Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess, and summarize the application experience of choledochoscope for treatment of parapancreatic abscess. Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec. 2000 to Dec. 2008 were analyzed retrospectively. These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first, then expanded the sinus tract gradually, and performed debridement by choledochoscope. The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping, netting and vacuum aspiration in every domain. Results Thirty-six patients were performed percutaneous puncture and placed drainage tube, 3 cases were given canalis singularis, 7 cases were double tube, 26 cases were over three tube. The debridement times were 3-14 by choledochoscope, average 5.6 times. There were 6 cases with improving systemic symptoms, blood routine and temperature recovering normal, and drink and food recovering, then discharged from hospital with tube after 1-2 times of debridement. Length of stay was 25-132 d, average 76 d. The curing rate was 91.7% (33/36). Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured. One case was dead of severe multiple organ failure combination. There were 2 patients with hemorrhage, 3 patients with external intestinal fistula. Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple, flexible and effective method. It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage, decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.
ObjectiveTo summarize the experiences of surgical treatment of sternal dehiscence after cardiac surgery. MethodsFrom January 2011 to January 2014, 7 patients with sternal dehiscence after cardiac surgery were admitted to our hospital. There were 4 male patients and 3 females with an age of 35-72 (52.5±13.4) years old. Two patients accepted coronary artery bypass, 4 underwent mechanical valve replacement and 1 underwent Sun’s procedure. The necrotic bones were debrided and sternal wires completely removed. After the original wires were completely extracted, the infected tissues behind the sternum were removed. Part of the pectoralis major was released with free tension on both sides when suturing was carried out over the sternal defect. Negative pressure drainage tube was used for full drainage. ResultsAll the patients were discharged from hospital with very good recovery. The sternal wound was healing well with normal thoracic appearance, and none of the patients had recurrent infections. ConclusionsPatients with sternal dehiscence after cardiac surgical procedure should undergo surgical debridement. Stabilizing the sternum, rich blood supply and improvement of overall condition of the patients are very important for recovery.
ObjectiveTo explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. MethodsBetween June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. ResultsThe operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. ConclusionIt is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010). ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
Objective To overview the effect of bacterial biofilms (BBF) on the formation of chronic osteomyel itis and the treatment measure. Methods The original articles in recent years about the relationship between BBF and chronic osteomyel itis were reviewed. Results The diagnosis and treatment of chronic osteomyel itis was very difficult, besides hyperplasia oflocal scar, poor blood supply, drug-resistant, forming of BBF also was an important reason. BBF formed on the surface of necrosis soft tissue and dead bone. Due to the protection of BBF, the bacterium were far more resistant to antimicrobial agents, which caused the recurrence of chronic osteomyel itis. The forming of BBF included three processes which were adhesion, development and maturity. As the major pathogens of chronic osteomyel itis, staphylococcus had its own characteristic. Designing therapeutic programmes according to these characteristics had become the trend of anti-infection treatment of BBF. Conclusion Although there are lots of studies on anti-biofilm due to the key factors during the forming of BBF, the most effective way of anti-biofilm is still debridement.
ObjectiveTo evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. MethodsBetween January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L4-S1) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L5, S1 level in 19 cases and L4, 5 level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. ResultsThe operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P < 0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P < 0.05). Drug resistance was observed in 4 cases; Bridwill gradeⅢand gradeⅣfusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. ConclusionOne-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.
Objective To observe the effect of radiofrequency ablation technology for the treatment of infected wounds in minipigs. Methods Infected wounds of full-thickness skin defects (about 6.15 cm2/wound) were prepared in 8 6-month-old minipigs (weighing, 30-35 kg) using the method of Davis et al. The 160 wounds were randomly divided into 4 groups (n=40). Infected wounds were debrided with the radiofrequency ablation technology in group A, with the electric knife in group B, and with the scalpel in group C; no treatment was done in group D as a control. The healing rate, healing time, and tissue filling rate were observed; bacterial quantitative examination and histological examination were done at 0, 2, 7, and 14 days after operation. Results All infected wounds were successfully established after 48 hours when Staphylococcus aureus dilution were inoculated. The wounds after radiofrequency ablation technology treatment were fresh and flat with slight bleeding; the healing time of group A was significantly shorter than that of groups B, C, and D (P lt; 0.05), and the healing rate of group A was significantly higher than that of groups B, C, and D at 7 and 14 days after operation (P lt; 0.05). The tissue filling rate of group A was significantly higher than that of groups B, C, and D at 2 days after operation (P lt; 0.05); the tissue filling rates of groups A, B, and C were significantly higher than that of group D at 7 and 14 days after operation (P lt; 0.05). At 0, 2, 7, and 14 days, there were significant differences in the bacterial count per gram tissue among 4 groups (P lt; 0.05), the order from low to high was groups A, B, C, and D. The histological observation showed that the surface of wound was smooth in group A at 0 day, and group A was better than the other groups in wound healing; at 2 days, some exudates were observed in 4 groups, but it was least in group A. There was inflammatory cell infiltration in various degrees in 4 groups at 7 and 14 days; it was lightest in group A with thick epithelium and dense collagen bundles, followed by groups B and C, and it was severe in group D. Conclusion The radiofrequency ablation technology can effectively remove the necrotic tissues of infected wounds, remarkably reduce the number of bacteria, improve the healing rate, and shorten the healing time of wounds.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.