BACKGROUND Currently,pediatric surgeons are challenged by a lack of consensus on the optimal management strategy(conservative or surgical)for children with Bell’s stage II necrotizing enterocolitis(NEC).AIM To evalua...BACKGROUND Currently,pediatric surgeons are challenged by a lack of consensus on the optimal management strategy(conservative or surgical)for children with Bell’s stage II necrotizing enterocolitis(NEC).AIM To evaluate the clinical efficacy of peritoneal drainage in very-low-birth-weight(VLBW)neonates with modified Bell’s stage II NEC.METHODS This was a retrospective analysis of 102 NEC(modified Bell’s stage II)neonates born with VLBW who were treated at the Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center)between January 2017 and January 2020;these included 24 cases in the peritoneal drainage group,36 cases in the exploratory laparotomy group,and 42 cases in the conservative treatment group.RESULTS The general characteristics were comparable in the three groups(P>0.05).Compared with conservative treatment,peritoneal drainage was associated with significantly shorter fasting time,abdominal distension relief time,fecal occult blood(OB)negative conversion time,and reduced hospital length of stay(HLOS)(P<0.05 for all).Despite some advantages of peritoneal drainage over conservative treatment in terms of cure,conversion to laparotomy,intestinal perforation,intestinal stenosis,and abdominal abscess rates,the differences were not statistically significant(P>0.05).Compared to exploratory laparotomy,the fecal OB negative conversion time was significantly shorter in the peritoneal drainage group(P<0.05);similarly,the exploratory laparotomy group showed longer fasting time,abdominal distension relief time,HLOS,and higher complication rate compared to peritoneal drainage group,but the between-group differences were not statistically significant(P>0.05).CONCLUSION Peritoneal drainage,an easy-to-operate procedure,can improve the clinical symptoms of VLBW neonates with Bell’s stage II NEC and help reduce the HLOS.展开更多
AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate r...AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.展开更多
AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of eff...AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of effective antibiotics. METHODS: A retrospective review of all adult patients who were operated for secondary peritonitis with sepsis due to complicated appendicitis was carried out. Total of 209 patients were identified from May 2005 to April 2009 with operative findings of gangrenous or perforated appendix. The patients were divided into two cohorts, those where prophylactic drainage was established(n = 88) and those where no drain was used(n = 121). Abdominal drain was removed oncethe drainage ceased or decreased(< 10-20 mL/d in closed system of drainage or when once daily dressing was minimally soaked in open system). Broad spectrum antibiotics to cover the gut flora were started in both cohorts at diagnosis and were stopped once septic features resolved. Peritoneal fluid for aerobic culture and sensitivity were routinely obtained intra operatively; however antibiotic regimens were not changed unless patient failed to respond to the antibiotics based on the institutional protocol. The co-morbidities and their influence on primary end points were noted. Immunocompromised patients, appendicitis complicated by inflammatory bowel disorder and tumors were excluded from the study. RESULTS: Disease stratification and other demographic features were comparable in both cohorts. There was zero mortality in drainage group while as one patient(0.82%) died in the non-drainage group. The median duration(in days) of hospital stay(6.5 vs 4); antibiotic use(5 vs 3.5); regular parental analgesic use(5 vs 3.5) and paralytic ileus(2.5 vs 2) was more common in the drainage group. Incidence of major wound infection in patients 14(15.9%) vs 22(18.18%) and residual intraabdominal sepsis(inter loop collection/abscess)-7(8%) vs 13(10.74%) requiring secondary intervention was not significantly different in drainage and non-drainage cohorts respectively. One patient in the drainage cohort had faecal fistula(1.1%). CONCLUSION: The complicated appendicitis in the modern era of antibiotics does not necessitate the use of prophylactic drain placement which at times may even prove counterproductive.展开更多
