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| 1 | Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery显示文摘Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries. | Hiromichi Kawaida Hiroshi Kono Naohiro Hosomura Hidetake Amemiya Jun Itakura Hideki Fujii Daisuke Ichikawa | 2019 | World Journal of Gastroenterology2019，25，28： | 43 |
| 2 | Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis显示文摘AIM:To conduct a meta-analysis to compare Rouxen-Y(R-Y) gastrojejunostomy with gastroduodenal Billroth Ⅰ(B-Ⅰ) anastomosis after distal gastrectomy(DG) for gastric cancer.METHODS:A literature search was performed to identify studies comparing R-Y with B-Ⅰ after DG for gastric cancer from January 1990 to November 2012 in Medline,Embase,Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library.Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed or random effects model.Operative outcomes such as operation time,intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture,bile reflux,remnant gastritis,reflux esophagitis,dumping symptoms,delayed gastric emptying and hospital stay were the main outcomes assessed.Meta-analyses were performed using RevMan 5.0 software(Cochrane library).RESULTS:Four randomized controlled trials(RCTs) and 9 non-randomized observational clinical studies(OCS) involving 478 and 1402 patients respectively were included.Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux(OR 0.04,95%CI:0.01,0.14;P < 0.00 001) and remnant gastritis(OR 0.43,95%CI:0.28,0.66;P = 0.0001),however needing a longer operation time(WMD 40.02,95%CI:13.93,66.11;P = 0.003).Metaanalysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux(OR 0.21,95%CI:0.08,0.54;P = 0.001),remnant gastritis(OR 0.18,95%CI:0.11,0.29;P < 0.00 001) and reflux esophagitis(OR 0.48,95%CI:0.26,0.89;P = 0.02).However,this reconstruction method was found to be associated with a longer operation time(WMD 31.30,95%CI:12.99,49.60;P = 0.0008).CONCLUSION:This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-Ⅰ reconstruction post DG.However there is a need for further adequately powered,welldesigned RCTs comparing the same. | Jun-Jie Xiong Kiran Altaf Muhammad A Javed Quentin M Nunes Wei Huang Gang Mai Chun-Lu Tan Rajarshi Mukherjee Robert Sutton Wei-Ming Hu Xu-Bao Liu | 2013 | World Journal of Gastroenterology2013，19，7： | 33 |
| 3 | Application value of enhanced recovery after surgery for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy显示文摘AIM To evaluate the safety and feasibility of enhanced recovery after surgery(ERAS) for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy.METHODS The clinical data of 42 patients who were divided into an ERAS group(n = 20) and a control group(n = 22) were collected. The observed indicators included operation conditions, postoperative clinical indexes, and postoperative serum stress indexes. Measurement data following a normal distribution are presented as mean ± SD and were analyzed by t-test. Count data were analyzed by χ~2 test.RESULTS The operative time, volume of intraoperative blood loss, and number of patients with conversion to opensurgery were not significantly different between the two groups. Postoperative clinical indexes, including the time to initial anal exhaust, time to initial liquid diet intake, time to out-of-bed activity, and duration of hospital stay of patients without complications, were significantly different between the two groups(t = 2.045, 8.685, 2.580, and 4.650, respectively, P < 0.05 for all). However, the time to initial defecation, time to abdominal drainage-tube removal, and the early postoperative complications were not significantly different between the two groups. Regarding postoperative complications, on the first and third days after the operation, the white blood cell count(WBC) and C reactive protein(CRP) and interleukin-6(IL-6) levels in the ERAS group were significantly lower than those in the control group.CONCLUSION The perioperative ERAS program for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is safe and effective and should be popularized. Additionally, this program can also reduce the duration of hospital stay and improve the degree of comfort and satisfaction of patients. | Yi-Feng Zang Feng-Zhou Li Zhi-Peng Ji Yin-Lu Ding | 2018 | World Journal of Gastroenterology2018，24，4： | 23 |
| 4 | Middle segmental pancreatectomy: A safe and organ-preserving option for benign and low-grade malignant lesions显示文摘AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas. | Zhi-Yong Du Shi Chen Bao-San Han Bai-Yong Shen Ying-Bing Liu ChengHong Peng | 2013 | World Journal of Gastroenterology2013，19，9： | 18 |
