中华胃肠外科杂志最新文献

In the past two decades, with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision, significant changes have occurred in the surgical treatment of right-sided colon cancer. The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium (CCRC) Organized national experts in colorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy, taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures, with a view to standardizing the surgical treatment of right colon cancer. The consensus recommendations were focused on three main aspects: (1) surgical anatomy: the key structures and its definitions related to the mesentery and vascular anatomy were clarified. It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision; (2) surgical technique: laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer; (3) surgical principles: D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer. Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis. Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis. Additionally, consensus recommendations were made regarding the location of vascular ligation, the extent of bowel resection, and anastomosis techniques.

Objective: To evaluate the characteristics, clinical management and clinical outcomes of type 2 intestinal failure (IF). Methods: A descriptive case-control study was carried out. The inclusion criteria were as follows: (1) the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus statement. (2) using a requirement for parenteral nutrition (PN) of 28 days or more as surrogate marker. (3) a multidisciplinary team (MDT) included surgeons, nutritionist, pharmacist, stoma therapists, and critical care physicians. (4) complete laboratory data. Patients with type 1 and type 3 IF and those who do not cooperate with follow-up. All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023. The pathophysiology, clinical management, and outcomes of type II IF were analyzed. Results: A total of 67 type II IF were included. The median age was 54 (15-83) with 43 males and 24 females. The body mass index was (17.5±3.8) kg/m², the incidence of malnutrition was 67.2% (45/67), the incidence of sarcopenia was 74.6% (50/67), the median number of previous surgeries was 2.0 (1-13), and the median duration time of PN was 2.1 (1-12) months. The underlying disease of type 2 IF included 36 Crohn`s disease, 2 ulcerative colitis, 3 radiation enteritis, 2 intestinal Behcet's disease, 4 mesenteric infarction, 1 aggressive fibromatosis, 5 abdominal cocoon syndrome, 5 gastrointestinal perforation, 1 hernia, 4 intestinal dysmotility, and 4 other reasons (gastrointestinal tumor, trauma, and non-Hodgkin's lymphoma). According to the pathophysiology of IF, there were 33 intestinal fistula, 12 intestinal dysmotility, 6 mechanical obstruction, 13 short bowel syndrome, and 3 extensive small bowel mucosal disease. After treatment with MDT, 67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment, of which 36 patients recovered with oral diet or enteral nutrition, 31 patients underwent reconstructive surgery after intestinal rehabilitation treatment failure. The median duration time of reconstructive surgery was 2.7 (1-9) months. 24 patients recovered intestinal autonomy after surgery, with 7 deaths, including 6 deaths due to abdominal infections and 1 case of intestinal dysmotility with abiotrophy and liver failure. Conclusion: Standardized multidisciplinary treatment plays an important role in type II intestinal failure, and it promotes patients with intestinal failure regain enteral autonomy.

The concept of membrane anatomy has been widely accepted and applied in clinical practice, but there are still many theoretical and practical conflicts. This article elucidates the fundamental concepts and manifestations of membrane anatomy, delineating its comprehensive integration of anatomical and surgical disciplines. Thereafter, this article specifically discusses its differences from the traditional anatomy and surgery, and then clarifies the important role of membrane anatomy as the third generation of surgical anatomy and the new surgical concept for the development of pelvic surgery.

Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.

This study elaborates the essence of distant lymph node metastasis and skip metastasis of esophageal cancer according to the membrane anatomy theory. Lymph distant metastasis of esophageal cancer is essentially the phenomenon of cancer cells shedding from the primary focus of esophageal cancer and transferring along the direction of lymphatic drainage to the root of the esophageal mesentery. Because the metastasis is relatively distant, it is called distant metastasis. Despite the long distance, this metastasis is still limited to the envelope-like-membrane structure of the esophageal mesentery and belongs to the category of mesangial carcinoma. The lymph node skip metastasis of esophageal cancer refers to the process in which esophageal cancer cells detach from the primary lesion and migrate along the lymphatic drainage direction within the envelope-like-membrane structure of the mesentery to the central lymph nodes at the root of the mesentery. During this metastatic process, the surrounding mesenteric lymph nodes which are tightly attached to the esophagus will not be affected by cancer metastasis because of the isolation barrier effect of the envelope-like membrane structure of the esophageal mesentery. Applying the theory of membrane anatomy to esophageal cancer radical surgery will make the surgery more scientific, reasonable, and standardized, and is expected to achieve dual benefits of both surgical and oncological effects in esophageal cancer radical surgery.