Murine Ileocolic Bowel Resection with Primary Anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn’s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.     

Emergency Resection in Treatment of Diverticular Disease of Colon Complicated by Peritonitis

Of a consecutive series of 25 patients with peritonitis secondary to colonic diverticular disease all, except one with faecal peritonitis, underwent some form of emergency resection.All the three patients with faecal peritonitis died, but the 22 with purulent peritonitis survived. The average duration of the emergency admission of the 22 survivors was 25.4 days, and in nine (41%) of them intestinal continuity had been restored by the end of that admission.Thus some form of emergency resection is the operation of choice in patients with spreading peritonitis due to diverticular disease of the sigmoid colon.     

改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。     

内支架对大肠癌急性梗阻一期切除吻合疗效的探讨

目的:探讨内支架对大肠癌急性梗阻一期切除吻合的疗效。方法:选择2010年7月至2012年7月来我院急诊治疗确诊为大肠癌导致急性肠梗阻的患者98例,随机分为观察组和对照组各49例,观察组患者植入内支架,一周后行一期吻合切除术,对照组行急诊切除手术。观察和比较两者患者一期切除率、治疗效果和并发症的情况。结果:观察组一期切除率为95.7%(47例)较对照组分71.4%(35例)高;两组比较差异均有统计学意义(x2=22.9,P0.05);实验组症状缓解48例(缓解率98%),对照组症状缓解33例(缓解率67.3%),两组临床疗效比较有显著性差异(x2=33.3,P0.001),实验组术后并发症发生率(10.2%)要明显小于对照组(26.5%)(x2=9.6,P0.01)。结论:大肠癌急性梗阻术前植入内支架能有效提高患者的一期手术吻合率和治疗效果,降低术后并发症,值得在临床推广。     

护理干预在直肠癌前切除术后并发吻合口瘘的应用及效果

目的：探讨护理干预在直肠癌前切除术后并发吻合口瘘的应用及效果。方法：将179例患者分为对照组和观察组,分别给予 常规护理和综合护理,观察护理干预在直肠癌前切除术后并发吻合口瘘的应用效果。结果：对照组术后3 d内5例患者发生吻合 口瘘,3例患者术后4-7 d发生吻合口瘘;观察组术后3 d内1例患者发生吻合口瘘,1例患者术后4-7 d发生吻合口瘘,两组吻合 口发生率差异有统计学意义（x2=3.880,P＜0.05）。经过护理和治疗后,观察组患者吻合口瘘愈合时间明显短于对照组（t=4.026,P＜ 0.05）。对照组SAS 阳性率69.23%,观察组50.00%,二者之间具有统计学差异（x2=5.186,P＜0.05）;对照组SDS阳性率61.54%,观 察组40.00%,二者之间具有统计学差异（x2=4.978,P＜0.05）。结论：合理有效的综合护理措施可以减少吻合口瘘和医患矛盾的发 生,提高患者对治疗的满意度,促进医患关系的和谐。     

降落伞式缝合在肠道吻合术中的应用

目的：通过胆肠吻合缝合技术的改进,减少并发症的发生。方法：对52例肠道吻合手术采用降落伞式缝合。结果：降落伞式胆肠吻合时间平均20min,明显缩短了手术时间,全部病例均未出现胆肠吻合漏,无死亡病例。结论：降落伞式胆肠吻合术具有操作简便、省时、并发症少等特点。     

降落伞式缝合在肠道吻合术中的应用

目的:通过胆肠吻合缝合技术的改进,减少并发症的发生。方法:对52例肠道吻合手术采用降落伞式缝合。结果:降落伞式胆肠吻合时间平均20 min,明显缩短了手术时间,全部病例均未出现胆肠吻合漏,无死亡病例。结论:降落伞式胆肠吻合术具有操作简便、省时、并发症少等特点。     

Impact of Ileocecal Resection and Concomitant Antibiotics on the Microbiome of the Murine Jejunum and Colon

