Marine-inspired molecular mimicry generates a drug-free, but immunogenic hydrogel adhesive protecting surgical anastomosis

Herein,we report the synthesis of a biomimic hydrogel adhesive that addresses the poor healing of surgical anastomosis.Dopamine-conjugated xanthan gum(Da-g-Xan)is fabricated using deep insights into the molecular similarity between mussels'adhesive and dopamine as well as the structural similarity between barnacle cement proteins and xanthan gum.The hydrogel mimics marine animals’adherence to wet tissue surfaces.Upon applying this adhesive to colonic anastomosis in a rat model,protective effects were shown by significantly improving the bursting pressure.Mechanistically,the architecture of Da-g-Xan hydrogel is maintained by dynamic intermolecular hydrogen bonds that allow the quick release of Da-g-Xan.The free Da-g-Xan can regulate the inflammatory status and induce type 2 macrophage polarization(M2)by specifically interacting with mannose receptors(CD206)revealed by RNA-sequencing and molecular binding assays.Consequently,an appropriate microenvironment for tissue healing is created by the secretion of chemokines and growth factors from M2 macrophages,strengthening the fibroblast migration and proliferation,collagen synthesis and epithelial vascularization.Overall,this study demonstrates an unprecedented strategy for generating an adhesive by synergistic mimicry inspired by two marine animals,and the results show that the Da-g-Xan adhesive augments native tissue regenerative responses,thus enabling enhanced recovery following surgical anastomosis.

Simulation and Experimental Study of Staple Line Reinforcement Surgery

The aim of this study was to evaluate the effectiveness of BM (basement membrane) and SIS (small intestine submucosa) composite extracellular matrix staple line reinforcement in surgical procedures through finite element modelling simulations and leak-proof performance experiments. The mechanical analyses of soft tissues with and without staple line reinforcement were performed by establishing finite element models of three tissues, namely, stomach, intestine and lungs, under the use scenarios of different anastomosis staple models;and the leak-proof performance of the staple line reinforcement was evaluated by simulating leak-proof experiments of gastric incision margins, intestinal sections, and lung incision margins in vitro. The results showed that the equivalent average stresses of the staple line reinforcement were increased by 20 kPa-68 kPa in gastric and intestinal tissues, and 8 kPa-22 kPa in lung tissues. and that the BM and SIS composite extracellular matrix staple line reinforcement could strengthen the anastomotic structure, and at the same time disperse the high stresses of the anastomosed tissues, which could effectively reduce the postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis. It can effectively reduce postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis.

Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

BACKGROUND Digestive tract resections are usually followed by an anastomosis.Anastomotic leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and mortality.Despite technical and technological advances and focused research,its rates have remained almost unchanged the last decades.In the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.AIM To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.METHODS PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021.Studies employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included.Reference lists from the selected articles were reviewed to identify additional pertinent articles.METHODS Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and limitations.RESULTS Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical trials.Experimental studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical results.Mesenchymal SCs are mostly employed,and delivery routes are mainly local injections and cell sheets followed by biosutures(sutures coated by SCs)or purely topical.As potential weaknesses,animal models need to be improved to make them more comparable and equivalent to clinical practice,and the SC isolation processes need to be standardised.There is notable heterogeneity in the studies,making them difficult to compare.Further investigations are needed to establish the indications,the administration system,potential adjuvants,the final efficacy and to confirm safety and exclude definitively oncological concerns.CONCLUSION The future role of SC therapy to induce healing processes in digestive anastomoses/sutures still needs to be determined and seems to be currently far from clinical use.

Clinical Significance of Recurrent Laryngeal Nerve Exposure During Esophagogastric Anastomosis of the Neck

OBJECTIVE To investigate the clinical value in a comparison between intraoperative exposure and non-exposure of the recurrent laryngeal nerve （RLN） of the neck during left neck esophagogastric anastomosis following resection of carcinomas of the middle and inferior-segment esophagus. METHODS From January 2003 to April 2009, 237 patients were selected to undergo resection of esophageal squamous carcinoma via posteroexternal incision of the left chest plus gastroesophageal anastomosis at the left neck incision. The 237 cases were divided into 2 groups： 115 of the total cases were in group A （the study group）, cases of resections with neck RLN exposure. Of the patients in this group, 64 were male and 51 female, with a mean age of 49 ranging from 31 to 73 years. Another 122 cases were in group B （the control group）, cases of resections without neck RLN exposure. In this group, 51 of the patients were male and 71 female, with a mean age of 45 ranging from 33 to 75 years. In the 2 groups, there were 9 cases in total with symptoms induced by RLN injury. RESULTS Hoarseness, choking cough when drinking, and difficult expectoration were found in 1 of the cases （1/115） in group A （0.087%）, while there were 8 cases （8/122） presenting with these symptoms in group B （6.5%）. There is statistical signi.cance in the di.erences of RLN injury between the 2 groups （P 〈 0.05）. CONCLUSION Analysis of study cases of esophageal carcinoma resection with left-neck esophagogastric anastomosis in the 2 groups indicated that the exposure of the RLN in group A resulted in an obviously lower rate of neck RLN injury after the surgery, compared to group B, where the RLN was not exposed. Exposure can lead to the avoidance of complications induced by RLN injury, such as dysarthria and choking cough when eating. As a result, satisfactory expectoration, which would diminish the incidence of pulmonary complications, can be reached allowing the patients to recover as early as possible. The results of our study suggest that the exposure of the RLN during the left -neck esophagogastric anastomosis has signi.cant clinical value, and that this approach can be recommended with con.dence.

