2018年 · 第56卷第11期

The author participated in the early research of Peng's pancreaticointestinal binding anastomosis, and deeply realized that binding instead of suture can eliminate pinholes, and the operation is simple and safe. In 2001, the author began to carry out laparoscopic pancreatic surgery. Because of the limited visual field of laparoscopic surgery, it is inconvenient to do binding anastomosis and sleeve anastomosis. Therefore, the author tried to use modern integrated needle and thread to perform pancreaticojejunostomy by catheter to mucosa. So far, our team has completed more than 500 cases of laparoscopic middle pancreatectomy and laparoscopic pancreaticoduodenectomy after pancreatojejunostomy. The experience is introduced below.

Tracheal intubation was first applied in liver and kidney transplantation, which has certain advantages in accelerating postoperative recovery. Retrospective study results showed that early postoperative operating room removal of tracheal intubation can accelerate postoperative recovery of lung transplant patients, including reducing mechanical ventilation-related complications, anastomotic leakage, hemodynamic instability, hospital-acquired pneumonia, sepsis, etc., thereby shortening ICU stay and reducing medical expenses^[1,2]。 In June 2018, the thoracic surgery department of our hospital performed early operating room extubation after lung transplantation in 2 patients, and the results were satisfactory. The experience is reported below.

A 62-year-old female was admitted to the hospital on 15 September 2017 due to "skin scleral yellowing for 3 weeks". There was no fever, abdominal pain and other discomfort since the onset of the disease. Physical examination: body mass index 29.6 kg/m²The skin sclera was obviously yellow, there was no tenderness and rebound pain in the abdomen, and there was no mass in the abdomen. The patient was previously in good health. Laboratory tests: ALT 274 U/L, total bilirubin 146.7 μ mol/L, direct bilirubin 84 μ mol/L, albumin 39.6 g/L. Tumor marker: CA19-9 72.09 U/ml. The results of abdominal enhanced CT examination showed that the intrahepatic and extrahepatic bile ducts were significantly dilated, and the duodenal papilla occupied space. Endoscopic ultrasound: hypoechoic mass of duodenal papilla, approximately 2.0 cm ×1.5 cm in diameter, involving the end of the bile duct. Biopsy findings: dysplasia of the duodenal epithelium with high-grade intraepithelial neoplasia.

Female, 82 years old, was admitted to the emergency department on April 25, 2017 due to distension and pain in the upper abdomen for 1 d. Since the onset of the disease, the patient has been accompanied by nausea and vomiting, and the vomit is food. After vomiting, the symptoms are not significantly relieved, and there is no discomfort such as chills, fever, palpitation and chest tightness, so he came to our hospital for treatment. In 2016, he was treated in another hospital due to acute pancreatitis, gallbladder stones and acute cholecystitis (specific treatment unknown), and was discharged after treatment improved. Has a history of hypertension for more than 20 years, and has not received standardized treatment. Physical examination: There was no obvious yellowing staining of the skin and sclera, soft abdomen, tenderness in the middle and upper abdomen, no obvious rebound pain, positive Murphy sign, and no subcostal attack of liver and spleen. The body mass index was 23.5 kg/m²。 Admission laboratory test: blood routine: white blood cell count 15.18×10⁹/L, the percentage of neutrophils was 85.4%, the C-reactive protein (CRP) was 43 mg/L, and the platelet count was 246×10⁹pieces/L; Blood gas: pH 7.4, PO₂was 66 mmHg (1 mmHg =0.133 kPa), PCO₂was 31 mmHg, HCO₃19.2 mmol/L, and the blood lactate concentration was 2.8 mmol/L; There were no obvious abnormalities in liver and kidney function and electrolyte. Admission CT plain scan + enhanced examination results: acute pancreatitis, pancreatogenic peritonitis, peripancreatic effusion, gallstones with cholecystitis, common bile duct dilation, intrahepatic and extrahepatic bile duct dilation, pleural effusion, pelvic effusion (Figure 1)。 Serum PCT was detected by ELECSYS B.R.A.H.M.S procalcitonin (PCT) antibody kit of Roche Company, Switzerland: 2~3 ml of peripheral venous blood was collected in the early morning, and the serum was separated within 1 h after blood collection. The PCT level was detected by immunofluorescence method. The results showed that the PCT was 0.067 μ g/L.

A 52-year-old male was admitted to the hospital on July 31, 2017 due to "intermittent right upper abdominal distension and pain for 1 year, aggravated for 1 d". The patient underwent pancreaticoduodenectomy (PD) 4 years ago due to a tumor in the lower segment of the common bile duct. Intraoperative pancreaticoenterostomy was performed by pancreatic duct-to-mucosa combined with internal drainage of pancreatic duct stent. The distal end of the stent crossed the bilioenterostomy area. No complications such as pancreatic fistula and bleeding occurred after operation, and the pathological examination reported that it was common bile duct adenoma. Physical examination at admission: Mild tenderness in the right upper abdomen, and a longitudinal surgical scar about 20 cm long was visible between the xiphoid process and the umbilicus. Laboratory tests: There were no abnormalities in liver function, blood biochemistry, blood routine and tumor markers. Auxiliary examination: CT scan of the whole abdomen showed intrahepatic bile duct dilatation, high-density shadow in the biliary duct lumen in the hilar area, with a maximum diameter of about 2.0 cm, extending to the biliary enterostomy area, and tubular density shadow in the common bile duct lumen, running down to the intestinal lumen; CT examination diagnosed high-density shadow of the common bile duct, which was considered as calculus (FIG. 1A、FIG. 1B)。

Professor Bi Jianwei, a member of the Communist Party of China, director, chief physician, professor and doctoral supervisor of the General Department of Changhai Hospital of Naval Medical University, a famous gastrointestinal surgery expert in China, and corresponding editorial member of the 13th editorial committee of Chinese Journal of Surgery, died in Shanghai at 16: 40 on September 18, 2018 at the age of 54 due to ineffective treatment.