Volume 16,Issue 6,2007 Table of Contents

1 Surgical management for ruptured abdomnial aortic aneurysm: a report of twelve cases

ZOU Jun-jie , ZHANG Xi-wei , SUN Peng , DONG Jian , CHEN Guo-yu

2007, 16(6):1. DOI: 10.7659/j.issn.1005-6947.2007.06.001

[Abstract](1086) [HTML](0) [PDF 935.19 K](1025)

Abstract:
Abstract:Objective:To explore the diagnosis and management of ruptured abdominal aortic aneurysm (RAAA).
Methods:Twelve patients with RAAA treated in past 7 years were revienled retrospectively. The main clinical manifestations were abdominal pain and / or back pain， low blood pressure or shock，and pulsating abdominal mass. All cases were accurately diagnosed with CT and 7 were treated by conventional operation, one by EVAR, and the other 4 did not receive surgical treatment.
Results:Perioperative death occurred in 5 cases (mortality rate was 62.5%) in 8 surgical treated patients, including circulatory failure in 2 cases, renal failure in 1 case, and multiple organ failure in 2 cases. All the 4 patients treated with nonoperative method were dead.
Conclusions:Surgical operation in RAAA cases still carried a high mortality.Early dignosis, appropriate resuscitation， urgent surgical repair, reduction of operative time, and infrarenal clamping are measures conducive to lowering the mortality rate of RAAA. EVAR has the potential to reduce the mortality rate from RAAA.

2 Surgical treatment for abdominal aortic aneurysm in 46 cases

LI Jie-qiu , XIA Hong-zhi , CHEN Xue-ming , LI Han-jun , XIE Xiao-feng , LIU Fei , GE Jian-jun , PENG Hao , KONG Ping

2007, 16(6):2. DOI: 10.7659/j.issn.1005-6947.2007.06.002

[Abstract](879) [HTML](0) [PDF 1023.22 K](896)

Abstract:
Abstract:Objective:To study how to improve the safety of the operation for abdominal aortic aneurysm (AAA).
Methods :Forty-six cases of AAA received resection of AAA plus artificial blood vessel transplantation in recent three and a half years in our 2 hospitals. The lesions involved only the abdominal aorta in 20 cases, and extended to unilateral common iliac and internal and external iliac arteries in 8 cases, to bilateral common iliac and external and internal iliac arteries in 16 cases, and involved the renal artery in 2 cases. Emergency operation was done in 3 cases.
Results:In these 46 cases, 45 were cured and 1 died, and no operative complications occurred.
Conclusions:Surgical operation is the best way to treatment AAA.

3 Clinical analysis of surgical treatment for superior mesenteric artery embolism

ZHAO Dongwen , LUO Tao , GU Yongquan , YU Hengxi , LI Jianxin , ZHANG Jian , WANG Zhonggao

2007, 16(6):3. DOI: 10.7659/j.issn.1005-6947.2007.06.003

[Abstract](777) [HTML](0) [PDF 1.07 M](1085)

Abstract:
Abstract:Objective:To assess the early diagnosis of acute mesenteric artery embolism and the clinical outcome of embolectomy.
Methods :The clinical data of 21 patients with superior mesenteric artery embolism between 1999 and 2005 were retrospectively analyzed. The patients were divided into two groups according to the operation time interval after onset of symptoms. Group I (n=9): patients were operated on in the first 6 hours after onset of symptoms; group II (n=12): patients were operated on more than 6 hours after onset. Urokinase administration directly into the superior mesenteric artery was an additional procedure during the embolectomy, and postoperative heparin anticoagalation was used in all patients.
Results:The circulation of the intestine returned to normal in 12 patients (all of the 9 patients in group I and 3 patients in group II) 30 minutes after embolectomy and administration of urokinase. Segmental intestinal resection was necessary in 4 patients and extended intestinal resection in 5 patients in group II.The motality of group II was 41.6% and 0 in group I.
Conclusions:Early recognition and prompt treatment can reduce the incidence of bowel necrosis and mortality rate of patients with superior mesentevic artery embolism.

