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17 January 2007, Volume 26 Issue 12 Previous Issue    Next Issue
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Prevention and management of hepatic arterial complications after orthotopic liver transplantation. Ma Yi,Wang Guodong,Wang Dongping,et al. 2006, 26(12): 1-957.  Abstract ( )   PDF (486KB) ( )   Objective:To investigate the risk factors,prevention and management of hepatic arterial complications after liver transplantation. Methods:Clinical data of 181 cases of allograft orthotopic liver transplantation admitted in 2004 in First Affiliated Hospital of Sun Yatsen University were analyzed retrospectively. Results:Among 181 cases,12 cases were related to arterial complications with incidence rate of 6.6% (12/181).Among 7 cases of arterial complications occurred in short term after operations,arterial thrombosis occurred in 5 cases and large area hepatic necrosis result from injury of right accessory hepatic artery by mistake occurred in 2 cases.Among 5 cases of arterial complications occurred in long term after operations,arterial thrombosis occurred in 2 cases and hepatic artery stenosis occurred in 3 cases.Among 12 cases of aterial related complications,7 cases underwent another liver transplantation;3 cases underwent emergency thrombolectomy and hepatic artery reconstruction;2 cases underwent thrombolysis treatment.Six cases died resulted from hepatic arterial complications, which accounted for 28.6% (6/21) of dead cases after liver transplantation. Conclusion:Application of microsurgical techiniques in hepatic arterial anastomosis, prophylasis and rectification of blood hypercoagulabale state are the important factors to decrease arterial complication incidence rate.Individualized therapeutic regimen should be applied to treat the complications related to artery and the revascularization or liver retransplantation are the main common regimen.Patients with severe liver functional lesion and low probability to reverse should be performed retransplantation and surgery should be performed before the appearance of liver function failure and severe infection.

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Postoperative mortality and major complications after hepaticojejunostomy:a multivariate analysis of clinical factors. Liu Jianwei 2006, 26(12): 1-941.  Abstract ( )   PDF (386KB) ( )   Objective:To investigate the postoperative mortality and major complications after hepaticojejunostomy and its relationship with clinical risk factors. Methods:The postoperative mortality and major complication incidence of 163 patients underwent hepaticojejunostomy between January 1990 and August 2004 in Guangzhou Red Cross Hospital of Jinan University were analyzed retrospectively.Univariate and multivariate analysis were used to analyze clinical risk factors. Results:Postoperative severe complications were observed in 39 patients (23.9%),and 19 patients (11.7%) died of complications.Logistic regression analysis revealed that malignant tumor,hypoalbuminemia and chronic disease were the independently significant factors for operative mortality.Hypoalbuminemia,more anastomotic stoma,chronic disease and malignant tumor were the independently significant factors for postoperative major complications. Conclusion:Hypoalbuminemia is the most important risk factor for outcome after hepaticojejunostomy.It’s important for surgeons to predominate opportunity and management of patients correctly for reducing postoperative complications.

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Multivariate analysis of affecting surgical margin status of breastconserving surgery for breast cancer. Zhang Qiang, Zhang Bin, Long Fei, et al. 2006, 26(12): 1-935.  Abstract ( )   PDF (260KB) ( )   Objective:To evaluate the correlations between surgical margin status of breastconserving surgery and several factors in breast cancer. Methods:Between July 2003 and December 2004,112 cases of primary breast cancer were treated by breastconserving surgery.Among them,9 cases were on stage 0,51 cases on stageⅠ,50 cases on stage Ⅱ,2 cases on stage Ⅲ.The correlations between surgical margin status of breastconserving surgery and clinical pathologic factors were analyzed. Result:Univariate analysis showed that operation methods,microcalcification scope of breast Xray,histological grade and EIC were the important factors affecting surgical margin status (P<0.05).Multivariate analysis showed that the factors influencing surgical margin status were operation methods,histological grade,EIC and microcalcification scope orderly. Conclusion:High quality mammography examination before breastconserving surgery and surgical margin from primary tumor not less than 1cm are important for avoiding marginpositive in breast cancer.The surgical margin specimens taken from the entire wall of the residual cavity and series section for pathological examination are effective methods for preventing falsenegative of the surgical margin.

