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51.
Hayato Sasaki Yoshiaki Murakami Kenichiro Uemura Takeshi Sudo Yasushi Hashimoto Naru Kondo Taijiro Sueda 《International surgery》2015,100(6):1084-1088
Postpancreatectomy hemorrhage is a potentially life-threatening complication. We report herein our experience with a 65-year-old man with locally advanced pancreatic adenocarcinoma who underwent pancreatoduodenectomy with lymphadenectomy following neoadjuvant chemoradiotherapy. On postoperative day 45, he developed massive hematemesis. Angiography revealed active bleeding from the common hepatic artery, and transcatheter coil embolization of that vessel was successfully performed. On postoperative day 64, he again developed massive hematemesis. Angiography revealed active bleeding from the proximal superior mesenteric artery. Immediately after coil embolization of that vessel, bypass grafting between the superior mesenteric artery and the right common iliac artery was performed, using a greater saphenous vein graft. The combination of embolization and bypass grafting is an option for treatment of bleeding from the superior mesenteric artery in an emergent situation.Key words: Superior mesenteric artery, Bleeding, Bypass, Pancreatoduodenectomy, Postpancreatectomy hemorrhagePostpancreatectomy hemorrhage (PPH) is a rare but life-threatening complication, often associated with the presence of a pancreatic fistula or intraabdominal abscess.1 The mortality associated with arterial bleeding after pancreatoduodenectomy is reportedly between 14.3% and 30.7%.2–6 With recent advances in interventional radiology techniques, transcatheter arterial embolization (TAE) has become an alternative to surgical treatment.3,5,7,8 However, it may be difficult to treat these patients with interventional radiology techniques alone, given their often unstable condition. In addition, the inappropriate use of TAE for arterial bleeding, especially after pancreatoduodenectomy, can lead to end-organ infarction and subsequent infection. We report herein our experience with a patient who had bleeding from the superior mesenteric artery (SMA) after pancreatoduodenectomy. This patient was successfully treated using SMA coil embolization followed by creation of an SMA-iliac artery bypass using a greater saphenous vein graft. 相似文献
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Minatoguchi S Takemura G Chen XH Wang N Uno Y Koda M Arai M Misao Y Lu C Suzuki K Goto K Komada A Takahashi T Kosai K Fujiwara T Fujiwara H 《Circulation》2004,109(21):2572-2580
56.
Strictureplasty for short duodenal stenosis in Crohn's disease 总被引:2,自引:0,他引:2
Takesue Y Yokoyama T Akagi S Ohge H Murakami Y Imamura Y Uemura K Kanehiro T Matsuura Y 《Journal of gastroenterology》2000,35(12):929-932
Involvement of the gastroduodenum is extremely rare in Crohn's disease. For obstructing duodenal Crohn's disease, bypass
procedures have traditionally been selected. However, more recently, strictureplasty has become an acceptable surgical option.
We treated two Crohn's disease patients with short proximal duodenal stenosis, using Finney-type strictureplasty. Their postoperative
courses were uneventful and they have remained asymptomatic during follow-up periods of more than 5 years, and 4 months, respectively.
Owing to the good clinical results of our two patients, we consider strictureplasty to be indicated for short proximal duodenal
stenosis in Crohn's disease.
Received: October 14, 1999 / Accepted: February 25, 2000 相似文献
57.
Hiroyuki Itoh Kimihiro Komori Satoru Funahashi Kenichiro Okadome Keizo Sugimachi 《Atherosclerosis》1994,110(2):259-270
Poor distal runoff and hyperlipidemia are factors affecting the fate of an implanted graft. In the present study, combined effects of poor distal runoff and hyperlipidemia on intimal hyperplasia (IH) of the vein graft were examined in a newly developed poor distal runoff model in rabbits. A poor distal runoff model was prepared in the right hindlimb of 30 rabbits. These animals were divided into two groups, depending on the diet provided; normolipidemic diet group (Group NL, n = 14) and hyperlipidemic 1% cholesterol diet group (Group HL, n = 16). Four weeks after preparing the poor runoff model, the femoral vein was implanted into the ipsilateral femoral artery. At 2, 4 and 6 weeks, the grafts were harvested. IH of the graft was measured and macrophages in the IH were examined immunohistochemically. Intimal cell proliferation was also determined by bromodeoxyuridine (BrdU) incorporation. IH of the vein graft was significantly accelerated in cases of poor distal runoff and hyperlipidemia. There were no macrophages in the IH in the NL group. In the HL group, macrophages infiltrated the outer layer of IH, sometimes just above the internal elastic lamina, and increased with time. In the poor distal runoff limbs at 6 weeks, macrophages also appeared in the subendothelial layer but were absent in that layer in the controls. Intimal cell proliferation expressed as the Brd U labeling index (LI) was maximum at 2 weeks. In the HL group, BrdU LI of 1H in the poor distal runoff limb was higher than in the control at 2 and 4 weeks. Throughout the experiments, BrdU Us in the HL group were significantly higher than in the NL. Hyperlipidemia accelerates intimal cell proliferation to a greater extent, then does 1H. In cases of a poor distal runoff, the enhancement of cell proliferation by hyperlipidemia is augmented. These responses, in the presence of a hyperlipidemia, may be closely related to the migration of macrophages. 相似文献
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Soh Nishimoto Kazutoshi Fujita Yohei Sotsuka Masato Kinoshita Toshihiro Fujiwara Kenichiro Kawai Masao Kakibuchi 《Journal of maxillofacial and oral surgery》2015,14(4):907-913