Common iliac artery occlusion with small intestinal transection caused by blunt abdominal trauma: A case report and review of the literature

BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.

A 26-year clinical observation of splenic auto-transplantation and oesophageal transection anastomosis:a new treatment strategy in patients with portal hypertension

Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oesophageal transection anastomosis. We report results from clinical observations, splenic immune function and portal dynamics in 274 patients. Methods From 1979 to 2005, 274 cirrhosis patients with portal hypertension underwent the new treatment strategy, and were followed up to compare results with those patients who underwent traditional surgical treatment. From 1999 to 2002 a randomized controlled trial （RCT） was performed on 40 patients to compare their post-operative immune function. From 1994 to 2006, another RCT enrolled 28 patients to compare portal dynamics using three-dimensional dynamic contrast-enhanced magnetic resonance angiography （3D DEC MRA） investigation post operation. Results Among 274 patients （mean age 41.8 years）, the emergency operative mortality （4.4%）, selective operative mortality （2.2%）, complication rate （17.9%）, prevalence of hepatic encephalopathy （〈1%）, rate of portal hypertension gastritis （PHG） bleeding （9.1%）, and morbidity of hepatic carcinoma （8%） were similar to those patients undergoing traditional operation; the spleen immunology function （Tuftsin, IgM） decreased in both groups 2 months post operation, but this decrease did not reach statistical significance. Through 3D DCE MRA, the cross sectional area and the velocity and volume of blood flow of the main portal vein decreased significantly after operation in both groups. The velocity and volume of blood flow in the auto-transplantation group was significantly lower than that in the control group. Conclusions Splenic auto-transplantation and esophageal transection anastomosis is a safe, effective, and reasonable treatment strategy for patients with portal hypertension with varicial bleeding. It not only can correct hypersplenism, but may also achieve complete hemostasis. Spleens auto-transplanted into the retroperitoneal space can preserve immune function and establish broad collateral circulation.

Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.In this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal dynamics.From 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery treatment.From 1999 to 2002,a randomized control trial(RCT)was performed on 40 patients to compare their immune function after operation.From 1994 to 2004,another RCT was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography(3D DEC MRA)investigation after operation.Among 274 patients(mean age 41.8 years),the emergency operative mortality(4.4%),selective operative mortality(2.2%),complication rate(17.9%),morbidity of hepatic encephalopathy(<1%),bleeding rate of portal hypertension gastritis(PHG)(9.1%),and morbidity of hepatic carcinoma(8%)were similar to those under traditional operation;the spleen immunology function(Tuftsin,IgM)decreased among the groups 2 months after operation.Through 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group.Splenic auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial bleeding.It can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

颈段食管癌的外科治疗

目的 :探讨颈段食管癌采用横断气管径路切除的手术方法及效果。方法 :在全麻气管插管下 ,颈部取“U”形切口 ,于 2～ 3气管环之间把气管横断 ,切除肿瘤并清扫淋巴结 ,于食管入口处把食管切断 ,行非开胸食管内翻拔脱 ,经食管床将胃拉至颈部行咽胃吻合。结果 :2 3例中 ,术后并发喉返神经损伤者 8例 ,颈部切口感染者 2例 ,咽胃吻合口瘘者 3例。均治愈出院 (1例于术后 8个月死于肺部感染 )。 15例生存超过 3年 ,3例生存超过 5年。结论 :横断气管径路切除食管癌是一种有效的手术方法 ,为颈段食管癌的外科治疗提供了一种新的手术路径。

大鼠面神经切断及修复后面神经核内胆碱乙酰转移酶的变化

为了研究面神经核胆碱乙酰转移酶在神经损伤及修复后的动态变化 ,用免疫组织化学方法 ,观察了成年大鼠面神经外周切断和即刻端端吻合后面神经核胆碱乙酰转移酶阳性神经元的数量和免疫反应强度的时程变化。结果证明 ,面神经切断后 ,损伤侧面神经核胆碱乙酰转移酶阳性神经元的数量和免疫反应强度均明显下降 ,术后第 7d下降至最低。面神经切断后立即行端端吻合 ,术后 7d内手术侧面神经核胆碱乙酰转移酶阳性神经元的数量和免疫反应强度的下降规律与面神经单纯切断组相同。面神经吻合后 ,术侧面神经核胆碱乙酰转移酶阳性神经元的数量和免疫反应强度的回升最早出现在吻合后第 14 d,术后 3 5 d手术侧面神经核胆碱乙酰转移酶阳性神经元的数量恢复至正常。上述结果提示 ,面神经吻合并不能阻止损伤侧面神经核胆碱乙酰转移酶免疫阳性产物的下降 ;伴随着面神经再支配的发生 。

