近十余年来，加速康复外科（enhanced recovery after surgery，ERAS）的理念及其路径在我国有了较为迅速的普及和应用。ERAS的临床实践表明，其理念及相关路径的实施必须以循证医学及多学科合作为基础，既要体现以加速康复为主要目的...近十余年来，加速康复外科（enhanced recovery after surgery，ERAS）的理念及其路径在我国有了较为迅速的普及和应用。ERAS的临床实践表明，其理念及相关路径的实施必须以循证医学及多学科合作为基础，既要体现以加速康复为主要目的的核心理念，也要兼顾病人基础疾病、展开更多
Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgi...Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy （PD）, plus extrahepatic bile duct resection and regional lyrnphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD （hepatopancreatoduodenectomy） has been applied to selected patients with widespread tumors. Preoperative biliary drainage （BD） followed by portal vein embolization （PVE） enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.展开更多
目的检索胰十二指肠切除术后患者早期肠内营养的相关证据,并对最佳证据进行总结,为临床护士实施胰十二指肠切除术后早期肠内营养管理提供循证依据。方法计算机检索UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健国际...目的检索胰十二指肠切除术后患者早期肠内营养的相关证据,并对最佳证据进行总结,为临床护士实施胰十二指肠切除术后早期肠内营养管理提供循证依据。方法计算机检索UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健国际合作中心图书馆、Cochrane Library、英国国家临床优化研究所、美国肠外肠内营养学会、欧洲临床营养与代谢学会、PubMed、中国生物医学文献数据库、维普、中国知网和万方数据库中关于胰十二指肠切除术后患者早期肠内营养的所有证据,包括指南、专家共识、系统评价、Meta分析。检索时限为建库至2020年6月15日。由2名经过循证培训的研究者独立完成文献的质量评价,并结合专业人士的意见,对符合质量标准的文献进行证据提取及总结。结果初步检索共获得文献281篇,最终纳入12篇文献,包括4篇指南、1篇专家共识、2篇系统评价、5篇Meta分析,从早期肠内营养适应证及安全性评估、开展早期肠内营养的时机、途径的选择以及目标营养需要量管理4个方面汇总11条最佳证据。结论胰十二指肠切除术后患者早期进行肠内营养安全可行。在实施早期肠内营养的管理中,护理人员应结合临床情境、医护人员应用证据的促进因素及阻碍因素、患者意愿选择最佳证据,以形成科学、有循证依据的胰十二指肠切除术后早期肠内营养管理方案,从而加速患者康复,提升护理质量。展开更多
BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definitio...BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.展开更多
目的探讨黄疸对胰十二指肠切除术(PD)的影响。方法对本院1998年1月至2004年6月195例行 PD 术的临床资料进行回顺性分析。以有无黄疸及黄疸的程度将病例分成三组,无黄疸者为 A 组(n=61);黄疸病人中总胆红素(TIBL)<171μmol/L 者为 B ...目的探讨黄疸对胰十二指肠切除术(PD)的影响。方法对本院1998年1月至2004年6月195例行 PD 术的临床资料进行回顺性分析。以有无黄疸及黄疸的程度将病例分成三组,无黄疸者为 A 组(n=61);黄疸病人中总胆红素(TIBL)<171μmol/L 者为 B 组(n=70);TIBL≥171μmol/L 者为 C 组(n=64)。将三组的一般背景资料和主要并发症发生例数进行两两比较,采用SPSS10.0统计学软件对数据进行统计学分析。结果术中出血,C 组(1180.6±1 321.4)ml,高于 B组(807.9±558.7)ml,差异有显著意义(t=2.159、P<0.05)。术后并发上消化道出血,C 组15.6%,高于 B 组4.3%,差异有显著意义(x^2=0.027、P<0.05)。术后并发肾功能衰竭,C 组12.5%,分别高于 A 组1.6%和 B 组2.9%,差异有显著意义(x^2=0.019、P<0.05,x^2=0.034、P<0.05)。结论梗阻性黄疸虽然是 PD 术的危险因素之一,但对重症黄疸只要认真进行围手术期准备,对没有严重合并症的病人行一期 PD 术还是可行的。展开更多
文摘Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy （PD）, plus extrahepatic bile duct resection and regional lyrnphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD （hepatopancreatoduodenectomy） has been applied to selected patients with widespread tumors. Preoperative biliary drainage （BD） followed by portal vein embolization （PVE） enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.
文摘目的检索胰十二指肠切除术后患者早期肠内营养的相关证据,并对最佳证据进行总结,为临床护士实施胰十二指肠切除术后早期肠内营养管理提供循证依据。方法计算机检索UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健国际合作中心图书馆、Cochrane Library、英国国家临床优化研究所、美国肠外肠内营养学会、欧洲临床营养与代谢学会、PubMed、中国生物医学文献数据库、维普、中国知网和万方数据库中关于胰十二指肠切除术后患者早期肠内营养的所有证据,包括指南、专家共识、系统评价、Meta分析。检索时限为建库至2020年6月15日。由2名经过循证培训的研究者独立完成文献的质量评价,并结合专业人士的意见,对符合质量标准的文献进行证据提取及总结。结果初步检索共获得文献281篇,最终纳入12篇文献,包括4篇指南、1篇专家共识、2篇系统评价、5篇Meta分析,从早期肠内营养适应证及安全性评估、开展早期肠内营养的时机、途径的选择以及目标营养需要量管理4个方面汇总11条最佳证据。结论胰十二指肠切除术后患者早期进行肠内营养安全可行。在实施早期肠内营养的管理中,护理人员应结合临床情境、医护人员应用证据的促进因素及阻碍因素、患者意愿选择最佳证据,以形成科学、有循证依据的胰十二指肠切除术后早期肠内营养管理方案,从而加速患者康复,提升护理质量。
文摘BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.
文摘目的探讨黄疸对胰十二指肠切除术(PD)的影响。方法对本院1998年1月至2004年6月195例行 PD 术的临床资料进行回顺性分析。以有无黄疸及黄疸的程度将病例分成三组,无黄疸者为 A 组(n=61);黄疸病人中总胆红素(TIBL)<171μmol/L 者为 B 组(n=70);TIBL≥171μmol/L 者为 C 组(n=64)。将三组的一般背景资料和主要并发症发生例数进行两两比较,采用SPSS10.0统计学软件对数据进行统计学分析。结果术中出血,C 组(1180.6±1 321.4)ml,高于 B组(807.9±558.7)ml,差异有显著意义(t=2.159、P<0.05)。术后并发上消化道出血,C 组15.6%,高于 B 组4.3%,差异有显著意义(x^2=0.027、P<0.05)。术后并发肾功能衰竭,C 组12.5%,分别高于 A 组1.6%和 B 组2.9%,差异有显著意义(x^2=0.019、P<0.05,x^2=0.034、P<0.05)。结论梗阻性黄疸虽然是 PD 术的危险因素之一,但对重症黄疸只要认真进行围手术期准备,对没有严重合并症的病人行一期 PD 术还是可行的。
