Clinical data of 14 patients with iatrogenic duodenal injuries treated in hospital from January 2000 and January 2010 were retrospectively reviewed.Iatrogenic duodenal injuries were found intraoperatively in 9 cases,in whom repair or additional jejunostomy was performed and all were cured and discharged.In 2 patients the duodenal injuries were found within 24 hours postoperatively,1 was cured,another had low flow duodenal fistula and cured with conservative treatment.Duodenal bypass and extraoral drainage were performed in 2 patients whose duodenal injuries was found 72 hours after surgery and died from severe infection of retroperitoneal space and multiple organ failure respectively.One patient whose duodenal injury was found 7 d postoperatively suffered from septic shock and died in 4 h after admission.The results suggest that early detection and early management would result in satisfied outcome for patients with iatrogenic duodenal injuries,the first 24 hours are crucial.

Twelve cases of colon carcinoid were treated by laparoscopic resection combined with colonoscopy from January 2003 to November 2009 in the First Huai'an Hospital. The tumors presented as submucosal lesions in colonoscopy with the size of 1.5 - 3.0 cm in diameter, which were difficult to be found by laparoscopy. All tumors were locally resected under laparoscopy with the assistance of colonoscopy successfully. Patients were followed up for 6 - 72 months, one case died 30 months after operation due to liver metastases. Colon carcinoid tumors with diameter from 1.5 - 3.0 cm often have muscular invasion and lymph node metastasis. The results indicate that laparoscopic resection combined with colonoscopy is a safe and effective procedure for colon carcinoid tumor.

ObjectiveTo observe the effect of succus entericus reinfusion with continuous enteral nutrition on the barrier function of intestinal mucosa and nutritional status in patients with stomal type fistulas. Methods Sixteen patients with stomal type fistula from July 1995 to May 2008 were enrolled in the study. A]l patients met the following conditions: gut function returned normal; abdominal infection was controlled; total enteral nutrition was provided ; and the length of small intestine for succus entericus reinfusion was more than 50 cm. Intestinal mucosa was taken at 25 to 30 cm away from stoma of fistula by endoscope 0, 7, and 14 days after reinfusior. Hematoxylineosin staining was performed to count the number of intestinal intraepithelial lymphocytes (IIELS). In addition,proliferating cell nuclear antigen (PCNA) was measured with immunohistochemical staining. Serum protein levels were determined by immunonephelometry. ResultsThe percentage of IIELS in intestinal mucosa ( 19.06％ ±4.81％ vs. 12.81％ ±2.95％, P=0.000) and the percentage of PCNA positive cells ( 12.13％ ±4.33％ vs.6.44％ ± 2.34％, P =0.000) 14 days after succus entericus reinfusion were significantly higher than those on the day of reinfusion. Serum fibronectin level increased from ( 152.80 ± 16.50 ) to ( 227.05 ± 45.36 ) mg/L ( P =0.000), and transferring protein level increased from ( 2.16 ± 0.52 ) to ( 2.62 ± 0.41 ) g/L ( P =0.017 ) 14days after succus entericus reinfusion. ConclusionSuccus entericus reinfusion is effective in protecting the intestinal mucosa in patients with stomal type fistulas.

Objective:To explore the application value of the suction-flushing electric coagulation in surgery of the traumatic splenic rupture.Methods:The clinical data of 31 patients with traumatic splenic rupture in the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from January 2013 to December 2019 were retrospectively analyzed. All patients were treated with suction-flushing electric coagulation.Results:The intraoperative hemorrhage was 100 to 1 200 (551 ± 90) ml, the operative time was 60 to 210 (113 ± 36) min, and the postoperative fluid drainage volume was 120 to 650 (367 ± 66) ml. All patients recovered successfully after surgery, electrocoagulation hemostasis was performed in 5 patients with splenic rupture, 25 patients with total splenectomy, and spleen preserving surgery in 1 patient with spleen preserving surgery after pancreatic body transection. There were no splenic infarction, splenic infection and portal vein thrombosis after 1 to 6 months′ follow-up.Conclusions:Suction-flushing electric coagulation is convenient and effective in the treatment of traumatic splenic rupture.