Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bid...Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bidirectional cavopulmonary anastomosis were enrolled the study. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were referred for evaluation based on 41 cardiac angiographies. The influential factors on the formation of collateral vessels were identified by binary logistic regression analysis. Results: The number of the left superior vena cava with collateral vessels was larger than right one, 22 versus 8 (X2 = 10.303, P = 0.001). The medium-distal parts of left systemic vena were prone to development of collateral channel. The logic function with respect to the probability of left systemic venous collateral channel could be expressed as the linear expression of left systemic venous pressure x: 0.418x ?7.111 (X2 = 23.095, P Setting 17.0 mmHg of left systemic venous pressure as prediction cut-point to discriminate the occurrence of left collateral vessels, the predictive accuracy reached 85.7%. Conclusions: The left systemic venous pressure was an independent factor associated with left systemic venous collateral channel after bilateral bidirectional cavopulmonary shunt. It might be practically feasible to predict the development of collateral vessels according to systemic venous pressure.展开更多
Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially...Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.展开更多
BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of b...BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.展开更多
文摘Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bidirectional cavopulmonary anastomosis were enrolled the study. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were referred for evaluation based on 41 cardiac angiographies. The influential factors on the formation of collateral vessels were identified by binary logistic regression analysis. Results: The number of the left superior vena cava with collateral vessels was larger than right one, 22 versus 8 (X2 = 10.303, P = 0.001). The medium-distal parts of left systemic vena were prone to development of collateral channel. The logic function with respect to the probability of left systemic venous collateral channel could be expressed as the linear expression of left systemic venous pressure x: 0.418x ?7.111 (X2 = 23.095, P Setting 17.0 mmHg of left systemic venous pressure as prediction cut-point to discriminate the occurrence of left collateral vessels, the predictive accuracy reached 85.7%. Conclusions: The left systemic venous pressure was an independent factor associated with left systemic venous collateral channel after bilateral bidirectional cavopulmonary shunt. It might be practically feasible to predict the development of collateral vessels according to systemic venous pressure.
文摘Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.
文摘BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.
文摘描述了一套显微外科手术机器人系统———“妙手(M icroHand)”.该系统采用主从遥操作方式,主从手为同构异型模式:主手是具有三维力感觉功能的PHANToM Desktop,从手是针对显微外科手术特点而设计的高精度关节型机器人.从手末端安装有六维力传感器M in i40,将检测到手术环境的力信息反馈给主手,从而使手术医生通过PHANToM感受手术环境的三维力信息.本系统成功地对兔子颈部和腿部1毫米动脉进行了血管吻合手术操作,证明了它的有效性.
