ABSTRACT: To investigate the diagnosis and treatment of delayed post-pancreaticoduodenectomy arterial bleeding (DPPAB).
Records of 336 patients who underwent pancreaticoduodenectomy (PD) between January 2000 and December 2010 were retrospectively analyzed. Detailed data of patients with DPPAB were assessed by a thorough review of medical records.
14 patients developed DPPAB. The mean time interval between the initial surgery and DPPAB was 33 days (range 7-72). Three patients experienced sentinel bleeding 5-8 days before DPPAB. All DPPAB patients had intra-abdominal septic complications before bleeding. The overall prevalence of success of angiography and transcatheter arterial embolization (TAE) was 85.7% (12/14), including 3 patients who achieved complete hemostasis by TAE after unsuccessful re-laparotomy. The prevalence of mortality of DPPAB was 28.6% (4/14). After hemostasis was achieved, intra-abdominal septic complications were controlled by percutaneous catheter drainage or re-laparotomy with drain replacement.
Angiography and TAE are recommended as the first-line diagnostic and treatment choice for DPPAB, respectively. Surgical intervention should be preserved to eliminate the cause of bleeding.
Pancreatology 09/2011; 11(5):455-63. · 1.99 Impact Factor
ABSTRACT: To discuss the treatment effect of wedge resection and thermal cautery of pleura for patients with malignant pleural effusion (MPE) caused by lung cancer under VATS.
37 patients with MPE underwent wedge resection and thermal cautery of pleura under VATS, from June 2005 to December 2008. Postoperative tumor markers level was contrasted with the preoperative, and the control rate of pleural effusion and survival rate of the patients were compared with control group, including 25 patients undergoing intrapleural chemotherapeutics in the same period.
In the group, the control rate of pleural effusion was 100%, but 60% in control group (P = 0.005). The 1-year survival rate of the group and the control group was 78.38% and 60% respectively (P = 0.003). CEA and CA-125 were descended obviously in postoperative day 7 in the group(P = 0.002);in control group, there were no significant change of CEA and CA125 after treatment (P = 0.797).
Wedge resection and thermal cautery of pleura under VATS can reduce tumor burden of patients with MPE to the maximum, and control MPE effectively and improve the quality of life for lung cancer patients with MPE.
Zhonghua yi xue za zhi 03/2011; 91(11):775-7.
ABSTRACT: To establish a scoring system predicting the ascites postoperatively by analyzing the variant factors associated with massive ascites after hepatectomy in the patients with hepatocellular carcinoma (HCC).
From January 2005 to January 2010, 324 patients with HCC underwent hepatectomy were analyzed retrospectively. There were 282 male and 42 female, aging from 17 to 84 years (mean age, 54 years). They were divided into two groups according to the volume of ascites. Variant preoperative, intraoperative and postoperative factors were compared and a scoring system was established to predict the postoperative ascites.
The univariate analyses revealed that various preoperative factors including prothrombin time, activated partial thromboplastin time, platelet count, albumin, aspartate aminotransferase had significantly difference in the two groups (P < 0.05). The operation time, intraoperative bleeding, hemihepatectomy or extended hemi-hepatectomy and the request of blood and serum transfusion had significantly difference in the two groups (P < 0.05). The multivariate analysis showed that the PLT, AST and the intraoperative plasma transfusion, hemihepatectomy or extended hemi-hepatectomy, the urine output and the drainage in the first postoperative day were independent factors (P < 0.05) for ascites. A scoring system was established based on the analysis. The specificity and the sensitivity were 86.2% and 83.3% respectively.
Variant factors are associated with postoperative ascites for hepatocellular carcinoma and the scoring system established can predict the ascites after hepatectomy accurately.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2010; 48(20):1534-8.
ABSTRACT: To investigate the method of early surgical treatment of bronchopleural fistula after pneumonectomy.
Twelve patients (9 males and 3 females with a mean age of 58.6-/+5.7 years) with bronchopleural fistula after pneumonectomy received a reoperation within 72 h after a definite diagnosis. Empyema was found in none of the 12 cases. Fistula occurred within 4 to 17 days (8 days in average) after the operation. The fistula of the residual main bronchus was resected, and the thoracic cavity was asepticized by flushing.
Ten patients were discharged with complete healing. One patient was discharged following open drainage with daily change of the wound dress. One patient died due to multiple organ failure. The hospital stay of the patients ranged from 18 to 49 days (31 days in average) after the reoperation.
Bronchopleural fistula after pneumonectomy, in case that empyema and multiple organ failure do not occur, can be healed by closing the fistula with the stapling device in early stage. Flushing the thoracic cavity is also necessary after the reoperation.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 05/2010; 30(5):1147-9.