复元活血汤对大鼠损伤坐骨神经组织p-Src、p-Erk表达的影响

目的:研究大鼠坐骨神经离断吻合术后,复元活血汤对其修复的影响,并探讨其可能机制。方法:将60只SD大鼠实施右侧坐骨神经离断吻合术,术后大鼠随机分为复元活血汤给药组、甲钴胺给药组和模型组,每组20只。复元活血汤组给予复元活血汤,按9 g·kg^(-1)·d^(-1)灌胃;甲钴胺组给予甲钴胺,按6.25×10^(-4)g·kg^(-1)·d^(-1)灌胃;模型组按复元活血汤的溶液剂量,给予等量溶剂灌胃;灌胃2~8周。假手术组大鼠20只,暴露右侧坐骨神经后,不做任何处理缝合切口。给药3 d后,ELISA法检测大鼠血清中IL-1β和TNF-α含量,给药2周后,RT-PCR法检测吻合口近、远端2 cm神经组织的IL-1β和TNF-αmRNA的表达,Western blot法检测p-Src、p-Erk1/2蛋白的表达;分别于给药2周、4周、8周后,检测大鼠坐骨神经功能指数;于给药8周后,观察坐骨神经和其支配肌肉的病理学改变。结果:与模型组比较,复元活血汤组和甲钴胺组大鼠坐骨神经功能指数显著改善,神经纤维生长良好,腓肠肌肌纤维直径和截面积显著改善,复元活血汤组大鼠血清中IL-1β和TNF-α含量显著降低,吻合口神经组织的IL-1β和TNF-αmRNA的表达显著减少,p-Src、p-Erk1/2蛋白表达显著降低(P<0.01)。结论:复元活血汤可通过减轻大鼠损伤坐骨神经吻合口炎症反应,抑制Src、Erk的磷酸化,促进神经的修复。

直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用

目的：探讨直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用价值。方法：回顾性分析我院28例行直肠拖出式切除术（试验组）和35例行经肛门局部切除术（对照组）的低位直肠侧方生长型绒毛状腺瘤病人治疗。结果：63例术前诊断为直肠绒毛状腺瘤，均占肠腔1／2周以上。术后病理证实有29例（46．0％）已发生癌变，其中12例浸润黏膜下层。15例浸润肌层，2例浸润外膜层；其中2例伴肠系膜淋巴结转移。试验组术后有3例病人分别出现吻合口漏、腹壁切口感染和不完全性肠梗阻；对照组术后有1例出现直肠出血。两组均无围手术期死亡。术后平均随访（47．8±18．0）（6～82）个月。试验组无复发；对照组有20例（57．1％）复发，其中15例为反复多次复发。有2例反复复发后演变成浸润癌．继而行Miles术。另1例术后1年出现多发肺转移。术后6个月，试验组平均每天排便（4．4±2．2）（2－9）次，仅5例有轻度大便污裤；仅1例有轻度的勃起功能障碍。对照组无明显控便功能和性功能障碍。结论：直肠拖出式切除术治疗直肠低位侧方生长型绒毛状腺瘤复发率低，消除了癌变和部分癌变进展的风险，未出现严重的并发症．肛门控便功能和性功能也保存较好，是一种比较理想的术式，值得临床推广。

Mechanical intestinal obstruction due to isolated diffuse venous malformations in the gastrointestinal tract: A case report and review of literature

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.

