ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has not been recommended in national and international guidelines nor endorsed by expert consensus; to investigate the primary obstacles to its standardization and widespread adoption; and to propose strategies leveraging China’s extensive clinical experience to refine the technique, establish standardized protocols, and address existing challenges, thereby defining its future role in metabolic surgery. MethodsBy systematically reviewing the evolution, current evidence profile, and distinctive features of SG-JJB compared to other SG-Plus procedures, this study aimed to identify constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we explored the feasibility of procedural refinements, key steps for standardization, and solutions to potential challenges, thereby facilitating the optimization and standardization of SG-JJB. ResultsThe three key constraints hindering SG-JJB development were: risks of blind loop syndrome, uncertainty regarding optimal bypass limb length, and limited evidence on long-term efficacy. To address these issues, this study proposed leveraging China’s clinical and multi-center collaboration strengths to: conduct high-quality studies defining the impact of bypass length on outcomes, establish unified diagnostic and monitoring protocols for blind loop syndrome, and systematically collect longitudinal data to evaluate long-term efficacy, thereby informing evidence-based surgical standardization. ConclusionsSG-JJB holds significant potential in Chinese bariatric-metabolic practice, yet its standardization faces persistent challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal for advancing SG-JJB standardization and adoption. Leveraging domestic clinical resources through multi-center collaborations, high-quality research, and evidence-based protocol development is the essential pathway to overcoming these barriers, achieving standardized implementation, and securing recognition in authoritative guidelines.
ObjectiveTo investigate the effectiveness of the modified Urbaniak operation to treat avascular necrosis of the femoral head (ANFH). MethodsA retrospective analysis was made on the clinical data of 38 patients (41 hips) with ANFH treated between February 2010 and October 2012 with the modified Urbaniak operation (to add lateral femoral incision based on femoral greater trochanter incision, to preserve the original fibula flap drilling, decompression and filling through trochanteric outer cortex, and to select the descending branch of lateral circumflex femoral artery as the supply vessel). Of 38 cases, 25 were male (28 hips), 13 were female (13 hips), aged 16-52 years (mean, 34 years); there were 19 cases (21 hips) of alcoholic ANFH, 9 cases (9 hips) of traumatic ANFH, 5 cases (6 hips) of hormone ANFH, and 5 cases (5 hips) of idiopathic ANFH. The disease duration ranged from 10 months to 6 years (mean, 3.7 years). According to Ficat staging criteria, 24 hips were rated as stages II and 17 hips as stage III. The preoperative Harris hip scores were 80.63±5.02 and 77.06±6.77 in patients at stage II and III respectively. The related complications were recorded after operation. According to the findings of postoperative X-ray films, 4 grades were improvement, stabilization, deterioration, and failure; improvement or stabilization was determined to radiological success. According to the Harris score to evaluate the function of hips, more than 80 was determined to clinical success. ResultsHealing by first intention was achieved in all patients after operation. Three cases had numbness and hypoaesthesia of the lateral femoral skin, 1 case had abnormal sensation of the dorsal foot, which had no effect on daily life. Thirty-eight cases (41 hips) were followed up 1 year to 3 years and 3 months (mean, 2 years and 3 months). There was no complication such as hip joint stiffness, hip or groin persistent pain, hip joint infection, or ankle instability. At last follow-up, the X-ray films showed improvement in 23 hips (56.1%), stabilization in 17 hips (41.5%), and deterioration in 1 hip (2.4%); 40 hips obtained the radiological success. According to the Harris score, the results were excellent in 17 hips, good in 20 hips, fair in 3 hips, and poor in 1 hip with an excellent and good rate of 90.2%; 37 hips achieved the clinical success. The Harris scores were 89.92±4.12 and 86.53±5.70 in patients at stage II and III respectively at last follow-up, showing significant differences when compared with preoperative ones (t=7.011, P=0.000;t=4.412, P=0.000). ConclusionThe modified Urbaniak operation has the advantages of more convenient operation, less complications, higher safety, and better hip functional recovery. It is an effective method to treat ANFH.
Objective To compare the effect of two different operations on treating severely comminuted intercondylar fracture. Methods From December 2001 to October 2003, 20 cases of severely comminuted intercondylar fracture were operated. Of the 20 cases, 7(group 1) were treated with closed reduction and retrograde intramedullary nailing through arthroscope, 13(group2) were treated with open reduction and retrograde intramedullary nailing without arthroscope. Follow-ups were conducted after operation. Results All cases of fracture were recovered. Swelling in group 1 was alleviated more obviously than that in group 2. In group 1, all knees could flex to 120° during 6th to 9th weeks after the operation. In group 2, only 4 could flex 110°.Conclusion Retrograde intramedullary nailing through arthroscope proves to be less invasive and more effective in treating heavily comminuted intercondylar fracture.
