基于S-Procedure的分段线性Delta算子系统的稳定性分析

本文研究了一类由Delta算子描述的分段线性系统的二次稳定性问题。基于Delta域的Lyapunov稳定性理论,利用S-procedure构造了分段Lyapunov函数,而且将分段线性Delta算子系统的二次稳定性判定问题转化为一组线性矩阵不等式的求解问题。

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient selection.METHODS: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). Pancreatic functional insufficiency was observed in 14 patients(30%). Two laparoscopic patients(2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29(290-370) min. Estimated intra-operativeblood loss was 57 ± 14(40-80) m L. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2(5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass(P < 0.001) and acute exacerbation(P < 0.001) were risk factors for intra-operative blood loss. CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

What operation for recurrent rectal prolapse after previous Delorme's procedure? A practical reality

AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range(IQR). Statistical analysis was carried out using the Fisher exact test.RESULTS: Median age at the time of surgery was 76 years(IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo(IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm(IQR: 5-7), median operative time was 100 min(IQR: 85-120) and median post-operative stay was 4 d(IQR: 3-6). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative mortality of 2.5%. Median follow-up was 6.5 mo(IQR: 2.15-16). Overall recurrence rate was 28%(n = 12). Recurrence rate for patients undergoing an urgent Delorme's procedure who presented as an emergency was higher(75.0%) compared to those treated electively(20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo(IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention(n = 1), repeat Delorme's procedure(n = 3), Altemeier's procedure(n = 5) and rectopexy with faecal diversion(n = 3). One patient was lost during follow up.CONCLUSION: Delorme's procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patientrelated factors that influenced the choice of the initial operation, i.e., Delorme's procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.

腹腔镜辅助Mile’s手术腹膜外造口与腹膜内造口的疗效对比和对外周血IL-6及IL-10水平影响分析

对比腹腔镜辅助Mile’s手术腹膜外造口与腹膜内造口的疗效。方法 收录研究样本的时间范围制定为2022年1月至2023年6月,以直肠癌行腹腔镜辅助Mile’s手术患者44例为主,治疗组、对照组,22例/组(随机数字表法分组),分别对其提供腹膜外造口、腹膜内造口。所有患者均完成研究和随访,且临床资料完全,而且并不存在脱落和失访的患者。将两组患者的施治效果展开分析。结果 研究组患者的恢复时间更短,造口时间更长,且患者的并发症发生率更低,生活质量、肛门排便功能更佳(p<0.05);两组患者的炎性水平无差异(p>0.05),研究组不加重炎症反应。结论 对于直肠癌行腹腔镜辅助Mile’s手术患者而言,腹膜外造口与腹膜内造口对比,前者效果更佳,有助于促进患者的康复,降低患者发生远期并发症的风险,提升患者的生活质量,改善患者的造口排便功能,对患者的炎性因子水平无明显影响。

Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele

BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

Isolated Pancreatic Tuberculosis in Non-immunocompromised Patient Treated by Whipple's Procedure:a Case Report

PANCREATIC tuberculosis(TB)is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations.Computed tomography(CT)and magnetic resonance imaging(MRI)have some diagnostic values in this disease,but it is easy to misdiagnose pancreatic TB as a pancreatic tumor.1 In this article,we present a case of non-immunocompromised patient developing an isolated pancreatic TB,report the CT and MRI findings,and the surgical procedure for it.

