BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(...BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.展开更多
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing...BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.展开更多
AIM:To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS:The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 20...AIM:To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS:The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed.The purse-string suture anoscope in the PPH kit was used on 15 patients(Group 1), and the modified anoscope was used on 22 patients (Group 2).Demographic characteristics of the patients, operation time,surgeon's performance,analgesic requirement,and complications were compared. RESULTS:Operation time was significantly longer in Group 1(42.0±8.4 min vs 27.7±8.0 min,P=0.039). The surgeons reported their operative performance as significantly better in Group 2(the results of the assessments were poor in ten,medium in four and good in one in Group 1,while good in all patients in Group 2,P<0.001).The need for haemostatic sutures was significantly higher in Group 1(six cases)and was needed in two cases in Group 2(P=0.034). CONCLUSION:Operation time decreased and thesurgeon's satisfaction increased with use of the modified anoscope,and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.展开更多
Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for p...Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for pericardial reconstruction.Besides,a few studies have reported on the mechanism of preventing pericardial adhesion.Herein,a functional barrier membrane with sutureability was developed via a modified electrospinning method.It was composed of poly(L-lactide-co-caprolactone)(PLCL)nanofibers,poly(vinyl alcohol)(PVA)aerogel,and melatonin,named PPMT.The PPMT had a special microstructure manifested as a staggered arrangement of nanofibers on the surface and a layered macroporous aerogel structure in a cross-section.Besides providing the porosity and hydrophilicity obtained from PVA,the structure also had suitable mechanical properties for stitching due to the addition of PLCL nanofibers.Furthermore,it inhibited the proliferation of fibroblasts by suppressing the activation of Fas and P53,and achieved anti-inflammatory effects by affecting the activity of inflammatory cells and reducing the release of pro-inflammatory factors,such as interleukin 8(IL-8)and tumor necrosis factorα(TNF-α).Finally,in vivo transplantation showed that it up-regulated the expression of matrix metalloproteinase-1(MMP1)and tissue inhibitor of metalloproteinase-1(TIMP1),and down-regulated the expression of Vinculin and transforming growth factorβ(TGF-β)in the myocardium,thereby reducing the formation of adhesions.Collectively,these results demonstrate a great potential of PPMT membrane for practical application to anti-adhesion.展开更多
基金This observational study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.
基金the National Natural Science Foundation of China,No.82172737 and 82003277Shanghai Municipal Education Commission,No.16411950403 and 19411951605。
文摘BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
文摘AIM:To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS:The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed.The purse-string suture anoscope in the PPH kit was used on 15 patients(Group 1), and the modified anoscope was used on 22 patients (Group 2).Demographic characteristics of the patients, operation time,surgeon's performance,analgesic requirement,and complications were compared. RESULTS:Operation time was significantly longer in Group 1(42.0±8.4 min vs 27.7±8.0 min,P=0.039). The surgeons reported their operative performance as significantly better in Group 2(the results of the assessments were poor in ten,medium in four and good in one in Group 1,while good in all patients in Group 2,P<0.001).The need for haemostatic sutures was significantly higher in Group 1(six cases)and was needed in two cases in Group 2(P=0.034). CONCLUSION:Operation time decreased and thesurgeon's satisfaction increased with use of the modified anoscope,and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.
基金The National Natural Science Fund of China(81873923)Shanghai Science and Technology Development Fund(20Y11910600,18441901900)supported this study.
文摘Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for pericardial reconstruction.Besides,a few studies have reported on the mechanism of preventing pericardial adhesion.Herein,a functional barrier membrane with sutureability was developed via a modified electrospinning method.It was composed of poly(L-lactide-co-caprolactone)(PLCL)nanofibers,poly(vinyl alcohol)(PVA)aerogel,and melatonin,named PPMT.The PPMT had a special microstructure manifested as a staggered arrangement of nanofibers on the surface and a layered macroporous aerogel structure in a cross-section.Besides providing the porosity and hydrophilicity obtained from PVA,the structure also had suitable mechanical properties for stitching due to the addition of PLCL nanofibers.Furthermore,it inhibited the proliferation of fibroblasts by suppressing the activation of Fas and P53,and achieved anti-inflammatory effects by affecting the activity of inflammatory cells and reducing the release of pro-inflammatory factors,such as interleukin 8(IL-8)and tumor necrosis factorα(TNF-α).Finally,in vivo transplantation showed that it up-regulated the expression of matrix metalloproteinase-1(MMP1)and tissue inhibitor of metalloproteinase-1(TIMP1),and down-regulated the expression of Vinculin and transforming growth factorβ(TGF-β)in the myocardium,thereby reducing the formation of adhesions.Collectively,these results demonstrate a great potential of PPMT membrane for practical application to anti-adhesion.
