BACKGROUND:The use of livers from nonviable fetuses is particularly attractive for its potential to solve the current limitations of organ availability for the pediatric recipient.Therefore,it is essential to study th...BACKGROUND:The use of livers from nonviable fetuses is particularly attractive for its potential to solve the current limitations of organ availability for the pediatric recipient.Therefore,it is essential to study the feasibility of orthotopic fetal liver transplantation.METHOD:We measured the hepatic and extra-hepatic anatomical structures of fetal and neonatal lambs and established an orthotopic liver transplantation model of the fetal lamb.RESULTS:Mean weight of the liver of fetal lambs at 142 to 145 days gestation was 34.75 g and the mean diameter of the portal vein was 3.03 mm,the supra-hepatic vena cava was 5.88 mm,and the infra-hepatic vena cava was 4.00 mm,which matched the corresponding sizes in neonatal lambs aged up to 2 weeks.Using standard surgical procedures we completed the vascular inosculation of fetal liver.However,all the newborn lamb recipients survived less than 24 hours.CONCLUSIONS:Orthotopic transplantation of the fetal liver is anatomically and technically feasible.However,perioperative issues need to be resolved prior to clinical application.展开更多
The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic a...The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.展开更多
A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra n...A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.展开更多
Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 pat...Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 patients with ASDH undergoing operations were collected, and the mortalities and functional survival rates were analyzed 2, 4, 6, and 8 hours after injury.Results: No significant difference was found in mortalities and functional survival rates at different operative timings. However, there was a clear trend that the shorter the operative timing was, the lower the mortality and the higher functional survival rate were. In addition, the mean time from injury to operation of non-survivors was significantly longer than that of survivors.Conclusions: Operative timing has potential influences on the prognosis of patients with ASDH. Surgical evacuation of ASDH should be performed as soon as possible once the operation indication emerges.展开更多
Objective:: To summarize the peri-operative experience from 53 patients with traumatic head injuries with GCS score 3-5. Methods: Fifty-three most severely head-injured patients with GCS score 3-5 were admitted to our...Objective:: To summarize the peri-operative experience from 53 patients with traumatic head injuries with GCS score 3-5. Methods: Fifty-three most severely head-injured patients with GCS score 3-5 were admitted to our department and treated operatively from Oct. 1994 to Jun. 1998 and the data were analyzed retrospectively. Results: Thirty-seven cases ( 69.8 %) survived, among them 28 ( 52.8 %) had a good recovery or moderate disability, and 9 (17%) had severe deficits. The other 16 ( 30.2 %) died after therapy. Conclusions: The prognosis of most severely head-injured patients could be improved by peri-operative treatment including premedical care, early evacuation of intracranial hematoma with large decompressive craniectomies, intracranial hypertension monitoring, moderate hypothermia therapy, effective prevention and treatment of cerebral vasospasm and complications.展开更多
Objective: To investigate the opportune time of sec-ondary definitive surgery for patients with multiple injuries from earthquakes based on the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and t...Objective: To investigate the opportune time of sec-ondary definitive surgery for patients with multiple injuries from earthquakes based on the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and the principles of damage control.Methods: Twenty-one patients with critical earthq-ake injuries were treated with damage control strategies, fol-lowed by medical support and surgical intervention to re-store their physical potential in the intensive care unit (ICU). Successive APACHE Ⅱ scoring was adopted to evaluate the patients' physiological status, and then, internal fixa-tion of fractures and other definitive operations were performed.Results: All the patients were effectively treated with few complications, low deformity rate and no death.Conclusions: Appropriate evaluation of patients' physi-ological potential, right decision on surgical time and proper operative method can reduce the rates of complications, disability and death for patients with critical earthquake injuries.展开更多
To summarize surgical treatments an d their corresponding curative effects on sciatic nerve injuries. Methods: Surgical treatments on sciatic nerve injury were perfo rmed in 28 patients from January 1990 to July 2000....To summarize surgical treatments an d their corresponding curative effects on sciatic nerve injuries. Methods: Surgical treatments on sciatic nerve injury were perfo rmed in 28 patients from January 1990 to July 2000. The treatments included neur olysis, neurolysis plus partial nerve anastomosis, nerve anastomosis and nerve t ransplantation. The curative effect was evaluated according to Sunderland criter ia. Results: Of 28 cases, 22 patients were followed up with a follo w up period of 13 months to 5 years (average 30 months). Of 22 nerves, 7 were e xcellent, 5 good, 7 fair and 3 poor, with an excellence rate of 54.5 %. Conclusions: The fair results of sciatic nerve injury are relat ed to its structural character. Surgical exploration should be performed if nerv e function does not recover 3 months after primary operation and if Tinels sig n and electromyogram show no signs of nerve regeneration. Electrophysiological m onitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosis.展开更多
