In order to salvage the extremity of dog with marked ischemia from extensive damage of the artery, an operation, diversion of saphenous artery and vein with the anterior tibial artery and vein was tried. The results showed that this operative technique was feasible as a method of treatment. Basing on this fact, the diversion of the saphenous vein in situ with the femoral artery, combined with selective extirpation of the valve of thd vein was used to treat 14 cases (15 limb) of high obliteration of artery of the lower extremities with good results.
Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs,62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the longterm surgical outcomes were summarized. Results During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a longterm effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. Conclusion The one-stage arteriovenous shunt performedon the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.
目的 观察体外静脉静脉转流对患者血流动力学的影响。方法原位异体肝移植患者14例，术中使用离心泵，部分肝素化方法行体外静脉转流。结果 体外静脉转流时间（98.9±23.6）min，转流量（1 168±260）ml/min，转流期及新肝5分钟心排血量（CO）明显下降，但仍维持在正常水平，体循环阻力（SVR）、肺循环阻力（PVR）转流30分钟后明显增加，心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）等在转流期均无明显变化，新肝早期MAP明显下降，SVR明显增加。结论 无肝期采用离心泵行体外静脉转流，有助于稳定血流动力学，但新肝早期仍有明显血压下降，主要通过适量快速泵灌注全血来纠正。
Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
Objective To assess the therapeutic effect of gastric bypass on type 2 diabetes mellitus (T2DM) after a one-year treatment in Mainland China. Methods Databases including The Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, CBM and CNKI were searched from inception to February 2012, and the relevant journals and references of articles were also searched to collect randomized controlled trials (RCTs) or before-after self-controlled trials on gastric bypass in treating T2DM in Mainland China. Two reviewers independently screened articles according to the predefined inclusion and exclusion criteria, extracted data, and evaluated quality of the included studies. Then meta-analyses were performed using RevMan 5.1.0. Results A total of 6 before-after self-controlled trials involving 131 patients were finally included. All these trials were graded as low quality. The results of meta-analysis showed that the therapeutic effect of gastric bypass on T2DM after a one-year treatment was good. There were significant reductions in both fasting plasma glucose (1 year: SMD=–2.55, 95%CI –3.40 to –1.69, Plt;0.000 01) and glycosylated hemoglobin (1 year: SMD=–1.98, 95%CI –2.33 to –1.62, Plt;0.000 01); there was no marked change in fasting insulin (SMD=–2.03, 95%CI –4.41 to 0.35, P=0.10). Sensitivity analysis indicated that these results were stable, but funnel-plots indicated possible publication bias existed. Conclusion One year after gastric bypass, T2DM patients in Mainland China get reduced in both fasting plasma glucose and glycosylated hemoglobin, but get no improvement in fasting insulin. However, this conclusion still needs to be further proved by more high-quality and large-scale clinical trials with long-term follow-up because of the limitation of quantity, scale and quality of the included studies.
Objective To investigate the indication and possibility of orthotopic liver transplantation for patient with alveolar hydatid disease. Methods An orthotopic liver transplantaion was successfully performed on two cases with unresectable alveolar hydatid disease using the new approach of venovenous bypass first.Results The recovery of liver graft function was good after the operation in these patients. Following up for nine and three months, the patients returned to his work without any complications. Conclusion It suggests that the case with advanced alveolar hydatid disease are an indication for liver transplantation. The new technique of venovenous bypass prior to mobilization of liver is feasible and safe.
Cava-atrial shunt was performed in the Treatment of Budd-Chiari syndrome in two cases, in which one belonged to type Ⅲ， and the oother type Ⅱ,the recent results were satidgactory. A rare cause of Budd-Chiari syndrome in one case is that some drugs for occluding the spermiduct was inadveretntly injected into the spermatic vein and inferior vana cava.
目的探讨主动脉血管旁路转流术在食管癌肿瘤侵及主动脉时手术治疗中的临床应用。 方法2012年2月至2013年3月，我院3例食管癌侵及主动脉病例，术前胸部CT检查显示食管肿瘤侵及降主动脉，选择左侧胸后外侧切口；术中在肿瘤侵及主动脉部位上下两端，临时架接“血管桥”，达到血管旁路转流的目的，再阻断受侵主动脉部位上下两端，进行充分彻底的肿瘤解剖，发生主动脉损伤或缺损，予以修补。 结果肿瘤解剖彻底，损伤的主动脉血管外膜及中层，予以修补，术后顺利恢复。术后随访7～20个月复查无肿瘤复发及转移。 结论主动脉血管旁路转流技术操作程序简单，安全可靠，创伤小，不增加额外的人员与设备（体外循环相关），增加了食管肿瘤的切除率。