Objective To study the earlier and later clinic results of 64 chronic duodenal ulcer patients treated with high selective vagotomy and mucosal antrectomy (HSV+MA). Methods The clinic results of the patients and the changes of gastrin, motilin and somatostatin in the blood were prospectively investigated. Results Fifty nine (92.2%) patients after 3-6 months of follow-up and 26 (92.9%) patients after 5-8 years of follow-up achieved Visick grates Ⅰ-Ⅱ. No patients died. Gastric acid secretion and infection rate of helicobacter pylori in antral mucosa were significantly reduced after operation. No significant difference was showed in bile acids and total bacterial counts of gastric juice before and after operation. No ulcer recurrence was found by barium meal and endoscopy. There was no significant difference in serum gastrin and plasma motilin before and after operation. The level of somatostatin in the blood of patients after 5-8 years of follow-up was decreased. Conclusion HSV+MA is the better operative treatment for duodenal ulcer, since it can not only effectively and lastingly decrease acid secretion and rates of ulcer recurrence, but also preserve the function of the antrum and pylorus and keep the gastric milieu interne relatively stable.
Abstract This experiment was to study the feasibility from direct observation of muscle contraction of the lower extremity fromelectrical stimulation threshold of nerve fascicle in identifying the Iα intrafusal afferent fibers during selective posterior rhizotomy (SPR) and to investigate the clinical relationship between the muscle spasm and the electrical stimulation of nerve fascicles. The electrical stimulation threshold of all nerve fascicles in 36 cases during SPR were analysed statistically. The results showed that there was a significant difference between the electrical stimulation threshold of the severed nerve fascicles and intact nerve fascicles no matter the nerve root or each posterior nerve rootlet was examined. It was simple and reliable for surgeons to identify correctly the Iα intrafusal afferent fibers intraoperatively from direct observation of the electrical stimulation threshold of nerve fascicle.
Objective To explore the effect of laparoscopic highly selective vagotomy (Hill) on the treatment for acute perforating duodenal ulcer. Methods In 19 patients with acute perforating duodenal ulcers, laparoscopic repair of the perforation, laparoscopic freeing of the vagus, cutting off of posterior vagal trunk, and highly selective resection of anterior vagal trunk were performed. Results In all 19 cases the operation was successful. No patient was converted into open highly selective vagotomy. Ulcer symptoms of 17 patients disappeared after operation, and gastroscopy in follow up after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 2 patients were markedly relieved and were easily controlled by medication. Conclusion The treatment of acute perforating duodenal ulcer by laparoscopic highly selective vagotomy (Hill) has the advantages of minor trauma, rapid postoperative recovery, and good results, it is a good procedure for the treatment of perforating duodenal ulcer.
Objective To investigate the effects of highly selective vagotomy plus mucosal antrectomy (HSVMA) and highly selective vagotomy (HSV) alone on the functions of the gastric antrum. MethodsEighteen dogs and 48 patients with chronic duodenal ulcer were tested. The time of gastric emptying, antral myoelectric activity, antral pressure were measured 4-6 months after operation in 18 dogs which were randomized into the control, HSV and HSVMA groups. The gastric evacuation, frequency and amplitude of electrogastrography (EGG) were observed 4-6 months after operation in 48 patients who were randomly divided into HSV (20 patients) and HSVMA (28 patients) group, their preoperative values were considered as control group. ResultsIt was found by barium meal examinations that the shape of the stomach and duodenum was normal and gastric peristalsis was clearly visible in all the animals and patients of two postoperative groups. The beginning and ending time of gastric emptying were (5.0±0.06) min and (4.0±0.4) h respectively in the dogs of HSVMA group, which were similar to those of the dogs of control and HSV group (Pgt;0.05). The frequency of the antral myoelectric action potential was (3.11±0.65 ) cycles/min in the dogs of HSVMA group, the frequency of EGG was (3.25±0.75) cycles/min in the patients of HSVMA group, which were significantly lower than that of the dogs or patients of control and HSV group (P＜0.05). Injection of pentagastrin in dogs or taking meal in patients significantly increased the antral pressure or amplitude of EGG. Conclusion The motor function of the reconstructed antrum in the HSVMA group approaches the normal level despite a lower antral myoelectric frequency. It is believed that HSVMA will be a choice for the treatment of duodenal ulcer.
