Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages

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.

Efficacy of peritoneal drainage in very-low-birth-weight neonates with Bell’s stage II necrotizing enterocolitis:A single-center retrospective study

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.

Drainage vs no drainage in secondary peritonitis with sepsis following complicated appendicitis in adults in the modern era of antibiotics

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.

Drainage of ascites in cirrhosis

For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.

Triple tube drainage for “difficult” gastroduodenal perforations:A prospective study

AIMTo prospectively study the outcome of difficult gastroduodenal perforations (GDPs) treated by triple tube drainage (TTD) in order to standardize the procedure.METHODSPatients 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.RESULTSBetween 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%).CONCLUSIONTTD 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.

THE RESEARCH OF FLOW CONTROLLED SYSTEM FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS (CCPD)

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

-PRCD联合APD对急性重症胰腺炎患者预后的影响

目的:分析超声引导经皮腹膜后穿刺置管引流(Percutaneous retroperitoneal catheter drainage,PRCD)联合腹腔穿刺引流(Abdominal paracentesis drainage,APD)对急性重症胰腺炎(Severe acute pancreatitis,SAP)患者预后的影响。方法:回顾性分析2021年03月至2022年09月期间本院急诊科诊治的92例SAP患者临床资料,依据治疗方式不同分为对照组(单纯PRCD,49例)和研究组(PRCD联合APD,43例)。治疗前、治疗后(48~72 h)分别采用酶速率法、血液分析仪计数法、酶联免疫吸附试验测定两组血淀粉酶、白细胞计数(White blood cell,WBC)、C反应蛋白(C reactive protein,CRP)水平,同时记录两组治疗情况、临床相关指标以及感染情况。结果:研究组的血淀粉酶、WBC、CRP水平均显著低于对照组(P<0.05)。研究组体温恢复正常、抗生素使用及重症监护室(Intensive care unit,ICU)住院时间均显著短于对照组,医疗费用显著低于对照组(P<0.05)。研究组多器官功能衰竭、急性呼吸窘迫综合征、多器官功能障碍综合征发生率、死亡率均显著低于对照组(P<0.05);研究组的并发感染率与对照组比较差异无统计学意义(P>0.05)。结论:超声引导下PRCD与APD联合可有效改善SAP患者的预后,不增加其感染发生风险。

急性阑尾炎并腹膜炎术后不置腹腔引流对临床疗效的影响

目的探讨急性阑尾炎并腹膜炎术后不放置腹腔引流对临床疗效的影响。方法将810例急性阑尾炎并腹膜炎患者随机分为引流组和非引流组,比较术后两组切口感染、肠粘连等并发症的发生率。结果引流组与非引流组切口感染率分别为20.5%和5.7%(P<0.01);肠粘连发生率引流组与非引流组分别为15.18%和3.16%(P<0.01),引流组还存在拔管恐惧,大网膜随管带出体外等并发症。结论急性阑尾炎并腹膜炎术后不置腹腔引流较置腹腔引流更明显地降低术后并发症,值得临床推广应用。

腹腔镜胆囊切除术中放置腹腔引流管的临床意义

目的 :探讨腹腔镜胆囊切除术 ( L aparoscopic Cholecystectomy,L C)中放置腹腔引流管的意义。方法 :对我院 1991年 9月～ 1999年 8月 6 5 0 0例 L C术中 82 7例放置腹腔引流管患者进行回顾分析。结果 :80 7例患者 ( 96 .5 % )腹腔引流管无明显液体引出 ,或仅有少量腹腔冲洗液 ,术后 2 4～ 48小时拔出 ;3例术后腹腔引流出大量鲜血 ,且有失血性休克症状 ,剖腹探查证实 ,2例为胆囊动脉分支出血 ,1例为钳夹胆囊动脉的钛夹脱落。 17例患者术后出现胆漏 ,3例漏胆较多 ,再手术证实为胆总管横断损伤 ;14例漏胆较少 ,放置 8天～1个月后拔除。结论 :L C术后定期观察腹腔引流物的色泽、性质 ,对及早发现手术并发症。