| 5 | Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial显示文摘AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n = 29), or another treatment modality(n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living(ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo. CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: Ⅱ. | Herwig Drobetz Lidia Koval Patrick Weninger Ruth Luscombe Paula Jeffries Stefan Ehrendorfer Clare Heal | 2016 | World Journal of Orthopedics2016，7，10： | 18 |
| 6 | Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction显示文摘AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level < 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored. | Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide Nobuo Toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama | 2016 | World Journal of Gastroenterology2016，22，14： | 18 |
| 7 | Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis显示文摘AIM To compare uncut Roux-en-Y(U-RY) gastrojejunostomy with Roux-en-Y(RY) gastrojejunostomy after distal gastrectomy(DG) for gastric cancer.METHODS A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed-or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status(serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Metaanalyses were performed using RevM an 5.3 software.RESULTS Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference(WMD):-12.95; 95%CI:-22.29 to-3.61; P = 0.007] and incidence of reflux gastritis/esophagitis(OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying(OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome(OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin(WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein. CONCLUSION U-RY reconstruction has some clinical advantages over RY reconstruction after DG. | Ming-Ming Sun Yi-Yi Fan Sheng-Chun Dang | 2018 | World Journal of Gastroenterology2018，24，24： | 16 |
| 8 | 腹腔镜保留脾脏胰体尾切除术:手术策略与技巧显示文摘胰腺解剖位置深在,周围毗邻重要脏器及大血管,手术难度较大,术后并发症发生率高,因此与腔镜胆道、胃肠手术相比,腹腔镜胰腺手术起步较晚,开展病例数较少。随着外科医师手术技术的进步及腔镜设备器材的优化改进,近十余年,腔镜胰腺手术的应用日益广泛,胰腺肿瘤局部摘除、胰体尾切除、胰十二指肠切除术等手术方式的安全性、有效性及根治性已得到证实,并能充分体现腔镜手术的优势,其中腹腔镜胰体尾切除术(1aparoscopic distal pancreatectomy,LDP)是应用最广泛、最成熟的腔镜胰腺手术。 | 展翰翔 王磊 胡三元 | 2016 | 腹腔镜外科杂志2016，21，1： | 15 |
| 9 | Management of distal humeral coronal shear fractures显示文摘Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface fol owing distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach(direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. | Shahram S Yari Nathan L Bowers Miguel A Craig Lee M Reichel | 2015 | World Journal of Clinical Cases2015，3，5： | 15 |
| 10 | Thrombus aspiration in acute myocardial infarction:Rationale and indication显示文摘Reperfusion of myocardial tissue is the main goal of primary percutaneous coronary intervention(PPCI) with stent implantation in the treatment of acute ST-segment elevation myocardial infarction(STEMI). Although PPCI has contributed to a dramatic reduction in cardiovascular mortality over three decades, normal myocardial perfusion is not restored in approximately one-third of these patients. Several mechanisms may contribute to myocardial reperfusion failure, in particular distal embolization of the thrombus and plaque fragments. In fact, this is a possible complication during PPCI, resulting in microvascular obstruction and no-reflow phenomenon. The presence of a visible thrombus at the time of PPCI in patients with STEMI is associated with poor procedural and clinical outcomes. Aspiration thrombectomy during PPCI has been proposed to prevent embolization in order to improve these outcomes. In fact, the most recent guidelines suggest the routine use of manual aspiration thrombectomy during PPCI(class Ⅱa) to reduce the risk of distal embolization. Even though numerous international studies have been reported, there are conflicting results on the clinical impact of aspiration thrombectomy during PPCI. In particular, data on long-term clinical outcomes are still inconsistent. In this review, we have carefully analyzed literature data on thrombectomy during PPCI, taking into account the most recent studies and meta-analyses. | Gennaro Sardella Rocco Edoardo Stio | 2014 | World Journal of Cardiology2014，6，9： | 15 |
| 11 | Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas显示文摘AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP. | Ren-Chao Zhang Jia-Fei Yan Xiao-Wu Xu Ke Chen Harsha Ajoodhea Yi-Ping Mou | 2013 | World Journal of Gastroenterology2013，19，37： | 14 |
| 12 | Gastric cancer arising from the remnant stomach after distal gastrectomy:A review显示文摘Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date. | Shinsuke Takeno Tatsuya Hashimoto Kenji Maki Ryosuke Shibata Hironari Shiwaku Ippei Yamana Risako Yamashita Yuichi Yamashita | 2014 | World Journal of Gastroenterology2014，20，38： | 13 |
