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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

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Military Medical Research 2022年第2期9卷 193-204页

作者： Kai Wang Shi-Long Sun Xin-Yu Wang Cheng-Nan Chu Ze-Hua Duan Chao Yang Bao-Chen liu Wei-Wei Ding Wei-Qin li jie-shou li Division of Trauma and Surgical Intensive Care Unit Research Institute of General SurgeryJinling HospitalMedical School of Nanjing UniversityNo.305 East Zhongshan RoadNanjing 210002China Division of Trauma and Surgical Intensive Care Unit Research Institute of General Surgerythe First School of Clinical MedicineSouthern Medical UniversityNanjing 210002China

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid status and FO.Therefore,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.Methods:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)management.The primary outcome was the 30-day primary fascial closure(PFC)rate.The secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after OA.The Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was built.Results:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,Plier than that of the TRD group by an average of 3.66 d(Plications.Conclusions:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation st

关键词： Trauma Open abdomen Fluid overload Fluid resuscitation Primary fascial closure Bioelectrical impedance analysis

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Non-operative management of isolated liver trauma

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 545-550页

作者： Min li Wen-Kui Yu Xin-Bo Wang Wu Ji jie-shou li Ning li Department of General Surgery Jinling HospitalMedicine School of Nanjing University

liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

关键词： liver trauma non-operative treatment non-operative management

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Fast-track rehabilitation program vs conventional care after colorectal resection:A randomized clinical trial

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World Journal of Gastroenterology 2011年第5期17卷 671-676页

作者： Gang Wang Zhi-Wei Jiang Jing Xu Jian-Feng Gong Yang Bao li-Fei Xie jie-shou li Research Institute of General Surgery Jinling Hospital School of Medicine Nanjing University Nan-j ing 210002 Jiangsu Province China Department of Medical Oncology Jinling HospitalSchool of Medicine Nanjing University Nanjing 210002 Ji-angsu Province China

AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P lications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P lications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P litation program than after conventional care(5 d vs 7 d,P litation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

关键词：大肠癌护理康复临床试验 VS 快速通道恢复时间随机

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Effect of Alemtuzumab on Intestinal Intraepithelial Lymphocytes and Intestinal Barrier Function in Cynomolgus Model

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Chinese Medical Journal 2015年第5期128卷 680-686页

作者： lin-lin Qu Ya-Qing Lyu Hai-Tao Jiang Ting Shan Jing-Bin Zhang Qiu-Rong li jie-shou li Department of Biliary Surgery The Affiliated Hospital of Qingdao University Qingdao Shandong 266000 China Department of General Surgery Institute of General Surgery Jinling Hospital Nanjing Jiangsu 210002 China

Background：Alemtuzumab has been used in organ transplantation and a variety of hematologic malignancies （especially for the treatment of B-cell chronic lymphocytic leukemia）.However,serious infectious complications frequently occur after treatment.The reason for increased infections postalemtuzumab treatment is unknown at this stage.We explore the effect ofalemtuzumab on intestinal intraepithelial lymphocytes （IELs） and intestinal barrier function in cynomolgus model to explain the reason of infection following alemtuzumab treatment.Methods：Twelve male cynomolguses were randomly assigned to either a treatment or control group.The treatment group received alemtuzumab （3 mg/kg,intravenous injection） while the control group received the same volume of physiological saline.Intestinal IELs were isolated from the control group and the treatment group （on day 9,35,and 70 after treatment） for counting and flow cytometric analysis.Moreover,intestinal permeability was monitored by enzymatic spectrophotometric technique and enzyme-linked immunosorbent assay.Results：The numbers of IELs were decreased significantly on day 9 after treatment compared with the control group （0.35 ± 0.07 × 10^8 and 1.35 ± 0.09 × 10^8,respectively; P 〈 0.05） and were not fully restored until day 70 after treatment.There were significant differences among four groups considering IELs subtypes.In addition,the proportion ofapoptotic IELs after alemtuzumab treatment was significantly higher than in the control group （22.01 ± 3.67 and 6.01 ± 1.42,respectively; P 〈 0.05）.Moreover,the concentration of D-lactate and endotoxin was also increased significantly on day 9 after treatment.Conclusions：Alemtuzumab treatment depletes lymphocytes in the peripheral blood and intestine of cynomolgus model.The induction of apoptosis is an important mechanism of lymphocyte depletion after alemtuzumab treatment.Notably,intestinal barrier function may be disrupted after alemtuzumab treatment.