腹腔镜下置管灌洗引流对重症急性胰腺炎猪的治疗作用

目的探讨腹腔镜下腹腔置管灌洗引流对重症急性胰腺炎猪的治疗作用。方法采用腹腔镜下主胰管内加压注射牛磺胆酸钠和胰蛋白酶的方法制作猪重症急性胰腺炎模型。将模型动物随机分为两组,每组5只:对照组造模后仅行基础支持治疗,治疗组造模后行腹腔镜下胰周置管灌洗引流和基础支持治疗。于造模前和造模成功后6、24、48和72h测定血清淀粉酶及血浆TNF-!和IL-6的含量,同时观察模型动物的生命体征和存活情况。结果72h内对照组1只家猪死亡,死亡率20%,治疗组无死亡。对照组造模后血清淀粉酶及血浆TNF-"和IL-6的含量明显升高,血清淀粉酶24h时达到高峰为(4901.3±512.4)u/L,6h时血浆TNF-а达到高峰为(1476.7±206.2)ng/L,24h时血浆IL-6达到高峰为(542.5±112.5)ng/L。治疗组造模后各时间点血清淀粉酶及TNF-а和IL-6的含量均显著性低于对照组(P<0.05)。结论腹腔镜下腹腔置管引流能够有效减轻重症急性胰腺炎家猪过度的炎症反应,降低死亡率,改善预后。

腹腔引流在腹腔镜胆囊切除术的应用体会

目的探讨腹腔引流在腹腔镜手术中的应用原则和方法。方法对该院2000年9月～2009年8月3000例LC术患者中250例放置腹腔引流管患者进行回顾分析。结果244例患者(97.6%)腹腔引流管无明显液体引出,或仅有少量腹腔冲洗液,术后24～48h拔出;3例术后腹腔引流出大量鲜血,且有失血性休克症状,剖腹探查证实,2例为胆囊动脉分支出血,1例为钳夹胆囊动脉的钛夹脱落;3例患者术后出现胆漏,1例漏胆较多,再手术证实为胆总管侧壁损伤,2例漏胆较少,放置8d～1个月后拔除。结论严格掌握腹腔镜手术术中腹腔引流的原则和方法,减少手术并发症的发生。

应用品管圈提高术后患者对腹腔引流管口渗液处理满意度的实践

目的 :探讨品管圈在提高患者对腹腔引流管口渗液处理满意度中的作用。方法 :成立品管圈小组,以"提高术后患者对腹腔引流管口渗液处理的满意度"为活动主题。通过现状调查,设定目标值,分析出影响患者对引流管口渗液处理满意度的主要因素为渗液处理的及时性、有效性及护士的服务态度,针对要因制定对策并组织实施。结果 :品管圈实施后患者对腹腔引流管口渗液处理的满意度由实施前的86.67%升至93.85%(P<0.05),护士的腹腔引流管专业知识考核成绩明显高于实施前(P<0.001),圈员综合素质得分优于活动前(P<0.05)。结论 :本次品管圈活动规范了腹腔引流管口渗液的处理方法,提升了患者对腹腔引流管口渗液处理的满意度,提高了本科室护理人员的团队精神及质量管理能力。

腹腔镜手术中腹腔冲洗引流的原则和方法

目的：探讨腹腔镜手术中腹腔冲洗引流的原则和方法。方法：总结腹腔镜胆囊切除术（LC）1200例，腹腔镜阑尾切除术（LA）356例（肝脏功能异常和急性化脓性炎症病例除外），术中冲洗422例，引流101例的临床资料。结果：术后除2例延期拔管外。余均于术后1～2d拔管。未发生与腹腔冲洗引流有关的并发症。结论：准确掌握腹腔镜术中腹腔冲洗引流的原则和方法，可以缩短手术时间，术后加快患者恢复，减少手术并发症的发生。

