Surgical intervention for the treatment of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease occurring in 1% to 5% of all neonatal intensive care unit (NICU) admissions. Although the majority of infants diagnosed with NEC are treated with medical management, up to 25% to 50% will require surgery. Surgical intervention is associated with significant morbidity and mortality, especially in the extremely low birth weight infant. To decrease the complication rate for these infants, a number of surgical procedures are advocated, including the traditional laparotomy with resection, primary anastomosis, the “patch, drain, and wait” approach, the “clip and drop” technique, and bedside peritoneal drainage. Here we examine current surgical interventions for the treatment of NEC with an emphasis on bedside peritoneal drainage. Management of idiopathic perforation with peritoneal drainage is also discussed because of its similarity to NEC. Neonatal nurses must understand the various surgical procedures to better address the concerns of parents and to provide optimal nursing care of the infant with NEC.     

Laparoscopic internal intestinal drainage of bile lakes in a patient with recurrence of jaundice after laparoscopic revision of Kasai portoenterostomy for biliary atresia: A case report

Bile lake, of the postoperative complications after Kasai portoenterostomy (PE) for biliary atresia, causes cholangitis that may induce progressive fibrosis of the liver. Standard treatment for bile lakes has not yet been established, but there are reports that surgical internal intestinal drainage for bile lakes effectively prevents cholangitis and maintains jaundice-free status. In this case, insertion of the percutaneous transhepatic biliary drainage into the bile lake allowed continuous drainage of large volumes of bile juice. However, reoperation following laparotomy increases the surgical risk of subsequent liver transplantation due to postoperative adhesion. Laparoscopic surgery was selected for the patient who was likely to require liver transplantation in the future. In this case, laparoscopic internal intestinal drainage of bile lakes was performed safely by a Cavitron ultrasonic surgical aspirator for the recurrence of jaundice after laparoscopic revision of PE. Cholangitis and jaundice were rapidly resolved after this surgical procedure.     

针对急性胰腺炎患者采取不同类别植入导管灌注冲洗技术的临床护理方法研究

本文总结了30例重症急性胰腺炎患者经过临床外科急诊手术后,采取分阶段灌洗方法治疗急性重症胰腺炎的临床护理经验。临床护理人员根据患者病情的特点,医护之间紧密配合协作,针对患者病情程度不同及时采用不同的临床灌洗技术对患者进行治疗。在急性胰腺炎患者发病的初期,利用CT、超声、MRI等影像技术的优势精确引导定位,对患者胰腺周围的坏死组织进行外科手术剥离切除,并在患者手术结束后及时植入引流管引流出胰腺周围的炎性渗出液,随即给予原位封闭式冲洗等治疗措施,用大流量腹膜腔冲洗液进行患者的后续治疗,当患者出现手术后切口感染时,及时行密闭式负压引流冲洗治疗。在对患者进行的腹腔冲洗术中,护理人员应密切观察患者有无出血、感染、水肿、血压变化等并发症的出现,并引导患者尽早下地活动,促进其胃肠道蠕动及肛门排气。经过医护人员精心的治疗护理,30例急性重症胰腺炎患者在较短的住院期内治愈出院,对其随访5~12个月,患者的病情恢复良好。     

Undiagnosed intra-operative intra-abdominal hemorrhage during an abdominoplasty: a case study

A case study is presented of a 40-year-old female who underwent an elective abdominoplasty with the administration of general endotracheal anesthesia. The intraoperative course was complicated by an unsuspected, undiagnosed bleed from a branching artery at the bifurcation of the abdominal aorta, first retroperitoneally, then into the peritoneal cavity. The peritoneal hemorrhage was unrelated to the surgical procedure, because the abdominal cavity was not entered during the elective procedure.     

