The origin of blood supply and the features of vascular distribution of the fascia lata was obeervedby the method of microsurgical anatomy.It was found that there were 4 sources of the blood supplyfor the fascia lata. The blood vessels in the anterior supperior femoral area were from the original partof the decp femoral artery,while in the inferior part,the arteriess were from the tributary of theperforating artery. The blood vessels in the poterior superior femoral area were from both t...
Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
Objective To investigate the clinical characteristics and mechanisms of ocular manifestations related to carotid artery stenosis. Methods The general clinic data and related ocular manifestations in 124 patients with carotid artery stenosis were retrospectively. Results In the 124 patients, 36 (29%) had ocular manifestations, and 28 (22. 6 %) complained the ocular discomfort as the first symptom. Among the 36 patients, 31 patients (86.1%) had been disclosed unilateral or double stenosis of internal carotid artery by carotid Doppler ultrasound examination, and the result of digital subtract angiography revealed middle and severe degree of internal carotid artery stenosis in 8 and 23 patients respectively. There was no statistic difference of incidence of ocular manifestations between 67 patients of severe internal carotid artery stenosis and 34 patients with middle one（chi;２test,P =0.266 2，P＞0.05). The ocular manifestations included amaurosis fugax (52.8%),acute decline or loss of the visual ability and defect of visual fields (36.1%), binocular diplopia (13.9%), ptosis (13.9%), and persistent high intraocular pressure(2.8%) one patient might had several ocular manifestations simultaneously. In 36 patients, central retinal artery occlusion had been diagnosed in 4, venous stasis retinopathy in 1,central or branch retinal vein occlusion in 6, neovascular glaucoma in 1, and anterior ischemic opticneuropathy in 2. One patient with double occlusion of internal carotid artery didnrsquo;t have any ocular manifestation. Conclusion Carotid artery stenosis, especially internal carotid artery may lead to acute or chronic ocular ischemic lesions, and the occurrence of ocular manifestations in chronic ocular ischemic lesions relates to compensa tion of collateral circulation；patients with ocular ischemic lesions are recomm end to undergo a routine carotid artery examination. (Chin J Ocul Fundus Dis, 2006,22:376-378)
Purpose To observe the changes of choroidal circulati on and the retinal lesions caused by ocular contusion with indocyanine green ang iography (ICGA). Methods ICGA examination was performed on 30 cases (30 eyes) of various traumatic condition in conjunction with fundus fluorescein angiography (FFA). Results FFA of 19 cases (63.3%) showed the hypofluorence in quadrant or whole disc in accordance with the area of delayed filling of choroid. Twentysix cases (86.2%) showed d efected choroidel perfusion in ICGA,among them 16 cases showed localized delayed perfusion, in which the shortest perfusion time was 1 min 50 s and the l ongest time was 5 min.43 s,and 10 patients showed localized perfusion defect,and reversed filling time of retinochoroid vessels in 6 patients. Five cases (16.6%) had delayed filling time in both choroidal and central retinal vessels . Damage of retinal pigment epithelium was found in the areas of choroidal abnor mal perfusion. Conclusion ICGA combined with simultane ously FFA, is valuable in evaluating blunt injury of the ocular fundus and ben eficial to its diagnosis and treatment. (Chin J Ocul Fundus Dis, 2001,17:122-124)
Objective To evaluate the influence of the location of retinal vessel trunk on neuroretinal rim width of inferior and superior sectors of optic disc, and explore its role in the diagnosis of glaucomatous optic nerve lesion. Methods The photographs of ocular fundus from 459 patients with clear location of retinal vessel trunk, including large disc in 131, medium disc in 145, horizontally oval disc in 75, and small disc in 108 were evaluated. Independent-sample t test was used to compare the difference of the superior and inferior rim widths between the higher-vessel group and the lower-vessel group, and to compare the difference of superior and inferior vessel distances between the narrow-superior-rim-width group and the narrow inferior-rim-width group. Results In most of the patients, or the ones with large and small disc, the ratio of superior rim width to summation of superior and inferior rim widths in the higher-vessel group（0.467plusmn;0.051，0.445plusmn;0.040，0.508plusmn;0.056）were less than which in