Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3±11.0 years (ranging 16-57 years). We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.
Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.
【Abstract】ObjectiveTo investigate the anatomic feature and special clinical manifestations of variant right intrahepatic bile duct draining into left hepatic bile duct near the umbilical portion. MethodsVariant right intrahepatic bile ducts joining into left hepatic bile ducts near the umbilical portions were identified through cholangiograms in 52 patients, who were included in this study. Their history, clinical process and operations were reviewed. ResultsThere were total 38 cases of intrahepatic gallstone in this group. High incidence of intrahepatic calculi was found in variant right intrahepatic bile ducts （23/38 cases, 60.52%） and left hepatic ducts （33/38 cases, 86.84%）. Most of these cases were accompanied with dilatation and stricture of bile ducts in these area. The gallstones in the variant right intrahepatic bile ducts were not detected in 8 cases (8/23) and the rate of residual gallstone was as high as 86.95%(20/23). Injury of variant right intrahepatic bile duct took place when left hepatectomy was performed in one case. ConclusionGallstone is very likely to be formed in the variant right intrahepatic bile duct due to derangement of bile hydrokinetics and compression of blood vessel. Special attention should be paid to the diagnosis and operation of this abnormity.
Objective To study the cl inical effect of expert tibial nail (ETN) in the treatment of the complex tibial fractures of type C. Methods From May to October 2008, 10 cases of complex tibial fractures of type C were treated with unreamed ETN and closed reduction. There were 7 males and 3 females aging from 23 to 50 years with an average age of 39 years. Fracture was caused by traffic accident in 6 cases, by crush in 2 cases, and by fall ing from height in 2 cases. According to Association for the Study of Internal Fixation (AO/ASIF) classification, there were 2 cases of 42-C1 fractures, 4 cases of42-C2 fractures, and 4 cases of 42-C3 fractures; including 4 cases of closed fractures and 6 cases of open fractures (2 cases of Gustilo type I and 4 cases of Gustilo type II). Results The mean duration of surgery and blood loss were 75 minutes (range, 60-110 minutes) and 55 mL (range, 20-100 mL), respectively. All the incision healed by first intension without compl ication of infection. All cases were followed up for 12-17 months (average 14 months). X-ray films showed that no breakage of nail, iatrogenic fracture, l imb shortening, and angulation deformity occurred. All fractures healed after 3-8 months (average 4.2 months). At last follow-up according to Johner-Wruhs standard for the functional recovery, the results were excellent in 8 cases and good in 2 cases. Conclusion ETN has an angular stable locking system for intramedullary nails, which can enhance axial and transverse stabil ity for the treatment of complex tibial fractures of type C. It will provide firm fixation and minimal invasion.
局部解剖学是一门非常重要的医学课程,是基础医学与临床医学的桥梁。重视局部解剖课外科技活动,能有效增强医学生的自学能力、团结协作能力、科研创新能力以及综合素质的提高。
ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.
Objective To observe the relationship between shallow optic cup，small disc and occurrence in patients with nonarteritic anterior ischemic optic neuropathy (NAION).Methods Ninetysix patients（96 diseased eyes）who accorded with the diagnosis criteria for NAION，with duration ge; three months and optic disc edema in paracmasis were selected. The fellow eyes of 96 NAION patients and 80 normal eyes were selected in our study. The horizontal and vertical disc and cup diameters，optic cup depth, and peripapillary retinal nerve fiber layer (RNFL) thickness were measured by quot;crossquot; and quot;ringquot; scan of optical coherence tomography (OCT，Humphrey 2000，German Carl Zeiss Company) inspection system. The cup depth were classified four grades by cup shape according to OCT images：GradeⅠ，bottom of optic cup above the anterior plane of peripapillary neuroepithelial layer（PNL）；GradeⅡ，bottom of optic cup above the plane of PNL；Grade Ⅲ，bottom of optic cup between the plane of PNL and choroidal pigment epithelium；Grade Ⅳ，bottom of optic cup under the