残胃开放吻合对预胃大部切除术后胃肠吻合口出血的探讨

统计分析我院１９８１年８月对１９９５年８月５８６例做胃大部分切除术的病人，在残胃钳夹与开放两种状态下胃大部分切除术，观察术后胃肠吻合口出血的并发症。胃肠钳夹吻合法４０２例，６例发生胃肠吻合口出血。残胃开放组１８４例，无一例发生术后吻合口出血。说明残胃开放吻合对预防胃大部切除术后胃肠吻俣口出血是一种简便、有效的手术方法。     

胃大部切除术行胃十二指肠吻合的改进体会

目的 探讨胃大部切除术行BillrothⅠ胃十二指肠吻合的一种新方法。方法 175例胃大部切除术后患者采用胃十二指肠小吻合口，小弯侧瓣向后旋转，使残胃小弯侧瓣口成为后壁之中点，残胃与十二指肠对端吻合的方法。结果 术后并发症少、无出血、无吻合口瘘。结论 此法操作简便、安全可靠、术后恢复满意，生活质量高，应在今后的临床应用中完善。     

胃部分切除引起上消化道出血的治疗

目的探讨胃部分切除术后上消化道出血的原因、预防及处理。方法回顾分析本院2000年1月至2010年12月间胃部分切除手术2680例,出现上消化道出血的25例的处理方法及结果。结果术中探查吻合口出血12例,残胃粘膜损伤出血3例,十二指肠球后溃疡出血2例,十二指肠残端出血2例,4例病人急诊胃镜检查证实均为吻合口出血,并在胃镜下止血,2例保守治疗痊愈。结论胃大部分切除术后病人出现上消化道出血的原因主要是吻合口炎、残胃炎、残胃粘膜病变、残胃癌等。预防正确估计病情和选择合适治疗方式十分重要。     

胃大部切除术后吻合口溃疡的诊治

目的 探讨胃大部切除术后吻合口溃疡的诊治方法.方法 1985年3月至2008年6月期间兰州大学第一医院收治的胃大部切除术后吻合口溃疡患者29例,均经胃镜证实,其中男16例,女13例;年龄30～51(40±3.0)岁;19例为十二指肠球部溃疡术后,10例为胃溃疡术后.初次手术到溃疡再发症状的时间,最短1例为1个月,其余28例为3～4年.2例吻合口溃疡穿孔及4例吻合口溃疡出血者行包括吻合口在内的残胃部分切除、胃空肠Roux-Y吻合术;其余均给予非手术治疗.结果 行再手术治疗者术后发生切口感染1例,行保守治疗;所有患者均治愈,随访1～5年,未出现溃疡复发.结论 吻合口溃疡首选保守治疗,多数可治愈.再次手术方式可采用残胃部分切除加胃空肠Roux-Y吻合术.     

电刀与一层吻合在胃大部切除术中的应用

无论胃及十二指肠的良性疾病或恶性肿瘤需行胃大部切除术时，我们往往担心的是术后吻合口出血、吻合口瘘等近期并发症。自2005年4月至2009年2月，我们采用电刀切断胃、切开空肠、胃肠一层吻合方法行幽门侧胃大部切除术68例，取到了很好的效果。     

胃大部分切除术后急性胃潴留的临床分析

随着胃大部分切除技术的成熟，一些近期并发症诸如吻合口出血、十二指肠残端破裂等发生的机会逐渐变小。但对我院1995年3月～2002年1月间214例胃大部分切除术后出现急性胃潴留的64例(占29．9％)患者的临床资料进行回顾性分析发现，术后急性胃潴留这一并发症并没有明显的减少，原因是多方面的，现报告如下。     

远端极量胃次全切除术

目的探寻远端极量胃次全切除术的可行性和安全性。方法对2005年1月至2007年4月第四军医大学西京医院普通外科远端极量胃次全切除术45例的临床资料进行分析。其中43例胃癌病人施行胃切除术,2例溃疡病行远端胃大部切除术后残胃吻合口溃疡反复出血者,将脾胃韧带内由脾下极向上的数支胃短血管分支离断,在切断胃短血管的近胃底胃大弯缘至贲门下2cm连线切除荷瘤胃。将仅由3支胃短动脉或2支胃短动脉及胃后动脉提供血运的残胃与空肠行Billroth-Ⅱ式胃空肠吻合。结果胃癌术后病理石蜡切片报告上切缘均干净,未发现肿瘤细胞。术后随访2~45个月,未出现吻合口癌及残胃癌复发,未发生胃缺血或吻合口瘘等并发症,术后残胃的功能正常。2例溃疡病行远端胃大部切除术后,残胃吻合口溃疡反复出血者术后无再出血发生。结论仅保留2支胃短动脉及胃后动脉,或3支胃短动脉的远端极量胃次全切除术是一种安全、实用的胃切除方法。     

食管残胃吻合治疗胃大部分切除术后食管癌6例报告

食管残胃吻合治疗胃大部分切除术后食管癌６例报告广东医学院附属医院心胸外科（湛江，５２４００１）陈捷钱定一何悦概１９９０年１月至１９９６年５月，我院对６例胃大部分切除术后食管癌，施行食管癌切除、食管残胃吻合术，占同期８１２例食管癌手术的０．７％。现报告...     

