BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-...BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.AIM To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.METHODS This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University from February 2011 to April 2022.Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group.The patients were followed for up to 11 years after surgery.We compared the postoperative platelet levels,perioperative splenic vein thrombosis,and serum immunoglobulin levels between the two groups.Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen.The operation time,intraoperative blood loss,evacuation time,and hospital stay were compared between the two groups.RESULTS The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group(P<0.05),and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group.The levels of serum immunoglobulins(IgG,IgA,and IgM)showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group(P>0.05),but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy(P<0.05).The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group(P<0.05),but there were no significant differences in the amount of intraoperative blood loss,evacuation time,or hospital stay between the two groups.CONCLUSION Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT,not only correcting hypersplenism but also preserving splenic function,especially immunological function.展开更多
Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and repre...Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.展开更多
AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with l...AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.展开更多
基金Supported by Chinese Postdoctoral Science Foundation,No. 2022M711911
文摘BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.AIM To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.METHODS This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University from February 2011 to April 2022.Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group.The patients were followed for up to 11 years after surgery.We compared the postoperative platelet levels,perioperative splenic vein thrombosis,and serum immunoglobulin levels between the two groups.Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen.The operation time,intraoperative blood loss,evacuation time,and hospital stay were compared between the two groups.RESULTS The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group(P<0.05),and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group.The levels of serum immunoglobulins(IgG,IgA,and IgM)showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group(P>0.05),but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy(P<0.05).The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group(P<0.05),but there were no significant differences in the amount of intraoperative blood loss,evacuation time,or hospital stay between the two groups.CONCLUSION Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT,not only correcting hypersplenism but also preserving splenic function,especially immunological function.
文摘Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.
文摘AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.
