Objective To study the vascular applied anatomy，the anatomic features of fascial，and interfascial space around the pancreas and duodenum，observe marker and safe surgical plane of pancreaticoduodenal region，and provide clinical anatomy basis for surgery of duodenum， pancreatic head，and distal common bile duct．Methods Anatomical observations were performed in 7 formalin fixed cadavers on duodenum，distal common bile duct，and pancreatic peripheral blood supply．Transverse mesocolon，pancreatic capsule and potential interfascial space，surgical plane and anatomic marker for reorganization around pancreas were observed．Results Gastropancreatic fold and hepatopancreatic fold formed by pancreatic capsule were good markers to locate the root of left gastric artery and common hepatic artery．A vessel-free plane between the behind pancreas and the anterior lamella of Gerota fascia could be used to make lymphadenectomy and pancreatic dissection behind pancreas and duodenum．Gerota fascia should be regarded as a safe posterior border to avoid injuring vessels and adrenal gland by mistake．The descending part and horizontal part of duodenum were mainly supplied by the anterior and posterior pancreaticoduodenal arterial arcade．The anterior and posterior pancreaticoduodenal arterial arcade should be protected in duodenum-preserving resection of pancreatic head．Conclusions Full understanding of pancreatic fascial and interfascial space formed in embryonic development is very important．Operation along the interfascial spaces is safe without bleeding and organ injury，which is essential in oncosurgery．
【Abstract】 Objective To study the effects of glutamine (Gln) combined with growth hormone （GH） on the levels of cytokine (TNF-α, IL-1, IL-6), coritsol and amino acid metabolism in septic rats. Methods Ten out of 79 SD rats were randomly collected as the control group. Thirty of 69 septic SD rats, which were made by cecal ligation and perforation (CLP) method and were given parenteral nutrition (PN) lived to day 6. They were also randomly divided into three groups as follows: septic group (n=10), parenteral supplemented glutamine group (Gln group, n=10), and Gln combined with GH (Gln+GH group, n=10). On the 6th day, blood drew from portal veins of the dead rats was used to detect the levels of TNF-α， IL-1， IL-6 and cortisol by ELISA. The plasma concentrations of free amino acids were determined by amino acid auto-analyzer. The muscle tissue of extensor digitorum longus was used to determine 3-methyl-histidine (3-MH) by high performance liquid chromatographic (HPLC). Results Except for the control group, most rats developed celiac abscess, hepatic abscess and pulmonary infection. The serum levels of TNF-α, IL-1, IL-6 and cortisol were significantly higher in the septic group than those of the other three groups, and they were significantly lower in the Gln+GH group than those of the Gln group, P＜0.05. Compared with the other three groups, the concentration of total amino acid in the septic group increased more, among which the glutamine and the branched chain amino acids were prominent. Most of concentrations of the amino acids decreased in the Gln group and the Gln+GH group, and the decreased amplitude of the Gln+GH group was larger, P＜0.05, albeit its level of Gln markedly increased. The concentration of 3-MH in muscle tissue was the highest in septic group, and it was significantly higher in the Gln group than that of the Gln+GH group, P＜0.01. ConclusionIt may be necessary to supplement GH combined with Gln as the content of PN to decrease cytokine levels and im-prove amino acid metabolism for septic case.
ObjectiveTo compare the advantages and disadvantages of transumbilical single port (TUSP) and conventional laparoscopic cholecystectomy (LC). MethodsThe clinical data of 45 patients underwent elective LC were analyzed, 20 patients with TUSP LC (TUSP-LC group), 25 patients with conventional LC (conventional LC group). The operation time, Child-Pugh score and painkiller application frequency within three days after operation, the first time of out of bed and hospital stay after operation, intraoperative blood loss, chronic pain within one month after surgery were compared between two groups. ResultsAll cases were operated successfully except one patient in the conventional LC group. The frequency of painkiller application within three days after operation and postoperative hospital stay in the TUSP-LC group were better than those in the conventional LC group (Plt;0.05). There were no significant differences on postoperative chronic pain of surgical area within 1 month and Child-Pugh score between two groups (Pgt;0.05). The operation time and intraoperative blood loss in the conventional LC group were less than those in the TUSP-LC group (Plt;0.05, Plt;0.01). ConclusionTUSP LC has the advantages of small wound, slight pain, and fast recovery.