Objective:To explore the clinical efficacy of plastic surgery of asymmetric double eyelid.Methods:The clinical data of 70 patients with asymmetrical double eyelid who underwent plastic surgery in our hospital from Apr...Objective:To explore the clinical efficacy of plastic surgery of asymmetric double eyelid.Methods:The clinical data of 70 patients with asymmetrical double eyelid who underwent plastic surgery in our hospital from April 2018 to December 2019 were retrospectively analyzed.The patients were divided into different groups based on different plastic surgery procedures.The control group(n=35 cases)were the patients who underwent double eyelid incision method,and the patients who used embedding double eyelid method were included in the observation group(n=35 cases).The operation time,intraoperative blood loss,incision size,healing time of incision,satisfaction of p1astic surgery and occurrence of complications were compared between the two groups.Results:The operation time and incision healing time of the observation group were shorter than those of the control group.The intraoperative blood 1oss and incision were less than those of the control group,and the satisfaction was higher than that of the control group.The difference was statistically significant(P<0.05).The incidence of complications in the observation group was slightly lower than the control group,but the difference was not statistically significant(P>0.05).Conclusion:For asymmetric double eyelid,it should undergo embedding double eyelid plastic surgery,because the operation time and incision healing time are shorter.And intraoperative blood 1oss and incision size are smal1er,which can improve patient satisfaction and reduce the incidence of complications.展开更多
BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to...BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.展开更多
Orbital fractures generally do not cause eyelid malposition.Studies have shown that mostly eyelid malposition is mainly due to the choice of surgical approaches of orbital fracture repair.Approaches are divided into t...Orbital fractures generally do not cause eyelid malposition.Studies have shown that mostly eyelid malposition is mainly due to the choice of surgical approaches of orbital fracture repair.Approaches are divided into transcutaneous and transconjunctival ones.The application of orbital fracture approaches depends on fractures’range and the surgeons’preferences.Eyelid malposition after orbital fracture surgery is not only an aesthetic concern but also a functional complication,which will cause eyes discomfort,such as corneal exposure and ocular irritation.Some patients may have multiple types of eyelid malposition.In this review,we summarized the surgical approaches of orbital fractures and the complications including scar,ectropion,retraction,entropion,flattening,laceration and lacrimal canaliculus avulsion and notch deformity that associated with eyelid,especially the lower eyelid.Reports revealed that the scar usually occurred in infraorbital incisions compared with subtarsal and subciliary incisions,and the transconjunctival approach had a higher incidence of entropion and flattening,and less ectropion than the transcutaneous approach.Meanwhile,pathogenesis of eyelid malposition after orbital fracture surgery are discussed.Furthermore,to prevent eyelid malposition complications,doctors should choose the appropriate orbital fracture approach according to the patient’s needs,and delicate tissue management,technical expertise,and meticulous hemostasis are necessary.Conservative treatment with taping,lubricating ointment,and steroid for eyelid malposition complications should be performed first,and then surgical intervention when the conservative treatment fails.展开更多
Background: Traditional full-incision double eyelid blepharoplasty has several significant disadvantages, including slow recovery and bilateral asymmetry, which results in high rates of patient dissatisfaction. These ...Background: Traditional full-incision double eyelid blepharoplasty has several significant disadvantages, including slow recovery and bilateral asymmetry, which results in high rates of patient dissatisfaction. These problems can be minimized using improved surgical techniques aimed at reducing tissue damage and bleeding, decreasing operation time, and especially at protecting the subcutaneous capillary network during the operation. We therefore aimed to guard the capillary network and reduce intraoperative bleeding using the practical technique of reverse orbicularis oculi muscle resection.Methods: Fifty cases of double eyelid blepharoplasty with traditional full-incision(group A) and 61 cases of reverse double eyelid blepharoplasty with a preserved capillary network(group B) were divided into two groups from October 1 to December 31, 2021 and from March 1 to May 31, 2022, respectively. The orbicularis oculi muscle was removed reversely from the front of the tarsal plate using double eyelid blepharoplasty, and the muscular membrane and subcutaneous capillary network were preserved. The operation time recorded in previous medical records was checked and compared with that of our novel technique. The recovery of double eyelid blepharoplasty was determined at 1, 4, and 12 weeks after the operation and patient satisfaction was also compared with that in previous