Reports 3 cases of transplantation ofmicrovaseular jejunal segments to reconstracthypopharynx and cervical esophagus. Threewere survived. The major advantages of thistechnique include the fat that it is a one staseprocedure, thereby allowing early rehabilita -tion , and that the complication rate is low.
目的总结降低胰十二指肠切除术后胰空肠吻合口漏发病率的经验体会。 方法切除胰头后，将胰腺残端游离2.5～3.0 cm，利用红色石蕊试纸遇碱性胰液变蓝的特性，帮助寻找胰腺断面被横断的小导管，丝线贯穿缝扎。将空肠袢断端2.0～2.5 cm浆肌层剥除后施行套叠式胰空肠端端吻合，距浆肌层游离缘1.0～1.5 cm 处空肠上下壁各缝1针固定，最后用纤维蛋白胶封闭吻合口。结果47例患者中无一例发生胰空肠吻合口漏。结论该法操作较简便，适用于胰腺残端各种情况的处理。
ObjectiveTo compare the efficacy and safety in the treatment of malignant gastric outlet obstruction between gastrojejunostomy (GJ) and self-expandable metallic stent (SEMS) placement.MethodsThe relevant literatures of efficacy and safety of GJ and SEMS placement in the treatment of malignant gastric outlet obstruction were searched in the PubMed, Embase, Cochrane Library, Web of Science, Clinical Trial, VIP, CNKI, Wanfang Data databases. The data were extracted and evaluated by the RevMan 5.3 software.ResultsA total of 12 articles with 1 505 patients were included, of which 620 underwent the GJ (GJ group) and 885 underwent the SEMS placement (SEMS group); 3 RCTs, 9 non-RCTs. The meta-analysis results showed: the length of hospital stay [MD=5.83, 95%CI (4.24, 7.42), P<0.000 01] and time of postoperative recovery diet [MD=3.41, 95%CI (1.79, 5.03), P<0.000 1] of the SEMS group were significantly shorter than those of the GJ group; Although the incidence of complications of the GJ group was significantly higher than that of the SEMS group [OR=1.85, 95%CI (1.27, 2.70), P=0.001], the technical success rate [OR=2.72, 95%CI (1.13, 6.53), P=0.03] and clinical success rate [OR=1.86, 95%CI (1.35, 2.57), P=0.000 2] were higher and the survival time was longer [MD=38.31, 95%CI (28.98, 47.64), P<0.000 01] of the GJ group as compared with the SEMS group.ConclusionsSEMS placement is more effective in recovering dietary capacity, length of hospital stay, and incidence of complications, while GJ is more effective in survival time, technical success rate, and clinical success rate. In clinical practice, we could choose different surgical method according to patient situation.
ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
Objective To summarize the recent research situation and progress of decellularized matrix in tissue engineered trachea transplantation and to forecast the possible perspects. Methods Recent original articles about study and application for decellularized matrix in tissue engineered trachea were reviewed. The application and study of different decellularized matrices involved in animals or patients with tracheal lesions were elaborated. Results Decellularized matrices researched and applied in tissue engineered trachea include jejunum, urinary bladder, aorta, and trachea. Conclusion Decellularized urinary bladder matrix and jejunal matrix appears to be efficacious method for the patch repair of partial circumferential tracheal defects. The application of decellularized aortic matrix may need more study, and decellularized tracheal matrix has a bright future in long tracheal defects.
OBJECTIVE: To study the effective protective measures to ensure sufficient blood supply to the jejunal segment in reconstruction of esophagus. METHODS: According to evidence based on medicine, we analyzed retrospectively 69 patients (48 cicatricial stenosis due to chemical burn, 21 defects due to excision of esophagus cancer), whose esophagus were reconstructed with free jejunal graft(in 28 cases) and with pedicle jejunal graft (in 41 cases) from 1980 to 2001. RESULTS: All patients were followed up for 1-21 years. Of 43 patients treated before 1996, 5 complicated by anastomotic leakage, 1 by strangulated intestinal obstruction; of 26 patients treated after 1996 (6 with free jejunal graft, 20 with pedicle jejunal graft), only one case complicated by anastomotic leakage. CONCLUSION: The preservative measures for good blood supply to the jejunal segment include the following aspects: (1) complete marginal vascular arcade without tension in the mesojejunum; (2) vessel anastomosis smooth; (3) 4-finger width pathway of jejunum; (4) the stable arterial blood pressure (more than 8 kPa); (5) a single-row anastomosis; and (6) the comprehensive preoperative management.
