Chyle Research Articles

Troubleshooting for chyle leak/lymphorrhea

Troubleshooting for chyle leak/lymphorrhea

Analysis of scrapping reasons for apheresis platele consumables used in Chengdu Blood Center

Objective To explore the scrapping reasons for the apheresis platele consumables of 3 different types blood cell separators used in Chengdu Blood Center. Methods From January 2015 to December 2017, a total of 63 782 sets of apheresis platelets consumables used in Chengdu Blood Center and Tianfu Blood Donation House were selected as subjects. Among them, the apheresis platelets consumables of MCS+ , Amicus, Trima Accel blood cell separators were 28 351, 15 482 and 19 949 sets, respectively. Retrospective investigation method was adopted to inquire the material scrapping situation in the resource management of Chengdu Blood Center and Tianfu Blood Donation House, through the Qiao Blood Station Management System. And the scrapping amount and reasons of apheresis platele consumables were counted, and were checked with the scrapping records from Consumables Scrap Statistics in Apheresis Room. Reasons for scrapped of apheresis platele consumables include consumable factors (pipe wrinkles, breakage, leakage, etc.) and collection factors (venipuncture failure, machine fault, chylemia blood, red blood cell overflow, blood donation response, etc.). After the data were verified correctly, the scrapping rates of apheresis platelets consumables were calculated. The scrapping rates of different blood cell separators and different scrapping reasons were compared by chi-square test, respectively. Results ① Among the 63 782 sets of apheresis platelets consumables, a total of 900 sets were scrapped, with a scrapping rate of 1.41% (900/63 782). The scrapping rate of MCS+ blood cell separators was 1.83% (518/28 351), which was higher than that of 1.41% (219/15 482) of Amicus and 0.82% (163/19 949) of Trima Accel blood cell separators, and the differences were statistically significant (χ2=239.10, P<0.001; χ2=162.15, P<0.001). ② Among the 900 sets of scrapping apheresis platelets consumables of this study, the scrapping rate due to collection factors was 1.16% (738/63 782), which was higher than that of 0.25% (162/63 782) due to consumables factors, and the difference was statistically significant (χ2=304.28, P<0.001). Among the 738 sets of scrapping apheresis platelets consumables due to collection factors, the scrapping rate of MCS+ blood cell separators was 1.61% (456/28 351), which was higher than that of 0.96% (148/15 482) of Amicus and 0.67% (134/19 949) of Trima Accel blood cell separators, and the differences were statistically significant (χ2=220.79, P<0.001; χ2=164.42, P<0.001). Among the 162 sets of scrapping apheresis platelets consumables due to consumables factors, the scrapping rate of Amicus blood cell separators was 0.46% (71/15 482), which was higher than of 0.22% (62/28 351) of MCS+ and 0.15% (29/19 949) of Trima Accel blood cell separators, and the differences were statistically significant (χ2=19.05, P<0.001; χ2=30.38, P<0.001). ③ Among the 738 sets of scrapping apheresis platelets consumables due to collection factors, venipuncture failure (0.38%, 241/63 782), machine fault (0.23%, 144/63 782) and chyle blood (0.21%, 133/63 782) were main scrapping reasons. Conclusions There are differences in the scrapping rate and reasons of apheresis platele consumables scrapping of 3 types of blood cell separators used in Chengdu Blood Center. The reasons for scrapping are mainly the collection factors, including venipuncture failure, machine failure and chyle blood. In the work of apheresis platelets collection, the appropriate blood cell separators and matching apheresis platelets consumables, should be selected according to the physical conditions of the blood donors, as well as the characteristics of the blood cell separators. Key words: Blood platelets; Blood safety; Apheresis platelets; Blood cell separators; Blood scrap

Research progress on neonatal lymphatic dysplasia

Neonatal lymphatic dysplasia is a congenital maldevelopment, causing effusion of chyle or lymph into the limbs or into the pleural, pericardial or peritoneal cavities, forming chylothorax ascites or edema, resulting in immunodeficiency and malnutrition.Neonatal lymphatic dysplasia is rare in neonate, but associated with significant mortality.So far, the etiology and pathological mechanism are still unclear.Lymphoscintigraphy is a diagnostic tool in newborns to obtain early diagnosis.Octreotide has been proposed for treatment of lymphatic dysplasia recently, however, the effiency and safety remain controversial.This article is to review the update in diagnosis and treatment of neonatal lymphatic disorders. Key words: Newborn; Lymphatic dysplasia; Chylothorax

