Journal of General Surgery for Clinicians

The discussion in risk of air embolus and brain injury by low central venous pressure by laparoscopic hepatectomy

DENG Jindan, ZHANG Yuenong, ZHANG Weiqiang, ZENG Zhiwen, CHEN Zhi, ZHOU Yuanjun

2021, 9(4): 2.

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Objective To investigate the development of air thrombolysis and the possible risk of

brain injury in laparoscopic hepatectomy. Methods 80 patients with selected laparoscopic hepatectomy

from Meizhou People's Hospital from April 2018 to January 2021, randomly divided into low central

venous pressure group (L group) and normal central venous pressure group (N group) and 40 each.

Gas incidence, bubble grade and duration were examined by esophageal echocardiography in both

groups which were compared in two groups; Postoperative neurological complications, postoperative

hospitalization, S100B protein and neuron-specific enolase (NSE) levels in preoperative and

postoperative venous blood were compared in two groups. Results Eventually included 66 patients, 35 in

the L group and 31 in the N group. The intraoperative duration of air bubbles in the L group was longer

than in the N group (P ＜ 0.05).Both L, N groups had increased postoperative S100B protein compared to preoperative, while postoperative NSE levels were also higher in the L group (P ＜ 0.05). There were

no significant differences in thrombolysis, bubble grade, postoperative neurological complications, time

of hospitalization, S100B protein and NSE levels in preoperative and postoperative venous blood, and

preoperative and postoperative NSE, differences in the N group (P ＞ 0.05). Conclusion In laparoscopic

hepatectomy, the application of low central venous pressure increased the duration of thrombolysis,

especially between the incidence of thrombolysis and the risk of brain injury.

Comparison of clinical efficacy between LigaSure hemorrhoidectomy and Ferguson hemorrhoidectomy for prolapsed mixed hemorrhoid

LIANG Yutuan, RONG Zhenxiang, XIONG Yan, LIU Huijun, ZHONG Jian, WU Shaohong, MAI Xianqiang, GONG Jie, DONG Jianfeng, WEN Chixiu

2021, 9(4): 8.

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Objective To observe the clinical efficacy of LigaSure hemorrhoidectomy and Ferguson

hemorrhoidectomy for prolapsed mixed hemorrhoids. Methods The clinical data of 120 patients with

prolapsed mixed hemorrhoids treated in Xinrongqi Hospital in Ronggui Street of Shunde District

in Foshan City from June 2018 to June 2019 were analyzed and randomly divided into observation

groups (receiving LigaSure hemorrhoidectomy, n=60) and controls methods. Group (received Ferguson

hemorrhoidectomy, n=60)according to different surgical . The two groups were compared for the number

of days of postoperative hospitalization, the cost of hospitalization, the amount of intraoperative bleeding,

the time of operation, postoperative pain, postoperative anal sphincter function and postoperative urinary retention, postoperative bleeding, wound infection, postoperative recurrence, and anal stenosis and other

differences. Results The number of hospital stays, hospitalization costs, intraoperative blood loss, and

operation time in the observation group were better than those in the control group (P ＜ 0.05). There

was no significant difference in wound healing time between the two groups (P ＞ 0.05). There were no

significant differences in the incidence of urinary retention, postoperative bleeding, incision infection,

postoperative recurrence, and anal stenosis (P＞0.05). The observation group had low pain scores at 1, 2,

3, 7 and 14 days after surgery. In the control group, the difference was statistically significant (P ＜ 0.05),

and there was no significant difference in the maximum systolic pressure and resting anal pressure of

the anal canal between the two groups (P ＞ 0.05). Conclusion LigaSure hemorrhoidectomy is safe and

effective for patients with prolapsed mixed hemorrhoids. Compared with Ferguson hemorrhoidectomy, it

can help shorten the operation time, reduce intraoperative bleeding, it is conducive to patient recovery.

Effect of endoscopic retrograde appendicitis therapy treatment on inflammation factor of acute appendicitis with peripheral abscess, efficacy and postoperative complications

LI Quanchun, PENG Lei, ZHANG Chunlei, YAN Huan

2021, 9(4): 15.

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Objective To investigate the clinical efficacy and safety of endoscopic retrograde acute

appendicitis with peripheral abscess formation, and to provide reference basis for clinical treatment.

