Establishment of a pig model with enteric and portal venous drainage of pancreatoduodenal transplantation

AIM： To establish the pig model of pancreatoduodena transplantation with enteric drainage （ED） and porta venous drainage （PVD）. METHODS： Forty-six hybrid Landrace pigs were divided into two groups （donors and recipients） randomly, and pancreatoduodenal allotransplantation was performed. Donors were perfused via abdominal aorta without clamping the portal venous outflow with UW solution at 80-100 cm H2O after heparinization. Whole pancreatoduodenal grafts were harvested with segments of abdominal aorta and portal vein, and shaped under 4℃ UW solution. Then, end-to-end anastomosis was performed with the donor iliac artery bifurcation Y graft to the recipient superior mesenteric artery and celiac artery. Furthermore, type I diabetes model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesentery vein. Meanwhile, end-toside anastomosis was performed with the donor common iliac artery bifurcation Y graft to the recipient abdominal aorta, and side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. Levels of plasma glucose, insulin and glucagon were measured during the operation and on the 1^st 3^rd 5^th and 7^th d after operation. RESULTS： Pancreatoduodenal allotransplantation was performed on 23 pigs of which 1 died of complication of anesthesia. The success rate of operation was 95.6%. Complications of operation occurred in two cases in which one was phlebothrombosis with an incidence of 4.6%, and the other was duodenojejunal anastomotic leak with an incidence of 4.6%. The level of plasma glucose decreased within 30 min, after removal of pancreas and recovered on the 2^nd after operation. The level of plasmainsulin and glucagon increased within 30 min after removal of pancreas and recovered on the 2^nd d after operation. Rejection occurred on the 1^st and reached the worst level on the 7^th d after transplantation, without change of plasma insulin and glucagon or clinical symptoms of rejection. CONCLUSION： Pancreatoduodenal transplantation in pigs can treat type I diabetes. ED and PVD can keep the function of endocrine in normal. The technique of pancreatoduodenal transplantation with ED and PVD may pave the way for the further application of pancreas transplantation in clinic.

Pancreaticoduodenal transplantation with portal venous and enteric drainage in rats

INTRODUCTIONThe use of combined pancreatic and renaltransplantation in patients with diabetes and end-stage renal failure has gained widespreadrecognition as an acceptable treatment option.Theprevailing method used for transplantation of thepancreas involves anastomosis of the graft’s portalvein and the rccipient’s iliac vein to provide

Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage

Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.

Labeled Hepasphere^(TM) behavior during venous drainage simulation at 1.5T

Stability of the magnetic resonance (MR) contrast agent inside vascular occlusion agents is important for their localization with magnetic resonance imaging (MRI). The aim of this paper is to study the behaviour of the superparamagnetic iron oxide (SPIO) within Hepaspheres? microparticles (MP) by MRI when they are submitted to negative pressure induced by venous drainage of a tumor. Therefore, a venous drainage model was established and three parameters were taken into account according to physiologic parameters in tumors: pH, temperature and flow blood rate. Four cycles of pumping were performed with the presence of labeled Hepaspheres? with Endorem?. Several MR images of MP and perfusion liquid were taken before and after pumping. Endorem? release was determined after correction of non-uniformity intensities in MR images. Intensity variation according to spatial position, coil and MR acquisition parameters was studied. Labeled microparticles (LB*MP) appeared as black spots in MRI images whatever duration and pH. Our model demonstrates the stability of the SPIO inside the occlusion agent during time. Moreover, the proposed correction method proves the reduction of the intensity non-uniformity in MRI images.

Surgical treatment for infra-cardiac total anomalous pulmonary venous drainage and early-mid follow-up results in 17 cases

Objective To evaluate effectiveness of urgent surgical correction for infra cardiac total anomalous pulmonary venous drainage (TAPVD) in infants and children. Methods From July 2000 to April 2009,seventeen patients with infra-cardiac type of total anomalous pulmonary venous connection received surgical correction

