Objective Laparoscopic surgery has become a routine general surgery with many advantages,such as alleviating abdominal pain.However,postoperative pain caused by abdominal drainage tubes has attracted little attention ...Objective Laparoscopic surgery has become a routine general surgery with many advantages,such as alleviating abdominal pain.However,postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff.The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy(LC)on patients’postoperative quality of life.Methods Patients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1,2023 to October 31,2023 due to gallstones with chronic cholecystitis were selected for this study.The patients were randomly divided into an experimental group and a control group.In the experimental group,the new abdominal drainage tube fixation method was used,while in the control group,the traditional method was used.Afterward,the quality of life of patient in terms of pain,activity,recovery time,and mental health status was evaluated.The exudate around the patient’s drainage tube was collected for bacterial culture and analysis.Results A total of 139 patients were randomly divided into an experimental group(70 patients)and a control group(69 patients).The patients’baseline characteristics were not significantly different.The patients in the experimental group had better outcomes in quality of life,with higher pain scores(24.03±2.37 vs.15.48±2.29,p<0.001)and activity scores(20.57±1.78 vs.14.13±1.43,p<0.001),and a shorter postoperative recovery time(2.36±0.68 d vs.2.96±1.34 d,p<0.001).The same results were shown in linear regression analysis scores of the 2 groups.The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group(12.9%vs.43.5%,p<0.001);and furthermore,the positive rate of conditional pathogenic bacteria was even lower(7.1%vs.33.3%,p<0.001)in the experimental group than in the control group.Conclusion This new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.展开更多
Objective: To explore the application value of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation. Methods: Seventy-five patients admitted to our Department of Trauma Su...Objective: To explore the application value of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation. Methods: Seventy-five patients admitted to our Department of Trauma Surgery from June 2022 to April 2024 who underwent rib fracture osteotomy and internal fixation were selected. According to the types of drainage tubes left in the patients after the operation, they were divided into the observation group (35 cases who were left with disposable grooved negative pressure drainage tubes) and the control group (40 cases who were left with closed silicone thoracic drainage tubes). Comparison of chest drainage, pain, postoperative complications, secondary chest penetration rate, drain placement time, hospitalization time, and treatment costs were compared between the two groups. Results: The total postoperative chest drainage volume of the observation group was less than that of the control group (P < 0.05);the degree of pain, the incidence of postoperative complications, and the rate of secondary chest puncture in the observation group were lower than that of the control group three days after the operation (P < 0.05);and the time of drain placement in the observation group was shorter than that of the control group (P < 0.05). Conclusion: The application of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation can significantly improve patients’ postoperative pain and discomfort, reduce complications, lower the rate of secondary chest penetration, promote patients’ postoperative recovery, decrease the amount of postoperative chest drainage, and shorten the time of drain placement, which is worthy of clinical promotion and application.展开更多
BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage...BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage or biliary stent placement is a preferable choice,the tumor cannot be controlled.This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage,thereby prolonging the survival time of patients.CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice.He was admitted to the hospital because of the recurrence of jaundice.Preoperative imaging and pathological biopsy revealed hilar CC(Bismuth-Corlette type IIIa).First,the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved.To further treat hilar CC and remove the biliary drainage tube as far as possible,the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation.After 1 mo of brachytherapy,the re-examination revealed that the obstructive lesions disappeared,and the drainage tube was finally removed.During the following 10 mo of follow-up,the patient's hilar CC did not recur.CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.展开更多
BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the end...BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the endoscopic closure fails,or the patient's clinical condition deteriorates.In cases of delayed AICP(>4 h),surgical repair or enterostomy is usually performed,but delayed rectal perforation is rare.CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection(ESD)at a local hospital for the treatment of a laterally spreading tumor of the rectum,and the wound was closed by an endoscopist using a purse-string suture.Unfortunately,the patient then presented with delayed rectal perforation(6 h after ESD).The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery(TEM);however,the perforation worsened and became enlarged,multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred,and the internal anal sphincter was damaged.As a result,the perforation became more complicated.Due to the increased bleeding,surgical treatment with suturing could not be performed using TEM.Therefore,the patient was sent to our medical center for follow-up treatment.After a multidisciplinary discussion,we believed that the patient should undergo an enterostomy.However,the patient strongly refused this treatment plan.Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared,we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent(SECMS)in combination with a transanal ileus drainage tube(TIDT).CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation,a SECMS combined with a TIDT can be used and may result in very good outcomes.展开更多