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Urinary trypsin inhibitor in SIRS and MODS of critically ill surgical patients：a placebocontrolled study. Wu Jianfeng,Guan Xiangdong,Xu Xiangdong,et al. 2006, 26(12): 1-919.  Abstract ( )   PDF (2276KB) ( )   Objective:To evaluate the efficacy of urine trypsin protease inhibitor in critically ill surgical patients and explore the mechanisms. Methods:Fifty-eight patients according with the criteria were randomly divided into ulinastatin treatment group (group U,n=30) and control group (group C,n=28).Patients in the group U received ulinastatin 200 000 units intravenous twice a day in 12 hours after operation,while those in the group C received equal quantity of normal saline as placebo.At the time of admission and 24，48，72 hours after initiation of treatment,serum levels of Cr,Lactic Acid,NO,IL-6,IL-8,TNF-α were measured and APACHEⅡ scores were made.The time of stay in SICU and mortality rate were recorded. Results:Plasma concentrations of three cytokines,IL-6,IL-8,TNF-α and APACHE scores in group U decreased more obviously than those in group C.Plasma concentrations of Cr,Lactic Acid,NO showed no significant difference between the two groups.Length of stay in the SICU and mortality rate showed no significant difference between two groups. Conclusion:Urine trypsin protease inhibitor can decrease the blood concentration of inflammatory cytokines TNFa,IL6 and IL8 in critically ill surgical patients.It can reduce APACHEⅡ scores.But it can not show a beneficial effect on clinical outcome in critically ill patients.Further study is need to test whether it can reduce the mortality rate of MODS.

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Thrombocytopenia in patients with multiple organ dysfunction syndrome. Du Bin,Xi Xiuming,Chen Huide,et al. 2006, 26(12): 1-964.  Abstract ( )   PDF (563KB) ( )   Objective:To study the risk factor for thrombocytopenia in patients with multiple organ dysfunction syndrome (MODS) and the influence on patient outcome. Methods:Three hundreds of sixty-six MODS patients admitted to 5 intensive care units within 1 year were analyzed retrospectively.The demographic characteristics,clinical information,acute physiology and chronic health evaluation (APACHE) Ⅱ score,and sequential organ failure assessment (SOFA) score were recorded upon review of patient record.The primary end point was hospital mortality. Results:One hundred and fiftyone patients (41.3%) died during hospitalization. Thrombocytopenia (odds ratio ［OR］ 2.143,95% confidence interval ［95%CI］ 1.114 - 4.121,P=0.022),neurologic failure (OR 6.033, 95% CI 3.164-11.506,P<0.001),and maximum SOFA score (OR 1.215,95%CI 1.112-1.328,P<0.001) were significantly associated with hospital mortality.Two hundred and twenty MODS patients (60.1%) developed thrombocytopenia.ICU stay (OR 1.017,95%CI 1.002-1.032,P=0.023) and maximum SOFA score (OR 1.271,95%CI 1.187-1.361,P<0.001) were significantly associated with development of thrombocytopenia,while maximum SOFA score (OR 1.405,95%CI 1.276-1.548,P<0.001) and secondary thrombocytopenia (OR 3.517,95%CI 1.780-6.951,P<0.001) were independent risk factor for hospital mortality in MODS patients with thrombocytopenia. Conclusion:Thrombocytopenia is very common in MODS patients,and is associated with increased hospital mortality.

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Immune regulation therapy on trauma,severe sepsis and MODS patients:a study of 70 cases. Huang Shunwei,Guan Xiangdong,Chen Juan,et al. 2006, 26(12): 1-959.  Abstract ( )   PDF (2975KB) ( )   Objective:To study the clinical effect of immune regulation therapy on trauma,severe sepsis and MODS patients. Methods:Seventy patients conform to the standard of trauma,severe sepsis and MODS were analyzed prospectively. All patients were divided into two groups at random.One was contrast group with regular therapy.The other was treatment group with Ulinastatin plus Thymosinα1 in a week.The immune index before and after therapy in the 1st,3rd,7th,14th and 28th day,including the continue change of lymphocytes,CD4,CD8,CD4/CD8 and monocytes HLADR CD14+ were observed. Results:Twenty patients died in the contrast group and thirteen patients died in the treatment group.It was significant difference between two groups,P＜0.05.CD4 in treatment group was significant higher than that in contrast group between the 7th and the 14th day of therapy,P＜0.05.CD8 in treatment group was significant higher than that in contrast group on the 14th day of therapy,P＜0.05.CD4/CD8 was no difference in two groups within 7 days of therapy,P＞0.05,but CD4/CD8 in treatment group decreased significantly after stopping immune regulation therapy,P＜0.05.Lymphocytes and monocytes HLADR CD14+ were significant higher than those in contrast group after the 7th day of therapy, which lasted till the 28th day. Conclusion:Immune regulation can improve the prognosis of trauma,severe sepsis and MODS patients within 28 days and increase lymphocytes and monocytes HLADR CD14+ significantly.It deserves recommendation for the clinic.The clinical effect of immune regulation therapy on the increase of CD4 and CD8 is out of synchronic or delayed,which may be relative to the different time of immune response and/or twoways regulation on the lymphocyte subgroup.Within 7 days of therapy,regular therapy or plus immune regulation therapy has the same value of maintaining the stabilization of CD4/CD8,but CD4/CD8 will decrease after stopping immune regulation therapy.The reason is unknown.It should be studied further after appropriately prolonging the course of immune regulation therapy.

