Research progress in perioperative management of portal vein thrombosis in liver transplantation / 器官移植

Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft

Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

Research progress of autologous peritioneal patch for repairing defective blood vessels / 中华肝胆外科杂志

In the process of radical resection of abdominal malignant tumors, large blood vessels are often invaded, which not only increases the difficulty of operation, but also directly affects the curative effect and prognosis. As the concept of expanded radical surgery combined with vascular resection and reconstruction and related techniques have been gradually recognized, surgeons have begun to use autologous, allogeneic or artificial vessels to repair the defective blood vessels during surgery, so as to achieve the effect of radical surgery. However, due to the short comings of these materials, scholars have been looking for better alternatives. In view of the fact that the mesothelial cells of the peritoneum and the endothelial cells of the blood vessels have many similarities in embryology, histology and physiology, and peritoneum is also easier to obtain than autologous, allogeneic or artificial vessels. To make the autologous peritoneum into a patch for repairing the defective blood vessels is feasible in theoretical and technical. In this paper, we review the current research progress of autologous peritoneal patch to repair blood vessels of defect.

Applications and prospects of 3D printing technology in pulp regeneration / 口腔疾病防治

@#In recent years, pulp regeneration has become a research hotspot in the field of stomatology. 3D printing can realize precise control of structure and shape of scaffolds, which provide basis for seed cell adhesion and growth factor release. The 3D printing "pulp complexes" constructed by 3D printing scaffolds for tissue engineering provides a new direction for pulp regeneration research. This paper reviews the applications of 3D printing technology in pulp regeneration. The results of literature review showed that the scaffold materials, seed cells and growth factors in the 3D printing "pulp complexes" all play an important role in the pulp regeneration research. Among them, the scaffold materials act as carriers to load seed cells and growth factors and provide a suitable microenvironment for them. The common seed cells such as dental pulp stem cells, stem cells from apical papilla and stem cells from the human pulp of exfoliated deciduous teeth can provide the cellular basis for pulp regeneration. Moreover, the introduction of growth factors can further support the differentiation of pulp tissue and the reconstruction of pulp vessels and promote pulp regeneration. At present, the 3D printing "pulp complexes" in the study of dental pulp regeneration has made some progress and can induce the formation of pulp-like tissues in the laboratory. However, preparing 3D-printing "pulp complex" with good biological activity, which integrates biomimetic blood vessels and nerves to supply oxygen and nutrients to the cells in the root canal, remains a huge challenge and still needs further exploration and research.

The clinical application of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction / 中国医师杂志

Objective:To investigate the clinical effect of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction.Methods:32 young permanent teeth with pulp and periapical lesions were randomly divided into two groups ( n=32): experimental group was treated with ultrasonic root canal intermittent irrigation and the control group was rinsed with sodium hypochlorite root canal. The changes of periapical lesions and root development were evaluated by preoperative and postoperative clinical symptom observation and radiograph examination, and the clinical effect of endodontic vascular reconstruction was discussed. The time of inflammation control was discussed by analyzing the starting point from the first diagnosis to the date of mineral trioxide aggregate (MTA) coverage. Results:The clinical symptoms of the 16 affected teeth in the experimental group and the control group disappeared, the periapical lesions were eliminated, and the root continued to develop. In the experimental group, root formation was observed in 13 of the affected teeth, with a success rate of 81.25% and a reduction rate of 18.75%. In the control group, root formation was observed in 10 of the affected teeth, with a success rate of 62.5% and a reduction rate of 37.5%. There was no difference in the effective rate between the experimental group and the control group ( P>0.05). The control time of inflammation was (28.44±5.98)days in the experimental group and (34.13±7.17)days in the control group, with statistically significant differences ( P<0.05). Conclusions:Ultrasonic root canal intermittent swabbing applied to pulp revascularization can achieve good clinical effect and shorten the time of inflammation control.

Latest Progresses in Surgical Treatment of Median Arcuate Ligament Syndrome / 中国医学科学院学报

Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.