Role of original and modified Frey's procedures in chronic pancreatitis

AIM To retrospectively review patients with chronic pancreatitis(CP) treated with Frey's procedures between January 2009 and January 2014.METHODS A retrospective review was performed of patients with CP treated with Frey's procedures between January 2009 and January 2014 in the Department of Pancreatic Surgery. A cross-sectional study of postoperative pain relief, quality of life(Qo L), and alcohol and nicotine abuse was performed by clinical interview, letters and telephone interview in January 2016. Qo L of patients was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30) version 3.0. The patients were requested to fill in the questionnaires by themselves via correspondence or clinical interview.RESULTS A total of 80 patients were enrolled for analysis, including 44 who underwent the original Frey's procedure and 36 who underwent a modified Frey's procedure. The mean age was 46 years in the original group and 48 years in the modified group. Thirtyfive male patients(80%) were in the original group and 33(92%) in the modified group. There were no differences in the operating time, blood loss, and postoperative morbidity and mortality between the two groups. The mean follow-up was 50.3 mo in the original group and 48.7 mo in the modified group. There were no differences in endocrine and exocrine function preservation between the two groups. The original Frey's procedure resulted in significantly betterpain relief, as shown by 5-year follow-up(P = 0.032), better emotional status(P = 0.047) and fewer fatigue symptoms(P = 0.028). When stratifying these patients by the M-ANNHEIM severity index, no impact was found on pain relief after the two types of surgery.CONCLUSION The original Frey's procedure is as safe as the modified procedure, but the former yields better pain relief. The severity of CP does not affect postoperative pain relief.

Strangulated ileal trans-coloanal-anastomotic hernia:A complication of Altemeier's procedure previously never reported

A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully

Comparison between open and laparoscopic reversal of Hartmann’s procedure for diverticulitis

AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis.METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective,singlecenter study of a prospectively maintained colorectal surgery database.All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis.Other indications for Hartmann’s procedures were excluded.Patients underwent open(OHR) or laparoscopic Hartmann’s reversal(LHR) between 2000 and 2010,and received the same pre-and post-operative protocols of cares.Operative variables,length of stay,short-(at 1 mo) and long-term(at 1 and 3 years) postoperative complications,and surgery-related costs were compared between groups.RESULTS: The OHR group consisted of 18 patients(13 males,mean age ± SD,61.4 ± 12.8 years),and the LHR group comprised 28 patients(16 males,mean age 54.9 ± 14.4 years).The mean operative time and the estimated blood loss were higher in the OHR group(235.8 ± 43.6 min vs 171.1 ± 27.4 min;and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively,P = 0.001).Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group,and 3 ± 1.3 d in the LHR group(P = 0.01).The length of hospital stay was significantly longer in the OHR group(11.2 ± 5.3 d vs 6.7 ± 1.9 d,P 【 0.001).The 1 mo complication rate was 33.3% in the OHR(6 wound infections) and 3.6% in the LHR group(1 hemorrhage)(P = 0.004).At 12 mo,the complication rate remained significantly higher in the OHR group(27.8% vs 10.7%,P = 0.03).The anastomotic leak and mortality rates were nil.At 3 years,no patient required re-intervention for surgical complications.The OHR procedure had significantly higher costs(+56%) compared to the LHR procedure,when combining the surgery-related costs and the length of hospital stay.CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays,complication rates,and costs compared to OHR.

Single institution experience with the Ladd's procedure in patients with heterotaxy and stage Ⅰ palliated single-ventricle

AIM:To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure.METHODS:We retrospectively reviewed the charts of all patients from January 2005 to March 2014 who were diagnosed with heterotaxy syndrome and an associated intestinal rotation anomaly who carried a cardiac diagnosis of functional single ventricle and were status post stage I palliation.A total of 8 patients with a history of stage I single-ventricle palliation underwent Ladd's procedure during this time period.We reviewed each patients chart to determine if significant intraoperative or post-operative morbidity or mortality occurred.We also described our protocolized management of these patients in the cardiac intensive care unit,which included pre-operative labs,echocardiography,milrinone infusion,as well as protocolized fluid administration and anticoagulation regimines.We also reviewed the literature to determine the reported morbidity and mortality associated with the Ladd's procedure in this particular cardiac physiology and if other institutions have reported protocolized care of these patients.RESULTS:A total of 8 patients were identified to have heterotaxy with an intestinal rotation anomaly and single-ventricle heart disease that was status post single ventricle palliation.Six of these patients were palliated with a Blaylock-Taussig shunt,one of whom underwent a Norwood procedure.The two other patients were palliated with a stent,which was placed in the ductus arteriosus.These eight patients all underwent elective Ladd's procedure at the time of gastrostomy tube placement.Per our protocol,all patients remained on aspirin prior to surgery and had no period where they were without anticoagulation.All patients remained on milrinone during and after the procedure and received fluid administration upon arrival to the cardiac intensive care unit to account for losses.All 8 patients experienced no intraoperative or post-operative complications.All patients survived to discharge.One patient presented to the emergency room two months after discharge in cardiac arrest and died due to bowel obstruction and perforation.CONCLUSION:Protocolized intensive care management may have contributed to favorable outcomes following Ladd's procedure at our institution.

