BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and vitamins.AIM To investigate the recovery of gastrointestinal function in patients af...BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and vitamins.AIM To investigate the recovery of gastrointestinal function in patients after hepato-biliary surgery and identify effective rehabilitation measures.METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects.They were divided into a control group and a study group based on the extent of the surgery,with 100 patients in each group.The control group received routine treatment,while the study group re-ceived targeted interventions,including early enteral nutrition support,drinking water before gas discharge,and large bowel enema,to promote postoperative gastrointestinal function recovery.The recovery of gastrointestinal function was compared between the two groups.RESULTS Compared with the control group,patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa(P<0.05).They also had shorter time to gas discharge and first meal(P<0.05),higher overall effective rate of gastrointestinal function recovery(P<0.05),and lower incidence of postoperative complications(P<0.05).CONCLUSION Targeted nursing interventions(early nutritional support,drinking water before gas discharge,and enema)can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications,which is worthy of promotion.展开更多
BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments o...BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.展开更多
目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接...目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜左肝蒂阻断术治疗。比较两组患者术后恢复指标、肝功能指标水平、生活质量调查量表(Medical Outcomes Study 36-Item Short Form Health Survey,SF-36)评分、两组患者切口感染、胆漏及腹腔积液等不良反应发生情况。结果:术后观察组各恢复指标、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)及总胆红素(Total bilirubin,TBIL)水平均低于对照组(P<0.05);治疗后观察组SF-36各方面评分均高于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(χ^(2)=4.510,P=0.034)。结论:腹腔镜下左肝蒂阻断术治疗肝内胆管结石患者有利于促进其术后恢复,缩短病程,还可促进肝功能以及生活质量的改善,安全性高。展开更多
Background:After major liver resection,the volume status of patients is still undetermined.However,few concerns have been raised about postoperative fluid management.We aimed to compare gut function recovery and short...Background:After major liver resection,the volume status of patients is still undetermined.However,few concerns have been raised about postoperative fluid management.We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection(LLR)with or without inferior vena cava(IVC)respiratory variability-directed fluid therapy in the anesthesia intensive care unit(AICU).Methods:This randomized controlled clinical trial enrolled 70 patients undergoing LLR.The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU,while the standard practice of fluid management was used for the control group.The primary outcome was the time to flatus after surgery.The secondary outcomes included other indicators of gut function recovery after surgery,postoperative length of hospital stay(LOS),liver and kidney function,the severity of oxidative stress,and the incidence of severe complications associated with hepatectomy.Results:Compared with patients receiving standard fluid management,patients in the intervention group had a shorter time to anal exhaust after surgery(1.5±0.6 days vs.2.0±0.8 days)and lower C-reactive protein activity(21.4[95%confidence interval(CI):11.9-36.7]mg/L vs.44.8[95%CI:26.9-63.1]mg/L)24 h after surgery.There were no significant differences in the time to defecation,serum concentrations of D-lactic acid,malondialdehyde,renal function,and frequency of severe postoperative complications as well as the LOS between the groups.Conclusion:Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.Trial Registration:ChiCTR-INR-17013093.展开更多
文摘BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and vitamins.AIM To investigate the recovery of gastrointestinal function in patients after hepato-biliary surgery and identify effective rehabilitation measures.METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects.They were divided into a control group and a study group based on the extent of the surgery,with 100 patients in each group.The control group received routine treatment,while the study group re-ceived targeted interventions,including early enteral nutrition support,drinking water before gas discharge,and large bowel enema,to promote postoperative gastrointestinal function recovery.The recovery of gastrointestinal function was compared between the two groups.RESULTS Compared with the control group,patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa(P<0.05).They also had shorter time to gas discharge and first meal(P<0.05),higher overall effective rate of gastrointestinal function recovery(P<0.05),and lower incidence of postoperative complications(P<0.05).CONCLUSION Targeted nursing interventions(early nutritional support,drinking water before gas discharge,and enema)can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications,which is worthy of promotion.
文摘BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.
文摘目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜左肝蒂阻断术治疗。比较两组患者术后恢复指标、肝功能指标水平、生活质量调查量表(Medical Outcomes Study 36-Item Short Form Health Survey,SF-36)评分、两组患者切口感染、胆漏及腹腔积液等不良反应发生情况。结果:术后观察组各恢复指标、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)及总胆红素(Total bilirubin,TBIL)水平均低于对照组(P<0.05);治疗后观察组SF-36各方面评分均高于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(χ^(2)=4.510,P=0.034)。结论:腹腔镜下左肝蒂阻断术治疗肝内胆管结石患者有利于促进其术后恢复,缩短病程,还可促进肝功能以及生活质量的改善,安全性高。
基金Nanjing Science and Technology Development Foundation(No.QRX17013)Nanjing Health Commission of Nanjing Municipal Government(No.YKK17084)
文摘Background:After major liver resection,the volume status of patients is still undetermined.However,few concerns have been raised about postoperative fluid management.We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection(LLR)with or without inferior vena cava(IVC)respiratory variability-directed fluid therapy in the anesthesia intensive care unit(AICU).Methods:This randomized controlled clinical trial enrolled 70 patients undergoing LLR.The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU,while the standard practice of fluid management was used for the control group.The primary outcome was the time to flatus after surgery.The secondary outcomes included other indicators of gut function recovery after surgery,postoperative length of hospital stay(LOS),liver and kidney function,the severity of oxidative stress,and the incidence of severe complications associated with hepatectomy.Results:Compared with patients receiving standard fluid management,patients in the intervention group had a shorter time to anal exhaust after surgery(1.5±0.6 days vs.2.0±0.8 days)and lower C-reactive protein activity(21.4[95%confidence interval(CI):11.9-36.7]mg/L vs.44.8[95%CI:26.9-63.1]mg/L)24 h after surgery.There were no significant differences in the time to defecation,serum concentrations of D-lactic acid,malondialdehyde,renal function,and frequency of severe postoperative complications as well as the LOS between the groups.Conclusion:Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.Trial Registration:ChiCTR-INR-17013093.
