The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amy...The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and ra...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.展开更多
In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were ...In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were reviewed. Thirteen patients developed subphrenic infection with the incidence of subphrenic infection being 6. 95%. The results of retrospective study on 187 liver resections demonstrated that the high risk factors related to subphrenic infection after hepatectomy were as follows: (1) The extent of liver resection was associated with subphrenic infection.(2) The incidence of subphrenic infection after liver resection of primary liver cancer patients with hepatic cirrhosis was higher than that of non-cirrhotic patients. (3) Intraoperative estimated blood loss greater than 1500 ml was found to be a significant risk factor in the development of postoperative subphrenic infection.(4) Adequate postoperative drainage of subdiaphragm and the raw surface of the liver was one of critical factors of decreasing subphrenic infection after liver resection.展开更多
BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepat...BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepatectomy from January 1985 throughJune 2002 were randomly divided into 2 groups accordingto resection of liver parenchyma, hepatic cirrhosis, primaryliver cancer, intraoperative blood loss, and subphrenicdrainage. The chi-square was used for statistical analysis.RESULTS: Thirteen patients (3.53%) of the 368 patientshad SI. The high-risk factors for SI after hepatectomy wererelated to resection of liver parenchyma and hepatic cirrho-sis ; but the course or stage of primary liver cancer was notrelated to the incidence of SI. Intraoperative blood loss ofover 1500 ml was found to be a significant risk factor forpostoperative SI. Adequate drainage of the subdiaphragmand the raw surface of the liver after operation was essentialto decreasing SI after liver resection.CONCLUSION: Inadequate subphrenic drainage maylargely contribute to SI in patients with hepatic malignancyundergoing hepatectomy apart from other factors. Com-prehensive measures should be taken to prevent the infec-tion after hepatectomy.展开更多
目的探讨不同压力CO_2气腹对机器人辅助腹腔镜前列腺癌根治术患者膈下疼痛的影响。方法选取机器人辅助腹腔镜前列腺癌根治术患者共150例,将其随机分为CO_2气腹压10 mm Hg、12 mm Hg、14 mm Hg 3组。采用视觉模拟评分法观察3组患者术后1...目的探讨不同压力CO_2气腹对机器人辅助腹腔镜前列腺癌根治术患者膈下疼痛的影响。方法选取机器人辅助腹腔镜前列腺癌根治术患者共150例,将其随机分为CO_2气腹压10 mm Hg、12 mm Hg、14 mm Hg 3组。采用视觉模拟评分法观察3组患者术后12 h、24 h和48 h膈下疼痛程度;记录术后膈下疼痛开始时间、膈下疼痛发生率及止痛药使用率。结果随CO_2气腹压升高,10 mm Hg组12 h、24 h和48 h膈下疼痛评分值显著下降,差异有统计学意义(P均<0.05);较之12 mm Hg组和14 mm Hg组,10mm Hg组在术后膈下疼痛开始时间、膈下疼痛发生率和止痛药使用率方面差异均有统计学意义(均P<0.05)。结论10 mm Hg的CO_2气腹压,机器人辅助腹腔镜前列腺癌根治术术后膈下疼痛程度和膈下疼痛的发生率最低,为围术期护理提供了新启示。展开更多
文摘The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.
文摘In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were reviewed. Thirteen patients developed subphrenic infection with the incidence of subphrenic infection being 6. 95%. The results of retrospective study on 187 liver resections demonstrated that the high risk factors related to subphrenic infection after hepatectomy were as follows: (1) The extent of liver resection was associated with subphrenic infection.(2) The incidence of subphrenic infection after liver resection of primary liver cancer patients with hepatic cirrhosis was higher than that of non-cirrhotic patients. (3) Intraoperative estimated blood loss greater than 1500 ml was found to be a significant risk factor in the development of postoperative subphrenic infection.(4) Adequate postoperative drainage of subdiaphragm and the raw surface of the liver was one of critical factors of decreasing subphrenic infection after liver resection.
文摘BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepatectomy from January 1985 throughJune 2002 were randomly divided into 2 groups accordingto resection of liver parenchyma, hepatic cirrhosis, primaryliver cancer, intraoperative blood loss, and subphrenicdrainage. The chi-square was used for statistical analysis.RESULTS: Thirteen patients (3.53%) of the 368 patientshad SI. The high-risk factors for SI after hepatectomy wererelated to resection of liver parenchyma and hepatic cirrho-sis ; but the course or stage of primary liver cancer was notrelated to the incidence of SI. Intraoperative blood loss ofover 1500 ml was found to be a significant risk factor forpostoperative SI. Adequate drainage of the subdiaphragmand the raw surface of the liver after operation was essentialto decreasing SI after liver resection.CONCLUSION: Inadequate subphrenic drainage maylargely contribute to SI in patients with hepatic malignancyundergoing hepatectomy apart from other factors. Com-prehensive measures should be taken to prevent the infec-tion after hepatectomy.
文摘目的探讨不同压力CO_2气腹对机器人辅助腹腔镜前列腺癌根治术患者膈下疼痛的影响。方法选取机器人辅助腹腔镜前列腺癌根治术患者共150例,将其随机分为CO_2气腹压10 mm Hg、12 mm Hg、14 mm Hg 3组。采用视觉模拟评分法观察3组患者术后12 h、24 h和48 h膈下疼痛程度;记录术后膈下疼痛开始时间、膈下疼痛发生率及止痛药使用率。结果随CO_2气腹压升高,10 mm Hg组12 h、24 h和48 h膈下疼痛评分值显著下降,差异有统计学意义(P均<0.05);较之12 mm Hg组和14 mm Hg组,10mm Hg组在术后膈下疼痛开始时间、膈下疼痛发生率和止痛药使用率方面差异均有统计学意义(均P<0.05)。结论10 mm Hg的CO_2气腹压,机器人辅助腹腔镜前列腺癌根治术术后膈下疼痛程度和膈下疼痛的发生率最低,为围术期护理提供了新启示。
