Simultaneous study of the motor and secretory functions of the small intestine following surgery of the abdominal organs in chronic experiments

The suggested method of an experimental animal preparation for simultaneous study of the motor and secretory functions of the small intestine through the single fistula consists in transection of the intestine with its distal end tightly sutured, and the proximal one end-to-end anastomosed to the efferent loop 22-24 cm from the sutured end. Into the formed in such a way "blind" site of the intestine, a fistula is inserted, which divides it into the "secretory" (12 cm in length) and "communicant" (10 cm) segments. From the "secretory" one the pure intestinal juice is aspirated through the fistula by a catheter, and intestinal motility is registered by means of a pressure gauge brought through the "communicant" segment into the intestine.     

Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity

Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.     

瘘管切除合并内口结扎治疗肛瘘临床疗效分析(附74例报告)

目的观察瘘管切除合并内口结扎治疗肛瘘的临床疗效。方法选择74例内口在肛管齿线附近的肛瘘患者,采用将瘘管完全剥离切除,内口盲端结扎的方法手术的临床资料作回顾性分析。结果 74例患者全部一次性治愈,住院时间为12~23d,完全愈合时间为22~47d。痊愈后肛门外观无缺损、移位等改变,生理功能正常。3例患者早期有少许黏液泄漏,8~10周后症状消失,肛门无失禁。结论采用瘘管切除合并内口结扎的手术方法治疗肛瘘彻底,治愈率高,疗效确切,无肛瘘再次复发。     

半封闭式缝合治疗肛瘘的临床观察

目的探讨半封闭式缝合治疗肛瘘的临床疗效。方法选择120例肛瘘患者,随机分为治疗组和对照组各60例。所有患者均采用低切高挂治疗。治疗组的切口采用半封闭式缝合,对照组的创面完全敞开。观察两组临床疗效、治愈时间和术后切口感染等情况。结果治疗组创面愈合时间明显短于对照组（P〈0.05）,并且术后切口感染未有明显增加。结论半封闭式缝合治疗肛瘘,痛苦小,疗程短,是较理想的手术方法。     

开放式瘘管全剔除术治疗高位肛瘘的临床疗效

为探讨开放式瘘管全剔除术治疗高位肛瘘的临床疗效,证实瘘管盲端处理不到位也是高位肛瘘复发的原因,回顾2011年6月至2013年6月我科采用开放式瘘管全剔除术（31例,治疗组）或切开挂线术（40例,对照组）治疗的高位肛瘘患者资料,并就术后复发情况进行对比分析。结果显示,治疗组中1例患者切除的瘘管组织病理切片发现已经恶变,为黏液腺癌。其余均随访6个月以上,治疗组复发1例（1／30,3．3％）,对照组复发5例（5／40,12．5％）,两组比较差异有统计学意义,P〈0．05。结果表明,开放式瘘管全剔除术治疗高位肛瘘疗效优于切开挂线术,进一步说明瘘管盲端处理不到位也是高位肛瘘术后复发的原因。     

脱细胞真皮基质治疗伴高位盲瘘的复杂性肛瘘疗效观察(附39例报告)

目的探讨高位盲瘘的微创治疗方法,研究脱细胞真皮基质在高位盲瘘治疗中的应用价值。方法 39例高位盲瘘患者,手术分2期进行,经括约肌或括约肌间肛瘘合并高位盲瘘Ⅰ期齿线下瘘管切开、内口挂线并高位盲瘘旷置引流,括约肌上肛瘘切开内口并高位盲瘘旷置引流;Ⅱ期高位盲瘘脱细胞真皮基质填塞治疗。观察Ⅱ期手术时间、术中出血、术后疼痛、住院总天数、住院总费用及复发率等临床及相关指标。结果 39例患者中有26例获得Ⅰ期治愈,13例患者治疗失败,改行肛瘘切开挂线术后痊愈。高位盲瘘脱细胞真皮填塞术手术治愈率66.7%。括约肌上并发高位盲瘘治愈2例,治愈率100%,经括约肌并发高位盲瘘治愈6例,治愈率50%,括约肌间并发高位盲瘘治愈18例,治愈率72%。结论应用脱细胞真皮基质材料治疗高位盲瘘具有损伤小、愈合时间短、肛门失禁率低、外形保留好等优势,值得进一步推广。     

Intraluminal release of serotonin during the interdigestive migrating complex in the canine small intestine

