BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic p...BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is difficult to establish the correct method for treating these conditions. METHODS: At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct. RESULT: The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION: For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.展开更多
Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and ...Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma ( with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases,posterior hepatic veins injuries in 8, pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4,contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (ALS) ≥ 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity hemorrhea.Two cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of gallbladder.Results: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma deaths at the early stage were caused by severe primary injuries resulting in failure of respiration and circulation, while mortality at the later stage was caused by multiple organ failure.Conclusions: Damage control surgery is important for the treatment against severe thoracic and abdominal injuries. It is suggested that the surgeon should select the reasonable auxiliary examination before operation, and take the proper time to perform damage control and definitive surgery.展开更多
A coupled CFD-DEM method is used to simulate the formation process of fracture plugging zone.A photo-elastic system characterizing mesoscale force chain network developed by our own is used to model the pressure evolu...A coupled CFD-DEM method is used to simulate the formation process of fracture plugging zone.A photo-elastic system characterizing mesoscale force chain network developed by our own is used to model the pressure evolution in fracture plugging zone to reveal the evolution mechanism of the structure of fracture plugging zone.A theoretical basis is provided for improving the lost circulation control effect in fractured reservoirs and novel methods are proposed for selecting loss control materials and designing loss control formula.CFD-DEM simulation results show that bridging probability is the key factor determining the formation of fracture plugging zone and fracture plugging efficiency.Critical and absolute bridging concentrations are proposed as the key indexes for loss control formula design.With the increase of absolute bridging concentration,the governing factor of bridging is changed from material grain size to the combination of material grain size and friction force.Results of photo-elastic experiments show that mesoscale force chain network is the intrinsic factor affecting the evolution of pressure exerting on the fracture plugging zone and determines the macroscopic strength of fracture plugging zone.Performance parameters of loss control material affect the force chain network structure and the ratio of stronger force chain,and further impact the stability and strength of fracture plugging zone.Based on the study results,the loss control formula is optimized and new-type loss control material is designed.Laboratory experiments results show that the fracture plugging efficiency and strength is effectively improved.展开更多
BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length...BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.展开更多
Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damag...Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS展开更多
Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined ...Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.展开更多
目的探讨应用损伤控制性手术(damage control surgery,DCS)治疗以重型颅脑损伤为主的多发伤的效果。方法 2010-2011年我院178例重型颅脑损伤伴多脏器损伤患者(DCS组)在治疗中贯彻损伤控制外科原则救治,并与2009-2010年我院收治采用常规...目的探讨应用损伤控制性手术(damage control surgery,DCS)治疗以重型颅脑损伤为主的多发伤的效果。方法 2010-2011年我院178例重型颅脑损伤伴多脏器损伤患者(DCS组)在治疗中贯彻损伤控制外科原则救治,并与2009-2010年我院收治采用常规方法救治的156例重型颅脑损伤伴多脏器损伤患者(非DCS组)死亡率及预后进行比较。结果 DCS组178例患者中136例行开颅血肿清除兼去骨瓣减压术,其他部位损伤分别行专科处理,存活109例(61.2%),死亡69例(38.8%),其中35例死于严重颅脑损伤,21例死于严重胸腹部损伤,13例死于MODS等严重并发症。DCS组和非DCS组患者围手术期死亡率[非DCS组为44.9%(70/156)]差异无统计学意义(P=0.988)。DCS组109例半年后随访GOS评分,恢复良好22例(20.2%),中残47例(43.1%),重残40例(36.7%)。DCS组和非DCS组存活患者恢复良好率[非DCS组为9.3%(8/86)]差异有统计学意义(P=0.037)。结论应用损伤控制外科原则处理以重型颅脑损伤为主的多发伤,合理选择和应用适当的措施,及时终止或减轻损伤导致的致命性脑损害,可提高救治成功率,值得临床重视及推广。展开更多
目的探讨损伤控制性手术（damage control surgery，DCS）在治疗严重肝外伤中的临床应用。方法通过回顾性分析在2000—04～2008—09间我院采用损伤控制性手术治疗出现血流动力学不稳定、低体温、代谢性酸中毒和凝血障碍等情况的26例严...目的探讨损伤控制性手术（damage control surgery，DCS）在治疗严重肝外伤中的临床应用。方法通过回顾性分析在2000—04～2008—09间我院采用损伤控制性手术治疗出现血流动力学不稳定、低体温、代谢性酸中毒和凝血障碍等情况的26例严重肝外伤（Ⅲ～Ⅵ级）患者的临床资料，总结出严重肝外伤应用损伤控制性手术的适应证、并发症和死亡率。结果26例患者中痊愈21例（治愈率80．2％），死亡5例（死亡率为19．2％），术后共17例发生了各种并发症（占65．4％）。结论对于严重肝外伤出现血流动力学不稳、低体温、代谢性酸中毒和凝血障碍等情况时选择损伤控制性手术不失为比较安全的、稳妥的手术方法，可有效地降低严重肝外伤的死亡率和并发症发生率。展开更多
文摘BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is difficult to establish the correct method for treating these conditions. METHODS: At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct. RESULT: The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION: For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.