Methods 86 patients with acute appendicitis with peripheral abscess treated in Dazhou integrated

traditional Chinese and Western medicine hospital from June 2018 to June 2020 were randomly divided

into study group and control group, with 43 cases in each group. The study group was treated with

endoscopic retrograde appendicitis therapy (ERAT), and the control group was treated with laparoscopic

appendectomy (LA). The total effective rate, the incidence of complications 2 weeks after operation and the levels of inflammatory factors (C-reactive protein, interleukin-6 and interleukin-8) before and

1 week after operation were compared between the two groups. Results After one week of treatment,

the total effective rate in the study group was 95.35% (41/43), which was significantly higher than

83.72% (36/41) in the control group (P ＜ 0.05). Before treatment, there was no significant difference in

C-reactive protein, interleukin-6 and interleukin-8 between the two groups (P ＞ 0.05); After one week of

treatment, C-reactive protein, interleukin-6 and interleukin-8 in the study group were significantly lower

than those in the control group (P ＜ 0.05). Two weeks after operation, the incidence of postoperative

complications in the study group was 4.65% (2/43), lower than 13.95% (6/43) in the control group (P

＜ 0.05). Conclusion Endoscopic retrograde surgery for patients with acute appendicitis with peripheral

abscess can reduce the level of inflammatory factors, reduce postoperative complications and improve the

curative effect.

Effects of lung protective ventilation strategy on oxygenation and serum inflammatory mediators in elderly patients undergoing laparoscopic colorectal cancer surgery

LI Ding, ZHANG Lei, JIANG Xiaohui

2021, 9(4): 21.

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Objective To investigate the effect of lung protective ventilation strategy on oxygenation

function and serum inflammatory mediators in elderly patients undergoing laparoscopic colorectal

cancer surgery. Methods Seventy-six elderly patients undergoing laparoscopic colorectal cancer surgery

in Cancer Hospital of Nantong University from March 2020 to April 2021 were randomly divided into

observation group and control group, 38 cases in each group. Patients in the observation group were

treated with pulmonary protective ventilation strategy, and patients in the control group were treated with

conventional positive pressure ventilation strategy. The changes of parameters of oxygenation function

and serum inflammatory mediators during operation, as well as the incidence of complications, were

compared between the two groups. Results In the data comparison of oxygenation function between the two groups, the observation group was significantly better than the control group(P ＜ 0.05); In the

comparison of serum inflammatory mediators, the data of observation group was better than control

group(P ＜ 0.05); The incidence of complications in observation group was significantly lower than that

in control group(P ＜ 0.05). Conclusion Lung protective strategy has a significant effect on the clinical

treatment of elderly patients undergoing laparoscopic surgery for colorectal cancer, with high safety.

The curative effect of endoscope combined with drugs in diagnosis and treatment of esophageal and gastric variceal bleeding in liver cirrhosis and the influencing factors of rebleeding

CHENG Jianing

2021, 9(4): 26.

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Objective To investigate the efficacy of endoscope combined with drugs in the diagnosis

and treatment of esophageal and gastric variceal bleeding in liver cirrhosis and the influencing factors

of rebleeding. Methods From February 2019 to February 2021, 80 patients with esophageal and gastric

varices rupture and bleeding of liver cirrhosis treated in Shenzhen Integrated Traditional Chinese

and Western Medicine Hospital were selected. All patients were treated with endoscopic esophageal

varices ligation combined with endoscopic varices sclerotherapy injection. They were divided into

recurrent group (n=22) and non-recurrent group (n=58) according to whether there was rebleeding after

operation, to analyze the efficacy of endoscopy combined with drugs in the treatment of esophageal and

gastric variceal bleeding in liver cirrhosis and the risk factors of rebleeding. Results All patients were

successfully hemostatic, and the success rate of hemostasis was 100.00%; There was no significant

difference in gender, age, portal vein diameter, Child-Pugh score, albumin concentration and blood

sodium level between recurrent group and non-recurrent group (P＞0.05); Portal vein diameter and Child-Pugh score were the risk factors of rebleeding after endoscopic combined with drug treatment of

esophageal and gastric varices bleeding in liver cirrhosis (P＜0.05). Conclusion Endoscope combined

with drugs is effective in the diagnosis and treatment of esophageal and gastric variceal bleeding in liver

cirrhosis. The risk factors of rebleeding after esophageal and gastric variceal bleeding in liver cirrhosis

include portal vein diameter and Child-Pugh score.

