Objective:To summarize and analyze the modalities and experience of retrograde distal perfusion with distal perfusion catheter (DPC) via cannulation of the posterior tibial artery in veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods:The clinical data of 15 patients who were treated with V-A ECMO and underwent DPC placement via the posterior tibial artery in our hospital from January 2022 to June 2023 were retrospectively analyzed.Results:The V-A ECMO catheterization method in 15 patients was percutaneous puncture catheterization, and all of them underwent surgical incision to indwelling retrograde DPC through the posterior tibial artery: 6 cases of preventive catheterization, 9 cases of remedial catheterization, the success rate of one-time catheterization was 93.33%, and the type of catheter was mainly 6 F sheath (66.67%). There was no ALI in preventive catheterization, and one case of osteofascial compartment syndrome occurred in remedial catheterization, and the catheterization time was (20.73 ± 3.47) min.Conclusions:In V-A ECMO, placement of DPC via the posterior tibial artery for retrograde distal perfusion is perfectly feasible, and has a high success rate, which can prevent or treat lower extremity ischemia.

Purpose: Whether a dilated intrahepatic bile duct (IHBD) has any effect on the prognosis of choledochal cyst (CC) remains controversial. We aimed to summarize the clinical characteristics and prognosis of CC with IHBD dilatation. Methods: One hundred ninety-two children diagnosed with CC were identified, including 127 without IHBD dilatation (group A) and 65 with IHBD dilatation (group B). A retrospective analysis was performed to explore the clinical characteristics and prognosis of CC with IHBD dilatation based on clinical indices, symptoms, and complications. Results: Compared with group A, incidences of jaundice and fever were higher in group B (P = 0.010 and P = 0.033). Preoperative total bilirubin, direct bilirubin, and indirect bilirubin were increased in group B compared to group A (P = 0.005, P < 0.001, and P = 0.014), as were preoperative ALT, AST, γ-GT, and total bile acid (P = 0.006, P = 0.025, P < 0.001, and P = 0.024). The risk of liver fibrosis or cirrhosis was significantly increased for group B compared with group A (P = 0.012) and also occurred earlier in group B (P = 0.006). In the dilated IHBDs, 95.4% (62 of 65) recovered to normal, and more than half of dilated IHBDs (37 of 65) recovered to normal in 1 week. Conclusion Most IHBDs can recover to normal postoperatively in a short time, and proactive treatment is recommended for CC patients with IHBD dilatation for significant abnormal liver functions.

OBJECTIVE: To assess the clinical application of preoperative retrograde portal venography for children with cavernous transformation of the portal vein (CTPV). METHODS: The clinical data of 8 cases of CTPV admitted in the Children's Hospital of Zhejiang University from January 2018 to September 2019 were retrospectively analyzed. Preoperative retrograde portography was performed to determine the corresponding vascular morphology and size of portal vein system. If the retrograde portography showed that the left branch of the shadow portal vein was unobstructed and its diameter was greater than 3 mm, Rex shunt would be performed after anatomic exploration of Rex recess; if retrograde portography showed that the diameter of left portal vein was less than 3 mm, but the diameter of left renal vein dissected during shunt operation was greater than 5 mm, Warren operation was selected. The patients were followed up for 1, 3 and 6 months after discharge, and then were followed up every 6 months. RESULTS: Retrograde portal venography was successfully performed in 8 child patients.The anatomical position and size of main portal vein and its left and right branches, left renal vein and other important vessels were determined. Among them, there was the well-developed left and right branches of portal vein in 4 child patients, in which the left and right branches of portal vein converged together, but did not communicate with the main portal vein. In addition, the left branch diameter of the portal vein was greater than 3 mm, and the anatomical exploration results during shunt were consistent with it, so Rex shunt was performed. In the other 4 cases, the left branch diameter of the portal vein was small (less than 3 mm) in 3 cases, and the right branch was not clearly developed. Moreover, the left branch of the portal vein was poorly developed and almost occluded in 1 case. However, the left renal vein in these 4 child patients was well developed, the blood flow was unobstructed and the diameter was greater than 5 mm, so Warren operation was performed. Seven patients recovered well after the operation, and the other one had digestive tract rudimentary one year after operation, and the condition was stable after conservative treatment. CONCLUSIONS The preoperative retrograde portal venography can be used to evaluate the portal vein system in children with CTPV, which provides important clinical basis for making appropriate treatment plan before surgery.
Child ; Humans ; Portal Vein/surgery* ; Portography ; Retrospective Studies