摘要:目的:探讨老年人股骨粗隆间骨折不同手术方式的选择。方法:我院2004年1月至2007年12月间应用不同术式治疗老年股骨粗隆间骨折110例,其中动力髋螺钉(DHS)25例, 股骨近端髓内钉(PFN)41例,人工股骨头置换44例。术后所有患者均获随访,平均12.6个月。对术后并发症和按照Kuderna 改良 Merli D’Aubigne标准得到的髋关节功能恢复优良数(率)进行评价。结果:术后出现并发症3例,其中PFN术式2例;人工股骨头置换术式1例。围手术期内无伤口感染,无死亡病例。三种术式总体优良数(率)为:107(97.3%)。结论:三种手术方式各有其优缺点,没有一种术式能普遍适用于各种类型粗隆间骨折,临床上,为了最大限度降低手术风险,我们没有必要专注或偏好于某一种手术方式,要根据患者的个体差异及每种术式的优缺点,灵活地为每例股骨粗隆间骨折患者制定出其最适宜的手术方式,大都能取得满意的疗效。Abstract: Objective: To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly. Methods:From January, 2004 to December, 2007, 110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively:dynamic hip screw (25 cases), proximal femoral nail (41 cases), hip hemiarthroplasty (44 cases). After surgery all patients were followed up; Followedup period range from 6 months to 18 months(average 12.6 months). The good and excellent number (rate) of 3 surgical methods with Merli D’Aubigne evaluation criteria were evaluated, and compared in the postoperative complications. Results: 3 complications occurred postoperatively ( 2 with PFN,1 with hip hemiarthroplasty), none wound infection or died in Perioperatie. The total good successful number (rate) was 107(97.3%). Conclusion:Each has its advantages and its disadvantages. None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture. In clinical work, we don not need to focus on or prefer to the only one of them in order to minimize the risk. The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.
Objective To establish dog model of testicular autotransplantation with a modified technique.Methods Testicular autotransplantations were performed on the right side of 30 male dogs, whose ages ranged from 1.5 to 2.0 years old and weights ranged from 14 to 17 kg. After the spermatic artery with a cuff of abdominal aorta and spermatic vein and with a cuff of inferior vena cava were detached, the testis was perfused and kept at icing temperature. An end-to-side anastomosis of the spermatic vessels to the external iliac vessels was conducted subsequently. The survival conditions of the auografts were assessed by digital subtraction arteriography (DSA). Histological examination and detection on the serum levels of follicle stimulating hormone (FSH), luteotrophic hormone (LH), and testosterone (T) were made at two weeks intervals. Results Of the 30 testicular autotransplantations performed, 27 cases were successful. The success rate was 90%. The time of heat ischemia, cold ischemia, anastomosis of spermatic vessels, and total operation was 4.5±0.9 minutes, 50.0±10.0 minutes, 35.5±5.5 minutes, and 3.5±0.5 hours respectively. DSA proved that the testis survived well. No morphological abnormality was found at different stages of the spermatogenic cells. The LH level was higherthan that before operation, being statistically different (Plt;0.05);however, the levels of FSH and T did not changed significantly (Pgt;0.05). Conclusion A stable and feasible model of testicular autotransplantation is established and it provides a reliable experimental platform for human testicular transplantation.
From July 1978 to July 1990, 11 operative methods for reconstruct the gluteal motors were performed in 733 cases. The result was satisfactory. The authors first introduced the Clinical material, then discussed principally how to selecte the operative type and some technical points to improve the result. It was thought that Obers operation was simple, easy and its result was reliable. So, it was taken as the method of priority in restoring the gluteal motors in this hospital.
目的 探讨闭合性十二指肠损伤的诊断与术式选择及其效果。 方法对1980～1999年间收治的33例闭合性十二指肠损伤患者临床资料进行回顾性总结分析。结果 合并伤27例，其中胰腺损伤占24.2%(8/33)，术前诊断率为18.2%(6/33)，术中漏诊率为15.2%(5/33)。术式选择：单纯十二指肠损伤以修补为主，十二指肠裂口较大或缺损者，可采用空肠浆膜覆盖术及十二指肠空肠Y型吻合术等其它术式，合并有胰腺损伤者宜行Graham简化术。同时应行充分的十二指肠减压和腹腔引流。术后并发症发生率为39.4%(13/33)，治愈率为84.8%(28/33)，死亡率为15.2%(5/33)。 结论 十二指肠损伤应重视早期诊断，在剖腹探查中应识别其损伤特征，并掌握切开探查方法，防止漏诊；术式选择宁简勿繁，不同患者适时、适当地采用最佳的诊断和治疗方法是十二指肠损伤手术成功的关键。
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points （2-9 points） on day 2, 2.2 points （1-8 points） on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia， 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.
Objective To analyze the current status of day surgery in West China Hospital of Sichuan University and compare it with the Recommended Catalogue of Day Surgery (2022 Edition), in order to provide reference for the update and expansion of day surgery procedures in hospitals. Methods The day surgical procedures carried out in West China Hospital of Sichuan University from October 2009 to July 2023 were collected. The day surgical procedures were classified based on surgical specialties, types of procedures, methods of operation, and surgical grading, etc. The day surgical procedures in West China Hospital of Sichuan University were compared with those in the Recommended Catalogue of Day Surgery (2022 Edition). Results A total of 576 types of daytime surgeries were carried out in West China Hospital of Sichuan University, involving 15 specialties. A total of 662 types of day surgeries were recommend in the nationally recommended catalogue for daytime surgery, involving 11 specialties. Among the nationally recommended surgical procedures, West China Hospital of Sichuan University had carried out 233 types of surgical procedures, and 26 additional types of surgical procedures were carried out as outpatient surgeries. According to the classification of surgical difficulty, the Level Ⅱ and Ⅲ surgeries were mainly carried out in West China Hospital of Sichuan University, and the Level Ⅱ surgeries were mainly recommend in the nationally recommended catalogue for day surgery. Conclusions The high-quality development of day surgery in China should not be limited to the supplement of surgical procedures. It is necessary to strive to increase the proportion of minimally invasive and fourth-level surgeries while ensuring medical quality and safety, and improve the overall medical level of day surgery.