4 Clinical analysis of composite sequential bypass graft for treatment of chronic limb ischemia

LUO Tao , GU Yong-quan , YU Heng-xi , LI Xue-feng , QI Li-xing , LI Jian-xin , ZHANG Jian , WANG Zhong-gao

2007, 16(6):4. DOI: 10.7659/j.issn.1005-6947.2007.06.004

[Abstract](812) [HTML](0) [PDF 1.04 M](919)

Abstract:
Abstract:Objective:To evaluate the outcome of composite sequential bypass in treatment of chronic lower extremity ischemia.
Methods :The clinical data of 25 patients with chronic lower limb ischemia who underwent composite sequential bypass reconstruction, in a 3year period, were retropectively analyzed. The composite vessel consisted of PTFE vassular prosthesis and autologous vein. The proximal end of PTFE was anastomosed to the common femoral artery, and the distal end to the isolated popliteal artery. The autologous vein exited from the lower end of PTFE vessel and was anastomosed to the tibial or peroneal artery in the leg.
Results:The venous reconstructions had the inflow taken from the distal PTFE artery (above knee in 5 and below knee in 20). The outflow involved the peroneal　artery in 12 (48%), the posterior tibial artery in 8(32%), and the anterior tibial artery in 5 (20%). Primary patency, secondary patency and limb salvage were 61%, 68% and 73% at 3 year, respectively.
Conclusions:Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction has high longterm patency rate and good effect of limb savage,it is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.

5 Experience of salvage treatment of patients with inferior vena cava injury: a report of 12 cases

TONG Qi-wen， HUANG Jian-hua， XIONG Jian -ming， LI Ding-jun， XU Guo-wu， CAO Li

2007, 16(6):5. DOI: 10.7659/j.issn.1005-6947.2007.06.005

[Abstract](1405) [HTML](0) [PDF 924.19 K](1023)

Abstract:
Abstract:Objective:To study a repair method for injury of inferior vena cava (IVC).
Methods :The clinical data of 12cases with inferior vena cava injury were analyzed retrospectively.
Results:Nine cases were due to blunt trauma and 3 penetrating injury. All cases were in shock at the time of admission and were diagnosed as injury of abdominal organs, but none were diagnosed as injury of inferior vena cava. All 12 cases underwent operative treatment. Five cases were treated by suture of the rupture of IVC successfully, and 2 cases were treated by suture of liver after omental packing the ruptur of IVC, and other 5 cases were treated by gauze packing. Postoperative complications occurred in7 cases (58.3%) and 3 cases (25.0%) died. Among them, 1 case died of massive hemorrhage during operation, in 5 cases who were treated by gauze packing and 2 died.
Conclusions:It is difficult to deal with injury of inferior vena cava, mortality is high and gauze packing together with modified normothermic hepatic vascular exclusion gives good results and merits widespread application.

6 Surgical treatment of diabetic arteriosclerotic occlusive disease of lower extremities in old patients

HAN Bing， ZHANG Hong-guang， ZHOU Chen-guang， JI Guo-hui

2007, 16(6):6. DOI: 10.7659/j.issn.1005-6947.2007.06.006

[Abstract](958) [HTML](0) [PDF 1.03 M](1093)

Abstract:
Abstract:Objective:To study the method and effect of treatment of diabetic arteriosclerotic occlusive disease (DASO) of lower extremities in old patients.
Methods :Fiftysix DASO patients were treated from January 2006 to January 2007. Fortyone of them were treated by PTA and stenting,11 cases were treated by embolectom and continuous intravascular medicine transfusion, and 4 cases were treated by PTA and bypass with vascular prosthesis.
Results:Clinical symptoms improved in all the 56 cases. No perioperative death or serious complications occurred. All cases were followedup for 3-12 months. Among them, 6cases were found with recurrence 3-6 months after the operation and were successfully treated by another PTA.The othe cases had satisfactory results.
Conclusions:PTA gives definitely good results in treatment of DASO. The procedure can be repeated and, when necessary, it can be combined with other treatment methods. PTA can be selected as first line therapy for vascular recanalization in elderly patients with DASO.