Ileocecal resection (ICR) is a commonly required surgical intervention in unmanageable Crohn’s disease and necrotizing enterocolitis. However, the impact of ICR, and the concomitant doses of antibiotic routinely given with ICR, on the intestinal commensal microbiota has not been determined. In this study, wild-type C57BL6 mice were subjected to ICR and concomitant single intraperitoneal antibiotic injection. Intestinal lumen contents were collected from jejunum and colon at 7, 14, and 28 days after resection and compared to non-ICR controls. Samples were analyzed by16S rRNA gene pyrosequencing and quantitative PCR. The intestinal microbiota was altered by 7 days after ICR and accompanying antibiotic treatment, with decreased diversity in the colon. Phylogenetic diversity (PD) decreased from 11.8 ± 1.8 in non-ICR controls to 5.9 ± 0.5 in 7-day post-ICR samples. There were also minor effects in the jejunum where PD values decreased from 8.3 ± 0.4 to 7.5 ± 1.4. PCoA analysis indicated that bacterial populations 28 days post-ICR differed significantly from non-ICR controls. Moreover, colon and jejunum bacterial populations were remarkably similar 28 days after resection, whereas the initial communities differed markedly. Firmicutes and Bacteroidetes were the predominant phyla in jejunum and colon before ICR; however, Firmicutes became the vastly predominant phylum in jejunum and colon 28 days after ICR. Although the microbiota returned towards a homeostatic state, with re-establishment of Firmicutes as the predominant phylum, we did not detect Bacteroidetes in the colon 28 days after ICR. In the jejunum Bacteroidetes was detected at a 0.01% abundance after this time period. The changes in jejunal and colonic microbiota induced by ICR and concomitant antibiotic injection may therefore be considered as potential regulators of post-surgical adaptive growth or function, and in a setting of active IBD, potential contributors to post-surgical pathophysiology of disease recurrence.     

Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study

ABSTRACT: BACKGROUND: The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. METHODS: 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. RESULTS: Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11 %) vs. 11 of 36 patients (31 %); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10-110) vs. 26 days (range 12 - 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28 % vs. 0 %; p = 0.002 and 11 % vs. 0 %; p = 0.046). The overall Inhospital mortality rate was 6 % (4 of 72 patients) without any differences between the study groups. CONCLUSIONS: The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.     

腹腔镜结肠癌根治术治疗老年局部进展期结肠癌的疗效和安全性及对患者免疫功能的影响

目的:比较分析腹腔镜和开腹结肠癌根治术治疗老年局部进展期结肠癌的临床疗效和安全性及对患者免疫功能的影响。方法:根据随机数字表法,将64例老年局部进展期结肠癌患者随机分为腹腔镜组和开腹组,每组各32例,分别接受腹腔镜、开腹结肠癌根治术治疗。比较两组手术相关指标、手术前后免疫功能变化、术后近远期并发症的发生情况及预后。结果:与开腹组比较,腹腔镜组患者手术时间明显延长,而术中出血量、胃肠功能恢复时间则明显缩短(P<0.05)。两组淋巴结清扫数比较差异无统计学意义(P>0.05)。术后3个月,腹腔镜组CD4+、CD4+/CD8+比值均明显高于开腹组(P<0.05),且与术前比较差异均无统计学意义(P>0.05)。与开腹组比较,腹腔镜组患者术后切口感染的发生率明显降低(P<0.05),两组其他近期并发症如吻合口瘘、吻合口出血,远期并发症如黏连性肠梗阻、切口疝的发生率比较差异均无统计学意义(P>0.05)。腹腔镜组与开腹组术后2年的局部复发率、1年和2年生存率比较差异均无统计学意义(P>0.05)。结论:腹腔镜手术和开腹手术治疗老年局部进展期结肠癌患者的临床疗效和预后相当,但腹腔镜手术对患者的免疫功能影响更小,且安全性更高。     

Stains for Strands in Sieve Tubes

Two very simple procedures give a staining-fixation of the so-called “strands” as well as portions of the sieve plates of sieve tubes of various broad-leaved deciduous trees. One procedure consists of placing hand-made sections (radial or tangential) of inner bark for 5 min in a 0.2% solution of ponceau S in 3% trichloroacetic acid, then soaking 5 min in 5% acetic acid. A second procedure consists of placing sections in 0.001% nigrosin in 2% acetic acid for approximately 15 hr, then washing briefly in distilled water. In the former procedure, strands, sieve plates, and what appears to be plasmalemma, appear reddish or pink, while cell walls do not stain. In the latter, strands and sieve plates appear bluish but phloem cell walls also become bluish, although xylem cell walls usually remain unstained.