2016年 · 第31卷第08期

The minimally invasive treatment of surgical diseases is the general development trend of surgery at present, and it is a kind of disease treatment mode that human beings strive for. The development of vascular diseases from giant invasive surgery to intracavitary minimally invasive treatment fully reflects the development trend of minimally invasive surgery and the progress of modern medicine. Patients with aortic disease are often old and frail, with many systemic diseases, and it is difficult to bear long-time and traumatic open surgery. The intracavitary minimally invasive treatment technique with short time, little trauma and fast postoperative recovery is the first choice for such patients.

For bacterial liver abscess, systemic antibiotics are commonly used for treatment, but the effect is slow. We used ultrasound-guided puncture catheter drainage of liver abscess + percutaneous puncture intrahepatic portal vein catheter micropump infusion of antibiotics for treatment, and achieved good results, which are reported below.

Compared with men, female inguinal hernia has its own characteristics. A total of 87 adult female patients with inguinal hernia were treated in the Department of Hernia Surgery, Affiliated Hospital of Qinghai University from April 2010 to May 2015. The reports are as follows.

Infection is one of the main postoperative complications and death causes in patients with malignant tumors, so early prediction and control of infection is one of the keys to reduce postoperative mortality in patients with cancer. procalcitonin (PCT) is a serological marker of infection, and there are few reports at home and abroad on its application in infection of cancer patients. From December 2012 to January 2014, Tianjin Medical University Cancer Hospital conducted postoperative PCT studies in 94 patients with malignant tumor infection in intensive care unit (ICU), and the reports are as follows.

Obturator hernia is a rare external abdominal hernia in clinic. It is an abnormal protrusion of preperitoneal fat or intestinal tube through the obturator, accounting for 0.05% to 0.40% of all hernias. Because of its characteristics of deep occurrence site, small hernia ring and inelasticity, the imprisoned intestinal tube is strangulated in a short period of time, and the mortality rate is high^[1]。 A total of 8 cases of obturator hernia were treated in the Second Affiliated Hospital of South China University from January 2004 to March 2015, which are now reported as follows.

Abdominal wall hematoma is a special type of abdominal wall injury, which is rare in clinic. For abdominal wall hematoma, early, timely and effective treatment is crucial. Conservative treatment is slow to recover, and surgical treatment is more traumatic. From July 2010 to January 2015, Huai' an Second People's Hospital affiliated to Xuzhou Medical College treated 18 patients with abdominal wall hematoma with percutaneous puncture and catheter thrombolysis and drainage, which are reported as follows.

hiatal hernia (HH) is a condition caused by the entry of abdominal organs (mainly the stomach) into the thoracic cavity through the diaphragmatic esophageal hiatus. The presence of HH causes the enlargement of esophageal hiatus and the weakening of the function of lower esophageal sphincter, which easily leads to the occurrence of gastroesophageal reflux disease (GERD). Laparoscopic fundoplication is a classic procedure for the treatment of GERD. When these patients are accompanied by HH, the hiatal hernia is usually repaired directly, followed by fundoplication. However, whether the existence of HH has an influence on the symptoms and treatment effect of GERD before and after anti-reflux surgery is not reported in relevant literature at home and abroad. From December 2012 to December 2014, 76 patients with symptomatic HH were admitted to the Interventional Department of the First Affiliated Hospital of Zhengzhou University, which are now reported as follows.

bone morphogenetic proteins-8B (BMP8B) belong to the BMP gene family. We investigated the relationship between the expression of BMP8B and the proliferation and apoptosis of pancreatic cancer cells.