Based on patient computerized tomography data,we segmented a region containing an intracranial hematoma using the threshold method and reconstructed the 3D hematoma model.To improve the efficiency and accuracy of iden...Based on patient computerized tomography data,we segmented a region containing an intracranial hematoma using the threshold method and reconstructed the 3D hematoma model.To improve the efficiency and accuracy of identifying puncture points,a point-cloud search arithmetic method for modified adaptive weighted particle swarm optimization is proposed and used for optimal external axis extraction.According to the characteristics of the multitube drainage tube and the clinical needs of puncture for intracranial hematoma removal,the proposed algorithm can provide an optimal route for a drainage tube for the hematoma,the precise position of the puncture point,and preoperative planning information,which have considerable instructional significance for clinicians.展开更多
Objective:To explore the main factors of drainage tube complications after hepatobiliary surgery.Methods:From November 2019 to October 2021,103 patients with drainage tube complications after hepatobiliary surgery in ...Objective:To explore the main factors of drainage tube complications after hepatobiliary surgery.Methods:From November 2019 to October 2021,103 patients with drainage tube complications after hepatobiliary surgery in Changshu No.2 People’s Hospital were selected as subjects for this study;the factors of postoperative drainage tube complications were analyzed by retrospective analysis.Results:The complications of drainage tubes include cavity organ damage,sliding of drainage tube into the abdominal cavity,broken drainage tube,blocked drainage tube,bleeding in drainage tube,bleeding from the mouth of drainage tube,abdominal cavity infection caused by drainage tube,and intestinal obstruction caused by drainage tube compression;the number of cases were 9,8,12,21,18,17,8,and 10,accounting for 8.74%,7.77%,11.65%,20.39%,17.48%,16.50%,7.77%,and 9.70%,respectively;the causes of these complications include early and late removal of drainage tube,improper positioning,color of drainage fluid,drainage tube falling out or self-removal,and so on.Conclusion:After hepatobiliary surgery,although the complications caused by drainage tubes have certain relationship with the indwelling time and surgery,the most critical is related to postoperative nursing care;therefore,it is necessary to observe the condition of the drainage tube and draining fluid after surgery,including the color of the fluid,its flow rate,and whether the drainage tube leaks or falls out;after surgery,patients should be encouraged to cooperate with the medical staffs,and family members should be reminded to pay attention to the observation of patients and informed about matters needing attention,so as to reduce the incidence of drainage tube complications after hepatobiliary surgery.展开更多
Objective: This study aims to compare the effects of different drainage tube diameters (22F vs. 26F) combined with negative pressure suction on patients after valve replacement surgery, including postoperative indicat...Objective: This study aims to compare the effects of different drainage tube diameters (22F vs. 26F) combined with negative pressure suction on patients after valve replacement surgery, including postoperative indicators and complications. Methods: A total of 104 patients undergoing valve replacement surgery were included and divided into a 22F group (45 patients) and a 26F group (59 patients). The basic characteristics, postoperative ICU stay duration, drainage duration, postoperative complications, and pain scores were compared between the two groups. All data were analyzed using SPSS statistical software, with p Results: There were no significant differences between the two groups in terms of age, sex, and underlying diseases. The ICU stay duration and drainage duration showed no significant differences (p > 0.05). The total drainage volume in the 22F group was significantly lower than that in the 26F group (225 vs. 380 ml, p = 0.035), and the pain scores on the third postoperative day were also significantly lower in the 22F group (p Conclusion: Compared to the 26F group, patients in the 22F group exhibited less postoperative drainage volume and lower pain scores, suggesting that the 22F drainage tube may have better clinical outcomes after valve replacement surgery.展开更多
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...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.展开更多
BACKGROUND Chylous ascites(CA) presents a challenge as a relatively common postoperative complication in gastric cancer(GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure dr...BACKGROUND Chylous ascites(CA) presents a challenge as a relatively common postoperative complication in gastric cancer(GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a lowfat diet. Drainage tube(DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.AIM To propose novel conservative treatment strategies for CA following GC surgery.METHODS The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.RESULTS 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association(R~2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost(postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001;total hospitalization: 33.2 d vs 24.7 d, P < 0.01;antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01;hospitalization cost: ￥9.2 × 104vs ￥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal.Furthermore, DT removal times were shorter in seven patients who underwent DT clamping(clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047;clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.CONCLUSION Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.展开更多
基金supported by grants from the Shandong Provincial Natural Science Foundation(No.ZR2021MH033)the Linyi People’s Hospital,and the Key R&D Plan of Linyi City(No.2023xy0029).
