A system for the clinico-immunological prognosis of infectious-inflammatory complications in planned surgery]

Postoperative infectious complications in planned surgery are a pressing problem. The preoperative condition of the patient and his immune system play an important role in their development. Fifty patients of the "risk" group were selected from the standpoint of classification of the etiological factors of secondary immunodeficiency states. Fifteen patients who had no symptoms classified as SIDS risk factors formed the control group. The immune status was examined before and on the third day after the operation in all patients of the main and control groups. Various infectious complications developed after the operation in 23 patients of the risk group. No such complications occurred in the control group. The preoperative immune status of the risk group patients differed significantly from that of the controls in 13 of 19 parameters. The patients of the main and control groups formed the instructing selection. An expert system of preoperative clinico-immunological prognostication of postoperative infectious-inflammatory complications was created on oasis of the methods of the theory of image recognition and instructing selection. The system was tested in a direct clinical experiment on 66 patients. The prognoses were correct in 89% of cases. It was thus proved that symptoms classified as SIDS risk factors influence the initial immunity status and the course of the postoperative period in planned surgery. An accurate, sensitive, and specific method for prognosticating postoperative infectious complications is suggested.     

Phagocytic link of immunity in patients surgically treated for chronic calculous cholecystitis]

Twenty-two females, 38 to 75 years of age, who underwent planned operation for chronic uncomplicated calculous cholecystitis were examined in the pre- and postoperative period. Postoperative pneumonia developed in 4 (13.4%) patients, no other complications occurred. Functional neutrophil activity was studied according to the following parameters: spontaneous and induced NBT test, myeloperoxidase activity, amount of cationic proteins, expression of Fc receptors, spontaneous and induced luminol-dependent chemiluminescence, neutrophil bactericidal action against H-thymidine-labelled Staphylococcus aureus (strain 209), amount of blood immunoglobulins, and the modulating effect of serum of patients on the chemiluminescence of neutrophils of healthy donors. The control group consisted of 35 volunteers whose ages ranged from 18 to 50 years. Basic differences were revealed between the indices of neutrophil activity in patients with an uneventful postoperative period and those of patients with infectious complications in the preoperative period which became much graver in the early postoperative period. This suggests that neutrophilic dysfunctions play a significant role in the development of postoperative infectious complications in this category of patients.     

早期肠内营养对老年胃癌术后患者营养免疫及人体成分的影响

目的 探讨早期肠内营养(EEN)对老年胃癌患者术后营养、免疫和人体成分的影响.方法 将360例老年胃癌患者分为EEN组和肠外营养(PN)组各180例.EEN组术后20～24 h开始行EEN;PN组术后1d经周围静脉或中心静脉开始PN.术前、术后1d、7d检测营养指标、免疫和人体成分指标测量.结果 两组患者术后营养、免疫指标及人体成分指标值均有降低,但EEN组术后下降程度显著小于PN组(均P＜0.05),并发症发生率低于PN组.结论 老年胃癌患者术后EEN支持能有效改善营养状况、免疫功能和人体成分的变化,减少术后并发症的发生,有利于促进患者康复.     

Does preoperative treatment with cimetidine increase the risk of postoperative infection?

During a 5-year period, 145 patients were operated on for benign peptic ulcer disease. 105 patients did not receive cimetidine in the few weeks just before the operation, while 40 patients used it until the night before the operation. Although differing in size, the groups were comparable with regard to other relevant data. The cimetidine treated patients had more abdominal infectious complications postoperatively but this difference only reached statistical significance when patients who were operated upon for bleeding were excluded. Furthermore, patients on cimetidine suffered from significantly more pulmonary infections than those not having this preoperative drug regimen. These results indicate an unfavourable effect on the postoperative infectious morbidity of having a patient on cimetidine treatment in the weeks immediately preceding operation for peptic ulcer disease.     

Effects of antibiotics on prevention of infection in contaminated abdominal operations.

A prospective study was undertaken on 102 patients with massice intraperitoneal contamination from traumatic or spontaneous perforation of intestinal or pancreaticobiliary tract to determine the effects of combined systemic and intraperitoneal antibiotic administration on the prevention of the postoperative sepsis, intra-abdominal abscess formation and wound infection. Large doses of gentamicin and clindamycin were given parenterally before, during, and after the operation for five days. In addition, the peritoneal cavity and the abdominal incision were irrigated intraoperatively with antibiotic solution containing the same antibiotics. The drugs were given so as to provide a potent level of antibiotics during the operation and in the immediate postoperative period. The postoperative wound infection rate was 4 per cent, intra-abdominal abscess 2.9 per cent, sepsis 1 per cent, resulting in a total infectious complication rate of 7.9 per cent. This is a marked reduction in the incidence of infectious complications and compares favorably with the results from either parenteral or intraperitoneal therapy alone. Furthermore, no complications were encountered due to this method of therapy. These results do not indicate that antimicrobial drugs be given prophylactically to all surgical patients, but they strongly suggest the advantages of combined systemic and intraperitoneal antibiotics in the management of patients with massive intraperitoneal contamination.     