腹腔引流管不同换药方法的应用效果分析

目的探讨腹腔引流管的换药方法,为减少感染等并发症提供借鉴。方法将180例患者随机分为两组,实验组采用泡沫敷料换药法,对照组采用传统换药法,对两组患者并发症的发生及换药间隔时间进行统计分析。结果实验组皮肤红肿、皮疹,糜烂、引流管感染等并发症的发生率均低于对照组(P<0.05),平均换药间隔时间长于对照组(P<0.05)。结论实验组有效减少了患者皮肤及引流管感染等并发症的发生,明显减少了换药次数,减少了患者的痛苦和医护人员的工作量。泡沫敷料换药法值得在临床上推广。

人体腹膜孔淋巴引流单位的超微结构研究

用电镜和锇酸－二甲基亚砜－锇酸（ＯｓＯ_４－ＤＭＳＯ－ＯｓＯ_４，ＯＤＯ）冷冻断裂技术观察了人体腹膜孔淋巴引流单位的超微结构。淋巴引流单位位于腹膜孔内，由３种结构组成，即立方形间皮细胞、淋巴陷窝内皮细胞和两者之间的结缔组织。上述３种结构相互并置，但其间无特殊的连接结构。立方形间皮细胞常伸出瓣膜状胞质突起，使腹膜下小管呈蜿蜒曲折状。间皮下结缔组织中成纤维细胞的胞质突起可与淋巴陷窝内皮细胞相贴，而结缔组织的纤维层则横跨腹膜孔，形成腹膜孔的底和淋巴陷窝的顶。在这些纤维层中，纤维相互交织构成一个三维的结缔组织网。通过结缔组织网孔，使立方形间皮细胞与淋巴陷窝的内皮细胞相连，形成腹膜下小管。借助于腹膜下小管，腹膜腔与淋巴陷窝相通。腹膜孔淋巴引流单位位于腹膜腔物质吸收的必经之处，对物质的吸收起调节作用。

腹腔镜腹腔置管灌洗引流治疗重症急性胰腺炎87例

目的：探讨腹腔镜下腹腔置管灌洗引流治疗重症急性胰腺炎（SAP）的临床疗效。方法：收集2009年1月至2014年5月的87例SAP患者资料,包括腹腔镜腹腔灌洗（LPLD）组46例和内科综合治疗组（非LPLD组）41例。LPLD组于发病1~2周内进行LPLD,余同非LPLD组治疗。分析比较两组患者的住院时间和ICU治疗时间,以及治愈率、并发症发生率和住院死亡率。结果：LPLD组住院时间、ICU治疗时间均少于非LPLD组,LPLD组的治愈率优于非LPLD组,差异均有统计学意义（P〈0.05）;两组并发症发生率比较,脓毒血症发生率差异有统计学意义（P〈0.05）,余差异均无统计学意义（P〉0.05）;两组住院病死率比较,差异无统计学意义（P〉0.05）。结论：腹腔镜灌洗治疗SAP短期获益更显著,是治疗SAP行之有效的手段,值得临床推广。

经皮腹腔穿刺引流治疗重症急性胰腺炎早期胰周或腹腔积液的疗效观察

目的：评价经皮腹腔穿刺引流治疗重症急性胰腺炎早期胰周或腹腔积液的临床效果及安全性。方法：应用超声或CT引导行经皮腹腔穿刺引流治疗重症急性胰腺炎早期胰周或腹腔积液患者37例,比较穿刺前和穿刺后第3天患者的临床症状及各项临床和检验指标,并观察并发症发生情况。结果：患者穿刺后第3天临床症状明显缓解,临床和生化指标及腹腔内压、急性生理与慢性健康状况评分、多器官功能障碍评分均较治疗前改善（P〈0.05-P〈0.01）。其中3例（8.1%）患者发生穿刺相关性损伤,2例（5.4%）引流过程中发生导管阻塞,3例（8.1%）发生导管易位,1例（2.7%）发生导管脱落,所有患者均无肠管及腹腔脏器损伤等严重并发症。结论：对于伴有腹腔或胰周积液的早期重症急性胰腺炎患者,经皮腹腔穿刺引流术可改善临床症状,缓解腹腔内压力并改善临床和检验指标。

