A new pedicled seromuscular flap technique for high-risk intestinal anastomoses

A new method for protecting intestinal anastomoses in patients at high risk of anastomotic dehiscence or fistula formation is described herein. This method involves raising a seromuscular flap on a pedicle from the stump of the intestine to be anastomosed. The anastomosis is performed, then covered with the seromuscular flap.     

The use of the rat facial nerve model to assess the effect of differing nerve anastomotic agents on the facial nerve

There are relatively few papers which prove that one nerve anastomotic agent for the facial nerve is superior to any other. Previous experiments on the division and anastomosis of the facial nerve have failed to consider the indeterminate variables involved, i.e. operator variability, controls and the reaction of the materials on normal nerve tissue. In this experiment, a variety of anastomotic agents were tested to see if the anastomotic agents themselves affected the extra-temporal facial nerve function. The absorbable suture, non-absorbable suture, glue and tube wrap used had no effect on normal nerve tissue or on the anastomosis of the sectioned facial nerve of the rat compared with simple laying together of the divided ends of the divided nerve.     

断流术并吻合器横断食管治疗食管曲张静脉出血疗效观察

目的探讨采用断流术并吻合器横断食管治疗门静脉高压症所致食管曲张静脉破裂出血的手术方法和临床效果。方法对48例包括急性出血期急诊手术22例,有出血病史作择期手术的19例和无出血病史作预防性手术的7例,经腹采用吻合器横断食管下段同时进行食管下段及贲门周围血管的选择性离断,观察其近期和远期止血效果。结果术后近期和远期止血效果都比较满意。结论该手术为食管下段横断和对食管下段与贲门周围血管选择性离断的联合应用,术中使用一次性吻合器进行食管下段的横断与吻合,使手术方法简便快捷,可减少手术创伤。     

The compensatory ‘rebound’ of reactive astrogliosis: glial fibrillary acidic protein immunohistochemical analysis of reactive astrogliosis after a puncture wound to the brain of rats with portocaval anastomosis

Summary This study was designed to compare the degree of reactive astrogliosis occurring around a puncture wound in the brain of normal rats and at different intervals after a similar puncture wound in rats with a portocaval anastomosis. The gliosis was evaluated by the number of astrocytes, the thickness of their processes and the intensity of the glial fibrillary acidic protein immunoreactivity. After the puncture wound in the brain of rats with a portocaval anastomosis, the gliosis varied at different intervals being: (1) decreased at 10 days, (2) markedly increased at 5 weeks and (3) significantly decreased at 8, 12, and 16 weeks. These findings suggest that 5 weeks after portocaval anastomosis, an active proliferation of the metabolically altered astrocytes occurs with heightened synthesis of glial fibrillary acidic protein in the period of adaptive compensation, the so-called compensatory rebound. At 8 weeks or more after portocaval anastomosis, these altered astrocytes were considered to be in the phase of decompensation and incapable of maintaining the reactive response which occurred in normal rats. The compensatory rebound and decompensatory decline illustrate the dynamic plasticity of the reactive astrogliosis.Supported by grant from the National Foundation of Natural Sciences No. 386-0956. This paper was read at the XIth International Congress of Neuropathology, September 7, 1990 in Kyoto, Japan     

食管贲门吻合癌性狭窄的临床治疗分析

目的探讨不同内镜下介入治疗方法对食管贲门吻合口癌性狭窄的疗效及适应证.方法将147例食管贲门吻合口癌性狭窄的患者分为单纯沙氏探条扩张组48例,内镜微波加局部化疗组41例,国产金属支架置入治疗组48例.各组在年龄、性别及Stooler分级方面经统计学处理差异无显著性.结果沙氏探条扩张组58例共扩张治疗102次,吞咽困难进步1～3级,一次治疗后有效率为97.4%;随访3～18个月,30例存活.内镜下微波加局部化疗组41例,经2～3次治疗后吞咽困难后进一步1～3级,经三次微波加局部注射治疗的有效率为95.1%;随访3～21个月,30例存活.金属支架治疗组48例45例一次置入成功,术后吞咽困难进步1～4级,总有效率达100.0%.随访3～38个月,42例存活,6例死于全身衰竭.结论金属支架置入治疗疗效最好,再狭窄发生率及出血、穿孔发生率低,且对有食管气管瘘的患者可经置入带膜支架从而达到堵塞瘘口的目的.     