Catheter drainage of pancreatic pseudocysts into the stomach

This paper reports on the technique and results of cystogastric catheter drainage, as described by Hancke, in eight patients with post-acute pseudocysts, and in one patient with acute necrotising pancreatitis. With this procedure, the catheter is passed, under gastroscopic and ultrasonographic control, percutaneously through the stomach into the pseudocyst in such a manner that the contents of the cyst drain into the stomach. Too small a residual stomach following surgery, and too small, or immature, cysts, represent the limitations of the technique. In five patients, complete, lasting emptying of the cyst was accomplished without any complications. The intervention can be carried out under local anesthesia.     

不同手术治疗原发性肝癌疗效及其预后影响因素分析

目的：探讨比较解剖式和非解剖式肝切除术治疗原发性肝癌（HCC）的手术疗效及其影响因素分析。方法将78例HCC患者按照手术方式的不同随机分为解剖式和非解剖式肝切除术组,每组各39例,对比两种手术方式的临床疗效,术中出血量、手术时间、住院时间、术后平均禁食时间、平均腹腔引流时间、并发症发生率及生存率指标,并筛选影响预后的因素。结果术后解剖组和非解剖组的总体有效率和住院时间比较差异无统计学意义（P＞0．05）;但解剖组平均出血量、禁食时间、腹腔引流时间、并发症的发生率均明显低于非解剖组,而手术时间则明显高于非解剖组,差异均有统计学意义（P＜0．05）;解剖组生存率优于非解剖组,且与肿瘤大小、门静脉浸润、切缘和乙肝显著相关（P＜0．05）。结论解剖式肝切除术虽操作复杂,但治疗HCC的临床疗效和安全性均优于非解剖式切除术,且能更好提高术后生存率。     

早期腹腔镜腹腔灌洗引流治疗重症急性胰腺炎合并腹腔积液

目的　探讨重症急性胰腺炎 (SAP)合并腹腔积液的早期治疗方法。方法　针对重症急性胰腺炎合并腹腔积液的早期病理发展特点 ,对 18例SAP患者早期采用经腹腔镜腹腔灌洗引流、胰包膜切开。结果　全组无死亡病例 ,均获治愈 ,随访 1～ 2 8个月 ,无并发症发生 ,恢复良好。结论　早期腹腔镜腹腔灌洗引流 ,能迅速消除腹腔内毒性渗液及酶性物质 ,有利于稳定急性期炎症反应 ,有效降低并发症的发生 ,是重症急性胰腺炎合并腹腔积液早期治疗的一种安全、可靠的微创治疗手段     

Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy

Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.     

结扎速血管闭合切割系统在巨大神经纤维瘤手术中的应用效果

目的：探讨结扎速血管闭合切割系统(LigaSure vessel sealing system, LVSS)在巨大神经纤维瘤手术中的应用效果。方法：选取2013年10月至2020年5月行巨大神经纤维瘤手术的患者22例纳入本研究。传统手术组12例采用常规缝扎电凝止血手术方式,LigaSure组10例采用LigaSure血管闭合切割的手术方式,对比两组患者切除瘤体大小、手术时间、术中出血量、术后引流量、术后拔管时间及术后并发症情况。结果：两组间患者的一般资料具有可比性。LigaSure组术中出血量、术后引流量、术后拔管时间均较传统手术组显著降低(P＜0.05)。两组间切除瘤体大小、手术时间及术前术后血红蛋白差值无统计学差异。传统手术组出现1例术后皮下积液,予再次引流后伤口愈合良好。结论：LigaSure在手术治疗巨大神经纤维瘤方面的应用安全有效,能显著地减少出血量,简化手术操作,缩短术后恢复时间,值得在临床上进一步推广。     

Intermittent self-catheterisation: teaching the skill to patients

Intermittent self-catheterisation (ISC) is not a new concept. However, it is a method that could be more widely used by patients to drain the bladder rather than having an indwelling catheter with a drainage bag and its associated problems. The author describes the procedure, patient assessment, and the training required by patients so that they can undertake ISC. Self-catheterisation promotes patient independence, improves quality of life and helps to avoid complications associated with indwelling urinary catheters.     

Malfunctioning peritoneal dialysis catheter and accompanying surgical pathology repaired by laparoscopic surgery.

