Late results with biograft in peripheral arterial surgery

A total of 106 vascular reconstructions below the inguinal ligament including axillo-femoral and femoro-femoral bypasses were performed using 137 Dardik's human umbilical veins. The indication for surgery was limb salvage in 29%. The distal anastomosis was done with the popliteal artery above the knee in 53 cases, below the knee in 31, and with a tibial artery in 1. The axillo-femoral bypass was performed in 21 cases, and femoro-femoral bypass in 32. The accumulated graft patency rates of femoro-popliteal bypass at 1 yr./3 yrs./5 yrs. were 93%/75%/75%, those of femoro-femoral bypass were 85%/85%/85%, and those of axillo-femoral bypass were 54%/27%/27%. No special risk factor influencing patency rate was found from this study. In long term period, graft aneurysm was observed in 3 cases. It is concluded that the human umbilical vein is the graft material of choice for femoro-popliteal or femoro-femoral bypass when the saphenous vein is not available, and the careful follow-up is important because of the risk of graft aneurysm.     

基层医院开展腹腔镜手术的初步体会(附94例报告)

目的：总结基层医院开展腹腔镜手术的经验和体会。方法：回顾性分析我院普通外科自2004年10月至2007年4月开展的94例各类腹腔镜手术的临床资料。结果：94例中包括腹腔镜胆囊切除术50例（2例因肝囊肿行腹腔镜联合肝囊肿开窗引流术）,腹腔镜消化道穿孔修补2例,腹腔镜阑尾切除术40例,腹腔探查2例;5例中转开腹,余均获成功,痊愈出院,无死亡病例及严重并发症发生。结论：严格选择病例、遵循腹腔镜手术原则并掌握一定的操作技巧是基层医院开展腹腔镜手术的关键。     

Day surgery in breast reconstructive surgery: our experience

Breast cancer is the most common tumour in Italy in the female population, counting for about 40000 new cases every year. The psychological aspects of breast mutilation and the social and economic implications are receiving increasing attention. Despite of the diffusion of screening programs to detect pre-clinical breast cancers, 30% of patients still undergo radical interventions. Therefore, many women present serious limitations of their social-life that can lead to severe depression since, in occidental countries, the biological function of the breast is less considered than its primary role of femininity and sexuality. The gold-standard is to conceal oncological radicality and aesthetic preservation. The Authors present their experience analysing the techniques employed.     

Laparoscopic assisted reconstructive surgery: a 7-year experience

PURPOSE: Laparoscopic assisted surgery results in an improved cosmetic appearance by allowing complex reconstruction without a midline upper abdominal incision. We report technique and outcomes in patients undergoing laparoscopic assisted reconstruction during a 7-year period. MATERIALS AND METHODS: A total of 31 consecutive patients with a mean age of 14 years (range 1 to 36) underwent laparoscopic assisted reconstructive surgery through a lower midline or Pfannenstiel incision by a single surgeon (SGD) between June 1995 and July 2002. Diagnoses included myelomeningocele (17), sacral agenesis (2), posterior urethral valves (2), classic bladder exstrophy (5), complicated ectopic ureter with ureterocele (1) and quadriplegia due to trauma (4). A total of 29 patients had 39 continent stomas (antegrade continence enema [ACE] or Mitrofanoff) created as part of the reconstruction. One case was converted to an open procedure due to dense adhesions and was excluded from the study. Continent stoma construction included Mitrofanoff stomas created from appendix (17), ileum (3), sigmoid (5) and bladder (1), and ACE stomas from appendix (12) and ileum (1). Ten patients underwent concurrent Mitrofanoff and ACE procedures. Laparoscopy was used for lysis of adhesions, mobilization of colon and/or harvesting the appendix, nephrectomy in preparation for ureteral augmentation, division of pedicle for gastrocystoplasty takedown and harvesting of omentum for interposition. Bladder augmentation (15), bladder neck reconstruction (7), fascial sling (3), ureteral reimplants (1), revision of epispadias (2) and/or redo orchiopexy (1) were concurrently performed in 19 patients. Data were obtained through chart review and personal communication. RESULTS: Median hospital stay was 6 days (range 2 to 20). Mean followup was 32 months (range 3 to 57). Revisions were required in 3 stomas (7.7%) at a mean of 19 months (range 8 to 36) postoperatively. Minor procedures were required in 10 stomas (25.6%) consisting of indwelling catheterization, dilation, collagen injection and cystoscopy. Of the 39 stomas 37 (94.9%) were continent of urine and/or stool, and easily catheterizable at last followup. Adequate capacity and compliance were maintained in all augmented bladders. No patient experienced delayed small bowel obstruction or other sequela of abdominal adhesions. CONCLUSIONS: At almost 3 years of mean followup laparoscopic assisted reconstructive surgery offers functional outcomes at least equivalent to conventional open surgery in complicated cases with excellent cosmesis. Laparoscopic assisted surgery remains our approach of choice for children and adults who require lower urinary tract reconstruction with a continent catheterizable stoma.     

