1.Application of superficial peroneal artery perforator flap in tiled reconstruction of thumbs and fingers
Heyun CHENG ; Jihui JU ; Qiang ZHAO ; Junnan CHENG ; Shuang LIU ; Benyuan WANG ; Quanwei GUO ; Wei ZHOU
Chinese Journal of Microsurgery 2023;46(6):631-636
Objective:To summarise the clinical application and results of superficial peroneal artery perforator flaps in tiled reconstruction of thumbs and fingers.Methods:From June 2020 to June 2022, 8 patients with finger or thumb defects (4 thumbs, 2 index fingers and 2 middle fingers) received digit reconstruction in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Two thumbs (2 patients) were reconstructed with a free partial hallux nail flap combined with a free perforator flap of superficial peroneal artery and an iliac bone graft, 1 thumb was reconstructed with a free partial hallux nail flap combined with a free perforator flap of superficial peroneal artery, 1 thumb and 2 middle fingers were reconstructed with free perforator flaps of superficial peroneal artery combined with iliac bone grafts, and 2 index fingers were reconstructed with lobulated free perforator flaps of superficial peroneal artery. The sizes of the flaps were 1.8 cm×3.2 cm-4.0 cm×10.0 cm. Lengths of iliac crest were 1.5-4.0 cm. The donor sites were directly sutured in 5 patients, skin grafts in 2 and superficial peroneal artery perforator flap reconstruction in 1 patient. Postoperative observations included survival of the digits and healing of the bone grafts. Monthly scheduled postoperative follow-ups were conducted at outpatient clinics and via telephone or WeChat reviews, covering function and appearance of the reconstructed digits, impact on the function and appearance of donor sites as well as the satisfaction of patients.Results:All 8 reconstructed digits survived in one stage and all the 5 bone grafts healed at 3 to 4 months after surgery. The mean postoperative follow-up period was 10 months, ranged 4 to 20 months. The texture of the reconstructed digits was close to that of the recipient site and good in elasticity, without purplish while in cold, nor ulceration, obvious bloating and pigmentation. Sensation of the digit pulps was recovered to S 2 to S 3, and the sensation in touch, pain and temperature were restored. TPD was not checked. There was no noticeable hyperplasia nor pain in the recipient and donor sites. There was no obvious hyperplasia or pain at the donor sites for the hallux nail flap, and the skin grafts or flaps in the donor sites survived well without ulceration or pain and the function of the donor feet were not affected. Functions of the reconstructed digits were assessed according to the Functional Assessment Criteria for Thumb and Finger Reconstruction of the Society for Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved in excellent and 4 in good. According to the University of Michigan Hand Profile Questionnaire (MHQ), patient satisfaction was found very satisfied with 4 patients and satisfied with the other 4 patients. Conclusion:The superficial peroneal artery perforator flap has advantages of thin and large area with pleasant texture, better sensation recovery and less damage to the donor site. It is an ideal flap for reconstruction of thumbs and fingers.