Introduction of PIC/S Accession Procedure and Suggestions for Establishing a Unified Quality Management System in China

Objective To introduce the accession procedure and evaluation of PIC/S,and help relevant departments in China to understand the requirements of PIC/S in detail,and to promote the process of China’s entry into PIC/S.Methods The procedures and steps of joining PIC/S,the evaluation process of PIC/S,and the experience of several countries in joining PIC/S were introduced and analyzed,which could help the relevant personnel in China understand the specific contents.Results and Conclusion According to the requirements of PIC/S,it is necessary to establish a unified GMP quality management system.

Analysis of Risk Factors of Postoperative Neurological Complications in Patients with Stanford Type A Aortic Dissection Undergoing Sun’s Procedure

Objective:This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects.Methods:From January 2019 to December 2020,the clinical data of 480 patients with Stanford type A aortic dissection,who were treated by Sun’s procedure in our center were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications.According to whether there were neurological complications after surgery,they were divided into two groups:the group with complications(n=70)and the group without complications(n=410).The clinical data of the two groups were collected and compared.Results:There were 70 cases of patients with postoperative neurological complications in 480 cases.The incidence rates of temporary neurological dysfunction(TND)and permanent neurological dysfunction(PND)was 11.5%(55/480)and 3.1%(15/480),respectively.Univariate analysis showed that the age(≥70 years),stroke history,femoral artery intubation and cardiopulmonary bypass(CPB)time were associated with postoperative PND(p<0.05).Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and assisted time of suction influenced the occurrence of postoperative TND(p<0.05).Multivariate logistic regression analysis showed that age(≥70 years),stroke history,femoral artery intubation and CPB time were independent risk factors for PND.Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and aspiration time were independent risk factors for TND.Compared with the two groups,the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged,and the mortality rate was significantly increased(p<0.05).Conclusion:There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery.With the improvement of surgical techniques,optimization of cerebral perfusion,and interventions for risk factors,Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.

Mile′s术会阴伤口Ⅰ期缝合56例临床分析

目的 :探讨低位直肠癌实施 Mile′s手术会阴伤口处理的重要性以及导致伤口裂开的因素。方法 :对 5 6例低位直肠癌实施 Mile′s手术会阴伤口 期缝合患者的临床资料进行了回顾性分析 ;对于已裂开的伤口 ,可于会阴伤口上、下方各重新放置橡皮引流管 1根 ,同时缝合裂开处 ,并经上方管冲洗、下方管引流。结果:5 6例会阴伤口 期愈合 5 2例 (92 .9% ) ,拔管后 8d左右痊愈 ;4例 (7.1% )会阴伤口拆线后部分裂开 ,其中 1例 (1.8% )因骶前感染裂开。 结论:低位直肠癌 Mile′s手术会阴伤口均可 期缝合 ;骶前感染与创面渗血、积液有关 ,术后有效地引流及术中无菌操作 。

