ObjectiveTo explore the diagnostic and therapeutic significance of laparoscopic surgery for abdominal trauma patients. MethodsClinical data of 65 patients with abdominal trauma who treated in Affiliated Laigang Hospital of Taishan Medical College from January 2010 to December 2014 were collected retrospectively, all patients were diagnosed by laparoscopic exploration, and therapies were depended on the results of laparoscopic exploration. ResultsOf the 65 patients, 60 patients were definitely diagnosed through laparoscopic exploration, but 5 patients transferred to laparotomy because of clear diagnosis was not achieved under laparoscopy. Of the 60 patients who were diagnosed clearly by laparoscopy, 23 patients didn't received any intervention because of no obvious injury observed, 27 patients received laparoscopic surgery (3 patients were assisted with hands), and 10 patients transferred to open operation because of peritoneal contamination. Incision infection occurred in 1 patient after operation, 1 patient suffered from subphrenic abscess, and other 63 patients didn't suffered from any complication. All of the patients were discharged successfully. All of the 65 patients were followed up for 2-48 months with the median time of 10 months. Severe complications did not occurred and no patient needed re-operation within the period of follow-up period. ConclusionsLaparoscopy is feasible, safe, and effective for the evaluation and treatment of abdominal trauma patients with stable hemodynamics, and it also has a higher diagnostic rate. Laparoscopy can also reduce the negative exploratory laparotomy for the abdominal trauma patients.
Objective To explore the donor maintenance points of donor donation after brain death （DBD）. Methods From December 2011 to January 2012，two cases of organ DBD in our hospital were performed. After diagnosis of brain death，mechanical ventilation，fluid resuscitation，vasoactive drugs，inotropic drugs，and so on were used，and invasive arterial pressure， central venous pressure，heart rate，blood gas exchange，urine output，electrolyte and acid-base balance，body temperature， hematocrit，albumin level were monitored，the donors vital organ perfusion were successfully kept at acceptable level. Results The vital signs of two cases of DBD donors were stable. The livers，kidneys，and corneas were donated，and the functions were stable and normal. Case one was diagnosed for brain death 6h after ICU admitted，the period from diagnosis to organ procurement was 33h. Case two was diagnosed for brain death 8h after ICU admitted，the period from diagnosis to organ procurement was 31h. All transplanted organs，livers，kidneys，and corneas，were working well after operation. Conclusions Donor maintenance process of DBD is the cornerstone to ensuring successfully organ donation and transplantation，which is important to improve the utilization rate of donated organs，and release the severely shortage of organ.
Objective To get the information about the cognition and attitude towards organ transplantation and donation in inpatients. Methods The inpatients were investigated by using a self-designed questionnaire，including general data，cognition and attitude towards organ transplantation and donation. The influence factors of organ transplantation and donation were analyzed by SPSS 18.0. Results A total of 1 000 questionnaires were delivered，973 returned，the effective questionnaire was 906，and the effective rate was 93.1%. In 906 valid questionnaires，788 （87.0%） patients knew organ transplantation；189 （20.9%） patients had transplanted relatives；511 （56.4%） patients were willing to accept the organ transplant surgery，226 （24.9%） patients did not want，169 （18.7%） patients did not know；490 （54.1%） patients agreed to donate organ，173 （19.1%） patients disagreed，243 （26.8%） patients did not know. The age，education，occupation，knowing organ transplants，and with organ transplanted relatives or not had significant influences to the willingness towards organ transplantation and donation （P＜0.01）. The gender had no effect on organ transplantation （P=0.727） and donation （P=0.935） concerned issues，but the age，education，knowing organ transplantation，and with organ transplanted relatives or not had significant influences on it （P＜0.01）. Most concerned factors about organ transplantation were as follows：with an available organ for transplantation 〔28.7% （260/906）〕，postoperative quality of life 〔23.0% （208/906）〕，risk of surgery 〔21.5%（195/906）〕，surgery costs 〔19.5% （177/906）〕，and postoperative rejection 〔7.3% （66/906）〕. Most concerned factors about organ donation were as follows：the reasonable usage of donated organs 〔57.4% （520/906）〕，attitude of relatives 〔23.8% （216/906）〕，and donation compensation 〔17.6% （159/906）〕，and others 〔1.2% （11/906）〕. According to the way of organ donation，403 （44.4%） patients were willing to accept donation after cardiac death （DCD），257 （28.4%） patients accept donation after brain death，246 （27.2%） patients accept living organ donation. The gender，education，and occupation had significant influences on the way of organ donation （P＜0.05），but age，knowing organ transplantation，and with organ transplanted relatives or not had no effects on it （P＞0.05）. Conclusions The lack of propaganda and the high costs of transplantation surgery are the main factors restricting the acceptance rate of organ transplantation. Over time，with continuous improvement of universal education and strengthening the publicity of organ transplantation，the acceptance rate will show a constant increase in the trend. By now，the most accepted way of organ donation is DCD in inpatients. The establishment of a reasonable organ allocation and compensation system is a corner stone to promote organ donation.
目的 探讨肝移植术后早期并发急性移植物抗宿主疾病(GVHD)的诊断和治疗。方法 回顾性分析我院2006年5月至2007年10月期间行肝移植手术50例，其中2例术后并发GVHD，分析该2例肝移植术后第14 d和第18 d以出现不明原因发热、皮疹、口腔多发溃疡、全血细胞减少、皮肤病理活检等临床资料为诊断依据和以不同的免疫抑制剂治疗的方案。结果 第1例患者加强免疫抑制剂治疗，发生败血症于术后67 d死于多器官功能衰竭； 第2例减少免疫抑制剂治疗，术后96 d治愈。结论 肝移植术后并发GVHD，减少免疫抑制剂方案可能是一种有效方案，但应警惕急性排斥反应和继发感染发生。