BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutane...BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.展开更多
BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage...BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage or biliary stent placement is a preferable choice,the tumor cannot be controlled.This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage,thereby prolonging the survival time of patients.CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice.He was admitted to the hospital because of the recurrence of jaundice.Preoperative imaging and pathological biopsy revealed hilar CC(Bismuth-Corlette type IIIa).First,the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved.To further treat hilar CC and remove the biliary drainage tube as far as possible,the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation.After 1 mo of brachytherapy,the re-examination revealed that the obstructive lesions disappeared,and the drainage tube was finally removed.During the following 10 mo of follow-up,the patient's hilar CC did not recur.CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.展开更多
BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS ...BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.展开更多
For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not r...For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.展开更多
BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical di...BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.展开更多
Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Periphe...Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Peripheral Vascular Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between June 21,2021 and February 1,2023,and randomized into an intervention group and a control group,with 68 cases in each group.Both groups received basic treatment.The intervention group was treated with thread-dragging therapy,while the control group was treated with debridement combined with routine dressing changes after surgery.Both groups were treated continuously for 2 months.The amputation rates and changes in the ulcer area were compared between the groups.The inflammatory response index including peripheral white blood cells(WBCs),neutrophil percentage(NEUT%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and interleukin 6(IL-6)were compared between the two groups.Results After treatment,the ulcer areas in the intervention group were significantly smaller than that of the control group(8.50±3.88 cm^(2) vs.10.11±4.61 cm^(2),P<0.05).The amputation rates of the two groups were not statistically significant(4.4%vs.5.9%,P>0.05).Differences of WBCs count,CRP,and ESR before and after therapy in the intervention group were better than the control group(P<0.05).However,there were no significant differences in changes of NEUT%,PCT,and IL-6 between the two groups(P>0.05).Conclusion Thread-dragging therapy may be effective in the treatment of NIDFU,with the additional advantages of less tissue damage after healing.(Registration No.ChiCTR2100047496)展开更多
The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is poor.More than 50%of patients with jaundice are inoperable at the time of first diagnosis.Endoscopic treatment in patients wit...The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is poor.More than 50%of patients with jaundice are inoperable at the time of first diagnosis.Endoscopic treatment in patients with obstructive jaundice ensures bile duct drainage in preoperative or palliative settings.Relief of symptoms(pain,pruritus,jaundice)and improvement in quality of life are the aims of palliative therapy.Stent implantation by endoscopic retrograde cholangiopancreatography is generally preferred for long-term palliation.There is a vast variety of plastic and metal stents,covered or uncovered.The stent choice depends on the expected length of survival,quality of life,costs and physician expertise.This review will provide the framework for the endoscopic minimally invasive therapy in extrahepatic cholangiocarcinoma.Moreover,additional therapies,such as brachytherapy,photodynamic therapy,radiofrequency ablation,chemotherapy,molecular-targeted therapy and/or immunotherapy by the endoscopic approach,are the nonsurgical methods associated with survival improvement rate and/or local symptom palliation.展开更多