The patient was a 43-year-old male of Tibetan nationality. He was admitted to the hospital on April 27, 2014 with the main complaint of "pain in the right inguinal area for 1 d, aggravated for 2 h". The patient suddenly experienced dull pain in the right inguinal area during work 1 d before admission, which was not paid attention to at that time. The pain worsened 2 h before admission, showed persistent distension and pain, and radiated to the lower abdomen and perineum. With nausea and no vomiting, history of right lateral cryptorchidism for decades. Physical examination: body temperature 36.6 ℃, pulse 86 beats/min, breathing 20 beats/min, blood pressure 100/70 mmHg. With a painful expression, he was helped into the ward and put himself in passive position. No obvious positive signs were seen in the abdominal abdomen. The right inguinal area tenderness is obvious, and a mass the size of a "pigeon egg" can be palpable. The texture is not hard and the mobility is acceptable. The right scrotum was empty, tenderness was positive, and the testes were not touched. No abnormalities were observed in the left scrotum and testes. B-ultrasound showed that a hypoechoic mass of 3.3 cm ×2.1 cm ×1.1 cm could be detected in the right inguinal area, and the internal echo was uniform in the clear border. No testis was detected in the right scrotum, and no abnormalities were found in other auxiliary examinations. Admission diagnosis: acute testicular torsion. Right testicular exploration was performed in emergency department. Take an incision in the right inguinal area, enter layer by layer, and the testis can be seen at the outer ring mouth. The testis is atrophied, the color is normal, and the testis and spermatic cord are not twisted. Fluid was seen in the cavity of the testicular sheath, and about 10 ml of purulent fluid was seen when the testicular sheath was incised. The inguinal canal was dissected, the sheath cavity of the testis communicated with the abdominal cavity, the appendix was imprisoned at the inner ring, the root of the appendix was perforated, and it was slightly adhered to the surrounding tissues. Protect the incision in the inguinal area, then take the right lower abdomen to explore the incision through the rectus abdominis muscle and enter the abdomen, release the inner ring, and also accommodate the herniated appendix. See that the appendix is about 4 cm long and 2 cm in diameter, with obvious edema and congestion, a fecal stone obstruction at the root, and a small amount of turbid exudate in the pelvic cavity. The appendix is routinely removed. After cleaning the abdominal cavity, a drainage tube is placed to close the abdominal cavity. After the inguinal incision was washed with iodophor solution, the hernia sac was free and sutured at a high position, and part of the testicular sheath was removed. A negative pressure drainage tube was placed in the inguinal area, which was drawn out and fixed along the low position of the scrotum, and the incision in the inguinal area was sutured. After operation, anti-infection support treatment was given, and he was cured and discharged. Testicular descent surgery and hernia repair are recommended after 6 months. Postoperative pathological diagnosis: acute suppurative appendicitis with perforation. Postoperative diagnosis: (1) acute suppurative appendicitis with perforation, (2) Amyand's hernia, (3) right testicular sheath cavity abscess, (4) right cryptorchidism. There was no abnormality after 2 months of follow-up.

A 75-year-old male was admitted to the hospital for the first time on 28 April 2014 due to "sudden thoracic and back pain for 14 days". He underwent vascular CTA examination and was diagnosed as an aortic dissection aneurysm with a rupture of approximately 1 cm near the left subclavian artery (LSA) (Figure 1), into vascular surgery. Previous history of hypertension for 7 years, blood pressure up to 180/100 mmHg, irregular medication. After admission, he underwent thoracic endovascular aortic repair (TEVAR) and axillary artery artificial vascular bypass under general anesthesia. Intraoperative stent completely covered LSA, and angiography showed that the dissected aneurysm was closed correctly, without endoleak, and no contrast medium was seen in the false lumen. He was cured and discharged after operation. After discharge, he was admitted for the second time on 31 May 2014 due to "difficulty eating with fever for 1 week". CT and gastroscopy were performed, and the formation of esophageal fistula near the aortic arch of the esophagus was observed (Figure 2), with a huge hematoma protruding into the esophagus. DSA angiography revealed type II endoleak at the initiation of LSA. A spring coil was used to embolize the root of LSA, and the internal leakage disappeared. The esophageal fistula gradually increased after operation, and the stent protruded into the esophagus under gastroscopy (Figure 3), and died of massive hematemesis shock on September 21, 2014.