2.Effects of free superficial peroneal artery perforator flap in repairing small and medium-sized thermal crush injury wounds in the hand
Heyun CHENG ; Jihui JU ; Qiang ZHAO ; Shengzhe LIU ; Guangliang ZHANG ; Tao ZHANG ; Benyuan WANG ; Quanwei GUO ; Shuang LIU
Chinese Journal of Burns 2023;39(6):546-551
Objective:To investigate the surgical methods and clinical effects of free superficial peroneal artery perforator flap in repairing small and medium-sized thermal crush injury wounds in the hand.Methods:A retrospective observational study was conducted. From August 2018 to December 2021, 12 patients (19 wounds) with small and medium-sized thermal crush injury in the hand who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 5 males and 7 females, aged from 30 to 54 years. The area of the wound was from 2.5 cm×2.0 cm to 14.0 cm×3.5 cm, and all the wounds were repaired by using free superficial peroneal artery perforator flaps from lower leg on one side (including single flap, multiple flaps, and multiple flaps with one pedicle resected from the same donor site). The area of the flap was from 3.5 cm×3.0 cm to 16.0 cm×4.0 cm. The wound in the donor site was sutured directly. The vascular crisis and survival of the flap were observed after operation. The texture, appearance, color, hyperpigmentation, sensation, and two-point discrimination of the flap repaired area were followed up, as well as the hyperplasia of scar and pain condition in the donor and recipient sites. At the last follow-up, the curative effect of flap repair was evaluated by the comprehensive evaluation scale, and the extension and flexion functions of the reserved digital joint were evaluated by the total active movement systematic evaluation method recommended by American Academy for Surgery of Hand.Results:One flap developed arterial crisis on the first day after operation but survived after timely exploration. The other 18 flaps survived successfully after operation. Follow-up of 4 to 24 months after operation showed good texture and appearance in the flap repaired area; the color of the flap repaired area was similar to that of the normal skin around the recipient site, without pigmentation; the protective sensation was restored in all cases, but there was no two-point discrimination; there was no obvious hypertrophic scarring or pain in the donor or recipient site. At the last follow-up, the curative effect of flap repair was evaluated with 3 flaps being excellent and 16 flaps being good; the extension and flexion functions of the reserved digital joint were also assessed, being excellent in 8 fingers, good in 9 fingers, and fair in 2 fingers.Conclusions:The blood supply of superficial peroneal artery perforator flap is sufficient and reliable, and multiple flaps of this type or multiple flaps with one pedicle can be resected from one donor site. The use of this flap to repair small and medium-sized thermal crush injury wounds in the hand results in minimal damage to the donor area, and good postoperative appearance and texture of the flap.
3.Repair of two wounds in the same or adjacent digits with free ipsilateral double pedicled superficial peroneal artery perforator flap
Heyun CHENG ; Jihui JU ; Qiang ZHAO ; Linfeng TANG ; Tao ZHANG ; Shuang LIU ; Benyuan WANG ; Quanwei GUO
Chinese Journal of Microsurgery 2022;45(6):608-612
Objective:To explore the surgical method and clinical effect of harvesting 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery in reconstruction of 2 defects in same or adjacent digits.Methods:From November 2017 to August 2021, 12 patients with 2 defects in same or adjacent digits were treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital with 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery. Among the patients, 1 had the defect in dorsal and palmar of index finger, 1 in thumb and index finger, 6 in index and middle fingers, 3 in middle and ring fingers, and 1 in ring and little fingers. The size of digit defects was 1.5 cm×0.8 cm-6.0 cm×3.5 cm. The size of flaps was 2.0 cm× 1.2 cm-8.0 cm×4.0 cm. All the patients were included in postoperative monthly follow-up to assess the recovery of recipient and donor sites at outpatient service, by telephone or WeChat.Results:All 24 flaps in 12 patients survived without vascular compromise and achieved 100% of survival rate. The follow-up period ranged from 4 to 18 months, with an average of 10 months. Six patients were treated with additional flap thinning and plastic surgery at 4 months after the primary surgery due to slightly bloated flaps. Otherwise, all the flaps in the recipient site had neither pigmentation, obvious hyperplasia nor scar pain. All flaps gained the protective sensations, however the assessment of TPD was not conducted. The flaps were wear-resist and had no ulceration. The texture of the flaps was soft with good elasticity, and the flap did not turn to purple or swelling when in cold. The functional recovery of 23 digits in 12 patients was evaluated according to the total active mobility (TAM) of the digits. It achieved excellent in 3 digits, good in 15 digits, and fair in 5 digits, with an excellent and good rate of 78.26%. A linear scar appeared at the donor site without obvious hyperplasia or scar pain. There were normal sensations around the scar and at the digit-tips. The blood supply to the digit-tips was normal.Conclusion:Harvest of multiple free pedicled perforator flaps from a single donor site of superficial peroneal artery is an effective method in reconstruction of 2 defects in same or adjacent digits at the same time. It has advantages of being a simple surgery procedure by sacrificing only one donor site. It achieves a minimal damage to the donor site and a reliable blood supply of the flap.
4.The willingness for dietary and behavioral changes in frontline epidemic prevention workers after experiencing the outbreak of COVID-19 in China: a cross-sectional study.
