ObjectiveTo evaluate the efficacy of XiaochengqiMixture (XM) on promoting healing of colonic stoma. MethodsForty Wistar rats were divided into two groups randomly after colonectomy: experimental group (n=20) and control group (n=20). In early postoperatively stage rats were given gastric administration of XM in the experimental group and pure water in the control group. On day 3, 7, and 14 after establishment of animal models, laparotomy was performed in two groups of rats, respectively. Anastomotic stoma and surrounding tissues were harvested to detect the context of hydroxyproline and collagen fiber proportion by Masson dying. ResultsOn day 3 after establishment of animal models, hyperplastic collagen with small fiber was observed while no fasciculus was found. Hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.05). On day 7 after operation, many fasciculuses were found in two groups of rats, hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.01). On day 14 after operation, fasciculuses became bigger and more regular in arrangement, but there was no significant difference between the two groups (Pgt;0.05). ConclusionXM is capable of promoting healing of colonic stoma and might prevent the occurrence of anastomotic fistula.
From 1978 to Dec. 1991, 50 cases of dilatation of the extrahepatic biliary duct in children were treated. They were classified as: cystic dilatation in 34 cases, arid fusiform dilatation in 16 cases. Types of reconstruction of the extrahepatic biliary duct included: excision of cystic dilatation and Rorx-en-Y hepatoductojejunostomy in 25 cases, and interposition of jejunum and hepatoductoduodenostomy in 9 eases. for those cases having fusiform dilatation, interposition of jejunum and hepatoductoduodenostomy，cases and Rorx-en-Y-hepatoductojejunostmy 5 cases.The follow-up period averajed 6.5 years. Forty nine patients were recoverwd from the teatment and 1 patient died.
目的 探討圓形吻合器在高齡賁門胃底癌經腹切除術中的應用。方法 回顧性分析1999年1月至2009年5月期間在我院接受圓形吻合器經腹切除術的238例70歲以上高齡賁門胃底癌患者的臨床資料，并對圍手術期結果進行分析。 結果 全組手術時間3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。術中并發大出血1例，給予積極止血，無術中死亡。所有病例機械吻合術后未出現吻合口漏。術后60例患者（25%）出現不同程度的并發癥，其中吻合口出血2例, 左側胸腔積液13例，肺部感染15例, 心衰3例, 肺不張2例, 心律失常10例，右側胸腔積液15例。無圍手術期死亡。術后隨訪3年，出現返流性食管炎45例，吻合口狹窄30例，無吻合口腫瘤復發，3年生存率為64%(152/238)。結論 應用圓形吻合器在高齡胃底賁門癌患者經腹切除術是安全、有效的。
Objective To simplify surgical technique andincrease postoperative survival rate, sleeve anastomosis technique combined cuff technique was used in developing the model of cervical heart transplantation in rats. Methods In this model, the hearts from 25 male SD rats were transplanted into the neck of Wistar rats by anastomosing the donor innominate artery to the recipient right common carotid artery by use of sleeve technique, and the donor pulmonary artery to the recipient right external jugular vein by use of cuff technique. After operation,the rats were treated with cyclosporine A (1.5mg/kg, q.d.), transplanted hearts were followed by daily inspection or palpation and the allograft survival time was more than 3 days as the standard of successful operation. Results The mean operative time was (48.7±3.4) min, with a successful rate of 88%(22/25). Complications were anastomotic hemorrhage( 1 case) and thrombosis(2 cases). During the followup period, 6 rats died of pulmonary infection, abscess in the neck,liver or bladder tumor. The remaining 16 transplanted hearts survived more than3 months. Conclusion The modified operation have advantages ofless operative procedure, shorter operation and ischemia time and easier monitoring of graft function.
【摘要】 目的 探討淚囊鼻腔吻合術后復發的原因和手術方法。 方法 對1999年1月-2009年10月因淚道阻塞行淚囊鼻腔吻合術后3個月以上復發的47例患者，行再吻合術，術中仔細分離切除瘢痕及肉芽，盡量做雙瓣吻合。 結果 本組50只眼，術后隨訪3個月～2年，成功49只眼，1例再阻塞，治愈率98%。 結論 首次手術失敗的主要原因是骨孔過小，吻合口粘連，淚囊太小或萎縮，解剖層次不清和手術操作粗暴導致術中出血等。再次吻合手術治療效果滿意。【Abstract】 Objective To explore the reasons of recurrence and the operative method for re-blockage after dacryocystorhinostomy. Methods Forty-seven patients with dacryocystorhinostomy who were recurred after 3 months were included from January 1999 to October 2009. All patients underwent re-anastomosis. The operation required careful separation and resection of scar and granulation, and performed anastomosis with double valve as far as possible. Results All patients were followed up for three months to two years. Operations were successful in 49 eyes of total 50 eyes, and re-obstruction in one case with a cure rate of 98%. Conclusion The major reasons for the failure of the first operation include too small bone hole, anastomotic adhesions, too small or atrophy of lacrimal sac, unclear anatomy and surgical gross bleeding. The best treatment is surgical re-anastomosis.