Successful use of octreotide and limited drainage in resistant chylothorax in congenital diaphragmatic hernia

In the conservative treatment of postdiaphragmatic hernia chylothorax, use of octreotide (OCT) had variable results. Limited chyle drainage has not been tried. A newborn, after the left Bochdalek diaphragmatic hernia repair, developed chylothorax. Treatment with intercostal chest tube (ICT) drainage, partial parenteral nutrition (PPN), and medium-chain triglyceride (MCT) with formula feeds was ineffective. ICT slipped out on the 13th day in the presence of significant residual chylothorax. Further drainage was not done. Addition of OCT infusion at maximum dose of 6 μg/kg/h cleared the chylothorax. No side effect of OCT was observed. The present case has proved that MCT feeding along with PPN is effective, and limited drainage of chyle is enough with OCT treatment in postdiaphragmatic hernia chylothorax.

Application of functional neck dissection with preservation of cervical plexus in differentiated thyroid carcinoma

Objective Investigate application of functional neck dissection with preservation of cervical plexus in differentiated thyroid cancer. Methods In the current hospital, 39 cases of patients with differentiated thyroid cancer and lymph nodes metastases were treated with selective neck dissection through a low-collar incision while preserving cervical plexus. The distribution of the lymph nodes, complications, recurrence rate, and clinical effect are studied. Results In the 39 cases, the cervical lymph node metastases were mainly distributed at Level Ⅳ (76.9%), Level Ⅲ (64.1%), Level Ⅱa (38.4%), Ⅱb(2.6%) and Ⅴb (12.8%). Three cases of complications were found after surgeries: one case of neck swelling, one case of bleeding, and one case of chyle leakage. No impairment in the sensation of ears, lower neck, shoulders, and the subclavian skin was found. No local relapse was found during the 5-60 months’ follow-ups. Compared with L-shape incision, the Low-collar incision is cosmetically desirable. Conclusion Neck dissection through a low-collar incision with preservation of cervical plexus results in a small incision and preserves cervical plexus while not increasing the recurrence rate. Key words: Differentiated thyroid cancer; Neck dissection; Low-collar incision; Cervical plexus

Feasibility analysis on membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer

To investigate the feasibility and safety of membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer. The clinical data of 41 patients with advanced distal gastric cancer who underwent laparoscopic gastrectomy using membrane-based right-sided approach for laparoscopic suprapancreatic lymph node dissection at the Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University from January 2016 to January 2018 were retrospectively analyzed. There were 24 males and 17 females with a mean age of 56.8 years and a mean body mass index of 22.6 kg/m². Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection contained 4 steps briefly: (1) dissection of mesenteria above the head of pancreas: the tri-junction of pancreas-duodenum was cut to expose and identify the logo of Benz;clearance of the membrane of No.5a was performed towards the left, and then expanded to the posterior layer of No.12a. (2) dissection of the V shape dorsal mesogastrium: membrane bridge at splenic artery trunk root was cut; in suprapancreatic space, clearance was performed towards to the left to the middle of the splenic artery trunk and expanded to the posterior Tolds plane upwards to the posterior phrenic angle and retroperitoneal esophagus, then the surrounding tissue of anterior abdominal aorta. (3) dissection of the U shape mesenteria:membrane bridge at common hepatic artery root was cut; mesentery was separated; the left gastric vein was freed and ligated at its root; in posterior pancreatic space, the mesentery of No.7, No.9 and No.8 was dissected in turns; the left gastric artery was high ligated and cut; the portal vein and posterior dorsal mesogastrium Toldt plane was routinely exposed; clearance was performed to right for No.8a and upward to the hepatic portal meeting at posterior mesentery No.12 plane. (4) dissection of the upper triangular area of pylorus: the trigone mesentery was cut along the upper edge of the pylorus; No.12a was swept upward along the gastric ventral mesentery; the upper boundary(No.8a) on the right side of the U-shaped membrane was joined. Intraoperative and postoperative presentations were analyzed. Laparoscopic gastrectomy for advanced distal gastric cancer with membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection was successfully carried out in all the 41 patients. Distal gastric mesenteria en bloc resection was successfully performed. The operation time was (145.2±25.4) minutes and intraoperative blood loss was (53.3±18.3) ml without massive bleeding and severe complication. Number of lymph nodes dissected was 41.1±6.4, and number of suprapancreatic lymph node dissected was 23.3±3.7 without residual cancer at cut margin by pathology. Postoperative drainage volume was (65.8±21.7) ml; time to withdraw of catheter was (7.0±1.7) days; time to fluid intake was (3.5±1.8) days; postoperative hospital stay was (10.4±2.8) days; time to postoperative anal exhaust was (3.3±1.1) days. No complications, such as chyle leakage, postoperative massive bleeding, anastomotic leakage, abdominal cavity infection or gastroplegia occurred within 30 days after surgery. Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer can achieve en bloc resection and conform to the radical principle of oncology, and is safe and feasible.