Recombinant human secretory leukocyte protease inhibitor ameliorated vessel preservation in experimentally isolated rat arteries

Vessel allograft preservation is essential for vascular reconstruction surgery. The preservation solution is crucial inextending the preservation period while maintaining vascular endothelial function. Currently, a 0.9% normal salinesolution (NSS) is widely used as a storage solution although its protective effect on endothelial preservation islimited. In this study, we determine the beneficial effect of recombinant human secretory leukocyte protease inhibitor(rhSLPI), supplemented to 0.9% NSS, for isolated aortic preservation. The thoracic and abdominal aorta were isolatedfrom Wistar rats (n = 6), and the aortic rings were subsequently cut and preserved in 0.9% NSS in the presenceand absence of 1 µg/ml rhSLPI for 0, 6, 24, and 48 hours. The preservative solution was collected to determine thereleased lactate dehydrogenase (LDH) activity and pro-inflammatory cytokine levels, including tumor necrosis factorα (TNF-α) and interleukin-6 (IL-6). Furthermore, the appearance and severity of vessel degeneration were subjected toblind histopathological assessment by pathologists. The results indicated that 0.9% NSS, supplemented with rhSLPI,significantly reduced the released LDH activity, TNF-α, and IL-6 levels and could attenuate endothelial detachment,endothelial degeneration, and endothelial necrosis. This study demonstrated for the first time that adding rhSLPI to asaline preservative solution could prevent vascular injury and possibly extend the graft storage duration before clinicalintervention.

Clinical observation of the treatment of diabetic foot with transverse tibial bone transport / 西安交通大学学报(医学版)

Objective: To compare the clinical effects of transverse tibial bone transport, interventional therapy and conventional therapy on diabetic foot. Methods: We selected 45 diabetic foot patients admitted to the research center from June 2016 to October 2018. We adopted the random number method and divided them into the interventional treatment group, transverse tibial bone transport group and conventional treatment group, with 15 patients in each. Patients in each group received routine clinical treatment, interventional treatment or lateral tibial transposition. Doppler ultrasound was used to measure and monitor the blood flow velocity of dorsal artery before and after treatment. Each group was recorded for the highest systolic blood pressure of the malleolus artery and the highest systolic blood pressure of the brachial artery to measure the malleolus brachial index (ABI), the skin temperature and pain VAS scores of the affected limbs and feet before and after surgery. The healing of ulcerated foot surface was observed before and after operation to evaluate the clinical therapeutic effects of these methods. Results: All the 45 patients were followed up for an average of 6.7 months (4-10 months). Compared with those in conventional treatment group, the postoperative ABI and the blood flow velocity of the dorsal artery in interventional treatment group and transverse tibial bone transport group were significantly better(P0.05). Conclusion: Compared with conventional basic treatment, transverse tibial bone transport and interventional treatment can significantly improve the blood flow parameters of diabetic foot patients, relieve the pain of the patients and promote the healing of ulcer surface. Transverse tibial bone transport is more effective, and its postoperative skin temperature and postoperative brachial-ankle index are better than those of interventional treatment.

Value of multi-slice spiral CT angiography and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer / 中华消化外科杂志

Objective@#To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages.@*Results@#(1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as the first branch of IMA. The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm. (3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels: two patients of type Ⅳ were excluded from the 60 patients. On the 2D CT images of the rest 58 patients, 39 (67.2%) had LCA adjacent to IMV and 19 (32.8%) had LCA distal to IMV at the horizontal level of IMA root. On the 3D images of blood vessels in the rest 58 patients, 37 (63.8%) had the LCA located at the ventral side of IMV, and 21 (36.2%) had the LCA located at the dorsal side of the IMV.@*Conclusion@#Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches, which has high clinical application value.

Comparison in preoperative evaluation effects of abdominal enhanced CT two-dimensional coronal imaging versus three-dimensional vascular reconstruction for critical blood vessels in right colon cancer / 中华消化外科杂志

Objective@#To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.@*Results@#(1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P<0.05). (3) The positional relationship between ICV and ICA: on the 2D coronal images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. On the 3D vascular reconstructed images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.@*Conclusion@#Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer, with a good consistency.