不同导管胸膜腔置管闭式引流治疗自发性气胸疗效比较

目的:比较不同导管胸膜腔置管闭式引流治疗自发性气胸疗效。方法:选取新乡市第一人民医院2018年9月至2023年9月收治的90例自发性气胸患者作为研究对象,应用随机数字表法将其分为三组,即中心静脉导管组、胸腔引流管组与三腔气囊导尿管组,各组均为30例。所有患者均采取胸膜腔置管闭式引流术进行治疗,三组患者分别采取中心静脉导管、胸腔引流管和三腔气囊导尿管进行引流。比较三组患者临床疗效,置管时疼痛发生率、置管时出血量、二次置管率与调整引流管率,平均切口大小、肺复张时间、置管时间、住院时间,术后疼痛程度,术后并发症发生情况。结果:胸腔引流管组和三腔气囊导尿管组的总有效率高于中心静脉导管组;中心静脉导管组和三腔气囊导尿管组患者置管时疼痛发生率、二次置管率与调整引流管率以及置管时出血量均明显低于胸腔引流管组;中心静脉导管组患者平均切口大小明显短于三腔气囊导尿管组和胸腔引流管组,且三腔气囊导尿管组短于胸腔引流管组;术后1 d、3 d、5 d,中心静脉导管组和三腔气囊导尿管组患者的视觉模拟评分法(VAS)评分明显低于胸腔引流管组,中心静脉导管组和三腔气囊导尿管组切口感染、肺水肿/皮下气肿、胸膜反应发生率明显低于胸腔引流管组;差异均具有统计学意义(P<0.05)。结论:采取胸腔引流管与三腔气囊导尿管进行胸膜腔置管闭式引流治疗自发性气胸疗效优于中心静脉导管,而应用中心静脉导管和三腔气囊导尿管患者置管时疼痛发生率较低,能够降低二次置管率、创伤性较低,降低术后疼痛程度,减少并发症发生率。

完全型肺静脉异位引流外科矫治术后垂直静脉-左心房残余分流介入治疗2例并文献复习

完全型肺静脉异位引流(TAPVC)是指肺静脉未能直接与左心房连接而均与右心房或体静脉系统连接的先天性心血管畸形。一旦发现,即有手术指征,通常需要行外科矫治术以重建其血管连接,恢复正常的血液循环。在TAPVC中,由于左心系统缺少正常的血液来源,因此左心房室发育不良(心腔容积明显缩小、顺应性减低),若又合并肺静脉梗阻,结扎垂直静脉(肺静脉常经此血管与体静脉系统连接)后易引起肺动脉高压危象和急性心力衰竭。因此,术者有时会保持垂直静脉开放,使其在术后循环中充当“减压阀”,以减少围手术期肺动脉高压危象。在大多数情况下,随着人体对重建的血液循环的适应,未结扎的垂直静脉会自发关闭;然而在少数情况下,它们会保持开放状态,导致大量左向右分流和右心扩张,需要随后对其进行手术结扎或介入封堵。这种病例非常少见,仅限于病例报道。在此,我们报道了2例效果良好的TAPVC矫治术后垂直静脉残余分流的介入封堵并对相关文献进行了系统复习。

胸腔穿刺置管联合持续负压吸引治疗微波消融肺结节所致气胸

目的观察胸腔穿刺置管联合持续负压吸引治疗微波消融(MWA)肺结节所致气胸的价值。方法回顾性分析21例肺结节经MWA后出现气胸而接受胸腔穿刺置管联合持续负压吸引治疗患者,观察胸腔穿刺置管联合持续负压吸引的疗效及安全性。结果胸腔穿刺置管联合持续负压吸引成功率和有效率均为100%(21/21)。胸腔积液发生率为14.29%(3/21),咯血发生率为9.52%(2/21),未见其他并发症。治疗后3个月,肺结节病灶71.43%(15/21)完全缓解,28.57%(6/21)部分缓解,总有效率和局部控制率均为100%(21/21)。结论胸腔穿刺置管联合持续负压吸引治疗MWA肺结节所致气胸安全、有效。

静脉3D融合技术辅助评估DAVF引流静脉是否兼具脑静脉回流功能

目的探讨静脉3D融合技术在确定硬脑膜动静脉瘘(DAVF)的引流静脉是否兼具脑静脉回流功能中的应用价值。方法回顾性分析2021年9月至2023年3月收治的6例伴有皮层静脉引流的DAVF的临床资料。行DSA后,在后处理工作站用“3D双血管融合技术”进行病变引流静脉与正常脑静脉3D融合,分别标记白、蓝色区别,通过血管融合技术可以看到两者有无共同的通路,以确定病变回流静脉是否存在具有正常引流功能。结果6例均获得良好的静脉3D融合影像,双血管融合影像可以清晰看到病变引流静脉(白色)与正常脑回流静脉(蓝色)相重叠,存在共同的通路,即兼具正常脑静脉回流的功能。6例均获得治愈性栓塞,术后复查造影示兼具正常回流功能引流静脉均获得保护,术后未发生颅内出血及脑梗塞等并发症,症状缓解或消失。术后3~6月随访DSA未见DAVF复发。结论应用静脉3D融合技术可帮助判断DAVF引流静脉是否兼具正常脑静脉回流的功能,术中对这类静脉保护可减少手术并发症。

