苦参素可促进大鼠小肠手术后消化道动力

目的:观察苦参素对大鼠小肠手术后消化道动力的作用。方法:大鼠禁食不禁水16小时,2ml/只钡剂灌胃后,水合氯醛麻醉,腹部正中切口开腹,在盲肠上10mm处的小肠切开约1/2～1/3的环形切口,间断缝合后关闭腹腔。术后单笼饲养,肌肉注射苦参素,每天1次连续3天,观察大鼠首次排出白色粪便的时间、钡剂排尽的时间和36小时大便湿重。结果:苦参素50mg/kg、100mg/kg剂量可使小肠手术后大鼠的首次排出的钡剂时间和钡剂排尽的时间比模型对照组明显提前,36小时大便湿重明显增加。结论:苦参素能明显促进大鼠小肠手术后的消化道动力。

黄牛直肠破裂手术治疗一例

通过直肠检查治疗家畜腹腔的某些疾病。已被兽医工作者所常用。但由于直肠检查不熟练或患畜剧烈骚动以及强烈努责等,有时会造成术者手指戮破肠壁而引起直肠破裂。现将笔者经手术治愈黄牛直肠穿孔一例报道如下:

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture.METHODS: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis.RESULTS: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen.CONCLUSION: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.

Clinical Study on Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis in Pancreaticoduodenectomy

Objective To study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis （SPDJCS） on the incidence of pancreatic fistula after pancreaticoduodenectomy, and to analyze its applicability, safety, and efficacies. Methods A prospective controlled trial was conducted with 165 cases receiving pancreati- coduodenectomy in the Department of Hepatopancreatobiliary Surgery from January 2010 to May 2012. The patients were divided into Group A （end-to-end/end-to-side invaginated anastomosis, n=52）, Group B （end-to-side mucosal anastomosis, n=48）, and Group C （SPDJCS, n=65）. The preoperative data, intra- operative data, and operative outcomes （incidence of pancreatic fistula, operation time, intraoperative blood loss, peritoneal drainage, peritoneal hemorrhage, peritoneal abscess, delayed gastric emptying, pulmonary infection, postoperative infection, blood transfusion, and perioperative mortality） were com- pared among the 3 groups. Results The total incidence of pancreatic fistula was 13.9% （23/165） in all the 165 patients. The inci- dence in Group A and Group B was 23.1% （12/52） and 18.8% （9/48）, both higher than that in Group C [3.1% （2/65）, both P〈0.05]. Group C showed significantly better outcomes than group A and B in terms of the opera- tion time （5.5±1.2 hours vs. 6.1±1.1 hours, 5.5±1.2 hours vs. 6.3±1.5 hours）, volume of blood loss （412.0±205.0 mL vs. 525.0±217.0 mL, 412.0±205.0 mL vs. 514.0±217.0 mL）, and postoperative drainage amount of plasma tubes （175.0±65.0 mE vs. 275.0±80.0 mL, 175.0±65.0 mL vs. 255.0±75.0 mL） （all P〈0.05）, while Group A and Group B displayed no difference in these aspects （P〉0.05）. As complications other than pancreatic fistula were concerned, the three groups were not different from each other （P〉0.05）. Conclusions SPDJCS may have the effect of reducing the incidence of pancreatic fistula after pan- creaticoduodenectomy. It could be safe, practical and convenient technique of anastomosis for pancreaticoje- junostomy.

Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis

Objective To explore the feasibility and efficiency of a novel magnetic compression anastomats(MCAs) in intestinal anastomosis.Methods A total of 36 male mongrel canines underwent intestinal anastomosis using traditional hand-sewn(n=18) or a novel MCAs(n=18).We compared the anastomosis time,postoperative complications,bursting strength of anastomoses,gross appearance,and pathology between two groups at each time-point of follow-up.Results The mean anastomosis time with MCAs was significantly less than that with hand-sewn(8.50±1.95 vs.31.1±4.32 minutes,P<0.001).The blood stools and intussusceptions occurred in both groups during follow-up period.Only 1 mongrel canine receiving intestinal anastomosis by MCAs experienced anastomotic leakage.The average bursting pressure of anastomoses obtained from mongrel canines undergoing intestinal anastomosis by MCAs was significantly higher than that by traditional hand-sewn at 1 week's follow-up time(P<0.05).Gross appearance of the anastomoses constructed by MCAs was relatively smoother and flatter.Pathological evalution of anastomoses revealed that general inflammation was greater in hand-sewn anastomoses than magnetic anastomosis.Conclusion The magnetic compression anastomat is a safe and effective device of sutureless intestinal anastomosis in canine models.

Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures

Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal procedure remains unclear.In this study,we compared the effect of two surgical techniques for wound closure following ileostomy reversal:gunsight suture(GS)and linear suture(LS).Methods:A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study.These patients were divided into two groups:the LS group and the GS group.We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI.Results:Both groups successfully underwent surgery.The rate of SSI was significantly lower in the GS group(n=2,0.02%)than in the LS group(n=16,12.00%,P=0.007).The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group(8.163.2 vs 10.865.4 days,P<0.001).Multivariate analysis showed that GS was an independent protective risk factor for SSI(odds ratio=0.212,P=0.048).Conclusions:Compared with the LS technique,the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery.The GS technique may be recommended for wound closure following ileostomy reversal.