Objective To improve the effect of surgical treatment for complex alveolar hydatid echinococcosis through multidisciplinary team (MDT) discussion. Methods The clinical data of 1 case of complicated alveolar echinococcosis treated in West China Hospital were discussed by MDT, and the best operation scheme was selected and followed-up for the patients. Results The CT imaging of the patient suggested the infringement of the first and second hepatic portal and inferior vena cava, decided to discuss the radical right hepatectomy and three biliary intestinal anastomosis by MDT, postoperative application of albendazole, was discharged after 12 months follow-up showed no recurrence of hepatic echinococcosis, and left liver obvious regeneration. Conclusion Complicated alveolar echinoccosis excision rate is low by surgical methods, through the discussion of MDT multidisciplinary can increase the efficacy of surgical treatment.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.
Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.
Objective To summarize the specific treatment for a patient diagnosed with recurrence of hepatocellular carcinoma following liver transplantation. Methods Considering the patient’s condition, multidisciplinary team (MDT) consultation of the specialists in radiology, oncology, radiotherapy, and liver surgery was conducted. Results After the MDT consultation, the patient was advised to receive surgery if the metastasis could be excluded. Surgical removal of the mass located at the body and tail of pancreas+splenectomy+enterodialysis was conducted. The alpha fetoprotein (AFP) level and abdominal CT were reviewed and no recurrence was found during the follow up period (by the end of May. 2018). Conclusion The MDT mechanism could provide individualized treatment for patients with complicated hepatocellular carcinoma and benefit those patients.
ObjectiveTo summarize experience of multidisciplinary team (MDT) in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis and explore its clinical differentiation with other common types of intrahepatic pneumatosis.MethodThe clinicopathologic data of rare patient with circumscriptus intrahepatic pneumatosis admitted to the Occupational Disease Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.ResultsA 60-year old female patient was admitted to this hospital with " abdominal pain and septic shock”. After the MDT discussion and analysis, the treatment regimens were decided as follows: the early anti-shock treatment, corrections of electrolyte disorder and hypoalbuminemia, platelet transfusion, ultrasound guided percutaneous catheter drainage (200 mL gas and 10 mL pus, the pneumonic Klebsiella which proved by the bacterial culture). The drainage tube was removed on postoperative day 6. After 5 d of the anti-inflammatory treatment with imipenem and statin sodium injection, it was downgraded to the cefazoxime (the third-generation cephalosporin) injection, and the anti-inflammatory treatment was continued for 6 d as well as the blood glucose was controlled. On the 7th day after the treatment, the right upper abdomen pain was relieved and without positive sign. The abdominal CT showed the localized pneumoconiosis in the right lobe of the liver was completely absorbed. The result of laboratory examination was basically normal. The patient was discharged on the 12th day after the operation and had no discomfort symptoms on month 1 after the operation. The abdominal CT showed the liver was not abnormal.ConclusionSurgeons should be fully aware of various types of intrahepatic pneumatosis so as to sufficiently investigate pathophysiological clue of disease to improve cure rate and reduce complications.
ObjectiveTo introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly.MethodsBy consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed.ResultsThe elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients.ConclusionSignificant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.
ObjectiveTo summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.MethodsThe literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.ResultsClinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.ConclusionThe application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.
ObjectiveTo explore value of multidisciplinary team (MDT) discussion in comprehensive downstaging treatment of liver cancer.MethodThe clinical data of 2 patients with liver cancer who could not undergo the radical surgery admitted to the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.ResultsCase 1 was diagnosed as the liver cancer with extensive double lung metastasis at admission. The clinical stage was stage Ⅲb; After MDT discussion, the patient was treated with chemotherapy and embolization via hepatic artery and bronchial artery; At the same time, the patient was treated with apatinib; At present, the metastasis of both lungs disappeared completely; The clinical stage was stage ⅡB, and the radical resection was proposed. Case 2 was diagnosed as the right liver cancer at admission. The clinical stage was stage Ⅰ b. The preoperative examination showed that the hepatic reserve function was poor and the patient could not tolerate the half hepatectomy; After MDT discussion, the patient was treated with the combination of chemotherapy and embolization via the hepatic artery and apatinib in the same period; At the same time, the patient was treated with liver protection. The clinical stage was reduced to stage Ⅰ a. The hepatic reserve function improved and the laparoscopic right hemihepatectomy was performed, no recurrence or metastasis was found after 3 months follow-up.ConclusionComprehensive downstaging treatment based on MDT model could bring better clinical outcomes for patients with liver cancer who are unable to undergo one-stage radical surgery.
ObjectiveTo discuss the diagnosis and endoscopic therapy of pancreaticobiliary maljunction by multidisciplinary team (MDT).MethodThe preoperative MDT discussion and the diagnosis and treatment process of patient with pancreaticobiliary maljunction in the Fifth People’s Hospital of Zunyi in 2019 were summarized.ResultsThe patient was admitted for “upper abdominal pain approximately 10 h”. The obvious extramural confluence of the pancreaticobiliary tract was observed and the length of common channel was approximately 1.8 cm. But the junction of the pancreaticobiliary tract was obviously controlled by the sphincter of Oddi, and the amylase value of the bile was higher than that of the serum. After the MDT discussion, there were still doubts about the diagnosis of pancreaticobiliary maljunction or high confluence of pancreaticobiliary ducts. After the left hepatic lateral lobectomy and exploration of common bile duct, the amylase value of bile, which was collected by the T-tube, was still obviously increased. Then the endoscopic sphincterotomy was performed, the amylase value of the bile decreased obviously and no abnormality was found in the follow-up for half a year after discharge.ConclusionsConcept and diagnostic criteria of “Japanese clinical practice guidelines for pancreaticobiliary maljunction” are conflicting and inaccurate. Severity of pancreaticobiliary reflux and change of amylase value of bile might have a more important diagnostic value. Endoscopic sphincterotomy might be suitable for a few special types of pancreaticobiliary maljunction.
ObjectiveTo study the diagnosis and treatment of multiple neuroendocrine carcinoma.MethodClinical data of a case of multiple neuroendocrine carcinoma was retrospective analyzed.ResultsAfter discussion by a multidisciplinary team (MDT), the patient was diagnosed as multiple neuroendocrine carcinoma with late clinical stage and inoperable. Chemotherapy and radiotherapy were given, which showed significant effects, and the patient died after 1 year of follow-up.ConclusionIn the clinical diagnosis and treatment of patients with multiple neuroendocrine carcinoma, MDT cooperative treatment model should be adopted to provide a better treatment program.