the lowervessel group（0.500plusmn;0.066，0.474plusmn;0.062，0.546plusmn;0.048）, and the differences were significant（P=0.000, 0.045, 0.018）; the ratio of superior vessel distance to summation of superior and inferior vessel distance in the narrow-superior-rim-width group（0.510plusmn;0.051，0.508plusmn;0.055，0.512plusmn;0.036）were less than which in the narrow-inferior-rim-width group（0.528plusmn;0.045，0.533plusmn;0.048，0.534plusmn;0.045）, and the differences were significant（P=0.000, 0.046, 0.022）. Conclusions The position of optic disc vessel trunk influences its superior and inferior rim width. The rim closer to vessel trunk position has narrower width than which comparatively far away from the position. In patients with large, medium, horizontally oval optic disc, glaucoma optic nerve lesion would be considered if the optic disc has the shape of narrower inferior rim, broader superior rim, and vessel location in the superior half of the disc. In the ones with small disc, the optic disc with the shape of narrower superior rim, broader inferior rim, and vessel location in the inferior half of the disc may suggest glaucoma optic nerve lesion. (Chin J Ocul Fundus Dis, 2007, 23: 118-121)
Objective To summarize the monitoring methods and preventions of the disorder of blood supplying of expanded flaps, so as to provide some references for improving the survival of expanded flaps. Methods The domestic and abroad related literature about the disorder of blood supplying of expanded flaps was reviewed and analyzed. Results Handheld Doppler, digital subtraction angiography, computer tomographic angiography, magnetic resonance angiography, and fluorescein angiography can be used as reliable preoperative imaging methods in designing expanded flaps with rich blood supply. Several techniques can be used for monitoring the blood supply of expanded flaps during the early postoperative period including traditional monitoring via physical examination, monitoring via dynamic infrared thermography, near-infrared spectroscopy tissue oximeter, external and implantable Doppler, and more recently developed diffuse correlation spectroscopy. Surgical delay, bloodletting, leech therapy, hyperbaric oxygen, and so on can decrease the risk of necrosis in expanded flaps. Conclusion The survival of expanded flap is influenced by many factors. Preoperative design by using handheld Doppler and new imaging technology and postoperative early detection of blood supply can provide references of timely intervention, so that ischemic necrosis of the flaps can be reduced, and the success rate of surgery can be improved.
Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma. Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study. The eyes included 34 eyes with primary open-angle glaucoma (POAG group), 33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group). Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group. The differences of age (t=1.197), sex (chi;2=3.548), average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05). The differences of age (F=2.645), sex (F=1.984), average diopter (F=2.621), and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significan(P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects. The watershed zones were classified into three types according to its location relative to the optic disc: in type Ⅰ, the watershed zone did not include the optic disc or could not be observed; in type Ⅱ, the watershed zone partially included the optic disc; in type Ⅲ, the watershed zone completely included the optic disc. The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed. The relationship between watershed zones, type and age, and MD were also analyzed by Pearson analysis method. Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6% and 56.8% in glaucoma group and control group, respectively; with a statistically significant difference (chi;2=8.756,P＜0.003). The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4%, 90.9%, 71.1% in POAG, NTG and CACG group, respectively. No significant differences were found between POAG and NTG group (chi;2=1.039), POAG and CACG group (chi;2=1.039, 1.166;P＞0.05). But there was significant difference between NTG and CACG group (chi;2=4.107,P＜0.05). Significant differences were found between POAG and control group, NTG and control group (chi;2=5.352, 10.141;P＜0.05). No significant difference was found between CACG and control group (chi;2=1.444,P＞0.05). There was no correlation between age and watershed zone type (r=0.114,P＞0.05). The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000). Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.
