Objective To explore the measures for early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 20 patients with iatrogenic injury in the distal part of common bile duct treated in our hospital from 1990 to 2008 were analyzed retrospectively. Results The injuries of 15 cases were found during the operation: 11 cases were treated with 3-stoma (bile duct, pancreas, duodenum)+Oddi sphinctreoplasty (OSP), 1 case with OSP+choledochojejunostomy, 2 cases with the perforated common bile duct suture repair+T tube drainage, 1 case with T tube drainage; All of them were cured after surgery. The other 5 cases were not found during the primary operation, 2 cases in which were cured with several operations, the other 3 were dead from infectious shock. Conclusions Early diagnosis and treatment of iatrogenic injury in the distal part of common bite duct can obtain perfect effects. Different procedures should be performed according to different degrees of the injury. The perfect preoperative imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.
31 cases of iatrogenic cholangic injury reported. 28 cases followed from 9 months to 6 years. iatrogenic cholangic injury is not an uncommon occurence main cases are inregular procedures, and carelessness in this group, only 9 cases were found intraoperatively. The main manifestations after injury were aggravating jaundice and/or bilious peritonitis. Symptoms, signs, B-type ultrsound and sometimes ERCP were used for diagnosis. Once the injury ascertained ends are the best treatment, an alternative Roux-Y Cholangiojejunostomy was also commonly used. In this group, 4 cases received the first methos and all with good results; 23 patients treated by the second methos, 17 were uneventful, 4 experienced more or less abdomenal pain, 2 suffered difinite repeated cholangitis and another 1 died.
Abstract： Objective To investigate the cause and treatment of iatrogenic tracheobronchoesophageal fistula and provide experiences for clinic treatment. Methods Between January 1995 to December 2008, 21 patients with tracheobronchoesophageal fistula were treated in Shanghai Chest Hospital and Shanghai 6th Hospital. Among them, iatrogenic fistula happened in 12 patients including 8 males and 4 females whose age ranged from 35 to 74 years old with an average age of 47. Fistula developed 21 d to 5 years after the treatment of the primary diseases which were mainly tumors. Two of them developed tracheoesophageal fistula, 10 bronchoesophageal fistula; 6 right bronchoesophageal fistula, and 4 left bronchoesophageal fistula. Fistula excision and surgical repair of the tracheobronchoesophageal fistula were performed on 2 patients; Lung lobectomy and repair of the esophageal fistula were performed on 5 patients; Tracheal fistula repair and pneumonectomy with reconstruction of the digestive tract were done on the rest 5 patients. Results No operative death occurred. Postoperative complications in 2 cases were cured without recurrence. In the 1year followup to all the 12 patients, no recurrence of fistula occurred. Conclusion Iatrogenic tracheobronchoesophageal fistula is a complex and severe disease for which surgery is the only best treatment.
Objective The intercellular adhesion (ica) gene of Staphylococcus epidermidis (SE) is a key factor to bacterial aggregation, to analysis the genotype of iatrogenic SE and to explore the effect of iatrogenic SE ica operon on theformation of bacterial biofilm on the surface of polyvinyl chloride (PVC). Methods Fifty-six cl inical isolates of iatrogenic SEwere selected, and PCR and gene sequencing were used to detect the genes related with bacterial biofilm formation. The genes contained 16S rRNA, autolysin (atlE), fibrinogen binding protein (fbe), and icaADB. The bacteria suspension of 1 × 105 cfu/mL iatrogenic SE was prepared; according to the test results of target genes, the PVC material and the genotype of icaADB+, atlE+, fbe+ strains were co-cultivated as the ica positive group; the PVC material and the genotype of icaADB-, atlE+, fbe+ strains were co-cultivated as the ica negative group. The thickness of biofilm and bacterial community quantity unit area on PVC materials were measured by confocal laser scanning microscope, and the surface structure of biofilm formation was observed by scanning electron microscope (SEM) at 6, 12, 18, 24, and 30 hours. Results The positive rate of 16S rRNA of iatrogenic SE strains was 100% (56/56). The genotype of icaADB+, atlE+, and fbe+ strains accounted for 57.1% (32/56). The genotype of icaADB-, atlE+, and fbe+ strains accounted for 37.5% (21/56). The sequencing results showed that the product sequences of 16S rRNA, atlE, fbe, and icaADB were consistent with those in GenBank. With time, no significant bacterial biofilm formed on the surface of PVC in ica operon negative group. But in ica operon positive group, the number of bacterial community was gradually increased, and the volume of bacterial biofilms was gradually increased on the surface of PVC. At 24 hours, mature bacterial biofilm structure formed, and at 30 hours, the volume of bacterial biofilms was tending towards stabil ity. The thickness of biofilm (F=6 714.395, P=0.000) and the bacterial community quantity unit area on PVC materials (F=435.985, P=0.000) in ica operon positive groupwere significantly higher than those in ica operon negative group. Conclusion Iatrogenic SE can be divided into 2 types ofica operon negative and ica operon positive bacteria. The iatrogenic SE ica operon can strengthen bacterium biofilm formation capabil ity on PVC materials, bacterium community quantity, and thickness of biofilm, it plays an important role in bacterium biofilm formation on PVC materials.
