Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy

BackgroundStoma-related obstruction (SRO) is defined as small bowel obstruction occurring around the limbs of diverting ileostomy (DI). This study was aimed to investigate the incidence, risk factors, and management of SRO after laparoscopic colorectal surgery with DI creation.MethodsThis study included 155 patients who underwent laparoscopic colorectal surgery with DI creation for rectal cancer (n = 138), ulcerative colitis (UC) (n = 14), and familial adenomatous polyposis (FAP) (n = 3) between 2011 and 2019. Univariate and multivariate analyses were performed to identify the risk factors of SRO.ResultsThe incidence of SRO was 7.7% (n = 12), and it was significantly lower (P < 0.01) in patients with lower anterior resection or intersphincteric resection (4.3%) than in those with ileal-pouch anal anastomosis (IPAA) (35.2%). The multivariate analysis revealed that IPAA was independently associated with the development of SRO (P = 0.001; odds ratio, 9.4; 95% confidence interval, 2.5–35.4). Eleven of 12 patients (92%) with SRO required trans-stomal tube decompression, and 8 of those (67%) underwent early stoma closure.ConclusionIPAA was an independent risk factor of SRO in laparoscopic colorectal surgery with DI creation. Early stoma closure was needed in most cases of SRO.     

"插入式"输尿管肠管吻合在原位肠道膀胱替代术中的应用

目的 探讨"插入式"输尿管肠管吻合在原位肠道膀胱替代术中的手术效果和临床疗效.方法 对38例原位肠道膀胱替代术中75侧行"插入式"输尿管肠管吻合术患者进行随访,通过影像学、膀胱尿道镜、病理学、实验室检查等观察临床疗效.结果 术后平均随访(31.65±14.14)个月,吻合口狭窄率4%(3/75);抗返流率100%;无吻合口漏;膀胱尿道镜下,输尿管种植部位形成乳头,钳取7例患者乳头表面小块上皮组织作病理检查,其中乳头基底部2例为肠黏膜上皮,乳头尖端5例为移行上皮;所有患者复查肾功能均在正常范围,血Cr 54-135 μmol/L,BUN 3.2～9.4 mmol/L.结论 "插入式"输尿管肠管吻合术是一种较理想的输尿管肠管抗返流吻合术式.     

Trapeziometacarpal joint osteoarthritis: a retrospective study comparing arthrodesis to tendon interposition arthroplasty

Abstract Surgical management of trapeziometacarpal joint osteoarthritis (OA) is still controversial. The aim of this study was to evaluate and compare results of trapeziometacarpal arthrodesis and of tendon interposition arthroplasty. One hundred twenty-six patients suffering from trapeziometacarpal OA underwent surgery between 1996 and 2001. Of these patients, 62 (78 thumbs) treated with joint arthrodesis and 33 (41 thumbs) treated with tendon interposition arthroplasty with abductor pollicis longus (APL) have been evaluated at follow-up and therefore entered this study. Mean age was 53 years, while the mean follow-up was 36 months. Overall results were satisfactory in 84 patients with good pain improvement. Patients treated with arthrodesis showed better functional ability in bi-digital pinch and grip strength. First finger opposition motion, however, was better conserved in patients treated with interposition arthroplasty. Fusions had an 11.5% complication rate (9 thumbs) with nonunions, whereas 14.8% (6 thumbs) of patients treated with interposition arthroplasty developed 1 first metacarpal base collapse, resulting in 1 first ray length reduction. Despite complications, however, patients did not report unsatisfactory results and generally experienced marked pain reduction. This study shows that arthrodesis can be considered the treatment of choice in patients suffering from trapeziometacarpal OA at Eaton stage III or less, whatever the age and when a good pinch strength is needed.     

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T₃ carcinoma, 15 patients T₄ and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.     

食管癌切除结肠代食管术44例

我们于１９８９年３月至１９９３年８月间，为４４例食管癌病人行食管癌切除、结肠代食管术。包括上段癌２３例，中段癌１８例，下段癌３例；其中上段癌病变长于７ｃｍ者６例，中段癌病变长于８ｃｍ者５例及下段癌中２例既往曾行胃大部切除术且病变长于９ｃｍ者均先行术前放疗，放疗剂量为３０～４０Ｇｙ。４０例（９０．９％）以结肠左动脉升支供血的横结肠行顺蠕动方向吻合，结果手术死亡１例，颈部吻合口瘘９例（２０．４５％）。我们认为本术式对中、上段癌病人疗效较满意，建议多采用以结肠左动脉为血供的横结肠作为移植段行顺蠕动方向吻合，为减少术后并发症，应注意加强病人围手术期的处置和护理。     

Mechanism of the enhancing effect of sorbitol on ileal Ca uptake in rat enterocytes

The effect of sorbitol on Ca uptake by isolated ileal epithelial cells was investigated. Intestinal cells were isolated from rat ileum by mechanical vibration.⁴⁵Ca uptake was approximately 2 times higher in cells exposed to 200 mM sorbitol ofd-alanine than in control cells. This enhancing effect of sorbitol on percentage Ca uptake decreased with increasing Ca concentrations in the incubation medium suggesting an effect on Ca entry velocity. The addition of 10 M nifedipine or 200 M verapamil to the incubation medium was devoid of any effect on Ca uptake in ileal cells, whereas 100 M trifluoperazine or chlorpromazine abolished the stimulatory effect of sorbitol. Finally, the effect of sorbitol on isolated cells was independent of a measurable change of cellular ATP content. In conclusion, the stimulatory effect of sorbitol on ileal Ca uptake is probably exerted through mechanisms other than an increase in intracellular ATP concentration. Sorbitol may enhance enterocyte Ca transport via a direct interaction with calmodulin and/or the Ca pump. It may also exert its effect through an inhibition of the basolateral Na Ca exchanger.     