Infectious complications after splenectomy in patients with cirrhosis of the liver

Based on an examination of 105 patients with cirrhosis of the liver with the syndrome of portal hypertension complicated by gastroduodenal bleedings who were subjected to splenectomy (in 86 patients there were proximal splenorenal anastomoses) the authors make a conclusion that infectious complications in the postoperative period in the group under analysis were developing against the background of the concomitant and predisposing conditions and can be compared in their incidence with infectious complications after other similar in severity operative interventions on organs of the abdominal cavity. In remote terms after operation the normalization of the indices of both cellular and humoral immunity was noted.     

用加速康复外科理念治疗胃癌患者的临床应用探讨

目的探讨加速康复外科理念在胃癌患者围手术期治疗过程中的应用。方法将80例胃癌患者随机分为传统方法组(n=40)和加速康复组(n=40),比较2组患者术前1 d、术后第1、3天的外周血总淋巴细胞计数(TLC)、C反应蛋白(CRP)、IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平,记录2组患者术后发热持续时间、首次排气时间,住院时间以及术后并发症情况。结果加速康复组术后首次排气时间提前,术后发热持续时间及住院时间均较传统方法组短(P<0.05),2组患者术后并发症发生率差异无统计学意义(P>0.05);2组患者术后第1天TLC与术前1 d相比降低,而CRP与术前1 d相比增高,差异均有统计学意义(P<0.01)。术后第3天加速康复组CRP较传统方法组明显降低(P<0.05),IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平均比传统方法组升高(P<0.05)。结论胃癌患者行加速康复外科理念治疗是安全有效的,且能减轻手术创伤对患者免疫功能的打击,促进患者康复。     

Immune responses and prediction of major infection in patients undergoing transhiatal or transthoracic esophagectomy for cancer

OBJECTIVE: To investigate alterations in immune responses after transhiatal versus transthoracic esophageal resection and to evaluate the role of preoperative immune functions in predicting postoperative infectious complications. SUMMARY BACKGROUND DATA: Impaired immune defense is associated with a decreased resistance to infection. Patients undergoing esophageal resection via a transhiatal or transthoracic approach are prone to develop infectious complications. There are no randomized data on immune responses after two major surgical interventions. METHODS: The study group consisted of 20 patients who were randomly allocated to a limited transhiatal or extended transthoracic esophagectomy for cancer. Blood samples were taken before the operation and at regular intervals thereafter from day 1 to day 10. Monocyte and T-helper type 1 (Th1) and type 2 (Th2) lymphocyte functions were assessed in stimulated whole blood cultures. RESULTS: Both surgical groups had severely depressed in vitro production of interleukin (IL)-12, IL-10, interferon-gamma, IL-2, IL-4, and IL-13 on postoperative day 1. Depression of Th2-type cytokine production was more profound after transthoracic than after transhiatal esophagectomy (IL-4, P=.005; IL-13,P=.007). Postoperative reduction in Th1-type cytokine production was similar between the two groups (interferon-gamma, P=.40; IL-2, P=.06). Irrespective of the surgical approach, patients who developed major infectious complications after surgery presented with a diminished T-cell cytokine production before the operation compared to those who had a relatively uneventful recovery (IL-4, P=.045; interferon-gamma, P=.064). In regression analysis, the occurrence of postoperative major infection was best predicted by increased duration of anesthesia ( P<.0001) and low preoperative interferon-gamma production ( P=.006). CONCLUSIONS: Both transhiatal and transthoracic esophagectomy induced severely depressed monocyte and T-lymphocyte cytokine production. The extent of the surgical procedure had a differential immunosuppressive impact on Th2-type but not on Th1-type cell activity, indicating that the two Th pathways were downregulated through distinct mechanisms. Preoperative interferon-gamma determination would be useful to anticipate the occurrence of postoperative major infectious complications.     

输血对食管癌病人免疫功能的影响

目的　探讨输血对食管癌病人免疫功能的影响。方法　95例食管癌病人围术期输血者49例、未输血者46例,于术前、术后1、3、7、14?d分别检查细胞及体液免疫指标--外周血T淋巴细胞及其亚群和血浆TNF、红细胞C     

Autologous bone marrow transfusion in the combined treatment of cancer of the thoracic segment of the esophagus]

Transplantation of autologous bone marrow was performed in 62 patients with carcinoma of the thoracic portion of the esophagus for prophylactics of disturbance of hemopoiesis and severe infectious complications in the postoperative period. With the help of myelokariocytopheresis procurement of the bone marrow was made 2-3 days before starting preoperative radiotherapy. After exfusion of the bone marrow mixture erythrocytes were separated and returned completely and immediately to the patient, myelokaryocytes being frozen. The volume of the bone marrow suspension from 1 patient made up on the average from 300 to 800 ml, the amount of the bone marrow cells in it from 4.5 to 11.2.10(9). Studies of the dynamics of concentrated and volumetric parameters of blood were performed. The functional specific features of the bone marrow erythropoiesis were estimated in the sternal punctate. The use of automyelotransfusion substantially reduced the frequency of infectious complications and, in the author's opinion, it is a fairly effective method of prophylactics and treatment of postoperative anemia.     