7 The correlation between Cockett syndrome and the relapse of acute deep vein thrombosis of the lower extremity after thrombectomy

YANG Dong-shan , LI Xue-feng , LIU Ru-hai , LI Feng-shan

2007, 16(6):7. DOI: 10.7659/j.issn.1005-6947.2007.06.007

[Abstract](1180) [HTML](0) [PDF 926.92 K](946)

Abstract:
Abstract:Objective:To explore the correlation between Cockett syndrome( stenosis of the left common iliac vein)and the relapse of acute deep vein thrombosis of the left lower extremity after thrombectomy.
Methods :The causes of relapse in 78 cases of acute deep vein thrombosis of the left lower extremity after thrombectomy performed in the past 11years were reviewed.
Results:The relapse rate was 47.6%(10/21) in the group with Cockett syndrome when thrombectomy was done but the stenosis of the left common iliac vein was not treated. The relapse rate was 14.8%(4/27) in the group with Cockett syndrome when thrombectomy and the stenosis of the left common iliac vein were treated. The relapse rate was 13.3%(4/30) in the group without Cockett syndrome.
Conclusions:Cockett syndrome is an important cause for the relapse of acute deep vein thrombosis of the left lower extremity after thrombectomy. The relapse rate was markedly decreased when thrombectomy combined with aggressive treatment of the stenosis of the left common iliac vein were performed.

8 Combination of minitrauma venous valve reparation and intravascular electric coagulation to treat primary deep venous valve dysfunction of lower limb

WANG Chun-xi , HAN li-na , PU Dong-li , SUN Sheng , CAO Xiao-ming , WANG Xiao-ling

2007, 16(6):8. DOI: 10.7659/j.issn.1005-6947.2007.06.008

[Abstract](741) [HTML](0) [PDF 1.08 M](961)

Abstract:
Abstract:Objective:To summarize the clinical experience of combination of minitramatic valve reparation with small femoral incision and intravascutlar electric coagulation of the varicose veins to treat primary deep venous valve dysfunction of lower limbs.
Methods :The clinical data of 67 patients with primary deep venous valve dysfunction who received operation of superficial femoral vein valve reparation and intravascular electric coagulation in the varicose vein was retrospectively analyzed.
Results:All patients could ambulate 5-10 hour′s after operation, stitches were taken out on 7th postoperation day and there were no complications. During 1 to 5 years follow-up by ultrasound, the clinical cure rate was 100% and 96.36% in 2 years and 3years respectively.
Conclusions:The combination of ineravascular electric coagulation and valve repair operations with small incision is a good, convenient, minitraumatic, aesthetic and rapid recuperative method for treatment of patients with primary deep venous valve dysfunction, and it is suitable for widespread use in base-level hospitals.

9 Hand-assisted laparoscopic hepatectomy for large left-lobe hepatic tumor: a report of 31 cases

ZHAN Xiao-jing , ZHANG Shao-geng , CHEN Yong-biao , GAO Yuan , WEI Wei-ming

2007, 16(6):9. DOI: 10.7659/j.issn.1005-6947.2007.06.009

[Abstract](790) [HTML](0) [PDF 1.24 M](677)