Intraluminal release of serotonin (5-HT) was evaluated in relation to the interdigestive migrating complex (IMC) in the canine small intestine. Thirty-Vella loops (TVL) were constructed in the proximal jejunum of eight dogs. After recovery, the loops were continuously perfused with normal saline at 37 degrees C and changes in intraluminal pressure recorded. For each 10-min period, a motility index (MI) was calculated using computer-assisted planimetry and expressed in mm2/10 min. Serotonin contents in the effluent perfusates were measured by radioimmunoassay. A characteristic phasic motor activity was recognized in the TVL with periods of rest or minimal activity (MI = 406 +/- 45 mm2/10 min, Phase I) alternating with periods of vigorous activity (MI = 2082 +/- 134 mm2/10 min, Phases II and III). Serotonin was constantly found in the effluent perfusates in relatively high concentrations, but 5-HT levels did not vary significantly with intestinal activity; levels averaged 120 +/- 19 ng/ml during Phase I and 110 +/- 13 ng/ml during phases II and III. We conclude that intraluminal 5-HT plays no major role in the physiologic local regulation of the canine IMC in the small intestine.     

带蒂肠浆肌层片加植皮修复腹壁缺损

目的 研究一种对腹壁缺损行之有效的修复方法。方法 1996年7月-2000年12月,应用带蒂肠浆肌层片加植皮修复腹壁缺损7例,其中前期手术副损伤口致肠瘘4例,肠肿瘤一期手术造瘘局部感染形成缺损2例,肠肿瘤侵犯腹壁1例,全麻下行剖腹探查手术,切除腹壁缺损周围水肿感染组织。切除病变肠管,截取带肠系膜的肠段,沿肠系膜缘对侧剖开肠管,刮除肠粘膜层,将带蒂肠浆肌层片与腹壁缺损边缘缝合,中厚皮片植皮。结果 术后6例腹壁创面Ⅰ期愈合,1例局部感染,植皮部分坏死,经二次植皮愈合;均无肠管吻合口漏发生,经1-2年随访,无腹壁疝或腹内疝发生;正常排便,营养状况明显改善。结论 以带蒂肠浆肌层片修补腹壁,术后局部张力小,血供丰富,成功率高。     

Implantation of Rectal Cancer in an Anal Fistula: Report of a Case

A 53-year-old man who had had an anal fistula for 20 years was admitted to our hospital with a large intestinal obstruction. Barium enema and colonoscopy confirmed advanced rectal cancer and we palpated a soft tumor, 3 cm in diameter, with inflammatory induration on the right side of the rectum. After draining a perianal abscess caused by the anal fistula, we performed low anterior resection. Histological examination of the perianal necrotic tissue obtained during resection of the perianal tumor encompassing the anal fistula revealed adenocarcinoma. Since the histology of the perianal lesion was identical to that of the rectal cancer, a diagnosis of cancer implantation rather than carcinoma originating in the anal fistula was entertained. Although the recurrence of rectal cancer by mucosal implantation is not uncommon, the coincidental implantation of rectal cancer in an anal fistula is extremely rare.     

一种新型腹腔感染动物模型的建立

目的 建立一种简单、稳定、便于再次进行肠道手术的腹腔感染动物模型。方法 大鼠分为3组：对照组行假手术；CLP(盲肠结扎穿孔)组行盲肠结扎加穿孔；腹腔感染组行肠瘘手术。检测血白细胞计数(WBC)，血及腹腔液细菌培养，死亡率及小肠常规病理。结果 腹腔感染组手术后WBC显著升高，腹腔液细菌培养均为阳性，以大肠埃希菌(10^6／m1)和D群链球菌(10^6～10^7／m1)最常见，光镜下可见肠壁浆膜层，肌层、小肠绒毛固有层内均有充血、水肿，伴有炎性细胞浸润。结论 这一模型进能够模拟临床腹腔感染，操作简单，结果稳定并便于进行再次肠道手术。     

封闭式负压引流治疗内脏暴露且难以短期缝合的腹壁切口全层裂开的处理经验

目的报道采用封闭负压引流处理腹壁切口裂开小肠暴露的临床经过和治疗经验。方法 60岁男性患者因肾周脂肪肉瘤,外院行脂肪肉瘤切除+左肾切除+结肠切除,术后吻合口漏加做结肠造瘘。入院时腹腔感染、腹壁切口全层裂开并脏器暴露、皮下脓肿、感染性休克、全身多器官功能不全,在规范的全身系统治疗的基础上,使用改良的封闭式负压引流术,回收腹部渗液、保护外露脏器、保护术口周围的皮肤和治疗术口感染;在治疗过程中出现小肠瘘的并发症,通过在小肠内置入内引流管、硅胶封堵和负压引流,治疗小肠瘘的并发症,使患者能够不依靠肠外营养而生存;9月后行手术成功切除小肠瘘。结果患者全身感染症状、内环境及小肠功能在1个月之后好转,逐渐缝合术口。新出现的小肠瘘的并发症,依靠小肠内引流管和负压引流,患者可不依靠肠外营养支持生存,等待二次手术时机。9个月后手术切除小肠瘘,术口完全愈合。结论封闭式负压引流可用于严重的腹腔感染后难以短期缝合的术口全层裂开的治疗。     