食管下段及胃底切除行“围巾式”食管-胃吻合98例分析

目的 介绍“围巾式”食管-胃吻合方法预防食管下段及胃底切除术后吻合口瘘和反流性食管炎的临床经验.方法 回顾分析1996年1月至2013年10月98例食管下段及胃底切除术行“围巾式”食管-胃吻合病例的临床结果.98例中男性61例,女性37例;年龄42～83岁,中位年龄65岁.肝硬化门静脉高压症并食管下段胃底静脉曲张出血78例,早期食管胃结合部癌15例,贲门及胃底部间质瘤5例.术后86例获得随访,随访率为87％,随访时间3～60个月,中位随访时间42个月.结果 98例中,1例术后发生残胃断口处吻合口瘘,其余97例均未发生吻合口瘘.无发生反流性食管炎病例.5例(5.1％)病人术后发生吻合口狭窄,经胃镜下球囊扩张后缓解,改进技术后再无吻合口狭窄发生.结论 “围巾式”食管-胃吻合可减少食管下段及胃底切除术后吻合口瘘和反流性食管炎,是一种安全、有效的消化道重建方式.     

保留幽门,胃窦粘膜—残胃全层吻合的胃大部切除术

保留幽门、胃窦粘膜－残胃全层吻合的胃大部切除术马建国王嘉毅李风英胃大部切除术后常会出现胆汁返流性胃炎、倾倒综合征、吻合口瘘以及远期发生残胃癌等多种并发症［１，２］。为此，我们采用自行设计的保留幽门、胃窦部粘膜－残胃全层吻合的胃大部切除术治疗胃十二指肠...     

Three-hour interval drain clamping reduces postoperative bleeding in total knee arthroplasty: a prospective randomized controlled trial

Background

Total knee arthroplasty (TKA) is a common procedure that has a risk of significant blood loss and blood transfusion, and carries a substantial risk for immunologic reactions and disease transmission. Drain clamping is a popular method that is applied to reduce blood loss after TKA. However, the clamping protocol remains controversial. Therefore, we established a new protocol, 3-h interval clamping, and compared the bleeding control efficacy of this protocol following TKA with the non-clamping technique.

Methods

Between March and July 2008, we enrolled 100 patients (100 knees) who underwent uncomplicated TKA using a minimally invasive surgical technique. The patients were randomly assigned into two groups based on the draining protocol: non-clamping (group A) and 3-h interval clamping (group B). For group A, a vacuum drain was connected to a container and was run continuously during the first postoperative day, whereas the vacuum was stopped twice (for ~3 h each time) for group B. Demographic characteristics and clinical data were collected, including the levels of hemoglobin and hematocrit, the total blood loss volume, the number of patients who required a blood transfusion, and any complications that developed. The perioperative data were compared between the two groups.

Results

The drainage blood volume in the interval-clamping group (group B) was significantly lower than that in the non-clamping group (group A) during the first 48 h following the procedure (p < 0.001 and p = 0.005 for first and second postoperative days, respectively). The mean fall in hemoglobin levels at 12 h in the interval-clamping group (2.8 ± 0.9 g/dL) was also lower than in the non-clamping group (3.2 ± 0.8 g/dL). In the 3-h interval clamping protocol, the number of patients requiring a transfusion was 2.2 times less than the number in the non-clamping protocol, but was not significantly different (odds ratio = 2.20, p = 0.24), and the significant predictor of blood transfusion was the preoperative hemoglobin level (odds ratio = 7.73, p < 0.001). No wound infection or clinical venous thromboembolisms were detected in our study.

Conclusion

The 3-h interval clamping is a newly developed protocol for reducing blood loss after TKA. The protocol lessens the decrease in postoperative hemoglobin levels. This protocol can be applied easily without increasing clinical thromboembolic events and wound complications.     