Weijun YU ; Ying XU ; Jianhua ZHANG ; Qing YUAN ; Yanfang GUO ; Zhixue LI ; Xiangyang HE ; Yan MA ; Fengmin CAI ; Zheng LIU ; Rencheng ZHAO ; Dewang WANG ; Jialong CHEN ; Quanwei GUO
Environmental Health and Preventive Medicine 2021;26(1):58-58
BACKGROUND:
The 2019 novel coronavirus disease (COVID-19) has had a massive impact on public health, resulting in sudden dietary and behavioral habit changes. Frontline epidemic prevention workers play a pivotal role against COVID-19. They must face high-risk infection conditions, insufficient anti-epidemic material supplies, mental pressure, and so on. COVID-19 seriously affects their dietary and behavioral habits, and poor habits make them more susceptible to COVID-19. However, their baseline dietary and behavioral habits before COVID-19 and their willingness to change these habits after the outbreak of COVID-19 remain unclear for these workers in China. This study aimed to explore the baseline dietary and behavioral habits of frontline workers and their willingness to change these habits after the outbreak of the epidemic; in addition, susceptible subgroups were identified by stratified analyses as targets of protective measures to keep them from being infected with COVID-19.
METHODS:
A cross-sectional study was conducted through an online questionnaire using a sample of 22,459 valid individuals living in China, including 9402 frontline epidemic prevention workers.
RESULTS:
Before COVID-19, 23.9% of the frontline epidemic prevention workers reported a high-salt diet, 46.9% of them reported a high frequency of fried foods intake, and 50.9% of them smoked cigarettes. After the outbreak of COVID-19, 34.6% of them expressed a willingness to reduce salt intake, and 43.7% of them wanted to reduce the frequency of pickled vegetables intake. A total of 37.9% of them expressed a willingness to decrease or quit smoking, and 44.5% of them wanted to increase sleep duration. Significant differences in the baseline dietary and behavioral habits and the willingness to change their habits were observed between frontline epidemic prevention workers and other participants. Among the frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19, frontline epidemic prevention experience was a promoting factor for adopting worse dietary and behavioral habits, including those in the high-salt intake subgroup (OR, 2.824; 95% CI, 2.341-3.405) and the 11-20 cigarettes/day subgroup (OR, 2.067; 95% CI, 1.359-3.143).
CONCLUSIONS
The dietary and behavioral habits of frontline epidemic prevention workers were worse than that those of other participants before COVID-19. They had a greater willingness to adopt healthy dietary and behavioral habits after experiencing the outbreak of COVID-19. However, frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19 continued in engage in these poor habits. Dietary and behavioral intervention policies should be drafted to protect their health, especially frontline epidemic prevention workers with poor habits at baseline.
Adult
;
COVID-19/psychology*
;
China/epidemiology*
;
Cross-Sectional Studies
;
Diet/standards*
;
Female
;
Health Behavior
;
Health Knowledge, Attitudes, Practice
;
Health Personnel/psychology*
;
Humans
;
Male
;
Risk Reduction Behavior
;
SARS-CoV-2
;
Surveys and Questionnaires
5. Anti-lung cancer effect of myeloid and plasmacytoid dendritic cell combined vaccines loaded with tumor cell lysates in vitro
Jianfeng TAN ; Chenghua ZHONG ; Jun CHEN ; Quanwei GUO ; Jun KUANG ; Jianhua ZHANG
Chinese Journal of Oncology 2019;41(7):501-507
Objective:
To investigate the feasibility of myeloid and plasmacytoid dendritic cell combined vaccines loaded with heat-treated Lewis lung cancer cell lysates for treatment of lung cancer in mice.
Methods:
Bone marrow cells were induced by the recombinant mouse fms-like tyrosine kinase receptor 3 ligand (rmFlt3-L) in vitro, myeloid dendritic cells (mDC) and plasmacytoid dendritic cells (pDC) were separated by magnetic beads. The mDC, pDC, and mDC∶pDC=1∶1 were stimulated with heat-treated Lewis lung cancer cell lysates, respectively. The effects of each group on stimulating of lymphocyte proliferation and inducing of T cell to kill tumor cells in vitro were compared. The alternations of the immunophenotypes of CD80, CD86, CD40 and major histocompatibility complex Ⅱ (MHC-Ⅱ) were detected by flow cytometry. The secretion of cytokines including interlukin-12 (IL-12), interlukin-6 (IL-6), and tumor necrosis factor α (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA).
