AIM: To examine the expression of cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2) in rat esophageal lesions induced by reflux of duodenal contents.
AIM:To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct.METHODS:Thirty-two male guinea pigs were randomly divided into control group,2-,3-,and 6-mo...AIM:To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct.METHODS:Thirty-two male guinea pigs were randomly divided into control group,2-,3-,and 6-mo groups after establishment of EEA model.Histological,immunohistochemical and serologic tests as well as measurement of bile contents were performed.The bile duct diameter and the diameter ratio (DR) were measured to assess the formation of relative stricture.RESULTS:Acute and chronic inflammatory reactions occurred throughout the healing process of bile duct.Serology test and bile content measurement showed no formation of persistent stricture in 6-mo group.The DR revealed a transient formation of relative stricture in 2-mo group in comparation to control group (2.94 ± 0.17 vs 1.89 ± 0.27,P=0.004).However,this relative stricture was released in 6-mo group (2.14 ± 0.18,P=0.440).CONCLUSION:A simple and reliable EEA model of guinea pig bile duct can be established with a good reproducibility and a satisfactory survival rate.展开更多
Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation a...Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute bile duct injury in dogs ). Methods: Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results: The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion: It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.展开更多
Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis ...Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.展开更多
BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because...BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied.展开更多
BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile ...BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.展开更多
Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the wo...Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.展开更多
文摘AIM: To examine the expression of cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2) in rat esophageal lesions induced by reflux of duodenal contents.
基金Supported by A grant from National 863 Program of China,No.2007AA04Z313
文摘AIM:To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct.METHODS:Thirty-two male guinea pigs were randomly divided into control group,2-,3-,and 6-mo groups after establishment of EEA model.Histological,immunohistochemical and serologic tests as well as measurement of bile contents were performed.The bile duct diameter and the diameter ratio (DR) were measured to assess the formation of relative stricture.RESULTS:Acute and chronic inflammatory reactions occurred throughout the healing process of bile duct.Serology test and bile content measurement showed no formation of persistent stricture in 6-mo group.The DR revealed a transient formation of relative stricture in 2-mo group in comparation to control group (2.94 ± 0.17 vs 1.89 ± 0.27,P=0.004).However,this relative stricture was released in 6-mo group (2.14 ± 0.18,P=0.440).CONCLUSION:A simple and reliable EEA model of guinea pig bile duct can be established with a good reproducibility and a satisfactory survival rate.
基金The study was supported by science and technology project founda-tion of Shanxi Province of China. (2005K11-G4)
文摘Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute bile duct injury in dogs ). Methods: Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results: The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion: It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.
基金Supported by the National Natural Science Foundation of China(30830099)China Postdoctoral Science Foundation(20100481341)Scienceand Technology Research and Development Project of Shaanxi Province(2009K14-01)
文摘Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.
文摘BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied.
基金Supported by Basic Research Foundation of Yunnan Province,No.202101AY070001-282.
文摘BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.
文摘Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.