Comparison of different surgical approaches in the treatment of benign breast tumors by mamotone minimal invasive surgery

HUANG Hui, LIU Zhen

2021, 9(4): 31.

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Objective To investigate the efficacy of minimally invasive mamotone in the treatment of

benign breast tumors by comparing annular areola incision with traditional incision approach. Methods

A retrospective analysis was performed on 120 patients with benign breast tumors treated with minimally

invasive mamotone in Jiangmen Maternal and Child Health Hospital from January 2018 to December

2019. According to the surgical methods, they were divided into the traditional group and annular areola

group. In the traditional group, there were 60 cases, and there were 60 cases in annular areola group.

Data related to surgery were compared between the two groups, including operation time, blood loss and

one-time puncture success rate. The wound of 1 month and 3 month after surgery were compared. The

cosmetic effect of 3 months after surgery were compared. Results The operation time was significantly

longer in the annular areola group than in the traditional group (25.25±4.65 vs 20.25±3.56min,

P<0.01). The comparison of intraoperative blood loss, one-time puncture success rate and intraoperative pain score between the two groups was not statistically significant (P ＞ 0.05). Vancouver scar

scale(VSS) assessment in the annular areola group were significantly better than those in the traditional

group at 1 and 3 months after surgery (P ＜ 0.01). There was no statistically significant difference in

breast appearance score between the two groups in 3 months after surgery (P ＞ 0.05). Conclusion The

minimally invasive mamotone using annular areola incision can effectively improve the cosmetic effect

while ensuring the curative effect.

Clinical analysis of postoperative bleeding after endoscopic treatment of early gastric cancer and precancerous lesions

ZHAO Xianglu, CUI Yanxin, GUAN Xin, JIANG Xiangjun

2021, 9(4): 37.

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Objective To investigate the influencing factors of bleeding after endoscopic submucosal

dissection (ESD) in early gastric cancer and precancerous lesions, and to conduct risk-stratification.

Methods During January 2016 to December 2020, 237 cases which experienced ESD surgery owing to

early gastric cancer and precancerous lesions were collected in Qingdao Municipal Hospital Affiliated

to Qingdao University. These cases were used to analyse influencing factors of bleeding after ESD.

Additionally, influencing factors was scored and stratified into high-risk, intermediate-risk, and low-risk.

Results 13 patients with early gastric cancer were bled after ESD, with an incidence of 4.5%. The size

of resecting lesions, pathological changes ≥ 2 lesions, the gastric ulcer history, the cirrhosis history, the

therioma history, aspirin using history, clopidogrel using history, and dual antiplatelet therapy history

were identified as influencing factors of bleeding after ESD by univariate analysis. Nevertheless, only

gastric ulcer history, the size of resecting lesions, the therioma history, and dual antiplatelet therapy history were identified has a close relation with bleeding after ESD by multivariate Analysis. Conclusion

Gastric ulcer history, the size of resecting lesions, therioma history, and dual antiplatelet therapy history

are independent risk factor of bleeding after ESD. For patients with multiple risk factors, preoperative

evaluation, intraoperative caution, and postoperative observation can effectively prevent postoperative

bleeding.

Influence of ultrasound-guided pudendal nerve block with different concentrations of ropivacaine on inflammatory factors and pain in patients with mixed hemorrhoidectomy

CHEN Dongyang, HU Xiaoying

2021, 9(4): 45.

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Objective To explore the efficacy of ultrasound-guided pudendal nerve block (PNB)

with different concentrations of ropivacaine on inflammatory factors and pain in patients with mixed

hemorrhoidectomy. Methods From January 2020 to March 2021, 90 patients underwent elective mixed

hemorrhoidectomy at Fuxing Chancheng Hospital of Foshan City were randomly divided into R1, R2 and R3 groups, Each group contained 30 cases; The three groups of patients underwent bilateral PNB

under ultrasound guidance; The concentration of ropivacaine in the R1 group was 0.25%, the R2 group

was 0.375%, and the R3 group was 0.5%;Compare the pain scores of the three groups at the 1h (T0), 6h

