Research progress of bile recycling after biliary drainage in patients with malignant obstructive jaundice / 中华肝胆外科杂志

Malignant obstructive jaundice is caused by direct invasion or compression of the biliary tract by malignant tumors of the bile duct, pancreas and other systems. Patients are often accompanied by symptoms such as malnutrition, low immune function, and organ damage. The treatments of active preoperative biliary drainage and reasonable reinfusion combined with enteral nutrition can help improve the safety of patients during the perioperative period, reduce postoperative complications, and improve the life quality of patients. This article reviewed the research progress of preoperative biliary drainage, bile recycling methods and precautions in patients with malignant obstructive jaundice, aiming to provide reference for clinical diagnosis and treatment practice.

Research progress of three techniques for hepatic hyperplasia / 中华肝胆外科杂志

Surgical resection is one of the important means to achieve long-term survival for patients with liver malignant tumor. However, most of the liver malignant tumor has been diagnosed in the middle and late stage, and lose the chance of surgical treatment. For these patients who have lost the chance of surgery, some surgeons have proposed the concept of planned liver resection, which is to reduce tumor stage and increase future liver remnant (FLR) in a planned way, so as to improve the safety of surgery and prolong the survival time of patients after surgery. For patients with FLR insufficiency after prior evaluation or/and treatment, the technique of hepatic hyperplasia is an important part of planned hepatectomy, that is, to effectively increase FLR in a short period of time by various means. Portal vein ligation (PVL) and portal vein embolization (PVE), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are three main techniques for hepatic hyperplasia. This article reviews the principle, effect and safety of three liver augmentation techniques.

Hemorrhage after laparoscopic pancreaticoduodenectomy: causes and countermeasures / 中华肝胆外科杂志

Objective:To study the causes of hemorrhage after laparoscopic pancreaticoduodenectomy (LPD) and to develop countermeasures in its prevention.Methods:The clinical data of 215 patients who underwent LPD at the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from December 2013 to May 2020 were reviewed. The patients’ clinical data including gender, age, comorbidities and postoperative complications such as bleeding, pancreatic fistula, biliary fistula and intraperitoneal infection were studied, with the aims to analyze the causes, clinical manifestations and treatment results of post-pancreaticoduodenectomy hemorrhage (PPH) after LPD.Results:Of 215 patients, there were 132 males and 83 females, aged (60.7±10.3) years. PPH occurred in 20 patients, incidence rate was 9.30%(20/215). Early hemorrhage was mainly caused by inadequate hemostasis or loosening of vascular clips, while delayed hemorrhage was mainly caused by gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instruments or pseudoaneurysms. Among the 20 patients, 6 patients had early hemorrhage and 14 delayed hemorrhage. There was 1 patient with grade A, 10 with grade B and 9 with grade C hemorrhage. Thirteen patients developed pancreatic fistula, 1 biliary fistula, and 2 intraperitoneal infection. One patient responded well to conservative treatment. Hemostasis was successfully achieved by gastroscopy ( n=1) and interventional therapy ( n=7). Eleven patients required laparotomy for hemostasis. In this study, 14 of 20 patients survivied PPH and 6 patients died. The mortality rate was 30% (6 of 20 patients with PPH). Conclusions:Early hemorrhage was caused by inadequate hemostasis or loosening vascular clips, while delayed hemorrhage was related to gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instrument or pseudoaneurysm. Careful hemostasis, adequate protection of blood vessels, and accurate anastomosis should be performed in LPD. DSA angiography should be used for arterial hemorrhage which progressed very rapidly. Interventional therapy including embolism and stenting were means to control arterial bleeding in PPH. Decisive surgical exploration when interventional therapy failed was important in reducing the mortality rate of these patients.

Clinical analysis of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children / 中华实用儿科临床杂志

Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children.Methods From January 2011 to December 2015,54 older children(31 males and 23 females) aged 8-14 years(average 11.4 years old) of humeral shaft fractures were treated in Children's Hospital of Nanjing Medical University with elastic stable intramedullary nail.The left side involved 24 cases and right involved 30 cases.Patients were divided into 3 groups according to different approaches:bilateral retrograde group (31 cases),radial retrograde group (15 cases) and anterograde group (8 cases).Abduction brace was carried out postoperatively for about 6 weeks.Implant removal took place about 3-4 months later,when the X-ray showed fracture line disappeared and continuous trabecular bone was formed.A retrospective study was performed to compare the operation time,imaging findings after the surgery,fracture healing time and recent complications among the 3 groups.Results Bilateral retrograde nailing operation lasted for an average of (51 ±25) min and residual angle in X-ray films postoperative was (5.4 ± 1.8) °.The radial retrograde nailing average operating time was(46 ± 12)min and average residual angle in X-ray films postoperative was (12.8 ±2.9)°,while anterograde nailing was (44 ±16) min and (13.0 ± 3.6)°.The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group,and the difference was statistically significant (F =19.340,P ＜ 0.01).Children were followed up for 6 to 18 months (averaged 11 months).Each fracture was healed successfully.The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8％ (30/31 cases),93.3％ (14/15 cases),87.5％ (7/8 cases).The excellent rates of Mayo scores of elbow joints 6 months after surgery were 93.5％ (29/31 cases),100.0％ (15/15 cases),100.0％ (8/8 cases).All fractures were healed without abnormal appearance or decreased range of motion.In terms of their complications,in the bilateral retrograde group,there was 1 case of iatrogenic ulnar nerve palsy and 5 cases with skin irritation.One case of skin irritation occurred in the radial retrograde group.Conclusions In treatment of humeral shaft fractures in older children,functional outcomes are similar in 3 groups.The technique of bilateral retrograde insertion is effective and has extensive applicability.

Clinical study of aged patients with secondary benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV).@*Methods@#Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0.@*Results@#20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ2=0.79, P>0.05; t=0.37, P>0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ2=6.67, P<0.05). Bilateral semicircular canals were involved in 5 of the 32 cases in secondary group(15.63%) and 4 of the 121 cases in aged primary group(3.31%), The difference was significant(χ2=6.94, P<0.05). The effective rate after first manual reduction was 57.50%(23/40)in secondary group and 82.31%(107/130)in primary group, the difference was significant(χ2=10.46, P<0.05). The total effective rate were 87.50%(35/40) after more than once manual reduction in secondary group and 91.54%(119/130) in primary group, the difference was not significant(χ2= 0.59, P>0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant(t=3.15, P<0.05). The recurrence rate was 37.50%(15/40) in the secondary group and 16.15%(21/130)in primary group after during follow-up for 12 months, the difference was statistically significant(χ2=8.35, P<0.05).@*Conclusions@#It′s shown that the aged patients with secondary BPPV is not rare in clinical practice, sudden deafness and head trauma are frequent more than other reasons. The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV. The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV, it′s needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.