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Modern Plastic Surgery 2012年第2期2卷 35-38页

作者： Medhat E. Habib Christoph H. Reuter Department of Plastic Reconstructive and Craniofacial Surgery Mafraq Hospital Abu Dhabi United Arab of Emirates

We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.

关键词： Hand Burn Mutilating Degloving Injury Superficial Inferior epigastric Artery Flap

A Point-Specific Site for Placement of epigastric Port in Iaparoscopic Management of Gallbladder Disease: An Observational Study

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Surgical Science 2013年第7期4卷 309-312页

作者： Mushtaq Chalkoo Shahnawaz Ahangar Faud Sadiq Baqal Alfar Ah Nafae Muntakhab Nafae Raiees Ahmad Malla Ajaz Ahmad Mallar Department of Surgery Government Medical College Srinagar India

Backgound: Laparoscopic cholecystectomy has revolutionized the world in the surgical management of benign gallbladder disease. However, for any procedure to learn properly, anatomy becomes a major concern. Aims and Objectives: We present a point, a convenient site, speedily accessible by our maneuver of placing epigastric port on the patient. Materials and Methods: This is an outcome of an observation with the prospective study of 100 patients irrespective of age, sex, body habitus and severity of gallstone disease. Our point for epigastric port satisfies all the criteria for an ideal port. Results: Our general observation with majority of patients with this point specific epigastric port placement was that it is easy to locate, needs less thrust on trocar for creation, stays on the linea alba, is easily maneuverable facilitates safe, easy and speedy dissection, causes less portal bleeds and is easy to angulate towards the right of falciform ligament. Conclusion: The point specific epigastric port conveys many benefits to the operating surgeon in terms of easy location, adds safety and speed to the procedure, causes less portal bleeds, needs less thrust and is easy to angulate to the right of the falciform ligament adding technical ease to the surgeon. It is easy to be learnt, taught and practiced by the young surgeons.

关键词： Laparoscopic Cholecystectomy epigastric Port Point Specific Anatomy

A rare cause of acute abdomen–Spontaneous rectus sheath hematoma

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Asian Pacific Journal of Tropical Biomedicine 2016年第10期6卷 892-895页

作者： Hock Chin Chong Feng Yih Chai Yew Eng Tan Sophia Si Ling Heng Siti Asilah Mohd Desa Department of Surgery Hospital Queen Elizabeth Department of Surgery Hospital Keningau

Spontaneous rectus sheath hematoma(SRSH) is a rare entity that mimics acute abdomen.Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms presentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis.Stable SRSH can be managed conservatively with good outcome.

关键词： Rectus muscle injury epigastric vessel Spontaneous Acute abdomen

Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy

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World Journal of Gastroenterology 2016年第17期22卷 4416-4420页

作者： Kosuke Takagaki Satoshi Osawa Tatsuhiro Ito Moriya Iwaizumi Yasushi Hamaya Hiroe Tsukui Takahisa Furuta Hidetoshi Wada Satoshi Baba Ken Sugimoto First Department of Medicine Hamamatsu University School of Medicine Department of Endoscopic and Photodynamic Medicine Hamamatsu University School of Medicine Department of Diagnostic Pathology Hamamatsu University School of Medicine Center for Clinical Research Hamamatsu University School of Medicine First Department of Surgery Hamamatsu University School of Medicine

An inverted Meckel's diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel's diverticulum, who was preoperatively diagnosed using doubleballoon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel's diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel's diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.

关键词： Inverted Meckel’s diverticulum Doubleballoon enteroscopy Small bowel tumor epigastric pain Heterotop

Gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia

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World Journal of Gastroenterology 2013年第32期19卷 5357-5364页

作者： Jiao Yu Shi Liu Xiu-Cai Fang Jun Zhang Jun Gao Ying-Lian Xiao Li-Ming Zhu Fen-Rong Chen Zhao-Shen Li Pin-Jin Hu Mei-Yun Ke Xiao-Hua Hou Division of Gastroenterology Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Division of Gastroenterology Peking Union Medical College HospitalChinese Academy of Medical Sciences Division of Gastroenterology Second Affiliated Hospital of Medical CollegeXi’an Jiaotong University Division of Gastroenterology Changhai HospitalSecond Military Medical University Division of Gastroenterology First Affiliated Hospital of Sun Yat-sen University

