Abstract:Objective:To explore the diagnosis and management of acute deep vein thrombosis(DVT) of lower extremity. Methods: The clinical data of 96 patients with DVT were analysed retrospectively. Results:The diagnosis rate of DVT by vascular color ultrasounography was 97.8%, by MVC/SVO ratio combined with air plethysmagraphy was 97.2%, and by ECT was 100%. The MVO/SVC ratio, and diameter of calf and thigh in surgery group and in non surgery group showed significant difference in 7 days after operation (P<0.01). In this series, the effect was excellent in 62 cases(64.6%), good in 25 cases (26.0%), bad in 3 cases (3.1%), and discharged oneself in 6(6.3%). Conclusions: Vascular color ultrasounography is the first choice of noninvasive examination . The air plethysmography is a objective, effective and noninvasive technique in the diagnosis and evaluation of treatment effect of DVT. Early embolectomy combined with thrombolytic and anticoagulant therapy can get good effect.

Abstract:Objective: To evaluate the effects of surgical treatment of acute deep vein thrombosis (DVT) of lower extremity. Methods : Thirtysix patients with acute DVT of lower extremity were treated by thrombectomy with thrombolytic,anticoagulant and compression on the affected lower extremity during and after operation. Results :No death and serious complications happened in this series. Thirtyone patients were followedup for 2 to 20 months with an average of 9 months. Symptoms disappeared totally in 23 patients, 8 patients had slight edema in the lower extremities. Conclusions :Combination of thrombectomy the thrombolytic and anticoagulant agent,and compression of the affected lower extremity is a safe and effective method in the treatment of acute DVT of lower extremity.

Abstract:Objective:To investigate the causes of groin lymphatic fistula after transluminal ultrasonic angioplasty (TUA) in the treatment of deep vein thrombosis(DVT) of lower extremity through groin incision. Methods: A retrospective analysis of the causes of groin lymphatic fistula(GLF) in 72 patients with DVT after treatment of ultrasonic ablation was made. Results:TUA and thrombectomy using Forgaty balloon catheter for DVT of lower extremity achieved successful recanalization in all the 72 cases (100%). Of the 72 cases,51 had iliac vein stenosis,the venous stenosis disappeared after balloon dilation;among the 51 cases,6 cases received stent placement. GLF occurred postoperatively in 60 cases. No death occurred in this series. Conclusions:TUA is an effective method in the treatment of DVT of lower extremity,but the incidence of postoperative GLF is high.The causes of GLF may be related to the injury of lymphatic vessels, increase of quantity of lymph flow induced by increased venous pressure, infection, surgical technique factors and postoperative medicine therapy etc.

Abstract:Objective:To evaluate the effect of varicose vein of lower limbs treated by intravenous laser treatment.Method:Intravenous laser apparatus combination with operation was used to treat the varicose vein of the lower extremities in 98 patients(all 118 legs).The change of symptoms and signs were recorded and compared before and after operation by using venous ultrasonagraphy and pathological examination to evaluate the treatment effect.Results:In the 84 followed up patieats (104 compromised legs),dull,heaviness were relieved completely after operation in 87 legs(83.7%),decreased in 11 legs(10.6%);skin pigmentation obviously decreased in 37 of 44 legs(84.1%);superficial varicose vein disappeared in all the patients.No blood flow signal was detected in 101 legs(97.1%) and slow blood flow in 3 legs(2.9%) were detected by ultrasounography.Pathological examination revealed various degeneration and necrosis in full layers of the vessels;and smooth muscle cells were disrupted,cell nucleus became pyknotic, the internal and external elastic laminar were ruptured and no inflammatory cell infiltration in the lumen and wall of the vessels were seen.Conclusions:Intravenous laser treatment is an ideal method in the treatment of varicose vein of lower extremities.

Abstract:Objective: To study the diagnosis and treatment of infected pseudoaneurysms(PA) resulting from drug injection. Methods:The clinical data of 11 cases of infected PA resulting from drug injection were reviewed retrospectively.1 patient was treated by nonoperation,10 cases were treated by artificial blood vessel transplantation after removal of PA and local debridement. Results:One case dead. All the 10 cases treated by operation had satisfactory results and none had ischemic symptom of the limbs.Eight grafts were patent demonstrated by color Dopler ultrasonography 3 months postoperatively. Conclusions :The diagnosis of PA induced by drug injection can be made by the history of drug injection, pulsate mass of injection site. The effective treatment should include control of infection,local debridement,PA resection and blood vessel implantation.

