BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter d...BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.展开更多
Previous study has demonstrated that the peripheral blood CD44 expression level is related with the clinical stage and lymph node metastasis of lung cancer. The present comment was to investigate the relationship betw...Previous study has demonstrated that the peripheral blood CD44 expression level is related with the clinical stage and lymph node metastasis of lung cancer. The present comment was to investigate the relationship between the peripheral blood CD44 expression level and clinic pathological change in 50 patients with non-small cell lung cancer (NSCLC) by flow cytometry method. The results showed that 1) the peripheral blood CD44 expression level in the NSCLC group was higher than that in the benign group (467 ± 15) or the normal group (448 ± 15);2) operation decreased the peripheral blood CD44 expression level in the NSCLC group (533 ± 10 vs. 324 ± 11);3) it also showed same results in NSCLC patients with and without lymph node metastasis (559 ± 12 vs. 477 ± 15) or before and after chemotherapy (550 ± 13 vs. 372 ± 10);4) there were significant differences in the peripheral blood CD44 expression level in non-small cell lung cancer patients of the clinical stage I, II, III and IV (474 ± 14, 526 ± 12, 528 ± 16 and 599 ± 20);And the peripheral blood CD44 expression level was not associated with the clinical pathology parameter including the patient age, gender and tumor size. The data suggested that the peripheral blood CD44 expression level was related with the NSCLC progress, lymphatic metastasis and clinical treatment, and the peripheral blood CD44 expression level as the clinical regular examination should evaluate the progress, lymphatic metastasis and clinical treatment for the patients with NSCLC.展开更多
To the Editor:Patients who undergo emergency general surgery(EGS)procedures are up to eight times more likely to die than those undergoing the same procedure electively.[1]The development of an appropriate EGS risk st...To the Editor:Patients who undergo emergency general surgery(EGS)procedures are up to eight times more likely to die than those undergoing the same procedure electively.[1]The development of an appropriate EGS risk stratification tool could facilitate accurate triage of high-risk patients,thereby supporting surgical decision-making,informed consent,and identification of EGS patients for transfer to a higher level of care.[2]However,the ideal EGS risk stratification tool does not exist yet.In 2016,a uniform system[American Association for the Surgery of Trauma(AAST)grade]for measuring anatomic severity of 16 common EGS diseases has been reported by the AAST Patient Assessment Committee.Simultaneously,the committee pointed out that this system is not intended to serve alone as a predictor of outcome.Other important factors of the outcome,such as physiological status,comorbidities,age,and complexity of operation procedures,should be integrated into the system for risk stratification.[3]In our EGS center,the spectrum of diseases is mainly abdominal related diseases among the 16 diseases including acute appendicitis,acute cholecystitis,acute diverticulitis of the colon,hernias,infectious colitis,intestinal obstruction,acute pancreatitis,pelvic inflammatory disease,perirectal abscess,and perforated peptic ulcer.We have identified abdominal related EGS diseases complicated with sepsis to be a major cause of morbidity and mortality in our EGS center.We assumed that the integration of anatomical severity of EGS diseases plus physiological severity and other parameters(eg,intra-operative variables,age,and comorbidities)together could work better.Thus,this study aimed to develop and validate a nomogram for predicting post-operative in-hospital outcome in abdominal related EGS diseases complicated with sepsis.展开更多
基金This work was supported by the Clinical Research Physician Program of Tongji Medical College,Huazhong University of Science and Technology。
文摘BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.
文摘Previous study has demonstrated that the peripheral blood CD44 expression level is related with the clinical stage and lymph node metastasis of lung cancer. The present comment was to investigate the relationship between the peripheral blood CD44 expression level and clinic pathological change in 50 patients with non-small cell lung cancer (NSCLC) by flow cytometry method. The results showed that 1) the peripheral blood CD44 expression level in the NSCLC group was higher than that in the benign group (467 ± 15) or the normal group (448 ± 15);2) operation decreased the peripheral blood CD44 expression level in the NSCLC group (533 ± 10 vs. 324 ± 11);3) it also showed same results in NSCLC patients with and without lymph node metastasis (559 ± 12 vs. 477 ± 15) or before and after chemotherapy (550 ± 13 vs. 372 ± 10);4) there were significant differences in the peripheral blood CD44 expression level in non-small cell lung cancer patients of the clinical stage I, II, III and IV (474 ± 14, 526 ± 12, 528 ± 16 and 599 ± 20);And the peripheral blood CD44 expression level was not associated with the clinical pathology parameter including the patient age, gender and tumor size. The data suggested that the peripheral blood CD44 expression level was related with the NSCLC progress, lymphatic metastasis and clinical treatment, and the peripheral blood CD44 expression level as the clinical regular examination should evaluate the progress, lymphatic metastasis and clinical treatment for the patients with NSCLC.
文摘To the Editor:Patients who undergo emergency general surgery(EGS)procedures are up to eight times more likely to die than those undergoing the same procedure electively.[1]The development of an appropriate EGS risk stratification tool could facilitate accurate triage of high-risk patients,thereby supporting surgical decision-making,informed consent,and identification of EGS patients for transfer to a higher level of care.[2]However,the ideal EGS risk stratification tool does not exist yet.In 2016,a uniform system[American Association for the Surgery of Trauma(AAST)grade]for measuring anatomic severity of 16 common EGS diseases has been reported by the AAST Patient Assessment Committee.Simultaneously,the committee pointed out that this system is not intended to serve alone as a predictor of outcome.Other important factors of the outcome,such as physiological status,comorbidities,age,and complexity of operation procedures,should be integrated into the system for risk stratification.[3]In our EGS center,the spectrum of diseases is mainly abdominal related diseases among the 16 diseases including acute appendicitis,acute cholecystitis,acute diverticulitis of the colon,hernias,infectious colitis,intestinal obstruction,acute pancreatitis,pelvic inflammatory disease,perirectal abscess,and perforated peptic ulcer.We have identified abdominal related EGS diseases complicated with sepsis to be a major cause of morbidity and mortality in our EGS center.We assumed that the integration of anatomical severity of EGS diseases plus physiological severity and other parameters(eg,intra-operative variables,age,and comorbidities)together could work better.Thus,this study aimed to develop and validate a nomogram for predicting post-operative in-hospital outcome in abdominal related EGS diseases complicated with sepsis.
