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Objective@#To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.@*Methods@#The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery, the 900th Hospital of the Joint Logistics Support Force of People′s Liberation Army from January 2018 to February 2019 were retrospectively analyzed. There were 31 males and 25 females, aged from 70 to 86 years, with average age was (75.52±3.57) years. According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval, all patients were divided into three groups. Patients in the group A(n=12), B(n=21), and C (n=23) performed LC were within 2 months, during 2-4 months, and during 4-6 months, retrospectively. Observation indicators: (1) Surgical situations. The operation and postoperative basic condition of the three groups were compared. (2) Follow-up situations. Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019. Measurement data with normal distribution were represented as (Mean±SD), and comparison multiple groups was done using single factor analysis of variance (AVONA test) , and comparison between groups was done using the t test, and comparison of multiple groups in pairs was done using the SNK-q test, and hierarchical data were analyzed using Kruskal-wallis H test. Count data were analyzed using the chi-square test or Fisher exact probability.@*Results@#(1) Surgical situations: the thickness of gallbladder wall before LC, the rates of converting to laparotomy, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.57±0.04) cm, 50.0%, (95.83±11.45) ml, (107.50±21.90) min, (5.67±3.40) d in the group A, and (0.43±0.03) cm, 9.5%, (69.52±24.59) ml, (71.43±12.16) min, (3.76±2.61) d in the group B, and (0.43±0.05) cm, 39.1%, (68.64±21.89) ml, (77.95±12.88) min, (5.05±2.95) d in the group C, respectively, showing significant differences in the above indicators between the three groups (P<0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, those in group A were higher than the group B and C (P<0.05), and with no statistically significant different between the group B and C (P>0.05). The rates of converting to laparotomy, the duration of postoperative hospital stay in group B were better than the group A and C (P<0.05), and with no statistically significant different between the group A and C (P>0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.43±0.03) cm, (46.67±9.82) ml, (67.69±7.77) min, (2.64±0.58) d in the gallbladder wall thickness of successful LC patients, and (0.52±0.04) cm, (123.53±17.30) ml, (134.12±25.51) min, (8.47±0.80) d in the laparotomy patients, respectively, showing significant differences in the above indicators between the two groups (P<0.05). (2) Follow-up situations: 56 patients were followed up and without perioperative death. No complications occurred after 3 months of follow-up.@*Conclusion@#Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy, shorten the operation duration and the duration of postoperative hospital stay, which is beneficial to the recovery of patients.
ABSTRACT
Objective To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.Methods The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery,the 900th Hospital of the Joint Logistics Support Force of People's Liberation Army from January 2018 to February 2019 were retrospectively analyzed.There were 31 males and 25 females,aged from 70 to 86 years,with average age was (75.52±3.57) years.According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval,all patients were divided into three groups.Patients in the group A(n =12),B (n =21),and C (n =23) performed LC were within 2 months,during 2-4 months,and during 4-6 months,retrospectively.Observation indicators:(1) Surgical situations.The operation and postoperative basic condition of the three groups were compared.(2) Follow-up situations.Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019.Measurement data with normal distribution were represented as (Mean ± SD),and comparison multiple groups was done using single factor analysis of variance (AVONA test),and comparison between groups was done using the t test,and comparison of multiple groups in pairs was done using the SNK-q test,and hierarchical data were analyzed using Kruskal-wallis H test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical situations:the thickness of gallbladder wall before LC,the rates of converting to laparotomy,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.57±:0.04) cm,50.0％,(95.83 ±11.45) ml,(107.50±21.90) min,(5.67±3.40) d in the group A,and (0.43 ±0.03) cm,9.5％,(69.52±24.59) ml,(71.43 ±12.16) min,(3.76±2.61) d in the group B,and (0.43 ± 0.05) cm,39.1％,(68.64 ±21.89) ml,(77.95 ±12.88) min,(5.05 ±2.95) d in the group C,respectively,showing significant differences in the above indicators between the three groups (P ＜ 0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,those in group A were higher than the group B and C (P ＜0.05),and with no statistically significant different between the group B and C (P ＞ 0.05).The rates of converting to laparotomy,the duration of postoperative hospital stay in group B were better than the group A and C (P ＜ 0.05),and with no statistically significant different between the group A and C (P ＞0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.43 ± 0.03) cm,(46.67 ± 9.82) ml,(67.69 ± 7.77) min,(2.64 ±0.58) d in the gallbladder wall thickness of successful LC patients,and (0.52±0.04) cm,(123.53 ±17.30) ml,(134.12±25.51) min,(8.47 ±0.80) d in the laparotomy patients,respectively,showing significant differences in the above indicators between the two groups (P ＜ 0.05).(2) Follow-up situations:56 patients were followed up and without perioperative death.No complications occurred after 3 months of follow-up.Conclusion Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy,shorten the operation duration and the duration of postoperative hospital stay,which is beneficial to the recovery of patients.
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Objective To evaluate the curative effect of salvage liver transplantation and repeated hepatectomy for recurrent hepatocel-lular carcinoma.Methods The data of 72 patients with recurrent hepatocellular carcinoma fulfilling Child-Pugh A and the Milan criteria from September 2004 to August 2010 were retrospectively studied.According to different treatments,53 patients were divided into repeated hepatec-tomy group,and 19 patients were divided into salvage liver transplantation group.The overall survival rates and disease-free survival rates after operation were evaluated by Kaplan-Meier method.COX proportional hazard was used for univariate analysis and multivariate analysis to eval-uate the risk factors for prognosis.Results The 1-year,3-year and 5-year survival rates were 86.79%,62.26% and 45.28% in repeated hepatectomy group,and 89.47%,68.42%and 57.89% in the salvage liver transplantation group respectively.There was no significant differ-ence in the overall survival rates between the two groups (χ2 =2.530,P =0.112).The 1-year,3-year and 5-year disease-free survival rates were 67.92%,47.17% and 35.85%in the repeated hepatectomy group,94.74%,68.42% and 52.63% in the salvage liver transplantation group respectively.There was a significant difference in the disease-free survival rates between the two groups(χ2 =4.395,P =0.036).The univariate analysis and multivariate analysis indicated that microvascular invasion,satellite lesion and multiple tumors were the independent risk factors to influence the survival.Conclusion The salvage liver transplantation obtains a better effect for the patients fulfilling Child-Pugh A and the Milan criteria,which is an effective method in the treatment of hepatocellular carcinoma.
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To investigate the effects of Xinji' erkang (XJEK), a compound Chinese herbal medicine, on isoproterenol-induced ventricular remodeling in mice.