medical records of patients in group A.Results: The reverse double eyelid blepharoplasty procedure was less complicated and easier to control than the traditional full-incision double eyelid blepharoplasty methodology. The average operation time of the double eyelid blepharoplasty cases with traditional full-incision was significantly greater than that of the cases of reverse double eyelid blepharoplasty with the capillary network preserved(45.68 ± 5.27 min and 31.11 ± 5.58 min,respectively;t=14.018 9, P=0.000 0). Patient satisfaction was 42% and 78.69%, respectively, at 1 week postoperation(χ~2=15.724 8, P=0.000 1), 62% and 90.16% at 4 weeks post-operation(χ~2=12.490 2, P=0.000 4),and 90% and 95.08%, at 12 weeks post-operation(χ~2=1.061 1, P=0.303 0).Conclusion: Reverse double eyelid blepharoplasty with preserved subcutaneous capillary network effectively decreases the operation time and improves post-operative patient satisfaction. It is a double eyelid blepharoplasty method worthy of popularization.展开更多
Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reco...Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reconstruction.In many cases,these procedures are combined,and there are many different techniques for each type of operation.Upper eyelid blepharoplasty usually includes the excision of skin,preseptal orbicularis oculi muscle,and orbital fat.Common methods of lower eyelid blepharoplasty are the skin-muscle flap,the skin flap,and the transconjunctival.Ptosis surgery is mainly divided into three types:transcutaneous,transconjunctival,and sling surgery.Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction.Different types and methods of surgery have their own advantages and disadvantages,and postoperative complications may occur.Therefore,postoperative complications of eyelid surgeries,such as dry eye symptoms,should be taken into serious consideration.Relevant literature involving these complaints can be found in PubMed by searching the terms“dry eye”,“eyelid”,“surgery”,and other related keywords.Moreover,various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index(OSDI),tear film breakup time,Schirmer test,fluorescein staining,and lissamine green staining after various eyelid surgeries.As dry eye disease is prevalent in the general population,it is more urgent to figure out what we can learn from these complaints.Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.展开更多
目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗...目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗组行眉下缘切口提升术联合重睑术,眉下切口组行眉下缘切口提升术,术后对患者进行随访,比较两组术后矫治效果,上睑缘至眉距离(The distance between the upper eyelid margin and the eyebrow,DEE)、睑裂宽度(The height of the palpebral fissure,HPF)、瞳孔中点睑缘与重睑距离(Middle pupil margin-fold distance,MPMFD)、角膜内侧睑缘与重睑距离(Medial corneal margin-fold distance,MCMFD)以及外眦处睑缘与重睑距离(Lateral canthus margin-fold distance,LCMFD)、上睑皱纹改善效果(Lemperle评分)、术后外观满意度、术后并发症发生率。结果:治疗后,联合治疗组DEE、HPF、MPMFD、MCMFD、LCMFD均高于对照组(P<0.05);治疗后,两组患者Lemperle评分均有所降低,但联合治疗组低于眉下切口组(P<0.05);治疗后,联合治疗组术后外观满意度96.88%高于眉下切口组76.67%(P<0.05);治疗后,联合治疗组与眉下切口组并发症发生率比较,差异无统计学意义(P>0.05)。结论:眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛,能够有效改善上睑松弛情况,减少上睑皱纹,且患者外观满意度较高。展开更多
While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anat...While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.展开更多
The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded st...The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.展开更多
AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention. METHODS: We retrospectively reviewed 56 patients who underw...AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention. METHODS: We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding. RESULTS: Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 (96%) patients. Enteroscopy provided accurate localization of the bleeding in 53 (95%) of 56 patients, but failed to disclose the cause of bleeding in 4 (7%). There was one case with negative intraoperative finding (2%). Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor (GIST) was most frequently diagnosed (55%). CONCLUSION: Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.展开更多
An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system...An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system was originally developed to treat intestinal perforation or to close the tissue after natural orifice transluminal endoscopic surgery.Two cases of successful management of an anastomotic leak after colorectal surgery using the OTSC system are reported.One patient avoided a temporary ileostomy.In the other,hospitalization was shortened by the use of the OTSC system.The OTSC system can be a potential option in the management of anastomotic leaks after colorectal surgery.展开更多
