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991.
De-Cai Yu Xing-Yu Wu Xi-Tai Sun Yi-Tao Ding 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(4):316-322
Background
Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy.Methods
Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases.Results
The average operative time was 327 min with an estimated blood loss of 554.55 mL. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma.Conclusion
The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis. 相似文献992.
Parra-Membrives P Ruiz-Luque V Escudero-Severín C Aguilar-Luque J Méndez-García V 《Diseases of the colon and rectum》2007,50(3):369-375
Purpose The aim of this study was to evaluate the effect of pentoxifylline on the healing of experimental ischemic colorectal anastomoses.
Methods Ninety-three Wistar rats were randomized into three groups (n = 31) and underwent resection of a colonic segment at the colorectal
junction. Group A rats received standard end-to-end anastomoses. Ischemic anastomoses were performed in Groups B and C rats
by coagulating mesocolon vessels 2 cm along each anastomotic end. Group C rats were treated with intraperitoneal injection
of pentoxifylline. Wound complications, intra-abdominal abscesses, intraperitoneal adhesions, and anastomotic leaks and stenosis
were recorded. Bursting pressure and tension were calculated. Histologic examination of the anastomosis was also performed.
Results Ischemia increased wound and intra-abdominal infections, adhesion formation, and anastomotic stenosis. Anastomotic leakage
was significantly higher in Group B (45.2 percent) than in Group A (9.7 percent). Bursting pressure and tension were significantly
lower in Group B (118.19 mmHg and 48.43 N/m) than in Group A (191.84 mmHg and 86.82 N/m). There was evidence for decreased
perianastomotic fibrosis and neutrophils presence after induced ischemia and a strong tendency to reduced neovascularization.
Pentoxifylline administration ameliorated the effects of ischemia, reducing wound and intra-abdominal infections, adhesion
formation, and leaks (16.1 percent). Anastomotic strength increased (bursting pressure and tension of 205.55 mmHg and 87.68 N/m,
respectively). Treated Group C had significantly higher neutrophils infiltration and fibrosis formation and a strong tendency
to increased neovascularization compared with Group B.
Conclusions Selective anastomotic devascularization induces ischemia and impairs experimental anastomotic healing, increasing leakage
rate. These effects may be ameliorated by pentoxifylline administration.
Supported by a grant from the “Servicio Andaluz de Salud,” Consejería de Salud, Junta de Andalucía. 相似文献
993.
994.
Pedrazzani C Marrelli D Rampone B De Stefano A Corso G Fotia G Pinto E Roviello F 《Digestive diseases and sciences》2007,52(8):1757-1763
Subtotal gastrectomy is considered the preferred treatment for gastric cancer with antral location. The aim of this study
was to assess the incidence of early postoperative complications and late functional results in patients who underwent subtotal
gastrectomy with Billroth II reconstruction for primary gastric adenocarcinoma. The results of 310 patients were analyzed
with regard to postoperative complications and death rates. Functional results as they relate to the gastric resection were
evaluated in 195 disease-free patients. Of the 310 patients, 77 developed postoperative general and surgical complications
(24.8%) and 13 consequently died (in-hospital mortality: 4.2%). Although infrequent (6 cases, 1.9%), anastomotic leak was
the most serious complication (4 cases died during the postoperative phase). Considering functional results, weight loss continued
for the first trimester after surgery, after which it stabilized. Loss of appetite was rarely observed; early after the operation
the majority of patients were consuming a normal diet and regularly consumed less than five meals per day (83.6%). Dumping
syndrome was uncommon and usually resolved within one year (12.3% at three months, 9.5% after one year, 5.2% after two years).
On the other hand, postprandial abdominal fullness was frequently observed (43.1% at three months, 36.1% after one year, 21.3%
after three years, and 16.5% after five years). Billroth II reconstruction after subtotal gastrectomy is associated with a
limited risk of anastomotic complications. Anastomotic leak, although infrequent, is a life-threatening complaint and requires
prompt recognition and aggressive surgical treatment. The incidence of late complications was low and the majority of patients
recovered from them within one year after surgery, although the occurrence of postprandial abdominal fullness was not completely
irrelevant. 相似文献
995.
重症心脏瓣膜病的外科治疗 总被引:3,自引:0,他引:3
目的:总结175例重症心脏瓣膜病的外科治疗结果,探讨提高早期生存率的措施.方法:自1993年9月至2002年9月,对175例重症心脏瓣膜病患者施行瓣膜替换术.其中单纯二尖瓣病变78例,二尖瓣合并主动脉瓣病变88例,其它心脏病变9例.45例进行三尖瓣成形,16例进行左心房折叠术.39例部分或全部保留二尖瓣装置.结果:175例中早期死亡9例,死亡率5%.术后并发低心排血量19例,心室颤动7例.随访137例,平均随访5年,死亡5例.结论:对重症心脏瓣膜病患者,注重改善术前心功能,掌握手术时机.重视围术期处理,可提高手术成功率. 相似文献
996.