生物降解吻合环在108例肠道吻合术中的应用

目的探讨生物降解吻合环在肠道吻合术中的应用价值。方法回顾性分析2002年1月至2005年11月108例使用吻合环行不同肠吻合术患者的临床资料。结果108例中行小肠-小肠端端吻合术2例，回肠-结肠端端吻合术74例，结肠-结肠端端吻合术23例，结肠-直肠端端吻合术9例。2例因小肠肠管的直径太小致吻合失败，106例吻合过程顺利。术后发生吻合口漏2例，占1．8％。术后无吻合口出血及吻合口狭窄，无手术死亡。结论肠吻合术时使用吻合环具有操作简便快捷，效果安全可靠等优点。     

Robot-assisted laparoscopic intestinal anastomosis

Introduction: Robotic telemanipulation systems have been introduced recently to enhance the surgeon's dexterity and visualization in videoscopic surgery in order to facilitate refined dissection, suturing, and knot tying. The aim of this study was to demonstrate the technical feasibility of performing a safe and efficient robot-assisted handsewn laparoscopic intestinal anastomosis in a pig model. Methods: Thirty intestinal anastomoses were performed in pigs. Twenty anastomoses were performed laparoscopically with the da Vinci robotic system (robot-assisted group), the remaining 10 anastomoses by laparotomy (control group). OR time, anastomosis time and complications were recorded. Effectiveness of the laparoscopic anastomoses was evaluated by postoperative observation of 10/20 pigs of the robot-assisted group for 14 days and by testing mechanical integrity in all pigs by measuring passage, circumference, number of stitches, and bursting pressure. These parameters and anastomosis time were compared to the anastomoses performed in the control group. Results: In all cases of the robot-assisted group the procedure was completed laparoscopically. The only perioperative complication was an intestinal perforation, caused by an assisting instrument. The median procedure time was 77 min. Anastomosis time was longer in the laparoscopic cases than in the controls (25 vs 10 min; p <0.001). Postoperatively, one pig developed an ileus, based on a herniation of the spiral colon through a trocar-port. For this reason it was terminated on the sixth postoperative day. All anastomoses of the robot-assisted group were mechanically intact and all parameters were comparable to those of the control group. Conclusion: Technical feasibility of performing a safe and efficient robot-assisted laparoscopic intestinal anastomosis in a pig model was repeatedly demonstrated in this study, with a reasonable time required for the anastomosis.     

End-to-side anastomosis for coarctation of the aorta and type a aortic arch interruption with hypoplastic aortic arch

Objective: We investigated the advantages of reconstructing the aortic arch in neonates and infants by end-to-side anastomosis (ESA) in aortic coarctation and type A aortic arch interruption. Subjects and Methods: The patients were 28 neonates and infants who underwent median full sternotomy for correction of aortic coarctation (CoA) and type A interrupted aortic arch (IAA), at our institute, from October 1997 to September 2002. The cases were divided into two groups: ESA was performed in 16 cases (group A) and extended end to end anastomosis in 12 cases (group B). All repairs were made using simple clamping of the descending aorta under cardiac arrest. We compared groups A and B with regard to duration of simple clamping, postoperative blood pressure in the upper and lower extremities, echocardiographic pressure gradient, and the presence or absence of tracheal stenosis as diagnosed by postoperative clinical symptoms and chest radiography. Results: No significant difference between the groups was found in age, gender, body weight, or the ratio of CoA to IAA. In addition, there was no defference between the two groups in the duration of simple clamping or the difference in blood pressure between the lower and upper extremities. However, the echocardiographic pressure gradient at the site of anastomosis in group A was significantly lower than that in group B. There were no cases with symptoms of bronchial stenosis in either group. Conclusion: ESA is a relatively simple method for treating CoA or IAA with hypoplastic aortic arch, and was found to be effective for the elimination of residual stenosis.     

肠道吻合术中应用生物降解吻合环的临床疗效观察

目的探讨肠道吻合术中使用生物降解吻合环的临床疗效。方法回顾性分析本组2003年9月至2006年12月90例肠道吻合术中使用生物降解吻合环的临床资料。结果90例中包括小肠-小肠端端吻合术3例,回肠端端吻合术62例,结肠-结肠端端吻合术15例,结肠-直肠端端吻合术10例。全部吻合过程顺利,术后无吻合口出血及狭窄和吻合口漏,无手术死亡。结论应用生物降解吻合环进行肠吻合术具有安全可靠,操作方便,节省时间,有效预防手术后并发症等优点。     

End-to-side anastomosis for coarctation of the aorta and type a aortic arch interruption with hypoplastic aortic arch

Objective: We investigated the advantages of reconstructing the aortic arch in neonates and infants by end-to-side anastomosis (ESA) in aortic coarctation and type A aortic arch interruption. Subjects and Methods: The patients were 28 neonates and infants who underwent median full sternotomy for correction of aortic coarctation (CoA) and type A interrupted aortic arch (IAA), at our institute, from October 1997 to September 2002. The cases were divided into two groups: ESA was performed in 16 cases (group A) and extended end to end anastomosis in 12 cases (group B). All repairs were made using simple clamping of the descending aorta under cardiac arrest. We compared groups A and B with regard to duration of simple clamping, postoperative blood pressure in the upper and lower extremities, echocardiographic pressure gradient, and the presence or absence of tracheal stenosis as diagnosed by postoperative clinical symptoms and chest radiography. Results: No significant difference between the groups was found in age, gender, body weight, or the ratio of CoA to IAA. In addition, there was no defference between the two groups in the duration of simple clamping or the difference in blood pressure between the lower and upper extremities. However, the echocardiographic pressure gradient at the site of anastomosis in group A was significantly lower than that in group B. There were no cases with symptoms of bronchial stenosis in either group. Conclusion: ESA is a relatively simple method for treating CoA or IAA with hypoplastic aortic arch, and was found to be effective for the elimination of residual stenosis.     