AIM To prospectively study the outcome of difficult gastroduodenal perforations(GDPs) treated by triple tube drainage(TTD) in order to standardize the procedure.METHODS Patients presenting to a single surgical unit of...AIM To prospectively study the outcome of difficult gastroduodenal perforations(GDPs) treated by triple tube drainage(TTD) in order to standardize the procedure.METHODS Patients presenting to a single surgical unit of a tertiary hospital with difficult GDPs(large, unfavourable local and systemic factors) were treated with TTD(gastrostomy, duodenostomy and feeding jejunostomy). Postoperative parameters were observed like time to return of bowel sounds, time to start enteral feeds, time to start oral feeds, daily output of all drains, time to clamping/removal of all drains, time for skin to heal, complications, hospital stay, and, mortality. Descriptive statistics were used. RESULTS Between December 2013 and April 2015, 20 patients undergoing TTD for GDP were included, with mean age of 44.6 ± 19.8 years and male:female ratio of 17:3. Mean pre-operative APACHE Ⅱ scores were 10.85 ± 3.55; most GDPs were prepyloric(9/20; 45%) or proximal duodenal(8/20; 40%) and mean size was 1.83 ± 0.59 cm(largest 2.5 cm). Median times of resumption of enteral feeding, removal of gastrostomy, removal of duodenostomy,removal of feeding jejunostomy and oral feeding were 4 d(4-5 IQR), 13(12-16.5 IQR), 16(16.25-22.25 IQR), 18(16.5-24 IQR) and 12 d(10.75-18.5 IQR) respectively. Median hospital stay was 22 d(19-26 IQR) while mortality was 4/20(20%). CONCLUSION TTD for difficult GDP is feasible, easy in the emergency, and patients recover in two-three weeks. It obviates the need for technically demanding and riskier procedures.展开更多
Peritoneal dialysis is widely used in clinical practices.The flow controlled sys-tem we have developed is completely under computer control.In order to be as simpleas possible,we use only one valve to control the thre...Peritoneal dialysis is widely used in clinical practices.The flow controlled sys-tem we have developed is completely under computer control.In order to be as simpleas possible,we use only one valve to control the three stages of peritoneal dialysis,that is the infusion,dwell,and drainage of dialysate.In clinical application the wholetime during which the pipeline is shut is about 8-10 hours for every treatment.In or-der to avoid the phenomenon that the pipeline can’t open after it was closed for展开更多
目的探讨和总结经原腹腔引流管置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术(PD)术后胰瘘(POPF)的临床效果和经验。方法回顾性分析衢州市人民医院2016年7月至2022年4月57例PD术后确诊为B级及以上POPF的病例临床资料。患者分别采...目的探讨和总结经原腹腔引流管置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术(PD)术后胰瘘(POPF)的临床效果和经验。方法回顾性分析衢州市人民医院2016年7月至2022年4月57例PD术后确诊为B级及以上POPF的病例临床资料。患者分别采用经原腹腔引流管置入自制管芯持续冲洗负压引流(观察组,n=30)及彩超定位下经皮腹腔穿刺置管引流(对照组,n=27)进行POPF的治疗,比较两组治疗效果。结果两组POPF均成功治愈。观察组与对照组比较,术后发热时间[8(5,14)d vs 12(7,19)d,P=0.004]、继发腹腔感染率[23.33%(7/30)vs 59.26%(16/27),P=0.006]、切口感染率[16.67%(5/30)vs 40.74%(11/27),P=0.042]、胰瘘治愈时间[(14(7,19)d vs 18(12,31)d,P=0.047]、拔管时间[(22(15,35)d vs 35(23,56)d,P=0.001]、术后住院时间[21(18,29)d vs 33(25,47)d,P=0.009]均降低。所有病例均未发生意外拔管、继发腹腔大出血、胃肠穿孔等情况,无二次手术或死亡病例。结论经原腹腔引流管置入自制管芯持续冲洗负压引流是一种创伤小、操作简单、安全经济的治疗POPF的引流装置和改进方法,规范操作、加强管路护理管理是保证POPF成功治疗的关键。展开更多
文摘BACKGROUND Currently,pediatric surgeons are challenged by a lack of consensus on the optimal management strategy(conservative or surgical)for children with Bell’s stage II necrotizing enterocolitis(NEC).AIM To evaluate the clinical efficacy of peritoneal drainage in very-low-birth-weight(VLBW)neonates with modified Bell’s stage II NEC.METHODS This was a retrospective analysis of 102 NEC(modified Bell’s stage II)neonates born with VLBW who were treated at the Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center)between January 2017 and January 2020;these included 24 cases in the peritoneal drainage group,36 cases in the exploratory laparotomy group,and 42 cases in the conservative treatment group.RESULTS The general characteristics were comparable in the three groups(P>0.05).Compared with conservative treatment,peritoneal drainage was associated with significantly shorter fasting time,abdominal distension relief time,fecal occult blood(OB)negative conversion time,and reduced hospital length of stay(HLOS)(P<0.05 for all).Despite some advantages of peritoneal drainage over conservative treatment in terms of cure,conversion to laparotomy,intestinal perforation,intestinal stenosis,and abdominal abscess rates,the differences were not statistically significant(P>0.05).Compared to exploratory laparotomy,the fecal OB negative conversion time was significantly shorter in the peritoneal drainage group(P<0.05);similarly,the exploratory laparotomy group showed longer fasting time,abdominal distension relief time,HLOS,and higher complication rate compared to peritoneal drainage group,but the between-group differences were not statistically significant(P>0.05).CONCLUSION Peritoneal drainage,an easy-to-operate procedure,can improve the clinical symptoms of VLBW neonates with Bell’s stage II NEC and help reduce the HLOS.
基金the National Natural Science Foundation of China,No.81772001,No.8177071311 and No.81502696the National Clinical Key Subject of China,No.41792113+1 种基金the Technology Plan Program of Sichuan Province,No.2015SZ0229,No.2018JY0041 and No.18YYJC0442the Science and Technology Development Plan of Sichuan Province,No.2016YJ0023
文摘AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.