文摘Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma ( with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases,posterior hepatic veins injuries in 8, pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4,contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (ALS) ≥ 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity hemorrhea.Two cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of gallbladder.Results: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma deaths at the early stage were caused by severe primary injuries resulting in failure of respiration and circulation, while mortality at the later stage was caused by multiple organ failure.Conclusions: Damage control surgery is important for the treatment against severe thoracic and abdominal injuries. It is suggested that the surgeon should select the reasonable auxiliary examination before operation, and take the proper time to perform damage control and definitive surgery.
基金Supported by the National Natural Science Foundation of China(51604236)Open Fund of the State Key Laboratory of Oil and Gas Reservoir Geology and Exploitation(PLN201913)+1 种基金Science and Technology Planning Project of the Sichuan Province,China(2018JY0436)Sichuan Youth Science and Technology Innovation Research Team Project for Unconventional Oil and Gas Reservoir Protection(2016TD0016)。
文摘A coupled CFD-DEM method is used to simulate the formation process of fracture plugging zone.A photo-elastic system characterizing mesoscale force chain network developed by our own is used to model the pressure evolution in fracture plugging zone to reveal the evolution mechanism of the structure of fracture plugging zone.A theoretical basis is provided for improving the lost circulation control effect in fractured reservoirs and novel methods are proposed for selecting loss control materials and designing loss control formula.CFD-DEM simulation results show that bridging probability is the key factor determining the formation of fracture plugging zone and fracture plugging efficiency.Critical and absolute bridging concentrations are proposed as the key indexes for loss control formula design.With the increase of absolute bridging concentration,the governing factor of bridging is changed from material grain size to the combination of material grain size and friction force.Results of photo-elastic experiments show that mesoscale force chain network is the intrinsic factor affecting the evolution of pressure exerting on the fracture plugging zone and determines the macroscopic strength of fracture plugging zone.Performance parameters of loss control material affect the force chain network structure and the ratio of stronger force chain,and further impact the stability and strength of fracture plugging zone.Based on the study results,the loss control formula is optimized and new-type loss control material is designed.Laboratory experiments results show that the fracture plugging efficiency and strength is effectively improved.
文摘BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.
基金The study is supported by a grant from special project of Chinese Military Medicine Science and Technology Research "11.5" plan (No. 06Z017).
文摘Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS
基金Key logistics scientific project of the "Thirteenth Five Year Plan" of Medical Research of PLA(ALJ19J001)Key Clinical Innovation Project of XinQiao Hospital and Army Medical University(2018JSLC0023/CX2019JS107)
文摘Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.
文摘目的探讨应用损伤控制性手术(damage control surgery,DCS)治疗以重型颅脑损伤为主的多发伤的效果。方法 2010-2011年我院178例重型颅脑损伤伴多脏器损伤患者(DCS组)在治疗中贯彻损伤控制外科原则救治,并与2009-2010年我院收治采用常规方法救治的156例重型颅脑损伤伴多脏器损伤患者(非DCS组)死亡率及预后进行比较。结果 DCS组178例患者中136例行开颅血肿清除兼去骨瓣减压术,其他部位损伤分别行专科处理,存活109例(61.2%),死亡69例(38.8%),其中35例死于严重颅脑损伤,21例死于严重胸腹部损伤,13例死于MODS等严重并发症。DCS组和非DCS组患者围手术期死亡率[非DCS组为44.9%(70/156)]差异无统计学意义(P=0.988)。DCS组109例半年后随访GOS评分,恢复良好22例(20.2%),中残47例(43.1%),重残40例(36.7%)。DCS组和非DCS组存活患者恢复良好率[非DCS组为9.3%(8/86)]差异有统计学意义(P=0.037)。结论应用损伤控制外科原则处理以重型颅脑损伤为主的多发伤,合理选择和应用适当的措施,及时终止或减轻损伤导致的致命性脑损害,可提高救治成功率,值得临床重视及推广。
文摘目的探讨损伤控制性手术（damage control surgery，DCS）在治疗严重肝外伤中的临床应用。方法通过回顾性分析在2000—04～2008—09间我院采用损伤控制性手术治疗出现血流动力学不稳定、低体温、代谢性酸中毒和凝血障碍等情况的26例严重肝外伤（Ⅲ～Ⅵ级）患者的临床资料，总结出严重肝外伤应用损伤控制性手术的适应证、并发症和死亡率。结果26例患者中痊愈21例（治愈率80．2％），死亡5例（死亡率为19．2％），术后共17例发生了各种并发症（占65．4％）。结论对于严重肝外伤出现血流动力学不稳、低体温、代谢性酸中毒和凝血障碍等情况时选择损伤控制性手术不失为比较安全的、稳妥的手术方法，可有效地降低严重肝外伤的死亡率和并发症发生率。