Abstract:Objective:To investigate the feasible and effective means for the lower extremity deep venous thrombosis(DVT).Methods :The clincal data of 211cases of lower extremity DVT treated in recent 9 years were analysed retrospectively.Antegrade infusion of high dose urokinase was performed via the dorsalis pedis vein of the involved lower limb in 179 patients.Of the 179 patients vena cava filters(VCF) was placed in 29 patients,including Tempofilter II VCF in 5patients, VenaTechTM LP VCF in 24patients.Other 32 cases underwent embolectomy after IVC filter placement(Tempofilter II was placed in 6patients, VenaTechTM LP was placed in 26patients). Results: 146 patients were followed up for 3108 months with averge 54months .A total of 61 IVC filters were successfully expanded,but 1 Tempofilter II VCF was migrated to proximal end of IVC.Tempofilter II VCF was taked out 24 week after the IVC filter placement . VenaTechTM LP occlusion in one case 14 months after the IVC filter placement.In thrombolytic group,87were cured,86 improved,6 ineffective. In operative group, 28were cured,3 improved,1 ineffective. The cured rate in operative group was better than that in thrombolytic group(P<0.05),but the total effective rate was similar in both groups.Conclusions: Vena cava filters placement can effectively prevent the formation of pulmonary embolism, but the indication should be strict.Combination of surgery with other therapy is effective in improving the results and preventing the sequela of lower extremity DVT.

Abstract:Objective:To study the operative procedure and effect of anastomostic pseudoaneurysm(APA). Methods:Eleven patients with APA were treated surgically.The diagnosis of APA in all the patients was comfirmed by angiography and ultrasonic examination. A small rupture leading to APA was repaired by lateral arteriorrhaphy using autologous vein patch in 4 cases; the APA caused by a big rupture of anastomosis,resection of the pseudoaneurysm and interposition of a PTFE or antologous vein were used in 7 cases.Results:10cases were followedup for 5-38 months (mean19.6 months),and 1case loss of followup.9 cases recovered to be normal in activities and works, only 1 case had nerve paralysis of the affect extremity caused by popliteal artery APA compression. All the cases have good blood perfusion of the extremities without recurrence. Conclusions: APA should be treated by surgery.During operation control blood vessels effectively and remove the pathological changetissues completely are important,and reasonable application of antibiotics and antithrombotic agents are the guarantee of getting successful results.

Abstract:Objective:To study the treament of arterial occlusion of lower extrimities. Methods:Seventythree cases(78 limbs) of chronic ischemia of lower extremities were diagnosed as artroial occlusion by color ultrasounography, DSA or MRA. Arterial bypass using grafting,endarterectomy and percuteneous transluminal angioplasty (PTA) were used for the artery segmental occlusion in 44 limbs. Venous arterialization and reconstruction of profunda femoris were performed for extensive occlusion in 29 limbs. Results:All the cases showed satisfactory results 6 months to 8 years after operation except 8 limbs (segmental occlusion in 3 limbs and extensive occlusion in 5 limbs) were amputated. Conclusions:The key points of improvement of the therapeutic effects of the arteral occlusion of lowe extremity lie on the choice of the therapeutic methods accoding to the results of DSA or MRA.

Abstract:Objective:To study the effect of apoptosis in the pathogenesis of great saphenous varicose(GSV) resulting from primary deep venous insufficiency (PDVI). Methods :Apoptosis and Bcl2 expression in the segment of first valve sinus of the GSV of PDVI of lower limbs were detected by transmission electron microscopy(TEM), agarose gel electrophoresis, TUNEL and immunohistochemistry. Results:There were 38 cases of PDVLs in experment group and 5 normal GSV in control group. In experiment group,the apoptosis cells(AC) (6.30±2.70)and apoptosis rate (AR)(0.42±2.12) in the first valve sinus of GSV were significantly higher than those in control group(1.60±0.81,0.21±1.10,respectively)(all P<0.05).In patients with I°,II° blood reflux of deep venous,the AC(3.06±1.65)and AR(0.36±2.41) were significantly lower than those in patients with III°,IV° blood reflux(9.85±3.26,0.48±2.96,respectively)(all P<0.05).
The Bcl2 expressions in the segment of first valve sinus of GSV in patient with PDVI (0.29±1.80) was significantly lower than that in control group (0.35±1.03)(P<0.05). Conclusions:Apoptosis and suppression of Bcl2 expression have important roles in the pathogenesis of PDVI of lower extremities.