文摘Objective:To explore the clinical efficacy of plastic surgery of asymmetric double eyelid.Methods:The clinical data of 70 patients with asymmetrical double eyelid who underwent plastic surgery in our hospital from April 2018 to December 2019 were retrospectively analyzed.The patients were divided into different groups based on different plastic surgery procedures.The control group(n=35 cases)were the patients who underwent double eyelid incision method,and the patients who used embedding double eyelid method were included in the observation group(n=35 cases).The operation time,intraoperative blood loss,incision size,healing time of incision,satisfaction of p1astic surgery and occurrence of complications were compared between the two groups.Results:The operation time and incision healing time of the observation group were shorter than those of the control group.The intraoperative blood 1oss and incision were less than those of the control group,and the satisfaction was higher than that of the control group.The difference was statistically significant(P<0.05).The incidence of complications in the observation group was slightly lower than the control group,but the difference was not statistically significant(P>0.05).Conclusion:For asymmetric double eyelid,it should undergo embedding double eyelid plastic surgery,because the operation time and incision healing time are shorter.And intraoperative blood 1oss and incision size are smal1er,which can improve patient satisfaction and reduce the incidence of complications.
基金Shanghai Jiaotong University,No.YG2019QNB24This study was reviewed and approved by Ruijin Hospital Ethics Committee(Approval No.2019-82).
文摘BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.
基金This work was supported by the National Natural Science Foundation of China(grants 81970834 and 81870688)the Science and Technology Commission of Shanghai Municipality(grants 19441900800).
文摘Orbital fractures generally do not cause eyelid malposition.Studies have shown that mostly eyelid malposition is mainly due to the choice of surgical approaches of orbital fracture repair.Approaches are divided into transcutaneous and transconjunctival ones.The application of orbital fracture approaches depends on fractures’range and the surgeons’preferences.Eyelid malposition after orbital fracture surgery is not only an aesthetic concern but also a functional complication,which will cause eyes discomfort,such as corneal exposure and ocular irritation.Some patients may have multiple types of eyelid malposition.In this review,we summarized the surgical approaches of orbital fractures and the complications including scar,ectropion,retraction,entropion,flattening,laceration and lacrimal canaliculus avulsion and notch deformity that associated with eyelid,especially the lower eyelid.Reports revealed that the scar usually occurred in infraorbital incisions compared with subtarsal and subciliary incisions,and the transconjunctival approach had a higher incidence of entropion and flattening,and less ectropion than the transcutaneous approach.Meanwhile,pathogenesis of eyelid malposition after orbital fracture surgery are discussed.Furthermore,to prevent eyelid malposition complications,doctors should choose the appropriate orbital fracture approach according to the patient’s needs,and delicate tissue management,technical expertise,and meticulous hemostasis are necessary.Conservative treatment with taping,lubricating ointment,and steroid for eyelid malposition complications should be performed first,and then surgical intervention when the conservative treatment fails.
文摘Background: Traditional full-incision double eyelid blepharoplasty has several significant disadvantages, including slow recovery and bilateral asymmetry, which results in high rates of patient dissatisfaction. These problems can be minimized using improved surgical techniques aimed at reducing tissue damage and bleeding, decreasing operation time, and especially at protecting the subcutaneous capillary network during the operation. We therefore aimed to guard the capillary network and reduce intraoperative bleeding using the practical technique of reverse orbicularis oculi muscle resection.Methods: Fifty cases of double eyelid blepharoplasty with traditional full-incision(group A) and 61 cases of reverse double eyelid blepharoplasty with a preserved capillary network(group B) were divided into two groups from October 1 to December 31, 2021 and from March 1 to May 31, 2022, respectively. The orbicularis oculi muscle was removed reversely from the front of the tarsal plate using double eyelid blepharoplasty, and the muscular membrane and subcutaneous capillary network were preserved. The operation time recorded in previous medical records was checked and compared with that of our novel technique. The recovery of double eyelid blepharoplasty was determined at 1, 4, and 12 weeks after the operation and patient satisfaction was also compared with that in previous medical records of patients in group A.Results: The reverse double eyelid blepharoplasty procedure was less complicated and easier to control than the traditional full-incision double eyelid blepharoplasty methodology. The average operation time of the double eyelid blepharoplasty cases with traditional full-incision was significantly greater than that of the cases of reverse double eyelid blepharoplasty with the capillary network preserved(45.68 ± 5.27 min and 31.11 ± 5.58 min,respectively;t=14.018 9, P=0.000 0). Patient satisfaction was 42% and 78.69%, respectively, at 1 week postoperation(χ~2=15.724 8, P=0.000 1), 62% and 90.16% at 4 weeks post-operation(χ~2=12.490 2, P=0.000 4),and 90% and 95.08%, at 12 weeks post-operation(χ~2=1.061 1, P=0.303 0).Conclusion: Reverse double eyelid blepharoplasty with preserved subcutaneous capillary network effectively decreases the operation time and improves post-operative patient satisfaction. It is a double eyelid blepharoplasty method worthy of popularization.
