ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
Objective To evaluate whether to defer abdomen surgery in patients having poorly controlled or untreated hypertension before operation. MethodsThe perioperative clinical data of 531 patients with hypertension in our hospital from January 1997 to December 1998 was retrospectively analyzed. ResultsThe modility of perioperative hypertensive events was not significantly different, between controlled and uncontrolled patients with grade one and grade two（Pgt;0.05）. In grade three and systolic hypertension, certain complications in patients with poorly controlled hypertension were higher than in those with wellcontrolled hypertension（P＜0.05）. Conclusion The patients with grade one and grade two hypertension are not at increased operative risk. In patients with grade three and systolic hypertension, perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 24/14.7 kPa （180/110 mm Hg） over 1 to 2 weeks.
Plasma cortisols in 18 abdominal emergency patients and 20 planned-operation patients were examined. The result showed that cortisols in planned-operation patients were increased after their operations. On the other hand, plasma cortisols in emergency patients were higher in preoperative period than that in the postoperative period. There were no furher increase after operations. The changes of plasma cortisols between two kinds of patients were very different. This means that stress reactions in the patient with acute abdomen can be reduced by early operations.
Objective To assess the risk factors associated with postoperative infection after elective abdominal operation for elderly in department of general surgery. Methods One hundred and fifty-nine consecutive elderly patients admitted to the department of general surgery in our hospital for elective abdominal operation between May 2010 and February 2012 were considered for inclusion and retrospectively analyzed. Thirty-eight patients （23.90%）with postoperative infection were taken as the infection group and 121 patients without postoperative infection as noninfection group. The differences in the objective physiological indicators， subjective health status indicators， operation status， the incidence of postoperative infective complications， and mortality were compared between the two groups. Results Of enrolled 159 patients in this study， the incidence of postoperative infective complications was 23.90% （38/159）； 2 patients died， and the postoperative mortality rate was 1.26%. Single factor and multivariate logistic regression analysis showed that preoperative malnutrition risk， history of diabetes， and chronic respiratory system disease were the independent risk factors of postoperative infection complications in elective abdominal surgery for elderly patients. Conclusion Improving preoperative respiratory function， diabetes mellitus， and nutritional status would help to reduce incidence of postoperative infection for elderly patients with elective abdominal operation.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
ObjectiveTo discuss the key points of nursing care for enhanced abdominal CT examination. MethodsA retrospective analysis of the clinical data of 1 500 patients receiving abdominal enhanced CT scan between March 2013 and March 2014 was carried out. Then, we summarized the nursing experiences before, during and after scanning, and various complications and accidents occurring during the examination. ResultsAll the patients completed the examination safely. Ten patients had mild adverse reactions, and the symptoms relieved or disappeared after active treatment; no medium or severe adverse reactions occurred. Two patients had extravasation of contrast medium, and the allergic symptoms gradually improved after the dressing of 50% wet magnesium sulfate. Five patients had poor image quality, including 2 with contrast agent extravasation, and 3 with respiratory motion artifacts. ConclusionGood nursing work is an important guarantee for the success of abdominal enhanced CT examination.
ObjectiveTo establish pig abdomen bullet wound model in seawater immersion condition and to analyze injury characteristics. MethodsTwenty Xishuangbanna pigs were randomly divided into seawater immersion group and control group,with 10 in each group.The left lower quadrant anti McBurney point of the pig semi-floating in the seawater was shot by using domestic 81-1 assault rifle at the distance of 10 meters,which were salvaged out of seawater at 60 minutes after injury in the seawater immersion group.The pigs in the control group were treated same as the seawater immersion group except seawater immersion.The mean arterial pressure (MAP),rectal temperature (RT),heart rate (HR),respiratory (R),white blood cell count (WBC),and C-reactive protein (CRP) were tested at 1 h,4 h,8 h after injury.The death of pig was observed. ResultsThe pig abdomen bullet wound models in the seawater immersion condition were successfully established.① Compared with the control group,the MAP and RT were significantly decreased at 1 h,4 h,8 h after injury,the HR or the R was significantly decreased at 4 h or 8 h after injury respectively in the seawater immersion group.② Compared with the normal value,the WBC obviously rose at 4 h and 8 h after injury,the CRP obviously rose at 1 h,4 h,and 8 h after injury in both two groups.Compared with the control group,the WBCs were significantly increased at 4 h and 8 h after injury (P<0.05),the CRPs were significantly increased at 1 h,4 h,and 8 h after injury (P<0.05) in the seawater immersion group.③ The mortality in the seawater immersion group (50%) was significantly higher than that in the control group (20%,P<0.05). ConclusionThe injury is more serious,the infection time is earlier,and the infection degree is aggravated,the mortality rate is higher for pig abdomen bullet wound model in seawater immersion condition.