2016年 · 第54卷第08期

Organ transplantation is currently the most effective treatment for end-stage organ failure. The results showed that the harvesting and preservation of donor organs and ischemia-reperfusion injury after transplantation were important factors affecting the prognosis of transplantation^[1]。 Since the middle of the 20th century, various research centers have continuously developed and improved organ protective solution. Collins solution, UW solution and HTK solution have come out one after another, which has promoted the rapid development of organ static cold preservation technology based on organ protective solution, made organ preservation get rid of the restriction of time and region, and greatly promoted the progress of organ transplantation^[2]。 Static cold preservation is the most commonly used technique for organ protection and is used by most organ transplant centers worldwide. At present, organ donation after the death of citizens has become the main source of organ donation in China. However, the possible lesions of donated organs itself, as well as long-term hot ischemia and cold ischemia, lead to more serious ischemia-reperfusion injury, which significantly affects the prognosis of transplantation. Therefore, how to improve the quality of donor organs is particularly important^[3]。 Recently, mechanical perfusion technology has been used in organ preservation and repair again. However, due to the comprehensive influence of pressure, perfusion speed, oxygenation and other parameters, its clinical application effect needs to be verified by the results of a large number of multi-center clinical trials^[4]。

chronic total occlusions (CTO) of lower extremity femoropopliteal artery are typical lesions of lower extremity atherosclerosis obliterans (ASO) and the most common form of lower extremity ASO. At present, subintimal angioplasty (SIA) has been widely used in the clinical treatment of CTO. We treated complex CTO lesions of femoropopliteal artery with guidewire difficult to be formed through the real lumen with SIA, and achieved satisfactory therapeutic results. The key points of technical operation are reported below.

PatientMale, 75 years old, admitted to hospital in October 2014 for "1 month of abdominal aortic aneurysm found on physical examination". With a history of hypertension for more than 20 years, blood pressure control can be achieved; Old myocardial infarction, 6 years after coronary artery bypass grafting. A pulsatile mass was palpable on abdominal examination without tenderness. Preoperative CT angiography showed that the maximum diameter of the abdominal aortic aneurysm was 98 mm, and a large number of mural thrombosis formed in the tumor cavity. Both renal arteries originated from the tumor body, the superior mesenteric artery originated from the normal aorta, about 5 mm away from the tumor body, and the celiac trunk artery was about 8 mm away from the superior mesenteric artery (Figure 1)。 Because the patient is older, has many concurrent diseases, and is in poor general condition, the family members refuse to undergo open surgery. After careful measurement and preoperative discussion, it was decided to use chimney technique combined with reverse branching technique to completely reconstruct the visceral and renal arteries and repair the abdominal aortic aneurysm. In order to further understand the anatomical shape of the lesion, three-dimensional printing technology was applied to model the lesion before operation, and specific surgical plan was formulated (Figure 2)。

The patient was a 70-year-old male. The main reason was "painless macroscopic hematuria for 2 weeks". B-ultrasound showed a hypoechoic tumor in the right side wall of the bladder, with a size of 1.74 cm ×1.60 cm ×0.82 cm, considering the stage T1 of bladder tumor; CT showed no abnormalities in the upper urinary tract, and a hypoechoic mass in the right wall of the bladder, with a size of 2.0 cm ×1.1 cm ×0.8 cm. After cystoscopic resection of the right lateral wall tumor, the surrounding mucosa was examined by narrow band imaging technique, and an isolated mucosal abnormality in the posterior wall was found (Figure 1，Figure 2)。 Under narrow-band imaging, the boundary of the mass was marked by electrosurgery (Figure 3), and then the diseased mucosa was removed under ordinary white light. Pathological findings: Papillary transitional cell carcinoma G3 (high-grade urothelial carcinoma), invasion of lamina propria, pT1a.

Question 13In laparoscopic left hemicolectomy, the left and right branches of the middle colonic artery often have variations. How to ensure the length and blood supply of the reserved intestine after severing the blood vessels?

Question 18How long after ulcerative colitis sigmoid perforation fistula can be repaid? Is colitis to be treated? How will future anastomotic healing be assessed?