Diagnosis and treatment of persistent ascites after liver transplantation

Persistent ascites is a rare complication in the perioperative period after liver transplantation, it will seriously affect patients′ prognosis. The reasons of persistent ascites may be associated with chyle leakage, abdominal infection, portal hypertension and so on. There are also some reasons still unclear. The related examination should be completed as soon as possible to find out the probable reasons. The key to successful treatment depends on the definite diagnosis of the reasons. The treatment strategy and prognosis of persistent ascites due to different reasons. This article focuses on the reasons, risk factors and treatment methods of persistent ascites after liver transplantation. Key words: Liver transplantation; Ascites; Treatment outcome; Risk factor

The establishment of a chyle testing method based on n-hexane extraction system

Objective To set up a chyle (n-hexane) testing method based on n-hexane extraction system. Methods The hydrothorax specimen which was positive in chyle testing was selected and the feasibility was evaluated by replace Diethyl ether with n-hexane. The optimal extraction volume ratio for the new chyle testing was confirmed and sultan Ⅲ dye process was improved. Then, the new chyle testing method and its standard operation process was established.A total of 120 specimens with triglyceride(TG)in different levels were collected and divided into three groups with 40 specimens for each group (group A. TG≤1.7 mmol/L; B. 5.6<TG<12.8 mmol/L; C. TG≥12.8 mmol/L). Then, 50 body fluid specimens were collected and used to confirm the above test results. A total of 134 real body fluid specimens were used to assessment the clinical using by review and calculating the clinical coincidence rate. Results N-hexane can replace Diethyl ether in the Chyle test. The extraction volume ratio of 1 ml sample plus 400 μl N-hexane is the best one and the sultan Ⅲ tube dying method is better than former direct smear. Compared with the old Chyle test using Diethyl ether, the new Chyle test using N-hexane is in good consistency with the Kappa value 0.95. The clinical coincidence rate of the above Chyle test reaches 94.8%(127/134) after the verification of 134 specimens. Conclusions A new N-hexane test is established successfully. It was convenient to operate with high security and little contamination and thus has a wide clinical application value.(Chin J Lab Med, 2018, 41: 527-530) Key words: Chyle; Hexanes; Ethyl ethers; Clinical laboratory techniques

The role of lymphography in diagnosis and treatment of chyluria

Objective To evaluate the use of unilateral pedicle lymphography(PLG) in preoperative localization and treatment of chyluria. Methods From October 2010 to March 2017, 25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed. There were 11 males and 14 females, aged 44-71 years, with an average of 58.5 years. The course of the disease was 6 months to 30 years, with an average of 8.3 years.Of them, 18 cases had undergone unilateral PLG and spiral CT angiography preoperatively. Surgical treatment was performed according to PLG imaging. Results Unilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy, with the sensitivity of 84.2%(16/19). In contrast, unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria. Albiduria were found in the remaining 5 cases in bladder, without ureteral excreted chyle. The sensitivity for chyluria positioning by cystoscopy was 64.5%(20/31). The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100%(31/31). There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P=0.2482). But in total lesion location, the sensitivity of PLG was higher than cystoscopy(P=0.0026). Eighteen patients who had undergone PLG combined with spiral CT angiography, could not only locate the chylous fistula, but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels. Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients. However, it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation. Chyluria recurred in 6 cases during follow-up of 6 to 58 months, and 4 were confirmed bilateral pyelolymphatic fistulas by PLG. Two of these 4 cases were cured by laparoscopic surgery or open surgery, respectively. The other 2 patients were cured by conservative treatment. Moreover, 2 patients with unilateral chyluria recurred in situ after the first laparoscopic surgery, which was confirmed by PLG. Notably, all these patients were cured by ESWL finally. Conclusions This study suggested that PLG displays remarkable advantage in terms of localization sensitivity. PLG combined with spiral CT angiography preoperatively can not only locate the chylous fistula, but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels. Depending on PLG and spiral CT angiography, renal pedicle lymphatic disconnection can effectively protect renal vessel. In addition, it can avoid the omission of ligation for perivascular lymphatic vessels. Furthermore, PLG plays a key role in temporarily obstructing the leakage of pyelolymphatic fistulas to some extent. Key words: Chyluria; Pedicle lymphography; Cystoscope; CT angiography

