目的介绍直肠癌根治手术中防止盆腔大出血的经验与紧急处理措施。方法1993年8月至2000年4月我科完成直肠癌根治手术687例。术者掌握盆腔解剖，沿间隙操作，保护好骶前静脉丛； 沿髂内动脉内侧镰状筋膜处理侧韧带，有时结扎直肠中动脉； 肿瘤浸润阴道或前列腺可边切除边缝合； 盆腔侧壁中度浸润者可在侧方淋巴结清除的同时，合并髂内动、静脉分支和肿瘤切除。发生盆腔大出血，根据大出血部位及肿瘤情况可采用骶丛止血钉按压法，纱布压迫止血法，缝扎止血法或血管修补术止血。结果发生术中大出血仅14例，术中失血量＜400 ml 5例，400～800 ml 8例，＞800 ml 1例。止血后未发生再次大出血。行Miles手术8例，保肛手术6例，无手术中死亡。结论直肠癌根治手术中按解剖层次正确操作，阻断直肠周围血流可防止盆腔大出血。发生盆腔大出血可用骶丛止血钉、纱布压迫、缝扎止血或血管修补术止血。
目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。
The purpose of this study was to determine the contribution of endotoxin (ET) in ocurrence and progression of acute pancreatitis (AP). The results indicated that correlation of ET changes with multiple organ damage in AP. The degree of ET elevation correlated well with the severty of AP. The level of plasma ET of severe AP patients was much higher than that of mild AP patients (Ｐ＜0.05). The chance of multiple organ damage got greater while the plasma ET level got higher. Moreover, the severety change of severe AP correlated with the change of plasma ET level. In other words, the ET level was reduced while the disease was recovering, elevated while it was becoming worse and maintained high level in dead cases. We think that plasma ET level can be used as a reference for differenciating mild AP with severe AP and a predictor for the prognosis of AP.
Objective To analysis the characteristics of clinical manifestation， diagnosis， and surgical strategy of patients with insulinoma and to summarize the experience in diagnosis and treatment of insulinoma. Methods The medical records of 88 patients with a clinical and pathologic diagnosis of insulinoma in West China Hospital from Oct. 2003 to Jan. 2010 were reviewed and the basic informations and therapeutic data were collected. Results Among the 88 patients， 63 cases （71.6%） were female and 12 cases were multiple endocrine neoplasia Type I （MEN-1） tumors. Eighty-eight patients’ age was （38.59±11.95） years old， body mass index was 27.78±5.86， and tumor diameter was（1.62±0.70） cm. Eighty-six point four percent of the patients had Whipple’ triad and 79.5% of the patients had a overnight fasting ratio of plasma insulin to glucose greater than 0.3. Diagnostic sensitivity of transabdominal ultrasonography， computed tomography scan， magnetic resonance imaging， and intraoperative ultrasonography were 30.8% （24/78）， 74.6% （53/71）， 82.5% （47/57）， and 100% （59/59）， respectively. Distal pancreatectomy （28 cases） and enucleation（64 cases） were performed in those patients， and pancreatic fistula rate were 14.3% （4/28） and 37.5% （24/64） respectively（P＞0.05）. The total duration of hospitalization and postoperative hospitalization time of patients that performed the distal pancreatectomy or enucleation were 28 d and 16 dvs. 29 d and 13 d， respectively （P＞0.05）. Conclusions Clinical diagnosis of insulinoma can rely on Whipple’ triad and plasma insulin/glucose value of fasting for 15 hours. Modern imaging has a high sensitivity of localization to avoid blind pancreatic resection. Complete surgical resection is the treatment of choice and enucleation acts as safe as distal pancreatectomy .
ObjectiveTo investigate the role of D-dimer in predicting the prognosis of the patients with acute pancreatitis (AP). MethodsThe medical records of 324 patients with a diagnosis of AP in West China Hospital from April to June 2014 were retrospectively analyzed. ResultsOverall mortality rate was 3%, the median hospital stay was (11±3) days, and the median Intensive Care Unit stay was (1±1) day. The prothrombin time, activated partial prothrombin time, fibrinogen, international normalized ratio, antithrombinⅢ, D-dimer, C-reactive protein, and procalitonin level in the organ failure (OF) patients were significantly higher than those in the non-OF patients (P<0.05). The D-dimer, C-reactive protein, and procalcitonin level in the patients with infection were significantly higher than those in the non-infectious onse (P<0.05). The D-dimer and procalcitonin level in the death group were significantly higher than those in the survivor group (P<0.05). D-dimer and procalcitonin level increased as the grade of AP increased (P<0.05); the difference in C-reactive protein between the light and middle type was not significant (P>0.05), while was significant between middle and severe, and light and severe (P<0.05). The area under the receiver operating characteristic curve (AUC) of OF predicted by D-dimer was higher than C-reactive protein and procalcitonin; AUC of infection predicted by D-dimer was lower than procalcitonin; AUC of death predicted by D-dimer was higher than C-reactive protein but lower than procalcitonin. ConclusionD-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the complications and death of AP. D-dimer provide a more accurate assessment of prognosis than C-reactive protein and procalcitonin in patients with AP.
ObjectiveTo investigate the effect of multidrug resistant (MDR) bacterial infection in clinical course of acute pancreatitis. MethodsThe medical records of 134 patients with a diagnosis of infected pancreatic necrosis in West China Hospital from Jan. 2003 to Jun. 2010 were reviewed. ResultsMDR microorganisms were found in 78 of the 134 patients. MDR group had higher rate of transferred patients than non-MDR group (38.5% vs. 10.7%, P=0.002). The intensive care unit admission rate was significantly higher in patients with MDR bacterial infections (48.7% vs. 26.8%, P=0.01). The mean intensive care unit stay was significantly longer in patients with MDR bacterial infections (20 days vs. 3 days, P<0.001). Mortality and total hospital stay was not significantly different in the patients with MDR infections vs. those without it (20.5% vs. 14.3%, P>0.05; 78 d vs. 55 d, P>0.05). ConclusionClinicians should be aware of the high incidence and impact of MDR infections in patients with acute necrotizing pancreatitis, especially in transferred patients.
Objective To summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.
Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.