Objective To systematically evaluate safety and effectiveness of using fast track surgery (FTS) protocol in perioperative management of hepatectomy. Methods The studies were collected by searching the PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP databases by two researchers. The FTS management was used in the FTS group and the traditional perioperative management was used in the traditional group. The meta analysis was performed using the RevMan 5.3 software. Results A total of 28 articles were included in the study, of which 1 632 patients in the FTS group and 1 820 patients in the traditional group; 14 RCTs, 14 CCTs. The results of meta analysis showed: Compared with the traditional group, the FTS not only could reduce the pain of patients during 24 and 48 hours after the surgery [24 h: WMD=–0. 92, 95%CI (–1.05, –0.79), P<0.000 01; 48 h:WMD=–0.73, 95%CI (–0.90, –0.56), P<0.000 01], but also shorten the first postoperative flatus time of patients [WMD=–17.36, 95%CI (–23.16, –11.56), P<0.000 01] and the length of hospital stay [WMD=–2.42, 95%CI (–3.02, –1.63), P<0.000 01] and reduce the hos-pitalization expenses [WMD=–0.52, 95%CI (–0.64, –0.41, P<0.000 01]; While the incidences of pulmonary comp-lications [OR=0.51, 95%CI (0.32, 0.81), P=0.005], total complications [OR=0.57, 95%CI (0.38, 0.87), P=0.008], and nausea and vomiting [OR=0.45, 95%CI (0.31, 0.65), P<0.000 1] were significantly decreased. The RCT group and CCT group showed the same conclusions with the overall study (except incidence of postoperative pulmonary complications between the two groups in the CCT study). Conclusion For patients with elective hepatectomy, it seems feasible to use FTS protocol, which could promote postoperative bowel recovery, shorten length of hospital day, and save medical resources.
Objective To explore the clinical application in the prevention of post-ERCP pancreatitis (PEP) for high-risk patients undergoing endoscopic duct stent placement. Methods The clinical data of 112 patients with high-risk PEP between January 2005 and June 2010 in this hospital were analyzed retrospectively. According to stents placement or not, 112 patients were divided into stent placement group (n=52) treated by ERCP and stents placement and non-stent placement group (n=60) treated by ERCP without stent retaining. PEP was diagnosed according to Cotton standard, the incidence rate of PEP was compared between two groups and the high-risk influencing factors were analyzed. Results According to Cotton standard, there were only 3 patients (5.8%) diagnosed PEP in the stent placement group, all symptoms disappeared on 48 h after operation, without a diagnosis for severe acute pancreatitis. There were 9 patients (15.0%) diagnosed PEP in the non-stent placement group, and 2 patients were severe acute pancreatitis, The status was better undergoing fasting, aprotinin, anti-inflammatory, and enteral nutrition supporting treatment. The incidence of PEP was associated with younger women (age ≤45 years), Oddi sphincter dysfunction, and no dilation of bile duct (Plt;0.05). Conclusion It can obviously reduce PEP occurrence in high-risk patients with stent placement.
Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome (MS). Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangiopancreatography (ERCP) were analyzed as well as B-ultrasonography (B-us), CT scan and magnetic resonance cholangiopancreatography (MRCP). According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% (48/56) in contrast with 17.44% (15/86) by B-us, with 9.52% (4/42) by CT scan and with 71.88%（23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ, 17 cases were type Ⅲ, and 6 cases were type Ⅳ. According to the Csendes typing, the cases of type Ⅰ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳ by the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.