Postoperative Intensive Care Treatment after Esophageal Resection

The aim of this article is to give a short review of problems associated with the intensive caretreatment of patients after esophageal resection.Pulmonary dysfunction,supraventricular tachyarrhyth-mia,anastomotie leakage and mental disorders are the topics covered.Systemic inflammatory reaction andsepsis is the linking topic between these specific complications.Pulmonary dysfunction having an incidenceof up to 40% is the most important complication.Low tidal volume ventilation,pain management includingepidural analgesia and early tracheostomy are the mainstay of therapy.Supraventricular tachyarrhythmiais an early indicator of emerging complications.Its symptomatic treatment is standardized using electriccardioversion,beta-blockers and amiodarone.Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis.Interventional endoscopy is increasingly suc-cessful in the therapy of these leakages.Microbiological surveillance and specific antibiotic therapy ensurethat a complication does not cause a septic cascade leading to multiorgan failure.The workload on ICUcaused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinalsurgery.     

直肠癌低位前切除术双吻合器致吻合口瘘原因分析及预防

为研究直肠癌低位前切除术中双吻合器致吻合口瘘的原因,并探讨其预防方法,3年中共应用双吻合器实施直肠癌低位前切除术70例,对发生吻合口瘘者进行分析和总结。结果示,发生吻合口瘘4例,发生率为571%(4/70)。初步研究结果提示,直肠癌低位前切除术双吻合器吻合安全可靠。吻合口瘘的发生原因主要是术中止血不彻底及吻合操作不规范所致。     

食管癌术后胸内吻合口瘘的非手术治疗

目的:探讨食管癌术后胸内吻合口瘘的非手术治疗的方法.方法:对 6例胸内吻合口瘘进行回顾性分析.结果:均痊 愈出院,无一例死亡.结论:对于胸内吻合口瘘,除要继续抗感染、营养支持外,还要综合处理.     

直肠癌全系膜切除术后吻合口瘘原因分析及防治措施

目的：分析直肠癌全直肠系膜切除术后发生吻合口瘘的原因及防治措施.方法：回顾性分析自2003年1月至2007年12月在我院行全直肠系膜切除保肛手术的214例中低位直肠癌患者的临床资料.结果：214例患者术后共发生吻合口瘘16例（7.5％）.发生时间为术后4-15d,平均（6.8±1.4）d.其中性别、肿瘤Dukes分期、病理类型及有无结肠储袋等对术后吻合口瘘的发生率没有显著影响,差异无统计学意义（P＞0.05）.而年龄、术前有无贫血及低蛋白血症、糖尿病史、有无合并肠梗阻、手术方式、吻合器应用、吻合器吻合后手工缝合减张及术后直肠留置肛管引流减压对术后吻合口瘘的发生率均有明显影响（P＜0.05）.4例严重吻合口瘘的患者并发弥漫性腹膜炎行横结肠造瘘术,术后4个月成功闭瘘.12例较轻的吻合口瘘患者采用单纯完全静脉营养、抗生素治疗、经引流管局部冲洗等措施全部治愈,愈合时间为14d至3个月,平均（28.7±2.3）d.术后无死亡患者.结论：高龄、贫血、低蛋白血症、合并糖尿病及肠梗阻、低位吻合口等是术后发生吻合口瘘的高危因素.吻合器吻合后手工缝合加固减张,术后直肠内留置肛管减压引流可显著减少吻合口瘘的发生.积极合理的采取非手术或手术措施治疗吻合口瘘是促进吻合口愈合的关键.