Comparison in preoperative evaluation effects of abdominal enhanced CT two-dimensional coronal imaging versus three-dimensional vascular reconstruction for critical blood vessels in right colon cancer / 中华消化外科杂志

Objective To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected.There were 33 males and 17 females,aged from 33 to 86 years,with an average age of 63 years.All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment.The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction.Observation indicators:(1) anatomical type of Henle trunk;(2) the length of Henle trunk and surgical trunk;(3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA).Measurement data with normal distribution were represented as Mean±SD,and count data were represented as absolute numbers.Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images.Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Bland-Ahman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Results (1) Anatomical type of Henle trunk:on the 2D coronal images,43 of 50 patients had the Henle trunk and 7 had no Henle trunk.On the 3D vascular reconstructed images,44 of 50 patients had the Henle trunk and 6 had no Henle trunk.There were 2,21,17,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 2D coronal images of 43 patients.There were 6,19,16,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients.Six patients with no Henle trunk,2 in type 0,18 in type Ⅰ,15 in type Ⅱ,and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images.The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ =0.830,95％ confidence interval:0.705-0.956,P＜0.05).(2) The length of Henle trunk and surgical trunk:on the 2D coronal images,43 of 50 patients had the length of Henle trunk as (10±5)mm,and 42 of 50 patients had the length of surgical trunk as (34± 12)mm.On the 3D vascular reconstructed images,44 of 50 patients had the length of Henle trunk as (9±5)mm,and 43 of 50 patients had the length of surgical truck as (35± 12)mm.The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872,0.979,P＜0.05).Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P＜0.05).(3) The positional relationship between ICV and ICA:on the 2D coronal images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.On the 3D vascular reconstructed images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.Conclusion Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer,with a good consistency.

Value of multi-slice spiral CT angiography and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer / 中华消化外科杂志

Objective To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Mfiliated Wuxi Second People's Hospital of Nanjing Medical University from February 2018 to March 2019 were collected.There were 39 males and 21 females,aged from 45 to 81 years,with an average age of 67 years.All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation.The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering.The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction,and the CT images of venous vessels with small density difference were abstracted by region growing method.Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added.All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team,and were identified inferior mesenteric artery (IMA) and branches after being bared vessels,including anatomic course of left colonic artery (LCA),sigmoid artery (SA),and superior rectal artery (SRA).Observation indicators:(1) anatomic courses of IMA,LCA,SA,and SRA on the 3D images and their consistency with intraoperative anatomic courses;(2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels;(3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels.Measurement data were represented as Mean±SD,and count data were represented as absolute numbers and percentages.Results (1) Anatomic courses of IMA,LCA,SA and SRA on the 3D images and their consistency with intraoperative anatomic courses:of the 60 patients,31 (51.7％) had type Ⅰ anatomic course of IMA on the 3D images,with LCA and SA from the common trunk;9 (15.0％) had type Ⅱ,with LCA and SA from the common trunk;18 (30.0％) had type Ⅲ,with LCA,SA,and SRA from the common trunk;2 (3.3％) had type Ⅳ,with no LCA.The consistency of anatomic courses of IMA,LCA,SA,and SRA on the 3D images with intraoperative anatomic courses of bared IMA,LCA,SA,and SRA was 100.0％ (60/60).(2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels:of the 60 patients,49 (81.7％) had LCA as the first branch of IMA,11 (18.3％) had SRA or SA as the first branch of IMA.The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm.(3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels:two patients of type Ⅳ were excluded from the 60 patients.On the 2D CT images of the rest 58 patients,39 (67.2％) had LCA adjacent to IMV and 19 (32.8％) had LCA distal to IMV at the horizontal level of IMA root.On the 3D images of blood vessels in the rest 58 patients,37 (63.8％) had the LCA located at the ventral side of IMV,and 21 (36.2％) had the LCA located at the dorsal side of the IMV.Conclusion Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches,which has high clinical application value.

Clinical efficacy of total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts for pancreatic cancer with vascular invasion / 中华消化外科杂志