Safety evaluation on initial 100 consecutive procedures of self-pulling and latter transected esophagojejunostomy

To evaluate the feasibility and the short-term safety of self-pulling and latter transected esophagojejunostomy(SPLT) in totally laparoscopic total gastrectomy (TLTG). One hundred patients with gastric cancer received TLTG-SPLT at General Surgery Department of Huashan Hospital (Fudan University) from June 2014 to January 2017(SPLT group). The clinicopathologic characteristics, surgical and postoperative outcomes were collected retrospectively and compared with the conventional group undergoing TLTG plus overlap or functional end-to-end anastomosis from October 2013 to December 2015. D2 lymph node dissection was regularly performed for all the patients. In SPLT group, a sterile hemp rope was held to ligate and drag down the esophagus to maintain "self-pulling" after the duodenum was transected by the first stapler, allowing the detachment of the posterior mediastinum. Then a hole 2-3 cm above the ligature rope was made on the right-posterior wall of the esophagus. When the mesenteric tension was checked, another hole was made at the anti-mesenteric border of the jejunum 20 cm distal to the ligament of Treitz. A side-to-side esophagojejunostomy (E-J) was then performed between the right-posterior wall of esophagus and the anti-mesenteric wall of the jejunum with the second linear stapler, forming an entry hole. The "latter transection" was applied with the third stapler inserted from the assistant's Trocar, which facilitated the esophagus and the afferent loop jejunum to be simultaneously transected above the level of the entry hole. After that, a side-to-side jejunojejunostomy(J-J) with another 2 staplers was carried out between the afferent loop stump and the Roux limb 40 cm below E-J, in which the E-J entry hole could also work as the entrance for the stapler. The TLTG-SPLT was therefore completed and the specimen was removed through the incision from the umbilical Trocar site. There were 66 male and 34 female patients in the SPLT group with median age of 64 years. The clinicopathologic baseline data of two groups were comparable(all P>0.05). All the patients underwent operations successfully, and none was converted to open surgery. No positive margin was found in either group. Mean operation duration was (178.2±35.9) minute in SPLT group, including (22.9±7.1) minute of reconstruction, which both were significantly shorter than those in conventional group [(204.4±55.8) minute, P=0.003; (30.5±7.2) minute, P=0.000]. Less blood loss [(74.3±72.5) ml vs. (104.2±71.6) ml, P=0.017] and earlier time to the first flatus [(1.9±1.6) days vs. (2.7±1.3) days, P=0.001] were observed in SPLT group. There were no significant differences in postoperative hospital stay and pathological findings between the two groups(all P>0.05). Postoperative operation-associated complications were found in 7 cases of SPLT group. Of these 7 patients, 1 case developed gastrointestinal bleeding, 3 pancreatic leakage, 2 chyle leakage, who all were discovered within postoperative 1 week and were cured by conservative treatment, while the other 1 case developed anastomotic fistula complicated with peritoneal infection who received laparoscopic exploration and peritoneal scavenge and drainage, then discharged 34 days later. Six patients in conventional group developed postoperative operation-associated complications, including 1 case of anastomotic bleeding, 3 cases of pancreatic leakage, 1 case of chyle leakage and 1 case of peritoneal infection. Morbidity of postoperative operation-associated complication was not significantly different between two groups [7.0%(7/100) vs. 11.5%(6/52), χ2=0.414, P=0.520]. Fifty patients from two groups underwent endoscopic examination at postoperative 6-month and 12-month, and no obvious anastomotic stenosis and esophageal reflux were observed. SPLT is a safe procedure with feasibibility in intracorporeal esophagojejunostomy.

Gefitinib leads to complete resolution of postoperative cervical chyloma and chylothorax in a lung cancer patient.