Metachronous ileal cancer after surgery for ascending colon cancer in a patient with Lynch syndrome: A case report

Introduction and importanceColorectal surveillance via colonoscopy in patients with Lynch syndrome reduces the mortality of colorectal cancer. On the other hand, it is unclear whether surveillance for other malignancies, including small bowel cancer, is beneficial. We report a patient with Lynch syndrome who developed ileal cancer after surgery for ascending colon cancer.Case presentationA 47-year-old man visited our hospital for a check-up for positive fecal occult blood. He was diagnosed with ascending colon cancer and met the clinical criteria for the diagnosis of Lynch syndrome based on his past and family history. The Bethesda markers demonstrated high-frequent microsatellite instability. Laparoscopy-assisted right hemicolectomy was performed. He received follow-up colonoscopy the next year, which revealed ileal cancer near the anastomosis. He underwent resection of the second cancer via a laparoscopic approach, and has been free from recurrence for five years.Clinical DiscussionSmall bowel cancer has a dismal prognosis because a high percentage of patients were diagnosed at advanced stages. The diagnosis of metachronous ileal cancer by the first follow-up colonoscopy after surgery for ascending colon cancer offered a long disease-free survival in our patient.ConclusionThe clinical course suggested the importance of inspecting the small bowel in Lynch syndrome patients, especially when colorectal cancer is diagnosed.     

Early one-stage orthotopic jejunal pedicle-graft interposition in long-gap esophageal atresia

Since 1988, four children with long-gap esophageal atresia have undergone one-stage orthotopic jejunal pedicle-graft interposition at the age of 2 to 3 months. Obtaining enough jejunal length was no problem and major early complications did not occur. In one patient stenosis of the distal anastomosis was problematic and required corrective surgery. None of the patients demonstrated jejunitis as a result of gastroesophageal reflux. With follow-up periods of 12, 27, 46, and 60 months, all patients are doing well. It is concluded that the jejunum is a better esophageal substitute than is generally appreciated.     

膀胱全切术后体外可控性回肠代膀胱术

 目的　探讨膀胱全切术后尿流改道新方法即体外可控性回肠代膀胱术的可行性及疗效。方法　取一段回肠 ,将中间部分折叠成N形并缝制成贮尿囊 ;远端回肠从腹壁造瘘口穿出体外 ,于此处取腹壁皮瓣包绕外露肠管缝制成皮管 ,构建输出道 ;将尿液控制器置于皮管外 ,利用气囊控制排尿。结果　 10只杂交狗顺利度过手术期 ,术后 3月时贮尿囊最大容量为 (15 0± 4 0 )ml,最大充盈压为 (2 4 .4± 5 .3)cmH2 O。临床应用 5例 ,随访 (3～ 14 )月 ,术后 3月时贮尿囊最大容量达 (2 90± 80 )ml,最大充盈压为 (36 .3± 8.2 )cmH2 O ,最大尿流率为 (2 0 .3± 4 .7)ml s,无残余尿。X线影像学检查 ,肾脏显影良好 ,输尿管通畅。尿液控制器的气囊充气后 ,无尿液流出 ;气囊消气后 ,尿液呈粗线条流出。结论　该尿流改道术式具有体外自主控制排尿的特点 ,不必佩戴集尿袋或自行导尿 ,且手术操作比较简单、并发症少、安全可靠。     

Lessons Learned: Trapeziectomy and Suture Suspension Arthroplasty for Thumb Carpometacarpal Osteoarthritis

In this study, we describe refinements of an accepted technique made by a single surgeon for trapeziectomy and suture suspension arthroplasty for thumb carpometacarpal (CMC) osteoarthritis after 220 cases over 4 years. Results are derived from 77 patients who underwent treatment using this technique comparing postoperative results with preoperative assessment and had sufficient data for inclusion. The surgical technique is described, including tips and modifications to avoid known possible complications. All patients in this study had advanced Eaton stage III or IV osteoarthritis. Grip strength and key pinch showed statistically significant improvement, and the improvement in palmar pinch approached significance. Pain scores were significantly decreased with over 50% of the patients rating their pain at 0 postoperatively. The overall complication rate was very low, and improvements in technique were made to mitigate future occurrence. This surgical technique for the treatment of thumb CMC arthritis achieved pain relief and recreated ligamentous support of the base of the first metacarpal to resist proximal migration after trapeziectomy, providing an increase in grip strength and key pinch with return of range of motion early in the postoperative period. Refinements on this technique through a large volume single surgeon experience provide technical tips for optimizing outcomes.