Results:
The lymphocyte proliferation in mice stimulated with mDC+ pDC group loaded with heat-treated Lewis lung cancer cell lysates was 10.80±0.66, significantly higher than 8.63±0.65 of mDC group and 7.10±0.46 pDC group under the same culture conditions, respectively (
6. Reconstruction of proximal thumb plane defect with iliac bone combined with the same pedicled toenail and dorsum pedis flaps
Kai WANG ; Jihui JU ; Guangzhe JIN ; Liping GUO ; Quanwei GUO
Chinese Journal of Plastic Surgery 2019;35(2):162-165
Objective:
To report the method and clinical effect of reconstruction of proximal thumb plane with iliac bone, combined with the same pedicled toenail and dorsum pedis flaps.
Methods:
From June 2010 to May 2017, 7 patients with various degrees of proximal thumb defect were treated in the Hand Surgery Department of Ruihua Affiliated Hospital of Soochow University. Among them, there were 3 males and 4 females, aged from 18 to 50 years, with an average age of 29 years. There were 5 cases of proximal thumb defect and 2 cases of distal thumb defect. The thumb reconstruction contained 3 steps: iliac bone graft was used to repair bone defect, toenail skin flap to repair dorsal thumb wound, and dorsum pedis flap to cover volar wound. Full thickness skin graft was used to repair donor site.
Results:
All the reconstructed fingers survived. The area of toenail skin flap was 3.0 cm×2.5 cm to 5.0 cm×3.0 cm in size. The area of dorsum pedis skin flap was 3.0 cm×3.0 cm to 6.0 cm×3.5 cm in size. The length of iliac bone graft was 2.5-5.0 cm. The follow-up time was 5-28 months, with an average of 10 months. All reconstructed finger pulp was full. The nails grew well. The appearance of fingers was satisfied, and the skin sensation of finger belly was restored to S2 to S3+ . Dorsum finger′s protective sensation of all cases were recovered, and the functions of finger joint were close to normal. The donor area on foot healed well. The scar was not obvious. The walking function was completely normal.
Conclusions
It is a good method to reconstruct proximal thumb with iliac bone combined with the same pedicled toenail and dorsum pedis flaps without sacrificing toes.
7.Clinical study on minimally invasive weaving technique for pectus carinatum
MO Yijun ; LIN Lina ; YAN Jun ; ZHONG Chenghua ; KUANG Jun ; GUO Quanwei ; TAN Jianfeng ; LI Dongfang ; ZHANG Jianhua
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2019;26(11):1119-1124
Objective To explore the practical feasibility of the weaving technique for pectus carinatum. Methods From January 2011 to December 2018, a total of 51 patients with pectus carinatum, including 47 males and 4 females at age of 9-29 (13.7±2.9) years, were applied with minimally invasive waving technique for the correction. The steel plate was inserted through the subcutaneous layer, intercostal space and over the sternal surface under direct thoracoscopic vision. The number of implanted steel plates was determined by the degree of chest wall deformity. The steel plate was removed 2 years after surgery. Results All the operations were successfully completed, the average operation time was 63.9±15.8 min, the amount of bleeding was 19.8±8.8 mL, and the duration of postoperative hospitalization was 4.6±1.6 d. The adverse events included intercostal artery injury (n=2), pneumothorax (n=4), pleural effusion (n=3) and skin rupture (n=1). And there were 29 patients of moderate pain (numerical rating scale 4-6 points) on the first day after surgery, but no patient was asked to remove the steel palate due to intolerable discomfort. All patients were followed up after plate placement. Of the 51 patients, the plates were removed in 37 patients until 2 years after placement, and the duration of postoperative hospitalization was 1.4±0.5 d. After 33 (1-48) months of routine follow-up after the removal of the plate, 22 patients achieved excellent outcomes and 9 patients with good outcomes. Besides, there were 5 patients with fair outcome and 1 patient with poor outcome. No adverse effect was found in growth and development after the steel plate placement. Conclusion Minimally invasive weaving technique is a safe, feasible, effective and individualized operation for pectus carinatum with substantial thoracic reconstruction.