Cervical chyloma is a not uncommon complication after neck surgery, especially following diagnostic excision of supraclavicular lymph nodes. Conservative treatment remains the standard approach but is inevitably distressful. We describe the case of a 60-year-old Asian woman who was diagnosed as having adenocarcinoma of the lung with cervical and supraclavicular node involvement. She developed persistent cervical chyle leak after excisional biopsy of the supraclavicular nodes and proved refractory to all management. Subsequent gefitinib therapy led to rapid resolution of chyloma and tumor regression. This case provided a unique experience of managing intractable postoperative chyloma in a cancer patient.

The key points of prevention for special surgical complications after radical operation of gastric cancer

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.

Application value of enhanced recovery after surgery in the pancreatic surgery

Objective To evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) in the pancreatic surgery. Methods The retrospective case-control study was adopted. The clinical data of 135 patients who underwent pancreatic surgery at the First Affiliated Hospital of Nanjing Medical University from October 2014 to March 2015 were collected. Forty-seven patients receiving ERAS management between January 2015 and March 2015 were allocated into the ERAS group and 88 patients receiving traditional perioperative management between October 2014 and December 2014 were allocated into the control group. Observation indicators included (1) postoperative clinical indexes: time for initial water intake, time for out-of-bed activity, time to initial defecation, time of gastric tube removal, time of urinary catheter removal, time of abdominal drainage-tube removal, duration of hospital stay, duration of hospital stay of patients without complications and hospital expenses, (2) postoperative complications: pancreatic fistula, delayed gastric emptying, bleeding, biliary fistula, chyle leakage, intra-abdominal infection, reoperation rate, mortality, incidence of complications and readmission rate within 90 days. The follow-up using telephone interview and outpatient examination was performed to detect postoperative recovery and further treatment of patients up to July 1, 2016. Measurement data with normal distribution were presented as ±s and analyzed by t test. Count data were analyzed by the chi-square test. Results (1) Postoperative clinical indexes: time for initial water intake, time for out-of-bed activity, time of urinary catheter removal and duration of hospital stay were (20±5)hours, (53±11)hours, (2.2±1.3)days, (15.6±8.2)days in the ERAS group and (25±3)hours, (59±8)hours, (3.8±1.7)days, (20.0±13.8)days in the control group, respectively, with statistically significant differences between the 2 groups (t=7.00, 3.75, 5.63, 2.00, P 0.05). There was no occurrence of death and reoperation in the ERAS group, 2 patients had readmission due to peritoneal effusion, and 2, 1 and 1 patients were respectively complicated with abdominal bleeding, intra-abdominal infection and chyle leakage. There was no occurrence of reoperation in the control group and 1 patient died of abdominal bleeding, and 5, 4, 3, and 1 patients were respectively complicated with intra-abdominal infection, bleeding, biliary fistula and chyle leakage as well as 1 patient received reoperation due to abdominal bleeding. The incidences of pancreatic fistula in grade B/C and delayed gastric emptying in grade B/C were 10.6%(5/47), 8.5%(4/47) in the ERAS group and 22.7%(20/88), 4.5%(4/88)in the control group, showing no statistically significant difference in the pancreatic fistula and delayed gastric emptying between the 2 groups (χ2=2.97, 0.86, P>0.05). Conclusion The perioperative ERAS program in the pancreatic surgery is safe and effective and should be popularized, meanwhile, it can also reduce duration of hospital stay and improve the quality of life and satisfaction of patients. Key words: Pancreatic surgery; Enhanced recovery after surgery; Perioperative period