Background:Cholestasis should be relieved by biliary drainage prior to major liver resection.This condition is often associated with bacterial colonization of the otherwise sterile biliary system.Cholangitis reduces t...Background:Cholestasis should be relieved by biliary drainage prior to major liver resection.This condition is often associated with bacterial colonization of the otherwise sterile biliary system.Cholangitis reduces the regenerative capacity of the remaining liver.Therefore,targeted antibiotic therapy is a key feature in perioperative treatment in patients with perihilar cholangiocarcinoma(pCCC).Methods:Between December 1999 and December 2017,251 pCCC patients were treated in our center.In total,115 patients underwent a microbiological analysis.In addition to the characterization of the specific microorganisms and antibiotic resistance,we analyzed subgroups according to preoperative intervention.Results:Enterococci(87/254,34%)and Enterobacteria(65/254,26%)were the most frequently detected genera.In 43%(50/115)of patients,Enterococcus faecalis was found in the bile duct sample.Enterococcus faecium(29/115)and Escherichia coli(29/115)were detected in 25%of patients.In patients with percutaneous transhepatic biliary drainage(3/8,38%)or stents(24/79,30%),Enterococcus faecium was diagnosed most frequently(P<0.05).Enterococcus faecium and Klebsiella oxytoca were significantly more frequently noted in the time period after 2012(P<0.05).With regard to fungal colonization,the focus was on various Candida strains,but these strains generally lacked resistance.Conclusions:pCCC patients exhibit specific bacterial colonization features depending on the type of preoperative biliary intervention.Specifically,targeted antibiosis should be applied in this patient cohort to minimize the risk of biliary complications after major liver resection.In our cohort,the combination of meropenem and vancomycin represents an effective perioperative medical approach.展开更多
Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities.Methods Seventeen patients with unilateral lower limb elephantiasis were includ...Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities.Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study(5 with primary lymphedema and 12 with secondary lymphedema).All patients were treated with one course(4 weeks)of complex decongestive therapy.Changes inextracellular fluid(ECF),BMI,circumferences,and skin properties including skin stiffness(SF),percent water content(PWC),and trans-epidermal water loss(TEWL)were measured before and after treatment.Results The“elephantiasis-like”appearance of the affected limb was greatly improved after treatment.The ECF,BMI,and circumferences were significantly decreased after treatment(P<0.001)with an average ECF of 2.97±1.82 L,BMI of 1.638±2.647 kg/m^2,and circumference of 6.58±2.79 cm.The values of PWC,TEWL,and SFwere 50.5%±10.6%,18.55±10.2 g/m^2 h,and 0.161±0.176 N,respectively,before treatment and 36.05%±7%,8.3±2.07 g/m^2h,and 0.086±0.038 N,respectively,after treatment,there by showing significant decreases(P<0.05).Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.展开更多
基金the Young Talent Program of LongHua Hospital Shanghai University of Traditional Chinese Medicine,No.RC-2019-01-01and the Shanghai Three-year Action Plan of Further Accelerated Development in Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-1007.
文摘BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.
文摘BACKGROUND Hilar cholangiocarcinoma(CC)is a common malignant tumor with high malignancy and poor prognosis.Most patients have lost the opportunity to undergo radical surgery when diagnosed.Although palliative drainage or biliary stent placement is a preferable choice,the tumor cannot be controlled.This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage,thereby prolonging the survival time of patients.CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice.He was admitted to the hospital because of the recurrence of jaundice.Preoperative imaging and pathological biopsy revealed hilar CC(Bismuth-Corlette type IIIa).First,the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved.To further treat hilar CC and remove the biliary drainage tube as far as possible,the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation.After 1 mo of brachytherapy,the re-examination revealed that the obstructive lesions disappeared,and the drainage tube was finally removed.During the following 10 mo of follow-up,the patient's hilar CC did not recur.CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.
文摘BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.
基金Supported by Sanming Project of Medicine in Shenzhen,No.SZSM202211029.
文摘For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.
基金Supported by Research fund of Dankook University in 2023,No.R202300627.
文摘BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.