经肛门串联重叠手术治疗直肠前突的临床研究

目的：探讨直肠前突病例的手术术式和治疗结果。方法：48例中，重度直肠前突采用经肛门直肠前壁切开将肌肉串联黏膜重叠缝合修补术，同时常规将内括约肌挑出切断术，包括耻骨直肠肌部分切除术和肠疝经腹切除冗长肠段，作对端缝合，疗效观察。结果：全部病例经6个月至2年的随诊，复查，排便通畅，临床症状消失，效果优者35例，良好11例，术后症状轻度改善2例，症状改善总有效率95.8%。结论：选择性直肠前突施行经肛门直肠前壁黏膜切开，肌肉串联，黏膜重叠缝合术效果满意，黏膜的分离，串联重叠缝合程度是手术成功的关键。     

Enterocutaneous fistula treated with a fasciocutaneous turnover flap

A new surgical repair of enterocutaneous fistula associated with abdominal wound defects is presented. The authors turned over the fasciocutaneous flap from the surrounding skin and sutured the intestinal lumen directly to the cutaneous side of the flap. The method is a risk-free extraperitoneal approach that can be performed using local anesthesia.     

323例简化捆绑式胰肠吻合的临床疗效

目的 探讨简化捆绑式胰肠吻合的临床疗效.方法 回顾性分析2005年3月至2010年5月华中科技大学同济医学院附属同济医院实施根治性胰十二指肠切除术治疗323例壶腹部周围癌患者的临床资料.胰肠吻合均采用简化的捆绑式胰肠吻合:胰腺断端游离3～4 cm;将6号或8号硅胶导尿管插入胰管内4～5 cm,胰腺断端外硅胶管为6～8 cm,用可吸收缝线将其缝合固定在胰腺断端上;胰腺断端交锁缝合止血.将空肠断端外翻2～3 cm,电灼损伤黏膜1 cm;回复外翻空肠,在空肠断端的系膜及其对侧和两者的中点与胰腺的下缘、上缘及其之间的胰腺被膜各对称性地缝合1针;并将空肠套在胰腺断端后打结固定.在确定空肠完整地套在胰腺游离段上后,用1-0可吸收线将空肠断端捆绑在胰腺游离段上.消化道重建均采用Child法.结果 323例患者顺利完成了简化的捆绑式胰肠吻合;1例胰肠吻合口出血患者于缝扎出血点后第3天发生胰瘘,置管引流出院1个月后自行痊愈.2例胆总管下端癌和2例胰腺钩突部癌患者分别于术后3、6和8、11 d发生胰瘘,经引流等保守治疗后痊愈.胰瘘发生率为1.5%(5/323).结论 简化的捆绑式胰肠吻合简单易行、安全、可靠,可明显降低胰瘘的发生率.

Abstract：

Objective To investigate the methods and techniques of simplified binding pancreaticojejunostomy for patients with periampullary malignant tumor after radical pancreatoduodenectomy (RPD). Methods From March 2005 to May 2010, 323 patients with periampullary malignant tumor received RPD at the Tongji Hospital of Huazhong University of Science and Technology, and their clinical data were retrospectively analyzed.Simplified binding pancreaticojejunostomy was applied after RPD: the distal end of pancreas was freed for 3-4 cm;a No. 6 or No. 8 silicone urinary catheter was inserted into the pancreatic duct for 4-5 cm, and the remaining urinary catheter (6-8 cm) out of the pancreatic duct was sutured to the pancreatic stump with absorbable sutures.The cutting end of the jejunum (2-3 cm) was everted, and the everted mucosa of the jejunum ( 1 cm) was injured by electrocautery, then the everted jejunum was reverted to its normal position. The cutting end of the mesentery of jejunum and its opposite side, as well as the mid-point of these two parts were sutured symmetrically with the lower and upper edges of the pancreas, and with the capsule of pancreas between them. The everted jejunum was wrapped over the pancreatic stump and sutured it to the pancreas for fixation. The cutting end of the jejunum was bound to the pancreatic stump with 1-0 absorbable suture after confirming the jejunum was completely invaginated into the pancreas. The alimentary tract was reconstructed by using Child's method. Results Simplified binding pancreaticojejunostomy was successfully completed in all patients, Pancreatic fistula was detected in one patient who was complicated with anastomotic bleeding on the third day after secondary laparotomy. The patient was discharged with catheter and spontaneously recovered one month later. Pancreatic fistula was also detected in two patients with distal bile duct carcinoma and two patients with carcinoma in the uncinate process of pancreas at postoperative day 3, 6, 8 and 11, and they were cured by expectant treatment. The incidence of pancreatic fistula was 1.5% (5/323). Conclusion Simplified binding pancreaticojejunostomy is simple, safe and feasible, and it can significantly reduce the incidence of pancreatic fistula.     

