Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
an easy and safe technique, liver transection by curettage and aspiration (LTCA), using an efficient instrument, Peng’s multifunction operative dissector (PMOD) is described in this article. A comparison brtween two groups of patients undergonig hapatectomy were made. One group were operated on with LTCA; the other group with forceps crush method (FCM). Results: the amount of blood loss with LTCA was only half of that with FCM. The time needed for liver transection with OTCA was 40 percent shorter than that with FCM. After comparision of a variety of currently available techniiques and surgical instruments, it is concluded that LTCA is superior to all other techniques, while PMOD is superior to CUSA.
Objective To investigate the effects of lycium barbarum polysaccharide (LBP) on the formation of traumatic neuroma and pain after transection of sciatic nerve in rats. Methods Forty Sprague-Dawley (SD) rats, weighing 200-220 g, half male and half female, were allocated into 2 groups randomly: LBP group and control group (n=20 per group). The right sciatic nerves were transected and 2 cm sciatic nerve were removed in all rats of the 2 groups. LBP were intraperitoneally injected in a volum of 10 mg/(kg·d) in the LBP group, while the same volum normal sal ine (NS) in the control group for 28 days. The deficiency of toenail and toe were observed to estimate the autophagy of the operated l imb. Light microscope and transmission electron microscope were used to observe the formation of traumatic neuroma aftertransection of sciatic nerve. Results Autophagy was observed in 5 rats (25%) of LBP group and in 12 rats (60%) of controlgroup at 4 weeks, showing significant difference (P lt; 0.05). Neuroma formed in 8 rats (40%) of LBP group and in 16 rats(80%) of control group, showing significant difference (P lt; 0.05). The observation of l ight microscope showed that there were unorganized growth cells in the neuroma, infiltrated muscle cells, the regeneration of axons and ensheathing cells to form small patch and funicular structure in the control group, while in the LBP group there were less prol iferation of nerve fibers with a regular arrangement. Transmission electron microscope showed that there were lots of axons in nerve tumour, more fusoid fibroblasts, more collagen fiber, and hyperplasia and degenerated myel in sheath in the control group, while in the LBP group there were less myel in sheath in the proximal end of injuring nerves, less Schwann cells and fibroblasts, and sparsed collagen fibers. Conclusion LBP can inhibit autophagy and the formation of traumatic neuroma after transection of sciatic nerve in rats.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.
Objective To refine the technique of portal inflow occlusion and parenchymal transection for laparoscopic hepatectomy in the porcine model. Methods Ten pigs were used. The portal inflow complete or selective occlusion was carried out with portal triad clamping or dissection and division of the left portal pedicle. The sequential laparoscopic local hepatectomy, left lateral lobectomy, and left medial lobectomy were performed without portal inflow occlusion. Parenchymal transection was performed with harmonic scalpel, LigaSure, microwave dissector, bipolar electrocautery, surgical clips, and endoscopic stapler. The efficacy and safety of different techniques in laparoscopic parenchymal transection of the liver were compared. Results The ischemic liver was darken with complete or selective portal triad clamping. The ischemic demarcation line between left and right lobe was obvious with the dissection and division of the left portal pedicle. There was an applicable scope of each hepatic parenchymal transection apparatus. The optimal combination of different techniques could increase efficacy and reduce hemorrhage in laparoscopic parenchymal transection of the liver. Conclusion Technical refinements of portal inflow occlusion and parenchymal transection in porcine models could provide evidences to clinical appliance of laparoscopic anatomic major hepatectomy.
ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding. MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect. ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2. ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.
ObjectiveTo summarize the mid-term follow-up results and postoperative aortic remodeling of treating blunt aortic injuries (BAI) with thoracic endovascular aortic repair (TEVAR).MethodsA retrospective study was conducted on BAI patients treated with TEVAR, who were admitted into the Department of Vascular Surgery in Zhongshan Hospital, Affiliated to Fudan University between September 2003 and December 2015. There were 15 males and 9 females at an average age of 45.6±14.0 years. The mechanism of BAI was mainly auto car crash. Totally 25 entry tears were detected and most of them were located at the aortic isthmus.ResultsTwenty-four BAI patients survived and eventually went through TEVAR. One patient died of pulmonary embolism 1 week post-TEVAR. Rate of technical success, clinical success and perioperative mortality was 100.0%, 95.8%, and 4.2%, respectively. Nineteen patients were followed up with a mean time of 35.1(13-87) months. All of them survived this period. Based on the follow-up imaging of CTA, 18 of them revealed no endoleak or stent migration, and 1 patient of transection still had perfusion of distal false lumen at the abdominal aorta. None of the aortic segments measured in this study showed expansion of ≥5 mm during follow-up. The aorta remodeled well in 94.7% of them.ConclusionTEVAR for treating BAI appears feasible with high rates of technical and clinical success rates. The mid-term follow-up results seems satisfying, but the long-term results are yet to be assessed with further follow-up.
ObjectiveTo investigate the clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein.MethodsClinical data of 8 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein in Xinqiao Hospital from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.ResultsAll patients were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 6 patients, mixed hepatocellular carcinoma and cholangiocarcinoma was found in 2 patients. All patients completed the operation successfully without conversion to open surgery. The median operation time was 220 min (190-240 min), median blood loss was 230 mL (200-280 mL), and blood transfusion was not needed. The postoperative median hospital stay was 8 d (7–12 d). All the patients recovered well without severe complications. Eight patients were followed up for 10.5 to 31.7 months, with a median follow-up time of 16.9 months. During the follow-up period, none of them developed hemorrhage, bile leakage, and other complications. There was no reoperation or perioperative mortality during the follow-up.ConclusionsThe method of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein is safe and effective. This method can shorten the operation time, improve the safety, and reduce the difficulty of operation.