Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to rest...Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.展开更多
BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed ...BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.展开更多
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
A stress analysis is described for a nuclear steam generator tubesheet with a thin, or irregular ligament, associated with a mis-drilled hole using the rules of ASME （American Society of Mechanical Engineers） B ＆ P...A stress analysis is described for a nuclear steam generator tubesheet with a thin, or irregular ligament, associated with a mis-drilled hole using the rules of ASME （American Society of Mechanical Engineers） B ＆ PV Section Ⅲ and non-mandatory Appendix A, Article A-8000 for stresses in perforated flat plates. The analysis demonstrates the proper application of the NB-3200 rules for this special application, with discussion of the differences between an actual tube hole deviation and what is assumed in ASME Appendix A. This is a companion paper to ＂Technical Justification Supporting Operation with a Tube Installed in a Mis-Drilled Hole of a Steam Generator Tubesheet＂.展开更多
针对双钨极单热丝自动TIG工艺原理和技术优越性进行探索,采用双钨极单热丝自动TIG工艺在SA-508 Grade 3 Class 1锻件管板上进行镍基合金堆焊,并对堆焊层的各项性能进行试验研究,验证该方法在管板堆焊技术中应用的可行性。通过对焊接工...针对双钨极单热丝自动TIG工艺原理和技术优越性进行探索,采用双钨极单热丝自动TIG工艺在SA-508 Grade 3 Class 1锻件管板上进行镍基合金堆焊,并对堆焊层的各项性能进行试验研究,验证该方法在管板堆焊技术中应用的可行性。通过对焊接工艺参数的优化,该工艺方法在核电产品及管壳式换热器类设备制造中进行推广应用,熔敷效率可达到2.5~6 kg/h,工艺熔敷效率约为普通单热丝自动TIG的3倍,可在有效保证核电产品管板镍基堆焊层质量的前提下,缩短核电产品的制造周期。展开更多
Aiming at the high angle of attack pull-up and multi-channel roll pull-up coupling problems of high maneuvering aircraft, this paper establishes the flight attitude control rate by means of unsteady flow numerical sol...Aiming at the high angle of attack pull-up and multi-channel roll pull-up coupling problems of high maneuvering aircraft, this paper establishes the flight attitude control rate by means of unsteady flow numerical solution, dynamic unstructured nested mesh assembly method and numerical solution method of flight mechanics equation. On this basis, a virtual flight simulation platform integrating pneumatics, motion and control is established. Based on this virtual flight simulation platform, F-16 aircraft is simulated by high angle of attack pull-up flight mode and multi-channel roll pull-up coupling flight mode. Finally, the influence of rudder on the yaw control channel is investigated. The results show that the numerical virtual flight simulation platform established in this paper has the ability to simulate maneuvering flight of aircraft.展开更多
文摘Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
文摘BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
文摘A stress analysis is described for a nuclear steam generator tubesheet with a thin, or irregular ligament, associated with a mis-drilled hole using the rules of ASME （American Society of Mechanical Engineers） B ＆ PV Section Ⅲ and non-mandatory Appendix A, Article A-8000 for stresses in perforated flat plates. The analysis demonstrates the proper application of the NB-3200 rules for this special application, with discussion of the differences between an actual tube hole deviation and what is assumed in ASME Appendix A. This is a companion paper to ＂Technical Justification Supporting Operation with a Tube Installed in a Mis-Drilled Hole of a Steam Generator Tubesheet＂.
文摘Aiming at the high angle of attack pull-up and multi-channel roll pull-up coupling problems of high maneuvering aircraft, this paper establishes the flight attitude control rate by means of unsteady flow numerical solution, dynamic unstructured nested mesh assembly method and numerical solution method of flight mechanics equation. On this basis, a virtual flight simulation platform integrating pneumatics, motion and control is established. Based on this virtual flight simulation platform, F-16 aircraft is simulated by high angle of attack pull-up flight mode and multi-channel roll pull-up coupling flight mode. Finally, the influence of rudder on the yaw control channel is investigated. The results show that the numerical virtual flight simulation platform established in this paper has the ability to simulate maneuvering flight of aircraft.