Objective: In this study, a new surgical technique was developed to reconstruct the lateral nail fold in the duplicated thumbs with a common nail and postoperative outcomes were evaluated. Methods: From December 2012 to October 2015, sixteen duplicated thumbs with a common nail were treated in our hospital using a flap from resected finger pulp which did not include the nail and phalanx. Unilateral inverting suture was performed between the flap and nail bed to reconstruct the lateral nail fold and nail groove. Postoperative outcomes were evaluated by Wang-Gao scoring system (total 12). Results: The follow-up period ranged from 10 to 45 months. The reconstructed nails were smooth and had a natural lunula, and the nail width was about 80%-100% of their normal sides. There was a right angle between the nail epithelium and lateral nail fold in four cases, and an acute angle in two cases. The reconstructed nails were asymmetrical in these thumbs. One patient showed a hypertrophy in the lateral nail fold. The reconstructed nails were evaluated by Wang-Gao scoring system: 10 in 2 cases, 11 in 4 and 12 in 10. All the cases had excellent results. Conclusions The nail width usually is more than 80% of the normal sides in the radial polydactyly with a common nail. The surgical technique can reconstruct a natural lateral nail fold and nail groove, and avoid the nail deformity caused by the Bilhaut-Cloquet procedure.

Objective To observe the effects of pretreatment with dimethyloxalylglycine (DMOG) on the survival of multi-territory perforator flap and the vessels of choke zone (CZ) 2 in rat,and to explore related mechanism.Methods Sixty adult SD rats were divided into group DMOG and normal saline group (NS) according to the random number table,with 30 rats in each group.Perforator flap with three angiosomes was made on the right dorsal side of rat,including deep iliac circumflex artery perforator,intercostal artery perforator,thoracodorsal artery perforator,as well as CZ 1 and CZ 2.Rats in group DMOG were intraperitoneally injected with 2 mL NS containing DMOG (40 mg/kg) 2 days before operation,2 hours before operation,and 2 days after operation.Rats in group NS were intraperitoneally injected with equivalent volume of NS at the same time point.On post operation day (POD) 7,gross observation was conducted,and the survival rate of flap was calculated.On POD 7,the vascularity in CZ 2 and potential zone of flap was observed using angiography.On POD 7,new vessel in CZ 2 of flap was observed with HE staining,and the microvessel density (MVD) was calculated.On POD 7,the expression of vascular endothelial growth factor (VEGF) in CZ 2 of flap was detected by immunohistochemistry and Western blotting (respectively denoted as integral absorbance values and ratio of gray value),and blood flow volume of vessel in CZ 2 of flap was examined by laser Doppler perfusion imager.The sample number of each index was 6 in each group.Data were processed with t test.Results (1) On POD 7,rats in two groups all survived,and the flaps were not infected.In group DMOG,the necrotic area of flaps of rats with dark yellow crust and soft texture was observed approximately at the distal end of skin entry point of thoracodorsal artery perforator.In group NS,the necrotic area of flaps of rats with brownish black crust and hard texture was observed approximately at the distal end of CZ 2.The survival rate of flap of rats in group DMOG was (88 ± 3) ％,which was significantly higher than that in group NS [(82 ± 3) ％,t =3.38,P ＜ 0.01].(2) On POD 7,there were clear vascular structure and many new vessels in CZ 2 of flaps of rats in group DMOG,with intact vascular structure in potential zone.On POD 7,there were unclear vascular structure and few new vessels in CZ 2 of flaps of rats in group NS,with disorder vascular structure in potential zone.(3) On POD 7,MVD in CZ 2 of flaps in rats of group DMOG was (29.2 ± 2.2)/mm2,which was significantly higher than that of group NS [(20.3 ± 3.6)/mm2,t =5.10,P ＜0.01].(4) On POD 7,the expressions of VEGF in CZ2 of flaps in rats of group DMOG detected by immunohistochemistry and Western blotting were 5 060 ± 432 and 0.48 ± 0.04 respectively,which were significantly higher than those of group NS (2 811 ± 382 and 0.26 ± 0.06,with t values respectively 9.54 and 5.67,P values below 0.01).(5) On POD 7,blood flow volume of vessel in CZ 2 of flaps in rats of group DMOG was (58 ±4) perfusion units (PU),which was significantly more than that of group NS [(46 ± 4) PU,t =5.20,P ＜ 0.01].Conclusions DMOG can increase the survival rate of multi-territory perforator flap through promoting angiogenesis in CZ 2 of flap on the back of rat and improving blood supply of flap.