323例简化捆绑式胰肠吻合的临床疗效

目的 探讨简化捆绑式胰肠吻合的临床疗效.方法 回顾性分析2005年3月至2010年5月华中科技大学同济医学院附属同济医院实施根治性胰十二指肠切除术治疗323例壶腹部周围癌患者的临床资料.胰肠吻合均采用简化的捆绑式胰肠吻合:胰腺断端游离3～4 cm;将6号或8号硅胶导尿管插入胰管内4～5 cm,胰腺断端外硅胶管为6～8 cm,用可吸收缝线将其缝合固定在胰腺断端上;胰腺断端交锁缝合止血.将空肠断端外翻2～3 cm,电灼损伤黏膜1 cm;回复外翻空肠,在空肠断端的系膜及其对侧和两者的中点与胰腺的下缘、上缘及其之间的胰腺被膜各对称性地缝合1针;并将空肠套在胰腺断端后打结固定.在确定空肠完整地套在胰腺游离段上后,用1-0可吸收线将空肠断端捆绑在胰腺游离段上.消化道重建均采用Child法.结果 323例患者顺利完成了简化的捆绑式胰肠吻合;1例胰肠吻合口出血患者于缝扎出血点后第3天发生胰瘘,置管引流出院1个月后自行痊愈.2例胆总管下端癌和2例胰腺钩突部癌患者分别于术后3、6和8、11 d发生胰瘘,经引流等保守治疗后痊愈.胰瘘发生率为1.5%(5/323).结论 简化的捆绑式胰肠吻合简单易行、安全、可靠,可明显降低胰瘘的发生率.     

Management of fistulas in Crohn's disease

AIM: This study was conducted to clarify operative indications, surgical treatment, and postoperative complications of intra-abdominal fistulas in Crohn's disease. METHODS: Of 213 patients undergoing surgical treatment for Crohn's disease in our institution between 1972 and 2000, 55 patients (25.8%) found to have 81 intra-abdominal fistulas were retrospectively reviewed. RESULTS: The most common indication for surgery was intestinal obstruction. A fistula represented a single indication for surgical treatment in 9 operations (15.5%). All patients with intra-abdominal fistulas underwent resection of the diseased intestinal segment. Closure of the fistulous defect of the affected lesion was achieved by suture (n = 27), stapled fistulectomy (n = 12), or resection (n = 11). Resection of the diseased bowel was achieved by en bloc removal of the fistula in 15 cases. When the fistula opened through the abdominal wall (n = 12), the diseased portion of the intestine was resected, and the fistulous tract was debrided. Only 1 patient died postoperatively from multiple organ failure because of anastomotic breakdown. CONCLUSIONS: The surgical treatment of an intra-abdominal fistula in Crohn's disease is based on resection of the diseased intestinal segments, and the affected lesion can be sutured. This procedure can be achieved safely, and the incidence of postoperative complications is low.     

