AIM:To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. Afte...AIM:To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to- mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS: The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain.Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION: A mucosa-to-mucosa pancreatico- jejunostomy is the best choice for anastomotic patency when展开更多
目的探讨经阴道实时四维超声造影(4D-Hy Co Sy)评估输卵管通畅性的可行性及安全性。方法 53例不孕症患者分别接受4D-Hy Co Sy及X线输卵管碘油造影(HSG)检查,并进行对照分析。结果共计103条输卵管中,4D-Hy Co Sy显示通畅46条,通而不畅32...目的探讨经阴道实时四维超声造影(4D-Hy Co Sy)评估输卵管通畅性的可行性及安全性。方法 53例不孕症患者分别接受4D-Hy Co Sy及X线输卵管碘油造影(HSG)检查,并进行对照分析。结果共计103条输卵管中,4D-Hy Co Sy显示通畅46条,通而不畅32条,阻塞25条;HSG显示通畅47条,通而不畅30条,阻塞26条。两种方法检测输卵管通畅性的一致率为89.3%,两种方法评估结果一致性较好(Kappa值=0.773)。结论 4D-Hy Co S能安全、有效评估输卵管通畅性,可作为临床筛查不孕症患者输卵管通畅性的有效手段推广应用。展开更多
BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction(MBO). However, the main problem with stent placement is the relativ...BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction(MBO). However, the main problem with stent placement is the relatively short duration of stent patency.Although self-expanding metal stents(SEMSs) have a longer patency period than plastic stents(PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS(ARPS) has been proposed. We developed a new ARPS with a "duckbilled" valve attached to the duodenal end of the stent.AIM To compare the patency of ARPSs with that of traditional PSs(TPSs) in patients with unresectable distal MBO.METHODS We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success,adverse events, and patient survival.RESULTS Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events(P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range(IQR),170], which was significantly longer than that in the TPS group(median, 130 d;IQR, 90, P = 0.005). No significant difference in patient survival was noted betwe展开更多
目的:研究声诺维经阴道实时三维超声造影(TVS RT-3D-Hy Co Sy)评价输卵管通畅性的可行性、准确性。材料与方法:对本院228例女性不孕症患者共446条输卵管进行TVS RT-3D-Hy Co Sy检查,与其中30例患者(55条输卵管)进行腹腔镜检查结果进行...目的:研究声诺维经阴道实时三维超声造影(TVS RT-3D-Hy Co Sy)评价输卵管通畅性的可行性、准确性。材料与方法:对本院228例女性不孕症患者共446条输卵管进行TVS RT-3D-Hy Co Sy检查,与其中30例患者(55条输卵管)进行腹腔镜检查结果进行对照比较,比较两种检查结果的一致性及图像质量。结果:腹腔镜检查结果为金标准,TVS RT-3D-Hy Co Sy检查输卵管阻塞敏感性、特异性、准确性分别为80.00%、88.88%、61.54%,与腹腔镜检查结果高度一致,即Kappa为0.804(P<0.01);两组图像质量评分均较高,且对比差异无统计学意义(P>0.05)。结论:TVS RT-3D-Hy Co Sy评价输卵管通畅性准确、可行。展开更多
Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwen...Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.展开更多
文摘AIM:To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to- mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS: The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain.Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION: A mucosa-to-mucosa pancreatico- jejunostomy is the best choice for anastomotic patency when
文摘目的探讨经阴道实时四维超声造影(4D-Hy Co Sy)评估输卵管通畅性的可行性及安全性。方法 53例不孕症患者分别接受4D-Hy Co Sy及X线输卵管碘油造影(HSG)检查,并进行对照分析。结果共计103条输卵管中,4D-Hy Co Sy显示通畅46条,通而不畅32条,阻塞25条;HSG显示通畅47条,通而不畅30条,阻塞26条。两种方法检测输卵管通畅性的一致率为89.3%,两种方法评估结果一致性较好(Kappa值=0.773)。结论 4D-Hy Co S能安全、有效评估输卵管通畅性,可作为临床筛查不孕症患者输卵管通畅性的有效手段推广应用。
基金Supported by the Sichuan Province Science and Technology Department,China,No.2017SZ0009
文摘BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction(MBO). However, the main problem with stent placement is the relatively short duration of stent patency.Although self-expanding metal stents(SEMSs) have a longer patency period than plastic stents(PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS(ARPS) has been proposed. We developed a new ARPS with a "duckbilled" valve attached to the duodenal end of the stent.AIM To compare the patency of ARPSs with that of traditional PSs(TPSs) in patients with unresectable distal MBO.METHODS We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success,adverse events, and patient survival.RESULTS Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events(P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range(IQR),170], which was significantly longer than that in the TPS group(median, 130 d;IQR, 90, P = 0.005). No significant difference in patient survival was noted betwe
文摘目的:研究声诺维经阴道实时三维超声造影(TVS RT-3D-Hy Co Sy)评价输卵管通畅性的可行性、准确性。材料与方法:对本院228例女性不孕症患者共446条输卵管进行TVS RT-3D-Hy Co Sy检查,与其中30例患者(55条输卵管)进行腹腔镜检查结果进行对照比较,比较两种检查结果的一致性及图像质量。结果:腹腔镜检查结果为金标准,TVS RT-3D-Hy Co Sy检查输卵管阻塞敏感性、特异性、准确性分别为80.00%、88.88%、61.54%,与腹腔镜检查结果高度一致,即Kappa为0.804(P<0.01);两组图像质量评分均较高,且对比差异无统计学意义(P>0.05)。结论:TVS RT-3D-Hy Co Sy评价输卵管通畅性准确、可行。
文摘Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.
