Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection an...Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods:Sixty-eight neonates undergoing laparotomy for IIP (n=20),NEC(n=43),and indeterminate cause (n=5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis-and stoma-related complications. Results:The median gestational age (GA) was 28.5 weeks and birth weight (BW)-was 940 g. Thirty-seven neonates had RA (NEC 22,IIP 14,1 unknown),28 RS (NEC 21,IIP 6,1 unknown),and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P=0.008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P=0.002). There was no statistically significant difference between the RA and RS groups for GA (P=0.93),BW(P=0.4),general complications (P=0.96),anastomosis and stoma complications (P=0.48),and deaths (P=0.42). Conclusions:RA,rather than stoma,is an acceptable option in the surgical management of preterm neonates with IIP or NEC.展开更多
BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outco...BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.展开更多
AIM： To explore some operative techniques to prevent the occurrence of delayed gastric emptying （DGE） alter pylorus-preserving pancreaticoduodenectomy （PPPD）.METHODS： One hundred and eighty-six patients in a sin...AIM： To explore some operative techniques to prevent the occurrence of delayed gastric emptying （DGE） alter pylorus-preserving pancreaticoduodenectomy （PPPD）.METHODS： One hundred and eighty-six patients in a single medical center who accepted PPPD were retrospectively studied. The incidence of DGE was investigated and the influence of some operative techniques on the prevention of DGE was analyzed.RESULTS： During the operative process of PPPD, the methods of detached drainage of pancreatic fluid and bile and gastric fistulization were used. Postoperatively, six patients suffered DGE among the 186 cases; the incidence was 3.23% （6/186）. One of them was complicated with intraabdominal infection at the same time, and two with pancreatic leakage.CONCLUSION： Appropriate maneuvers during operation are essential to avoid postoperative DGE in PPPD. The occurrence of DGE is avoidable. It should not be used as an argument to advocate hemigastrectomy in PPPD.展开更多
AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 m...AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.展开更多
Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients ...Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients who had right hemicolectomy from June 2007 to June 2010, including 68 cases with superior mesenteric vascular intrathecal approach to resect specimen, and compared the operation time, blood loss, hospital stay and the number of dissected lymph nodes with patients treated with conventional surgery. Results: Compared the vascular intrathecal approach with conventional approach, the operation time and blood loss were decreased significantly, the number of Dukes C No. 3 lymph node dissection was increased, while the incidence of postoperative complications and hospital stay were equivalent to traditional surgery group. Conclusion: The use of vascular intrathecal approach in right hemicolectomy can significantly shorten the operation time and reduce bleeding and improve surgical radical outcomes.展开更多
文摘Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods:Sixty-eight neonates undergoing laparotomy for IIP (n=20),NEC(n=43),and indeterminate cause (n=5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis-and stoma-related complications. Results:The median gestational age (GA) was 28.5 weeks and birth weight (BW)-was 940 g. Thirty-seven neonates had RA (NEC 22,IIP 14,1 unknown),28 RS (NEC 21,IIP 6,1 unknown),and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P=0.008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P=0.002). There was no statistically significant difference between the RA and RS groups for GA (P=0.93),BW(P=0.4),general complications (P=0.96),anastomosis and stoma complications (P=0.48),and deaths (P=0.42). Conclusions:RA,rather than stoma,is an acceptable option in the surgical management of preterm neonates with IIP or NEC.
文摘BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.
文摘AIM： To explore some operative techniques to prevent the occurrence of delayed gastric emptying （DGE） alter pylorus-preserving pancreaticoduodenectomy （PPPD）.METHODS： One hundred and eighty-six patients in a single medical center who accepted PPPD were retrospectively studied. The incidence of DGE was investigated and the influence of some operative techniques on the prevention of DGE was analyzed.RESULTS： During the operative process of PPPD, the methods of detached drainage of pancreatic fluid and bile and gastric fistulization were used. Postoperatively, six patients suffered DGE among the 186 cases; the incidence was 3.23% （6/186）. One of them was complicated with intraabdominal infection at the same time, and two with pancreatic leakage.CONCLUSION： Appropriate maneuvers during operation are essential to avoid postoperative DGE in PPPD. The occurrence of DGE is avoidable. It should not be used as an argument to advocate hemigastrectomy in PPPD.
文摘AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.
文摘Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients who had right hemicolectomy from June 2007 to June 2010, including 68 cases with superior mesenteric vascular intrathecal approach to resect specimen, and compared the operation time, blood loss, hospital stay and the number of dissected lymph nodes with patients treated with conventional surgery. Results: Compared the vascular intrathecal approach with conventional approach, the operation time and blood loss were decreased significantly, the number of Dukes C No. 3 lymph node dissection was increased, while the incidence of postoperative complications and hospital stay were equivalent to traditional surgery group. Conclusion: The use of vascular intrathecal approach in right hemicolectomy can significantly shorten the operation time and reduce bleeding and improve surgical radical outcomes.
