and it can cause serious consequences. The main treatment methods are conservative treatment, percutaneous drainage, surgical treatment, endoscopic drainage technology, combined with traditional Chinese and Western medicine treatment, and each method has its own indications and advantages and disadvantages. Conclusion The treatment of pancreatic pseudo cyst is varied, and it should be individualized treatment according to different indications, different patients and the development stage of the disease.

    Release date:2017-01-18 08:04 Export PDF Favorites Scan
  • Diagnosis and Treatment of Marginal Ulcer after Subtotal Gastrectomy

    目的 探讨胃大部切除术后吻合口溃疡的诊治方法。方法 1985年3月至2008年6月期间兰州大学第一医院收治的胃大部切除术后吻合口溃疡患者29例,均经胃镜证实,其中男16例,女13例; 年龄30~51(40±3.0)岁; 19例为十二指肠球部溃疡术后,10例为胃溃疡术后。初次手术到溃疡再发症状的时间,最短1例为1个月,其余28例为3~4年。2例吻合口溃疡穿孔及4例吻合口溃疡出血者行包括吻合口在内的残胃部分切除、胃空肠Roux-Y吻合术; 其余均给予非手术治疗。结果 行再手术治疗者术后发生切口感染1例,行保守治疗; 所有患者均治愈,随访1~5年,未出现溃疡复发。结论 吻合口溃疡首选保守治疗,多数可治愈。再次手术方式可采用残胃部分切除加胃空肠Roux-Y吻合术。

    Release date:2016-09-08 10:54 Export PDF Favorites Scan
  • Risk Factors and Preventive Measures of Surgical Site Infection

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  • Dolichocolon with Colorectal Cancer: Report of 17 Cases and Review of The Literatures

    目的总结结肠冗长症合并结直肠癌的临床病理特征,并文献复习结肠冗长症与结直肠癌的关系。 方法回顾性分析兰州大学第一医院普外一科2011年1月至2012年12月期间收治的17例结肠冗长症合并结直肠癌患者的临床资料。 结果184例结直肠癌患者中合并结肠冗长症17例(9.24%),合并家族性息肉病恶变2例(1.09%),合并遗传性非息肉病性结直肠癌1例(0.54%),合并炎症性肠病1例(0.54%)。合并结肠冗长症的比例较高(P<0.05)。其中术前经结肠气钡灌肠检查诊断为结肠冗长症5例,术中诊断为结肠冗长症12例。所有患者均行手术治疗,切除结肠13~80 cm,平均33.8 cm。术后发生肺部感染、切口液化1例,腹水1例,肠瘘1例,骶前感染1例。术后17例患者均获随访,随访时间6~12个月,中位数为10个月。随访期间,1例患者于术后1年出现卵巢转移。 结论结肠冗长症合并顽固性便秘可能是结直肠癌发病的高危因素。

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  • 胰腺钩突癌误诊为十二指肠憩室1例报道

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  • Effects and Safety of Laparoscopic Cholecystectomy and Open Cholecystectomy for Chronic Atrophic Cholecystitis:A Meta-Analysis of RCTs

    ObjectiveTo systematically evaluation the efficacy and safety of laparoscopic cholecystectomy(LC) and open cholecystectomy(OC) for chronic atrophic cholecystitis. MethodsStandard electronic database such as PubMed, Web of science, Cochrane library, CNKI, VIP, CBM, and Wanfang database were searched to retrieve relevant randomized controlled trials(RCTs) that comparing LC with OC, which were analyzed systematically using RevMan5.2. ResultsSeven RCTs including 758 patients were brought into this Meta analysis. There were significant differences between two groups regarding operative time(MD=-27.70, 95% CI:-44.25--11.16, P=0.001), amount of blood loss during operation(MD=-113.25, 95% CI:-141.68--84.81, P < 0.000 01), the recovery time of gastrointestinal function(MD=-28.49, 95% CI:-29.80--27.18, P < 0.000 01), and length of hospital stay(MD=-3.83, 95% CI:-6.01--1.65, P=0.000 6), There were statistically significant difference in utilization rate of anodynes after operation(MD=0.12, 95% CI:0.06-0.23, P < 0.000 1) and terrible postoperative complications(MD=0.24, 95% CI:0.12-0.47, P < 0.000 01) between LC and OC. ConclusionsIn both efficacy and safety, LC for chronic atrophic cholecystitis are significantly superior than the traditional OC. But now the clinical randomized controlled trials about LC is less and the quality is poor, so that its long-term safety evaluation still needs large sample quality RCTs to be further verified.

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  • 不同胰-空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响

    目的比较胰十二指肠切除术中不同胰-空肠吻合方式对术后胰瘘发生率的影响。 方法回顾性分析兰州大学第一医院普外科2009年1月至2014年1月期间施行胰十二指肠切除术的115例患者的临床资料,根据胰-空肠吻合方式将患者分为3组:套入吻合组45例,行胰-空肠套入式吻合;黏膜吻合组54例,行胰管-空肠黏膜吻合;浆肌层吻合组16例,行胰管-空肠浆肌层吻合,比较3组患者术后的胰瘘发生率。 结果115例患者术后发生胰瘘20例,胰瘘发生率为17.4%(20/115),其中套入吻合组10例,占22.2%(10/45);黏膜吻合组4例,占7.4%(4/54);浆肌层吻合组6例,占37.5%(6/16)。3组患者的胰瘘发生率比较不同或不全相同(P=0.011),其中套入吻合组和浆肌层吻合组的胰瘘发生率均高于黏膜吻合组(P<0.017),而前2组间胰瘘发生率的差异无统计学意义(P>0.017)。 结论良好的吻合技术是预防胰瘘发生的重要保障,胰管-空肠黏膜吻合的操作简便,胰瘘发生率低,建议采用。

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  • Research status of PD-1/PD-L1 inhibitors therapy in gastric cancer

    ObjectiveTo describe the research status of programmed death receptor protein 1 (PD-1) and its ligand(PD-L1) inhibitors in advanced gastric cancer and to understand the key issues of PD/PD-L1 inhibitors in order to provide atheoretical basis for future research.MethodThe classical and up to date literatures on the immunotherapy, especially thePD-1/PD-L1 inhibitors in the advanced gastric cancer were reviewed.ResultsThe PD-1/PD-L1 inhibitors were the hot spot in the current research of tumor immunotherapy. The pembrolizumab and nivolumab were the commonly immunosuppressive agents in the current clinical research, which had also achieved the great success in the clinical research of gastriccancer since it was shown the good results in the malignant melanoma and hematological malignancies. In some clinical studies, the PD-1/PD-L1 inhibitors treatment showed the longer overall survival than the conventional chemotherapy, especially in the patient with positive PD-1. However the study still had some issues to be solved, such as no accurate prediction for the beneficiary population, the tumor hyperprogression and so on. It was gratifying that the current research on the basic research of tumor immunity was increasing, then it provided a theoretical support for solving these problems.ConclusionsTumor immunosuppressive therapy such as PD-1/PD-L1 inhibitors brings a new idea in treatment of patients with advanced gastric cancer. Although there are still many problems need to be solved in clinical research, it is believed that PD-1/PD-L1 inhibitors will become one of key players in treatment of patients with advanced gastric cancer in the further study.

    Release date:2020-03-30 08:25 Export PDF Favorites Scan
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