| 13 | Coronal shear fractures of distal humerus: Diagnostic and treatment protocols显示文摘Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management. | Ajay Pal Singh Arun Pal Singh | 2015 | World Journal of Orthopedics2015，6，11： | 13 |
| 14 | Bilateral medial medullary infarction with distal stenosis of hypoplastic vertebral artery显示文摘To the Editor:Bilateral medial medullary infarction(MMI)is a rare stroke subtype.[1]usually leads to quadriplegia,sensory disturbance,hypoglossal palsy,bulbar paralysis,etc.[2]We encountered a patient with rapidly progressive tetraparesis and diffusion-weighted imaging(DWI)exhibited a“heart appearance”sign in the bilateral ventral medulla.Computed tomography angiography(CTA)demonstrated that the left vertebral artery(VA)was hypoplastic and there was an atherosclerotic stenosis in the V4 segment. | Jie-Ping Lu Yan Wu Fang Xiao Huai-Yu Li Qi-Qiang Tang | 2019 | Chinese Medical Journal2019，，8： | 13 |
| 15 | Current opinion on lymphadenectomy in pancreatic cancer surgery显示文摘BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the outcome.The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial.Four prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection.The exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic factor.Positive lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head location.The extended lymphadenectomy does not have any place,unless in randomized trials.In cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising results.Nevertheless,accurate localization and detailed examination of the resected specimen are required for better staging. | Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，1： | 12 |
| 16 | Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases显示文摘Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion. | PNVSV Prasad Amit Nemade Rashid Anjum Nilesh Joshi | 2019 | Chinese Journal of Traumatology2019，22，2： | 11 |
| 17 | Laparoscopic spleen-preserving distal pancreatectomy for pancreatic neoplasms:A retrospective study显示文摘AIM:To describe the clinical characteristics,technical procedures,and outcomes of patients undergoing laparoscopic spleen-preserving distal pancreatectomy(LSPDP)for benign and malignant pancreatic neoplasms.METHODS:The clinical data of 38 patients who underwent LSPDP in the Sir Run Run Shaw Hospital between January 2003 and August 2013 were analyzed retrospectively.Surgical techniques for LSPDP included preservation of the splenic artery and vein(Kimura’s technique)and ligation of the splenic pedicle with preservation of the short gastric vessels(Warshaw’s technique).RESULTS:There were no conversions to open surgery in the 38 patients.Splenic vessels were conserved during spleen-preserving pancreatectomy,except in two patients who underwent resection of the splenic vessels and preservation only of the short gastric vessels.The mean operation time was 123.2±52.4 min,the mean intraoperative blood loss was 78.2±39.5 mL,and the mean postoperative hospital stay was 7.6±2.9 d.The overall rate of postoperative complications was 18.4%(7/38),and the rate of clinical pancreatic fistula was13.2%(5/38).All postoperative complications were treated conservatively.The postoperative pathological diagnoses were 22 cases of benign pancreatic disease and 16 cases of borderline or low-grade malignant lesions.During a median follow-up of 38 mo(range:5-133mo),no recurrence was observed.CONCLUSION:LSPDP is a safe,feasible and effective procedure for the treatment of benign and low-grade malignant tumors of the distal pancreas. | Jia-Fei Yan Xiao-Wu Xu Wei-Wei Jin Chao-Jie Huang Ke Chen Ren-Chao Zhang Ajoodhea Harsha Yi-Ping Mou | 2014 | World Journal of Gastroenterology2014，20，38： | 11 |
| 18 | 腹腔镜手术在胰腺外科中的应用显示文摘腹腔镜手术具有视野清晰、微创等优势,目前已逐步取代传统开腹手术成为绝大多数腹部疾病的首选术式。然而,由于胰腺解剖复杂,手术难度高,腹腔镜手术在胰腺外科中的应用远落后于其在胃肠道等方面的应用。近年来随着腹腔镜技术的进步及其临床应用的推广,腹腔镜胰腺手术在一些医疗中心取得令人鼓舞的成绩。本中心已顺利完成了腹腔镜胰腺远端切除术(laparoscopic distal pancreatectomy, LDP)、腹腔镜胰腺中段切除术(laparoscopic central pancreatectomy,LCP)及腹腔镜胰头十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)等。现结合文献报道和本中心经验初步探讨腹腔镜手术在胰腺外科中的应用价值。 | 牟一平 金巍巍 | 2014 | 中华肝脏外科手术学电子杂志2014，3，4： | 11 |
| 19 | Bone three-dimensional microstructural features of the common osteoporotic fracture sites显示文摘Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age. | Huayue Chen Kin-ya Kubo | 2014 | World Journal of Orthopedics2014，5，4： | 11 |
| 20 | Management of chronic disruption of the distal tibiofibular syndesmosis显示文摘Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment. | Wataru Miyamoto Masato Takao | 2011 | World Journal of Orthopedics2011，2，1： | 11 |
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