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Experience of Laparoscopy in Diagnosis and Treatment of Bile Leakage or Intestinal Fistula in 12 Cases

目的探讨腹腔镜在胆瘘或肠瘘诊治中的应用价值。 方法回顾性分析2008年11月至2013年4月期间广西壮族自治区桂东人民医院和广西壮族自治区民族医院收治的应用腹腔镜诊治的12例胆瘘或肠瘘患者的临床资料。 结果12例患者中胆瘘7例，肠瘘5例，均在手术后发生，均经腹腔镜探查后确诊。12例患者均在腹腔镜下行再次置管引流、缝闭迷走胆管或肠瘘管等处理。手术时间60～170 min、（90±19）min，住院时间3～7 d、（4±1）d，术中出血量20～150 mL、（70±12）mL，术后均顺利康复出院。术后12例患者均获访，随访时间为1个月～5年，平均随访时间为36个月，未发现胆瘘或肠瘘复发者。 结论腹腔镜探查有助于胆瘘或肠瘘的诊断，并可达到微创手术治疗的目的。

TELESCOPIC ADHESIVE ANASTOMOSIS OF SMALL BLOOD VESSEL APPLIED IN FORMATION OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS

The formation of an arteriovenous fistual for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time-consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40 +/- 0.20 mm (radial artery) or 2.40 +/- 0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180 degrees apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thickness of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so-formed fistula would fulfill the need of hemodialysis.

藏线缝合修补术治疗中低位直肠阴道瘘

目的　总结藏线缝合修补术在治疗中低位直肠阴道瘘的可行性，并总结临床经验。 方法　回顾分析2007年10月－2011年6月采用藏线缝合修补术治疗12例中低位直肠阴道瘘患者的临床资料，观察术后创面愈合时间、肛门功能等情况，并对患者进行随访。 结果　12例患者经一次手术治愈，10例随访1年, 肛门功能无明显影响，无复发现象。 结论　藏线缝合修补术治疗中低位直肠阴道瘘是一种安全有效的手术方法。

颈动脉海绵窦漏致低灌注性视网膜病变一例

先天性冠状动脉瘘外科治疗

目的总结外科手术矫治先天性冠状动脉瘘的临床结果及相关经验。方法回顾性分析 2010 年 1 月至 2019 年 6 月就诊于泰达国际心血管病医院的 25 例先天性冠状动脉瘘患者的临床资料，其中男 17 例、女 8 例，年龄 5 个月至 53 岁，中位年龄 5 岁。其中合并房间隔缺损 1 例，合并动脉粥样硬化 1 例。手术方式：直接缝闭瘘口 16 例，心包补片修补瘘口 9 例。1 例患者非体外循环下手术矫治；其余 24 例均在体外循环下行手术矫治，其中 2 例心脏未停跳下外科矫治。结果所有患者顺利出院，体外循环时间（59.75±22.75）min，主动脉阻断时间（34.55±13.22）min。术中探查发现均为单一瘘口。右冠状动脉-左室瘘 2 例（8.0%）、右冠状动脉-右房瘘 3 例（12.0%）、右冠状动脉-右室瘘 10 例（40.0%）、左冠状动脉-右室瘘 4 例（16.0%）、左冠状动脉-右房瘘 2 例（8.0%）、左冠状动脉-肺动脉瘘 4 例（16.0%），其中 1 例为罕见的窦房结动脉-右房瘘，窦房结动脉起自右冠状动脉。患者术后均给予阿司匹林抗血小板治疗 3 个月，其中 2 例随访中发现瘘口残端血栓形成。所有病例已扩张冠状动脉，未恢复正常内径。随访 1 个月至 3 年，无患者死亡和心肌缺血及残余瘘发生。结论有症状或者分流量明显的先天性冠状动脉瘘，应尽早手术矫治，术中根据解剖特点确定手术方式，外科手术结果满意。

带蒂肋间肌瓣防治支气管胸膜瘘17例临床分析

目的 探讨采用带蒂肋间肌瓣包埋支气管残端预防和治疗支气管胸膜瘘的临床意义，总结治疗经验。 方法  回顾性分析2001年10月至2009年6月重庆市江津中心医院对17例肺癌、肺结核伴支气管扩张、支气管扩张患者行肺切除术后采用带蒂肋间肌瓣包埋支气管残端的临床资料。14例为预防性治疗，男8例，女6例；年龄21～69岁；其中6例行全肺切除术，8例行肺叶切除术。3例行肺癌肺叶切除术后支气管胸膜瘘二期修补术，男2例，女1例；年龄58～68岁。 结果 预防性治疗14例患者，手术时间135～275 min，均治愈，无并发症；随访12例，随访时间6～60个月，随访期间无1例发生支气管胸膜瘘。3例肺癌术后支气管胸膜瘘接受带蒂肋间肌瓣治疗患者手术时间75～165 min，2例痊愈，1例同时行局部胸膜内胸廓成形术痊愈；3例均随访6～24个月，无1例再发支气管胸膜瘘。 结论  带蒂肋间肌瓣包埋支气管残端防治支气管胸膜瘘安全有效，尤其适用于肺切除术后支气管残端或吻合口的加固预防支气管胸膜瘘的发生。