关键词： Alemtuzumab Barrier Function Infection Intestinal lntraepithelial Lymphocytes Lymphocyte Depletion

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Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Program for Locally Advanced Gastric Cancer

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Chinese Medical Journal 2018年第4期131卷 413-419页

作者： Jian Zhao Gang Wang Zhi-Wei Jiang Chuan-Wei Jiang Jiang liu Can-Can Xia jie-shou li Research Institute of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu 210002 China

Background： Most studies on enhanced recovery after surgery （ERAS） for gastric cancer exclude patients who received neoadjuvant chemotherapy. Here, we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer. Methods： From April 2015 to July 2017, 114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care （SC） groups. Postoperative length of stay, complications, bowel function, and nutritional status were recorded. Results： The postoperative length of stay of the ERAS group was shorter compared with that of the SC group （5.9 ± 5.6 vs. 8.1 ± 5.3 days, P=0.037）.The postoperative complication rate was 9.3% in the ERAS group and 11.5% in the SC group（P=0.700）.The time to first flatus （2.7 ± 2.0 vs. 4.5 ± 4.6 days, P = 0.010） and time to a semi-liquid diet （3.2 ± 2.1 vs. 6.3 ± 4.9 days, P 〈 0.001） in the ERAS group were shorter compared with those in the SC group. On the 10thday after surgery, the values of weight, total protein, albumin, and prealbumin of the ERAS group were lower compared with those of the SC group. Conclusions： Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer. The nutritional status of these patients was not adversely affected.

关键词： Advanced Gastric Cancer Enhanced Recovery after Surgery Gastrectomy Length of Stay Neoadjuvant Chemotherapy

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Intercostal artery damage and massive hemothorax after thoracocentesis by central venous catheter： A case report

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Chinese Journal of Traumatology 2017年第5期20卷 305-307页

作者： Bai-Qiang li Bo Ye Fa-Xi Chen Lu Ke Zhi-Hui Tong jie-shou li Wei-Qin li Department of General Surgery SICU Jinling Hospital Medical School of Nanjing University Nanjing 210002 China

中央静脉的导管(CVC ) 广泛地在最近的年里以特别护理单位(ICU ) 在各种各样的刺和排水操作被使用。比作常规操作设备，因为容易的使用，身体的更少的损坏和方便固定过程的优点， CVC 被临床医生欢迎。我们与严重尖锐胰腺炎(树液) 遇到... 详细信息

中央静脉的导管(CVC ) 广泛地在最近的年里以特别护理单位(ICU ) 在各种各样的刺和排水操作被使用。比作常规操作设备，因为容易的使用，身体的更少的损坏和方便固定过程的优点， CVC 被临床医生欢迎。我们与严重尖锐胰腺炎(树液) 遇到了一个病人由于胸的洞开发了心脏的拘捕巨大的流血 24 ? 在有 CVC 的 thoracocentesis 以后的 h。Thoracotomy 外科立即被执行，它证实了脊间的动脉损害。没有任何神经病学的复杂并发症，病人二个月以后从医院被解除。这里，我们报导这个案例提醒所有紧急情况部门和 ICU 医生对胸的洞流血跟随 CVC 进行的 thoracocentesis 的复杂并发症给予更多的注意。

关键词：人体损伤病例报告穿刺胸腔动脉导管静脉重症急性胰腺炎

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paired Coagulation Status in the Crohn＇s Disease Patients Complicated with Intestinal Fistula

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Chinese Medical Journal 2018年第5期131卷 567-573页

作者： Yuan li Jian-An Ren Ge-Fei Wang Guo-Sheng Gu Xiu-Wen Wu Song liu Hua-Jian Ren Zhi-Wu Hong jie-shou li Department of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu 210002 China Department of General Surgery Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu 210093 China

Background： Intestinal fistula is one of the common complications of Crohn＇s disease （CD） that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula. Methods： Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinting Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student＇s t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups. Results： Compared with CD patients without intestinal fistula, prothrombin time （PT） in patients with intestinal fistula was significantly longer （12.13 ± 1.27 s vs. 13.18± 1.51 s,P〈0.001 in overall cohort： 11.56± 1.21 svs. 12.61 ±0.73 s,P 0.001 in females： and 12.51± 1.17 s vs. 13.37± 1.66 s, P - 0.003 in males）. Platelet （PLT） count was much lower in intestinal fistula group than in nonintestinal fistula group （262.53 ± 94.36 × 109/L vs. 310.36 ± 131.91× 109/L, P = 0.009）. Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT （odds ratio [OR] 1.900, P 〈 0.001 ）, a reduced amount of PLT （OR = 0.996, P = 0.（124）, and an increased operation history （OR = 5.408, P 〈 0.001 ）. Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline （ 12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006）. Conclusions： Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.

