应用新鲜成人尸体小腿10侧,用 X 线血管造影的方法,对小腿深筋膜以浅的小动脉血管的密度、方向和吻合进行了研究。发现皮肤和浅筋膜层中纵行血管密度明显高于横行者。纵行血管密度以浅筋膜层为高,横行血管密度两层比较差别不明显。各层...应用新鲜成人尸体小腿10侧,用 X 线血管造影的方法,对小腿深筋膜以浅的小动脉血管的密度、方向和吻合进行了研究。发现皮肤和浅筋膜层中纵行血管密度明显高于横行者。纵行血管密度以浅筋膜层为高,横行血管密度两层比较差别不明显。各层中分区血管密度的比较说明,不论何种走向的血管,其密度可因部位而异。不同层次、不同部位、不同方向的血管吻合率比较均无显著差别。血管密度高的部位血管吻合也相应丰富。为小腿轴型皮瓣设计提供了参考。展开更多
Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable m...Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.展开更多
The development of intestinal anastomosis techniques,including hand suturing,stapling,and compression anastomoses,has been a significant advancement in surgical practice.These methods aim to prevent leakage and minimi...The development of intestinal anastomosis techniques,including hand suturing,stapling,and compression anastomoses,has been a significant advancement in surgical practice.These methods aim to prevent leakage and minimize tissue fibrosis,which can lead to stricture formation.The healing process involves various phases:hemostasis and inflammation,proliferation,and remodeling.Mechanical staplers and sutures can cause inflammation and fibrosis due to the release of profibrotic chemokines.Compression anastomosis devices,including those made of nickel-titanium alloy,offer a minimally invasive option for various surgical challenges and have shown safety and efficacy.However,despite advancements,anastomotic techniques are evaluated based on leakage risk,with complications being a primary concern.Newer devices like Magnamosis use magnetic rings for compression anastomosis,demonstrating greater strength and patency compared to stapling.Magnetic technology is also being explored for other medical treatments.While there are promising results,particularly in animal models,the realworld application in humans is limited,and further research is needed to assess their safety and practicality.展开更多
BACKGROUND Portal vein arterialization(PVA)has been used in liver transplantation(LT)to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for co...BACKGROUND Portal vein arterialization(PVA)has been used in liver transplantation(LT)to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis(PVT).The effect of PVA on portal perfusion and primary graft dysfunction(PGD)has not been assessed.All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed.To account for the time-sensitive effects of graft perfusion,patients were classified into two groups:prereperfusion(pre-PVA),if the arterioportal anastomosis was performed before graft revascularization,and postreperfusion(post-PVA),if PVA was performed afterward.The pre-PVA rationale contemplated poor portal hemodynamics,severe vascular steal,or PVT.Post-PVA was considered if graft hypoperfusion became evident.Conservative interventions were attempted before PVA.展开更多
Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drai...Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drainage.There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses.There is growing interest and research about artificial intelligence in EUS.Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic.The range of EUS-guided drainage procedures has expanded.EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option.EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography(ERCP)is now an accepted alternative to percutaneous transhepatic biliary drainage.EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates.Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction,and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible,but further prospective randomized studies are needed to establish the actual clinical impact.展开更多
Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating...Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions.展开更多
Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of...Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β Galactosidase (β Gal) structural gene (lacZ gene) was conducted. A soaked medical 8 0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β Gal histochemical staining was performed and β Gal enzyme activity was assayed with 5 bromo 4 chloro 3 indolyl β D galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β Gal enzyme activity was detected at different stages after operation, but in the experimental group, β Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.展开更多
The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a corona...The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a coronary artery bypass grafting (CABG) operation. It allows the surgeon to perform a hand-sewn anastomosis with no disruption of the intima of the aorta, and no need for partial clamping. During a 36-month period 109 CABG operations were performed, and the CycloneTM System (and its predecessor, the HexalonTM) was utilized to create 138 proximal anastomoses. This study demonstrates that this is a safe and effective method of creating a clampless, no-touch proximal anastomoses during off-pump CABG.展开更多
We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreatico...We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreaticogastrostomy(PG)or a control group with a routine mucosa-to-mucosa PG.At six months anastomoses had strictured and closed in both groups.The authors concluded that“bridging”PG is feasible and safe in damage control surgery during the early stage of pancreatic injury.In this letter we comment on the study design,specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre.Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.展开更多
The collateral circulation is crucial for the pathophysiology and outcome of acute cortical ischemia.Current understanding of collateral circulation still remains sparse,largely due to prior limitations of spatial or/...The collateral circulation is crucial for the pathophysiology and outcome of acute cortical ischemia.Current understanding of collateral circulation still remains sparse,largely due to prior limitations of spatial or/and temporal resolution in methods to evaluate these diminutive redistributive routes of cerebral blood flow(CBF)especially in leptomeningeal anastomoses that connected cortical arteries.In the study,based on a mini-stroke model,laser speckle imaging with high spatiotemporal resolution was used to assess the dynamic evolution of the collateral circulation around a mini-ischemia in the rat cortex.We found that the blood flow and diameter in the intra-arterial anastomoses were enhanced immediately after the ligation of one branch of middle cerebral artery and recovered to baseline level as arterial recirculation was performed.Whereas the communicative flow-through of the posterior cerebral artery and the middle cerebral artery anastomoses was not significant enough to be determined.This is the evidence that intra-arterial anastomoses were the primary routes to restore blood flow into the ischemic territory during the acute phase of ischemia,and laser speckle imaging method was proven as a powerful tool to be potential for subserving further investigation of the collateral circulation.展开更多
文摘应用新鲜成人尸体小腿10侧,用 X 线血管造影的方法,对小腿深筋膜以浅的小动脉血管的密度、方向和吻合进行了研究。发现皮肤和浅筋膜层中纵行血管密度明显高于横行者。纵行血管密度以浅筋膜层为高,横行血管密度两层比较差别不明显。各层中分区血管密度的比较说明,不论何种走向的血管,其密度可因部位而异。不同层次、不同部位、不同方向的血管吻合率比较均无显著差别。血管密度高的部位血管吻合也相应丰富。为小腿轴型皮瓣设计提供了参考。
文摘Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.
