Objective To investigate the effect of one stage arterialization of posterior tibial vein in treatment of peripheral arterial extensive occlusive disease. Methods Forty-six cases (56 limbs) of patients with peripheral arterial extensive occlusive disease were treated with one stage arterialization of posterior tibial vein. Results The symptom of pain disappeared right after one stage arterialization of posterior tibial vein in all patients . Skin temperature went up. The long-term results were satisfactory during the period of 3 months to 7 years follow-up, except two limbs were amputated and two limbs were reoperated with pedicle omental transplantation. Conclusion The technique of one stage arterialization of posterior tibial vein has advantages of one-stage procedure, various indications, little influence to venous return and rapid relief of ischemic symptoms.
In recent years, robot-assisted esophagectomy has become increasingly widespread, but the esophagogastric anastomosis step remains relatively complex and cumbersome. Currently, commonly used gastrointestinal reconstruction anastomosis techniques include end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Depending on the anastomosis method, they can be further divided into manual anastomosis and mechanical anastomosis, with common instruments including circular staplers and linear staplers. In esophageal cancer surgery, the choice of esophagogastric anastomosis technique is typically based on the tumor’s location and size as well as the surgeon’s preference. Each anastomosis technique has its advantages and disadvantages. With continuous improvements in anastomosis techniques and updates in stapling instruments, the incidence of complications after esophagogastric anastomosis has been effectively reduced. However, safely and efficiently completing gastrointestinal reconstruction during surgery remains a significant challenge. Scholars have made extensive explorations in this field, actively proposing and achieving various reconstruction methods, leading to significant progress. This article reviews the research progress of robot-assisted esophagogastric anastomosis techniques from both the anastomosis techniques and methods perspectives.
Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. MethodsWe retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.
Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were included in this study. Relevant variables were screened using univariate and multivariate logistic regression analyses. A nomogram was then developed to predict the risk factors associated with postoperative AL. The predictive performance of the nomogram was validated using the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were included in the study, comprising 354 males and 114 females, with a mean age of (62.8±7.2) years. The tumors were predominantly located in the middle or lower esophagus, and 51 (10.90%) patients experienced postoperative AL. Univariate logistic regression analysis indicated that age, body mass index (BMI), tumor location, preoperative albumin levels, diabetes mellitus, anastomosis technique, anastomosis site, and C-reactive protein (CRP) levels were potentially associated with AL (P<0.05). Multivariate logistic regression analysis identified age, BMI, tumor location, diabetes mellitus, anastomosis technique, and CRP levels as independent risk factors for AL (P<0.05). A nomogram was developed based on the findings from the multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was 0.803, indicating a strong concordance between the actual observations and the predicted outcomes. Furthermore, decision curve analysis demonstrated that the newly established nomogram holds significant value for clinical decision-making. Conclusion The predictive model for postoperative AL in patients with carcinoma of the esophagus and gastroesophageal junction demonstrates strong predictive validity and is essential for guiding clinical monitoring, early detection, and preventive strategies.