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Effects of hypertonic saline and hydroxyethyl starch on fluid balance after Zhao Jianguo,Zhang Yingtian,Shao Yongsheng,et al. 2006, 26(12): 1-910.  Abstract ( )   PDF (428KB) ( )   Objective:To investigate the effects of 7.5% hypertonic saline (HS) and 6.0% hydroxyethyl starch (HES) on postoperative fluid balance and clinical outcome in patients performed elective major abdominal surgery. Methods:One hundred and twenty patients with gastrointestinal carcinoma performed radical surgery between June 2003 and December 2005 in Affiliated Hospital of Jianghan University were studied.The patients were assigned to receive lactated Ringer's solution following 4mL/kg of 7.5% hypertonic saline and 60% hydroxyethyl starch 500mL (HS/HES,n=40) or lactated Ringer’s solution following 4mL/kg of 7.5% hypertonic saline (HS,n=40) or lactated Ringer's solution (RL,n=40) only during the early postoperative period in SICU.Fluid infusion volumes, urine outputs, fluid balance,body weight change,PaO2/FiO2 ratio as well as the incidence of complication and mortality were compared among the three groups. Results:Urine outputs on the operative day in HS/HES group and HS group were significantly more than those in RL group.Fluid infusion volumes on the operative day and the first postoperative day in HS/HES group and HS group were significantly lesser than those in RL group.The volumes of the positive fluid balance during first 48 hours after surgery in HS/HES group and HS group were significantly lesser than those in RL group.Body weight gain after surgery in HS/HES group and HS group were significantly lower than that in RL group.PaO2/FiO2 ratio after surgery in HS/HES group and HS group is higher than that in RL group.The overall incidence of complication and the incidence of pulmonary infection in HS/HES group and HS group were lower than those in RL group.Decrease of volumes of the positive fluid balance and body weight gain in HS/HES group were more significant than those in HS group. Conclusion:7.5% hypertonic saline has an intense diuretic effect,which can reduce postoperative fluid infusion volumes and positive fluid balance after major abdominal surgery as well as accelerate negative fluid balance appearance more early, and make the overall incidence of complication and the incidence of pulmonary infection incidence after the surgery lower.The results were better when hypertonic saline combined with hydroxyethyl starch.

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Effect of high ligation of inferior mesenteric artery in rectal cancer surgery. Cao Zhixin,Xu Xiangshang,Yang Chuanyong. 2006, 26(12): 1-959.  Abstract ( )   PDF (454KB) ( )   Objective:To evaluate the clinical effect of high ligation of inferior mesenteric artery in rectal cancer surgery. Methods:Four hundreds and ninetynine patients with rectal cancer underwent high ligation of inferior mesenteric artery in Tongji hospital of Tongji Medical College,Huazhong University of Science and Technology between January 2000 and December 2005 were reviewed retrospectively. Results:The metastatic rate of the lymph nodes at the root of the inferior mesenteric artery was 14.4%.The inferior mesenteric artery root nodal metastasis occurred more frequently with low differentiation adenocarcinoma,mucous adenocarcinoma,signetring cell cancer and pT3 or pT4 stage rectal cancer. Conclusion:In radical surgery of rectal cancer, the high ligation of the inferior mesenteric artery should be performed for the following risk factors:patients with low differentiation adenocarcinoma,mucous adenocarcinoma,signetring cell cancer and pT3 or pT4 stage rectal cancer.The high ligation of the inferior mesenteric artery can improve 5-year survival rate.

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Pathologic study of mesorectal metastases and micrometastases in patients with rectal cancer. Wang Cun,Zhou Zongguang,Wang Zhao,et al. 2006, 26(12): 1-910.  Abstract ( )   PDF (3003KB) ( )   Objective:To investigate the patterns of mesorectal neoplastic foci,examine involvement and micrometastases of lymph nodes. Methods:Large tissue slice and tissue microarray were applied in the pathologic study of 31 cases of total mesorectal excision (TME) specimen admitted between March 2002 and May 2002 in West China Hospital of Sichuan University. Results:Three hundreds and fortynine mesorectal neoplastic foci were examined from 18 cases of specimen.One third of them were in the outer layers of mesorectum.Concerning position of primary tumor,ipsolateral neoplastic foci were significantly more than contralateral ones (P<0.05).Distal mesorectal spread was examined in 4 cases of specimen with the distance ranged from 10cm to 35cm.Twelve cases of specimen were diagnosed as circumferential margin involved (CMI),but its relationship with tumor location was not proved.Altogether,972 lymph nodes were harvested with 128 involved by tumor.No significant difference in occurrence rate of micrometastases was observed among tumors of different stage. Conclusion:Complete excision of the mesorectum with fascia propria circumferentially intact is essential.Circumferential margin involvement and micrometastases suggested adoption of postoperative adjuvant radiochemotherapy for advanced tumors.

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Ileus tube in the treatment of early postoperative inflammatory small bowel obstruction:a study of 8 cases. Yao Hongwei,Fu Wei,Yuan Jiong,et al. 2006, 26(12): 1-959.  Abstract ( )   PDF (457KB) ( )   Objective:To evaluate the role of vianasal ileus tube in the conservative treatment of early postoperative inflammatory small bowel obstruction (EPISBO). Methods:The data of eight casas of EPISBO admitted between March 2005 and August 2005 in Peking University Third Hospital were reviewed retrospectively.All patients failed to improve with nasogastric tube decompression,and then vianasal ileus tube decompression was recommended.The curative effects were observed according to some outcome measures. Results:With the ileus tube decompression,the volume of gastrointestinal decompression was increased significantly,and the abdominal circumstance and intraabdominal pressure were decreased significantly compared with the nasogastric tube decompression.After 3 to 10 days of vianasal ileus tube decompression,all patients were discharged without complication or emergency re-operation. Conclusion:Patients with EPISBO can be managed by vianasal ileus tube decompression safely and effectively.It is possible for patients to avoid reoperation of laparotomy.

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Hepatic benign tumor and tumorlike lesions：an analysis of 15 cases. Qian Bo,Zhu Lixin,Xiong Qiru,et al. 2006, 26(12): 1-910.  Abstract ( )   PDF (285KB) ( )   Objective:To explore the clinical characters and treatment of the hepatic benign tumor and tumorlike lesions. Methods:A retrospective analysis was performed in 15 cases of the hepatic benign tumor and tumorlike lesions admitted by pathology between January 1984 and January 2005 in the First Hospital of Anhui Medical University. Results:The partial hepatectomy was performed in all patients except for one case of liver biopsy. Conclusion:With the popularization of advanced imaging techniques,the incidences of the hepatic benign tumor and tumorlike lesions have been increased in recent years.The resection is the most important and safer method for treating and diagnosing the liver benign tumor and tumorlike lesions.

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The effect of hypocaloric and low nitrogen parenteral nutrition on outcome of surgical patients underwent abdominal operation. Wu Guohao,Zhang Yanwei,Yuan Lei,et al. 2006, 26(12): 1-951.  Abstract ( )   PDF (423KB) ( )   Objective:To assess the effect of hypocaloric and low nitrogen parenteral nutrition (PN) on the clinical outcome of patients underwent abdominal surgery. Methods:One hundred and twenty-eight patients underwent abdominal surgery between March 2006 and August 2006 in Zhongshan Hospital of Fu Dan University were divided into two groups randomizely.Study group (n=62) received calorie (76.98±17.57) kJ/(kg·d) and nitrogen (0.10±0.03)mol/(kg·d) using a standardized regimen （KabivenTMPI，Fresenius Kabi，Germany）.Control group (n=66) received calorie (112.13±27.20) kJ/(kg·d) and nitrogen (0.24±0.06)mol/(kg·d)in 3L bag.PN infused continuously for 7 days postoperatively.Biochemical indicators,nutritional status,hospital stay,complications from operative day to the postoperative 28th day were recorded to identify the difference between two groups.〖JP〗 Results:The concentrations of total protein,albumin,prealbumin in two groups in the end of study were lower than preoperative concentrations without significent differences between two groups.Weights in study group decreased (4.4±2.6)kg in postoperative 7 days,and weight in control group decreased (4.2±3.0)kg,(P=0.137).The growth of blood glucose level in study group was lower than that in control group with significent difference.Eight patients in study group received insulin for 27 times with (4.6±3.2)U of insulin every time.Twentythree patients in control group received insulin for 92 times with (8.4±4.7)U of sinsulin every time.There were significent differences between two groups,(P1=0.0047,P2=0.0051) There were no significant difference between two groups in the incidence of complications and hospital stay （P1=0.143,P2=0.232）. Conclusion:Hypocaloric and low nitrogen parenteral nutrition using standardised regimens can control postoperative blood glucose level better than traditional parenteral nutrition does.It has the same effectiveness in nutrition outcome and prognosis.