ObjectiveTo explore the therapeutic effect of total hip arthroplasty (THA) and hip adductor amputation (HAA) in the surgical treatment of osteonecrosis of femoral head. MethodsA total of 74 patients with osteonecrosis of femoral head with hip adduction deformity were included between June 2011 and May 2012. Among them, 38 patients had undergone THA, and 36 patients had undergone THA+HAA. Statistics about hip abductor function and Harris scores before and 1 week and 12 months after the surgery were recorded. SPSS 19.0 was used for statistical analysis. ResultsThe patients' wounds had the Ⅰ-stage healing in both of the two groups. Two patients had scrotum swelling in THA+HAA group, who left the hospital after treating. One week after the surgery, the hip passive abduction angles increased (32.1±2.8) and (19.7±3.3)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 45.8±2.8 and 40.9±2.3, respectively; 12 months postoperatively, the hip passive abduction angles increased (32.2±0.9) and (26.8±2.8)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 52.7±7.2 and 49.4±4.4, respectively. The above comparative differences was statistically significant (P<0.05). ConclusionThe surgical method of adductor amputation can improve the range of motion of the hip, raise the quality of life of the patients with osteonecrosis of the femoral head after the surgery.
Forty-two patients with duodenal ulcer underwent highly selective vagotomy and mucosal antrectomy (HSV+MA) and were followed up for 3 years. Two weeks, 1 year and 3 year after operation, serum gastrim level and gastric emptying capacity were tested. The results show that he postoperative levels of serum gastrin were lower than the preoperative ones, but wih no significant difference (Ｐ＞0.05). Only a few patients had delayed gastric emptying 2 weeks and 1year after operation,but it returned to normal in 3 years .The authors conclude that HSV+MA is a better operative treatment for duodenal ulcer since it can abolish the factors of postoperative ulcer recurence and perserve the functions of the antrum and the pylorus.
ObjectiveTo analyze the safety and feasibility of the adhesion dissection in transaxillary uniportal thoracoscopy for palmar hyperhidrosis.MethodsData of 168 patients, including 77 males and 91 females with an average age of 14 - 41 (24.3±5.4) years, who received transaxillary uniportal video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis from January 2015 to July 2018 were retrospectively analyzed. Severe adhesion was found in 4 patients and mild adhesion was found in 12 patients. Artificial pneumothorax was used to help dissect adhesion. Preoperative CT scan could help locate the rib according to the relative position to azygos vein or aotic arch.ResultsAll of 168 patients were successfully completed with transaxillary uniportal VATS. Then chest tubes were put in the 4 severe adhesion patients. The tube was removed from one patient after 11 days because of air leak, and from the other three patients on the next day. The other 164 patients with or without adhesion were discharged from hospital on the operation day or the next day.ConclusionAdhesion dissection in transaxillary uniportal VATS for palmar hyperhidrosis is safe and feasibile.
ObjectiveTo explore clinical outcomes of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH), and compare the results between T2 segment surgery and T2-T3 segment surgery. MethodsFrom April 2009 to August 2012, 48 consecutive PH patients underwent single-port VATS in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. There were 18 male and 30 female patients with their age of 14-40 (22.1±5.4) years. According to different surgical procedures, all the patients were divided into T2 segment group (29 patients) and T2-T3 segment group (19 patients). Preoperative characteristics, surgical results and postoperative morbidity were compared between the 2 groups. ResultsPH symptoms disappeared after VATS in all the patients. Patients were followed up for 6-44(21.3±10.1)months, and 2 patients were lost in both T2 segment group and T2-T3 segment group. The incidence of postoperative compensatory sweating was 66.7% (18/29) in T2 segment group and 70.6% (12/19) in T2-T3 segment group. The incidence of moderate to severe compensatory sweating of T2 segment group was significantly higher than that of T2-T3 segment group (51.9% vs. 29.4%, P < 0.05). Twenty-six patients (96.3%) in T2 segment group and 16 patients (94.1%) in T2-T3 segment group were completely or partially satisfied with surgical results. ConclusionVATS is the only effective surgical procedure for the treatment of moderate to severe PH. Both T2 and T2-T3 segment sympathectomy can effectively reduce PH symptoms after VATS, but the incidence of postoperative compensatory sweating is high, which has negative influence on patients'satisfaction.
Objective To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies. Methods The spastic bladder models were established in 12 male dogsand were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2(group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3(group B), rhizotomy of the anterior roots of S2 and S3(group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological -observation, the changes of all functional data were recorded and comparedbetween pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the halfanterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120±30), (100±30)ml and (120±20) cm H2 O, respectively before rhizotomy. Results After rhizotomy, the bladder capacity in 4 groups amounted to (150±50), (180±50), (230±50), and (400±50) ml, respectively; and the urine evacuation volume were (130±30), (180±50), (100±50) and (50±30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed. Conclusion The effectof selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.