中心静脉导管胸腔闭式引流术与胸腔穿刺抽液术在结核性胸膜炎患者中的应用效果分析

目的:对比中心静脉导管(CVC)胸腔闭式引流术(TCD)与胸腔穿刺抽液术治疗结核性胸膜炎(TBP)患者的效果。方法:回顾性选取2020年1月至2023年6月濮阳市第五人民医院60例TBP患者病例资料,按手术方案不同分为两组。以接受CVC-TCD治疗的30例患者列为A组,以接受胸腔穿刺抽液术治疗的30例患者列为B组。对比两组手术效果、围术期指标、术前、术后14 d CD4^(+)/CD8^(+)炎性因子[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、γ-干扰素诱导蛋白10(IP-10)]、免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、并发症发生率。结果:A组手术优良率96.67%(29/30)相较于B组73.33%(22/30)更高(P<0.05);A组胸液吸收时间、退热时间相较于B组更短,胸膜厚度、抽液总量相较于B组更低(P<0.05);A组术后14 d血清IFN-γ、TNF-α、IP-10水平相较于B组更低(P<0.05);A组术后14d CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平相较于B组更高(P<0.05);A组并发症发生率3.33%(1/30)相较于B组26.67%(8/30)更低(P<0.05)。结论:与胸腔穿刺抽液术治疗TBP患者相比,经CVC-TCD治疗可进一步提升手术效果,优化围术期指标,缓解机体炎性反应状态,提高免疫功能,降低并发症发生风险。

Microscopic Structure of the Sigmoido-Jugular Junction in the Third-Trimester Fetus

Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is this the same presentation observed in fetuses? Objective: To describe the sigmoido-jugular junction in fetuses. Materials and Methods: Over a period of seven months, a histochemical and immunohistochemical study was conducted on 30 sigmoido-jugular junctions taken from 15 fetuses aged at least 32 weeks of gestation. These fetuses were obtained following expulsion due to intrauterine death, after informed consent from the parents. Results: Three portions can be identified: sigmoid, junctional, and jugular. Histochemical preparations revealed the existence of two constant layers and a third layer present only at the jugular level. From the inside out, the layers are as follows: 1) Inner Layer (Endothelium): This layer is clearer from the junction and reveals the presence of smooth muscle cells at the sigmoid level in immunohistochemistry. 2) Outer Layer: At the sigmoid and junctional levels, this layer consists of collagen fibers and becomes median at the jugular level, where it is composed of elastic and muscular collagen fibers. 3) Third Layer: Present only at the jugular level, this layer corresponds to the adventitia. Conclusion: The architecture of the sigmoido-jugular junction in fetuses, which is identical to that in adults, excludes the metaplastic hypothesis regarding endothelial smooth muscle cells in the sigmoid portion. Instead, it favors their role in regulating encephalic venous drainage.

产前频谱多普勒超声检查肺静脉对胎儿完全型肺静脉异位引流的诊断价值

目的探讨产前频谱多普勒超声检查诊断胎儿完全型肺静脉异位引流(TAPVC)的价值。方法选取超声科进行胎儿结构筛查的26例孕妇,行常规产前超声与频谱多普勒超声检查,分析影像学特征,产后复查超声心动图。结果以产前超声心动图检查结果为金标准,产前频谱多普勒超声检查诊断26例为TAPVC,诊断率是100%,心上型、心内型、心下型分别为14例、7例、5例;常规超声诊断率是73.1%,分别为11例、7例、1例,两种检查方式差异有统计学意义(P<0.05)。26例孕妇中选择继续妊娠4例,胎儿出生后复查与产前频谱多普勒超声诊断结果一致,其余均终止妊娠,5例经家属同意行解剖尸检,和产前频谱多普勒超声诊断结果一致。结论产前频谱多普勒超声诊断TAPVC具有良好的应用价值,具有较高的诊断率。

