Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to rest...Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.展开更多
目的探讨腹腔镜联合支架手术对结肠癌并肠梗阻患者治疗效果及预后的影响。方法选择2017年5月-2020年5月周口市中心医院结肠癌并肠梗阻患者84例作为对象,随机分为对照组(n=42例)和观察组(n=42例)。对照组采用开腹手术治疗干预,观察组先...目的探讨腹腔镜联合支架手术对结肠癌并肠梗阻患者治疗效果及预后的影响。方法选择2017年5月-2020年5月周口市中心医院结肠癌并肠梗阻患者84例作为对象,随机分为对照组(n=42例)和观察组(n=42例)。对照组采用开腹手术治疗干预,观察组先行支架手术治疗,术后择期(7-14 d)给予腹腔镜手术干预,两组术后7d对患者效果进行评估,比较两组手术指标、SRC-3基因水平、炎症因子水平、术后并发症发生率。结果观察组围术期手术时间较对照组长(P<0.05);观察组围术期出血量、切口长度、术后排气、住院时间多(短)于对照组(P<0.05);两组术后7d SRC-3 m RNA水平无统计学意义(P>0.05);观察组术后7d炎症因子水平低于对照组(P<0.05);观察组术后切口感染、腹腔出血、肺部感染、吻合口漏、炎性肠梗阻发生率,低于对照组(P<0.05)。结论先行支架手术治疗,术后给予腹腔镜手术干预治疗结肠癌并肠梗阻患者中手术创伤较小,能降低IL-6、TNF-α、IL-10等炎症因子水平,手术安全性较高,预后较好。展开更多
文摘Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
文摘目的探讨腹腔镜联合支架手术对结肠癌并肠梗阻患者治疗效果及预后的影响。方法选择2017年5月-2020年5月周口市中心医院结肠癌并肠梗阻患者84例作为对象,随机分为对照组(n=42例)和观察组(n=42例)。对照组采用开腹手术治疗干预,观察组先行支架手术治疗,术后择期(7-14 d)给予腹腔镜手术干预,两组术后7d对患者效果进行评估,比较两组手术指标、SRC-3基因水平、炎症因子水平、术后并发症发生率。结果观察组围术期手术时间较对照组长(P<0.05);观察组围术期出血量、切口长度、术后排气、住院时间多(短)于对照组(P<0.05);两组术后7d SRC-3 m RNA水平无统计学意义(P>0.05);观察组术后7d炎症因子水平低于对照组(P<0.05);观察组术后切口感染、腹腔出血、肺部感染、吻合口漏、炎性肠梗阻发生率,低于对照组(P<0.05)。结论先行支架手术治疗,术后给予腹腔镜手术干预治疗结肠癌并肠梗阻患者中手术创伤较小,能降低IL-6、TNF-α、IL-10等炎症因子水平,手术安全性较高,预后较好。
