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This paper summarized the rehabilitation nursing management of a patient with severe traumatic brain injury complicated with multiple rupture of thoracic-abdominal organs based on the concept of enhanced recovery after surgery. Based on the enhanced recovery after surgery, a multidisciplinary team for rehabilitation management was set up. Comprehensive treatment and nursing interventions including postoperative management of intracranial pressure, management of traumatic liver injuries, exercise rehabilitation, postoperative thromboembolism prevention, enteral nutrition support and management of antiepileptic drug were carried out to prevent postoperative complications and improve the rehabilitation. (本文总结1例基于加速康复外科(ERAS)理念的重型颅脑创伤伴肝脾破裂、肋骨骨折、肺、肾挫裂伤危重症患者的康复护理经验。基于ERAS理念, 组建多学科康复管理团队, 制定全面的康复治疗方案, 包括术后颅内压管理、创伤性肝损伤康复、运动康复管理、术后血栓预防管理、术后肠内营养管理、术后抗癫痫等详细的康复方案, 有效预防相关并发症, 促进患者康复。)

脾血管瘤在临床上并不常见,发病率低。脾脏海绵状血管瘤是脾脏血管源性肿瘤中常见的一 种病理类型。目前来说,脾脏海绵状血管瘤的病因尚不完全明确,临床上缺乏典型性与特异性。该文就1例脾 脏多发结节性海绵状血管瘤进行报道。 [ABSTRACT FROM AUTHOR]

Objective To investigate the benefits and risks of splenectomy in adult patients with hepatolenticular de⁃ generation (HLD)and hypersplenism. Methods A total of 100 adult patients with liver cirrhosis and hypersplenism were collected and were divided into the HLD group of 50 cases and the viral hepatitis B (HBV) group of 50 cases. Patients in both groups received splenectomy, and the operation time, intraoperative blood loss and postoperative drainage volume were recorded, and intraoperative MAP, HR, and SPO2 were monitored. Fasting venous blood was collected at 1 day before surgery and 1, 7, and 14 days after surgery. We used an automatic blood cell analyzer to detect WBC, RBC, PLT and Hb, and used automatic biochemical analyzer to detect liver function indexes AST, ALT, TBIL and ALB. The incidence of postoperative complications (including intraabdominal hemorrhage, pancreatic leakage, portal vein system thrombosis (PVST), incision complications, pulmonary infection and urinary tract infection)were observed, and the mortality rate at discharge was calculated. Results There were no significant differences in operation time, intraoperative blood loss, postoperative drainage, MAP, HR, or SPO2 at different time points during the operation between the two groups (all P>0. 05). The postoperative WBC in both groups was higher than that before operation, reaching the highest point on the 1st day after operation, and gradually decreased to the normal range on the 7th and 14th days after operation (all P<0. 05)；postoperative RBC, Hb, and PLT in both groups were higher than those before surgery, and those on the 7th and 14th days after surgery were higher than those on the 1st day after surgery, and those on the 14th day after surgery were higher than those on the 7th day after surgery (all P<0. 05). The levels of ALT, AST and TBIL in the two groups in⁃ creased on the 1st day after operation in comparison with those before operation, decreased to the preoperative level on the 7th day after operation, and continued to decrease on the 14th day；on the 1st day after operation, ALB decreased com⁃ pared with that before operation, increased to the preoperative level on the 7th day after operation, and continued to increase on the 14th day after operation (all P<0. 05). Six cases in the HBV group and 9 cases in the HLD group had surgical complications, and the complication grades were all grade I. There was no significant difference in the incidence of complications between the two groups (P>0. 05). There were no deaths in either group. Conclusions Splenectomy for HLD complicated with hypersplenism not only achieves the expected curative effect, but also improves postoperative liver function. In comparison with patients with hypersplenism caused by other diseases who undergo splenectomy, the pa⁃ tients’postoperative complications and mortality do not increase, and their intraoperative vital signs are stable. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 244 patients with portal hypertension who were admitted to Beijing YouAn Hospital from April 2010 to September 2015 and underwent esophagogastric devascularization and splenectomy. According to the presence or absence of variceal rebleeding, these patients were divided into non-rebleeding group and rebleeding group. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for statistically significant variables identified by the univariate analysis. ResultsOf all 244 patients, 38 (15.6%) experienced variceal rebleeding. The univariate analysis showed that there were significant differences between the two groups in the history of variceal bleeding, preoperative ascites, total bilirubin after surgery, portal venous pressure after devascularization, portal venous pressure before and after splenectomy, and preoperative international normalized ratio (χ2=5.530、4.120，t=3.591、4.098、2.516、2.622、4.278，P=0.016, 0.026, 0.008, 0.002, 0.022, 0.012, and 0.003). The multivariate logistic regression analysis showed that variceal rebleeding after esophagogastric devascularization and splenectomy was associated with the history of variceal bleeding (95%CI:1.113-13.704，P=0.033), preoperative ascites (95%CI:1.257-5.437,P=0.010), and portal venous pressure after devascularization (95%CI:1.022-1.172,P=0.010). ConclusionHistory of variceal bleeding, preoperative ascites, and portal venous pressure after devascularization are independent risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare the effect of laparoscopic and open splenectomy plus cardiac peripheral vascular disconnection in the treatment of liver cirrhosis with portal hypertension. Methods: A total of 120 patients with cirrhosis and portal hypertension were selected from January 2012 to December 2013 in Tangdu Hospital of the Fourth Military Medical University. All of themwere randomly divided into the observation group ( n=60 ) and control group (n=60). The observation group was treated by splenectomy plus cardiac peripheral vascular disconnection which used laparoscopy, and the control group was treated by traditional open surgery. The intraoperative blood loss, operation time, postoperative hospital stay, recovery time of gastrointestinal tract and occurrence of complications were compared between two groups. Results: The average operation time of observation group showed no significant difference from the control group (P> 0.05). However, the intraoperative blood loss, postoperative hospital stay time, recovery time of gastrointestinal tract and occurrence of complications of observation group were all better than those of the control group (P <0. 05). The postoperative complications included postoperative fever, wound infection, abdominal bleeding and portal venous system thrombosis effusion, the incidence of which was obviously lower in the observation group than those of in the control group (P<0.05). Conclusions: Splenectomy plus cardiac peripheral vascular disconnection which used laparoscopy had significant clinical efficacy and high safety in the treatment of liver cirrhosis with portal hypertension. [ABSTRACT FROM AUTHOR]