胰十二指肠切除术后死亡的相关危险因素分析

摘要：目的 探讨胰十二指肠切除术(PD)后与手术死亡有关的危险因素，以降低手术病死率。方法 回顾9年间接受PD连续123例患者的临床资料。分析变量包括临床资料、实验室数据、手术因素、病理诊断和并发症。结果 术后30d内病死率为7.3%。腹腔出血（OR=17.954）、糖尿病（OR=7.097）、消化道出血（OR=7.789）、术前血清白（清）蛋白（OR=10.689）和手术失血量（OR=5.473）为独立的危险因素。结论 PD手术死亡的主要危险因素为术前血清白（清）蛋白过低、糖尿病、手术失血量大、术后消化道出血及腹腔出血。因此，围手术期应注意对这些危险因素进行处理。     

左侧结肠癌性梗阻一期切除吻合治疗:附58例报告

摘要：为探讨左侧结肠癌并急性肠梗阻理想的处理原则和方法,回顾分析58例左侧结肠癌并发急性肠梗阻行一期切除吻合术患者的临床资料。本组均成功手术，无手术死亡，术后除7例有切口不同程度液化感染外，无吻合口漏、腹腔感染等并发症，均痊愈出院。提示：对能耐受手术切除的左侧结肠癌并发梗阻，在必要的围手术期处理前提下，一期切除吻合是可行的。避免了横结肠造口、二期手术、癌肿扩散及并发症的发生。     

腹膜后副神经节瘤8例报告

笔者回顾性分析11年间收治的8例腹膜后副神经节瘤患者的临床资料。其中男女各4例。平均年龄44.4岁。均行手术治疗。术中见肿瘤多有完整包膜，血供丰富，与腹主动脉、下腔静脉、肾静脉等关系密切。肿瘤最大直径20cm，最小3cm。5例手术完全切除，1例手术部分切除，2例手术活检。6例随访患者中1例锁骨上淋巴结活检者术后11个月死于肿瘤复发转移，5例手术完全切除肿瘤者均无瘤生存。提示该病一期手术完全切除肿瘤是重要的治疗方法。     

胆道再手术原因分析：附828例报告

目的:分析导致再次胆道手术的原因，以期减少胆道再手术率。方法:总结1990—1999年间收治的再次胆道手术患者828例的临床资料，对胆道疾病再次手术的原因进行归类分析。结果:再手术的主要原因是结石复发或残留，占65.10%;结石合并Oddi括约肌狭窄占33.82%;单纯Oddi括约肌狭窄占9.54%;胆管损伤性狭窄和胆肠吻合口狭窄占10.39%;胆道系统肿瘤占6.52%。结论:胆道再手术的主要原因仍以结石复发或残留为主，其次为Oddi括约肌狭窄;损伤性胆管狭窄等与手术有关的因素不容忽视。减少胆道再次手术的关键在于初次手术的彻底性和手术方法的合理性。     

胆囊癌GBC-SD细胞经顺铂处理后的survivin表达及意义

目的: 探讨经顺铂（DDP）处理胆囊癌细胞后survivin表达及其与肿瘤细胞耐药之间的关系。 方法:采用MTT比色法测定胆囊癌细胞对4种化疗药物的敏感性。RT-PCR检测survivin mRNA的表达。Western blot检测survivin蛋白表达的变化。结果:GBC-SD细胞对化疗药物的敏感性从高到低依次为DDP>ADM>5-FU>MMC。化学药物处理后的第1天，3组胆囊癌细胞的survivin mRNA表达水平均降低;其中0.5μg/mL DDP＋GBC-SD组下降了10%，3μg /mL DDP＋GBC-SD组下降36%，6μg /mL DDP＋GBC-SD组下降了28%。第3天，0.5μg/mL DDP组和3μg/mL DDP组GBC-SD细胞的survivin mRNA表达与第1天比较，分别上升22%和64%，但6μg/mL DDP组仍持续降低，仅为第1天的66%。0.5μg/mL DDP组和3μg/mL DDP组作用3d后的GBC-SD细胞中survivin蛋白含量分别升高了15%和12%，而6μg/mL DDP组则下降了80%。 结论:低浓度的DDP即能诱导胆囊癌细胞内survivin的表达增加，这可能是胆囊癌细胞对化疗药物产生耐药性的因素之一。     

Continuous locked suture technique for arterial anastomosis in rat small bowel transplantation

Continuous locked suture technique in arterial anastomosis was used in a rat heterotopic small bowel transplantation model. Blood loss, time consumption and success rate of the technique, as well as long-term blood flow and histological changes of arterial anastomosis and intestinal graft were compared with the traditional simple continuous suture technique. The results showed that the time consumption was similar between the two techniques while the continuous locked suture technique had a higher success rate (P = 0.016) and was more secure than the simple continuous suture technique. Moreover, it provided a higher long-term blood flow. Under light microscopy and electron scanning microscopy, the anastomosis of continuous locked suture technique showed significantly less stenosis than those of simple continuous suture technique. No difference was found between the two techniques considering the graft intestinal histological changes. In conclusion, the continuous locked suture technique was a more superior technique than simple continuous suture technique in arterial end-to-side anastomosis considering long-term hemodynamics.     

Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report

BACKGROUND Xanthogranulomatous inflammation(XGI) is an uncommon process involving an accumulation of inflammatory cells, commonly lipid-laden macrophages. XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract. We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum, in which the patient had an initial diagnostic laparoscopy, continued to have symptoms, then proceeded to have the definitive treatment. To our kn...     

Transgastric small bowel resection and anastomosis: a survival study

Background  

Recently, natural orifice transluminal endoscopic surgery has emerged with new ideas of a transgastric access. The authors have evaluated the possibility of transgastric bowel resection with several modifications. This study aimed to evaluate transgastic small bowel resection using an automated stapling device via an assisting trocar. In a survival experiment, the possible technical problems, medical complications, and safety of the procedure were investigated as well as the postoperative course and follow-up care.     

Vascular anastomosis and two-stage reconstruction of the gut in a living-related small bowel transplant recipient: a case report

AIM: We sought to discuss vascular anastomosis and gut reconstruction in a living-related small bowel transplantation recipient. METHODS: Living-related small bowel transplantation was performed successfully on a boy with short gut syndrome in two stages. In the first stage, 120 cm, of his mother's ileum was implanted into the recipient with the artery and vein anastomosed to the recipient's sigmoid artery and inferior mesenteric vein, respectively. The two ends of the implanted intestine were constructed as stomas. In the second stage, reconstruction of the continuity of the digestive tract was performed at 188 days after the initial transplantation. The residual small bowel was transected and both ends were anastomosed to the proximal and distal end of the graft in end-to-side fashion. The stomas were closed 30 and 43 days later. RESULTS: Both procedures were successful. Postoperative cytomegalovirus infection and acute rejection occurred successively and were controlled. No leakage of the reconstructed gut or other complications developed after the second procedure. The recipient is alive at 15 months with 8 kg an increase in weight. He is caring for himself independently and has a half-liquid diet, sometimes supplied with auxiliary enteral nutrition. A d-xylose test increased from 4.25% to 25% after the small bowel transplantation. CONCLUSIONS: Vascular anastomoses should be performed according to the state of graft and the recipient. The portal route is the first choice when possible. A two-stage gut reconstruction could decrease the incidence of complications, and offer a useful method in living-related small bowel transplantation.     

Intra-abdominal propylene suture fragment leading to complete small bowel obstruction: A case report

IntroductionPropylene sutures are non-absorbable sterile surgical sutures, which when present intra-abdominally act as a foreign body leading to adhesion formation. Post-operative adhesions are a common cause of bowel obstruction, with complete closed loop obstruction presenting as a surgical emergency.Case detailsA 66-year-old man who had undergone a laparotomy for bowel obstruction two years back, presented to our emergency department with features of complete bowel obstruction. Midline laparotomy revealed propylene suture and intra peritoneal adhesions acting as a constricting band around the jejunum to be the cause.DiscussionAdhesions are common perturbing problem after surgeries. The presence of a foreign body further incites the process of adhesion formation by causing hindrance to the fibrinolysis process. In this case, the adhesive bands acted synergistically with the encircling prolene suture material from the previous surgery in causing a complete loop obstruction.ConclusionPropylene sutures used in routine surgical procedures can migrate intra-abdominally, and lead to adhesion formation. Adhesions along with the non-absorbable suture can cause complete bowel obstruction.     

End-to-end anastomosis in right-sided hemicolectomy

The authors made an analysis of the nearest and long-term results of treatment of 139 patients subjected to right-sided hemicolectomy with different variants of ileotransversoanastomoses. Best results were obtained after end-to-end enterocolostomy.     

Cyanoacrylate-assisted arterial anastomosis in rat small bowel transplantation

Purpose  

Microarterial anastomosis in rat small bowel transplantation (SBTx) remains technically difficult and time-consuming especially for beginners of microsurgery. In the exploration of the facilitated microarterial anastomosis strategies, we assessed the performance of n-butyl-cyanoacrylate-assisted suture technique (CAST) in comparison with simple continuous suture technique (SCST).