ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding.
MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect.
ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2.
ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.
The modified "seagull flap" for creating a new web in treated congenital syndactyly is deseribed. The technique is easy and this method can produce a web that is wide enough to allow adequate digital separation when fingers are abducted. The contour is satisfaction.
ObjectiveTo summarize the occurrence of anal fistula in Crohn disease (CDAF) accompanying with preoperative rectal stenosis and analyze its influencing factors. Meanwhile to explore the effect of improved anal sphincter retention virtual-hanging (hereafter this text will be abbreviated as virtual-hanging) for treatment of CDAF. MethodsThe CDAF patients admitted to the Third People’s Hospital of Bengbu from January 2019 to June 2021 were retrospectively collected, who were treated with virtual-hanging. Meanwhile the multivariable logistic regression analysis was used to identify the risk factors for accompanying with preoperative rectal stenosis and which were used to establish a decision tree model by Chi squared automatic interaction detection method. ResultsA total of 234 patients with CDAF were collected, and the incidence of accompanying with preoperative rectal stenosis was 22.2% (52/234). The multivariate logistic regression analysis found that the patients with preoperative proctitis, Montreal subtype B2, fistula located above the musculi levator ani (MLA), single fistula accompanied by branches or multiple fistulas, lymphocyte count (Lym) ≥6.03×109/L, platelet count (PLT) ≥0.61×109/L, erythrocyte sedimentation rate (ESR) ≥39.11 mm/h, C-reactive protein (CRP) ≥5.13 mg/L, and brain natriuretic peptide (BNP) ≥313.26 ng/L had higher probability of accompanying with preoperative rectal stenosis (P<0.05). For the patients with or without preoperative rectal stenosis, the CD activity index score and perianal CD activity index score, and anal resting pressure all showed decreasing trends after treatment with the virtual-hanging, and the anal maximal contraction pressure showed a increasing trend as compared to before treatment. The decision tree consisted 18 nodes and 9 terminal nodes. The gain map of the decision tree model gradually increased from 0% to 100%; The index chart maintained a high level starting from 198% and then rapidly decreased to 100%. The area under the receiver operating characteristic curve of the decision tree model was 0.852 [95%CI (0.821, 0.908)], with a sensitivity of 84.35% and a specificity of 82.33%. ConclusionsThe incidence of accompanying with preoperative rectal stenosis in patients with CDAF is relatively higher. The effect of virtual-hanging for treatment of CDAF is better. For patients with preoperative proctitis, Montreal subtype B2, fistula above the MLA, single fistula accompanied by branches or multiple fistulas, and higher Lym, PLT, ESR, CRP, and BNP, attention should be paid to their accompanying with preoperative rectal stenosis. The decision tree model based on these factors to distinguish whether accompanying with preoperative rectal stenosis is better.
Objective To find a more perfect method of treating developmental dislocation of the hip(DDH). Methods From March 1994 toDecember 2002, on the basis of the ordinary operative method, Pemberton method was improved for 48 cases of DDH 49 articulatio coxae which had superficial and small acetabula but bigheads of femur. Osteotomy points were moved higher to enlarge area of bone flapturned over. A piece of full thickness ilium including periosteum was removed as a free bony graft. Capsula articularis growing thicker was made into 2 layers, of which the inner layer was used to tighten articularis and the outer layerwas used to stabilize bone flap. Results All patients were followed up for 18 months to 5 years, the function of articulatio coxae and degree of bony union, inclusion area to head of femur and ischemic necrosis of femoral head were observed through X-ray. According to Zhou Yongde’s criteria for the curative effect of congenital dislocation of the hip, there were 18 cases of 26-30 scores(3 hips), 27 cases of 21-25 scores, 2 cases of 1620 scores(3 hips), and 1 case under 15 scores, and the total superior ratewas 93.8%. Conclusion Improved Pemberton method can enlarge inclusion area tohead of femur, avoid decreasing acetabular volume, and stabilize articulatio well, which made operative indication bigger than original Pemberton method.
In order to resolve the shortcomings of traditional pedicled abdominal skin flap, the pedicled abdominal subcorium vascular-net flap was reformed and applied clinically. Twenty-eight cases with scar on hand or wrist were treated, including 20 males and 8 females. The age was ranged from 18 to 35 years old. The key point in the design was rotating 45 degrees of the flap from the primary site toward the pedicle. The ratio of the length to width of the flap was 1-1.8 : 1, and the wound of the donor site was covered by direct suture. Five to seven days later, all the flaps were divided and survived. The advantages of this flap were as follows: skin-grafting on the donor site was not necessary; the time needed for cutting the pedicle was shortened, and the flap is thinner than the traditional flap.