8.Anti?lung cancer effect of myeloid and plasmacytoid dendritic cell combined vaccines loaded with tumor cell lysates in vitro
Jianfeng TAN ; Chenghua ZHONG ; Jun CHEN ; Quanwei GUO ; Jun KUANG ; Jianhua ZHANG
Chinese Journal of Oncology 2019;41(7):501-507
To investigate the feasibility of myeloid and plasmacytoid dendritic cell combined vaccines loaded with heat?treated Lewis lung cancer cell lysates for treatment of lung cancer in mice. Methods Bone marrow cells were induced by the recombinant mouse fms?like tyrosine kinase receptor 3 ligand ( rmFlt3?L) in vitro, myeloid dendritic cells ( mDC) and plasmacytoid dendritic cells (pDC) were separated by magnetic beads. The mDC, pDC, and mDC ∶ pDC=1 ∶ 1 were stimulated with heat?treated Lewis lung cancer cell lysates, respectively. The effects of each group on stimulating of lymphocyte proliferation and inducing of T cell to kill tumor cells in vitro were compared. The alternations of the immunophenotypes of CD80, CD86, CD40 and major histocompatibility complex Ⅱ( MHC?Ⅱ) were detected by flow cytometry. The secretion of cytokines including interlukin?12 (IL?12), interlukin?6 (IL?6), and tumor necrosis factor α ( TNF?α) were detected by enzyme?linked immunosorbent assay ( ELISA). Results The lymphocyte proliferation in mice stimulated with mDC+pDC group loaded with heat?treated Lewis lung cancer cell lysates was 10.80±0.66, significantly higher than 8.63±0.65 of mDC group and 7.10±0.46 pDC group under the same culture conditions, respectively ( P<0.05). When the ratio of effector cells:target cells (E ∶ T) was 10 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 31.68%±2.93%, significantly higher than 17.44%±0.97% of mDC group and 10.29%±1.33% of pDC group, respectively (P<0.05). When the ratio of E ∶ T was 20 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 54.77%± 3.28%, significantly higher than 35.25%± 1.51% of mDC group and 15.52%±0.73% of pDC group, respectively (P<0.05). When the ratio of E ∶ T was 40 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 73.01%± 0.91%, significantly higher than 51.36%± 0.58% of mDC group and 22.65%± 1.28% of pDC group, respectively (P<0.05 ). With the rate of E ∶ T increased, the killing rate also increased. The mean fluorescence intensities of surface molecules including CD80, CD86, CD40 and MHC?Ⅱ of mDC:pDC=1 group pulsed with heat?treated Lewis lung cancer cell lysates were higher than those of mDC group and pDC group. The IL?6 cytokine concentrations of mDC+pDC group, mDC group and pDC group loaded with heat?treated Lewis lung cancer cell lysates were (586.67±52.52) pg/ml, (323.33±67.14) pg/ml and (166.67± 16.07) pg/ml, respectively. The concentrations of IL?12 in each group were ( 2 568.75± 119.24) pg/ml, (2 156.25±120.55) pg/ml and (672.92±31.46) pg/ml, respectively. The concentrations of TNF?α in each group were (789.33±48.08) pg/ml, (584.89±116.49) pg/ml and (291.56±40.73) pg/ml, respectively. The concentrations of IL?6, IL?12 and TNF?α secreted by mDC+pDC group were much higher than those of mDC group and pDC group under the same culture conditions ( P<0.05). Conclusions The mDCs and pDCs combined vaccines pulsed with heat?treated Lewis lung cancer cell lysates have synergistic effects on inducing of T lymphocyte proliferation and killing tumor cells in vitro. This synergistic anti?tumor effect is related with up?regulation of co?stimulatory molecules and increased secretion of cytokines.