文摘AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of effective antibiotics. METHODS: A retrospective review of all adult patients who were operated for secondary peritonitis with sepsis due to complicated appendicitis was carried out. Total of 209 patients were identified from May 2005 to April 2009 with operative findings of gangrenous or perforated appendix. The patients were divided into two cohorts, those where prophylactic drainage was established(n = 88) and those where no drain was used(n = 121). Abdominal drain was removed oncethe drainage ceased or decreased(< 10-20 mL/d in closed system of drainage or when once daily dressing was minimally soaked in open system). Broad spectrum antibiotics to cover the gut flora were started in both cohorts at diagnosis and were stopped once septic features resolved. Peritoneal fluid for aerobic culture and sensitivity were routinely obtained intra operatively; however antibiotic regimens were not changed unless patient failed to respond to the antibiotics based on the institutional protocol. The co-morbidities and their influence on primary end points were noted. Immunocompromised patients, appendicitis complicated by inflammatory bowel disorder and tumors were excluded from the study. RESULTS: Disease stratification and other demographic features were comparable in both cohorts. There was zero mortality in drainage group while as one patient(0.82%) died in the non-drainage group. The median duration(in days) of hospital stay(6.5 vs 4); antibiotic use(5 vs 3.5); regular parental analgesic use(5 vs 3.5) and paralytic ileus(2.5 vs 2) was more common in the drainage group. Incidence of major wound infection in patients 14(15.9%) vs 22(18.18%) and residual intraabdominal sepsis(inter loop collection/abscess)-7(8%) vs 13(10.74%) requiring secondary intervention was not significantly different in drainage and non-drainage cohorts respectively. One patient in the drainage cohort had faecal fistula(1.1%). CONCLUSION: The complicated appendicitis in the modern era of antibiotics does not necessitate the use of prophylactic drain placement which at times may even prove counterproductive.
文摘AIM To prospectively study the outcome of difficult gastroduodenal perforations(GDPs) treated by triple tube drainage(TTD) in order to standardize the procedure.METHODS Patients presenting to a single surgical unit of a tertiary hospital with difficult GDPs(large, unfavourable local and systemic factors) were treated with TTD(gastrostomy, duodenostomy and feeding jejunostomy). Postoperative parameters were observed like time to return of bowel sounds, time to start enteral feeds, time to start oral feeds, daily output of all drains, time to clamping/removal of all drains, time for skin to heal, complications, hospital stay, and, mortality. Descriptive statistics were used. RESULTS Between December 2013 and April 2015, 20 patients undergoing TTD for GDP were included, with mean age of 44.6 ± 19.8 years and male:female ratio of 17:3. Mean pre-operative APACHE Ⅱ scores were 10.85 ± 3.55; most GDPs were prepyloric(9/20; 45%) or proximal duodenal(8/20; 40%) and mean size was 1.83 ± 0.59 cm(largest 2.5 cm). Median times of resumption of enteral feeding, removal of gastrostomy, removal of duodenostomy,removal of feeding jejunostomy and oral feeding were 4 d(4-5 IQR), 13(12-16.5 IQR), 16(16.25-22.25 IQR), 18(16.5-24 IQR) and 12 d(10.75-18.5 IQR) respectively. Median hospital stay was 22 d(19-26 IQR) while mortality was 4/20(20%). CONCLUSION TTD for difficult GDP is feasible, easy in the emergency, and patients recover in two-three weeks. It obviates the need for technically demanding and riskier procedures.
文摘Peritoneal dialysis is widely used in clinical practices.The flow controlled sys-tem we have developed is completely under computer control.In order to be as simpleas possible,we use only one valve to control the three stages of peritoneal dialysis,that is the infusion,dwell,and drainage of dialysate.In clinical application the wholetime during which the pipeline is shut is about 8-10 hours for every treatment.In or-der to avoid the phenomenon that the pipeline can’t open after it was closed for
文摘目的探讨和总结经原腹腔引流管置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术(PD)术后胰瘘(POPF)的临床效果和经验。方法回顾性分析衢州市人民医院2016年7月至2022年4月57例PD术后确诊为B级及以上POPF的病例临床资料。患者分别采用经原腹腔引流管置入自制管芯持续冲洗负压引流(观察组,n=30)及彩超定位下经皮腹腔穿刺置管引流(对照组,n=27)进行POPF的治疗,比较两组治疗效果。结果两组POPF均成功治愈。观察组与对照组比较,术后发热时间[8(5,14)d vs 12(7,19)d,P=0.004]、继发腹腔感染率[23.33%(7/30)vs 59.26%(16/27),P=0.006]、切口感染率[16.67%(5/30)vs 40.74%(11/27),P=0.042]、胰瘘治愈时间[(14(7,19)d vs 18(12,31)d,P=0.047]、拔管时间[(22(15,35)d vs 35(23,56)d,P=0.001]、术后住院时间[21(18,29)d vs 33(25,47)d,P=0.009]均降低。所有病例均未发生意外拔管、继发腹腔大出血、胃肠穿孔等情况,无二次手术或死亡病例。结论经原腹腔引流管置入自制管芯持续冲洗负压引流是一种创伤小、操作简单、安全经济的治疗POPF的引流装置和改进方法,规范操作、加强管路护理管理是保证POPF成功治疗的关键。
