OBJECTIVE: To investigate the effect of vasostomy on apoptosis in the male rat spermatogenic cells after vasoligation. METHODS: Model of vasoligation and vasostomy in male rat was established, and then terminal deoxynucleotidyl transferase-mediated dUTP nick labelling technique to detect the apoptosis of spermatogenic cells at 4, 8, 12, 16 weeks after vasostomy. RESULTS: The number of apoptotic cells in vasostomy group was significantly lower than that of vasoligation group since 8 weeks after vasostomy(P lt; 0.05). The number of apoptotic cells in 8 and 12 weeks after vasostomy were significantly higher than that in prevasoligation(P lt; 0.05). 16 weeks after vasostomy, the number of apoptotic cells restored to the level same as that in prevasoligation stage. CONCLUSION: Vasostomy can reverse the apoptosis of spermatogenic cells due to vasoligation.
Objective To analyze the difference in the incidence of postoperative pancreatic leakage and anasto-motic bleeding complications in various methods of pancreaticojejunostomy after pancreaticoduodenectomy （PD）. Methods The clinical data of 526 patients underwent pancreaticojejunostomy from January 2008 to September 2012 in this hospital were analyzed retrospectively. End-to-side “pancreatic duct to jejunum mucosa-to-mucosa” anastomosis （abbreviation：mucosa-to-mucosa anastomosis） was performed in 359 patients， which contained 149 patients with internal drainage， 130 patients with external drainage， and 80 patients with no drainage. End-to-side invaginated anastomosis was performedin 165 patients without drainage. In addition， side-to-side anastomosis was performed in 2 patients without drainage.Results There were 34 cases （6.46%） of pancreatic leakage， 8 cases （1.52%） of anastomotic bleeding in pancreaticoje-junostomy， and 32 cases of death （6.08%）. ① The pancreatic leakage rate of mucosa-to-mucosa anastomosis was signi-ficantly lower than that of end-to-side invaginated anastomosis 〔4.18% （15/359） versus 11.52% （19/165）， χ2=10.029， P=0.002〕. There was no significant difference of the anastomotic bleeding incidence between mucosa-to-mucosa anasto-mosis and end-to-side invaginated anastomosis 〔1.67% （6/359） versus 1.21% （2/165）， χ2=0.159， P=0.691〕. ② In the mucosa-to-mucosa anastomosis group， the pancreatic leakage rates in the ones with internal drainage and external drainage were lower than those in the ones without drainage， respectively （2.68% （4/149） versus 11.25% （9/80）， χ2=7.132， P=0.008；1.54% （2/130） versus 11.25% （9/80）， χ2=9.410， P=0.002）；which was no significant difference between the ones with internal drainage and external drainage 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕. But there were no significant differences for both the pancreatic leakage 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕and anastomotic bleeding incidence 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕 between the ones with internal drainage and external drainage. Conclusions Mucosa-to-mucosa anastomosis has a lower pancreatic leakage incidence as compared with end-to-side invaginated anastomosis. However， there is no significant difference of the anast-omotic bleeding incidence. Internal or external drainage could reduce the incidence of pancreatic leakage， but have no obvious effect to the anastomotic bleeding incidence.
ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.
ObjectiveTo analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. MethodData were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. ResultsOne hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it. ConclusionDelay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.
ObjectiveTo compare the effectiveness of antecolic duodenojejunostomy (ADJ) and retrocolic duodenojejunostomy (RDJ) after pylorus-preserving pancreaticoduodenectomy (PPPD). MethodsRandomized controlled trials (RCTs) of ADJ versus RDJ after PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and Wanfang database from inception to April 2014, as well as Google. After quality assessment of RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version, Meta analysis was performed by RevMan 5.1 software. ResultsFour RCTs of 462 patients in total were included in this Meta-analysis. The results of Meta-analysis showed that, there were no significant differences in the operation time (MD=14.02, 95% CI:-41.42-69.46, P=0.62), incidence of postoperative complications (RR=1.09, 95% CI:0.81-1.48, P=0.56), incidence of delayed gastric emptying (RR=0.63, 95% CI:0.31-1.28, P=0.20), incidence of pancreatic fistula (RR=1.13, 95% CI:0.72-1.75, P=0.60), incidence of abdominal abscess (RR=0.92, 95% CI:0.54-1.58, P=0.77), and mortality (RR=0.61, 95% CI:0.24-1.60, P=0.32) between ADJ group and RDJ group. ConclusionsThe effectiveness of ADJ is similar with RDJ after PPPD, so the reconstruction way after PPPD can be routed according to the surgeon's preference.
Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo investigate the effects of health education pathway intervention on self-care agency and health lifestyle promotion in colostomy patients. MethodsEighty-eight rectal cancer patients who had undergone colostomy were randomly divided into control group and intervention group (with 44 patients in each) between March 2012 and September 2013. The control group received conventional nursing only, while the intervention group were given health education pathway intervention besides conventional nursing. The self-care agency and health lifestyle promotion in the two groups under pre-colostomy state, one week after colostomy and two weeks after colostomy were surveyed and compared based on the exercise of self-care agency scale and the health promotion lifestyle profile. ResultsAfter health education pathway intervention, the scores of self-care agency and health lifestyle promotion in the intervention group were significantly higher than those in the control group (P<0.05), and the hospitalization expenditure was also obviously lower. Furthermore, the satisfaction degree on nursing service was significantly higher than that of the control group (P<0.05). ConclusionThe health education pathway intervention can greatly improve self-care agency and quality of life in rectal cancer patients who have undergone colostomy.
The secondary anastomotic stenosis is often occured from the repair and reconstructive operation of the injured bile duct. It is difficult to treat and the outcome is serious. In order to prevent this complication, the fibrin glue instead of traditional suturing technique combined with inner support was used. Fifty-four hybrid dogs were divided into 3 groups. Group A received Roux-en-y choledochojejunostomy with fibrin glue; group B received Roux-en-y choledochojejunostomy, with a fibrin glue combined support left permanently in the bile duct and group C received Roux-en-y choledocholejejunostomy with fibrin glue combined a support left temporarily in the bile duct. The amount of collagen in the scar was measured at 3/4, 3, 6, 9, 12 months respectively after operation. The results showed: 1. the mature period of scar was shortened from 12 months to 9 months when fibrin glue instead of suture was used in choledochojejunostomy; 2. the mature period of scar was further shortened from 9 months to 6 months when fibrin glue combined with inner support instead of fibrin glue was used in choledochojejunostomy. The conclusions were as follows: 1. fibrin glue could facilitate the healing of wound by inhibiting the formation of scar and accelerrate the maturation of scar; 2. when the inner support was used with fibrin glue in the operation, the mature period of scar could be further shortened; 3. the mechanism of action of the fibrin glue included minimizing the injury, avoiding foreign-body reaction, modifying organization of hematoma, preventing formation of biliary fistular and enhancing intergration and cross-linkage of collagen.