9.Anti?lung cancer effect of myeloid and plasmacytoid dendritic cell combined vaccines loaded with tumor cell lysates in vitro
Jianfeng TAN ; Chenghua ZHONG ; Jun CHEN ; Quanwei GUO ; Jun KUANG ; Jianhua ZHANG
Chinese Journal of Oncology 2019;41(7):501-507
To investigate the feasibility of myeloid and plasmacytoid dendritic cell combined vaccines loaded with heat?treated Lewis lung cancer cell lysates for treatment of lung cancer in mice. Methods Bone marrow cells were induced by the recombinant mouse fms?like tyrosine kinase receptor 3 ligand ( rmFlt3?L) in vitro, myeloid dendritic cells ( mDC) and plasmacytoid dendritic cells (pDC) were separated by magnetic beads. The mDC, pDC, and mDC ∶ pDC=1 ∶ 1 were stimulated with heat?treated Lewis lung cancer cell lysates, respectively. The effects of each group on stimulating of lymphocyte proliferation and inducing of T cell to kill tumor cells in vitro were compared. The alternations of the immunophenotypes of CD80, CD86, CD40 and major histocompatibility complex Ⅱ( MHC?Ⅱ) were detected by flow cytometry. The secretion of cytokines including interlukin?12 (IL?12), interlukin?6 (IL?6), and tumor necrosis factor α ( TNF?α) were detected by enzyme?linked immunosorbent assay ( ELISA). Results The lymphocyte proliferation in mice stimulated with mDC+pDC group loaded with heat?treated Lewis lung cancer cell lysates was 10.80±0.66, significantly higher than 8.63±0.65 of mDC group and 7.10±0.46 pDC group under the same culture conditions, respectively ( P<0.05). When the ratio of effector cells:target cells (E ∶ T) was 10 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 31.68%±2.93%, significantly higher than 17.44%±0.97% of mDC group and 10.29%±1.33% of pDC group, respectively (P<0.05). When the ratio of E ∶ T was 20 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 54.77%± 3.28%, significantly higher than 35.25%± 1.51% of mDC group and 15.52%±0.73% of pDC group, respectively (P<0.05). When the ratio of E ∶ T was 40 ∶ 1, the killing rate of the mDC+pDC group loaded with heat?treated tumor cell lysate was 73.01%± 0.91%, significantly higher than 51.36%± 0.58% of mDC group and 22.65%± 1.28% of pDC group, respectively (P<0.05 ). With the rate of E ∶ T increased, the killing rate also increased. The mean fluorescence intensities of surface molecules including CD80, CD86, CD40 and MHC?Ⅱ of mDC:pDC=1 group pulsed with heat?treated Lewis lung cancer cell lysates were higher than those of mDC group and pDC group. The IL?6 cytokine concentrations of mDC+pDC group, mDC group and pDC group loaded with heat?treated Lewis lung cancer cell lysates were (586.67±52.52) pg/ml, (323.33±67.14) pg/ml and (166.67± 16.07) pg/ml, respectively. The concentrations of IL?12 in each group were ( 2 568.75± 119.24) pg/ml, (2 156.25±120.55) pg/ml and (672.92±31.46) pg/ml, respectively. The concentrations of TNF?α in each group were (789.33±48.08) pg/ml, (584.89±116.49) pg/ml and (291.56±40.73) pg/ml, respectively. The concentrations of IL?6, IL?12 and TNF?α secreted by mDC+pDC group were much higher than those of mDC group and pDC group under the same culture conditions ( P<0.05). Conclusions The mDCs and pDCs combined vaccines pulsed with heat?treated Lewis lung cancer cell lysates have synergistic effects on inducing of T lymphocyte proliferation and killing tumor cells in vitro. This synergistic anti?tumor effect is related with up?regulation of co?stimulatory molecules and increased secretion of cytokines.
10.Clinical efficacy of stapler technique for repair of cervical tracheoesophageal fistula
ZHANG Jinzhou ; YANG Jianbao ; LI Bin ; ZHANG Jianhua ; JIANG Peng ; SONG Tieniu ; WEI Xiaoping ; ZHU Duojie ; MENG Yuqi ; GUO Quanwei
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2018;25(2):153-158
Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01). Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.

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