关键词： Coagulation Crohn＇s Disease： Inflammatory Bowel Disease： Intestinal Fistula Prothrombin Time

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Growth hormone stimulates remnant small bowel epithelial cell proliferation

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World Journal of Gastroenterology 2000年第6期6卷 909-913页

作者： Xin Zhou Ning li jie shou li Medical School Nanjing UniversityNanjing 210093Jiangsu ProvinceChina Research Institute of General Surgery Jinling HospitalNanjing 210002Jiangsu ProvinceChina

INTRODUCTIONCurrently the major treatment choices for shortbowel syndrome are parenteral nutrition and smallbowel transplantation.Both therapies involvegreat fiscal challenge and recurring complications.Recent years h... 详细信息

关键词： short bowel syndrome insulin-like growth factor I intestine small/surgery proliferation growth hormone intestinal mucosa rats

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＂Fast-track＂ and ＂Minimally Invasive＂ Surgery for Gastric Cancer

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Chinese Medical Journal 2016年第19期129卷 2294-2300页

作者： Xin-Xin liu Hua-Feng Pan Zhi-Wei Jiang Shu Zhang Zhi-Ming Wang Ping Chen Yan Zhao Gang Wang Kun Zhao jie-shou li Department of General Surgery Jinling Hospital School of Medicine Nanjing University Nanjing Jiangsu 210002 China Department of General Surgery The First People's Hospital of Yangzhou Clinical Medical School Yangzhou University Yangzhou Jiangsu 225001 China Department of Gastrointestinal Surgery Northern Jiangsu People's Hospital Clinical Medical School Yangzhou University Yangzhou Jiangsu 225001 China

Background：Enhanced recovery after surgery （ERAS） protocols or fast-track （FT） programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery （MIS） is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods：We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares （SC） or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups：open gastrectomies （OG） with SC （OG ＋ SC group,n =167）;OG with FT programs （OG ＋ FT group,n =277）;laparoscopic gastrectomies （LG） with FT programs （LG ＋ FT group,n =248）;and robot-assisted gastrectomies （RG） with FT programs （RG ＋ FT group,n =292）.Patients＆#39; data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results：The OG ＋ SC group showed the longest postoperative hospital stay （mean：12.3 days,median：11 days,interquartile range [IQR]：6-16 days）,while OG ＋ FT,LG ＋ FT,and RG ＋ FT groups recovered faster （mean：7.4,6.4,and 6.6 days,median：6,6,and 6 days,IQR：3-9,4-8,and 3-9 days,respectively,all P 〈 0.001）.The postoperative rehabilitation parameters such as flatus time after surgery （4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days） followed the same manner.After 30 postoperative days＆#39; follow-up,the total incidence of complications was 9.6% in OG ＋ SC group,10.1% in OG ＋ FT group,8.1% in LG ＋ FT group,and 10.3% in RG ＋ FT group.The complications showed no significant differences between the four groups （all P 〉 0.05）.Conclusions：ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique.MIS further reduces

关键词： Enhanced Recovery after Surgery Fast-track Surgery Gastrectomy Minimally Invasive Surgery Optimized Care

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Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis

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World Journal of Gastroenterology 2013年第46期19卷 8722-8730页

作者： Jian-Feng Gong Wei-Ming Zhu Wen-Kui Yu Ning li jie-shou li Department of General Surgery Jinling Hospital Medical School of Nanjing University

AIM:To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis(EPSBO-OP).METHODS:This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June2002 to January 2009.Patients were randomized into two groups:a control group received total parenteral nutrition and nasogastric(NG)tube feeding;and an intervention group received,in addition,somatostatin and dexamethasone treatment.The primary endpoints were time to resolution of bowel obstruction and length of hospital stay,and the secondary endpoints were daily NG output and NG feeding duration,treatment-related complications,postoperative obstruction relapse,and patient satisfaction.RESULTS:Thirty-six patients were allocated to the intervention group and 34 to the control group.No patient needed to undergo surgery.Patients in the intervention group had an earlier resolution of bowel obstruction(22.4±9.1 vs 29.9±10.1 d,P=0.002).Lower daily NG output(583±208 vs 922±399 mL/d,Plications(P=0.770)and relapse of obstruction(P=0.357)were comparable between the two groups.There were no significant differences in postoperative satisfaction at 1,2 and 3 years between the two groups.CONCLUSION:Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay,and are safe for symptom control without increasing obstruction relapse.

关键词： Dexamethasone Intestinal obstruction Parenteral nutrition Postoperative period Somatostatin

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