OBJECTIVES: To review the laparoscopic salvaging of malfunctioning peritoneal dialysis (PD) catheters, and to present our experience with laparoscopic repair of dysfunctional Tenckhoff catheters and the treatment of accompanying surgical pathologies. DESIGN: Malfunctioning peritoneal catheters were repaired using laparoscopic rescue techniques. Accompanying surgical problems were treated in the same operation. The effectiveness of these approaches was validated by comparison with other remedial techniques described previously. PATIENTS: Malfunctioning PD catheters were salvaged by laparoscopic surgery in 8 patients, and accompanying surgical problems were treated in the same operation in 3 of the 8 patients. MAIN OUTCOME MEASURES: Outcome was measured by the successful return to adequate PD and effective treatment of surgical problems. RESULTS: Eight patient studies show laparoscopic correction of malfunctioning catheters and the treatment of accompanying surgical pathologies with the return to successful PD. CONCLUSION: The salvaging of malfunctioning PD catheters by laparoscopic surgery is an ideal method. This procedure permits simultaneous identification and correction of other surgical problems that could otherwise complicate dialysis therapy.     

Branch Reports

ABSTRACT: This article will look at the short-term surgical management of a cat with a cat bite abscess (CBA), requiring surgical debridement of the wound and drain placement. Planning is an important skill in surgical nursing which can reduce anaesthetic duration and lead to improved surgical outcome. Extensive preparation was required in this case, including solutions for skin scrub and lavage along with equipment for surgery and anaesthesia. Lavage is explored including the use of isotonic solutions, pressures and technique. Hartmann’s is recommended for wound lavage with the use of a 20 ml syringe and an 18–19-gauge needle. Chlorhexidine solutions should be used with caution. Post-operatively patients with drains should have sterile absorbent dressings and Elizabethan collars to prevent ascending infection and premature drain removal. However, neither were possible in this case due to the position of the wound and management with T-shirts were necessary.     

Surgical treatment of pancreatitis: review of a series.

In this review of the surgical experience with pancreatitis, 55 patients had acute relapsing pancreatitis associated with gallstones and 47 had chronic pancreatitis of alcoholic, idiopathic, or familial causation. The severity of pancreatitis associated with gallstones could not be correlated with results of preoperative biochemical tests; only one-third of patients were found to have stones within the biliary ductal system; and postoperative mortality (5%) could not be correlated with the severity of pancreatic inflammation or the timing of surgical intervention. Postoperative observations have revealed that all but four of the patients have remained asymptomatic. With regard to the patients with alcoholic, idiopathic, or familial disease who had significant pancreatic ductal dilatation or obstruction, ductal drainage procedures with or without resection benefited 80%. In the absence of ductal dilatation or obstruction, major resective surgery benefited 50% of patients. Continuing alcohol abuse limited the effectiveness of any operative procedure, and diabetes occurred more often after major resective procedures.     

An unusual case of partial anomalous pulmonary venous drainage.

We report a case of partial anomalous pulmonary venous drainage where the left upper and lower pulmonary veins drain into a separate posterior left atrial (LA) chamber before continuing as a vertical ascending vein. The vertical vein then joins the left innominate vein, which eventually drains into a normal right-sided superior vena cava. There was no fenestration or communication between this posterior chamber and the true LA. The true LA contained the fossa ovale and LA appendage. The right upper and lower pulmonary veins drain normally into the true LA. To our knowledge, this is the first case where the left upper and lower pulmonary veins drain into a separate posterior LA chamber before continuing into a vertical vein. The diagnosis was initially made with transesophageal echocardiography and confirmed by magnetic resonance imaging. The patient later underwent successful corrective operation.     

Chest tubes: indications, placement, management, and complications

Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.     

Current status of natural orifice translumenal surgery

Translumenal access to the peritoneal cavity will have definite advantages in situations whereby the transcutaneous route into the peritoneal cavity is not optimal. For example, transgastric approach may decrease the risk of postoperative wound complications in patients who have marked obesity, as well as in patients who have anterior abdominal wall infection or severe scarring. Natural orifice translumenal surgery provides an exciting opportunity to improve surgical intervention using the skills, imagination, and ingenuity of endoscopists and endoscopic surgeons.     