A 71-year-old male was admitted to the hospital due to "abdominal distension, abdominal pain with cessation of anal exhaustion and defecation for 4 days". In the past 2 years, "incomplete intestinal obstruction" appeared intermittently, 3 to 4 times/year, and improved after conservative treatment. He had undergone surgical treatment for left varicocele 9 years ago, and had no history of abdominal surgery and trauma. The patient has a history of irregular stool for nearly 20 years. Admission physical examination: A huge spherical bulge was seen in the right lower abdomen, and a spherical mass could be palpable. There was no tenderness and tremor, no abdominal muscle tension, and intestinal sounds were 2~3 times/min. Abdominal upright X-ray showed that the small intestine was dilated and multiple air-liquid planes were visible. Abdominal CT examination showed that the right ileal wall was thickened, but small intestine-colon intussusception was not excluded (Figure 1)。 Emergency exploratory laparotomy was performed. During the operation, the small intestine of the abdominal cavity was wrapped in three white fibrous connective tissues (Figure 2), respectively located in the upper left, lower left and lower right abdomen, no omentum was seen, and the stomach and colon were squeezed into the upper abdomen and posterior abdomen, respectively. The connective tissue envelope was incised, and the compressed and adhered small intestinal tube was released. The distal ileum was folded and circuited, and the intestinal tube was dilated. The middle ileum was severely dilated, and a distal ileal diverticulum with perforation of the intestinal wall was visible 40 cm from the ileocecal region. Intraoperative diagnosis: abdominal cocoon, intestinal obstruction, small intestinal diverticulum with perforation. Small intestinal release and partial intestinal resection were performed. After anastomosis of the intestinal tube, an intestinal obstruction catheter was placed and the small intestine was arranged in sequence, and the head of the catheter was led out of the body from the right lower abdominal wall. After operation, symptomatic treatment such as fasting water, gastrointestinal decompression, anti-infection and parenteral nutrition were given. The gastrointestinal function of the patient recovered 10 days after operation, the anus exhausted and defecated, and the incision healed well. After 2 weeks, the small intestinal catheter was intermittently extracted, and the incision healed at 15 days. There were no complications such as leaky intestine, abdominal infection and short bowel syndrome, and the patient recovered and was discharged. Postoperative pathological report: fibrous tissue envelope, acute suppurative inflammation of the small intestinal wall involving the whole thickness of the intestinal wall.

A 35-year-old male was admitted to the hospital on April 5, 2015 because "physical examination found a left neck mass for more than 2 years". Physical examination: A round painless mass with a size of about 4 cm ×4 cm and a clear boundary can be palpable in the upper part of the anterior edge of the left sternocleidomastoid muscle. Pulsation can be palpable under pressure, and no vascular murmur can be heard during auscultation. Head and neck computed tomogrphy angiography (CTA): high-density shadow of mass at the bifurcation of the left common carotid artery (FIG. 1A)。 Ultrasound of the neck showed that the blood supply inside the tumor was abundant. Clinical diagnosis: Left carotid body tumor (CBT) (Shamblin grade II). Surgery: The incision was selected at the anterior edge of the sternocleidomastoid muscle, and the left common carotid artery was routinely dissected. The common carotid artery was controlled with a mantle, and the bifurcation of the carotid artery was freely exposed. A solid, medium spherical mass was found by exploration, with a capsule, and nourishing blood vessels were visible in the membrane, which was close to the internal and external carotid arteries. The tumor capsule was directly dissected to reach the sarcoid tumor body. The tumor was bluntly and sharply separated and completely removed. After the tumor was removed, the hemostasis was compressed and the hemostasis was combined with the intracapsular ligation of the main nourishing blood vessel.Figure 2)。 The intraoperative hemodynamics were stable, the operation took 65 min, and the blood loss was about 200 ml. The postoperative pathological diagnosis was paraganglioma (FIG. 1B)。 The patient was discharged 3 d postoperatively.

Endovascular repair has gradually replaced traditional surgery because of its advantages such as less trauma, quick recovery, low perioperative mortality and low complication rate. However, for aortic lesions involving or adjacent to important branch arteries, the application of endovascular techniques still faces great challenges. In recent 10 years, fenestration stent, branch stent and chimney technology have been gradually applied to the treatment of aortic lesions involving branch arteries. However, due to their respective defects, their application has been greatly restricted. Against this background, the multilayer bare stent technology emerged, and the preliminary research results are encouraging. However, the treatment failure or even rupture and branch blockage occurred in the medium and long-term follow-up. In addition, the mechanism of aneurysm isolation is still not very clear, and the clinical indication is still very controversial.

At present, infection is still a serious complication of liver transplantation and an important cause of death after transplantation. With the development of immunosuppressive agents, the incidence of rejection has decreased significantly, but the risk of opportunistic infection after liver transplantation is gradually increasing. The so-called opportunistic infection refers to infectious diseases in which some conditionally pathogenic pathogens do not cause disease when human immune function is normal, but can take the opportunity to invade human body and cause obvious clinical symptoms and signs when human immune function is reduced. It lacks specificity in clinical symptoms and imaging manifestations, and the onset is insidious. After infection, the disease often progresses rapidly and is dangerous. If it is not diagnosed early and effectively treated, it will endanger the patient's life. This article reviews the diagnosis and treatment of several common opportunistic pathogen infections.