基金supported by a grant from the Science and Technology Commission of Shanghai Municipality(07-JC14045)
文摘BACKGROUND:The use of livers from nonviable fetuses is particularly attractive for its potential to solve the current limitations of organ availability for the pediatric recipient.Therefore,it is essential to study the feasibility of orthotopic fetal liver transplantation.METHOD:We measured the hepatic and extra-hepatic anatomical structures of fetal and neonatal lambs and established an orthotopic liver transplantation model of the fetal lamb.RESULTS:Mean weight of the liver of fetal lambs at 142 to 145 days gestation was 34.75 g and the mean diameter of the portal vein was 3.03 mm,the supra-hepatic vena cava was 5.88 mm,and the infra-hepatic vena cava was 4.00 mm,which matched the corresponding sizes in neonatal lambs aged up to 2 weeks.Using standard surgical procedures we completed the vascular inosculation of fetal liver.However,all the newborn lamb recipients survived less than 24 hours.CONCLUSIONS:Orthotopic transplantation of the fetal liver is anatomically and technically feasible.However,perioperative issues need to be resolved prior to clinical application.
基金Scientific Research Foundation for Returned Overseas Chinese Scholars,Slate Education Commission(1997-832)
文摘The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.
文摘A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.
文摘Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 patients with ASDH undergoing operations were collected, and the mortalities and functional survival rates were analyzed 2, 4, 6, and 8 hours after injury.Results: No significant difference was found in mortalities and functional survival rates at different operative timings. However, there was a clear trend that the shorter the operative timing was, the lower the mortality and the higher functional survival rate were. In addition, the mean time from injury to operation of non-survivors was significantly longer than that of survivors.Conclusions: Operative timing has potential influences on the prognosis of patients with ASDH. Surgical evacuation of ASDH should be performed as soon as possible once the operation indication emerges.
文摘Objective:: To summarize the peri-operative experience from 53 patients with traumatic head injuries with GCS score 3-5. Methods: Fifty-three most severely head-injured patients with GCS score 3-5 were admitted to our department and treated operatively from Oct. 1994 to Jun. 1998 and the data were analyzed retrospectively. Results: Thirty-seven cases ( 69.8 %) survived, among them 28 ( 52.8 %) had a good recovery or moderate disability, and 9 (17%) had severe deficits. The other 16 ( 30.2 %) died after therapy. Conclusions: The prognosis of most severely head-injured patients could be improved by peri-operative treatment including premedical care, early evacuation of intracranial hematoma with large decompressive craniectomies, intracranial hypertension monitoring, moderate hypothermia therapy, effective prevention and treatment of cerebral vasospasm and complications.
文摘Objective: To investigate the opportune time of sec-ondary definitive surgery for patients with multiple injuries from earthquakes based on the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and the principles of damage control.Methods: Twenty-one patients with critical earthq-ake injuries were treated with damage control strategies, fol-lowed by medical support and surgical intervention to re-store their physical potential in the intensive care unit (ICU). Successive APACHE Ⅱ scoring was adopted to evaluate the patients' physiological status, and then, internal fixa-tion of fractures and other definitive operations were performed.Results: All the patients were effectively treated with few complications, low deformity rate and no death.Conclusions: Appropriate evaluation of patients' physi-ological potential, right decision on surgical time and proper operative method can reduce the rates of complications, disability and death for patients with critical earthquake injuries.
文摘To summarize surgical treatments an d their corresponding curative effects on sciatic nerve injuries. Methods: Surgical treatments on sciatic nerve injury were perfo rmed in 28 patients from January 1990 to July 2000. The treatments included neur olysis, neurolysis plus partial nerve anastomosis, nerve anastomosis and nerve t ransplantation. The curative effect was evaluated according to Sunderland criter ia. Results: Of 28 cases, 22 patients were followed up with a follo w up period of 13 months to 5 years (average 30 months). Of 22 nerves, 7 were e xcellent, 5 good, 7 fair and 3 poor, with an excellence rate of 54.5 %. Conclusions: The fair results of sciatic nerve injury are relat ed to its structural character. Surgical exploration should be performed if nerv e function does not recover 3 months after primary operation and if Tinels sig n and electromyogram show no signs of nerve regeneration. Electrophysiological m onitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosis.