Successful outcome of retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts: A case report

BACKGROUNDChronic pancreatitis occasionally requires surgical treatment that can be performed with various techniques. Often, this type of surgery presents with postoperative complications. We report a case of a successful retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts.CASE SUMMARYA 62-year-old male with a 10-year history of chronic pancreatitis presented with epigastric pain for one week and a 20 kg weight loss over one year. Computed tomography showed stones in the pancreas (mainly the head), expansion of the main pancreatic duct, and thinning of the pancreatic parenchyma. Magnetic resonance imaging showed infected pancreatic cysts connected to the stomach with a fistula from the splenic hilum to the caudal portion of the liver’s lateral segment. An endoscopic retrograde pancreatography was performed; the guide wires could not pass through the stones in the pancreas and therefore, drainage of the main pancreatic duct was not achieved. Next, a distal pancreatomy and splenectomy were performed; however, the pancreatic juice in the remaining parenchyma was blocked by the stones. Hence, we performed a retrograde pancreatojejunostomy and Roux-en-Y anastomosis. The patient had no postoperative complications and was discharged from the hospital on postoperative day 14.CONCLUSIONA distal pancreatomy, retrograde pancreatojejunostomy, and Roux-en-Y anastomosis could be an effective surgical procedure for intractable chronic pancreatitis.     

微创腔镜手术器械安全流程管理

目的通过对腔镜手术器械环节的管理,探讨腔镜手术器械在手术使用中的各项安全管理措施,保障手术的安全进行。方法通过对我院2009年7—12月胸腔镜、腹腔镜、宫腔镜、脑室镜、机器人1910例手术腔镜器械的灭菌后的发放、手术使用、手术后接收等各项流程环节控制管理,进行腔镜手术器械的人员培训,梳理流程,增强腔镜手术器械安全管理意识,把控腔镜手术器械质量控制环节的过程管理,进行问题差距管理,改进管理中存在的问题,提高腔镜手术器械的管理质量。结果对1910例腔镜手术的管理,进行环节的流程安全管理,保障手术的顺利进行。结论通过对腔镜物品、器械管理过程追踪临床手术使用、手术后接收、清洗、整理、检查等制定安全管理措施,有效避免腔镜器械管理中的疏漏,临床使用效果显著。     

Patient with mediastinitis caused by delayed mucosal damage after peroral endoscopic myotomy

Peroral endoscopic myotomy (POEM) is a groundbreaking procedure for treating esophageal achalasia, and many reports from various facilities have described its safety and efficacy. However, there have been few reports on adverse events. Here, we report a case of a patient with mediastinitis caused by delayed mucosal damage after POEM. This case was the most severe among all POEM cases at our hospital. A 58‐year‐old man had experienced dysphagia and chest tightness since he was around 50 years old. At a previous hospital, he had been diagnosed with nonerosive reflux disease and had undergone fundoplication. As his symptoms did not improve, he was referred to our department. POEM was able to be finished but a stable visual field could not be maintained throughout procedure because of strong esophageal contractions. From findings of endoscopy and esophagography after POEM, the patient was diagnosed mediastinitis caused by delayed esophageal perforation. In this case, conservative treatment (fasting, antibiotic therapy, and enteral feeding) was successful. However, the option to administer surgical treatment, such as drainage, must not be overlooked.     

Surgical Vacuum Drains: Types, Uses, and Complications

High- and low-pressure vacuum drains are commonly used after surgical procedures. High-pressure vacuum drains (ie, sealed, closed-circuit systems) are efficient and allow for easy monitoring and safe disposal of the drainage. Low-pressure vacuum drains use gentle pressure to evacuate excess fluid and air, and are easy for patients to manage at home because it is easy to reinstate the vacuum pressure. Perioperative nurses should be able to identify the various types of commonly used drains and their surgical applications. Nurses should know how to care for drains, how to reinstate the vacuum pressure when necessary, and the potential complications that could result from surgical drain use.