A double stapled technique for oesophago-enteric anastomosis

AIM:Leakage from oesophageal anastomosis is associated with substantial morbidity and mortality.This study presented a novel,safe and effective double stapled technique for oesophago-enteric anastomosis. METHODS:The data were obtained prospectively from hospital held clinical database.Thirty nine patients(26 males,13 females)underwent upper-gastrointestinal resection between 1996 and 2000 for carcinoma(n=36), gastric lymphoma(n=1),and benign pathology(n=2). Double stapled oesophago-enteric anastomosis was performed in all cases. RESULTS:No anastomotic leak was reported.In cases of malignancy,the resected margins were free of neoplasm. Three deaths occurred,which were not related to anastomotic complications. CONCLUSION:Even though the reported study is an uncontrolled one,the technique described is reliable,and effective for oesophago-enteric anastomosis.

Iatrogenic bile duct injuries:Etiology,diagnosis and management

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.

Endoscopic management of biliary strictures after liver transplantation

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classifi ed as anastomotic or non-anastomotic strictures according to location and are defi ned by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is signifi cant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer

AIM： To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a selfexpandable metal stent （SEMS） for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS： The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary＇s Hospital, were reviewed retrospectively. RESULTS： Twenty patients （15 male, mean age 63 years） were included. The operations were a total gastrectomy with esophagojejunostomy （n = 12）, subtotal gastrectomy with Billroth-Ⅰ reconstruction （n = 2） and subtotal gastrectomy with Billroth- Ⅱ reconstruction （n = 8）. The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients （15%） within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-Ⅱ reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d （range, 5-439 d）. The median survival was 83 d （range, 12-439 d）. CONCLUSION： Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer, A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction:Preliminary experience

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.

Covered nitinol stents for the treatment of esophageal strictures and leaks

AIM:To compare 2 different types of covered esophageal nitinol stents(Ultraflex and Choostent) in terms of efficacy,complications,and long-term outcome.METHODS:A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent(n = 33) or a Choostent(n = 32) from June 2001 to October 2009 was conducted.RESULTS:Stent placement was successful in all patients without hospital mortality.No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups.The median follow-up time was 6 mo(interquartile range 3-16 mo).Endoscopic reintervention was required in 9 patients(14%) because of stent migration or food obstruction.No significant difference in the rate of reintervention between the 2 groups was observed(P = 0.8).The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent(P = 0.6).At 1-mo follow-up endoscopy,the cover membrane of the stent appeared to be damaged more frequently in the Choostent group(P = 0.34).Removal of the Choostent was possible up to 8 wk without difficulty.CONCLUSION:Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks.Removal of the Choostent was easy and safe under mild sedation.

咽胃吻合术后颈胃坏死折叠胸大肌肌皮瓣修补1例

1临床资料 患者,男,59岁。因进食呛咳1个月于2017-07-06入院,术前诊断：下咽恶性肿瘤、食管癌。患者于2017-07-13全麻下行＂气管切开术、全喉全下咽切除术、双侧颈淋巴结清扫术、气管造瘘术、食管切除术、胃上徙管状胃成形术、咽胃吻合术、空肠造瘘术＂。手术顺利,术后患者一般情况可,术后5天颈部引流管口有棕褐色液体流出,急诊手术探查,术中见颈部大量黄色脓性分泌物流出,颈段胃壁前份颜色淡黄色,无血运,上至舌根。

Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis

Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional （3D） media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope （arterial microscope group） were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system （arterial 3D group）.For the other 20 rats,10 femoral vein anastomoses using a conventional microscope （venous microscope group） were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system （venous 3D group）.The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows：anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively （P ＞0.05）.The average venous anastomotic time of the venous microscope group and venous 3D group was 29.95 and 31.50 minutes,respectively （P ＞0.05）.Conclusions A small vessel anastomosis can be performed successfully with the help of a 3D display system.Although the vascular anastomotic time did not demonstrate a significant difference between the groups,the 3D microsurgical video system offers another option to improve the working environment for surgeons.Further development of our 3D monitoring system should focus on a higher resolution and better flexibility.