(T1), 12h (T2), 24h (T3) and 48h (T4) after the operation of the three groups; The levels of inflammatory

factors in the three groups before and 24h after the operation were compared; The incidence of adverse

reactions in the three groups were compared. Results The visual analogue scale(VAS) scores of the R2

and R3 groups from T1 to T4 were lower than that of the R1 group at the same time, and the difference

were statistically significant (P ＜ 0.05);There were no statistically significant difference in the VAS

scores of the R2 and R3 groups at T1 ～ T4 (P ＞ 0.05); the levels of tumor necrosis factor(TNF)-α,

interleukin(IL)-6, IL-8 and IL-12 in the R2 and R3 groups were higher than that at 24h after surgery

in the R1 group at the same period, the difference were statistically significant (P ＜ 0.05);There were

no significant difference in the levels of TNF-α, IL-6, IL-8 and IL-12 in the R2 and R3 groups at 24h

after surgery (P ＞ 0.05); There were no significant difference in the adverse reactions between the three

groups (P ＞ 0.05). Conclusion 0.375% and 0.50% concentration of ropivacaine applied to ultrasoundguided

PNB compare with 0.25% concentration of ropivacaine, the postoperative pain of patients is

significantly reduced, the inflammatory response is significantly reduced, and the adverse reactions are

equivalent.

Comparing the efficacy of totally extraperitoneal prosthesis and transabdominal preperitoneal prosthesis in the treatment of inguinal hernia

LI Tao, LIAO Yuhua, YANG Jin, SONG Binghai, HUANG Zhongyong, ZHANG Shilong

2021, 9(4): 53.

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Objective To analyze the efficacy of totally extraperitoneal prosthesis (TEP) and

transabdominal preperitoneal prosthesis (TAPP) in the treatment of inguinal hernia. Methods 74 inguinal

hernia patients in Chibi People's Hospital from May 2017 to May 2020 were randomly selected and

divided into TEP group and TAPP group by random number method, with 37 patients in each group. TEP

group received TEP surgical treatment, and TAPP group received TAPP treatment. General indicators,

pain, inflammatory cytokine levels and complications were compared between the two groups. Results

The time of operation in TEP group was less than that in TAPP group (P ＜ 0.05), the time of bed

activity, length of hospital stay and intraoperative blood loss were more than that in TAPP group, and

the difference was not statistically significant(P ＞ 0.05). There was no significant difference in VAS

score between the two groups before treatment (P ＞ 0.05). VAS scores of patients in the TAPP group

2h and 12h after surgery were lower than those in the TEP group, but the difference was not statistically significant(P ＞ 0.05). There was no significant difference in interleukin-6, C-reactive protein and white

blood cell levels between the two groups (P ＞ 0.05). The levels of interleukin-6, C-reactive protein

and white blood cell in the TAPP group were lower than those in the TEP group, but the difference

was not statistically significant(P ＞ 0.05). The complication rate of TAPP group was lower than that

of TEP group (P ＜ 0.05). Conclusion Compared with TEP, TAPP has shorter operation time and less

postoperative complications and inflammatory reactions. It is reliable efficacy.

Research progress of independent risk factors related to hepatocellular carcinoma

CHEN Xiaobin, ZHENG Fan, LI Chengjin, HUANG Chunyin, YOU Yuekai, HUANG Jianqiang, CHEN Jianwei, LIN Chen,

2021, 9(4): 59.

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Hepatocellular carcinoma (HCC) is a kind of primary liver cancer with high morbidity

and mortality. Its disease progression is complicated. Although the guidelines for screening and

monitoring have been improved, there is currently no research on the pathogenesis of HCC. Perfection

requires a deeper understanding of its mechanism. This article summarizes the independent risk factors

related to HCC through epidemiology, and provides a basis for reducing and preventing the incidence of

HCC by raising awareness, better screening and surveillance methods, and adjusting targeted prevention

and treatment interventions.

Analysis on the review and return of inpatient orders in general surgery in Qingdao Municipal Hospital

SUN Chen, YANG Xu, ZHAO Mingyang, SUN Fusheng, SHI Tao

2021, 9(4): 64.

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Objective To analyze the reasons of return of inpatient orders in general surgery

department, find out the problems and put forward countermeasures. Methods Unreasonable

prescriptions from January to June 2021 in general surgery department were selected through prescription

review system, supplemented by Excel data statistics. Results From January to June 2021, a total of 144

approved and returned prescriptions in general surgery department were counted, and all the prescriptions

were inappropriate. Among them, there were 75 cases with inappropriate usage and dosage. A total of 47

patients with inappropriate administration route; A total of 19 cases of unsuitable drugs were selected;

Repeated administration was performed in 3 cases. Conclusion The review of doctor's order is of great

significance to find the problem of irrational drug use in time and promote clinical rational drug use.

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