AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proxi...AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further conf irmed with a larger patient sample.展开更多
BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile ...BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.展开更多
We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosoma...We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.展开更多
A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In hi...A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.展开更多
BACKGROUND Isolated gastrointestinal venous malformations(GIVMs)are extremely rare congenital developmental abnormalities of the venous vasculature.Because of their asymptomatic nature,the diagnosis is often quite cha...BACKGROUND Isolated gastrointestinal venous malformations(GIVMs)are extremely rare congenital developmental abnormalities of the venous vasculature.Because of their asymptomatic nature,the diagnosis is often quite challenging.However,as symptomatic GIVMs have nonspecific clinical manifestations,misdiagnosis is very common.Here,we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction.A literature review was also conducted to summarize clinical features,diagnostic points,treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.CASE SUMMARY A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days.Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge.Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall.Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels.Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall.The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon.Laparoscopic subtotal proctocolectomy,pullthrough transection and coloanal anastomosis and ileostomy were performed.Histopathology revealed intact mucosa and dilated,thin-walled blood vessels in the submucosa,muscularis,and serosa involving the entire colorectum.The patient recovered with complete symptomatic relief during the 52-mo follow-up period.CONCLUSION The diagnosis of isolated GIVMs is challenging.The information presented here is significant for the diagnosis and management of symptoms.展开更多
目的:研究完全腹腔镜胃癌根治术联合overlap吻合术对消化道重建、并发症及患者生活质量的影响。方法:选取2019年6月至2021年12月于蚌埠医学院第一附属医院接受诊治的110例胃癌患者为研究对象。根据不同手术方式分为对照组(传统腹腔镜胃...目的:研究完全腹腔镜胃癌根治术联合overlap吻合术对消化道重建、并发症及患者生活质量的影响。方法:选取2019年6月至2021年12月于蚌埠医学院第一附属医院接受诊治的110例胃癌患者为研究对象。根据不同手术方式分为对照组(传统腹腔镜胃癌根治术,n=60)与观察组(完全腹腔镜胃癌根治术联合overlap吻合术,n=50),比较2组手术疗效及并发症,并采用胃肠道生活质量表(Gastrointestinal Quality of Life,GIQLI)评估生活质量。结果:观察组手术全程用时、消化道重建用时、总失血量均少于对照组(均P<0.05);2组肿瘤大小、淋巴结清扫数比较差异均无统计学意义(均P>0.05)。观察组术后排气时间、流食进食时间、下地时间均少于对照组(均P<0.05);2组住院时间差异无统计学意义(P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。随访6个月,2组GIQLI各维度得分及总分均高于出院当天(均P<0.05),观察组GIQLI各维度得分及总分均高于对照组(均P<0.05)。结论:完全腹腔镜胃癌根治术联合overlap吻合术能有效重建消化道,减少并发症,改善生活质量。展开更多
文摘AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further conf irmed with a larger patient sample.
基金Supported by Basic Research Foundation of Yunnan Province,No.202101AY070001-282.
文摘BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.
文摘We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.
基金Supported by the Key Research and Development Program of the Science and Technology Department,Jiangsu Province,China,No.BE2015722the Science and Technology Development Fund Project of Nanjing Medical University,Jiangsu Province,China,No.2011NJMU246
文摘A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.
文摘BACKGROUND Isolated gastrointestinal venous malformations(GIVMs)are extremely rare congenital developmental abnormalities of the venous vasculature.Because of their asymptomatic nature,the diagnosis is often quite challenging.However,as symptomatic GIVMs have nonspecific clinical manifestations,misdiagnosis is very common.Here,we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction.A literature review was also conducted to summarize clinical features,diagnostic points,treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.CASE SUMMARY A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days.Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge.Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall.Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels.Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall.The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon.Laparoscopic subtotal proctocolectomy,pullthrough transection and coloanal anastomosis and ileostomy were performed.Histopathology revealed intact mucosa and dilated,thin-walled blood vessels in the submucosa,muscularis,and serosa involving the entire colorectum.The patient recovered with complete symptomatic relief during the 52-mo follow-up period.CONCLUSION The diagnosis of isolated GIVMs is challenging.The information presented here is significant for the diagnosis and management of symptoms.
文摘目的:研究完全腹腔镜胃癌根治术联合overlap吻合术对消化道重建、并发症及患者生活质量的影响。方法:选取2019年6月至2021年12月于蚌埠医学院第一附属医院接受诊治的110例胃癌患者为研究对象。根据不同手术方式分为对照组(传统腹腔镜胃癌根治术,n=60)与观察组(完全腹腔镜胃癌根治术联合overlap吻合术,n=50),比较2组手术疗效及并发症,并采用胃肠道生活质量表(Gastrointestinal Quality of Life,GIQLI)评估生活质量。结果:观察组手术全程用时、消化道重建用时、总失血量均少于对照组(均P<0.05);2组肿瘤大小、淋巴结清扫数比较差异均无统计学意义(均P>0.05)。观察组术后排气时间、流食进食时间、下地时间均少于对照组(均P<0.05);2组住院时间差异无统计学意义(P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。随访6个月,2组GIQLI各维度得分及总分均高于出院当天(均P<0.05),观察组GIQLI各维度得分及总分均高于对照组(均P<0.05)。结论:完全腹腔镜胃癌根治术联合overlap吻合术能有效重建消化道,减少并发症,改善生活质量。