扩大左半结肠切除术中不同结直肠吻合方式的近期疗效比较

目的：比较扩大左半结肠切除术中不同结直肠吻合方式的近期疗效。方法：回顾性分析2000年7月—2013年8月实施的扩大左半结肠切除术28例临床资料,根据吻合方式不同分为传统组（15例）和改良组（13例）,传统组行常规小肠前结直肠吻合术;改良组行经小肠系膜（8例）或小肠系膜后（5例）直肠吻合术。比较两组的术中、术后指标。结果：两组手术时间、术中出血量差异无统计学意义（P>0.05）,改良组术后平均排气时间、术后恢复正常饮食时间、住院时间均短于传统组（P<0.05）;改良组术后总并发症发生率明显低于传统组（23.1% vs. 46.7%,P<0.05）,其中主要差异在于高位小肠梗阻发生率（26.7% vs. 0.0%,P<0.05）。结论：扩大左半结肠切除术中,采用经小肠系膜和小肠系膜后结直肠吻合术能减少吻合口张力,避免压迫空肠,术后疗效明显优于小肠前结直肠吻合术。

     

改良胆肠袢式吻合术治疗小儿胆管扩张症：附51例报告

目的：探讨改良胆肠袢式（Warren）吻合术对先天性胆管扩张症患儿的临床疗效。 方法：回顾性分析2005年1月—2012年12月收治的51例先天性胆管扩张症患儿的临床资料,其中23例行改良的胆肠袢式吻合术（观察组）,28例行胆管空肠Roux-en-Y吻合术（对照组）,比较两组患儿术中及术后情况。 结果：与对照组比较,观察组手术时间、术中出血量减少,肠鸣音恢复时间、排气时间缩短（均P<0.05）。两组术后7 d肝功能指标差异均无统计学意义（均P>0.05）。术后观察组与对照组分别有1例、4例发生轻微胆汁反流,对照组有2例发生急性胆管炎,两组两种术后并发症发生率无统计学差异（均P>0.05）。 结论：改良胆肠袢式吻合术治疗先天性胆管扩张症操作简单、术后恢复快,近期疗效确切,但远期效果需进一步研究。     

Pancreatico-jejunal vs pancreatico-gastric anastomosis after cephalic duodenopancreatectomy

Pancreatoduodenectomy has been for a long time a procedure with high postoperative morbidity and mortality. Several complications after pancreatic resections are known, but one of the most severe is the fistula of the pancreatic anastomosis. Avoiding the pancreatic fistula caused many surgical innovations regarding the procedure of reestablishing the continuity after pancreatoduodenectomy. The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatoduodenectomy. No technique was proved to be superior so far, the benefits of these 2 types of pancreatic anastomosis being the subject for intense debates. From 2000 to 2004, 17 patients underwent pancreatoduodenectomy, for pancreas, ampulla, distal bile duct or duodenum cancers. Pancreatic anastomosis was accomplished by pancreatico-gastrostomy in 11 cases and by pancreatico-jejunostomy in 6 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups was made mainly analysing postoperative mortality and morbidity. Postoperative morbidity was 9,1% after pancreatico-gastrostomy and 33,3% after pancreatico-jejunostomy. Postoperative mortality was none after pancreatico-gastrostomy and 16,7% after pancreatico-jejunostomy. This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but in most cases the surgeon will choose based on his experience. These results have to be confirmed or invalidated by a prospective multicentric randomised study.     

Telescopic anastomosis in colorectal surgery

The most frequent postoperative morbidity and mortality in the colorectal surgery is caused by the failure of the anastomosis. On the base of the statistics the postoperative mortality caused by the failure of the anastomosis can rise up to 20%. In the last decade a lot of types of anastomoses was initiated, for example: telescopic anastomosis, mechanical anastomosis with stapler, anastomosis with a bio-fragmentary ring. In the technique of the telescopic anastomosis, introduced from the beginning of 20th century, many changes had made. The experimental and the operative results shown that the telescopic anastomosis is a secure, fast and cheap procedure in the surgery of the colon. Conclusions: the telescopic anastomosis is applicable also in emergency, with a short septic time , easy procedure and doesn't need special instruments.