Immunonutrition in elective gastrointestinal surgery patients.

BACKGROUND: Previous trials have shown that perioperative immunonutrition could protect patients from infectious complications after gastrointestinal cancer operations. The purpose of this study was to determine whether perioperative immunonutrition decreases postoperative morbidity, especially infection complications, mortality and length of hospital stay in patients undergoing major gastrointestinal tract surgery. METHODS: One hundred patients with a planned elective operation for benign or malignant gastrointestinal illness were randomized into two groups: group 1) oral supplementation for five days before and five days after surgery with 900 mL/day of a formula enriched with arginine, gamma-3-fatty acid and RNA + liquid diet ad libitum on one and two postoperative day and then solid food (immunonutrition group; n = 50) or group 2) no artificial nutrition before and after surgery, on one and two postoperative day intravenous solution of 5% glucose and electrolytes and then normal diet (conventional group; n = 50). RESULTS: The groups were comparable for all key baseline and surgical characteristics. There were nine (18%) infectious complications in both groups. Overall complication rates were 28% (n = 14) in the immunonutrition group and 24% (n = 12) in the conventional group. No significant difference between the groups was found in complication rates, mortality or length of hospital stay. CONCLUSION: Routine perioperative immunonutrition to the patients undergoing major gastrointestinal surgery is not beneficial.     

Significance of endovideosurgery in treatment of surgical infections

Results of treatment of 186 patients treated in the clinic in the period from 2000 through 2005 for infectious complications after severe combined injuries who underwent 264 operations have been studied. It was established that the endovideosurgical method of sanitation of the infection focus was used in 50% of cases at an average. The investigation of surgical treatment of infectious complications in patients with severe surgical pathology has shown high efficiency of endovideosurgical method for treatment of such complications in the third period of wound dystrophy. The proposed endovideosurgical methods of sanitation of the infection focus have a number of advantages over open ones--low traumatism, less number of postoperative infectious complications, less duration of the postoperative period.     

Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group

BACKGROUND: The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion. It is still debated, however, whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise affects the prognosis. METHODS: Patient risk variables, variables related to operation technique, blood transfusion and the development of infectious complications were recorded prospectively in 740 patients undergoing elective resection for primary colorectal cancer. Endpoints were overall survival (n = 740) and time to diagnosis of recurrent disease in the subgroup of patients operated on with curative intention (n = 532). The patients were analysed in four groups divided with respect to administration or not of perioperative blood transfusion and development or non-development of postoperative infectious complications. RESULTS: Overall, 19 per cent of 288 non-transfused and 31 per cent of 452 transfused patients developed postoperative infectious complications (P< 0.001). The median observation period was 6.8 (range 5.4-7.9) years. In a multivariate analysis, risk of death was significantly increased among patients developing infection after transfusion (n = 142) compared with patients receiving neither blood transfusion nor developing infection (n = 234): hazard ratio 1.38 (95 per cent confidence interval (c.i.) 1.05-1.81). Overall survival of patients receiving blood transfusion without subsequent infection (n = 310) and patients developing infection without preceding transfusion (n = 54) was not significantly decreased. In an analysis of disease recurrence the combination of blood transfusion and subsequent development of infection (hazard ratio 1.79 (95 per cent c.i. 1.13-2.82)), localization of cancer in the rectum and Dukes classification were independent risk factors. CONCLUSION: Blood transfusion per se may not be a risk factor for poor prognosis after colorectal cancer surgery. However, the combination of perioperative blood transfusion and subsequent development of postoperative infectious complications may be associated with a poor prognosis.     

Correction of immunological status of patients with cholelithiasis for the prevention of postoperative complications]

An investigation of immune status of patients with chronic calculous cholecystitis prior to operation and in the postoperative period has proved the development of a pronounced secondary immune deficiency involving T and B-systems of the immune control as well as factors of nonspecific resistance. These changes may be considered as risk factors of the development of infectious complications in the postoperative period. Prophylactics of the secondary immune deficiency by administration of Contrical is indicated which permitted the amount of postoperative complications and the period of stay at the hospital to be decreased.     