In order to investigate the causes, diagnosis, treatment, outcome and prevention of iatrogenic nerve injury in the neck, 8 cases with iatrogenic nerve injuries were analyzed. Among them, 5 cases were accessory nerve injury, 3 cases were brachial plexus injury. All of the cases were treated by surgical methods, including neurolysis, repair by direct suture, nerve graft and transposition. After 1-3 years follow up the effect was excellent in 2 cases who were accessory nerve injury, good in 5 cases, and poor in 1 case who was brachial plexus injury. It was concluded that high responsibility of surgeons and careful manipulation during operation were the key to prevention of nerve injuries.
Nerve injury following operation is one of the main causes of the iatrogenic peripheral nerve injury. In order to learn lessons from these cases, one hundred and seven cases of peripheral nerve injury complicated with the orthopedic operations were analyzed. Forty-four cases were cutting injury during operation, made up 41% of all cases and 27 cases were stretch and compression injury, made up 25%. The involved nerves included 41 radial nerves and 24 common peroneal nerves, composing 60.7% of all nerve injury. The operations responsible were mainly the bone and joint operations, which made up 81%. The cause, prophylaxis, diagnosis and treatment were discussed. The rich appropriate knowledge of anatomy and responsibility of the surgeon were emphasized in order to prevent the occurrence of complication. Once the injury was suspected, diagnosis should be made promptly and effective treatment should be performed in time.
Objective To formulate an evidence-based nursing scheme of eye care for an unconscious patient undergoing mechanical ventilation with eye complication. Methods Under the principle of PICO, the issue was put forward aiming directly at patient’s clinical manifestations, and the following databases as The Cochrane Library (Issue 12, 2011), PubMed (January 1980 to November 2011), EMbase (1974 to 2011) and CBM (1978 to 2011) were searched. Results A total of 3 guidelines, 2 systematic reviews and 9 randomized controlled trials (RCTs) were included. The evidence showed that eye cleaning was the very important part of eye care, and the commonly-used cleaning or rinsing solutions were saline and sterile water. Both moist cover and lubricating eye drops / ointment were used to prevent dryness in the eyes. For instance, polyethylene moisture covers could effectively prevent corneal abrasion, and lubricating eye drops / ointment were beneficial to eye observation, so these two methods needed to be properly selected in combination with patient’s conditions. Nurses had to assess the ability of the patient to close eyelids daily and helped the patient to close eyes, but the passive eyelids closure was inferior to the artificial tear ointment in the effect on preventing corneal abrasions; the integrated intervention of maintaining eyelids closure and forming eyeballs moisture chamber was more effective to prevent eye complications. According to the available evidence mentioned herein and the patient’s conditions, the following nursing scheme of eye care was formulated: cleaning the eyelids and peripheral skin using 0.9% saline gauze, covering the eyes with sterile polyethylene films which were fixed by anti-allergic adhesive tapes, changing the dressing every 12 hours, and observing closure of the eyelids every day. Seven days later, eye symptoms got obviously improved, with decreasing secretion, without congestion and chemosis, and negative results of fluorescein staining test. Conclusion Eye cleaning removes secretion and bacteria from the eyes. Polyethylene film prevents tear from evaporation and fully promotes the immune function of tears which can reduce the risk of infection. Eyelids closure and local moisture environment benefit the corneal epithelial repair.
