A modified abstructingpressing therapy done on 14 patients with high or low external intestinal fistulas following postoperative infection after abdominal operations was reported. The results showed that high or low external intestinal fistulas could be cured by the combined method of obstruction and compression. This therapy decreased the mortality rate, saved the patients from the risk period and shortened curing course of treatment. Finally the characteristics, the surgical procedure, precautions and advantages of the method were disscussed.
目的:探讨胰十二指肠切除术后胰瘘的原因及其预防。方法: 2003年1月至今,对46例行胰十二指肠切除术中采取胰管空肠吻合方式的病例资料进行回顾分析。结果: 46例患者行胰十二指肠切除术后无一例发生胰瘘。结论: 胰十二指肠切除术采取胰管空肠吻合方式可有效预防胰瘘的发生。
【Abstract】ObjectiveTo determine the risk factors associated with development of pancreatic fistula after pancreatoduodenectomy (PD). Methods The clinical data of 123 consecutive patients who underwent PD from Dec. 1994 to Dec. 2003 were analysed retrospectively. Results The incidence of pancreatic fistula was 11.4% (14/123). Univariate analysis showed history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level, type of pancreatojejunostomy and diameter of pancreatic duct were significantly associated with pancreatic fistula after PD. Multivariate analysis using Logistic regression identified four variables as independent factors associated with the occurrence of pancreatic fistula: history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level and type of pancreatojejunostomy. Conclusion History of upper abdominal operation, soft texture of pancreas, postoperative serum hemoglobin level less than 90 g/L and routine invaginated pancreaticojejunostomy are main risk factors associated with development of pancreatic fistula after PD.
Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.
ObjectiveTo evaluate the various methods in prevention of pancreatic fistula after pancreaticoduodenectomy.MethodsThe literatures over the years related to prevention of pancreatic fistula were reviewed.ResultsManagement of the pancreatic stump following pancreaticoduodenectomy played the most important role in preventing pancreatic fistula. None of the methods of pancreatic stump had proved to be perfect in preventing pancreatic fistula, though pancreaticojejunostomy was the most widely practiced reconstruct strategy in varieties of option. For pancreaticojejunostomy and pancreaticogastrostomy, the rate of this complication was 12.3% and 11.1%,respectively. In recent years, a new procedure, bindingup pancreaticoduodenectomy, had shown a promise and excellent results in prevention of pancreatic fistula, the rate of fistula was 0 for consecutive 100 cases after pancreaticoduodenectomy.ConclusionBindingup pancreaticojejunostomy have a definite effect to avoid pancreatic fistula and be worthy of being recommended
【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.