Objective To investigate the effectiveness of endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch for chronic abdominal wall sinus by comparing with the traditional surgical method. Methods Retrospective analysis was made on the clinical data of 53 cases of chronic abdominal wall sinus between January 2006 and May 2012. Of 53 patients, 18 underwent endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch (trial group), and 35 underwent traditional surgical treatment (control group). No significant difference was found in gender, age, etiology, disease duration, and location between 2 groups (P gt; 0.05). Results The blood loss during sinus clearance, postoperative hospitalization days, and sinus union time of the trial group were significantly better than those of the control group (P lt; 0.05), but no significant difference was found in the operative time for sinus clearance (t=0.28, P=0.78). No postoperative sinus bleeding or infection occurred in the trial group, but bleeding and infection in 5 and 3 cases of the control group respectively, showing significant differences between 2 groups (P lt; 0.05). The follow-up time was 4-18 months (mean, 12.4 months) in the trial group, and was 6-48 months (mean, 38.5 months) in the control group. No sinus recurrence was observed during follow-up. Conclusion Endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch has the following advantages in treating chronic abdominal wall sinus: clear view, thorough cleaning of granulation necrosis tissues, less bleeding, faster sinus union, and shorter hospitalization days; however, further observations on the long-term effectiveness and the safety are required .
ObjectiveTo sum up the clinical characteristics,surgical management,and effectiveness of pressure sore of sinus type. MethodsBetween January 2009 and April 2013,17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated,and the clinical data were analyzed retrospectively.There were 11 males and 6 females with an average age of 27.4 years (range,17-49 years).The median disease duration was 1.5 years (range,6 months to 7 years).Of 17 cases,there were 14 primary cases and 3 recurrent cases; 10 focuses of 8 cases were classified as simple sinus type,and 9 focuses of 9 cases as complex sinus type,which had a false synovial sheath complicated with one to four "second sinus".The pressure sore of sinus type majorly located at the ischial tuberosity.The size of pressure sore ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm,and the length of "second sinus" ranged from 8 to 32 cm with an average of 17 cm.After the false synovial sheath was totally excised,the wound was repaired by local sliding or rhombus flaps at the first or second stage in patients with simple sinus type pressure sore.On the basis of excising the false synovial sheath,the "second sinus" was totally removed in the patients with complex sinus type pressure sore. ResultsWound dehiscence occurred in 1 case of simple sinus type pressure sore at 4 days,which was cured after it was sutured again.Wound infection occurred at 9,17,and 23 days respectively in 3 cases of complex sinus type pressure sore,which was cured after second debridement and necrosis tissues removal.The other wounds healed by first intention,and the flaps totally survived.All patients were followed up 6-12 months (mean,9.3 months).No recurrence was observed. ConclusionAccording to the clinical characteristics,pressure sore of sinus type could be divided into simple sinus type and complex sinus type.The key of successful treatment is to thoroughly excise false synovial sheath and "second sinus".
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.