Analysis of Risk Factors for Pancreatic Fistula after Distal Pancreatectomy

ObjectiveTo explore risk factors for pancreatic fistula and severe pancreatic fistula (grade B and C) after distal pancreatectomy. MethodsOne hundred and fifty patients underwent distal pancreatectomy were collected and analyzed from January 2012 to December 2014 in this retrospective study,among which 61 cases were male,89 cases were female,age from 18 to 78 years old.The risk factors for pancreatic fistula and severe pancreatic fistula after distal pancreatectomy were analyzed by univariate and multivariate logistic regression analysis. ResultsIn these patients,136 cases were underwent laparotomy,8 cases were underwent total laparoscopic surgery,6 cases were underwent hand assisted laparoscopic surgery;39 cases were preserved spleen,111 cases were combined splenectomy.Technique for closure of the pancreas remnant,15 cases were used cut stapler (Echelon 60,EC60),77 cases were used cut stapler (Echelon 60,EC60) combined with manual suture,52 cases were underwent manual cut and suture,and 6 cases were underwent pancreatic stump jejunum anastomosis.The total incidence of complications was 36.0%(54/150),the postoperative hospitalization time was (9.1±6.2) d,the reoperation rate was 2.7%(4/150),the perioperative mortality was 0,the incidence of postoperative pancreatic fistula was 34.7%(grade B and C was 10.0%).In these patients with postoperative pancreatic fistula,the postoperative hospitalization time was (12.6±9.3) d,the reoperation rate was 7.7%(4/52).The results of the univariate and multivariate logistic regression analysis showed that the hypoproteinemia (OR=4.919,P<0.05) was the risk factor for pancreatic fistula after distal pancreatectomy,the malignancy (OR=4.125,P<0.05) was the risk factor for severe pancreatic fistula after distal pancreatectomy. ConclusionsIncidence of pancreatic fistula after distal pancreatectomy is related to hypoproteinemia before operation,it is needed to improve the nutritional status by nutrition treatment for reducing postoperative pancreatic fistula.If patient with malignancy has postoperative pancreatic fistula,it is likely to be severe pancreatic fistula.

SURGICAL TREATMENT OF LYMPHATIC FISTULA OF SCROTUM

Abstract In order to investigate the different methods of operation to treat lymphatic fistula of scrotum, subtotal scrotectomy, ligation of lymphatic vessel and anastomosis of inguinal lymph nodes with greater saphenous vein were performed. From 1980 to 1994, 15 patients were treated, among them, 2 patients had complicated with chyluria. The clinical results were satisfactory after a follow-up for six months to three years. It was considered thatthe anastomosis of inguinal lymph node with the greater saphenous vein was the most effective method, besides, the method was simple and safe, as well.

Fogarty balloon catheter embolectomy for arteriovenous graft thrombosis in hemodialysis patients: an analysis of outcomes

Objective To evaluate the effect of Fogarty balloon catheter embolectomy on arteriovenous graft thrombosis in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 11 patients who underwent maintaining hemodialysis and arteriovenous graft thrombosis through Fogarty balloon catheter embolectomy between March 2010 and November 2014. The thrombosed graft was incised, and a 4 or 6 French catheter was placed in the venous and arterial limbs of the graft respectively. The Fogarty balloon was passed beyond the thrombus and pulled out after saline was infused into the balloon, and the thrombus was taken out. The procedure was considered unsuccessful if the blood flow was not re-established or if the graft re-thrombosed within hours. Results The treatment was successfully performed in all the patients. Of the 11 patients, 3 received balloon dilation due to stenosis of venous anastomosis, and 2 received angioplasty due to underlying arterial anastomosis lesion. After corresponding measures were taken, the thrombus of all the 11 patients were taken out, and blood flow was recovered. Two to seven days after surgery, low molecular weight heparin was used for anti-coagulation. The blood flow of all arteriovenous grafts reached over 250 mL/min. All the patients were followed up for 4 to 30 months. During the follow-up, the arteriovenous graft remained functional in 5 patients; 4 patients had re-thrombosis on day 2, 3, 25, and 71 after surgery respectively; one changed to undergo peritoneal dialysis due to rupture and infection of the graft, and one patient was transferred to another hospital in another area and was not followed up any longer. The therapy was successful in 81.8% of this group of patients. Conclusion Fogarty balloon catheter embolectomy is effective in restoring patency of thrombosed arteriovenous graft in hemodialysis patients, and more studies are needed.

Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreatico-duodenectomy

ObjectiveTo investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. MethodsEighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group (n=42) and imbedding pancreaticojejunostomy (technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures) group as modified group (n=36). The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. ResultsThe rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group (8.3% vs. 31.0%, P < 0.05), pancreaticojejunostomy time ofmodified group was significantly shortened [(35.6±12.4) min vs. (52.8±24.6) min, P < 0.05] and total operative time also shortened [(322.4±23.6) min vs. (384.2±30.2) min, P < 0.05). There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, ?incision infection, and hospital stays (P > 0.05)]. Conciusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.