Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

Digestive tract reconstruction pattern as a determining factor in postgastrectomy quality of life

Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL is observed at approximately 12 mo postoperatively. We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients, and believe it requires further discussion. Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously. The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support. Whether the use of Billroth-I gastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial, but Roux-en-Y gastrojejunostomy is likely to be preferable. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation:An updated systematic review and metaanalysis

BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.

Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging. METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (99mTc), the emptying time of the gastric substitute was evaluated using a 99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared. RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86±6.43 min) was far closer to normal, signif icantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07±15.77 min, P=0.002) and P type esophagojejunal anastomosis (27.88±6.07 min, P=0.001) methods. The half-emptying actual curve and f itting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches. CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

Modified hepatic outflow tract reconstruction in piggyback liver transplantation

OBJECTIVE: To summarize the experience in modified reconstruction of the hepatic outflow tract during piggyback liver transplantation at our hospital. METHODS: The clinical data on 67 patients undergoing piggyback liver transplantation with modified hepatic outflow tract reconstruction from January 1999 to October 2002 were analyzed retrospectively. RESULTS: In this group, 7 patients (10. 45%) died perioperatively. Complications included: pulmonary infection (38 patients); multiple organ system failure (10), intraperitoneal bleeding (6), acute respiratory distress syndrome (14), thrombosis of the hepatie artery (1), and bile leakage (1). No hepatic outflow occluded. Two recipients survived for over 3 years, 8 over 2 years, and 19 over a year. CONCLUSION: Modified hepatic outflow reconstruction in piggyback live transplantation may increase the success rate of liver transplantation and decrease technical complications.

Tissue engineering for urinary tract reconstruction and repair: Progress and prospect in China

Several urinary tract pathologic conditions,such as strictures,cancer,and obliterations,require reconstructive plastic surgery.Reconstruction of the urinary tract is an intractable task for urologists due to insufficient autologous tissue.Limitations of autologous tissue application prompted urologists to investigate ideal substitutes.Tissue engineering is a new direction in these cases.Advances in tissue engineering over the last 2 decades may offer alternative approaches for the urinary tract reconstruction.The main components of tissue engineering include biomaterials and cells.Biomaterials can be used with or without cultured cells.This paper focuses on cell sources,biomaterials,and existing methods of tissue engineering for urinary tract reconstruction in China.The paper also details challenges and perspectives involved in urinary tract reconstruction.

A review of complications after ureteral reconstruction

Objective:This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults,emphasizing their presentation,diagnosis,and management in the treatment of ureteral structure disease.Methods:This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction,with a focus on examining the range of complications that can arise post-surgery.Special attention is given to the presentation of each complication,the diagnostic process involved,and the subsequent management strategies.Results:Ureteral reconstruction can treat ureteral stricture disease with low morbidity;however,complications,although uncommon,can have severe consequences.The most notable complications include urinary extravasation,stricture recurrence,urinary tract infections,compartment syndrome,symptomatic vesicoureteral reflux,and Boari flap necrosis.Each complication presents unique diagnostic challenges and requires specific management approaches.Conclusion:Ureteral reconstruction is a highly effective treatment for ureteral stricture disease.Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.

Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer:A prospective case–control study

BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.

Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction for benign pancreatic diseases

Surgery such as digestive tract reconstruction is usually required for pancreatic trauma and severe pancreatitis as well as malignant pancreatic lesions. The most common digestive tract reconstruction techniques (e.g., Child&#x02019;s type reconstruction) for neoplastic diseases of the pancreatic head often encompass pancreaticojejunostomy, choledochojejunostomy and then gastrojejunostomy with pancreaticoduodenectomy, whereas these techniques may not be applicable in benign pancreatic diseases due to an integrated stomach and duodenum in these patients. In benign pancreatic diseases, the aforementioned reconstruction will not only increase the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the risks of traction, twisting and angularity of the jejunal loop. In addition, postoperative complications such as mixed fistula are refractory and life-threatening after common reconstruction procedures. We here introduce a novel pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction in two cases of benign pancreatic disease, thus decreasing not only the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the possibility of postoperative complications compared to common reconstruction methods. Postoperatively, the recovery of these patients was uneventful and complications such as bile leakage, pancreatic leakage and digestive tract obstruction were not observed during the follow-up period.