胆管对端吻合术后胆管纤维化的动物实验研究

目的探讨胆管对端吻合术后胆管纤维化的机制。方法将12头6~8个月龄、体重30~40 kg的内江小香猪分为实验组和对照组,每组6头。实验组胆总管横断伤后行对端吻合术,对照组为假手术组,仅行T管置入。术后9个月采用Masson染色、荧光定量聚合酶链反应、免疫组化对比分析吻合口胆管组织中促纤维化因子转化生长因子-β1(TGF-β1)、结缔组织生长因子(CTGF)和上皮间质转化(EMT)标志物细胞角蛋白-19(CK19)、E-钙粘蛋白(E-Cad)、纤维母细胞特异蛋白-1(S100A4)、α-平滑肌肌动蛋白(α-SMA)以及胶原成分胶原I(COL-1)、胶原III(COL-3)和纤连蛋白(FN)含量的表达变化。结果 Masson染色表明,实验组胆管黏膜下胶原纤维增多。与对照组相比,实验组吻合口胆管组织中主要纤维化指标TGF-β1[(3.482±0.313)比(1.000±0.102),t=18.43,P<0.001]和CTGF[(2.160±0.287)比(1.000±0.103),t=9.32,P<0.001]mRNA表达增加,差异具有统计学意义。实验组EMT标志物CK19和E-Cad的mRNA和蛋白表达均比对照组下降,而S100A4和α-SMA的mRNA和蛋白表达均比对照组增加,差异均具有统计学意义(均P<0.01)。结论胆总管横断伤后即时行对端吻合术可行,但长期观察吻合口胆管组织内存在纤维化。

复元活血汤对大鼠损伤坐骨神组织VEGF、TGF-β1表达的影响

目的：研究复元活血汤对大鼠坐骨神经离断吻合术后修复的影响,并探讨其可能机制。方法：120只SD大鼠随机分为坐骨神经离断吻合术模型组、甲钴胺给药组、复元活血汤给药组和假手术组,每组30只。模型组手术暴露右侧坐骨神经,离断后显微镜下缝合,缝合切口,并按复元活血汤的溶液剂量给予等量溶剂灌胃;甲钴胺组手术离断缝合右侧坐骨神经后,缝合切口,并给予甲钴胺,按6.25×10-4g/kg剂量灌胃;复元活血汤组手术离断缝合右侧坐骨神经后,缝合切口,并给予复元活血汤9 g/kg灌胃,给药2～8周;假手术组暴露右侧坐骨神经后,不做任何处理缝合切口。分别于术后2周、4周、8周,检测大鼠坐骨神经功能指数,小腿三头肌湿重比,坐骨神经干动作电位潜伏期、振幅和传导速度;于术后8周用荧光金示踪法检测大鼠脊髓右侧背根神经节阳性细胞数。于术后2周Western blot法检测吻合口近、远端2 cm神经组织的VEGF、TGFβ1蛋白的表达。结果：与模型组比,复元活血汤组和甲钴胺组大鼠坐骨神经功能指数显著改善,坐骨神经传导速度、振幅显著提高,潜伏期显著缩短,脊髓右侧背根阳性神经元细胞数显著增多;吻合口神经组织的VEGF、TGF-β1表达显著升高。结论：复元活血汤可通过增加大鼠吻合口组织VEGF和TGF-β1的表达,促进神经的修复。

补阳还五汤对大鼠坐骨神经横断吻合术后MAP-2,NF-M,GAP-43蛋白表达的影响

目的:探讨补阳还五汤对坐骨神经横断吻合术后,大鼠坐骨神经中微管相关蛋白-2(MAP-2),神经丝蛋白(NF-M),生长相关蛋白-43(GAP-43)表达量的影响,探究补阳还五汤促进周围神经再生的机制。方法:实验选取SD大鼠作为实验对象,实验模型选取坐骨神经横断模型,随机分为模型组、假手术组、补阳还五汤组高、中、低剂量(29.6,14.8,7.4 g·kg^(-1))组、弥可保(0.156 mg·kg^(-1))组,模型组、假手术组给予等体积蒸馏水灌胃。造模成功后各组使用相应药物干预4周,4周后测试各组大鼠的坐骨神经功能指数(SFI),斜板实验度数及坐骨神经苏木素-伊红(HE)染色,并通过免疫组化和蛋白免疫印迹法(Western blot)检测各组大鼠坐骨神经吻合处的MAP-2,NF-M,GAP-43的蛋白表达。结果:与假手术组比较,模型组大鼠SFI,斜板实验度数,MAP-2,NF-M,GAP-43表达量显著增高(P<0.01);与模型组比较,补阳还五汤高、中、低剂量组SFI,斜板实验度数,MAP-2,NF-M,GAP-43表达量均明显增加(P<0.05,P<0.01)。结论:补阳还五汤对大鼠坐骨神经横断吻合术后神经再生具有十分积极的作用。