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41.
42.
Javairiah Fatima Scott G. Houghton Michael G. Sarr 《Journal of gastrointestinal surgery》2007,11(8):1052-1056
Small bowel transplantation (SBT) is associated with poorly understood enteric dysfunction. The study of SBT in mice is hindered
by the technical difficulty of orthotopic SBT in the mouse. Our aim was to develop an easy preparation of extrinsic denervation
of the entire jejunoileum in mice as a model of orthotopic SBT. All neurolymphatic tissues accompanying the superior mesenteric
artery (SMA) and vein (SMV) were ligated just distal to the middle colic vessels. The SMA and SMV were then stripped of investing
adventitia, and the mesentery to jejunum and colon were transected radially. Jejunum and colon were not transected and reanastomosed.
To confirm extrinsic denervation 1, 3, and 6 months later, segments of small bowel were stained for protein gene product 9.5
(PGP9.5) and tyrosine hydroxylase (TH). Tyrosine hydroxylase immunoreactive intensity was then quantified using a semiquantitative
analysis. Immunohistochemical fluorescence showed persistence of PGP9.5 immunoreactivity confirming enteric nerves in jejunoileum;
however, there was no TH immunoreactivity in jejunoileum in denervated mice despite the expected preservation of TH immunoreactivity
in the still-innervated duodenum at 1 month. At 3 months, sparse immunoreactivity for TH was present, and by 6 months, reinnervation
of TH-containing nerves appeared similar to controls. Quantification of intensity at each time-point further confirmed this
trend. This technique in the mouse accomplishes a complete extrinsic denervation of jejunoileum early postoperatively (1 and
3 months); reinnervation occurs by 6 months. This is an easily learned murine model of orthotopic SBT.
Presented at the American Gastroenterological Association during Digestive Disease Week in Los Angeles, CA, as a poster presentation
on May 23 2006. Abstract published in GastroenterologyE 2006; 130:A604. 相似文献
43.
Laureano Fernández-Cruz Rebeca Cosa Laia Blanco Sammy Levi Miguel-Angel López-Boado Salvador Navarro 《Journal of gastrointestinal surgery》2007,11(12):1607-1622
Laparoscopic pancreatic surgery (LPS) has seen significant development but much of the knowledge refers to small and benign
pancreatic tumors. This study aims to evaluate the feasibility, safety, and long-term outcome of the laparoscopic approach
in patients with benign, premalignant, and overt malignant lesions of the pancreas. This study, currently, is the largest
single center experience worldwide. One hundred twenty-three consecutive patients underwent laparoscopic pancreatic surgery
from April 1998 to April 2007, 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic
drainage was performed, and were excluded from the analysis. The 103 patients were divided based on preoperative diagnosis:
group I, inflammatory tumors for chronic pancreatitis (eight patients); group II, cystic pancreatic neoplasms (29 patients);
group III, intraductal papillary mucinous neoplasms (10 patients); group IV, neuroendocrine pancreatic tumors (NETs) (43 patients);
and group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R
0 or R
1 resection (transection margins on the specimen were inked). Perioperative data, postoperative complications, and resection
modalities were compared using statistical analysis. Long-term outcomes were analysed by tumor recurrence and patient survival.
The overall conversion rate was 7%. Laparoscopic distal pancreatic resection was performed in 82 patients (79.6%). Laparoscopic
spleen-preserving distal pancreatectomy (Lap SPDP) was performed in 52 patients (63.7%), but with splenic vessels preservation
in 22% and without splenic vessels preservation in 41.5%. Laparoscopic en-bloc splenopancreatectomy (Lap SxDP) was performed
in 30 patients (36.6%) and laparoscopic enucleation (Lap En) in 20 patients (19.4%). There was no mortality. The overall complication
rate was 25.2, 16.7, and 40% after Lap SPDP, Lap SxDP, and Lap En, respectively. The overall morbidity rate was significantly
higher (p > 0.05) in the group of Lap SPDP without splenic vessels preservation comparing with Lap SPDP with splenic vessels preservation
because of the occurrence of splenic complications (20.6%). The overall pancreatic fistulas was 7.7, 10, and 35% after Lap
SPDP, Lap SxDP, and Lap En, respectively; the severity of fistula was significantly higher in the Lap En group (p > 0.05). The mean hospital stay was within 1 week in all groups, except in the group of ductal adenocarcinoma, which is 8 days.
In this series, 27 patients (26.2%) had malignant disease. R
0 resection was achieved in 90% of ductal adenocarcinoma and 100% for other malignant tumors. The median survival for ductal
adenocarcinoma patients was 14 months. This series demonstrates that LPS is feasible and safe in benign-appearing and malignant
lesions of the pancreas. 相似文献
44.
Background The incidence rate of incisional hernias after open surgery has been reported to be higher than that of port site hernias
after laparoscopic surgery. No studies have compared the costs for the health care system in treating those two types of hernia.
Methods A systematic review was conducted to obtain the baseline data, and a decision analysis model was created to simulate the occurrence
and recurrence of incisional and port site hernias.