Research progress in three-dimensional reconstruction of the rat spinal tract

BACKGROUND： Recently, three-dimensional （3D） reconstruction of the corticospinal tract has been attempted in treatment for corticospinal tract injury. However, results remain unsatisfactory. OBJECTIVE： This manuscript reviews technique progress and problems in 3D reconstruction of rat spinal tracts, as well as 3D reconstruction of human spinal tracts. RETRIEVAL STRATEGY： Using the keywords ＂rat, spinal tracts, three-dimensional reconstruction＂, the PubMed database was searched for English articles pertaining to 3D reconstruction of the rat spinal tract that were published between January 1996 and January 2007. Meanwhile, the above-mentioned keywords in Chinese were also used to search the CNK1 database for articles that were published between January 1999 and January 2007. Inclusion criteria： manuscripts that addressed the study of 3D reconstruction of the rat spinal tract and review articles. Exclusion criteria： old and repetitive articles. All manuscripts were initially evaluated, followed by extensive review. LITERATURE EVALUATION： A total of 154 related manuscripts were collected; a total of 27 were evaluated and reviewed for the present review. One manuscript assessed rat behavioral functions, four were experimental reports addressing micro-3D reconstruction techniques, ten were experiment reports about image analysis of rat corticospinal tracts, and twelve were experiment articles related to image processing of serial spinal cord sections. DATA SYNTHESIS： Rat spinal cord sections were obtained through section staining or magnetic resonance imaging （MRI） techniques, specifically localizing the inner tracts. Software was used to construct 3D reconstruction from the serial sections to observe and analyze rat spinal cord structures. The rat spinal cord is small, with complicated inner tracts, which makes accurate 3D reconstruction difficult. CONCLUSION： The assembly of 3D reconstructions from rat spinal cord serial sections and the visualization of the inner tracts are imperative for studying rat spinal cord diseases.

Coronary Artery Complications after Right Ventricular Outflow Tract Reconstruction Surgery

Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.

Three-dimensional computed tomography reconstruction diagnosed digestive tract perforation and acute peritonitis caused by Monopterus albus:A case report

BACKGROUND Few reports have described living foreign bodies in the human body.The current manuscript demonstrates that computed tomography(CT)is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.The threedimensional(3D)reconstruction technology could clearly display anatomical structures,lesions and adjacent organs,improving diagnostic accuracy and guiding the surgical decision-making process.CASE SUMMARY Herein we describe a 68-year-old man diagnosed with digestive tract perforation and acute peritonitis caused by a foreign body of Monopterus albus.The patient pre-sented to the emergency department with complaints of dull abdominal pain,profuse sweating and a pale complexion during work.A Monopterus albus had entered the patient’s body through the anus two hours ago.During hospitalization,the 3D reconstruction technology revealed a perforation of the middle rectum complicated with acute peritonitis and showed a clear and complete Monopterus albus bone morphology in the abdominal and pelvic cavities,with the Monopterus albus biting the mesentery.Laparoscopic examination detected a large(diameter of about 1.5 cm)perforation in the mid-rectum.It could be seen that a Monopterus albus had completely entered the abdominal cavity and had tightly bitten the mesentery of the small intestine.During the operation,the dead Monopterus albus was taken out.CONCLUSION The current manuscript demonstrates that CT is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.

Duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲ a hilar cholangiocarcinoma

At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a singlelayer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow- up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.

Fluoro-ruby retrograde tracing and three-dimensional visualization of the corticospinal tract in the guinea pig

Fluoro-ruby was injected into the posterior funiculus of the spinal cord in the cervical （C5-T2） and lumbar （L3-6） segments of adult guinea pigs. The spinal cord was cut into serial frozen sections. The Fluoro-ruby labeling was clearly delineated from the surrounding structure. The labeling traversed the cervical, thoracic and lumbar segments, and was located on the ventral portion of the posterior funiculus on the injected side, proximal to the intermediate zone of the dorsal gray matter. The fluorescence area narrowed rostro-caudally. The spinal cord, spinal cord gray matter and corticospinal tract were reconstructed using 3D-DOCTOR 4.0 software, resulting in a robust three-dimensional profile. Using functionality provided by the reconstruction software, free multi-angle observation and sectioning could be conducted on the spinal cord and corticospinal tract. Our experimental findings indicate that the Fluoro-ruby retrograde fluorescent tracing technique can accurately display the anatomical location of corticospinal tract in the guinea pig and that three-dimensional reconstruction software can be used to provide a three-dimensional image of the corticospinal tract.

两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用比较

目的:初步探讨两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的安全性及优缺点。方法:回顾性分析2019年11月—2021年9月在南京中医药大学附属医院普外科行达芬奇机器人辅助远端胃癌根治术的64例患者的临床资料。根据吻合方法不同将其分为手工缝合吻合组(n=35)和器械辅助吻合组(n=29)。收集患者围手术期的临床资料,对比两种吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的优缺点。结果:64例患者均顺利完成手术,所有患者均在机器人镜下完成腔内消化道重建,无中转开腹。两组患者在手术时间、术中出血量、术后首次肛门排气时间、术后首次下床活动时间、术后首次进食流质时间及术后住院时间方面无明显统计学差异。器械辅助吻合组胃肠吻合时间较手工缝合吻合组短,而手工缝合吻合组的吻合耗材费用较低,差异具有统计学意义。两组患者术后均恢复良好,无并发症发生。结论:两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用都是安全可行的,器械辅助吻合的时间更短,手工缝合吻合的费用更低。

