We present three cases of patients (at the age of 56 years, 49 years and 74 years respectively) with severe acute pancreatitis (SAP), complicated by intra-abdominal compartment syndrome (ACS) and respiratory insuffici...We present three cases of patients (at the age of 56 years, 49 years and 74 years respectively) with severe acute pancreatitis (SAP), complicated by intra-abdominal compartment syndrome (ACS) and respiratory insufficiency with limitations of mechanical ventilation. The respiratory situation of the patients was significantly improved after decompression laparotomy (DL) and lung protective ventilation was re-achieved. ACS was discussed followed by a short review of the literature. Our cases show that DL may help patients with SAP to recover from severe respiratory failure.展开更多
Objective: To establish and optimize an enhanced recovery after surgery (ERAS) program, for the classic posterior lumbar decompression and fusion (PLDF).Methods: 1.An ERAS for PLDF procedure during the perioperative p...Objective: To establish and optimize an enhanced recovery after surgery (ERAS) program, for the classic posterior lumbar decompression and fusion (PLDF).Methods: 1.An ERAS for PLDF procedure during the perioperative period had been designed. 2.A total of 155 patients (73 in the ERAS group and 82 in the traditional health care group) were analyzed, and their clinical outcomes were compared. The evaluation indexes included physiological function, postoperative visual analogue scale (VAS), pain score, postoperative complications. Results: ERAS significantly promoted early food-taking (7.93±2.15h vs 24.54 ± 5.72h, P < 0.00), early catheter removal (36.31 ± 8.42h vs 71.48 ± 13.75h, P < 0.00), early defecation (3.80 ± 1.3 days vs 5.3±1.41 days, P < 0.00);reduced the incidence of urinary tract infection (2.7% vs 9.7% P = 0.01) and shorter hospital stay (3.80 ± 1.04 days vs 7.29±1.62 days, P < 0.00), while no difference between the two groups in vomiting, lung infection, wound bleeding and infection. Conclusion: ERAS for PLDF can facilitate the recovery of physiological function, reduce postoperative pain, reduce operative complications and morbidity after surgery and contribute to a shorter hospital stay. Further research is needed to optimize the process.展开更多
Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression...Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.展开更多
文摘We present three cases of patients (at the age of 56 years, 49 years and 74 years respectively) with severe acute pancreatitis (SAP), complicated by intra-abdominal compartment syndrome (ACS) and respiratory insufficiency with limitations of mechanical ventilation. The respiratory situation of the patients was significantly improved after decompression laparotomy (DL) and lung protective ventilation was re-achieved. ACS was discussed followed by a short review of the literature. Our cases show that DL may help patients with SAP to recover from severe respiratory failure.
文摘Objective: To establish and optimize an enhanced recovery after surgery (ERAS) program, for the classic posterior lumbar decompression and fusion (PLDF).Methods: 1.An ERAS for PLDF procedure during the perioperative period had been designed. 2.A total of 155 patients (73 in the ERAS group and 82 in the traditional health care group) were analyzed, and their clinical outcomes were compared. The evaluation indexes included physiological function, postoperative visual analogue scale (VAS), pain score, postoperative complications. Results: ERAS significantly promoted early food-taking (7.93±2.15h vs 24.54 ± 5.72h, P < 0.00), early catheter removal (36.31 ± 8.42h vs 71.48 ± 13.75h, P < 0.00), early defecation (3.80 ± 1.3 days vs 5.3±1.41 days, P < 0.00);reduced the incidence of urinary tract infection (2.7% vs 9.7% P = 0.01) and shorter hospital stay (3.80 ± 1.04 days vs 7.29±1.62 days, P < 0.00), while no difference between the two groups in vomiting, lung infection, wound bleeding and infection. Conclusion: ERAS for PLDF can facilitate the recovery of physiological function, reduce postoperative pain, reduce operative complications and morbidity after surgery and contribute to a shorter hospital stay. Further research is needed to optimize the process.
基金This study was supported by the National Natural Science Foundation of China(81770556).
文摘Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.
