Objective To investigate safety and short-term effect of subtotal hepatectomy with caudate lobe as sole remnant liver in treatment of hepatolithiasis, and to analyze diagnosis and treatment process of bronchobiliary fistula after hepatectomy. Methods The clinical data of 1 patient with hepatolithiasis combined with liver atrophy-hypertrophy syndrome and caudate lobe with compensatory hypertrophy who was admitted to the Gansu Provincial People’s Hospital in August 2016 were analyzed retrospectively. The body surface area of the patient was 1.47 m2, the standard total liver volume was 1 040 cm3. According to the results of CT, the expected residual 1iver volume (caudate lobe volume) after the hepatectomy was 643 cm3, and the ratio of residual liver volume over the standard total liver was 61%. The patient received the subtotal hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage. The follow-up including the postoperative complications and recurrence of calculus was performed by the regular hospital check up till September 2017. Results The subtotal hepatectomy with caudate lobe as sole remnant liver was performed successfully. The operative time and intraoperative blood loss were 280 min and 3 000 mL, respectively. The peritoneal drainage tube was removed on the 8th postoperative day with a good recovery of liver function. The postoperative pathological examination showed that there were some intrahepatic bile duct pigment stones, the bile duct wall fibrous tissue hyperplasia combined with a focal liver cells hydropic degeneration, and no canceration. The patient was discharged on the 40th postoperative day. Two months later, the T tube cholangiography showed that the inferior extremity bile duct was unobstructed and there was no residual intra- and extra-hepatic stone. The liver function was normal, then the T tube was removed. After 6 months, the patient coughed and exhausted the bilious sputum, meanwhile the sputum culture showed that there were the Escherichia coli and Streptococcus viridans, then the bronchobiliary fistula was diagnosed. After the multidisciplinary discussion, the patient received the right thoracocentesis and double abdominal drainages around liver, meanwhile, combined with the anti-inflammatory, liver protection, intravenous nutrition support, etc., the bilious sputum was obviously reduced. So far, the patient had been followed up for one year, the patient's cough, and expectoration symptoms disappeared and his condition was stable. Conclusions Caudate lobe-sparing subtotal hepatectomy in treatment of hepatolithiasis is safe and feasible, but it is possible that bronchobiliary fistula is followed after operation, individual and multidisciplinary collaboration in treatment of bronchobiliary fistula caused by extensive hepatectomy is safe and feasible.
Objective To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle. Methods Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 ± 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 ± 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot). Results The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 ± 14.7 and 75.8 ± 14.5, respectively; SF-36 scores were 76.6 ± 13.1 and 75.5 ± 13.2, respectively; and significant differences were found when compared with preoperative scores (P lt; 0.05), but no significant difference between postoperative 6 months and last follow-up (P gt; 0.05). Conclusion For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.
ObjectiveTo explore the application of MDT mode in the diagnosis and treatment of a large retroperitoneal small cell carcinoma.MethodsA huge retroperitoneal tumor about 25 cm×18 cm was found by the preoperative abdominal MRI examination, which was considered as the malignant tumor. Considering the patient’s condition, MDT consultation of the specialists in radiology, oncology, vascular surgery, urinary surgery, and anesthesiology was conducted.ResultsBy MDT discussion, the general condition of patient was good. At present, the diagnosis of the huge retroperitoneal tumor was confirmed. Although the tumor was surrounded with related organs closely, yet the radical operation was finished smoothly and the R0 resection was achieved through the collaboration of MDT. The operation lasted 365 minutes, and the intraoperative blood loss was about 200 mL. Postoperative pathology confirmed that the tumor margin was negative and no postoperative complication occurred. The total number of hospital stays was 23 days. The patient’s return to the hospital for review in 4 months after discharge revealed a tumor recurrence. Then, combined with radiotherapy and chemotherapy, the patient’s condition was stable during treatment.ConclusionFor rare cases of retroperitoneal small cell carcinoma involving multiple disciplines, the treatment based on MDT is able to bring better clinical outcome to patients due to safer and more feasible.
Objective To assess the effect of astragaulus membranaceus in the treatment of pulmonary tuberculosis. Methods Through applying the methods provided by the Cochrane Collaboration, the randomized controlled trials (RCTs) or quasi-RCTs of astragaulus membranaceus in the treatment of pulmonary tuberculosis were searched in The Cochrane Library (Issue 3, 2010), CNKI (1991 to May 2010), VIP (1989 to May 2010), EMbase (1981 to May 2010), and PubMed (1981 to May 2010). Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross checked then. The RevMan 5.0 software was used to conduct meta-analyses. Results Twelve RCTs involving 1 054 patients were included. All trials were tested in the mainland China. The results of meta-analyses showed that: a) The astragaulus membranaceus could assist the conventional drug to cure pulmonary tuberculosis, promote sputum negative conversion, focal absorption and cavity reduction in lung; b) The astragaulus membranaceus could reduce the adverse reactions of the conventional drug; c) The astragaulus membranaceus combined with the conventional drug could improve the patients’ symptoms and signs; and d) The astragaulus membranaceus combined with the conventional drug could reduce the bacterial relapse rates in follow-up after treatment. Conclusion The current evidence shows that the astragaulus membranaceus has some effects and is relatively safe to treat pulmonary tuberculosis. However, it is far from enough to recommend astragaulus membranaceus as a conventional adjuvant therapy for pulmonary tuberculosis because of no sufficient evidence obtained from this study for its small sample and low methodology quality. Therefore, more double-blind multi-center RCTs with high quality, large sample, and adequate follow up are required for further verification.
Objective To explore whether the intraoperative cholangiography （IOC） should be applied in laparoscopic cholecystectomy routinely or selectively. Methods Data of routine IOC group （1 520 patients）and selective IOC group （457 patients）in laparoscopic cholecystectomy were collected and analyzed， including cholangiography time， success rate， common bile duct stones rate， open cholecystectomy rate， and hospital stay after operation. All IOC cases were performed by home-made cholangiography appliance or infusion needle. Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time， success rate， open cholecystectomy rate， and hospital stay after operation （P＞0.05）. However， compared with routine IOC group， the common bile duct stones rate， anatomic variation rate， and iatrogenic damage rate were significantly higher in selective IOC group （28.25% vs. 13.43%， 10.71% vs. 7.43%， 2.05% vs. 1.02%， P＜0.05）. Conclusions For avoiding iatrogenic bile duct damage and residual stones， routine IOC should be applied in early-stage of laparoscopic cholecystectomy， and IOC should be applied selectively when the surgeon have LC technique at their finger ends.