胃近端切除伴双通道重建手术ICD-9-CM-3编码探讨

双通道重建理论上是近端胃切除术较为理想的消化道重建方式,由于ICD-9-CM-3词典库更新停滞以及医院端现用手术词典库扩码不足等原因,对于胃近端切除伴双通道重建手术的ICD编码存在一定争议。本文从相关手术的内涵和历史演进等角度,对该手术的ICD-9-CM-3编码进行了分析探讨。

腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后影响分析

目的:探究腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后的影响。方法:回顾性分析107例腹腔镜下远端胃癌切除后消化道重建患者的临床资料,术后均随访1年。根据患者消化道重建方式不同分为Ⅰ组(n=30)、II组(n=28)和R组(n=49),Ⅰ组采取Billroth-Ⅰ式吻合;Ⅱ组患者采取Billroth-Ⅱ式联合布朗吻合;R组患者采取Roux-en-Y吻合。探究各组围术期情况,比较各组术后3周内及术后1年时并发症发生情况。结果:Ⅰ组患者手术时间低于Ⅱ组及R组(P<0.05);各组患者术后3周内并发症发生率比较,差异均无统计学意义(P>0.05);术后1年,R组患者胆汁反流、反流性胃炎发生率低于Ⅰ组及Ⅱ组(P<0.05)。结论:Billroth-Ⅰ式吻合有助于缩短手术时间,但Roux-en-Y吻合在术后远期效果更具优势。

腹腔镜辅助根治性近端胃切除双通道重建的临床应用

目的:探讨腹腔镜辅助根治性近端胃切除双通道重建术式的应用价值。方法:回顾分析2019年2月至2023年2月为70例早期近端胃癌患者行腹腔镜辅助近端胃切除术的临床资料。根据消化道重建方式分为食管胃重建组(n=31)与双通道重建组(n=39)。观察两组手术时间、消化道重建时间、出血量、术后恢复情况、反流性食管炎情况。结果:两组均成功完成手术,双通道重建组手术时间、消化道重建时间长于食管胃重建组,差异有统计学意义。两组术中出血量、术后通气时间、淋巴结清扫数量、术后住院时间、总并发症发生率差异无统计学意义。双通道重建组术后反流性食管炎发生率低于食管胃重建组。结论:腹腔镜辅助近端胃切除双通道重建术可减少近端胃癌术后反流性食管炎的发生,值得临床推广。

裤形吻合与RY吻合方式在胃癌全胃切除后的应用价值比较

目的:比较裤形吻合与Roux-en-Y(RY)吻合方式在胃癌全胃切除后的应用价值。方法:选取2020年1月至2023年5月我院收治的行全胃切除术治疗的胃癌患者108例作为研究对象,分为RY吻合组54例、裤形吻合组54例,两组均接受全胃切除术治疗,RY吻合组、裤形吻合组分别于胃癌全胃切除术后以RY吻合方式、裤形吻合方式行消化道重建。比较两组手术指标、术后并发症、营养指标[总蛋白(TP)、血红蛋白(Hb)、血清白蛋白(ALB)及预后营养指数(PNI)]、生命质量(QLQ-C30)及远期不良事件发生率。结果:两组患者手术指标比较无意义(P>0.05)。RY吻合组术中1例由于肠管尺寸原因更换吻合器,RY吻合组术中吻合器更换率高于裤形吻合组,但两组比较无意义(P>0.05)。裤形吻合组术后并发症总发生率低于RY吻合组(P<0.05)。裤形吻合组远期不良事件总发生率低于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月营养评价指标TP、Hb、ALB、PNI均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组TP、Hb、ALB、PNI高于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月生命质量QLQ-C30评分均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组生命质量QLQ-C30评分高于RY吻合组(P<0.05)。结论:与RY吻合的胃癌全胃切除后消化道重建方式比较,裤形吻合所带来的并发症较低,且裤形吻合在抗胆汁反流、反流性食管炎、食物排空障碍方面优于RY吻合,患者术后可获得更好的营养支持,患者生命质量显著提高,应用价值较高。

国人胆道三维重建解剖变异应用研究

目的通过三维重建国人胆道系统,研究国人胆道走行及其解剖变异特点。方法利用海信计算机辅助手术系统对100例梗阻性胆道疾病患者的腹部CT数据进行三维重建,得到胆道三维模型,观察肝内胆道系统的走形,根据黄氏分型法(右后叶胆管、右前叶胆管与左肝管的汇入方式)以及是否存在副肝管对胆道进行分型。结果成功重建100例国人的胆道三维模型,观察到胆道有7种类型,54%(54例)拥有典型的胆道解剖结构(Ⅰ型);46%(46例)有解剖变异,其中10%(10例)为Ⅱ型,14%(14例)为Ⅲ型,10%(10例)为Ⅳ型,2%(2例)为Ⅴ型,2%(2例)为Ⅵ型,此外有8%(8例)存在副肝管,其中6例同时伴有其他变异。结论通过三维重建模型,能清晰识别国人胆道系统走形及变异特点,发现新的胆道变异类型,有助于指导临床诊疗。