Object To evaluate the significance of double common bile duct （DCBD） in hepatobiliary surgery. Metheds The data of diagnosis and treatment of two patients with DCBD in our hospital between Jul. to Dec. 2010 were analyzed retrospective， and the related literatures were reviewed. Results The right hepatic bile duct of DCBD due to mistaking it for cystic duct in 1 case was accidental injuried during laparoscopic cholecystectomy. Another example，the DCBD was confirmed by intraoperative exploration and choledochoscopic examination， at the same time with chole-dochal cyst， anomalous pancreaticobiliary ductal junction （APBDJ）， primary hepatolithus， and choledocholith， and then operation was performed. Two cases were typeⅤb of DCBD. A total of 32 English literatures were reviewed. Since the beginning of 1932 English literature had reported 100 cases of DCBD. The type Ⅱand typeⅢwere the most common type of DCBD， and the typeⅤonly 10 cases. There were 27 cases of DCBD in twenty-five Chinese articles from 1994 to 2012. The typeⅤwas the most common type of DCBD. The accessory common bile duct （ACBD） opening in the duod-enum， gastric， and pancreatic duct were the most common. The common complications included stone， APBDJ， choled-ochal cyst， tumor etc. Conclusions DCBD is a very rare anatomic variation of extrahepatic bile duct， often accompanied by calculus of bile duct and common bile duct cyst， APBDJ， and other biliary anatomy abnormality， and potentially carci-nogenic potential. The existence of DCBD may increase the risk of iatrogenic bile duct injury and complexity of biliary operation. In view of this， this abnormality of extrahepatic duct should be paid with close attention during operation.
Objective To summarize the experiences in diagnosis and treatment for iatrogenic injury of cholodocho-pancreatico-duodenal junction （CPDJ）. Method The clinical data of 9 patients with CPDJ injury were analyzed retro-spectively. Results Double lumen tube drainage was emplaced in all the operations. Nutrition support and inhibitor ofpancreatic secretion were applied in all the patients. ①CPDJ injuries were observed intraoperatively for 6 out of 9 patientswith CPDJ injury. Two patients with simple perforation of posterior wall of common bile duct inferior segment and 2patients with simple duodenal perforation who were treated by perforation repair， common bile duct T tube drainage， andperitoneal drainage. Two cases of bile duct or duodenal injury with pancreatic injury were treated by choledochojejunostomyand BillrothⅡgastrojejunostomy. These 6 patients with CPDJ injury were cured and none of case was death. ②Injuries of CPDJ were observed postoperatively for 3 out of 9 patients with CPDJ injury. Total bile diversion or total bile diversion with duodenal diverticulum were performed in 2 cases of bile duct or duodenal injury with pancreatic injury， respectively. The one with total bile diversion only was died of abdominal infection， duodenal fistula， wound dehiscence， abdominal and upper gastrointestinal tract bleeding， and multiple organ failure；the one with total bile diversion with duodenal diverticulum and the one with sequent PTCD and choledochojejunostomy for biliary obstruction caused by operation ofgigantic duodenal interstitialoma were cured. Conclusions CPDJ injury usually occurs in biliary duct exploration， endoscopic sphincterectomy or duodenal operation. It is easily misdiagnosed and serious consequences may happen from this. Timely and correct treatment should be taken according to the specific injury observed during or after the operation.
Objective To investigate the anatomic factors on iatrogenic biliary injury for elevating surgical safety and decreasing incidence of iatrogenic biliary injury. Methods The clinical data of 39 patients with iatrogenic biliary injury and anatomic varied factors in operation records from January 2000 to August 2009 in The Second Affiliated Hospital of Kunming Medical College were analyzed retrospectively. Results Thirty-nine patients with iatrogenic biliary injury were divided into 5 types according to Bismuth typing, including type Ⅰ 6 cases, type Ⅱ 19 cases, type Ⅲ 8 cases, type Ⅳ 5 cases, and type Ⅴ 1 case. Anatomic varied factors included bile duct variation in 15 cases, cystic duct abnormal position in 10 cases, vascular variation in 13 cases, and porta hepatis rotation in 1 case. Biliary injuries were found during operation in 6 cases, 24—72 h after operation in 16 cases, and stenosis of biliary duct was found in 17 cases 3 months to 2 years after operation. Two cases were dead because of liver function failure or myocardial infarction, withdraw was 4, the other patients were cured. Conclusion Anatomic factors are important objective elements in iatrogenic biliary injury, paying attention to abnormal anatomic factors can effectively prevent iatrogenic biliary injury.