Results The overall risk of having incisional hernias was eight-times higher than that of having port site hernias (7.4% vs 0.9%).
A cost savings of £93 per patient can be generated for the health care system in the UK. Similar results were obtained for
Germany, Italy and France.
Conclusions The additional treatment costs for incisional hernia should be taken into account when the costs of a surgery performed by
open approach are compared with by laparoscopy. 相似文献
45.
A. Ravikumar S. Mohanty R. P. Vatsanath S. Raghunandhan 《Indian journal of otolaryngology and head and neck surgery》2004,56(4):317-320
The co-existence of fungal elements in allergic nasal Polyposis, has given rise to a distinct clinical entity known as ‘Allergic
fungal sinusitis ’ (AF’S). Many a time, these fungal elements may not be diagnosed pre-operatively by routine diagnostic nasal
endoscopy or CT scan of paranasal sinuses, due to the florid presentation of nasal polyps, which usually obscure the underlying
fungal pathology. The diagnosis is often made intra-operatively. The post-operative confirmation of AFS is by histopathology,
fungal smear, fungal culture, allergic murin study and fungal specific IgE titres. We report a series often such cases done
in our institution, which highlight that AFS should be considered as a differential diagnosis in Sinonasal Polyposis cases,
for their effective management. 相似文献
46.
目的 探讨如何选择合适的保肛手术方法治疗低位直肠癌。方法 44例肿块下缘距肛缘5~7cm的低位直肠癌患者,对21例采用改良的结肠肛管吻合术(A组)、23例应用吻合器技术的前切除术(B组)进行治疗;并对两组疗效予以对比。结果 A组患者无远端直肠残端肿瘤残留,B组有2例。肿瘤远端直肠切除距离A组平均为(2.81±0.35)cm,B组(1.73±0.42)cm。两组比较,差异有显著性意义(t=9.083,P<0.001)。A组术后两年均无吻合口复发,B组有4例,B组吻合口复发率明显高于A组(x~2=4.234,P=0.04)。A组术后早期排便功能较差,但均能在半年内改善;B组术后排便功能良好。结论 低位直肠癌患者肿瘤下缘距肛缘5~7cm、肿瘤“T”分期为Ⅱ、Ⅲ期、术前指诊肿瘤可推动、肿瘤侵犯肠壁范围不到1周可行保肛手术。应根据患者体型、骨盆宽窄、肿瘤分化程度及其侵犯肠管的周径合理选择改良的结肠肛管吻合术或吻合器技术的前切除术。 相似文献
47.
糖尿病患者超声乳化白内障吸除手术的临床观察 总被引:4,自引:0,他引:4
目的:探讨糖尿病患者进行超声乳化白内障吸除联合人工晶状体植入手术的临床效果。方法:50例(61只眼)糖尿病患者(设为A组)和同期163例(174只眼)血糖正常患者(设为B组)接受超声乳化白内障吸除联合人工晶状体植入手术。糖尿病患者手术前通过饮食疗法、口服药物或肌注胰岛素治疗,使空腹血糖降到 10mmol/L以下。术后随访 1~28个月(平均 8.6个月),复查视力、裂隙灯及眼底检查。结果:术后矫正视力≥0.5者,A组为77.1%;B组为80.5%。两组经统计学处理差异无显著性(P>0.05)。两组术中出现后囊破裂及术后发生角膜水肿和前房渗出等并发症的差异无显著性(P>0.05 )。结论:糖尿病患者进行超声乳化白内障吸除手术前只要有效控制血糖,其手术效果与对照组患者相同。但术后血糖的控制仍然十分重要。眼科学报2003;19:98-100。 相似文献
48.
Shengsong Huang~ Minbin Yu~ Jie Lian~ Min Fan~ Changyu Qiu~ Zhongshan Ophthalmic Center Sun Yat-sen University Guangzhou China The Department of Ophthalmology The First Hospital of Quanzhou Fujian China 《眼科学报》2003,19(3):156-160
Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5% Alcaine eye drops combined with subconjunctival anesthesia with 2% Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes (85.2%) were painless (Grade Ⅰ), 50 eyes (14.0%) were slight painful (Grade Ⅱ), and 3 eyes (0.8%) were more painful (Grade Ⅲ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow vi 相似文献
49.
腹腔镜辅助子宫肌瘤剔除术30例手术体会 总被引:1,自引:0,他引:1
目的:观察腹腔镜辅助子宫肌瘤剔除术的疗效,探讨腹腔镜辅助子宫肌瘤剔除术的可行性。方法:回顾性分析我院2008年全年30例子宫肌瘤患者的手术方法及手术结果。结果:30例患者全部治愈,平均手术时间78min,术后患者指征数据佳。结论:腹腔镜辅助子宫肌瘤剔除术综合了经典开腹及微创手术的优点,可以提倡。 相似文献
50.
Takashi Iwazawa Mitsunobu Imazato Tadashi Ohnishi Yutaka Kimura Hiroshi Yano Takushi Monden 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(8):386-389
We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman
with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series
that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung.
Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory
change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that
identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by
squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically
compatible with congenital fistulae. 相似文献