Observations on the gastrointestinal movements of the tortoise (Geoclemys reevesii) by means of the abdominal-window-technique]

In the tortoise the gastrointestinal movements were observed utilizing the abdominal-window-technique. The results obtained were summarized as follows: (1) So far as the intestine was exposed to the atmosphere both in vivo and in vitro, the intestine was motionless in most cases. On the other hand, the abdominal-window-technique proved to be very useful to observe the gastrointestinal movements. (2) The operation was carried out under the aseptic precaution as follows: First the back of the animal was removed at its left side to make a retangular window of 8 X 1.5-4 cm, then ovaries and fallopian tubes on the left side were removed and lastly the window thus formed was covered with a 0.2 mm thick, transparent vinyl-plate, being sutured at its border to the back. In addition, the border of the window plate was firmly sticked to the back by means of adhesives, Aron Alpha A and Araldite. (3) a. In the region of the stomach situated just anal to the cardia contractions (stomach peristalses) recurrently started with a time interval of 21 to 32 sec, sweeping down the wall of the stomach with a velocity of 0.5 to 0.9 mm/sec, until they came to an end at the pylorus. b. In the small intestine, there recurrently occurred contraction waves with a time interval of about 45 seconds, traveling analwards with a velocity of about 0.3 mm/sec. c. In the large intestine, there were observed two kinds of movements, i.e., antiperistalses as well as mass peristalses. In the former contraction waves recurrently started at the anal end (coprodaeum) of the large intestine with a time interval of 18 to 25 sec, propagating oralwards with a velocity of about 1 min/sec, until they waned rapidly to disappear after propagating only a short distance (about 2 to 3 cm). In the latter powerful contractions occasionally started at the uppermost part of the large intestine to propagate analwards at first slowly with a velocity of about 0.15 mm/sec, and then rapidly with a velocity of about 0.5 mm/sec, until they arrived at the proctodaeum to expel a fecal mass 7 to 8 mm thick and 15 mm long.     

Injury of large intestine in urgent surgery

The results of examination and surgical treatment of 108 patients (93 males, 15 females), aged from 19 to 73 years, with large intestine injuries of different origin are presented. Large intestine injuries as a result of stab-incised abdominal wounds was in 58 patients, gunshot wounds--in 29, blunt trauma--in 21. The diagnosis of large intestine injuries was based on clinico-laboratory, X-ray and instrumental examinations. The injury of blind intestine was revealed in 8 patients, ascending colon--in 11, transverse colon--in 39, descending colon--in 5, sigmoid colon--in 45. All the patients were operated. The method of choice in the surgical treatment of these injuries was suturing of damaged portion of large intestine, which was performed in 72 patients. In 14 patients the suturing was complemented by decompressive colostomy, in 3--by extraperitonisation of the damaged site, in 4--by extraperitonisation and decompressive colostomy, in 2--by terminal ileostomy. Resection of damaged intestinal segment with primary anastomosis was performed in 4 patients, right-side hemicolectomy--in 7, Hartmann's operation--in 17, resection of large intestine with bitrunk colostoma creation--in 3, transfer of damaged segment of large intestine--in 5. Repeated operations for intestine integrity repair and fistula closure were performed in 47 patients. 18 (16.7%) patients died after operation as a result of peritonitis (7), shock and acute hemorrhage (10), denutrition due to intestinal fistula (1).     

胰横断部-空肠Roux-Y术治疗胰头颈部横断伤

目的 提高胰头颈部断裂伤治疗水平。方法 对6例胰头颈部断裂伤患者施行胰横断部—空肠Roux—Y术，胰头、体尾端胰管及空肠盲襻负压外引流，吻合口的叠套深度为1．5cm。结果 术后第15天造影显示胰管及空肠引流通畅，吻合口处无积液，无腔外渗出。术后恢复好，无胰瘘发生。结论 本术式对预防胰头颈部横断损伤术后胰瘘的发生有一定作用。     

Experimental investigation of the mechanism of propagation of the interdigestive migrating electric complex

The following results were obtained from investigations of the mechanisms of propagation of the interdigestive migrating electric complex (IMEC) obtained by inducing action potential from dogs in a fasted conscious state according to anastomosis of the transected small intestine. The IMEC occurring on the oral side always showed normal continuous propagation in the stump of the blind loop with no anastomosis in the small intestine. Even in cases of transplantation of the small intestine in different parts of the same digestive tract during IMEC propagation, the IMEC skipped over this and propagation showed normal continuity. From the above results, it appears that the normal mechanism of propagation occurs with no relation to anastomosis of the small intestine, and movement of the intestinal contents also play no role. It is therefore assumed that coordination of the propagation of IMEC is via the exrinsic nervous system. When the distal small intestine was transected, the frequency of the IMEC was the same as the frequency of the distal BER and the velocity was also decreased. The transplanted small intestine maintained the normal propagation velocity after transection. New electric complexes were seen from the stump of the distal intestine and they migrated to the caudal side. From these results, it appears that the propagation of IMEC also occurs via nervous systems other than the extrinsic nervous system and that innervation by regulation of the extrinsic and intrinsic nervous system is involved in the propagation of IMEC.