Objective To investigate the clinical efficacy of total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts for pancreatic cancer with vascular invasion.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 9 patients with pancreatic cancer who underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts in the Beijing Chao Yang Hospital of Capital Medical University from January 2014 to September 2016 were collected.There were 4 males and 5 females,aged from 53 to 78 years,with a median age of 60 years.Involvement of portal vein (PV) and (or) superior mesenteric vein (SMV),splenic vein or convergence was detected in patients by preoperative evaluation,which indicated borderline resectable pancreatic cancer.Patients underwent complete surgical resection of tumor and involved portal veins,and then underwent vascular and digestive tract reconstruction.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Patients were followed up by telephone interview and outpatient examination to detect survival of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,measurement data with skewed distribution were expressed as M (range),and count data were expressed as absolute number.Results (1) Intraoperative situations:9 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts successfully,including 1 undergoing total pancreaticoduodenectomy due to positive margin of pancreatic neck during pancreatico-duodenectomy for pancreatic head carcinoma,3 of pancreatic head carcinoma with portal vein involvement and atrophy of pancreatic body and tail,and 5 of carcinoma of pancreatic neck and body with portal vein involvement.The operation time,portal vein occlusion time,and volume of intraoperative blood loss were (573± 19) minutes,(21 ±4) minutes,and (717±33) mL.(2) Postoperative situations:4 of 9 patients had postoperative complications,including 2 with grade Ⅰ complication and 2 with grade Ⅱ complication.There was no grade Ⅲ or above complication.No anastomotic stenosis or thrombus formation after reconstruction for portal vein.The perioperative complications were cured after conservative treatment.Duration of postoperative hospital stay was 17 days (range,10-25 days).Nine patients underwent subcutaneous injection of insulin to control blood glucose during the period fasting for solids and liquids.After resuming the semi-liquid diet of diabetes,patients received subcutaneous injection of rapid acting insulin before meals combined with subcutaneous injection of long-acting insulin before bedtime,with a insulin need of 24-36 U/d.Patients had postprandial blood sugar level of 8-11 mmol/L,without unmanageable hyperglycemia orlong-term application of insulin pump.Patients received oral trypsin pancreatin instead of trypsin,with no gastrointestinal symptoms such as bloating and steatorrhea,no malnutrition.Of 9 patients,2 had well-differentiated adenocarcinoma,4 had moderately differentiated adenocarcinoma,and 3 had poor-differentiated adenocarcinoma.There were 3 patients with no vascular invasion,1 with endangidic invasion,5 with tumor infiltration of tunica adventitia vasorum.One of 9 patients was in IIA stage of TNM staging,3 were in the II B stage,and 5 were in IIIB stage.The negative rate of pathological sections for excised specimen margin was 8/9.(3) Follow-up:9 patients were followed up for 7-37 months,with a median follow-up time of 15 months.Four patients survived,4 died of tumor recurrence and metastasis,and 1 died of cerebrovascular accident.Conclusion Total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving portal vein,splenic vein or junction.

Postoperative nursing care of one patient with pancreatic cancer undergoing pancreaticoduodenectomy combined with resection of superior mesenteric vein and artificial vascular reconstruction / 中国实用护理杂志

Objective@#To summarize the postoperative nursing experience of 1 patient with pancreatic cancer who underwent pancreaticoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction.@*Methods@#The nursing measures included: paying attention to anticoagulation treatment and observing its effect, strengthening pain management, giving nutritional support, pertinent nursing care for gastroparesis, guiding quantitative respiratory treatment for patient, preventing the lack of trace elements during jejunitas.@*Results@#Through active and effective nursing, the patients were discharged smoothly forty-seven days after operation.@*Conclusions@#Through nursing of 1 patient with pancreatic cancer underwent pancreatoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction after surgery, nurses can improve the nursing skills and nursing observation ability, as well as the theoretical basis and practical experience for the future clinical work.

Value of the multi-slice spiral CT angiography, CT colonography and image fusion technology in preoperative evaluation of laparoscopic right colon cancer / 中华消化外科杂志