【摘要】目的比較胃腸機械吻合與傳統手工吻合對術后并發癥的影響，探討機械吻合的安全性問題。 方法對我院1999年1月至2003年12月期間收治的932例行Billroth Ⅱ式胃腸吻合術患者的資料進行回顧性分析，了解其術后并發癥的發生情況。 結果行機械吻合的392例中出現術后并發癥8例（吻合口漏7例，梗阻1例），其發生率為2.04%； 而使用傳統手工吻合的540例中出現術后并發癥44例（吻合口漏28例，出血4例，梗阻12例），其發生率為8.15%，明顯高于前者（P＜0.01）。 結論胃腸機械吻合較傳統手工吻合更為安全。
目的探討如何降低胰十二指腸切除術后胰空腸吻合口漏的發生。方法采用胰管空腸吻合胰腺殘端套入法行胰腸吻合，按胰、膽、胃順序與空腸重建消化道。結果27例胰十二指腸切除術中，手術并發癥7例（25.93%），其中應激性潰瘍出血3例，胃排空延遲2例，腹腔及腹壁創口感染各1例，均經非手術治愈。全組無圍手術期死亡，亦無一例發生胰瘺。結論胰瘺的發生同術式和操作技術密切相關，亦與吻合口部位血供和張力以及吻合口遠端通暢與否有關。本術式增加了胰空腸吻合的嚴密性，對預防胰瘺的發生起到了積極的效果，且操作簡便，易于掌握，效果可靠。
目的 比較吻合器痔上黏膜環切術(PPH)與傳統痔切除術(Milligan-Morgan，MM)治療混合痔的臨床療效。方法 200例混合痔患者中行PPH和MM治療各100例，比較2組患者的療效及并發癥。結果 PPH在療效及術后并發癥發生方面與MM組比較，差異均無統計學意義（P＞0.05）。結論 在治療混合痔方面PPH不優于MM。
ObjectiveTo investigate the effectiveness and technical key points of limb salvage surgery by allotransplantation of cryopreservated vascularized bone in children and adolescents with osteosarcoma. MethodsA retrospective analysis was made on the clinical data of 21 children and adolescents with osteosarcoma receiving limb salvage surgery by allotransplantation of cryopreservated vascularized bone from their relatives between February 2004 and April 2012. There were 13 males and 8 females, aged from 7 to 16 years (mean, 12.6 years). According to Enneking stage system, 15 cases were rated as stage ⅡA and 6 cases as stage ⅡB. The tumors located at the distal femur in 10 cases, at the proximal femur in 1 case, at the proximal tibia in 8 cases, at the proximal humerus in 1 case, and at the distal radius in 1 case. Imaging examination showed that epiphyseal extension of malignant bone tumors in 7 cases. The iliac bone allograft with deep iliac vessels was obtained from their lineal consanguinity. After preservation by a twostep freezing schedule, the iliac bone allograft with deep iliac vessels was implanted into the bone defect area after tumor resection. The size of iliac bone flap was 8.0 cm×3.0 cm×2.0 cm-14.0 cm×5.0 cm×2.5 cm. Reserved joint surgery was performed on 16 cases and joint fusion surgery on 5 cases, and external fixation was used in all cases. The chemotherapy was given according to sequential high-dose methotraxate, adriamycin, and cisplatine before and after operation. ResultsAll 21 cases were followed up from 5 months to 11 years (mean, 6.4 years). At 2 weeks after operation, the erythrocyte rosette forming cells accounted for 56.7%±3.9%, showing no significant difference when compared with that of normal control (58.3%±4.3%) (t=1.56, P=0.13), which suggested no acute rejection. At 4 weeks after operation, single photon emission computerized tomography bone scan indicated that the blood supply of bone graft was rich, and the metabolism was active. At 12 weeks after operation, the digital subtraction angiography showed the artery of iliac bone flap kept patency. X-ray films showed that malunion and non-union occurred at 5 and 6 months after operation in 1 case, respectively. The bone graft healed in the other patients, and the healing time was 3.2-6.0 months (mean, 4.4 months). At last follow-up, American Musculoskeletal Tumor Society (MSTS) score was significantly improved to 26.80±2.14 from preoperative value (17.15±1.86) (t=-4.15, P=0.00). The survival rate was 85.7% (18/21) and the recurrence rate was 9.5% (2/21). ConclusionAllotransplantation of cryopreservated vascularized bone from the relatives provides a new method for the treatment of osteosarcoma in children and adolescents. A combination of allotransplantation and chemotherapy can achieve the ideal treatment effect. The correct cutting, preservation, and transplantation of the donor bone, and indication are the key to improve the effectiveness.