Evaluation for Madigan＇s prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan‘s prostatectomy (MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasia were divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symptom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The International Continence Society (ICS) nomogram, Abrams-Gfiffiths (AG) number and linear passive urethral resistance relation analysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamic parameters before and after operation, as well as the advantages and post-operative complications were recorded and compared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urodynamic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantages of the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower incidence of retrograde ejaculation and erectile dysfunction. Conclusion: Both MPC and SPPC can effectively relieve BOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC.     

优质护理在腹腔镜治疗腹壁缺损患者术后的干预效果分析

目的探讨优质护理在腹腔镜治疗腹壁缺损患者术后的干预效果。方法回顾性分析2014年1月至2017年10月南通市中医院收治78例腹壁缺损患者的临床资料。根据护理方式不同分为观察组(39例)和对照组(39例)。78例患者行无张力修补开放手术后,给予对照组患者围手术期常规护理,给予观察组患者围手术期优质护理。比较2组患者术后切口愈合情况、术后并发症、手术相关临床参数及疼痛程度情况。结果对照组1例患者拆线后伤口为Ⅱ期愈合,其余患者均为Ⅰ期愈合。与对照组比较,观察组术后自主活动时间提前,住院时间缩短,并发症发生率降低,差异均有统计学意义(P<0.05)。术后12 h至7 d,2组患者视觉模拟评分均呈逐渐降低趋势,观察组低于对照组,差异有统计学意义(P<0.05)。结论优质护理模式能够减轻腹壁缺损患者术后疼痛,促进伤口愈合,降低并发症发生风险。     

糖尿病骨折患者围手术期的处理

目的　探讨糖尿病 (DM)骨折患者围手术期治疗的特点及DM对骨折手术的影响。方法　回顾分析 97例接受手术治疗的DM骨折患者围手术期血糖调控以及并存疾病的术前诊治情况。对术前准备时间、住院时间、伤口愈合等级、术后并发症发生率及住院费用等与非糖尿病对照组进行对比分析。　结果　 (1)DM骨折组入院后应用胰岛素将血糖控制在目标值 (空腹血糖 :6 0～ 8 0mmol/L ,餐后血糖 :8 0～ 11 1mmol/L) ,手术后期 (PP)胰岛素用量为 (0 5± 0 2 )U·d-1·kg-1,较稳定期[SP :(0 7± 0 2 )U·d-1·kg-1]和手术期 [OP :(0 7± 0 3)U·d-1·kg-1]明显减少 ,有显著性差异 (P <0 0 5 ) ;(2 )DM骨折组入院后新发现合并症 (心电图ST T改变、心律失常、高血压病、血脂异常、泌尿系感染 )病例数多于对照组 ,经过术前对症及改善微循环治疗 ,均耐受了相应的手术治疗 ;(3)DM骨折组比对照组术前准备时间延长 [(16 7± 4 2 )d比 (8 5± 3 7)d]、住院时间延长 [(30 1± 8 6 )d比 (17 6± 5 7)d],西药费、检查费、化验费均增高 ,有显著性差异 (P <0 0 1) ;(4 )手术切口全部甲级愈合 ,DM组与对照组骨折术后并发症发生率分别为 2 0 6 %和 1 0 3% ,无显著性差异 (P >0 0 5 )。结论　有效地控制DM骨折患者血糖 ,合理治     

Bacterial translocation after cirrhotic liver resection: a clinical investigation of 181 patients

BACKGROUND: Cirrhotic patients are usually associated with a high susceptibility to infection. Although bacterial translocation from gut mucosa to mesenteric lymph node (MLN) and systemic circulation is a well-known phenomenon after hepatectomy, its role in cirrhotic patients remains unclear. MATERIALS AND METHODS: MLN was harvested for bacterial culture before and after liver resection in 181 cirrhotic patients. The characteristics and postoperative courses of patients with positive and negative bacterial culture for MLN after hepatectomy were compared. Postoperative systemic antibiotics were administered if infectious complications occurred. RESULTS: No bacteria were cultured in MLN before hepatectomy. Bacterial translocation (BT) to MLN after hepatectomy occurred in 36 patients (BT group). After multivariate analysis, intraoperative blood transfusion was the only independent factor that influenced bacterial translocation rates after cirrhotic liver resection. BT group patients also had higher infectious and overall complication rates, with a longer postoperative hospital stay. Among the cultured bacteriae from infected sites in BT group patients with infectious complications, only 2 patients (12.5%) had totally different bacterial species to those cultured from MLNs. CONCLUSIONS: Bacterial translocation more often occurred after liver resection in cirrhotic patients who received intraoperative blood transfusion. Such patients had higher postoperative infectious and overall complication rates. Thus, avoidance of intraoperative blood transfusion is mandatory for cirrhotic liver resection.     

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Summary The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calcualted. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.     

The course of the postoperative period in patients with cerebral gliomas after different volumes and kinds of surgery

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.