The experimental study of pedicled jejunum flap repaired bile duct defect / 中华肝胆外科杂志

ObjectiveTo study the physiologic and pathlogic alteration of the artificial bile duct generated by pedicled jejunum flap(CBD)in repairing local defect common bile duct of dog. Methods Common bile duct defected model was generated by partially cutting off CBDofdog.The pedicled jejunum flap with mesentery blood supply was created to repair the local defect CBD.The pH of bile was mcasuratcd during and post operation, the pathologic study was undertaken after 6 months.ResultsThe experimental group live 6 months and the symptom and signs is abnormal after operation.The result of blood routine and biochemistry examination is no change(P＞0.05).The pH of postoperative bile decrease(P＜0.01).The pH of bile was changed remarkably 1 day after the pedicled jejunum flap replacement.But no significant changing in the following 6 months(P＞0.05).The postoperative pathologic study show:the anastomosis of experimental group healing well,and fiber tissue proliferates at the site of anastomosis,The Epithelium of the jejunum flap was atrophy and there were large quantity of lymphocytes,plasma cells and neutrophil within the jejunum flap(10/10).The epithelium of bile duct nearby the jejunum flap appears slight proliferate and infused with lymphocytes and plasma cells(10/10).There were lymphoid follicles in 3/10 cases.ConclusionsThe jejunum flap repairing bile duct healing well,but there was inflamatic change around the jejunum flap and nearby bile duct after the replacement.These observation suggested it is feasible to use the jejunum flap repairing the defected bile duct.The local physiology is stable without any changes in pH of bile acid.The alterative materials like umbilical ligment,blood vessel would be favorable in repair of defected bile duct.

Exploration of the significance of using Kappa index in clinical teaching of acute appendicitis abdominal signs / 中华医学教育探索杂志

Objectives To study the significance of using kappa value in surgical clinical teaching.Methods The interns in Department of General Surgery were included,and were divided into routine teaching group and targeted teaching group randomly. Kappa statistic was used to compare the consistency of physical examination.Results The results showed that Morris's point tenderness was grasped more efficiently in targeted teaching than routine teaching group.Conclusion With the help of kappa value teachers can find the teaching items more correlated with training and give students targeted teaching so as to improve the teaching effect.