胆总管在穿过十二指肠壁时与胰管汇合，汇合后略膨大，称Vater壶腹（简称壶腹）。壶腹及其外周环绕的括约肌向十二指肠肠腔突出，使十二指肠粘膜隆起形成十二指肠乳头。在壶腹周围（包括壶腹），上述组织结构所发生的肿瘤统称为壶腹周围肿瘤，并以恶性居多。壶腹周围的恶性肿瘤包括来自壶腹、胆总管下端、十二指肠乳头和胰头的癌肿，临床上把前三者连同胰头癌统称为壶腹周围癌。目前，外科手术仍是治疗壶腹部肿瘤的主要手段，提高壶腹部肿瘤的外科治疗技术水平是患者获得治愈的唯一途径。壶腹部肿瘤因其组织来源不同其生物学行为亦表现出很大差异，应根据壶腹部肿瘤的不同组织来源、生物学行为及其发展阶段作出合理的外科治疗。
The morphologic changes of the liver,heart and kidney in relation to the serum choleic acids in obstructive jaundce of rats were investigated.One of the results showed that one to two weeks after the common bile duct was ligated and servered,the damages to the damages to the mitochondria were found in the organs,while the serum choleic acids markedly increased.The other result was that when the rats were fed with sodium cholate in the dosage that their peak blood concentrations were close to the average results concentration in obstrcutive jaundice,their mitochondrial damage were in the similar degree.These results suggest that choleic acids stasisi is one of the factors of multiple organ damage in obstructive jaundice.
In this study, hypertonic saline infusion (experimental group ) and blood transfusion plus normal saline infusion (control group) were used for the treatment of uncontrolled hemorrhagic shock in dogs. The amount of blood loss from injured vessels are compared between two groups. Results: the amount of blood loss from injured vessels in shock stage were 35.2ml in the experimental group and 34.6ml in the control group, which showed no marked difference between two groups(Ｐ＞0.05).The amount of blood loss in resuscitation stage for experimental group was 15.10±1.52ml(early stage) and 14.00±1.37ml(late stage) and for control group was 14.20±1.52ml and 12.90±1.71ml respectively(Ｐ＞0.05).The amount of blood loss in resuscitation stage for both groups is much less than that in shock stage (Ｐlt;0.05).The results showed that infusion of hypertonic saline 30 min after uncontrolled shock is a safe and effective treatment which dose not cause further bleeding from the injured vessels. Clinical observation also confirmed the result.
Three different methods of electrocautery were used to study the effects of electrocoagu-lation on limbs and intraabdominal blood vessel of 6 rabbits. These methods are non-touching, touching and segmental electrocoagulation. The results show that all three methods can satisfactorily stop bleeding of the blood vessel which is smaller than 1. 5mm in diameter. For arteries with the diameter 1.5～2.0mm. the effect of segment electrocoagulation is better than the other methods because it has a long burn end after cautery.
Objective The effects of seromuscular layer anastomosis， extramucosal anastomosis，single-layer anastomosis and double-layer anastomosis of gastrointestinal tract on anastomotic healing were compared. Methods Chinese rabbits were divided into four groups: group A (double-layer anastomosis, n=10), group B (single-layer inverted anastomosis, n=10), group C (extramucosal anastomosis, n=10) and group D (seromuscular layer anastomosis, n=10). Five anastomoses were performed in each animal: one side-to-side gastroduodenal anastomosis, two end-to-end ileal and colonic anastomoses respectively. Half of each group was sacrificed on postoperative day 3 and 7 respectively to determine in situ anastomostic bursting pressures (ABP) and hydroxyproline (HP) content, and to receive histopathologic examination. Inflammatory index and mucosal healing index of anastomosis were calculated. Results There were no significant differences in case of ABP among the groups on day 3, and with the same result among group A, B and C on day 7 in gastroduodenal, ileoileal and colocolonic anastomoses. On day 7, the ABP of gastroduodenal anastomosis was dramatically higher in group D than group A and B (P＜0.05), the ABP of ileoileal anastomosis in group D was significantly increased compared with group A (P＜0.01), and the ABP of colocolonic anastomosis in group D was also higher than group A, B and C (P＜0.05). There was no statistical difference in HP content among the 4 groups in gastroduodenal and ileal anastomoses on day 3 (Pgt;0.05), and in ileal and colonic anastomoses on day 7 (Pgt;0.05). HP content was higher in group A than group B on day 3 in colonic anastomoses (P＜0.05), and it was also found to be higher in group D than group A on day 7 in gastroduodenal anastomosis (P＜0.025). Inflammatory reaction was not different among the 4 groups in gastroduodenal and ileoileal anastomoses on day 3, and the inflammatory indices of gastroduodenal and colocolonic anastomoses in all groups were similar on day 7. The inflammatory index of colocolonic anastomosis was signicantly increased in group A than group C on day 3 (P＜0.05), and that of ileoileal anastomosis in group A was higher than group D on day 7 (P＜0.05). The mucosal healing indices of anastomoses were not significantly different among the 4 groups on day 7. Conclusion Seromuscular layer anastomosis of gastrointestinal tract is as safe as other hand-sewn anastomoses, but it is more convenient and simpler than others.
ObjectiveTo investigate the clinical effect of end-to-side binding pancreaticojejunostomy.MethodsFrom March 2009 to December 2019 , 70 patients (pancreatic head cancer in 16 cases, duodenal papillary cancer in 27 cases, bile duct cancer in 8 cases, periampullary cancer in 2 cases, gallbladder cancer invading the pancreatic head in 1 case, intraductal papillary myxoma of pancreas in 6 cases, and mass-type chronic pancreatitis in 10 cases) were performed with end-to-side binding pancreaticojejunostomy were retrospectively analyzed, including large pancreas remnant (n=4). The main procedures included isolation of the pancreatic remnant, incising the jejunal wall and preplacing with seromuscular purse string suture around the incision, performing end-to side binding pancreaticojejunostomy.ResultsThe procedures were successful in all 70 patients. Postoperative complications included pancreatic fistula (n=3, 4.3%), of three patients cured with reoperation, jejunal loop decompression tube was not placed in 2 patients, and 1 patient had pancreatic fistula and bleeding on the eighth day after operation. One out of 3 patients developing abdominal hemorrhage which reoperation died of acute respiratory distress syndrome, 1 patient was cured with the vascular interventional hemostasis. Gastrointestinal anastomotic bleeding (n=1) and adhesive intestinal obstruction (n=1) were cured with reoperation, biliary leakage (n=1) was cured with conservative treatment.ConclusionEnd-to-side binding pancreaticojejunostomy is simple, safe and reliable.