AIM:To study the evolution of gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia(FD).METHODS:From June 2008 to November 2009,a total of 1049 patients with FD(65.3%female,mean age42.80±11.64 years)who visited the departments of gastroenterology in Wuhan,Beijing,Shanghai,Guangzhou,and Xi’an,China were referred for this study.All of the patients fulfilled the RomeⅢcriteria for FD.Baseline demographic data,dyspepsia symptoms,anxiety,depression,sleep disorder,and drug treatment were assessed using self-report questionnaires.Patients completed questionnaires at baseline and after1,3,6 and 12 mo follow-up.Comparison of dyspepsia symptoms between baseline and after follow-up was explored using multivariate analysis of variance of repeated measuring.Multiple linear regression was done to examine factors associated with outcome,both longitudinally and horizontally.RESULTS:Nine hundred and forty-three patients(89.9%of the original population)completed all four follow-ups.The average duration of follow-up was12.24±0.59 mo.During 1-year follow-up,the mean dyspeptic symptom score(DSS)in FD patients showed a significant gradually reduced trend(P<0.001),and similar differences were found for all individual symptoms(P<0.001).Multiple linear regression analysis showed that sex(P<0.001),anxiety(P=0.018),sleep disorder at 1-year follow-up(P=0.019),weight loss(P<0.001),consulting a physician(P<0.001),and prokinetic use during 1-year follow-up(P=0.035)were horizontally associated with DSS at 1-year followup.No relationship was found longitudinally between DSS at 1-year follow-up and patient characteristics at baseline.CONCLUSION:Female sex,anxiety,and sleep disorder,weight loss,consulting a physician and prokinetic use during 1-year follow-up were associated with outcome of FD.

关键词： Functional dyspepsia Gastrointestinal symptoms Dyspeptic symptom score Helicobacter pylori infection Postprandial distress syndrome epigastric pain syndrome RomeⅢcriteria

Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery

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World Journal of Clinical Oncology 2016年第1期7卷 114-121页

作者： Michael S Pollhammer Dominik Duscher Manfred Schmidt Georg M Huemer Section of Plastic Aesthetic and Reconstru-ctive Surgery Department of General Surgery Kepler University Hospital Linz MAZ - Microsurgical Training and Research Center

Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960 s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast recon-struction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.

关键词： Breast cancer Microsurgery Autologous tissue transfer Breast reconstruction Flap Transverse musculocutaneous gracilis Fasciocutaneous infragluteal Deep inferior epigastric perforator

Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

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Plastic and Aesthetic Research 2017年第8期4卷 127-134页

作者： Alejandro Ruiz-Moya Rafael-Antonio Lopez-Garcia Domingo Sicilia-Castro Tomas Gomez-Cia Pedro Infante-Cossio Department of Plastic and Reconstructive Surgery Virgen del Rocio University Hospital41013 SevilleSpain Department of Surgery School of MedicineUniversity of Seville41009 SevilleSpain

Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction. Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected. Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups' superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371). Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon.

关键词： Deep inferior epigastric artery perforator flap venous congestion breast reconstruction computed tomography angiography preoperative imaging virtual reality

Analysis on the Effect of Application of the DIEP Flap in Breast Reconstruction Surgery

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Journal of Clinical and Nursing Research 2018年第1期2卷 1-5页

作者： Tan Jialiang Benxi Shengda Hospital Benxi Liaoning117000

Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy,which are possibly due to burns,trauma,infections,congenital dysplasia and sex reassignment surgery etc.,with the prevalence of unilateral breast reconstruction.After attempting to carry out breast reconstruction with latissimus dorsi,many surgeons constantly improved,designed,and modified multiple forms of operation programs and thus promote increasing improvement in repair and reconstruction of the breast after breast reduction surgery and mastectomy for breast cancer[1].Currently,breast reconstruction after breast cancer surgery is just in the early stage while it has occupied an important position in developed countries,therefore,the knowledge of breast reconstruction needs to be enhanced and publicized in our country.Some data show the quality of life in patients following breast reconstruction surgery is significantly higher than that in patients undergoing lumpectomy plus radiotherapy or simple mastectomy.More and more patients pursue breast reconstruction after mastectomy for breast cancer.Breast reconstruction is roughly divided into lost chest wall skin repair,hemispherical breast reconstruction,anterior axillary fold repair,plastic surgery for subclavian depression,nipple and areola reconstruction and asymmetrical breast repair.In the reconstruction of breasts,it is necessary to endeavor to make the rebuilt breast symmetrical to the healthy side so that future adjustment will be simple and easily feasible.

关键词： Breast restructuration surgery Deep inferior epigastric perforator Effect of application

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小儿细菌性肝脓肿(附110例临床分析)

中华小儿外科杂志 1986年第5期8卷 277-279页

作者：徐尚恩许华峰杨启政霍玉琴河南医科大学附属第三医院小儿外科

小儿细菌性肝脓肿在小儿外科感染性疾病中并不少见.但由于抗生素应用欠妥以及激素应用不慎重,使不典型病例增多,诊断治疗因而被延误.为此将我院自1964～1985年治疗的小儿细菌性肝脓肿110例予以分析讨论.

关键词：小儿外科细菌性肝脓肿临床分析 analysis diagnosis and treatment liver abscess treatment techniques clinical features epigastric pain 抗生素应用感染性疾病诊断治疗激素应用分析讨论典型病例 typical mass