AIM: To study the long-term therapeutic effect of 'heartshaped' anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage 'heart-shaped' anastomosis ...AIM: To study the long-term therapeutic effect of 'heartshaped' anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage 'heart-shaped' anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our 'heartshaped anastomosis' procedure. 'Heart-shaped'anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.展开更多
By means of the continuation theorem of the coincidence degree theory,the existence of two periodic solutions of a delayed single species model with feedback regulation and harvest term is obtained.
Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- t...Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single- implant cephalomedullary fixation by following basic surgical principles that have been summarized in this article.展开更多
Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has b...Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.展开更多
基金Supported by the National Natural Science Foundation of China, No.39670746
文摘AIM: To study the long-term therapeutic effect of 'heartshaped' anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage 'heart-shaped' anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our 'heartshaped anastomosis' procedure. 'Heart-shaped'anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.
基金Supported by the Science and Technical Foundation to Hubei University of Technology[2006(5)]
文摘By means of the continuation theorem of the coincidence degree theory,the existence of two periodic solutions of a delayed single species model with feedback regulation and harvest term is obtained.
文摘Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single- implant cephalomedullary fixation by following basic surgical principles that have been summarized in this article.
基金Project supported by the Medical and Health Technology Development Program of Zhejiang Province(No.2015KYA130)the National Natural Science Foundation of China(No.31571446)
文摘Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.