Objective To observe the distribution and variation of right colonic vessels,and investigate the clinical value of computed tomography angiography (CTA),computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People's Hospital of Nanjing Medical University between January 2015 and July 2017 were collected.Patients received preoperative plain and enhanced scans of abdominal and pelvic CT.The original images were reconstructed and fused by CTA and CTC,and then coming out with three-dimensional images of blood vessels and gut.Observation indicators:(1) branches of superior mesenteric artery (SMA);(2) positional relationship between SMA and superior mesenteric vein (SMV);(3) composition of gastrocolic venous trunk.Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard,with a good imaging performance.Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy,showing a coincidence rate of 100.0％ (38/38).(1) Branches of SMA:results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery,middle colonic artery and ileocolic artery were respectively 94.7％ (36/38),92.1％ (35/38) and 100.0％ (38/38).A right colonic artery was found in 28 patients.Ten patients had structure variation of right colonic artery,including 3 with 2 right colonic arteries and 2 without right colonic artery.The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients;the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients.(2) Positional relationship between SMA and SMV:results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0％ (38/38).The SMA in 20 patients was located in the ventral side of SMV;SMA in 18 patients was located in the dorsal side of SMV.(3) Composition of gastrocolic venous trunk:results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks,which belonged to four sources,including right colonic vein,middle colonic vein,fight gastric epiploic vein and anterior superior pancreaticoduodenal vein.Among 29 patients,18 had 2-or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein,middle colonic vein and right colonic vein;3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein;8 had 3-or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein,anterior superior pancreaticoduodenal vein,right colonic vein and middle colonic vein.Conclusion CTA,CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels,with a high clinical value.

Laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction:an analysis of 7 patients / 中华肝胆外科杂志

Objective To review our experience in laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction.Methods Of 183 patients who underwent laparoscopic pancreaticoduodenectomy in our department from November 2013 to January 2017,major vascular resection and reconstruction using the SMA first approach for total mesopancreas excision was performed in 7 patients.The clinical data of these 7 patients were retrospectively analyzed.Results Total 3D laparoscopic surgery was performed in all these 7 patients.The mean operation time,mean blood loss and blood flow occlusion time were (551.4 ± 83.8) min,(671.3 ± 256.3) ml and (45.8 ± 6.7) min,respectively.Six out of 7 patients were pathologically diagnosed to have pancreatic adenocarcinoma with negative surgical margins.Two patients had lymphatic metastasis (the number of metastatic lymph node was 1 in each patient).The mean number of lymph nodes resected was (12.7 ± 5.8).The portal vein-superior mesenteric vein (PV-SMV) was segmentally resected and reconstructed using an end to end anastomosis following the preoperative plan in 4 patients.These included 2 patients who underwent total pancreatectomy.The portal vein was wedge-resected and reconstructed by venorrhaphy in 2 patients.The remaining 1 patient was histopathologically diagnosed to have a mass-type chronic pancreatitis.Only 1 patient was treated in the ICU for 1 day after surgery.Post-operative complications occurred in 2 patients and they were managed with nonsurgical treatment (PV-SMV thrombosis and gastric emptying disorder in 1 and a pancreatic leakage (level A) in 1).The mean length of post-operative hospital stay was (13.7 ± 3.2) days with no in-hospital mortality.Seven patients were alive by April 2017.The mean follow-up for the 6 patients with pancreatic adenocarcinoma was 4.5 (3.5 ～9) months.Conclusions Based on our experience in skillful and masterly major vascular resection and reconstruction in open surgery and on our experience in standard laparoscopic pancreaticoduodenectomy,laparoscopic pancreatieoduodenectomy combined with major vascular resection and reconstruction was feasible and safe.This surgery requires very mature skills in laparoscopic surgery.

Laparoscopic and robotic radical pancreaticoduodenectomy combined with major vascular resection and reconstruction: a report of 5 patients / 中华肝胆外科杂志

Objective To analyze our experience on laparoscopic and Da Vinci robotic radical pancreaticoduodenectomy combined with major vascular resection and reconstruction,and to expand the indications of surgery for patients with pancreatic cancer.Methods From December 2013 to January 2016,67 patients underwent laparoscopic and Da Vinci robotic pancreaticoduodenectomy in our department.The resection was combined with major vein resection in 5 patients.We retrospectively analyzed the clinical data of these patients who had laproscopic or Da Vinci robotic pancreaticoduodenectomy with major vascular resection and reconstruction.Results The mean operation time was 378 (360 ～ 480) minutes,and the mean estimated blood loss was 360 (120 ～450) ml.4 patients underwent laparoscopic wedge-resection of PV/SMV without interruption of blood flow.After pancreaticoduodenectomy using the superior mesentery artery first approach,one patient underwent resection of a segment of portal vein and superior mesenteric vein followed by an end to end anastomosis using the Da Vinci robotic system.The total blood flow occlusion time was 35 minutes.Intraoperative frozen section biopsy and postoperative pathological results were chronic pancreatitis with pancreatic cancer in all these patients.The veins were invaded by tumor in 3 patients.In the remaining 2 patients,the vascular wall showed chronic inflammation.All the surgical resection margins were tumor negative.Postoperative complications included one patient with bile leakage,one patient with upper gastrointestinal bleeding and one patient with a grade A pancreatic fistula (PF).The patient with upper gastrointestinal bleeding was managed successfully using hemostatic treatment under gastroscopy,and the other patients all recovered well after conservative therapy.There was no death in this study.The mean postoperative hospitalization stay was 14 (9 ～35) days.Conclusions Laparoscopic or Da Vinci robotic radical pancreaticoduodenectomy combined with major vascular resection is safe and feasible in selected patients with pancreatic cancer.However,surgeons need to be experienced at both open pancreaticoduodenectomy combined with vascular resection and at standard laparoscopic pancreaticoduodenectomy.