plane of choroidal pigment epithelium connection. The grades of optic cup and value in three groups were statistically analyzed. The follow up ranged from six months to three years.Results The disc diameter in horizontal scanning of diseased eyes，fellow eyes and normal eyes were (1.29plusmn;0.19), (1.32plusmn;0.17), (1.40plusmn;0.15) mm，and diameters in vertical scanning were (1.52plusmn;0.14), (1.49plusmn;0.17), (1.60plusmn;0.22) mm, respectively. Compared the diseased eyes and fellow eyes with normal eyes，the difference were statistically significant in horizontal scanning (t=4.291,3.315; P＜0.05) and in vertical scanning (t=2.812, 3.654; P＜0.05). Compared the diseased eyes with fellow eyes，the difference of average diameter were not statistically significant in horizontal and vertical scanning (t=1.153,1.335; P＞0.05). Of the diseased eyes，GradeⅠoptic cup in 36 eyes（37.50），Grade Ⅱ-Ⅲoptic cup in 52 eyes（54.17%），Grade Ⅳoptic cup in eight eyes（8.33%），and GradeⅠ-Ⅲ optic cup in 88 eyes（91.67%）were found. Of the fellow eyes，GradeⅠoptic cup in 18 eyes（18.75%），Grade Ⅱ-Ⅲoptic cup in 69 eyes（71.88%），Grade Ⅳoptic cup in nine eyes（9.34%），and GradeⅠ-Ⅲ optic cup in 87 eyes（9066%）were found. Compared the average RNFL thickness of diseased eyes with the fellow eyes and normal eyes，the differences were statistically significant in temporal, upper, nasal, lower quadrant(t=12.862，10.147，15.046，8.180，12.859，9.562，12.174，8.632；P＜0.001). Compared the average RNFL thickness of the fellow eyes and normal eyes，the differences were not statistically significant in all quadrants（t=1.040，1.576，1.062，1.192；P＞0.05）. During the followup，eight eyes with recurrence which optic cup were GradeⅠand Ⅱin diseased eyes；44 eyes（45.8%）occurred NAION. Correlation analysis showed that there was negative correlation between incidence of fellow eye and optic cup depth(t=-0.757, P=0.000). Conclusion Optic cup and disk in NAION patients are smaller than that in the normal，the anatomical characteristics of shallow cup and small disc was one of the NAION pathogenesis.
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
ObjectiveTo explore the prevalence and adjacency of the tributaries of superior mesenteric vessel. MethodsThis study is a prospective study. The patients with right-sided colonic malignant tumor who underwent laparoscopic complete mesocolon excision at the Division of Colorectal Surgery of Peking Union Medical College Hospital from July 2016 to September 2022 were collected. The real-time observation and evaluation of vascular anatomy was performed by the operator and recorded by a resident. The continuous variables without a normal distribution were summarized as median (P25, P75). The categorical variables were presented as number (%). ResultsA total of 200 patients were enrolled, including 114 males and 86 females, with an age of 63.5 (53.5, 72.0) years. The prevalence of ileocolic artery and vein was 98.0% (196/200) and 98.5% (197/200), respectively. There were 168 (86.2%) cases of the ileocolic vein accompanied the course of the ileocolic artery at the origin in 195 patients with simultaneous presence of ileocolic artery and vein. The right colic artery and vein was present in 39.5% (79/200) and 18.5% (37/200) patients, respectively. The prevalence of the middle colic artery and vein was 96.5% (193/200) and 90.5% (181/200), respectively. And the prevalence of the middle colic vein accompanied the path of the middle colic artery at the root was 67.8% (118/174) in the 174 patients with simultaneous presence of middle colic artery and vein. The trunk length of the middle colic artery was 2.2 (1.6, 3.2) cm. The Henle trunk was present in 185 (92.5%) cases, with a trunk length of 1.00 (0.50, 1.40) cm, and its lower edge was 2.80 (2.20, 3.30) cm from the junction of the pancreatic head and the horizontal part of the duodenum.ConclusionsThe results from the data analysis of this study suggest that the ileocolic artery and vein are present most constantly with a high incidence of the ileocolic vein accompanied the course of the ileocolic artery at the origin of superior mesenteric vessels. Therefore ileocolic artery and vein are expected to serve as an optimal anatomical landmarks for the caudal-to-cranial medial approach in laparoscopic complete mesocolon excision.