Techniques for Avoiding Saccular Extended Obstruction at the Anastomotic Site of Functional End-to-End Anastomosis

Saccular extended obstruction is generated when the anastomotic site of functional end-to-end anastomosis is extended saccularly and blocked by intestinal contents. This is a specific complication of functional end-to-end anastomosis. Saccular extended obstruction of the anastomotic site of func-tional end-to-end anastomosis causes postoperative intestinal obstruction. Saccular extended obstruction places a heavy burden on patients because surgery is necessary for treatment of intestinal obstruction due to saccular extended obstruction. However, saccular extended obstruction is not a commonly recognized complication. The greatest factor contributing to the development of saccular extended obstruction is an acute angle between the portions of the intestinal tract oral and aboral to the anastomotic site. When this angle approaches obtuse angle, preferably close to a straight line, stagnation of the intestinal contents does not occur at the anastomotic site of functional end-to-end anastomosis and saccular extended obstruction is avoided. For making the angle of anastomotic intestinal tracts obtuse or straight, it may be effective that the entry hole of stapling suture instrument creating the anastomotic stoma is closed perpendicular to the intestinal axis.

Effect of swirling flow on platelet concentration distribution in small-caliber artificial grafts and end-to-end anastomoses

Platelet concentration near the blood vessel wall is one of the major factors in the adhesion of platelets to the wall.In our previous studies,it was found that swirling flows could suppress platelet adhesion in small-caliber artificial grafts and end-to-end anastomoses.In order to better understand the beneficial effect of the swirling flow,we numerically analyzed the near-wall concentration distribution of platelets in a straight tube and a sudden tubular expansion tube under both swirling flow and normal flow conditions.The numerical models were created based on our previous experimental studies.The simulation results revealed that when compared with the normal flow,the swirling flow could significantly reduce the near-wall concentration of platelets in both the straight tube and the expansion tube.The present numerical study therefore indicates that the reduction in platelet adhesion under swirling flow conditions in small-caliber arterial grafts,or in end-to-end anastomoses as observed in our previous experimental study,was possibly through a mechanism of platelet transport,in which the swirling flow reduced the near-wall concentration of platelets.

成人胆总管囊肿不同术式的选择与疗效

目的探讨成人先天性胆总管囊肿在合并有不同病变时的外科治疗手术方式及效果。方法回顾性分析1979￣2006年首都医科大学北京同仁医院收治的64例成人先天性胆总管囊肿患者临床资料。结果64例患者分别经B超、CT、ERCP、MRCP及术中造影或术中探查确诊。其中合并胰胆管合流异常(AJPBDS)58例。施行外引流术8例,行经内镜鼻胆管引流术(ENBD)7例,内引流7例,囊肿切除、肝总管空肠Roux-en-Y吻合术57例(其中13例行二次手术)。随诊2个月￣24年,7例急性胆道感染者行ENBD治疗控制感染确切;8例外引流手术患者,7例行二次手术囊肿切除、肝总管空肠Roux-en-Y吻合术;7例行内引流手术患者2例发生癌变,内引流术术后5例因反复胆道感染及胆道结石形成、吻合口狭窄再手术;47例囊肿切除、肝总管空肠Roux-en-Y吻合术术后随访无反复胆道感染及胆管结石等并发症。结论先天性胆总管囊肿多数合并AJPBDS,其治疗以手术切除囊肿、胰胆管分流及胆-肠重建为基本原则。视病情选择适宜的手术方式。合并急性胆道感染时行ENBD或外引流控制感染效果确切;囊肿切除、胰胆分流术效果良好。

L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage

There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve roots.Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule.The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs.We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage.In a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over time.At 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic side.At 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots.In addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord.Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved.These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal ankle.Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage.All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.IACUC-1906009)in June 2019.

Use of Muscle Feeding Arteries as Recipient Vessels for Soft Tissue Reconstruction in Lower Extremities

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.

优质护理在泪小管断裂吻合术患者中的应用

目的探讨行泪小管断裂吻合术患者的护理方法。方法选择127例泪小管断裂患者,将其随机分为两组。两组均行泪小管吻合术,对照组采取普通眼科手术护理,实验组采用优质护理。随访3~6个月,比较两组的临床效果与护理满意度。结果实验组总有效率为95.38%,对照组为80.65%。两组比较有统计学差异(χ2=6.62,P=0.01)。实验组护理满意度为96.92%,高于对照组的82.26%(χ^2=7.43,P=0.006)。结论对行泪小管断裂吻合术患者实施优质护理,能显著提高临床疗效及患者满意度。

胆管T型切除端端吻合在胆囊癌根治术中应用研究

目的探讨胆管T型切除端端吻合在胆囊癌根治术中的应用。方法回顾性分析海军军医大学附属东方肝胆外科医院2012—2021年以来收治的胆囊癌行胆管T型切除端端吻合的13例病人资料,通过分析病人手术方式、术后病理及分期、术后并发症及复查随访情况探讨此种手术方式的安全性及可行性。结果13例病人中男性5例,女性8例,年龄范围50~83岁,平均年龄66岁,合并胆囊结石10例,结石合并息肉1列,2例无结石或息肉,肿瘤位于胆囊管4例,胆囊颈部4例,胆囊体部3例,胆囊底部2例,CA19-9升高3例。术中平均出血量为277(100~600)mL,术后平均住院时间10(6~16)d,均未出现胆瘘。其中1例失访,其余12例随访时间为1个月至8年,生存时间为1~96个月,中位生存时间36个月,目前生存病人为6例,生存时间为1~96个月,中位生存时间28个月,除去1例近期手术者,术后生存时间均在2年以上,最长8年。术后随访未见明确胆管复发狭窄证据,所有生存病人至随访终点未见肿瘤复发转移。结论保证胆管切缘阴性,R0切除的前提下,对于部分病人可把胆管T型切除端端吻合作为胆囊癌根治的一种选择。

Successful infrainguinal revascularization with autologousvein for inadvertent stripping of superficial femoral artery:a case report

A referral patient who had previously under-gone varicose vein surgery was admitted as an emergency case.On admission,the patient complained of intolerable pain,paralysis and paresthesia of the affected limb,which was characterized by acute arterial ischemia symptoms.Color Doppler of the artery of the affected limb indicated that no bloodflow signal existed in the superficial femoral artery.During exploratory operation,we found that the right superficial femoral artery instead of the great saphenous vein of the affected limb had been stripped and ligated.Therefore,the intact right great saphenous vein was taken for auto-transplantation by inverse end-to-end anastomosis to the proximal and distal residual superficial femoral artery,which resulted in gradual recovery.Except for ischemic reperfusion injury,no other post-operative complications occurred after a 10 month follow-up;however,the long-term curative effect needs further observation.Here we report our treatment experience.