Relaparotomies following the creation of intestinal anastomoses in newborn infants]

An analysis of the immediate postoperative period in 295 newborns after putting intestinal anastomoses was made. Postoperative surgical complications were found in 38 children who required 47 relaparotomies. Surgical tactics was determined for the complications of the postoperative period as well as the indications for relaparotomy.     

Reasons for relaparotomies following operations on the biliary tract in nontumorous lesions

According to the authors' data the incidence of relaparotomies after 1500 operations for non-tumor diseases of bile ducts was 2.5%. Causes of relaparotomies at early and late terms of the postoperative period were different. The dependence of results of the treatment on the amount of relaparotomies and the presence of such complications as jaundice, cholangitis and pancreatitis has been established. In such complications and increased amount of relaparotomies lethality was considerably higher. General lethality after relaparotomies was 49%. Complex of prophylactic and curative measures of the complications resulting in relaparotomies has been developed.     

Indications for relaparotomy and its results

For the recent six years 6855 operations on abdominal organs have been performed which were followed by relaparotomies in 104 patients (1.5%). The authors show that the greatest amount of relaparotomies followed operations for ulcer disease, tumors and cholecystitis. The main causes of relaparotomies were peritonitis, intestinal obstructions and bleedings. The group of greater risk consisted of men aged 50-60. The amount of relaparotomies can be reduced due to unification of medical tactics, strict observation of the operation technique and responsible management of the patients in the postoperative period.     

The problem of relaparotomy in emergency surgery

For the recent 15 years the authors have made 6220 operations on organs of the abdominal cavity, among them there were 111 relaparotomies in 96 patients (1.78%). An atypical course of the postoperative period was an early symptom of unfavorable state of the stomach. Thirty patients died (31.25%). The authors consider that a delayed first operation in urgent surgery is one of the main causes resulting in relaparotomy and appeal to properly perform the sanitary-instructive work, dispensary observation and planned sanitation of surgical patients.     

Principles of determination of surgical policy in general peritonitis

Based on clinical examination and analysis of treatment results of 575 patients with general peritonitis, the most informative factors were determined which predict lethal outcome, progression of peritonitis and help choose the most effective surgical policy. It is demonstrated that conventional treatment is preferable in the interval of perioperative score of APACHE II from 0 to 10, and programmed sanation relaparotomies -- from 11 to 15. Data about efficacy of total intestinal decompression and peritoneal-enteral lavage, and also methods of mathematical prediction of postoperative complications and outcomes are presented. Prognostic value of individual symptoms, different degree of organs dysfunction and SIRS criteria in early postoperative period were determined.     

Surgical treatment of complications after operations on the biliary tract

Causes of relaparotomies after operations for cholelithiasis are analyzed. The frequency of relaparotomies after cholecystectomies was 2.1%. Technical defects in performing operations were the cause of postoperative complications in 52.4% of the cases. Of 63 patients subjected to relaparotomy 23 patients died (36.5%). Prophylactics of complications after operations on bile ducts should be directed first of all to careful observation of the cholecystectomy technique.     

"Routine" versus "on demand" ultrasonography in the surgical intensive care patient. A prospective randomized study

Between May 1988 und March 1989 all patients who underwent elective or emergency surgery followed by intensive care were randomly assigned to group A (n = 149): routine sonography at the postoperative day 1, 3, 7 and 9, group B (n = 151): sonography on demand. In these two groups, the following parameters were compared: number of relaparotomies, lethality of relaparotomies, total lethality, moment of relaparotomy, period of hospitalisation, time spent with sonography. In the analyzed parameters, our examination showed no difference between the two groups. For this we state that the routine sonographical control of the surgical patient with intensive care being opposed to the sonography on demand shows no significant advantage. The demand for a routine sonography as a postoperative control can not be generally supported.     

Intestinal obstruction in the early postoperative period in patients with gastrointestinal tumors

Data on the clinical course and medical tactics in mechanical small intestine ileus developing in the early postoperative period in patients with carcinoma of the gastrointestinal tract are given. The mechanical intestinal ileus was responsible for relaparotomies in 22 patients (5 of them died). An early repeated operation is stressed to be necessary which is less dangerous for the patient than a continuous waiting.     

Possibility of predicting and preventing postoperative complications leading to relaparotomy

The occurrence of relaparotomies is known to be 1,2% of operations on the abdomen organs. Pyo-inflammatory complications are responsible for more than half cases resulting in relaparotomies. Relaparotomies are divided into emergent and urgent, radical and palliative. A system for prognosis of complications and differential diagnosis of postoperative paresis of the gastro-intestinal tract and postoperative peritonitis is presented. Prophylactics of postoperative complications reduced lethality after relaparotomies from 79% to 56%.     

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.     

Strategy of the surgical treatment of postoperative complications in patients with obstructive ileus of the colon of tumorous etiology]

Under analysis were postoperative intraperitoneal complications and results of relaparotomies in 33 patients (13 women and 20 men) aged from 33 to 76 years with obturative ileus caused by stenosing cancer of different portions of the colon. High frequency of peritonitis in the general picture of postoperative complications was due to incompetent sutures of the colonic anastomoses applied during emergency and urgent operations in patients with sub- and decompensated forms of intestinal obstruction. The best variant of completion of radical operations in emergency surgery in this category of patients is the formation of a single- or double-trunk colostomy without a primary reestablishment of the continuity of the intestinal tube especially when stenosing cancer is localized in the left part of the colon.     

Relaparotomy in children]

Specific features of the course of complicated and noncomplicated postoperative period were studied in 21,294 children. Data of 682 relaparotomies were analyzed. The definition of the term "relaparotomy" and classification of relaparotomies are given.     

老年患者骨科手术风险性预测及相关因素的前瞻性研究

目的　通过对老年骨科患者生活能力水平与手术并发症之间关系的研究 ,为老年骨科患者提供最佳的手术方案 ,从而减少围手术期致险事件的发生。方法　将 189例 6 0岁以上的骨科患者随机分为研究组及对照组 ,对照组依据各脏器系统检验结果确定手术时机及手术种类 ,研究组则根据患者的生活能力水平确定所进行手术的种类。统计两组间围手术期并发症发生率及死亡率。结果　研究组出现各类并发症 11例 ,并发症发生率 12 .79% ,死亡 1例 ,死亡率 1.16 %。对照组出现各类并发症 5 0例 ,并发症发生率 4 8.5 4 % ,死亡 6例 ,死亡率 5 .83%。两组间并发症发生率及死亡率比较差异有显著性意义 (P<0 .0 5 )。结论　生活能力水平是评估老年人身体健康程度的最重要的指标 ,以此为依据选择老年人所需进行骨科手术的种类 ,可以明显降低老年骨科患者围手术期的并发症发生率及死亡率。     

Indications for relaparotomy

From 1980 to 1987, 10,446 patients were operated on. In 152 patients, the necessity of a repeated operative intervention arose. In 106 patients the emergency, in 42--delayed, and in 4--elective relaparotomies were performed. There were the following indications for relaparotomy: diffuse and circumscribed peritonitis (78 patients), ileus (46), eventration (11), hemorrhage (12), others (5). Diagnosis of postoperative complications requiring relaparotomy is difficult. The postoperative lethality was 26%.     

腹腔镜胃十二指肠溃疡穿孔修补的优势和手术体会

【摘要】〓目的〓探讨腹腔镜治疗急性上消化道穿孔的临床疗效及优点。方法〓选取2011年1月至2013年12月收治的急性上消化道穿孔确诊患者,年龄26~75岁,平均56.8岁,行腹腔镜修补术43例(腔镜组),开腹修补术40例(开腹组),记录并对比两组的手术时间、寻找病灶时间、术后排气时间、住院时间、术后疼痛评分、并发症等情况。结果〓所有病例均随访6~18个月,平均14.6个月,两组均无围手术期死亡病例和严重并发症;两组的手术时间无明显差异,但在手术中寻找病灶时间、术后排气时间、住院时间、术后疼痛评分和并发症发生率等方面,腹腔镜组明显优于开腹组(P<0.05)。结论〓腹腔镜下行急性上消化道穿孔修补术损伤小、术后恢复快,可成为胃十二指肠穿孔修补手术的首发选择。     

The course and surgical treatment of gastroduodenal ulcer in patients with diabetes mellitus

The work deals with the features of the course of gastric and duodenal ulcers in diabetes mellitus and the frequency and pattern of the complications. The authors recommend criteria for preparation for surgical treatment, methods for compensation of the disturbances of carbohydrate metabolism, and the methods of postoperative management of such patients. The late-term results and analysis of treatment are discussed briefly. The coexistence of peptic ulcer and diabetes mellitus is a rare occurrence. During a 20-year period 31 patients were treated at the clinic, 21 of them underwent operation, in 5 patients an operation was considered inexpedient, another 5 patients refused to be operated on. The postoperative period was free of complications in 19 patients, there were no fatal outcomes.     

Relaparotomy in abdominal injuries

Relaparotomies in the postoperative period were performed in 56 out of 529 patients (10,6%) operated upon for injuries of organs of the abdominal cavity. Twenty-two of them died. In most cases relaparotomies were caused by peritonitis, intraabdominal bleedings and abscesses.     

Non-directed relaparotomy for intra-abdominal sepsis. A futile procedure

Over a 50-month period, 2,657 primary laparotomies were performed; 192 patients underwent urgent relaparotomy for complications of primary laparotomy. Forty-seven relaparotomies were performed for Type I intra-abdominal sepsis (IAS-1) with a 12.8 per cent mortality, and 46 for Type 2 IAS with a 82.6 per cent mortality (P less than 0.001). Of the 46 IAS-2 patients, 31 relaparotomies were "directed" by positive peritoneal signs (CAT/ultrasound/PIPIDA examinations) with 94 per cent (29/31) yielding positive findings. Fifteen were "non-directed" in an effort to uncover an occult source of continuing sepsis of MOSF and yielded a 13 per cent (2/15) positive rate (P less than 0.001), and a 93 per cent (14/15) mortality. Relaparotomy for sepsis directed by positive radiologic or clinical findings can be reliably expected to demonstrate a surgical focus whose correction may yield patient survival; non-directed relaparotomy, however, seldom demonstrates a focus and does not contribute to survival.     

结直肠外科快速康复模式加速直肠癌术后康复的临床研究

目的评价结直肠外科快速康复模式（FT）对加速直肠癌手术患者术后康复的作用。方法将83例直肠癌择期手术病例随机分为2组，围手术期管理分别接受快速康复模式（即简化肠道准备、手术前夜允许进普通饮食、术后不待肛门排气即拔除胃管并恢复饮食、术后强制早期活动、不常规放置引流管及早期拔除尿管等；FT组，44例）和传统模式（对照组，39例），记录两组患者的术后住院时间、30d内手术并发症和再入院率并作统计学分析。结果两组患者性别、术式、合并症、肿瘤TNM分期等变量的构成比及年龄、手术时间、失血量等计量资料比较，差异均无统计学意义（P〉0．05）。FT组术后平均住院时间（4．7±2．6）d，较对照组的（8．9±2．8）d显著缩短（P〈0．01）；其术后30d内并发症发生率也明显低于对照组（P〈0．05）；再入院率两组比较P=0．326．FT组未见升高。结论结直肠外科快速康复模式用于择期直肠癌围手术期临床管理，可加速患者的康复。     

The surgical treatment of echinococcosis of the diaphragmatic surface of the liver]

The results of surgical treatment of 628 patients aged 15-76 years operated on for echinococcosis of diaphragmatic surface of the liver have been analysed for period from 1976 to 1996. 333 patients had complicated echinococcosis, 124 combined pathology of other organs. Methods which have been applied for diagnosis of echinococcosis of the liver and its complications are described. Details of surgical treatment of the echinococcosis of the diaphragmatic surface of the liver are elucidated in time course aspects, as a staged treatment, during which various factors were used for antiparasitic treatment of cystic cavity as well as various methods of elimination of the residual cavity. Problems concerning application of laser and plasmatic scalpel during various stages of the operation, as well as low-intensity lasers and low-frequency ultrasound during the operation and in postoperative period are considered. Postoperative complications were detected in 99 (15.8%) patients, lethal outcomes were in 5 (0.8%) cases.