基金Supported by the Health and Family Planning Research Project of Pudong New Area Health Committee,Shanghai,China(No.PW2020E-4)。
文摘Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Peripheral Vascular Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between June 21,2021 and February 1,2023,and randomized into an intervention group and a control group,with 68 cases in each group.Both groups received basic treatment.The intervention group was treated with thread-dragging therapy,while the control group was treated with debridement combined with routine dressing changes after surgery.Both groups were treated continuously for 2 months.The amputation rates and changes in the ulcer area were compared between the groups.The inflammatory response index including peripheral white blood cells(WBCs),neutrophil percentage(NEUT%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and interleukin 6(IL-6)were compared between the two groups.Results After treatment,the ulcer areas in the intervention group were significantly smaller than that of the control group(8.50±3.88 cm^(2) vs.10.11±4.61 cm^(2),P<0.05).The amputation rates of the two groups were not statistically significant(4.4%vs.5.9%,P>0.05).Differences of WBCs count,CRP,and ESR before and after therapy in the intervention group were better than the control group(P<0.05).However,there were no significant differences in changes of NEUT%,PCT,and IL-6 between the two groups(P>0.05).Conclusion Thread-dragging therapy may be effective in the treatment of NIDFU,with the additional advantages of less tissue damage after healing.(Registration No.ChiCTR2100047496)
文摘The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is poor.More than 50%of patients with jaundice are inoperable at the time of first diagnosis.Endoscopic treatment in patients with obstructive jaundice ensures bile duct drainage in preoperative or palliative settings.Relief of symptoms(pain,pruritus,jaundice)and improvement in quality of life are the aims of palliative therapy.Stent implantation by endoscopic retrograde cholangiopancreatography is generally preferred for long-term palliation.There is a vast variety of plastic and metal stents,covered or uncovered.The stent choice depends on the expected length of survival,quality of life,costs and physician expertise.This review will provide the framework for the endoscopic minimally invasive therapy in extrahepatic cholangiocarcinoma.Moreover,additional therapies,such as brachytherapy,photodynamic therapy,radiofrequency ablation,chemotherapy,molecular-targeted therapy and/or immunotherapy by the endoscopic approach,are the nonsurgical methods associated with survival improvement rate and/or local symptom palliation.
文摘Background:Cholestasis should be relieved by biliary drainage prior to major liver resection.This condition is often associated with bacterial colonization of the otherwise sterile biliary system.Cholangitis reduces the regenerative capacity of the remaining liver.Therefore,targeted antibiotic therapy is a key feature in perioperative treatment in patients with perihilar cholangiocarcinoma(pCCC).Methods:Between December 1999 and December 2017,251 pCCC patients were treated in our center.In total,115 patients underwent a microbiological analysis.In addition to the characterization of the specific microorganisms and antibiotic resistance,we analyzed subgroups according to preoperative intervention.Results:Enterococci(87/254,34%)and Enterobacteria(65/254,26%)were the most frequently detected genera.In 43%(50/115)of patients,Enterococcus faecalis was found in the bile duct sample.Enterococcus faecium(29/115)and Escherichia coli(29/115)were detected in 25%of patients.In patients with percutaneous transhepatic biliary drainage(3/8,38%)or stents(24/79,30%),Enterococcus faecium was diagnosed most frequently(P<0.05).Enterococcus faecium and Klebsiella oxytoca were significantly more frequently noted in the time period after 2012(P<0.05).With regard to fungal colonization,the focus was on various Candida strains,but these strains generally lacked resistance.Conclusions:pCCC patients exhibit specific bacterial colonization features depending on the type of preoperative biliary intervention.Specifically,targeted antibiosis should be applied in this patient cohort to minimize the risk of biliary complications after major liver resection.In our cohort,the combination of meropenem and vancomycin represents an effective perioperative medical approach.
文摘Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities.Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study(5 with primary lymphedema and 12 with secondary lymphedema).All patients were treated with one course(4 weeks)of complex decongestive therapy.Changes inextracellular fluid(ECF),BMI,circumferences,and skin properties including skin stiffness(SF),percent water content(PWC),and trans-epidermal water loss(TEWL)were measured before and after treatment.Results The“elephantiasis-like”appearance of the affected limb was greatly improved after treatment.The ECF,BMI,and circumferences were significantly decreased after treatment(P<0.001)with an average ECF of 2.97±1.82 L,BMI of 1.638±2.647 kg/m^2,and circumference of 6.58±2.79 cm.The values of PWC,TEWL,and SFwere 50.5%±10.6%,18.55±10.2 g/m^2 h,and 0.161±0.176 N,respectively,before treatment and 36.05%±7%,8.3±2.07 g/m^2h,and 0.086±0.038 N,respectively,after treatment,there by showing significant decreases(P<0.05).Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.