中心静脉导管持续引流肿瘤相关性腹水管理的最佳证据总结

目的检索、评价并总结中心静脉导管持续引流肿瘤腹水管理的最佳证据,为临床优化导管引流管理提供参考。方法系统检索UptoDate、BMJ最佳临床实践、JBI循证卫生保健中心数据库、PubMed、Cochrane Library、医脉通、中国知网等数据库中关于中心静脉导管持续引流肿瘤相关性腹水导管的指南、系统评价、专家共识、临床决策和随机对照试验等。2名研究者进行文献质量评价和资料提取,并结合专业人员的判断,进行证据汇总。结果共纳入12篇文献,其中临床决策1篇,专家共识3篇,系统评价1篇,随机对照试验6篇,队列研究1篇。汇总了关于中心静脉导管引流肿瘤腹水管理的23条证据,包括评估、腹水引流调节装置、导管固定、敷料、冲管和封管、导管堵塞处理、腹水渗漏预防处理、并发症处置及健康教育9个方面。结论总结中心静脉导管持续引流肿瘤相关性腹水管理的证据,为临床医护人员实施中心静脉导管引流腹水以及优化导管引流管理提供循证依据。

标准化护理在静脉留置针穿刺负压引流治疗患儿中的应用效果

目的探究标准化护理在静脉留置针穿刺负压引流治疗患儿中的应用效果。方法回顾性选取2018年1月至2023年8月江西省九江市妇幼保健院儿外科收治的50例头皮血肿患儿作为研究对象,按照不同护理方法分为观察组(25例)与对照组(25例),观察组采用标准化护理流程,对照组采用常规护理方法。比较两组的护理质量、头皮血肿消失时间、住院时间、住院费用。结果观察组的护理质量评分高于对照组,差异有统计学意义(P<0.05)。观察组头皮血肿消失时间、住院时间短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05)。结论在静脉留置针穿刺负压引流治疗小儿头皮血肿的同时给予其标准化的护理流程,能够有效降低并发症的发生,还能提高治疗效果,值得研究和推广。

负压辅助静脉引流技术在心脏外科应用进展与挑战

负压辅助静脉引流(VAVD)技术是一种通过在密闭的储血器内施加负压以增加静脉引流量的技术。在心脏外科手术中,特别是微创心脏手术和低体重患者的手术中,VAVD技术因其能够提高静脉回流效率、减少体外循环(CPB)预充量及改善手术视野的显著优势而得到广泛应用。本文综述了VAVD技术的基本原理、在心脏外科中的临床应用及其带来的技术优势,包括提高手术安全性和减少术中并发症。此外,还探讨了VAVD技术在实际应用中所面临的挑战,如气体栓塞风险、血液损伤、设备的复杂性及较高的操作要求等。为解决这些问题,本文提出了改进措施和未来研究方向,以期进一步优化VAVD技术的应用,提高其在心脏外科手术中的可靠性和安全性,促进VAVD技术在心脏外科中的广泛应用和持续改进。

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

Objective:To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter(CVC),compared with using a conventional chest tube.Methods:A prospective controlled study with the Ethics Committee approval was undertaken.A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs(n=214) or conventional chest tubes(n=193).The Seldinger technique was used for drainage by CVC,and the conventional technique for drainage by chest tube.If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days,the treatment was considered successful.The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0.A P value of less than 0.05 was taken as indicating statistical significance.Results:Compared with the chest tube group,the operation time,fraction of analgesic treatment,time of surgical wound healing,and infection rate of surgical wounds were significantly decreased(P<0.05) in the CVC group.There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications(P>0.05),or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully(P>0.05).Conclusions:Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube.Its complications can be prevented and it has the potential to replace the large-bore chest tube.

Surgical Treatment of Anomalous Pulmonary Venous Drainage:Report of 127 cases

Objectives We did a retrospective study to summarize the surgical experience of anomalous pulmonary venous drainage (APVD) correction and discuss effective way of improving the surgical outcome. Methods From January 1985 to May 2008, 127 patients [56 men and 71 women, aged 14-55 years with an average of (26.79±10.62) years] with APVD underwent surgical treatments. Among them, 13 patients had simple partial APVD with intact atrial septum, 104 patients had partial APVD with atrial septal defect and 10 patients had total APVD. Seventy-one patients of them accompanied with other cardiac anomalies which were also corrected in their operations. Results One early operative death due to severe low cardiac output syndrome (LCOS) developed postoperatively, which resulted in a mortality rate of 0.78%. Among other patients, 10 patients complicated with LCOS, 11 patients with arrhythmia, 7 patients with acute renal failure and 4 patients with poor wound healing, all discharged from hospital after treatment. Postoperative echocardiography reexamination revealed 1 case of mild residual shunt in atrial septum but without pulmonary vein stenosis. Conclusion For right atrial and ventricle enlarged patients with or without pulmonary hypertension, surgeons should be vigilance of accompanied APVD whether atrial septal defects exist or not. As long as no contraindications are found, surgical treatment should be performed once accurate diagnosis is obtained.

