Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum

IntroductionTorsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation.Presentation of caseWe present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia.DiscussionOmental torsion should always be included in the differential diagnosis of acute abdomen.ConclusionCT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.     

胃癌腹膜微转移与网膜乳斑的关系

目的 观察网膜乳斑在腹膜微转移中的作用.方法 将30只小鼠分成3组,向小鼠腹腔内打入1×106经Dil荧光标记的BS186MFC胃癌细胞,3组小鼠分别于24、48、72 h被杀死取其大网膜,免疫荧光标记大网膜乳斑中的巨噬细胞,在免疫荧光显微镜下观察乳斑区胃癌细胞的变化.结果 乳斑与非乳斑区在24、48、72 h不同时间点标记胃癌细胞比率分别为484:1、136:1、10:1.各时间点胃癌细胞在乳斑区的差异有统计学意义(P<0.05).标记细胞数在乳斑与非乳斑区之间的差异有统计学意义(P<0.01).结论 网膜乳斑对胃癌细胞的腹膜微转移有抑制和杀伤作用.     

Utility of Divided Omentum for Preventing Complications Associated with Laparoscopic Gastric Bypass

Background Laparoscopic Roux-en-Y gastric bypass has emerged as a standard surgical treatment for morbid obesity. However, prevention of postoperative complications associated with bariatric surgery is an important consideration. Methods To reduce postoperative complications and achieve adequate body weight loss, we introduce a simple procedure using a divided omentum during laparoscopic Roux-en-Y gastric bypass. The actual aim of this procedure is to prevent leakage from the gastric pouch or anastomosis and the gastro-gastric fistula because of reentry of the alimentary tract. Between February 2002 and April 2007, we performed laparoscopic Roux-en-Y gastric bypass for morbid obesity in 94 patients. In the most recent 83 cases, our simple procedure using a divided omentum was employed. Results These patients comprised 20 males and 63 females, with a mean age of 38 years, and a mean body mass index of 44.1 kg/m². At surgery, the omentum is routinely divided using laparoscopic coagulating shears before performing gastrojejunostomy to reduce the tension on the anastomosis caused by the route of reconstruction. After performing hand-sewn gastrojejunostomy, the left side of the divided omentum is moved cranially and interposed between the gastric pouch and the excluded stomach. The omentum is then sutured from the posterior aspect of the gastric pouch to the anterior side of the anastomosis. Conclusion Our procedure using a divided omentum during bariatric surgery is feasible and safe for obtaining better outcomes without artificial materials. Although the long-term outcome of this technique is still unclear, we believe that it will contribute to decreasing the particular complications related to laparoscopic Roux-en-Y gastric bypass for morbid obesity.     

高频超声诊断小儿腹股沟疝大网膜嵌顿伴化脓的价值

目的探讨高频超声对小儿腹股沟疝大网膜嵌顿伴化脓的诊断价值。方法回顾性分析经临床手术及病理证实的13例小儿腹股沟疝大网膜嵌顿伴化脓的声像图表现，并对其伴随的睾丸及其他并发症进行总结分析。结果误诊1例，其余12例的声像图特点为疝囊内不均质中强回声区内见多个不规则、大小不等的无回声区，可呈网格状，通过疝囊颈与腹腔相通。中强回声及无回声区内均未见血流信号。13例中12例伴有1种或多种并发症。结论小儿腹股沟疝大网膜嵌顿伴化脓具有特征性的声像图表现，高频超声可作出正确诊断，同时可检出睾丸情况及其他并发症。     

小网膜淋巴血管瘤1例

患者女,34岁,主因"发现腹部包块1周"就诊.患者于1周前体检发现腹部包块,无腹胀、腹痛,无发热,无恶心、呕吐.查体:上腹部较饱满,未触及包块,无压痛,无反跳痛及肌紧张.     

Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis

PURPOSE: The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection. METHODS: Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39–83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbility and mortality related to omentoplasty. RESULTS: The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P = not significant). Two leakages were evident clinically in Group A and seven in Group B (P<0.05). Three leaks were documented radiologically in Group A and eight in Group B (P = not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow-up, one stricture developed in Group A and three in Group B (P = not significant) CONCLUSIONS: Despite a similar incidence of staple-ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage.     

大网膜血管的观察与测量

为满足微血管外科需要,对57例福尔马林固定成人尸体大网膜血管作了观察,并按手术剪裁最大利用范围设计测量点,以装有测微器的手术显微镜和生物显微镜进行测量。仍按Alday和Goldsmith以及宁夏医学院解剖教研组分型标准,将大网膜血管分为五种类型,Ⅰ型(50.88％)和Ⅱ型(24.56％)属常见型;对大网膜血管弓的组成和层次进行了观察,大网膜两层融合或两层可辨但不能分离占70.18％,故临床应用进行延长剪裁,应循其主要血管走行按一整层对待。各动脉外径均值大小依次为胃网膜右动脉、胃网膜左动脉,大网膜左动脉、大网膜右动脉和大网膜中动脉,后者最小;检测结果动脉外径均>0.5mm,故均可供显微外科吻合使用。静脉外径均值大于相应动脉,并发现9例静脉外观酷似动脉,值得临床应用时注意。     

经Triton处理的气管异体移植后的转归

目的：确定经Triton处理的异体气管移植后的转归。方法：以犬为实验对象，将异体气管经Triton处理后移植于受体的胸段气管缺损处，大网膜包裹吻合口，3个月后行病理检查，观察移植物的转归。结果：实验组(6只)：4只犬存活至处死，病理检查显示移植物软骨环完整、无软化，表面被上皮覆盖。1只犬术后4d死于张力性气胸。1只犬术后15d死于移植物感染；对照组(4只)：4只犬分别于术后24～29d死于排斥反应。结论：经Triton处理的异体气管段移植后，软骨无吸收、脱落，实验犬可长期存活。