腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠的临床研究

目的 探讨经腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠（CSP-Ⅱ）的安全性和有效性。方法 选择2019年1月1日－2020年6月30日在该院就诊的CSP-Ⅱ患者41例,分为A组（实验组,n = 20）和B组（对照组,n = 21）。A组行腹腔镜下连续褥式内翻缝合,B组行腹腔镜下子宫切开取胚术。比较两组患者手术时间、术中出血量、术后第1天血清β-人绒毛膜促性腺激素（β-HCG）值、住院时间、β-HCG转阴时间、术后第1天血红蛋白（HB）值、恢复月经时间、术后第1天较手术前1天血清β-HCG的下降百分率。结果 A组术后第1天β-HCG值较B组高,但两组比较,差异无统计学意义（P > 0.05）;B组住院时间较A组时间长,但两组比较,差异无统计学意义（P > 0.05）;A组β-HCG转阴时间和恢复月经时间较B组长,术后第1天HB值较B组高,两组比较,差异均有统计学意义（P < 0.05）;A组术中出血量少于B组,手术时间短于B组,两组比较,差异有统计学意义（P < 0.05）;两组术后第1天血清β-HCG水平均较术前1天下降50.00%以上。B组瘢痕肌层切除后,行病理检查发现：肌层内存在少许绒毛组织,纤维平滑肌组织间见大量增生的滋养细胞。结论 腹腔镜下连续褥式内翻缝合治疗CSP-Ⅱ具有手术简单、术中出血少、手术时间短、创伤小等优势,可切除憩室、增加子宫下段厚度和缩短避孕时间的优点,但术后血清β-HCG下降缓慢、恢复月经时间长。     

Independent risk factors for early urologic complications after kidney transplantation

Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six‐month follow‐up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression. Urologic complications occurred in 29 cases (4.6%) at a median of 40 d (range 1–999) post‐transplantation and included 17 ureteral strictures (2.6%), five (0.8%) ureteral obstructions due to donor‐derived stones or intraluminal thrombus, and seven urine leaks (1.1%). All except two complications occurred within the first year of transplantation. Risk factors for urologic complications on univariate analysis were dual KTX (p = 0.04) and renal artery multiplicity (p = 0.02). On multivariate analysis, only renal artery multiplicity remained significant (aHR 2.4, 95% confidence interval 1.1, 5.1, p = 0.02). Donation after cardiac death, non‐mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dL or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urologic complications. Our data suggest that donor artery multiplicity is an independent risk factor for urologic complications following KTX.     

The successful management of a Bronchoesophageal fistula after lung transplantation: a case report

We describe an unprecedented, disastrous complication after bilateral lung transplantation (BLT), a bilateral bronchial dehiscence with a right bronchoesophageal fistula leading to life‐threatening septic shock. We also report the successful endoscopic management of this complication by double stenting and stress the efficacy of the multidisciplinary approach to this critical case.     

Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction

Complications of the acromioclavicular joint injuries can occur as a result of the injury itself, conservative management, or surgical treatment. Fortunately, the majority of acromioclavicular surgeries utilizing modern techniques and instrumentation result in successful outcomes. However, clinical failures do occur with frequency. The ability to identify the causative factor of failures makes revision surgery more likely to be successful. The purposes of this review are to highlight common problems that can occur following acromioclavicular joint surgery and discuss techniques that can be utilized in revision surgery.     

阿托伐他汀钙联合羟苯磺酸钙治疗糖尿病下肢动脉硬化闭塞症对照研究

目的：探讨阿托伐他汀钙联合羟苯磺酸钙治疗糖尿病下肢动脉硬化闭塞症的临床疗效。方法将30例2型糖尿病下肢动脉硬化闭塞症患者随机分为治疗组18例和对照组12例,两组均予以诺和灵30 R皮下注射治疗,治疗组在此基础上口服阿托伐他汀钙、羟苯磺酸钙治疗,观察16周。检测两组腓总神经感觉传导速度、踝臂指数、趾臂指数及血糖、血脂的变化。结果治疗后两组腓总神经感觉传导速度、踝臂指数、趾臂指数均较治疗前显著提高（P＜0．05或0．01）,治疗组较对照组提高更显著（P＜0．01）;治疗组脉博波传导速度较治疗前显著下降（P＜0．01）,对照组则无显著变化（P＞0．05）。治疗组总胆固醇、三酰甘油、低密度脂蛋白水平均较治疗前显著下降（P＜0．01）,对照组虽较治疗前有所下降,但差异无显著性（P＞0．05）。结论阿托伐他汀钙联合羟苯磺酸钙治疗能有效改善糖尿病下肢动脉硬化闭塞症患者下肢缺血状况。     

Pancreas Transplantation With Enteroanastomosis to Native Duodenum Poses Technical Challenges—But Offers Improved Endoscopic Access for Scheduled Biopsies and Therapeutic Interventions

To facilitate endoscopic access for rejection surveillance and stenting of the pancreas, we have abandoned the duodenojejunostomy (DJ) in favor of duodenoduodenostomy (DD) in pancreas transplantation (PTx). From September 2012 to September 2013 we performed 40 PTx with DD; 20 solitary‐PTx (S‐PTx) and 20 simultaneous pancreas and kidney transplantation (SPK). We compared the outcomes with results from 40 PTx‐DJ (10 S‐PTx and 30 SPK) from the preceding era. The DD‐enteroanastomoses were performed successfully. Endoscopic pancreas biopsies (endoscopic ultrasound examination [EUS]) yielded representative material in half of the cases. One exocrine fistula was treated by endoscopic stenting. PTxs‐DD were associated with a higher rate of thrombosis compared to PTx‐DJ (23% vs. 5%) and reoperations (48% vs. 30%), as well as inferior graft survival (80% vs. 88%). Time on waiting list, HLA A + B mismatches and reoperations were associated with graft loss. Only recipient age remained an independent predictor of patient death in multivariate analysis. PTx‐DD showed a higher rate of thrombosis and inferior results, but facilitated a protocol biopsy program by EUS that was feasible and safe. Given that technical difficulties can be solved, the improved endoscopic access might confer long‐term benefits, yet this remains to be proven.     

Vascular Management During Live Donor Nephrectomy: An Online Survey Among Transplant Surgeons

In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem‐o‐lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as “surgeon” and selected “kidney” as organ type. Two hundred forty‐three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA? and TA?stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non‐fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non‐transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety.