Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
Objective To improve the effect of surgical treatment for complex alveolar hydatid echinococcosis through multidisciplinary team (MDT) discussion. Methods The clinical data of 1 case of complicated alveolar echinococcosis treated in West China Hospital were discussed by MDT, and the best operation scheme was selected and followed-up for the patients. Results The CT imaging of the patient suggested the infringement of the first and second hepatic portal and inferior vena cava, decided to discuss the radical right hepatectomy and three biliary intestinal anastomosis by MDT, postoperative application of albendazole, was discharged after 12 months follow-up showed no recurrence of hepatic echinococcosis, and left liver obvious regeneration. Conclusion Complicated alveolar echinoccosis excision rate is low by surgical methods, through the discussion of MDT multidisciplinary can increase the efficacy of surgical treatment.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.
Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.
Objective To summarize the specific treatment for a patient diagnosed with recurrence of hepatocellular carcinoma following liver transplantation. Methods Considering the patient’s condition, multidisciplinary team (MDT) consultation of the specialists in radiology, oncology, radiotherapy, and liver surgery was conducted. Results After the MDT consultation, the patient was advised to receive surgery if the metastasis could be excluded. Surgical removal of the mass located at the body and tail of pancreas+splenectomy+enterodialysis was conducted. The alpha fetoprotein (AFP) level and abdominal CT were reviewed and no recurrence was found during the follow up period (by the end of May. 2018). Conclusion The MDT mechanism could provide individualized treatment for patients with complicated hepatocellular carcinoma and benefit those patients.
ObjectiveTo summarize experience of multidisciplinary team (MDT) in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis and explore its clinical differentiation with other common types of intrahepatic pneumatosis.MethodThe clinicopathologic data of rare patient with circumscriptus intrahepatic pneumatosis admitted to the Occupational Disease Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.ResultsA 60-year old female patient was admitted to this hospital with " abdominal pain and septic shock”. After the MDT discussion and analysis, the treatment regimens were decided as follows: the early anti-shock treatment, corrections of electrolyte disorder and hypoalbuminemia, platelet transfusion, ultrasound guided percutaneous catheter drainage (200 mL gas and 10 mL pus, the pneumonic Klebsiella which proved by the bacterial culture). The drainage tube was removed on postoperative day 6. After 5 d of the anti-inflammatory treatment with imipenem and statin sodium injection, it was downgraded to the cefazoxime (the third-generation cephalosporin) injection, and the anti-inflammatory treatment was continued for 6 d as well as the blood glucose was controlled. On the 7th day after the treatment, the right upper abdomen pain was relieved and without positive sign. The abdominal CT showed the localized pneumoconiosis in the right lobe of the liver was completely absorbed. The result of laboratory examination was basically normal. The patient was discharged on the 12th day after the operation and had no discomfort symptoms on month 1 after the operation. The abdominal CT showed the liver was not abnormal.ConclusionSurgeons should be fully aware of various types of intrahepatic pneumatosis so as to sufficiently investigate pathophysiological clue of disease to improve cure rate and reduce complications.
ObjectiveTo summarize the experience of combined treatment of conventional transcatheter arterial chemoembolization (cTACE) and drug-eluting-bead chemoembolization(D-TACE) in a case of advanced hepatocellular carcinoma with intrahepatic metastasis.MethodsA patient with advanced hepatocellular carcinoma who was admitted to The Second Affiliated Hospital of Chongqing Medical University in October 2018 was treated with TACE for three times.ResultsAfter MDT discussion, three interventional operations were performed on this patient in The Second Affiliated Hospital of Chongqing Medical University. CT examination after the first treatment with cTACE showed that lipiodol deposited in liver lesions and the lesions were more stable than before; after the second treatment with cTACE and D-TACE, CT examination showed more lipiodol deposited in the tumors, and the tumors were more limited and significantly reduced; after the third treatment with cTACE, CT examination showed that the tumors were effectively controlled and no progress was made. This patient was followed-up for 2 months after the fourth cTACE, tumors were effectively controlled and no progress occurred.ConclusionsIn advanced hepatocellular carcinoma with intrahepatic metastasis, TACE is the best treatment. Combination of D-TACE and cTACE can achieve better clinical efficacy.
ObjectiveTo introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly.MethodsBy consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed.ResultsThe elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients.ConclusionSignificant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.
ObjectiveTo explore the clinical characteristics, diagnosis, and treatment norms of gastrointestinal stromal tumor, so as to deepen clinicians’ understanding of the gastrointestinal stromal tumor and avoid misdiagnosis.MethodsThe clinical data of a patient with gastrointestinal stromal tumor who treated in March 2019 in The First Hospital of Kunming was retrospectively analyzed, and determining the methods of the treatment through MDT mode.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, cardiothoracic surgery department, oncology department, and anesthesia department, it was considered that surgical treatment was the best treatment scheme. The operation time was 120 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroesophageal reflux, and other complications occurred after the operation, and the patient was discharged successfully on the 10th day after the operation. Postoperative treatment was assisted by imatinib. Follow-up was conducted for more than 4 months, with no obvious complication occurred after discharge, so continued to follow-up.ConclusionGastrointestinal stromal tumor can be diagnosed and treated by multidisciplinary approach, and surgical resection is still the most important and effective treatment.
ObjectiveTo summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.MethodsThe literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.ResultsClinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.ConclusionThe application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.