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...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.展开更多
Retrocaval ureter is one of the very rare congenital anomalies.We report a case of retrocaval ureter in a 6-year-old girl who presented with right flank pain and hydronephrosis.The diagnosis was made on intravenous ur...Retrocaval ureter is one of the very rare congenital anomalies.We report a case of retrocaval ureter in a 6-year-old girl who presented with right flank pain and hydronephrosis.The diagnosis was made on intravenous urography which showed typical“J”shape deformity in the proximal dilated ureter with moderate hydronephrosis.CT scan delineated the course of ureter.The patient was operated and findings were confirmed.The ureter was transected near the pelvis and a pyeloureteric anastomosis with pre-caval transposition of the ureter was performed and the patient was discharged in fair health.展开更多
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...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.展开更多
Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. ...Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. This is a retrospective study that included 3 cases of retrocaval ureters in Egypt and Saudi Arabia. Standard open ureteroureteric anastomosis was performed through a flank incision for each case. Patients’ symptoms were re-evaluated after two to four months. Complete recovery from symptoms occurred, and hydroureter and hydronephrosis regressed in all cases. Early diagnosis and treatment are the keys to prevent hydronephrosis and deterioration of renal functions.展开更多
目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范...目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范围13~25 cm。常见医源性输尿管损伤原因为泌尿外科手术6例,妇产科手术2例,普外科手术1例。9例患者均行回肠代输尿管术,术后留置输尿管内双J管1~2个月。对所有入组患者进行门诊及电话随访,了解其并发症及术后肾功能情况,采用Clavien并发症分级系统对术后并发症进行分级。结果：9例手术均顺利完成,手术时间为203~394 min,平均（278.1±68.8）min,估计出血量为10~1 000 m L（中位数200 m L）,平均住院时间为（16.8±7.5）d。4例（44.4%）患者发生术后并发症,均为ClavienⅠ~Ⅱ级轻微并发症,其中不全肠梗阻3例（33.3%）,近端吻合口漏1例（11.1%）。中位随访时间11个月,8例（88.9%）患者术后肌酐水平较术前相比有所改善或稳定。随访过程中3例（33.3%）患者出现轻度肾积水,但无明显症状亦不需特殊处理;1例（11.1%）患者发生短期泌尿系感染,需口服抗生素治疗;未发现代谢性并发症发生。结论：回肠代输尿管术是一种可选择的尿路重建方式,尤其对难治性医源性长段输尿管损伤的治疗效果满意,其远期临床疗效仍需进一步观察。展开更多
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...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.展开更多
Near-infrared fluorescence(NIRF)is a technique of augmented reality that,when applied in the operating theatre,allows the colorectal surgeon to visualize and assess bowel vascularization,to identify lymph nodes draini...Near-infrared fluorescence(NIRF)is a technique of augmented reality that,when applied in the operating theatre,allows the colorectal surgeon to visualize and assess bowel vascularization,to identify lymph nodes draining a cancer site and to identify ureters.Herein,we review the literature regarding NIRF in colorectal surgery.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
We have introduced the glouse supporter(GS)for microsurgery since 1991 andreported its experimental studies in 1992,and now we present its results on clinicalapplications in this paper.GS is made from glucose,sodium c...We have introduced the glouse supporter(GS)for microsurgery since 1991 andreported its experimental studies in 1992,and now we present its results on clinicalapplications in this paper.GS is made from glucose,sodium chloride and dextranumin proper ratio.It has been proved to have no material toxicity on animals and展开更多
文摘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.
文摘Retrocaval ureter is one of the very rare congenital anomalies.We report a case of retrocaval ureter in a 6-year-old girl who presented with right flank pain and hydronephrosis.The diagnosis was made on intravenous urography which showed typical“J”shape deformity in the proximal dilated ureter with moderate hydronephrosis.CT scan delineated the course of ureter.The patient was operated and findings were confirmed.The ureter was transected near the pelvis and a pyeloureteric anastomosis with pre-caval transposition of the ureter was performed and the patient was discharged in fair health.
基金supported by Grant-in-Aid from the National Natural Science Foundation of China (10632010,11072023)
文摘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.
文摘Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. This is a retrospective study that included 3 cases of retrocaval ureters in Egypt and Saudi Arabia. Standard open ureteroureteric anastomosis was performed through a flank incision for each case. Patients’ symptoms were re-evaluated after two to four months. Complete recovery from symptoms occurred, and hydroureter and hydronephrosis regressed in all cases. Early diagnosis and treatment are the keys to prevent hydronephrosis and deterioration of renal functions.
文摘目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料,其中男性3例,女性6例,中位年龄40岁。中位输尿管损伤长度为20 cm,范围13~25 cm。常见医源性输尿管损伤原因为泌尿外科手术6例,妇产科手术2例,普外科手术1例。9例患者均行回肠代输尿管术,术后留置输尿管内双J管1~2个月。对所有入组患者进行门诊及电话随访,了解其并发症及术后肾功能情况,采用Clavien并发症分级系统对术后并发症进行分级。结果：9例手术均顺利完成,手术时间为203~394 min,平均（278.1±68.8）min,估计出血量为10~1 000 m L（中位数200 m L）,平均住院时间为（16.8±7.5）d。4例（44.4%）患者发生术后并发症,均为ClavienⅠ~Ⅱ级轻微并发症,其中不全肠梗阻3例（33.3%）,近端吻合口漏1例（11.1%）。中位随访时间11个月,8例（88.9%）患者术后肌酐水平较术前相比有所改善或稳定。随访过程中3例（33.3%）患者出现轻度肾积水,但无明显症状亦不需特殊处理;1例（11.1%）患者发生短期泌尿系感染,需口服抗生素治疗;未发现代谢性并发症发生。结论：回肠代输尿管术是一种可选择的尿路重建方式,尤其对难治性医源性长段输尿管损伤的治疗效果满意,其远期临床疗效仍需进一步观察。
基金the National Natural Science Foundation of China,No.81171147(to LXL)“Key Medical Talents of Qiangwei Project”Research Foundation of Health Department of Jiangsu Province,No.ZDRCA2016010(to LXL)+3 种基金“Xingwei Project”Key Personal Medical Research Foundation of Health Department of Jiangsu Province,No.RC201156(to LXL)Jiangsu Province’s Key Discipline of Medicine,No.XK201117(to LXL)the Priority Academic Program Development of Jiangsu Higher Education Institutions,PAPD(to LXL)the Natural Science Foundation of Jiangsu Province,No.BK20171064(to BSH).
文摘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.
文摘Near-infrared fluorescence(NIRF)is a technique of augmented reality that,when applied in the operating theatre,allows the colorectal surgeon to visualize and assess bowel vascularization,to identify lymph nodes draining a cancer site and to identify ureters.Herein,we review the literature regarding NIRF in colorectal surgery.
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We have introduced the glouse supporter(GS)for microsurgery since 1991 andreported its experimental studies in 1992,and now we present its results on clinicalapplications in this paper.GS is made from glucose,sodium chloride and dextranumin proper ratio.It has been proved to have no material toxicity on animals and