目的总结主动脉瘤的外科治疗、腔内隔绝治疗的经验。方法回顾性分析1992年9月至2005年2月我院收治各类主动脉瘤患者46例的临床资料,男性38例,女性8例;平均年龄51.7岁;升主动脉瘤17例,胸主动脉瘤8例,腹主动脉瘤21例。手术治疗40例,其中Bentall手术10例,同期Bentall联合全弓替换1例,全弓替换2例,单纯升主动脉人工血管替换4例,胸主动脉瘤体切除人工血管置换3例,其中1例同时行双肾动脉搭桥术,胸主动脉瘤人工血管修补2例,1例行包裹术,腹主动脉瘤21例中行腋-股动脉人工血管搭桥2例,“Y”型人工血管置换7例,直型人工血管替换8例。腔内隔绝治疗6例;其中StanfordB型夹层动脉瘤2例,腹主动脉瘤4例。结果手术死亡1例,死亡率为2.5%,腔内隔绝治疗均成功。随访1个月至10年,有10例患者失访,随访期间1例死亡,总死亡率为4.3%。结论外科手术仍然是治疗主动脉瘤的一种十分有效和经济实用的主要方法。 相似文献
997.
Colović R Micev M Jovanović M Matić S Grubor N Atkinson HD 《World journal of gastroenterology : WJG》2008,14(23):3759-3762
Neurenteric cysts are extremely rare congenital anomalies, often presenting in the first 5 years of life, and are caused by an incomplete separation of the notochord from the foregut during the third week of embryogenesis. They are frequently accompanied with spinal or gastrointestinal abnormalities, but the latter may be absent in adults. Although usually located in the thorax, neurenteric cysts may be found along the entire spine. We present a 24-year-old woman admitted for epigastric pain, nausea, vomiting, low grade fever and leucocytosis. She underwent cystgastrostomy for a Ioculated cyst of the distal pancreas at the age of 4 years, which recurred when she was at the age of 11 years. Ultrasound and computer tomograghy (CT) scan revealed a 16 cmx 15 cm cystic mass in the body and tail of pancreas, with a 6-7 mm thickened wall. Laboratory data and chest X-ray were normal and spinal radiographs did not show any structural abnormalities. The patient underwent a complete cyst excision, and after an uneventful recovery, remained symptom-free without recurrence during the 5-year follow-up. The cyst was found to contain 1200 mL of pale viscous fluid. It was covered by a primitive singlelayered cuboidal epithelium, along with specialized antral glandular parenchyma and hypoplastic primitive gastric mucosa. Focal glandular groups resembling those of the body of the stomach were also seen. In addition, ciliary respiratory epithelium, foci of squamous metaplasia and mucinous glands were present. The wall of the cyst contained a muscular layer, neuroglial tissue with plexogenic nerve fascicles, Paccini corpuscle-like structures, hyperplastic neuroganglionar elements and occasional psammomatous bodies, as well as fibroblast-like areas of surrounding stroma. Cartilagenous tissue was not found in any part of the cyst. Immunohistochemistry confirmed the presence of neurogenic elements marked by S-100, GFAP, NF and NSE. The gastric epithelium showed mostly CK7 and EMA immunoexpression, and the respiratory epithelium reve 相似文献
998.
999.
Forshaw MJ Maphosa G Sankararajah D Parker MC Stewart M 《Techniques in coloproctology》2006,10(1):21-27
Background The development of anastomotic strictures following colorectal surgery is a frequent problem, but commonly used treatments
(e.g. dilatation or revisional surgery) are often ineffective. This study assessed the efficacy of self–expanding metallic
stents (SEMS) and endoscopic transanal resection of strictures (ETARS) in managing high–grade benign colorectal anastomotic
strictures after the failure of first–line therapies.
Methods All patients with biopsy–proven benign anastomotic strictures (luminal diameter <7 mm) following colorectal surgery, seen
in the period April 1995–October 2004, were treated with either SEMS or ETARS.
Results In the study period, we treated 10 patients (7 men) of median age 71 years. Ten ETARS procedures were performed in six patients,
with a mean operating time of 42 minutes and a median hospital stay of 1 day. Early complications of ETARS included: re– operation
for bleeding, asymptomatic anastomotic perforation and technical failure in an acutely angulated stricture. SEMS were successfully
inserted into five patients (including two with failed ETARS) without any early complications. Overall, nine patients have
had satisfactory longterm outcomes (median follow–up, 29 months; range, 3–75 months).
Conclusions SEMS and ETARS are simple, safe and effective methods in treating high–grade anastomotic strictures. 相似文献
1000.
目的评价自主研发CAD/CAM种植导板制作系统在无牙颌种植修复中的临床应用。方法选择5例单颌无牙颌患者。锥形束CT扫描采集数据,导入自主研发种植导板软件进行导板的数字化设计,快速成型机制作种植导板。在导板引导下进行无牙颌种植手术,植入ITI种植体。3个月后复查,行种植义齿修复。术后定期随访。结果为5例患者制作完成丙烯酸树脂CAD/CAM种植导板,在导板引导下采用不翻瓣术式共植入38枚ITI种植体,初期稳定性良好,术后反应小。术后3个月骨结合良好,仅1枚种植体脱落。5例患者均采用固定式种植修复,术后6个月及1年的随访显示,修复体功能和美观良好。结论该自主研发的CAD/CAM种植导板制作系统应用于无牙颌种植手术,能实现术前精确设计和术中精确控制种植体位置,减少了手术创伤和术后并发症,取得良好的种植修复效果。 相似文献