Angioscopy as an adjunct to arterial reconstructive surgery: a preliminary report

To date our use of angioscopy as an adjunct to in situ vein grafting, arterial embolectomy, femoropopliteal bypass surgery, and laser recanalization has been studied in 11 patients. Three angioscopes have been used: a 1.7 mm optiscope, a 2.8 mm laser optiscope, and a 3.2 mm bronchoscope. Scopes were introduced through an arteriotomy and a clear field maintained by continuous saline infusion. Twenty-four angioscopic evaluations were performed in the 14 patients studied. Adequate visualization was achieved with all three scopes. Angioscopy showed total atherosclerotic occlusion of six superficial femoral and popliteal arteries, intimal flaps in two arteries, thrombus in two arteries and one graft, adequate valvulotomy in three saphenous veins used for in situ bypass grafting, and removal of thrombus after embolectomy in one artery. With the 2.8 mm laser optiscope, the optical fiber used for laser recanalization could be positioned at the site of arterial occlusion before lasing and recanalization were done under direct vision. The 1.7 mm scope could be passed through the recanalized artery to inspect the channel and confirm communication with the artery distal to the occlusion. Thus, angioscopy appears to be potentially useful as a diagnostic device in arterial occlusive disease and as an adjunct in in situ saphenous vein grafting or laser recanalization of occluded arterial segments.     

Great saphenous vein protection in arterial reconstructive surgery

An original method of great saphenous vein bypass protection during reconstructive arterial surgery is described. The use of a reinforced prosthetic support (Ringed PTFE), surrounding the vein, avoids possible compression by anatomical structures and strangulation by scar tissue after reoperation. This technique can also prevent eventual dilatation of the vein graft. Since 1981, this technique has been successfully applied to 30 selected patients. On the basis of clinical experience, the authors conclude that this method is safe and effective, and may increase the long-term patency rate of saphenous vein grafts.     

Use of modified heterologous arterial prostheses in reconstructive arterial surgery]

Results with modified heterologous artery prostheses in reconstructive artery surgery.     

腹腔镜泌尿外科手术326例临床经验总结

目的 探讨腹腔镜手术治疗泌尿外科疾病的临床疗效并总结经验.方法 总结2006年3月至2010年8月期间采用腹腔镜手术治疗326例泌尿外科疾病的临床资料.其中精索静脉高位结扎术148例、肾囊肿去顶减压术45例、输尿管切开取石术72例、鞘状突高位结扎术15例、肾蒂淋巴管结扎术7例、肾切除术10例、离断性肾盂成形术10例、肾上腺肿瘤切除术10例、肾癌根治术6例、隐睾下降固定术2例、巨输尿管成形术1例.结果 322例手术获成功,4例中转开放手术.手术时间12-270 min.术中出血量2~500ml,术后住院时间2~11 d.未发生严重并发症.结论 腹腔镜手术治疗泌尿外科疾病具有微创,并发症少、术后恢复快、住院时间短等优势,疗效满意,应用价值高.     

The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery.

PURPOSE: The aim of the study was to investigate the arterial distribution of the eyelids. METHODS: The location, course, length and diameter of eyelid arteries were determined in 19 preserved and latex injected adult male cadaver heads. RESULTS: The diameter of the medial palpebral artery was found to be 1.50+/-0.28mm on the right, and 0.70+/-0.12mm on the left. The diameter of the lateral palpebral artery was measured as 0.62+/-0.10mm on the right, and 0.59+/-0.12mm on the left. The medial palpebral arteries travelling in the medial part of the eyelids usually arose as separate branches for the upper and lower lids, as superior and inferior medial palpebrals. In all cases, four arterial arcades, the marginal, peripheral, superficial orbital, and the deep orbital arcades, were revealed in the upper palpebra. These arterial arcades gave off small perforating branches. The perforating branches were identified on both sides of the tarsal plate and the orbicularis muscle. In four cases (11%) visible arterial variation was found near the inferolateral end of the levator palpebrae. Although many differences in the arterial features of the eyelid have been noted, there may not be a significant difference in the basic vasculature of the palpebra among races. A better understanding of the palpebral vascularity should allow modification of reconstructive techniques and reduce postoperative complications after eyelid surgery.     

应用达芬奇机器人手术系统治疗94例肝胆胰疾病的经验总结

目的 总结达芬奇机器人手术系统治疗肝胆胰疾病的临床经验.方法 回顾性分析2009年1月至12月第二炮兵总医院应用达芬奇机器人手术系统治疗94例肝胆胰疾病患者的临床资料.结果 90例患者由达芬奇机器人手术系统完成手术,4例中转开腹,中转率为4%(4/94).肝脏手术16例,其中1例右肝后叶巨大血管瘤患者因血管瘤与下腔静脉关系密切,中转开腹;肝门部手术27例;胰腺手术19例,其中2例因胰头肿瘤巨大暴露不佳,1例因胆总管下段肿瘤太小,术中通过胆道镜探查+活组织检查无法明确肿瘤性质而中转开腹;其他部位手术32例(包括胆肠吻合6例,胆总管探查取石11例等).结论 应用达芬奇机器人手术系统可以完成各类型肝胆胰外科手术,拓展了腹腔镜外科的手术适应证.