The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakag...The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow.We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse.Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade.Computed tomography of the chest showed lower third esophageal wall thickening.The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space.The upper end of the esophagus was resected 5 cm above the tumor.The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity.The patient started a liquid diet on postoperative day 8 and was discharged on the 10 th postoperative day without complications.In this report,we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.展开更多
The colon is an alternative graft organ for esophageal reconstruction.The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion,to evaluate the out...The colon is an alternative graft organ for esophageal reconstruction.The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion,to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range:270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20,16.8%), the larynx (n=3,2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon).One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.展开更多
Mg-2Al-1.2Ca-0.2Mn(at%)-based alloys with Ce-rich mischmetal(MM) substitution of 0–0.6 at% for Ca were hot extruded at 400 °C. The effect of MM substitution on the microstructure and mechanical properties of the...Mg-2Al-1.2Ca-0.2Mn(at%)-based alloys with Ce-rich mischmetal(MM) substitution of 0–0.6 at% for Ca were hot extruded at 400 °C. The effect of MM substitution on the microstructure and mechanical properties of the extruded alloys was investigated. The as-cast Mg-2Al-1.2Ca-0.2Mn alloy is mainly composed of a-Mg, Mg_2Ca and(Mg,Al)_2Ca phases and Al_8Mn_5 precipitates, whereas the substitution of MM brings about the formation of Al_(11)MM_3, Al_2MM phases and Al_(10)MM_2Mn_7 particles with the absence of (Mg,Al)_2Ca phase. The volume fraction of MM-containing phases increases with increasing MM contents. All of the extruded alloys exhibit bimodal microstructure comprising fine dynamically recrystallized grains with almost random orientation and coarse deformed grains with strong basal texture. Dense nanosized planar Al_2Ca and spherical Al–Mn phases precipitate inside the deformed grains. High tensile yield strengths of~ 350 MPa and moderate elongations to failure of >12% are obtained in all extruded alloys; the MM substitution induces negligible difference in the tensile properties at ambient temperature, while the highest MM substitution improves the strength at 180 °C due to the better thermal stability of the fragmented MM-containing phases.展开更多
基金financially supported by the National Natural Science Foundation of China(Nos.52171117,52001161,51927801,51871111)JianHua Research Foundation of Hebei University of Technology,China(Nos.HB1921,HB1920)the Natural Science Foundation of Jiangsu Province,China(Nos.BK20200695,BK20202010)。
文摘The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow.We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse.Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade.Computed tomography of the chest showed lower third esophageal wall thickening.The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space.The upper end of the esophagus was resected 5 cm above the tumor.The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity.The patient started a liquid diet on postoperative day 8 and was discharged on the 10 th postoperative day without complications.In this report,we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.
文摘The colon is an alternative graft organ for esophageal reconstruction.The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion,to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range:270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20,16.8%), the larynx (n=3,2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon).One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.
基金supported by JSPS Grant-in-Aid for Young Scientists(B),16K18266JST Advanced Low Carbon Technology Research and Development Program(ALCA),12102886
文摘Mg-2Al-1.2Ca-0.2Mn(at%)-based alloys with Ce-rich mischmetal(MM) substitution of 0–0.6 at% for Ca were hot extruded at 400 °C. The effect of MM substitution on the microstructure and mechanical properties of the extruded alloys was investigated. The as-cast Mg-2Al-1.2Ca-0.2Mn alloy is mainly composed of a-Mg, Mg_2Ca and(Mg,Al)_2Ca phases and Al_8Mn_5 precipitates, whereas the substitution of MM brings about the formation of Al_(11)MM_3, Al_2MM phases and Al_(10)MM_2Mn_7 particles with the absence of (Mg,Al)_2Ca phase. The volume fraction of MM-containing phases increases with increasing MM contents. All of the extruded alloys exhibit bimodal microstructure comprising fine dynamically recrystallized grains with almost random orientation and coarse deformed grains with strong basal texture. Dense nanosized planar Al_2Ca and spherical Al–Mn phases precipitate inside the deformed grains. High tensile yield strengths of~ 350 MPa and moderate elongations to failure of >12% are obtained in all extruded alloys; the MM substitution induces negligible difference in the tensile properties at ambient temperature, while the highest MM substitution improves the strength at 180 °C due to the better thermal stability of the fragmented MM-containing phases.
