ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.
ObjectiveTo investigate the prevention and control measures and procedures for surgical operation safety during the outbreak of new coronavirus pneumonia.MethodsAfter interpreting the diagnosis and treatment plan of new coronavirus pneumonia, the prevention and control plan of new coronavirus pneumonia, and the technical guidelines for prevention and control of new coronavirus pneumonia infection in medical institutions, we formulated and improved the prevention and control measures and procedures for surgical safety in our hospital.ResultsA total of 567 patients were operated in our hospital from January 22, 2020 to February 10, 2020, including 501 were operated in the surgical center and 66 were operated in the interventional center. Among all the cases, there were 303 emergency operation and 264 scheduled or limited operation. In the emergency operation, the top three were 130 cases of caesarean section (42.9%), 63 cases of abdominal digestive system operation (20.8%) and 31 cases of skull operation (10.2%). In the scheduled or limited operation, the top four were 65 cases of benign diseases of the eye (24.6%), 57 cases of tumor (21.6%), 53 cases of orthopedic surgery (20.1%), and 25 cases of coronary angiography (9.4%). All the patients were successfully completed the operation and recovered well after the operation. No serious surgical complications or infection-related complications occurred.ConclusionDuring the outbreak of new coronavirus pneumonia, surgery and epidemic prevention and control can be carried out by adjusting and optimizing measures and procedures.
ObjectiveTo explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.MethodsThe clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.ResultsTwo cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.