To the Editor:Establishing dual arterial and portal inflow is essential for liver transplantation[1].Inadequate portal inflow compromises graft function and graft survival[2].Portal hypoperfusion is usually a conseque...To the Editor:Establishing dual arterial and portal inflow is essential for liver transplantation[1].Inadequate portal inflow compromises graft function and graft survival[2].Portal hypoperfusion is usually a consequence of spontaneous portosystemic shunt,ligation of which展开更多
BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound inf...BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.展开更多
BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node ...BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.展开更多
目的探讨胃网膜右动脉（RGEA）在非体外循环冠状动脉旁路移植术（OPCAB）中的临床应用。方法 2008年12月至2009年7月南京医科大学第一附属医院对38例冠心病患者采用RGEA行OPCAB治疗,根据在OPCAB中采用的移植血管不同将76例患者分为两组,...目的探讨胃网膜右动脉（RGEA）在非体外循环冠状动脉旁路移植术（OPCAB）中的临床应用。方法 2008年12月至2009年7月南京医科大学第一附属医院对38例冠心病患者采用RGEA行OPCAB治疗,根据在OPCAB中采用的移植血管不同将76例患者分为两组,RGEA组：38例,男36例,女2例;年龄65.87±6.29岁;采用常规移植血管加RGEA行OPCAB;对照组：38例,男35例,女3例;年龄66.68±6.24岁;采用左乳内动脉（LIMA）、桡动脉（RA）、大隐静脉（SV）作为移植血管行OPCAB。对两组患者的术中、术后临床资料进行分析、比较。结果两组患者手术顺利,无手术死亡,无二次止血、功能性胃排空障碍和严重感染等并发症发生。与对照组比较,RGEA组的手术时间延长（295.53±45.16 min vs.262.50±42.44 min,P=0.001）,吻合口总数（4.71±0.56个vs.5.29±0.92个,P=0.002）和术中血浆用量减少（194.74±186.30 ml vs.565.79±382.70 ml,P=0.000）;术后机械通气时间延长（1 398.82±1 349.94 min vs.985.39±170.30 min,P=0.036）,24 h胸腔引流量（394.71±205.36 ml vs.536.32±258.85 ml,P=0.008）、术后红细胞总量（1.67±1.48 U vs.2.81±2.48 U,P=0.010）、术后住院时间（12.47±3.20 d vs.15.47±9.31 d,P=0.035）均减少。随访72例,随访时间9~17个月,失访4例。随访期间两组患者无心肌缺血表现,RGEA组患者无胃部相关并发症发生。结论 RGEA是CABG良好的移植血管,手术技术要求较高,手术时间较长。展开更多
文摘To the Editor:Establishing dual arterial and portal inflow is essential for liver transplantation[1].Inadequate portal inflow compromises graft function and graft survival[2].Portal hypoperfusion is usually a consequence of spontaneous portosystemic shunt,ligation of which
文摘BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.
文摘BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.
文摘目的探讨胃网膜右动脉（RGEA）在非体外循环冠状动脉旁路移植术（OPCAB）中的临床应用。方法 2008年12月至2009年7月南京医科大学第一附属医院对38例冠心病患者采用RGEA行OPCAB治疗,根据在OPCAB中采用的移植血管不同将76例患者分为两组,RGEA组：38例,男36例,女2例;年龄65.87±6.29岁;采用常规移植血管加RGEA行OPCAB;对照组：38例,男35例,女3例;年龄66.68±6.24岁;采用左乳内动脉（LIMA）、桡动脉（RA）、大隐静脉（SV）作为移植血管行OPCAB。对两组患者的术中、术后临床资料进行分析、比较。结果两组患者手术顺利,无手术死亡,无二次止血、功能性胃排空障碍和严重感染等并发症发生。与对照组比较,RGEA组的手术时间延长（295.53±45.16 min vs.262.50±42.44 min,P=0.001）,吻合口总数（4.71±0.56个vs.5.29±0.92个,P=0.002）和术中血浆用量减少（194.74±186.30 ml vs.565.79±382.70 ml,P=0.000）;术后机械通气时间延长（1 398.82±1 349.94 min vs.985.39±170.30 min,P=0.036）,24 h胸腔引流量（394.71±205.36 ml vs.536.32±258.85 ml,P=0.008）、术后红细胞总量（1.67±1.48 U vs.2.81±2.48 U,P=0.010）、术后住院时间（12.47±3.20 d vs.15.47±9.31 d,P=0.035）均减少。随访72例,随访时间9~17个月,失访4例。随访期间两组患者无心肌缺血表现,RGEA组患者无胃部相关并发症发生。结论 RGEA是CABG良好的移植血管,手术技术要求较高,手术时间较长。