Clinical effect of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail

Objective To explore the safety and feasibility of radical antegrade modular pancreato-splenectomy (RAMPS) for carcinoma of pancreatic body and tail (CPBT). Methods The retrospective cohort study was adopted. The clinical data of 99 patients with CPBT who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to October 2015 were collected. Among the 99 patients, 21 receiving RAMPS were allocated into the RAMPS group and 78 receiving traditional resection of body and tail of pancreas and splenectomy were allocated into the operation group. Observation indexes included (1) surgical situation: operation time, volume of intraoperative blood loss, volume of blood transfusion, combined organ resection, combined vascular resection, status of the resection margin, (2) postoperative situation: overall complications, major postoperative complications [pancreatic fistula, chyle leakage, abdominal bleeding, hemorrhage of digestive tract, delayed gastric emptying, pleural effusion, pulmonary infection, peritoneal effusion, abdominal infection, wound infection, deep venous thrombosis in the lower limbs, multiple organ dysfunction syndrome (MODS)], reoperation, duration of hospital stay, hospital expenses, (3) follow-up: the postoperative survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the patients′ survival and tumor recurrence and metastasis up to March 2016. Measurement data with normal distribution were presented as ±s and comparison between groups was evaluated with the Student t test. Measurement data with skewed distribution were presented as M(Qn) and comparison between groups was evaluated with the Wilcoxon rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. The survival time was calculated by the Kaplan-Meier method. Results (1) Surgical situation: operation time, volume of intraoperative blood loss, volume of blood transfusion and number of patients combined with organ resection were 235 minutes(180 minutes, 278 minutes), 400 mL (350 mL, 650 mL), 3.1 U (2.5 U , 5.6 U), 13 in the RAMPS group and 180 minutes (130 minutes, 210 minutes), 225 mL (200 mL, 400 mL), 0 (0, 2.0 U), 10 in the operation group, respectively, with statistically significant differences between the 2 groups (Z=3.529, 2.675, 3.389, P 0.05). (2) Postoperative situation: number of patients with overall complications, pancreatic fistula in grade A, pancreatic fistula in grade B, pancreatic fistula in grade C, chyle leakage, abdominal bleeding, hemorrhage of digestive tract, delayed gastric emptying, pleural effusion, pulmonary infection, peritoneal effusion, abdominal infection, wound infection, deep venous thrombosis in the lower limbs, MODS and reoperation were 16, 6, 5, 2, 1, 1, 0, 1, 7, 0, 6, 4, 1, 0, 0, 0 in the RAMPS group and 48, 15, 19, 2, 5, 4, 2, 1, 18, 4, 15, 5, 1, 2, 1, 1 in the operation group, respectively, with no statistically significant differences between the 2 groups (χ2=1.554, 1.642, P>0.05). The duration of hospital stay and hospital expenses were 15 days (13 days, 23 days), 74 632 Yuan (67 041 Yuan , 92 445 Yuan) in the RAMPS group and 12 days (10 days, 16 days), 64 410 Yuan (54 709 Yuan, 80 842 Yuan) in the operation group, respectively, showing statistically significant differences between the 2 groups (Z=3.529, 2.675, P 0.05). Conclusion RAMPS in the treatment of CPBT is safe and feasible, and it could not increase the incidence of complications, however, enhance the R0 resection rate compared with traditional resection of body and tail of pancreas and splenectomy. Key words: Neoplasms, body and tail of pancreas; Radical antegrade modular pancreatosplenectomy; Radical resection of body and tail of pancreas

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

Chylothorax is a rare form of chyle accumulation that can be associated with both traumatic and non-traumatic causes. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a left-sided chylothorax as a late complication to his thoracic spine trauma. A 19-year-old multi-trauma patient with bilateral pneumothorax, bilateral lung contusions and a severe thoracic spine fracture-dislocation was admitted to the intensive care unit (ICU) of our hospital intubated due to his unstable respiratory function. Bilateral thoracostomies were placed to his thoracic cavity prior to his admission to the ICU. The thoracic fracture-dislocation was stabilized with posterior fixation of his thoracic spine during his stay at the ICU. He was transferred to the neurosurgery department where at the 50th day of his hospitalization, a left-sided chylothorax was identified. Conservative management was decided and the chyle leak ceased over a period of 2 weeks. The patient was discharged from the clinic after a 3-month period of hospitalization. Traumatic chylothorax is a rare complication directly linked to thoracic spine fractures. It can occur immediately after trauma or several weeks after as in our case. Early diagnosis and treatment are essential for the avoidance of severe complications linked to the chyle loss. J Med Cases. 2015;6(12):568-571 doi: http://dx.doi.org/10.14740/jmc2364w

Clinical analysis of 39 cases with reoperation for thyroid

Objective To explore the cause of the thyroid reoperation ,methods,surgical approach ,and the prevention of complications .Methods 39 cases of thyroid reoperation in patients with clinical data were reviewed and analyzed.Results Thyroid papillary carcinoma in 11 cases,follicular carcinoma in 2 cases,nodular 22 cases of thyroid,thyroid adenoma 1 case,3 cases of primary hyperthyroidism .The incidence of transient hypoparathyroidism ac-counted for 2 cases,temporary laryngeal recurrent nerve injury in 2 cases,chyle leakage in 1 case,in total of 12.8%of postoperative complications .Conclusion Improper operation method choice for the first time and the misdiagnosis was the main cause of reoperation , The reoperation of thyroid is difficult and has more complications .Preoperative evaluation and careful operation can prevent the occurrence of complications . Key words: Thyroid/Surgery; Reoperation; Complication

