目的 探讨捆绑式胰肠吻合术的改良方法。方法 对8例胰十二指肠切除术患者行捆绑式胰肠吻合术时采用带血管蒂的大网膜包绕空肠浆肌鞘，以达捆绑之目的。8例中行桥袢空肠造瘘5例，胆总管造口T管引流3例，并观察其术后5 d内每天平均引流液量。结果 8例患者均治愈出院，无胰瘘、胆瘘发生； 5 d内每天平均引流液量除第1天胆总管造口低于空肠造瘘外，其余4 d每天平均引流液量均明显高于空肠造瘘； 1例空肠造瘘者术后第8天继发胰腺残端出血，经电灼后止血。结论 带血管蒂的大网膜包绕空肠浆肌鞘完全可以代替粗线环绕空肠结扎，并使整个空肠浆肌鞘与胰腺紧贴，更利于胰肠间愈合； 空肠造瘘或胆总管造口对桥袢空肠均有减压引流的作用，但T管引流更简单、有效、省时。
目的 探讨Miles手术重建盆底腹膜困难时的处理对策。方法 对Miles手术重建盆底腹膜困难的患者，根据其大网膜的解剖情况，将带血管蒂大网膜经左或右结肠旁沟放入骶前腔，利用大网膜去填塞骶前腔或修补盆底腹膜缺损。结果 3例患者分别用带蒂大网膜加气囊填塞骶前腔、带蒂大网膜单纯填塞骶前腔、带蒂大网膜修补盆底腹膜等方法，减轻了缝合盆底腹膜时的张力，使盆底腹膜得以顺利重建。结论 用带血管蒂大网膜填塞骶前腔或修补盆底腹膜缺损，可防止Miles术后并发症发生，促进患者早日康复。
Objective Engineer heart tissue (EHT) was constructed with mesenchymal stem cells (MSCs) and poly lacticacidCOglycolic acid (PLGA), and grafted onto the surface of myocardial infarction rats. We hypothesized that great omentum wrapping would increase EHT blood supply and ameliorate EHT microenvironment which is in favor of cardiac collagen remodling and heart function. We hope that omentun wrapped EHT could provide a valuable strategy for surgically myocardial infarction therapy. Methods MSCs were isolated from SD rats.Eight weeks after SD rats were subjected to left anterior descending (LAD) ligation, 18 rats were enrolled and divided into three groups, group A(n=6): great omentum wrapped MSCsPLGA EHT implantation; group B (n=6):MSCsPLGA EHT implantation; control group (n=6): the myocardial infarction; the sham group (n=6): only opened and closed chest, underwent LAD ligation, but no EHT implantation. Four weeks after transplantation, the following variables were evaluated: specimen stained with picrosirius red, left ventricle function evaluated by echocardiography, infarction ventricular wall motion by color kinesis (CK). Results Hearts of group A showed significantly less fibrosis than group B and control group (Plt;0.05). Infarction ventricular wall motion assessed by CK indicated significantly improvement in group A compared with group B and control group (Plt;0.05). Four weeks after transplantation, cardiac echocardiography showed left ventricle ejection fraction was lower in control group and group B compared with group A (Plt;0.05). Conclusion Transplantation of MSCsPLGA EHT with great omentum wrapping ameliorated infarction ventricular collagen remodeling, ameliorated infarction ventricular wall motion and preserved left ventricular function.
Objective To explore an effect of the artificial nerve graft wrapped in the pedicled greater omentum on the early revascularization and an effectof the increased blood supply to the artificial nerve graft on the nerve regeneration. Methods Seventy-five rabbits were randomized into 3 groups, in which there were 2 experimental groups where the rabbits were made to abridge respectively with the artificial nerve grafts wrapped in the pedicled greater omentum (Group A) and with the artificial nerve grafts only (Group B), and the control group where the rabbits were abridged with the autologous nerve (Group C).On the 3rd, 7th and 14th days after operation, the evans blue bound to albumin (EBA) was injected into the vessels in all the grafts to show their revascularization. Twelve weeks after operation the nerve regeneration was evaluated with theelectrophysiological and histological observations on the serial sections, and was evaluated also with the transmission electron microscope. Results The artificial nerve grafts wrapped in the pedicled greater omentum in Group A and the autologous nerve grafts in Group C showed a beginning of revascularization on the3rd day after operation, and the revascularization was increased on the 7th and14th days. Compared with Groups A and C, the artificial nerve grafts in Group Bshowed a delayed revascularization on the7th day after operation. At 12 weeks after operation, there were no significant differences in the motor never conduction velocity, density of the regenerated myelinated nerve fibers, myelin sheath thickness, and diameter between Group A and Group C(Pgt;0.05). However, both Group A and Group C were superior to Group B in the above variables, with significant differences(Plt;0.05). Conclusion Utilization of the pedicled greater omentum to wrapthe artificialnerve grafts can promote an early revascularization of the artificial nerve graft and an early nerve regeneration of the artificial nerve graft because of an enhanced blood supply to the nerve graft.
Objective To evaluate the outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. Methods From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm×7 cm to 25 cm×17 cm. Results The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. Conclusion It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.
OBJECTIVE: To explore the effects of different methods of fetal spinal cord(FSC) tissue transplanted on reversing the axotomy-induced neurons atrophy of adult rats injured spinal cord. METHODS: One hundred and twenty adult rats received lumbar spinal cord hemisection. Experimental rats were divided into five groups, the control group(Group A); spinal cord hemisection only(Group B); spinal cord hemisection plus FSC transplant (Group C); spinal cord hemisection plus FSC transplant plus pedicled paraspinal muscle(Group D); spinal cord hemisection plus FSC transplant plus pedicled omentum (Group E). Combined behavioral scores(CBS), somatosensory evoked potentials (SEP), motor evoked potentials(MEP) were examined to evaluate the recovery of neurological function after operation. Rats were sacrificed after 1, 4 and 12 weeks. Nissl stained section was used for neurons quantitative image analysis. The positive cells were quantitative analysis by computer image analysis system. RESULTS: The different methods of FSC tissue transplantation could prevent the neurons atrophy secondary to axon injury of spinal cord in adult rats. The size of neurons were observed in five groups, they were group E gt; group D gt; group C gt; group B gt; group A (P lt; 0.05). Those increases in size of neurons were paralleled with a significant improvement in neurological function recovery. CONCLUSION: It indicates that the different methods of FSC tissue transplantation can maintain the neurons morphology and improve the neurological function of rats.