直肠癌Mile’s术后局部复发的CT及彩色多普勒血流显像诊断

目的 :评价CT及彩色多普勒血流显像对直肠癌Mile’s术后局部复发的诊断价值。材料和方法 :对 47例直肠癌Mile’s术后患者行CT检查 ,其中 3 1例做了经会阴和骶部彩色多普勒检查 ,观察肿块血流信号特点并测定血流动力学指标 (PSV ,EDV ,RI ,PI)。结果 :术后复发肿块边缘多出现棘突、分叶或毛刺 ,而非复发肿块大多边缘光滑 ;术后复发肿物血流信号以Ⅱ～Ⅲ级为主 ,血流动力学特征为低PSV、低PI、低RI、高EDV。结论 :CT和彩色多普勒血流显像对于直肠癌Mile’s术后局部肿块的检查各具优势 ,二者联合检查可以互为补充 ,有助于提高术后复发诊断的准确率。

直肠癌Mile’s手术会阴切口一期缝合处理体会

目的:探讨Mile’s手术会阴切口一期缝合的效果及影响愈合的因素。方法:观察58例Mile’s手术会阴切口一期缝合的愈合状况,分析影响愈合的因素。结果:58例患者中52例术中会阴切口一期缝合,术后切口裂开1例,局部愈合不良4例;另6例术中行纱布填塞压迫止血,术后一次性取出纱布,仍行伤口一期缝合,愈合良好。结论:Mile’s手术会阴切口一期缝合较传统的会阴切口敞开愈合的方法缩短了住院时间,避免了术后长期换药,极大减轻了患者的痛苦。影响愈合的因素主要有切口感染或污染、切口内引流不畅等。骶前静脉丛出血术中行纱布填塞,取出纱后再行一期缝合,仍可达到预期效果。

1例全内脏反位直肠癌行腹腔镜Mile's术围术期护理

全内脏反位（简称SIT）又称“镜面人”,是一种罕见的解剖变异,发生率约1/100 000[1],其特征是胸腔和腹腔内脏位置与正常人相反,如同正常人在镜子中的影像。对于引起全内脏反位的原因迄今尚无定论,目前多数学者认为是染色体结构或数目的改变和DNA分子内核苷酸的排列或组合顺序发生错位,导致胚胎畸形发育。Mile＇s术即经腹会阴联合直肠癌根治术,适用于肿瘤距肛缘7 cm以下的直肠癌患者。传统的开腹手术创伤大，而腹腔镜下直肠癌根治术具有切口小、术中肿瘤受挤压小、肠道干扰小、患者术后痛苦小、下床活动早、肠道功能恢复快等优点。2013年11月本院普外科收治1例SIT合并直肠癌患者，通过成功的手术治疗及精心的护理，患者恢复良好，随访效果满意，现将护理体会总结如下。

Mile's术中骶前出血2例不同结果体会

直肠癌根治术中，骶前出血是严重而危急的并发症，有文献报道其发生率为2％～5％．现介绍2例同是术中骶前出血．不同的治疗结果体会。

健康教育在Mile's直肠癌根治术的应用

目的总结健康教育在Mile's直肠癌根治术的应用体会。方法责任护士发放肠造口护理手册,采用口头讲解,结合图形、模型、实物以随机性、整体性及示范教育等方法,根据患者入院、术前、术后、出院四个阶段存在的问题采取相应的具有针对性的健康教育。结果患者手术后恢复良好,无护理并发症发生。结论对行Mile's直肠癌根治术患者实施有效健康教育,为患者提供连续性的身心护理,有效的提高了患者遵医行为,促进患者早日康复及提高患者术后生活质量。

Orem自理模式在直肠癌Mile’s术后病人护理中的应用

[目的]观察Orem自理模式在直肠癌Mile’s术后病人护理中的应用效果。[方法]选择58例直肠癌Mile’s术后病人随机分为观察组和对照组,每组29例,对照组采用传统分级护理模式进行护理。观察组采用Orem自理模式实施护理。观察并比较两组病人的护理效果。[结果]观察组干预后6个月、12个月日常生活活动量表(ADL)评分高于对照组(P<0.05);医疗费用相对少于对照组。[结论]应用Orem自理模式对直肠癌Mile’s术后病人进行护理,有利于提高护理效果,提高病人的生活质量,降低医疗费用。