Application of somatostatin in expectant treatment for postoperative chylothorax in children after congenital heart disease surgery

Objective To investigate the therapeutic efficacy of somatostatin on chylothorax after congenital heart disease surgery in children. Methods Retrospective analysis was performed in 13 postoperative chylothorax cases from Jan.2003 to Dec.2012, who were divided into control group (n=6) and treatment group(n=7), and there was no significant difference in age, weight, and time of occurrence between the 2 groups.The diagnosis standard for chylothorax was the same.The changes of chylous volume during the treatment were analyzed between 2 groups, and healing time and other data were analyzed too. Results Control group: clinical cure in 3 cases, conservative treatment failed in 3 cases(2 cases recovered after operation and 1 case died). The chyle volume of control group reduced obviously compared with post treatment from beginning [(256.6±124.2) mL/d]to 1 week[(155.5±85.7) mL/d] and 2 weeks[(142.3±110.3) mL/d] later( t=4.623, 2.099; P=0.002, 0.044). But it did not reduce obviously in 3 weeks later[(139.4±113.4) mL/d](t=1.745, P=0.07). Treatment group: 6 cases in treatment group were successful in recovery after conservative treatment and 1 case underwent operation.The chyle volume of treatment group reduced obviously compared with post treatment from beginning to 1 week [(51.2±18.7) mL/d]and 2 weeks [(19.3±7.05) mL/d]later ( t=5.549, 6.638; P=0.001, 0.001). Compared with the control group, the difference between 2 groups in post treatment(1 week later, 2 weeks later) was of statistical significance(t=2.900, 2.412; P=0.014, 0.034). The healing time of conservative treatment in 2 groups(only for recovery) had obvious difference[(32.8±1.8) d, (25.2±1.7) d](t=2.512, P=0.028). Conclusions The use of somatostatin can significantly promote the recovery of chylothorax in children, and it should be actively used in early conservative treatment. Key words: Somatostatin; Chylothorax; Congenital heart disease; Thoracic duct ligation; Child

Outcomes of open and minimally invasive esophagectomy for esophageal cancer

Objective To compare the safety, feasibility, and long-term outcomes between com- bined thoracoscopic and laparoscopic esophagectomy （TLE） and open three-field esophagectomy （OE） for esophageal cancer. Methods The data of 183 patients with esophageal cancer who accepted T LE （n = 94） or OE （n = 89） from February 2009 to December 2011 were retrospectively collected and compared. Results Demographics, pathologic data in each cohort were almost identical. No significant differences were observed in operative time, the number of lymph node harvested, rates of anastomotic leak, thoracic ab- scess, chyle chest, re-operation, vocal cord paralysis, gastric emptying dysfunction and morbidity. A significant difference was observed in blood loss （86. 6 ±38.3 ml in TLE group vs. 217.4 ±87. 2 ml in OE group, P=0.000）, rate of transfusion （1.1% vs. 6.7%, P=0.045）, hospital stay （13.9 ±7.5 d vs. 17. 1 ± 10. 2 d, P =0. 017）, rate of overall surgical complications （23.4% vs. 38. 2% , P =0. 030） , rate of pulmonary complications （9.6% vs. 27.0%, P =0.002） and rate of arythmia （4. 1% vs. 12.4%, P = 0. 046）. Median follow-up time was 28.0 ±2. 0 months （95% CI： 24. 2-31.8）. No difference between the two groups concerning survival was observed （P = 0. 954）. Conclusion The TLE for esophageal cancer is safe and feasible. Although it cannot improve the survival of long-term, it is worth spreading in intraoperative and postoperative advantages compared with OE group. Key words: Esophageal neoplasms ; Thoracoscopes ; Laparoscopes ; Thoraeis surgical procedures; Controlled clinical trials

Analytical performance and accuracy verification of four domestic and two imported enzymatic creatinine assay kits