基金This study was supported by the State Scholarship Fund from China Scholarship Council,China(No.202008080258).
文摘Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reconstruction.In many cases,these procedures are combined,and there are many different techniques for each type of operation.Upper eyelid blepharoplasty usually includes the excision of skin,preseptal orbicularis oculi muscle,and orbital fat.Common methods of lower eyelid blepharoplasty are the skin-muscle flap,the skin flap,and the transconjunctival.Ptosis surgery is mainly divided into three types:transcutaneous,transconjunctival,and sling surgery.Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction.Different types and methods of surgery have their own advantages and disadvantages,and postoperative complications may occur.Therefore,postoperative complications of eyelid surgeries,such as dry eye symptoms,should be taken into serious consideration.Relevant literature involving these complaints can be found in PubMed by searching the terms“dry eye”,“eyelid”,“surgery”,and other related keywords.Moreover,various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index(OSDI),tear film breakup time,Schirmer test,fluorescein staining,and lissamine green staining after various eyelid surgeries.As dry eye disease is prevalent in the general population,it is more urgent to figure out what we can learn from these complaints.Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.
文摘目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗组行眉下缘切口提升术联合重睑术,眉下切口组行眉下缘切口提升术,术后对患者进行随访,比较两组术后矫治效果,上睑缘至眉距离(The distance between the upper eyelid margin and the eyebrow,DEE)、睑裂宽度(The height of the palpebral fissure,HPF)、瞳孔中点睑缘与重睑距离(Middle pupil margin-fold distance,MPMFD)、角膜内侧睑缘与重睑距离(Medial corneal margin-fold distance,MCMFD)以及外眦处睑缘与重睑距离(Lateral canthus margin-fold distance,LCMFD)、上睑皱纹改善效果(Lemperle评分)、术后外观满意度、术后并发症发生率。结果:治疗后,联合治疗组DEE、HPF、MPMFD、MCMFD、LCMFD均高于对照组(P<0.05);治疗后,两组患者Lemperle评分均有所降低,但联合治疗组低于眉下切口组(P<0.05);治疗后,联合治疗组术后外观满意度96.88%高于眉下切口组76.67%(P<0.05);治疗后,联合治疗组与眉下切口组并发症发生率比较,差异无统计学意义(P>0.05)。结论:眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛,能够有效改善上睑松弛情况,减少上睑皱纹,且患者外观满意度较高。
文摘While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.
文摘The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.
文摘AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention. METHODS: We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding. RESULTS: Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 (96%) patients. Enteroscopy provided accurate localization of the bleeding in 53 (95%) of 56 patients, but failed to disclose the cause of bleeding in 4 (7%). There was one case with negative intraoperative finding (2%). Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor (GIST) was most frequently diagnosed (55%). CONCLUSION: Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.
文摘An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system was originally developed to treat intestinal perforation or to close the tissue after natural orifice transluminal endoscopic surgery.Two cases of successful management of an anastomotic leak after colorectal surgery using the OTSC system are reported.One patient avoided a temporary ileostomy.In the other,hospitalization was shortened by the use of the OTSC system.The OTSC system can be a potential option in the management of anastomotic leaks after colorectal surgery.