Pleural drainage following total cavopulmonary connection in the era of central venous catheter

Background Pleural effusion after the Fontan operation contributes significantly to morbidity and prolonged hospitalization. The purpose of the present study was to investigate whether chest tubes placed in different cavities during the surgery would contribute to the drainage and also to evaluate risk factors of thoracic drainage with central venous catheter after total cavopulmonary connection in the era of the central venous catheter. Methods From January 2009 to June 2012, 109 consecutive patients underwent total cavopulmonary connection at Guangdong General Hospital. With 102 patients for investigation, preoperative, intraoperative and postoperative factors were obtained. Thoracic drainage with central venous catheter was whenever necessary. Duration of chest tube drainage and time of thoracic drainage with central venous catheter added up to total duration of pleural drainage. Binary logistic regression using forward LR method was applied for the analysis of the risk factors for thoracic drainage with central venous catheter. Results After total cavopulmonary connection, compared with chest tubes placed in single pleural cavity with or without pericardial or retrosternal cavity, those in both pleural cavities seemed to have the chance of longer hospital stay （P = 0.028）. No other significant differences were obtained in factors of ventilation time, extubated central venous pressure in superior vena cava, ICU stay, total duration of pleural drainage. Sildenafil was the preventive factor for reducing central venous pressure and preventing from postoperative pleural effusion. Conclusions After total cavopulmonary connection, patients with tubes placed in both pleural cavities would not have the chance of shorter total duration of pleural drainage and surprisingly turns out to have longer hospital stay. Sildenafil is a preventive factor for thoracic drainage with central venous catheter.

加速康复外科在老年肝移植受者围手术期临床应用中的效果

目的探索加速康复外科(ERAS)指导下的围手术干预策略在老年肝移植受者中的应用价值。方法回顾性分析405例肝移植受者的临床资料,根据年龄分为老年组(≥60岁,122例)和非老年组(<60岁,283例),所有患者均进行ERAS指导下的围手术期干预处理,分析两组受者术中、术后相关指标,并发症发生情况及出院情况。结果两组受者麻醉时间,手术时间,无肝期,出血量,输血量,关腹前乳酸水平,呼吸机辅助时间,重症监护室(ICU)入住时间,Caprini评分,CHIPPS评分,胃管、尿管、引流管拔除时间,首次饮水时间,首次下地活动时间和首次肛门排气时间差异均无统计学意义(均为P>0.05),老年组首次进食时间晚于非老年组(P<0.05)。两组受者发热、腹腔积液、肺部感染、胃排空障碍、出血、非活动性静脉血栓发生率差异均无统计学意义(均为P>0.05)。两组受者出院前天冬氨酸转氨酶、总胆红素、直接胆红素、血清肌酐水平及总住院时间差异均无统计学意义(均为P>0.05);老年组受者丙氨酸转氨酶值比非老年组低,差异有统计学意义(P<0.05)。非老年组与老年组受者术后30 d内均无非计划再次手术发生,出院后30 d内再入院率差异无统计学意义(P>0.05)。结论ERAS干预策略有助于老年肝移植受者围手术期的恢复,达到与非老年肝移植受者同等的术后恢复水平。

体外循环中负压辅助静脉引流装置操作规范流程及使用标准

1背景负压辅助静脉引流(vacuum-assist venous drainage,VAVD)是指在体外循环中重力引流的基础上,将专用负压控制器连接到密闭的硬壳静脉贮血器,使静脉贮血器内形成控制性微负压,从而增加静脉引流量。早在20世纪50年代就有使用负压帮助静脉引流的报道^([1]),但在1954年Gibbon使用重力简化腔静脉引流^([2])并在临床中广泛使用。21世纪初微创心脏手术的出现使VAVD再次进入人们视野,并逐渐在微创心脏手术^([3-6])、减少预充中^([7-9])发挥着不可替代的作用。但随着VAVD相关溶血和动脉栓塞的风险、不良事件等报道^([10-11]),使其再次引起关注。