Objective To explore the diagnostic and treating scheme of primary sclerotic cholangitis. Methods 24 cases of primary sclerotic cholangitis identified by radiological and pathological examinations from 1972 to 1998 were analysed retrospectively. According to Thompson, 1 case was classified as type Ⅰ, 5 cases were type Ⅱ, 10 cases were type Ⅲ and 8 cases were type Ⅳ. The operation were as follows,resection of gallbladder plus T tube drainage in 8 cases, plus Roux-en-Y anastomosis of bile duct and jejunum in 12 cases, plus U tube stent and drainage in 4 cases. Results The total mortality rate was 25% (6/24) in 2～18 years follow-up after operation. Conclusion Early diagnosis and operation may resolve the drainage of bile into the jejunum. When serious lesions and worse liver functions exist, liver transplantation should be considered.
ObjectiveTo explore clinical effect of enteral nutrition (EN) through nasojejunal tube in severe acute pancreatitis (SAP).MethodsThe clinical and pathological data of 76 patients with SAP who met the inclusion criteria and treated in the Third People’s Hospital of Henan Province from June 2015 to December 2018 were retrospectively collected. According to the nutritional support therapy adopted in the course of treatment, the patients were divided into an EN group (n=44) and a parenteral nutrition group (PN group, n=32), the patients in the EN group were given the EN through the nasojejunal tube and the patients in the PN group were given the routine PN. The APACHE Ⅱ and SOFA scores, nutritional status, and immune function were observed before the treatment and on week 2 after the treatment in the two groups.ResultsThere were no significant differences in the general data of the gender, age, body mass index, etc. between the two groups (P>0.050). ① The score of APACHEⅡ or SOFA score on week 2 after the treatment in both groups was significantly lower than that before the treatment (P<0.050), which in the EN group was significantly lower than that in the PN group on week 2 after the treatment (P<0.050). ② The levels of albumin and prealbumin were increased significantly and the hemoglobin level was decreased (P<0.050) on week 2 after the treatment as compared with those before the treatment in the two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ③ The CD4, CD8, and CD4/CD8 and IgG, IgM, and IgA on week 2 after the treatment were significantly lower than those before the treatment in these two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ④ The levels of endotoxin, D-lactic acid, diamine oxidase, and serum high mobility group protein B1 on week 2 after the treatment were significantly lower than those before the treatment in the two groups (P<0.050), and which in the EN group were significantly lower than those of the PN group on week 2 after the treatment (P<0.050). ⑤ The complications rate in the EN group was significantly lower than that in the PN group [20.45% (9/44) versus 53.13% (17/32), χ2=8.786, P=0.003].ConclusionEN through nasojejunal tube has a good effect on patients with SAP, which is helpful to improve their immune and nutritional status.
Twenty one cases of hepatocholelithiasis treated through hepatic round ligament approach for hepaticojejunostomy is reported. Of them 5 were introgenic injury to the biliary tract， 8 were left hepatolithiasis (7 complicated with bile duct stricture), 2 were intrahepatic sandy stone with acute suppurative cholangeitis, and 3 were residual stone in left hepatic duct with cystlike dilatation after T-tube drainage; while traumatic injury to the biliary passages, previous multiple biliary tract operations and left hepatic duct stone with acute hemorrhage were present in one of case individually 75.9% each. The ages of the patients were between 32 to 50 years. Clinical follw-up in this series was satisfactory. The authors consider that this approach gives good exposure with little injury to the liver and no liver resection needed. The indication for this approach mode of anastomosis and some operative details are discussed.