文摘The development of intestinal anastomosis techniques,including hand suturing,stapling,and compression anastomoses,has been a significant advancement in surgical practice.These methods aim to prevent leakage and minimize tissue fibrosis,which can lead to stricture formation.The healing process involves various phases:hemostasis and inflammation,proliferation,and remodeling.Mechanical staplers and sutures can cause inflammation and fibrosis due to the release of profibrotic chemokines.Compression anastomosis devices,including those made of nickel-titanium alloy,offer a minimally invasive option for various surgical challenges and have shown safety and efficacy.However,despite advancements,anastomotic techniques are evaluated based on leakage risk,with complications being a primary concern.Newer devices like Magnamosis use magnetic rings for compression anastomosis,demonstrating greater strength and patency compared to stapling.Magnetic technology is also being explored for other medical treatments.While there are promising results,particularly in animal models,the realworld application in humans is limited,and further research is needed to assess their safety and practicality.
文摘BACKGROUND Portal vein arterialization(PVA)has been used in liver transplantation(LT)to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis(PVT).The effect of PVA on portal perfusion and primary graft dysfunction(PGD)has not been assessed.All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed.To account for the time-sensitive effects of graft perfusion,patients were classified into two groups:prereperfusion(pre-PVA),if the arterioportal anastomosis was performed before graft revascularization,and postreperfusion(post-PVA),if PVA was performed afterward.The pre-PVA rationale contemplated poor portal hemodynamics,severe vascular steal,or PVT.Post-PVA was considered if graft hypoperfusion became evident.Conservative interventions were attempted before PVA.
文摘Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drainage.There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses.There is growing interest and research about artificial intelligence in EUS.Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic.The range of EUS-guided drainage procedures has expanded.EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option.EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography(ERCP)is now an accepted alternative to percutaneous transhepatic biliary drainage.EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates.Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction,and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible,but further prospective randomized studies are needed to establish the actual clinical impact.
文摘Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions.
基金a grant from the ScientificCommittee of Hebei Province(No.982 76 110 1)
文摘Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β Galactosidase (β Gal) structural gene (lacZ gene) was conducted. A soaked medical 8 0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β Gal histochemical staining was performed and β Gal enzyme activity was assayed with 5 bromo 4 chloro 3 indolyl β D galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β Gal enzyme activity was detected at different stages after operation, but in the experimental group, β Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.
文摘The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a coronary artery bypass grafting (CABG) operation. It allows the surgeon to perform a hand-sewn anastomosis with no disruption of the intima of the aorta, and no need for partial clamping. During a 36-month period 109 CABG operations were performed, and the CycloneTM System (and its predecessor, the HexalonTM) was utilized to create 138 proximal anastomoses. This study demonstrates that this is a safe and effective method of creating a clampless, no-touch proximal anastomoses during off-pump CABG.
文摘We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreaticogastrostomy(PG)or a control group with a routine mucosa-to-mucosa PG.At six months anastomoses had strictured and closed in both groups.The authors concluded that“bridging”PG is feasible and safe in damage control surgery during the early stage of pancreatic injury.In this letter we comment on the study design,specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre.Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.
基金supported by the National High Technology Research and Development Program of China(Grant No.2007AA022303)the National Natural Science Foundation of China(Grant No.30500115)+1 种基金the NSFC-FBR International Joint Research Project(Grant No.30711120171)the Program for Changjiang Scholars and Innovative Research Team in University.
文摘The collateral circulation is crucial for the pathophysiology and outcome of acute cortical ischemia.Current understanding of collateral circulation still remains sparse,largely due to prior limitations of spatial or/and temporal resolution in methods to evaluate these diminutive redistributive routes of cerebral blood flow(CBF)especially in leptomeningeal anastomoses that connected cortical arteries.In the study,based on a mini-stroke model,laser speckle imaging with high spatiotemporal resolution was used to assess the dynamic evolution of the collateral circulation around a mini-ischemia in the rat cortex.We found that the blood flow and diameter in the intra-arterial anastomoses were enhanced immediately after the ligation of one branch of middle cerebral artery and recovered to baseline level as arterial recirculation was performed.Whereas the communicative flow-through of the posterior cerebral artery and the middle cerebral artery anastomoses was not significant enough to be determined.This is the evidence that intra-arterial anastomoses were the primary routes to restore blood flow into the ischemic territory during the acute phase of ischemia,and laser speckle imaging method was proven as a powerful tool to be potential for subserving further investigation of the collateral circulation.