改良双套管持续冲洗负压吸引在肠瘘治疗中的临床分析

目的 探讨改良双套管持续冲洗负压吸引方法治疗肠瘘的临床效果。方法 回顾性分析2003年2月~2013年9月在本科住院治疗肠瘘患者的临床资料,其中A组27例采用自制双套管连接低负压持续引流,B组24例采用传统单腔引流管,分析和比较两组的住院天数、最高体温、引流液量、吻合口狭窄发生率、再手术率及痊愈时间。结果 A组住院天数、痊愈时间短于B组,引流液量少于B组,吻合口狭窄发生率、再手术率低于B组,两组比较差异有统计学意义（P〈0.05）。结论 术后发生肠瘘应立即采用自制双套管及持续低负压冲洗,较传统治疗方式能取得更好的治疗效果。

早期腹腔穿刺置管灌洗引流在急性重症胰腺炎治疗中的应用

目的探讨超声引导下经皮穿刺置管引流术在早期重症急性胰腺炎的临床应用价值。方法重症胰腺炎患者60例随机分为置管灌洗引流治疗（观察组）32例和传统手术治疗（对照组）28例，对两组患者的疗效及治疗前后实验室检查指标进行对比分析。结果观察组治愈率68．75％，总有效率87．50％，对照组治愈率46．43％，总有效率64．29％，两两比较差异均有统计学意义；病死率观察组3．13％，对照组21．43％，两者比较差异有统计学意义（P〈0．05）；观察组患者症状消失时间、饮食恢复正常时间以及住院天数等与对照组相比差异有统计学意义；观察组血淀粉酶、尿淀粉酶、血糖、血钙、白细胞计数等实验室检查指标与对照组相比差异也有统计学意义（P〈O．05）。结论超声引导置管灌洗引流能够缓解重症急性胰腺炎患者的腹腔高压症状，提高治愈率，降低并发症和病死率，较传统手术治疗方法效果好，且简单易行，具有较好的临床应用价值。

新生儿坏死性小肠结肠炎分级法在NEC诊疗中的价值评价

目的:分析新生儿坏死性小肠结肠炎(NEC)分级法在NEC诊疗中的价值。方法:回顾性分析2005-2010年我院新生儿科NEC分级法实施前后NEC患儿的死亡率、需要外科手术干预的发生率、禁食时间、静脉营养时间和住院时间,并比较剖腹肠切除术患儿和腹腔引流患儿生存率,禁食时间、静脉营养时间和住院时间。结果:对照组和NEC分级组患儿死亡率无显著差异(9%vs8.4%),NEC分级组患儿的外科干预率要高于对照组(37.7%vs26%),但外科干预死亡率低于对照组(12.7%vs18.8%);两组患儿禁食天数和静脉营养时间无显著差异,NEC分级组患儿住院时间短于对照组(37.2±14.6)dvs(45.6±18.3)d;腹腔引流术患儿的死亡率低于剖腹手术组(9.1%vs16.7%),静脉营养时间短于对照组(38.8±9.5)dvs(45.8±10.5)d,但禁食时间和住院时间与剖腹手术患儿无显著差异。结论:实施NEC分级诊疗,将外科干预时机前移有助于缩短NEC患儿的住院时间,但对患儿的病死率没有显著影响,与传统剖腹探查术相比,行腹腔引流术患儿的死亡率更低,静脉营养时间和住院时间较短。