Objective To study the operative method for severe duodenal trauma.Methods The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.Results In 8 cases duodenal diverticulization was performed,of which 5 cases were cured,2 cases developed intestinal fistula,and one died.Of 9 cases who underwent panceaticoduodenectomy(PD),3 were cured but 6 had pancreatic leakage,and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture,13 cases cured,2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy(PD with preserved duodenum),4 cases recovered and 1 had pancreatic leakage,but 3 with wrap-type pancreaticojejunostomy had no complications.Conclusions The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma.This procedure plus removal of head of pancreas and pancreaticojejunostomy(PD with preserved duodenum) can be used for severe pancreatic injury with excellent result,but duodenal diverticulization or panceaticoduodennectomy must not be undertaken lightly.

Objective To study the effect and mechanism of gastric bypass surgery on type 2 diabetic rats.Methods The models of type 2 diabetic rats were induced by stretozotocin and 20 diabetic rats were randomly divided into 2 groups:diabetes-operation group (DO group,n =10)and diabetes-control group(DC group,n =10).20 normal rats were randomly divided into 2 groups:normal-operation(NO group,n =10) and normalcontrol group(NC group,n =10).Rats in DO and NO group underwent GBP and rats in DC group and NC group underwent sham operation.Fasting blood glucose(FBG) levels of rats in each group were detected before operation and on 72 h,1th week,4th week,8th week after operation.On the 8th week after operation,pancreas tissues were harvested for HE staining and immunofluorescence,histological changes observed.Results The FBG levels of rats were not statistically significant different before operation between DO group and DC group or between NO group and NC group (P ＞ 0.05).After operation,the FBG levels of rats in DO group gradually declined (P ＜ 0.05).FBG levels of rats in DO group were lower after operation than before operation(P ＜0.05) ; After operation FBG levels of rats were higher in DO group than in NO group and NC group at the same time point (P ＜0.05).In DC group,the difference of FBG levels of rats at different time point was not statistically significant(P ＞ 0.05).The difference of FBG had no statistically significance between the different time points of the same group or between the same time point of different groups (P ＞ 0.05).HE staining showed that,in DO group,newborn small islets appeared in pancreas which increased the number of islet.The new islets were smaller,mostly around the pancreatic duct and the structure was similar to that of the normal islets.Immunofluorescence staining also showed that the number of islets increased.Insulin immunofluorescence found more isolated small islets composed of two or three insulin positive cells.Insulin and glucagon double immunofluorescence found insulin and glucagon double positive(INS +/GLU +)cells in some islets.Conclusions GBP has obvious hypoglycemic effects on FBG levels of type 2 diabetic rats,in which the regeneration of pancreas islets may play an important role,while on normal rats GBP has no hypoglycemic effects.

With the widespread implementation of laparoscopic cholecystectomy in various levels of medical institutions, surgical complications have also increased. Among them, the incidence of bile duct injury remains high in complex laparoscopic cholecystectomy. The reason for this is that surgeons cannot effectively and accurately identify the relationship between the aberrant bile duct and the cystic duct and the common bile duct, resulting in the accidental injury of the bile duct, resulting in long hospital stays, increased medical costs, and decreased long-term quality of life for patients. Intraoperative cholangiography, as a real-time visual method of biliary presentation, can effectively reduce the incidence of iatrogenic bile duct injury. However, most surgeons do not fully understand the technology of intraoperative cholangiography during cholecystectomy. This article reviews the application of intraoperative cholangiography in laparoscopic cholecystectomy based on the clinical experience of the author′s team and the literature in recent years, with the aim of deepening the understanding of surgeons about intraoperative cholangiography, so as to better apply it to clinical practice and benefit patients.

Objective To propose a one-way fluid-structure interaction (FSI) method based on an idealized aortic dissection model, so as to analyze the hemodynamics and wall stress in the false lumen (FL) under the influence of multiple overlapping uncovered stents (MOUS). Methods Upon establishment of the numerical model, the models were divided into two categories according to whether the model involved FL perfused branch artery. The characteristics of hemodynamics and wall stress state in the post-operative scenarios were simulated under different surgical strategies. The wall stress state of the FL before and after thrombosis formation was also compared and analyzed. ResultsThe release process of the stents had little influence on wall stress of the FL. The high velocity and high wall shear stress (WSS) area in the FL could not be reduced by using the MOUS alone. If only the proximal entry tear was blocked with a covered stent-graft, the distal end would maintain a region of high flow rate and high WSS. The combination of covered stent-graft and MOUS would result in a region of low flow rate and low WSS, as well as reduced wall pressure and wall stress in the FL. Compared with the model with FL perfused branch arteries, the model without it was more likely to form a region of low flow rate and low WSS after surgery. However, blood pressure in the FL was relatively higher. The formation of thrombus in the FL could greatly reduce wall stress in the area covered by the thrombus. Conclusions The method proposed in this study can simultaneously investigate hemodynamics and wall stress characteristics of the FL, and provide support for studying mechanical mechanism of FL thrombolysis induced by MOUS and the post-operative aortic expansion.