Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life...Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported.However,current evidence is lacking to support any recommendation.The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.展开更多
AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September ...AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our series.CONCLUSION: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.展开更多
Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostom...Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy.Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy.The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980.Despite its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve problems.Operative mortalities have also been reported in the literature.Most of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the technique.Many modifications have been introduced to prevent this problem.Some patients have had their pouch removed because of complications mainly related to valve dysfunction.Although revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life.Today,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA.Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.展开更多
Objective： Explore laparoscopic cholecystectomy ordination and nursing methods. Methods： A retrospective analysis of our hospital from July 2009 to January 2011 Laparoscopic cholecystectomy in 89 cases of nursing da...Objective： Explore laparoscopic cholecystectomy ordination and nursing methods. Methods： A retrospective analysis of our hospital from July 2009 to January 2011 Laparoscopic cholecystectomy in 89 cases of nursing data. Results： This group of patients the operation is successful, no serious complications occurred. Through surgery and nursing, has obtained the desired effect .Conclusions： The accuracy of the nursing co-ordination is to ensure the success of laparoscopic cholecystectomy. The most important thing is, with laparoscopic cholecystectomy and intraoperative nursing can improve the quality of life of patients.展开更多
Objective: To study the effect of standard large trauma craniotomy(SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS≤8). Methods: 230 patients with severe TBI were randomly divided into two ...Objective: To study the effect of standard large trauma craniotomy(SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS≤8). Methods: 230 patients with severe TBI were randomly divided into two groups. 115 patients underwent SLTC (10 cm×12 cm) as an SLTC group, and other 115 patients underwent temporo parietal or fronto temporal craniotomy (6 cm×8 cm) according to the position of hematomas as a routine craniotomy (RC) group. Other treatments were identical in two groups. According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups. Results: 27 patients got good outcome and moderate disability ( 23.5 %), 40 severe disability and vegetative survival ( 34.8 %), and 48 died ( 41.7 %) in SLTC group. 21 patients got good outcome and moderate disability ( 18.3 %), 28 severe disability and vegetative survival ( 24.3 %), and 66 died ( 57.4 %) in RC group. The incidence of incision hernia was lower in SLTC group than in RC group. However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups. Conclusions: Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.展开更多
Objective: To sum up the experience in treating very severe traumatic brain injuries. Methods: Retrospective analysis of 68 patients with very severe traumatic brain injuries treated in our hospital from 1997 to 2002 ...Objective: To sum up the experience in treating very severe traumatic brain injuries. Methods: Retrospective analysis of 68 patients with very severe traumatic brain injuries treated in our hospital from 1997 to 2002 was done. Results: Forty one (60%) patients died. In the 50 patients treated surgically 27 (40%) survived, 8 recovered well, 9 had moderate disability and 10 had sever deficits. The 18 patients treated non operatively all died. Conclusions: Much attention should be given to the observation of the changes of severe brain injuries with cranial base injury. Timely operative decompression, basic life support, keeping effective brain blood perfusion and effective oxygen supply, improving cerebral microcirculation and preventing or controlling complications are the main methods to raise the successful rate of treating very severe brain injuries and the life quality of the patients.展开更多
文摘Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported.However,current evidence is lacking to support any recommendation.The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.
文摘AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our series.CONCLUSION: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.
文摘Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy.Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy.The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980.Despite its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve problems.Operative mortalities have also been reported in the literature.Most of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the technique.Many modifications have been introduced to prevent this problem.Some patients have had their pouch removed because of complications mainly related to valve dysfunction.Although revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life.Today,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA.Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.
文摘Objective： Explore laparoscopic cholecystectomy ordination and nursing methods. Methods： A retrospective analysis of our hospital from July 2009 to January 2011 Laparoscopic cholecystectomy in 89 cases of nursing data. Results： This group of patients the operation is successful, no serious complications occurred. Through surgery and nursing, has obtained the desired effect .Conclusions： The accuracy of the nursing co-ordination is to ensure the success of laparoscopic cholecystectomy. The most important thing is, with laparoscopic cholecystectomy and intraoperative nursing can improve the quality of life of patients.
文摘Objective: To study the effect of standard large trauma craniotomy(SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS≤8). Methods: 230 patients with severe TBI were randomly divided into two groups. 115 patients underwent SLTC (10 cm×12 cm) as an SLTC group, and other 115 patients underwent temporo parietal or fronto temporal craniotomy (6 cm×8 cm) according to the position of hematomas as a routine craniotomy (RC) group. Other treatments were identical in two groups. According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups. Results: 27 patients got good outcome and moderate disability ( 23.5 %), 40 severe disability and vegetative survival ( 34.8 %), and 48 died ( 41.7 %) in SLTC group. 21 patients got good outcome and moderate disability ( 18.3 %), 28 severe disability and vegetative survival ( 24.3 %), and 66 died ( 57.4 %) in RC group. The incidence of incision hernia was lower in SLTC group than in RC group. However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups. Conclusions: Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.
文摘Objective: To sum up the experience in treating very severe traumatic brain injuries. Methods: Retrospective analysis of 68 patients with very severe traumatic brain injuries treated in our hospital from 1997 to 2002 was done. Results: Forty one (60%) patients died. In the 50 patients treated surgically 27 (40%) survived, 8 recovered well, 9 had moderate disability and 10 had sever deficits. The 18 patients treated non operatively all died. Conclusions: Much attention should be given to the observation of the changes of severe brain injuries with cranial base injury. Timely operative decompression, basic life support, keeping effective brain blood perfusion and effective oxygen supply, improving cerebral microcirculation and preventing or controlling complications are the main methods to raise the successful rate of treating very severe brain injuries and the life quality of the patients.