Objective To understand anatomy of parathyroid gland and explore its application value in protection of parathyroid gland function during thyroidectomy. Methods The literatures, which were associated with the parathyroid anatomy and hypoparathyroidism were collected. The origin, function, anatomical location, number, blood supply, lymphatic system of the parathyroid gland and its relationship with surrounding tissues of parathyroid gland and its clinical significance in the thyroidectomy, were reviewed. Results The position of the superior parathyroid gland was relatively constant, and the inferior parathyroid gland was more likely to be ectopic. The number of the parathyroid gland was uncertain. The mainstream view was that the arterial supply of the parathyroid glands was mainly ensured by the inferior thyroid artery, a few by anastomosis of the superior and inferior thyroid arteries, or by the superior thyroid artery. However, the alternative view was that the blood supply of the parathyroid gland was not mainly derived from the inferior thyroid artery. The parathyroid gland was not easily distinguished from the adipose tissue and lymph node. Whether there was an independent lymphatic system in the parathyroid gland was still controversial. In the thyroidectomy, the parathyroid gland and its blood supply were reserved or protected by distinguishing from the Zuckerkandl tubercle, recurrent laryngeal nerve, and parathyroid specific attachment fat, which were identified by utilizing of the nanocarbon, loupe magnification, etc.. Especially in the central lymph neck dissection, the main thyroid artery trunk and its important branches should be carefully dissected or retained through the gentle capsular dissection and the correct use of energy devices for vessel sealing. The parathyroid gland in situ was reserved according to the parathyroid type. If it was not possible to be preserved, the parathyroid autotransplantation was necessary during the thyroidectomy. Conclusions Understanding origin and location of parathyroid gland, it could provide a direction for searching parathyroid gland during thyroidectomy. Being familiar with blood supply of parathyroid gland makes it possible to protect blood vessel and preserve parathyroid gland. Gentle capsular dissection, rational use of energy device, and indocyanine green angiography seem to be more important. Number of parathyroid gland allows us to treat each parathyroid gland as the last one, if it is not preserved in situ , parathyroid gland need to be autografted to avoid hypoparathyroidism.
ObjectiveTo understand the methods of judging the blood supply of parathyroid during thyroidectomy at home and abroad in recent years. MethodThe literature on parathyroid blood supply was collected, the research progress was reviewed, and the advantages and disadvantages of related methods were analyzed. ResultsIn recent years, near-infrared fluorescence, laser speckle contrast imaging and other technologies had been applied. They showed better advantages as compared with naked eye observation. The research on parathyroid blood supply at home and abroad was still in its infancy, and more clinical samples and related equipment optimization were still needed. ConclusionFluorescence imaging technology has a certain auxiliary role in the judgment of intraoperative parathyroid blood supply and can reduce the incidence of hypoparathyroidism to a certain extent.
OBJECTIVE :To investigate ocular vessel flow velocity in normal eyes by color Doppler imaging(CDI). METHODS: Ninety people (180 normal eyes)had flow velocity measured by CDI in three vessels,ophthalmic artery (OA),central retinal artery(CRA) and posterior ciliary artery (PCA),and the relations between velocity and affecting factors were analysed. RESULT: The diastolic and systolic velocity of OA,CRA and PCA were (31.7plusmn;10.9)cm/s, (7.2plusmn;2.6)cm/,s, (10.2plusmn;3.4)cm/s, (2.8plusmn;1.2)cm/s and (11.3plusmn;3.6)cm/s, (3.2plusmn;1.4)cm/s respectively. The velocity of OA had possitive correl-ativity with RBC,HCT and negative correlativity with age,while it revealed no relationship with sex, laterality of right or left eye,and normal IOP. CDI of ocular vessels in normal eyes is a triangle with three peaks and double sunkens in its frenquency spectum, revealed highly resistant,and both the pulsatility and resistive indexes were relatively high. The width of each frequency band basically was the same,and there was no obvious frequency window. CONCLUSION: The ocular application of CDI might lay the foundation of a comparatively comprehensive knowledge of the ocular hemodynamics. （Chin J Ocul Fundus Dis,1997,13: 99-101）