Objective To assessed the analytical performance of six commercial enzymatic creatinine (Cr) reagents and compared the accuracy among them.Four reagents came from domestic manufactures (Maker Biotechnology,Beijing Strong Biotechnologies,Biosino Bio-technology & Science,BaiDing Biological Engineering,labeled as A,B,C,D respectively) and the other two reagents came from oversea manufactures (Sekisui Medical Technology,Japan and Wako Pure Chemical Industries,Japan,labeled as E,F respectively). Methods Performance verification test.70 serum samples were obtained from chronic kidney disease outpatients and medical center healthy volunteers in Peking Union Medical College Hospital from May 2010.Among 30 patients ureh CKD (15 moles,15 females) aged 18 to 80 years old;40 healthy volunteers (20 males,20 females) aged 20 to 60 years old.To evaluate the within-run imprecision and total imprecision according to the CLSI EP15-A protocol,two level control materials were measured with six reagents in five days,with a frequency of four times a day.To verify the linear ranges according to the EP6-A protocol,a series of samples that mixed by high and low level serum or urine pools with specific ratio were tested.To evaluate the anti-interference ability,we tested the sera added specific concentration of substances (bilirubin,hemoglobin,chyle).To verify the reasonable dilution ratio,diluted sera in different ratio were tested.Correlations and deviation among the detection results of six reagents were evaluated by testing 50 fresh patient samples.Accuracy was evaluated by measuring the NIST SRM 967a and NIST SRM 909b standard substances. Results There were no significant differences between the domestic and imported Cr reagents,with the within-run CV ranging from 0.5% to 1.2% and the total CV ranging from 0.5% to 1.9%,all of which were lower than the allowed biological variation for imprecision (3.0%).Linear ranges of the six Cr reagents were all relatively wide.No significant interference (bias%≤±10%) was found in the test of six reagents when conjugated bilirubin≤332μmol/L,unconjugated bilirubin≤327μmol/L,or chyle turbidity≤1530 FTU; no significant interference was found for the test of C,D,F reagents when Hb≤4.83 g/L; and for A,B,E when Hb≤3.381,3.864,4.347g/L,respectively.Percent deviation of the measured results of dulited serum samples diluted by 2 to 16 times compared to the results of the original samples ranged from 95.96% to 108.62%.Fresh patient samples comparison tests exhibited good correlation among the six reagents (r=1.000),although there were some differences (-4.91% to -4.75%).For NIST 967a,the percent bias ranged from -1.85% to 2.81% (level 1,66.5μmol/L),and from -2.28% to 2.05% (level 2,346.2μmol/L),none of the six reagents exceeded the allowed Cr bias derived from biological variation (4.0%).For NIST 909b,the percent bias ranged from -13.4% to 1.01% for level 1 (56.18μmol/L),while its value ranged from -6.49% to -1.79% for level 2 (467.4μmol/L),and these biases all exceeded the allowable range of target value. Conclusions Assessment of four domestic enzymatic Cr reagents and two imported reagents show high precision,wide linear range,and their dilution accuracy can meet the clinical needs.Moreover,the six regents show good anti-interference capability (bilirubin,hemoglobin,chyle) and high accuracy.No significant differences have been found in the above assessed properties among these reagents.(Chin J Lab Med,2013,36:806-811) Key words: Creatinine; Indicators and reagents; Reagent kits; diagnostic

Application of direct lymphangiography in the diagnosis of primary chyluria

To discuss the role of direct lymphangiography in the diagnosis of primary chyluria. Iodized oil was infused into lymphatic vessel of unilateral foot in 25 cases. The condition of lymphatic system imaging was dynamically observed via Innova 2100-IQ digital flat-panel angiography system. All of them underwent direct lymphangiography. The results revealed unilateral (n = 18) or bilateral (n = 7) renal reflux of contrast media. Among 22 stenotic cases, there were partial (n = 18) or whole (n = 4) cervical section of thoracic duct, no imaging in cervicothoracic section of thoracic duct (n = 1); thin imaging in cervical section and partial thoracic section (n = 2); retroperitoneal lymphangictasia & tortuous lymphatic vessels (n = 21); reflux of contrast medium to pelvic and/or contralateral sacroiliac part (n = 13). Capable of acquiring dynamic images of chyle (lymph) circulation, direct lymphangiography provides accurate estimation for the location, scope, extent of lesions of renal chylous reflux in primary chyluria so as to guide surgery. Stenotic cervical section of thoracic duct plays an important etiologic role in primary chyluria.