文摘Objective Laparoscopic surgery has become a routine general surgery with many advantages,such as alleviating abdominal pain.However,postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff.The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy(LC)on patients’postoperative quality of life.Methods Patients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1,2023 to October 31,2023 due to gallstones with chronic cholecystitis were selected for this study.The patients were randomly divided into an experimental group and a control group.In the experimental group,the new abdominal drainage tube fixation method was used,while in the control group,the traditional method was used.Afterward,the quality of life of patient in terms of pain,activity,recovery time,and mental health status was evaluated.The exudate around the patient’s drainage tube was collected for bacterial culture and analysis.Results A total of 139 patients were randomly divided into an experimental group(70 patients)and a control group(69 patients).The patients’baseline characteristics were not significantly different.The patients in the experimental group had better outcomes in quality of life,with higher pain scores(24.03±2.37 vs.15.48±2.29,p<0.001)and activity scores(20.57±1.78 vs.14.13±1.43,p<0.001),and a shorter postoperative recovery time(2.36±0.68 d vs.2.96±1.34 d,p<0.001).The same results were shown in linear regression analysis scores of the 2 groups.The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group(12.9%vs.43.5%,p<0.001);and furthermore,the positive rate of conditional pathogenic bacteria was even lower(7.1%vs.33.3%,p<0.001)in the experimental group than in the control group.Conclusion This new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.
文摘Objective: To explore the application value of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation. Methods: Seventy-five patients admitted to our Department of Trauma Surgery from June 2022 to April 2024 who underwent rib fracture osteotomy and internal fixation were selected. According to the types of drainage tubes left in the patients after the operation, they were divided into the observation group (35 cases who were left with disposable grooved negative pressure drainage tubes) and the control group (40 cases who were left with closed silicone thoracic drainage tubes). Comparison of chest drainage, pain, postoperative complications, secondary chest penetration rate, drain placement time, hospitalization time, and treatment costs were compared between the two groups. Results: The total postoperative chest drainage volume of the observation group was less than that of the control group (P < 0.05);the degree of pain, the incidence of postoperative complications, and the rate of secondary chest puncture in the observation group were lower than that of the control group three days after the operation (P < 0.05);and the time of drain placement in the observation group was shorter than that of the control group (P < 0.05). Conclusion: The application of disposable grooved negative pressure drainage tubes in rib fracture incision and internal fixation can significantly improve patients’ postoperative pain and discomfort, reduce complications, lower the rate of secondary chest penetration, promote patients’ postoperative recovery, decrease the amount of postoperative chest drainage, and shorten the time of drain placement, which is worthy of clinical promotion and application.
文摘BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage or biliary stent placement is a preferable choice,the tumor cannot be controlled.This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage,thereby prolonging the survival time of patients.CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice.He was admitted to the hospital because of the recurrence of jaundice.Preoperative imaging and pathological biopsy revealed hilar CC(Bismuth-Corlette type IIIa).First,the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved.To further treat hilar CC and remove the biliary drainage tube as far as possible,the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation.After 1 mo of brachytherapy,the re-examination revealed that the obstructive lesions disappeared,and the drainage tube was finally removed.During the following 10 mo of follow-up,the patient's hilar CC did not recur.CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.
基金Supported by the Hangzhou Major Science and Technology Projects,No.202004A14the Hangzhou Medical and Health Science and Technology Plan,No.OO20190610 and No.A20200174+1 种基金the Zhejiang Medical and Health Science and Technology Plan,No.WKJ-ZJ-2136 and No.2019RC068the Natural Science Foundation of Zhejiang Province,No.LGF21H310004.
文摘BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the endoscopic closure fails,or the patient's clinical condition deteriorates.In cases of delayed AICP(>4 h),surgical repair or enterostomy is usually performed,but delayed rectal perforation is rare.CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection(ESD)at a local hospital for the treatment of a laterally spreading tumor of the rectum,and the wound was closed by an endoscopist using a purse-string suture.Unfortunately,the patient then presented with delayed rectal perforation(6 h after ESD).The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery(TEM);however,the perforation worsened and became enlarged,multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred,and the internal anal sphincter was damaged.As a result,the perforation became more complicated.Due to the increased bleeding,surgical treatment with suturing could not be performed using TEM.Therefore,the patient was sent to our medical center for follow-up treatment.After a multidisciplinary discussion,we believed that the patient should undergo an enterostomy.However,the patient strongly refused this treatment plan.Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared,we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent(SECMS)in combination with a transanal ileus drainage tube(TIDT).CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation,a SECMS combined with a TIDT can be used and may result in very good outcomes.