A clinical application of laser direction in anastomosis for inferior canalicular laceration

Objective： To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration. Methods ： Forty-nine patients （ 49 eyes ） suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal puncture and the nasal broken end of lacerated lacrimal canaliculus was more than 6 ram. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6 months. Results： In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was （5.75 ± 1.49） minutes and the mean time of operation was （49.21 ±3.37） minutes; both were significantly shorter than that of the control group （P 〈 0.01 ）. The cure rate of the laser-directing group was 96.55 %, higher than that of the control group but without statistical significance （ P 〉 0.05 ）. Conclusions： The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

Surgical treatment for traumatic transection of left common carotid artery

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality.1 Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass （CPB）, improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome.2-6 However, there exists controversies about it.7-9 In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.

Sutureless choledochoduodenostomy with an intraluminal degradable stent in dog model

Background It is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model. Methods A patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group （SG, n=20） and a control group （CG, n=18）. Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy （single layer discontinuous anastomosis with absorbable suture）. Dogs of each group were divided into 4 subgroups according to time of death （1,3, 6, and 12 months postoperatively） to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography （MRCP） to assess the stricture. Results All procedures were completed successfully. The surgical time of the SG was significantly less than the CG （SG： （19.2±4.3） minutes, vs. CG： （29.2±7.1） minutes, P=0.000）. One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction during months of follow-up. Conclusion The technique of sutureless choledochoduodenostomy with a degradable intraluminal stent is feasible and a safe procedure in this dog model.

Efficiency and therapeutic effect of modified pigtail probe in anastomosing lacerated lacrimal canaliculus

Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.

Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration

Objective： To evaluate the therapeutic effects of two anastomoses （canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis） on nasolacrimal laceration for over 7 mm from the broken end to the dacryon. Methods： A total of 71 patients （44 males and 27 females, aged 16-55 years, mean=34.32 years） with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis （the treatment group） and 34 with end-to-end anastomosis （the control group）, detaining silicone tubes till 3 months later. Results： The cure rate of the treatment group （89.19%） was significantly higher than that of the control group （55.56%）. Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant （P〈0.05）. Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups （P〉0.05）. Conclusions： When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.

A novel method for reconstruction in laparoscopic pancreaticoduodenectomy:an experience of 13 cases

Laparoscopic pancreaticoduodenectomy(LPD)is a challenging operation to general surgeon.Up to date,only about 135 cases have been reported,16 cases in China,119 cases outside China.The reconstruction of alimentary system is a key procedure to ensure success of the whole surgery.It is worth investigating the methods of reconstruc-tion in LPD.A retrospective study is made to investigate the methods of reconstruction in LPD.We analyze 13 cases of LPD performed in our center.Child’s or modified Child’s method was used to make the reconstruction in our practice.We tried three methods to make the anastomosis of pancre-aticojejunostomy,including end-to-end dunking binding pancreaticojejunostomy in two cases,end-to-end dunking pancreaticojejunostomy using interrupted suture in two cases,and duct-to-jejunal end-to-side embedding pancreaticojeju-nostomy in nine cases.The clinical data was collected and analyzed.Three of four patients,who underwent end-to-end pancreaticojejunostomy,had a little pancreatic leakage,especially in the first case.None of other nine patients,who underwent duct-to-jejunal end-to-side embedding pancreati-cojejunostomy,was detected to have pancreatic leakage,and the operating time of these nine cases was less than other four cases.Duct-to-jejunal end-to-side embedding pancreaticoje-junostomy is a safe and efficient method of reconstruction in LPD.

Biomechanical effect of major extremity vessels in choosing repair methods for peripheral artery injury

Objective： To investigate the biomechanical effect of major extremity vessels to choose appropriate repair methods for vascular injuries of the extremities. Methods ： The data of 385 patients （337 males and 48 females, aged 18-71 years, mean = 32.6 years ） including 403 injured vessels, who suffered from vascular injuries of the extremities and were treated in our hospital from October 1960 to August 2005, were studied retrospectively in this article. We compared the results of different repair methods for the defect of vessels and evaluated different injured vessels for repairing arterial injuries with anastomosis and venous graft, respectively. Results： A significant difference was found between the defect lengths of the arteries repaired with anastomosis and venous graft （ P 〈 0. 0001 ）. The upper limits of the confidence interval in the defect lengths of the brachial artery, the femoral artery and the popliteal artery were 3.43 cm, 2. 38 cm and 2. 42 cm, respectively, when repaired with anastomosis. The lower limits were 2.16 cm, 2.16 cm and 1. 63 cm, respectively, when repaired with venous graft. The defect length of each artery repaired with venous graft had linear correlation with the graft length. Conclusion - Because of the longitudinal biomechanical difference of different options of repair arterial injuries. human peripheral vessels, are necessary for different arterial injuries.