Value of artery resection in pancreatic cancer surgery / 临床肝胆病杂志

Locally advanced pancreatic cancer often invades the surrounding blood vessels. Currently, pancreatectomy combined with venous resection for the treatment of patients with venous involvement is accepted worldwide, but pancreatectomy combined with arterial resection for arterial involvement is still controversial. With reference to the latest research advances at home and abroad and the experience in our center, this article investigates the value of arterial resection in pancreatic cancer surgery, in order to provide a reference for clinical studies.

Modified orthotopic segmental small bowel transplantation in rats / 中华消化外科杂志

Objective To establish a simple and stable orthotopic segmental small bowel transplantation model in rats.Methods Eighty male SD rats were divided into donors and recipients.Orthotopic segmental small bowel transplantation was performed by end-to-side anastomosis between donor abdominal aorta tundish-shape patch with arteria mesenterica superior pedicle and abdominal aorta of the recipients; end-to-end anastomosis between the portal vein of the donors and the left renal vein of the recipients was done using the cuff technique ; the large part of the small bowel of the recipients was excised,and it was replaced by the segmental intestine of the donors.Results The operation time of the donors and recipients were (40 ± 5) minutes and (50 ±8)minutes,respectively.The warm ischemia time and cold ischemia time were (5 ± 2) minutes and (15 ± 5) minutes,respectively.The anastomosis time of arteries and veins were (5 ± 2) minutes and (4 ± 2) minutes,respectively.The survival time of 90.0％ (36/40) of rats was more than 10 days.Conclusion The modified rat model of orthotopic segmental small bowel transplantation is easy to manipulate,and has the advantages of short operation time,high survival rate and stability.

Efficacy of pancreaticoduodenectomy combined with vascular resection and reconstruction / 中华消化外科杂志

Objective To investigate the efficacy of pancreaticoduodenectomy (PD) combined with vascular resection and reconstruction.Methods The clinical data of 56 patients who received PD combined with vascular resection and reconstruction at the Southwest Hospital of Third Military Medical University from January 2007 to May 2011 were retrospectively analyzed.The incidence of perioperative complications,mortality and postoperative conditions were also analyzed.Results The mean operation time and intraoperative blood transfusion were 473 minutes (range,234-853 minutes) and 781 ml (range,0-900 ml),respectively.Seven patients did not receive blood transfusion.The median period of hospital stay was 25.9 days (range,17-100 days).A total of 43 patients underwent PD combined with vascular reconstruction.The incidence of perioperative complications and mortality rate were 34％ (19/56) and 7％ (4/56),respectively.There were 42 patients with pancreatic ductal adenocarcinoma,5 with ampullary carcinoma,3 with distal bile duct carcinoma,4 with papillary carcinoma of duodenum,1 with pancreatic neuroendocrine carcinoma and 1 with pancreatic serous cystadenoma.All patients were followed up till August 2011,and the 1-year survival rate was 57％ (32/56).The mean survival time was 13.5 months.The weight of 32 surviving patients increased and no abdominal pain occurred.Within 3 months after the operation,5 patients had slight diarrhea and were administered antidiarrheal; thrombosis in the artificial blood vessels and peritoneal effusion were found in 1 patient,while 6 months later,collateral circulation was formed and the peritoneal effusion was diminished.Conclusion PD combined with vascular resection and reconstruction can improve the quality of life for patients with pancreatic cancer and with blood vessels involvement.