基金funded by the National Science Foundation of China,Nos.51674121 and 61702184the Returned Overseas Scholar Funding of Hebei Province,No.C2015005014the Hebei Key Laboratory of Science and Application,and Tangshan Innovation Team Project,No.18130209B.
文摘Based on patient computerized tomography data,we segmented a region containing an intracranial hematoma using the threshold method and reconstructed the 3D hematoma model.To improve the efficiency and accuracy of identifying puncture points,a point-cloud search arithmetic method for modified adaptive weighted particle swarm optimization is proposed and used for optimal external axis extraction.According to the characteristics of the multitube drainage tube and the clinical needs of puncture for intracranial hematoma removal,the proposed algorithm can provide an optimal route for a drainage tube for the hematoma,the precise position of the puncture point,and preoperative planning information,which have considerable instructional significance for clinicians.
文摘Objective:To explore the main factors of drainage tube complications after hepatobiliary surgery.Methods:From November 2019 to October 2021,103 patients with drainage tube complications after hepatobiliary surgery in Changshu No.2 People’s Hospital were selected as subjects for this study;the factors of postoperative drainage tube complications were analyzed by retrospective analysis.Results:The complications of drainage tubes include cavity organ damage,sliding of drainage tube into the abdominal cavity,broken drainage tube,blocked drainage tube,bleeding in drainage tube,bleeding from the mouth of drainage tube,abdominal cavity infection caused by drainage tube,and intestinal obstruction caused by drainage tube compression;the number of cases were 9,8,12,21,18,17,8,and 10,accounting for 8.74%,7.77%,11.65%,20.39%,17.48%,16.50%,7.77%,and 9.70%,respectively;the causes of these complications include early and late removal of drainage tube,improper positioning,color of drainage fluid,drainage tube falling out or self-removal,and so on.Conclusion:After hepatobiliary surgery,although the complications caused by drainage tubes have certain relationship with the indwelling time and surgery,the most critical is related to postoperative nursing care;therefore,it is necessary to observe the condition of the drainage tube and draining fluid after surgery,including the color of the fluid,its flow rate,and whether the drainage tube leaks or falls out;after surgery,patients should be encouraged to cooperate with the medical staffs,and family members should be reminded to pay attention to the observation of patients and informed about matters needing attention,so as to reduce the incidence of drainage tube complications after hepatobiliary surgery.
文摘Objective: This study aims to compare the effects of different drainage tube diameters (22F vs. 26F) combined with negative pressure suction on patients after valve replacement surgery, including postoperative indicators and complications. Methods: A total of 104 patients undergoing valve replacement surgery were included and divided into a 22F group (45 patients) and a 26F group (59 patients). The basic characteristics, postoperative ICU stay duration, drainage duration, postoperative complications, and pain scores were compared between the two groups. All data were analyzed using SPSS statistical software, with p Results: There were no significant differences between the two groups in terms of age, sex, and underlying diseases. The ICU stay duration and drainage duration showed no significant differences (p > 0.05). The total drainage volume in the 22F group was significantly lower than that in the 26F group (225 vs. 380 ml, p = 0.035), and the pain scores on the third postoperative day were also significantly lower in the 22F group (p Conclusion: Compared to the 26F group, patients in the 22F group exhibited less postoperative drainage volume and lower pain scores, suggesting that the 22F drainage tube may have better clinical outcomes after valve replacement surgery.
文摘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.
基金Ethics Committee of Fudan University Shanghai Cancer Center Review Board[Approval No.FUSCC-D-2021-164].
文摘BACKGROUND Chylous ascites(CA) presents a challenge as a relatively common postoperative complication in gastric cancer(GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a lowfat diet. Drainage tube(DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.AIM To propose novel conservative treatment strategies for CA following GC surgery.METHODS The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.RESULTS 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association(R~2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost(postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001;total hospitalization: 33.2 d vs 24.7 d, P < 0.01;antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01;hospitalization cost: ￥9.2 × 104vs ￥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal.Furthermore, DT removal times were shorter in seven patients who underwent DT clamping(clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047;clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.CONCLUSION Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.