Abstract:Objective:To investigate the expression and significance of p38 mitogenactivated protein kinase (MAPK) in autogenous vein graft. Methods: Autogenous vein graft model was established by transplanting the right jugular vein to infrarenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after surgery,respectively. Reverse transcriptionPCR and in situ hybridization,Western blot and immunohistochemistry methods were used to detect the expression of protein and phosphorylation protein of p38 and p38mRNA. Results:The expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%±26%）,and significantly higher than that on 4,6,8 weeks( P<0.01 vs.), Expression of p38 detected by Western blot reached to the peak on 2 to 4 weeks, and decreased significantly to 1/4 to 1/2fold on 8 weeks after surgery. The positive cells were mostly located in the vascular smooth muscle cells(VSMCs) in the media and/or intimal hyperplasia of vein graft. Conclusions: The activation of p38 MAPK system in intimal hyperplasia and vascular remodeling after vein graft may become a new target of the therapy for stenosis or obliteration of vein graft.

Abstract:Objective:To evaluate the transfection characteristic of Dosper and Lipofectamine to establish the basis for future massive application . Methods:The retroviral vector inserted SV40LT antigen gene was transfected into PA317 cell lines by Dosper or Lipofectamine mediation with or without serum. The viral titer was determined with the NIH3T3 cells. Results: In withoutserum condition, the transfection efficiency in Lipofectamine group was higher than that in Dosper group, but no significant difference(P＞0.05); in with serum condition, the transfection efficiency in Dosper group was significant higher than that in Lipofectamine group (P﹤0.01). And the transfection efficiency in both groups with serum were significant lower than that in both without serum groups. Conclusions:Transfection efficiency are high in using Dosper and Lipofectamine in without serum condition.

Abstract:Objective:To explore the clinical significance of arterial portography in the diagnosis and management of prehepatic type portal hypertension(PHPHT). Methods:Between 2000 to 2002, all the 11 patients with PHPHT were diagnosed by angiography and B type ultrasounography. Different operations were parformed including mesocaval shunt in 5 patients,portalvena cava shunt in 1, splenorenal shunt in 2,and portoazygos venous disconection in 1. Two patients were not operated. Results: Nine cases undergoing surgical operations had satisfactory outcome. Conclusions: PHPHT can be correctly diagnosed by indirect portal venography which is important for the choice of operation.

Abstract:Objective:To investigate the feasibility and effect of the operation performed on the shortterm after stop of esophageal variceal bleeding(EVB) in patients with portal hypertension. Methods:The clinical data of fifty two cases of EVB undewent pericardiac devascularization (PCDV) operation or combination of PCDV and shunt operation (combined operation) 12 weeks after the EVB stopped were analysed. Results:After operation, the portal pressure in combined operation group and PCDV group was （9.3±2.25）cmH2O and（3.65±1.52）cmH2O respectively. The operative mortality was 5.8% (3/52) and the mobidity was 44.2%（23/52）in this series. No rebleeding occurred in combined operation group,but recurrent bleeding developed in 2 cases in PCDV group during the early postoperative period. The incidence of rebleeding was 5.6% in combined operation group and 20.0% in PCDV group in long followup period. Postoperative encephalopathy occured in 2 cases in combined operation group and 1 case in PCDV group. Conclusions:For the patients with portal hypertension complicated with EVB,surgical therapy 12 weeks after stop of EVB might be a safe and feasible method. Combined operation should be performed on the younger patients with higher portal pressure(>35cmH2O) and the liver function belongs to Child A or B grade;however, if the patient with hepatic function of Child C grade,the first choice of surgical procedure is PCDV.

Abstract:Objective: To investigate the ideal procedure of digestive tract reconstruction after total gastrectomy. Methods:The clinical data of 86 cases undergoing total gastrectomy were reviewed retrospectively. Results:Total gastrectomy was performed in 86 cases, including 76 cases of gastric carcinoma, 8 cases of malignant lymphoma and 2 of leiomyosarcoma;and 17 cases in stage II, 48 cases in stage III, and 21 cases in stage IV. Radical total gastrectomy was performed in 48 cases and palliative total gastrectomy in 38 cases. Gastrectomy combining with resection of tail of pancreas, splenectomy, transverse colectomy or partial hepatectomy was performed in 28 cases; and with drug delivery system implanted into hepatic artery in 28 cases. The reconstruction of digestive tract included esophagoduodenostomy in 12 cases, Braun esophagojejunostomy in 15 cases, RouxenY esophagojejunostomy in 29 cases, and jejunal pouch interposition in 30 cases. Postoperative complications occurred in 18 cases, including anastomosis leakage in 3 cases and pancreatic fistula in 1 case. Postoperative heartburn occurred in 21 cases, dumping syndrome in 18 cases, epigastric fullness in 15 cases, diarrhoea in 12 cases, and dysphagia in 9 cases. Conclusions :Jejunal pouch interposition is an ideal procedure for reducing the patients′ postoperative symptoms and improving the quality of life after total gastrectomy.