Objective To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly.Methods From February 2007 to January 2015,we collected the patients with radial polydactyly,whose nail width or thumb girth was less than 80％ of contralateral side.Among them,some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb.In these cases,an island compound flap,which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail,part distal phalanx and skin,combining with ulnar side of ulnar thumb was used to reconstruct a new thumb.Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size.There were 26 patients,including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA.Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system.Results There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands:both thumbs only had one PPDA;the main thumb had two while the extra thumb still had one.The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months.Flap results included survival in 22 patients,tension vesicle in 2 patients and tip necrosis in 2 patients.The incision was infected in one patient with the treatment of changing dressing regularly.The function results were excellent in 21 patients,good in 4,fair in 1.Aesthetic results were excellent in 13 patients,good in 4 and fair in 1.Conclusions There is always one developed PDAA in extra thumb,which can be used to design a flap.The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs.Using an axial or island flap to reconstruct a new thumb can not only change the appearance,but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

Objective To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly.Methods From February 2007 to January 2015,we collected the patients with radial polydactyly,whose nail width or thumb girth was less than 80％ of contralateral side.Among them,some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb.In these cases,an island compound flap,which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail,part distal phalanx and skin,combining with ulnar side of ulnar thumb was used to reconstruct a new thumb.Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size.There were 26 patients,including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA.Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system.Results There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands:both thumbs only had one PPDA;the main thumb had two while the extra thumb still had one.The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months.Flap results included survival in 22 patients,tension vesicle in 2 patients and tip necrosis in 2 patients.The incision was infected in one patient with the treatment of changing dressing regularly.The function results were excellent in 21 patients,good in 4,fair in 1.Aesthetic results were excellent in 13 patients,good in 4 and fair in 1.Conclusions There is always one developed PDAA in extra thumb,which can be used to design a flap.The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs.Using an axial or island flap to reconstruct a new thumb can not only change the appearance,but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

Objective To investigate the effects of enteral nutrition (EN) for diabetes mellitus on the clinical outcomes of critically ill patients with hyperglycemia.Methods Sixty-four critically il1 patients with hyperglycemia were randomly divided into the control group and intervention group.The control group was given homemade homogenized meals and the study group was given EN for diabetes mellitus.Both were given the same total energy and nitrogen content.EN was applied 3 days after ICU admission and then lasted 14 days.Blood glucose was controled at 6.1-8.5 mmol/L by insulin therapy.No albumin,blood plasma,or parenteral nutrition was provided to all patients.The lactulose mannitol ratio,biochemical indicators,total insulin dosage,and short-term and longterm outcomes were analyzed before and after EN support.The quality of life was evaluated using Stroke Specific Quality of Life Scale.Results Finally 59 patients were enrolled in the study,with 30 in the intervention group and 29 in the control group.The lactulose mannitol ratios in the intervenion group were significantly lower than those in the control group 7 days (0.221 ±0.117 vs.0.299 ±0.154,t =-2.199,P =0.032) and 14 days (0.169 ±0.122 vs.0.305 ±0.129,t =-4.191,P =0.000) after EN support.Meanwhile,the total insulin dosages were also significantly less in the intervention group [7 days,(195 ± 54) vs.(227 ± 60) U ; t =-2.096,P =0.041 ;14 days,(392 ±114) vs.(459 ±118) U; t =-2.221,P =0.030].Compared with the control group,the intervention group had significantly shorter duration of mechanical ventilation [(8.00 ± 1.75) d vs.(6.73 ±2.05) d,t=-2.547,P=0.014] and ICU stay[(10.00±1.95) vs.(8.80±2.17) d,t=-2.233,P=0.030],lower total hospitalization expenses [(56 238.39 ± 17 869.61) vs.(70 395.63 ±20 111.69) Yuan,t =-2.861,P =0.006],and faster recovery of daily activities [(17.59 ± 3.21) vs.(35.34 ± 8.65) scores,t =10.030,P =0.000] and living quality of life [(22.67 ± 4.51) vs.(40.55 ± 8.88) scores,t =9.397,P =0.000] after 90 days of treatment.Conclusion The EN for diabetes mellitus may improve the outcomes of critically ill patients with hyperglycemia compared with blend diet.

Objective:The purpose of the study was to investigate the effects of enteral nutrition on stress response and gut barrier function after surgery for esophageal cancer. Methods: Patients who underwent esophagectomy were divided into two groups. Group PN (28 patients) served as the control group. Group EN (26 patients) received enteral nutrition. Results: The serum total protein, albumin, prealbumin and transferrin decreased after operation, but there were no differences between the two groups. The serum levels of IL-6 were significantly higher on the first and third postoperative days after the operation in two groups (P

Objectives:The purpose of this study was to investigate the effects of soybean oil emulsion on stress response and immune function after surgery for esophageal cancer. Mehtods:Patients who underwent esophagectomy with thoracotomy were divided into two groups.Group A(15 patients) received fatfree parenteral nutrition(PN) as the control group.Group B(18 patients) were fed by PN with soybean oil emulsion.There was no significant difference between the two groups in regard to either clinical backgrounds,nutritional parameters, or proteins measured before and after the operation. Results:The serum levels of cortisol and IL6 were significantly higher on the first and third postoperative days(P