Abstract:
Abstract:Objective:To study the feasibility and safety of hand-assisted laparoscopic hepatectomy for large left-lobe hepatic tumor.
Methods :Thirty-one patients with large left-lobe hepatic tumor underwent hand-assisted laparoscopic anatomic and non-anatomic hepatectomy, including 19 cases of hepatocellular carcinoma, 2 cases of cholangiocelluar carcinoma, 7 cases of hepatic cavernous hemangioma, 1 case of hepatic metastatic squamous cell carcinoma, 1 case of hepatic cystadenoma and 1 case of hepatic spindle cell tumour.
Results:The operation procedures were completed safely in all patients, including 5 left hemihepatectomies, 21 left lateral segmentectomies, and 5 atypical hepatectomies. Sixteen cases had occlusion of hepatic hilum during the procedure and the mean occlusion time was 14.3minutes. The mean operation time was 109minutes.Mean blood loss was 112ml. The mean tumor size was 8.3 cm.No serious postoperative complications occurred. The mean postoperative hospital stay was 7.8 days.
Conclusions:Hand-assisted laparoscopic hepatectomy for large hepatic tumor is feasible and safe in selected patients.

10 Clinical study of laparoscopic hepatectomy for hepatolithiasis

FAN Qin-qiao , CHEN Shu-wei , CAO Wen-sheng , YU Yi , HU Xiu-hong

2007, 16(6):10. DOI: 10.7659/j.issn.1005-6947.2007.06.010

[Abstract](825) [HTML](0) [PDF 924.48 K](725)

Abstract:
Abstract:Objective:To explore the feaibility of laparoscopic hepatectomy (LH) for hepatolithiasis.
Methods :Eight patients with hepatolithiasis were treated by laparoscopic cholecystectomy(LC) and common bile duct exploration(LCBDE) and LH. Laparoscopic resection of left lateral lobe of liver was performed in 7 cases, and left hemihepatectomy in 1 case.
Results:〗Procedures were all successful with operation time of (285.00±37.42) minutes, and bleeding volume (306.25±29.73)mL.The postoperative hospital stay was (7.88±1.36) days. No complications occurred.No residual stone was found in any patient.
Conclusions:LH was safe and effective for hepatolithiasis, and gives better results when combined with choledoscopic stone removal

11 Effects of laparoscopic versus open hepatectomy on liver function

WANG Gang , LIU Rong , JIANG Jun-yuan , YANG Sui-chong , NIE Yong , WENG Mai , LI Chang-Geng

2007, 16(6):11. DOI: 10.7659/j.issn.1005-6947.2007.06.011

[Abstract](1310) [HTML](0) [PDF 936.89 K](761)

Abstract:
Abstract:Objective: To study the effects of laparoscopic and open hepatectomy(LH and OH) on liver function of patients, and to evaluate patients′ traumatic reaction after LH.
Methods :Forty patients scheduled to undergo hepatectomy were divided into LH group and OH group randomly in PLA General Hospital from Jun. 2004 to Feb. 2005. Data of pre-and post-operative liver function of the two groups were compared.
Results:Postoperative mean value of ALT, AST and LDH in LH group and OH group elevated quickly, and the postoperative mean value of these markers was significantly different compared to that of the preoperative value, and the mean value in OH was higher than that in LH. There was no significant difference between postoperative and preoperative level of ALP and γ-GT in both groups, but postoperative mean value of them in OH was higher than that in LH. There was no significant difference between the 2 groups in TBIL and DBIL level, but their postoperative mean value in OH was higher than that preoperatively.
Conclusions:The effects of LH on liver function in patients are less than those of OH. This finding suggests that patients′ traumatic reaction after LH is less than that after OH and this is beneficial for the reduction of hepatic failure after LH.

12 Hand-assisted laparoscopic colectomy: a report of 50 cases

QIU Hui-zhong , LIN Guo-le , WU-bin , XIAO Yi , ZHOU Jiao-lin

2007, 16(6):12. DOI: 10.7659/j.issn.1005-6947.2007.06.012

[Abstract](957) [HTML](0) [PDF 926.37 K](748)

Abstract:
Abstract:Objective：To evaluate the role of using the hand-assisted laparoscopic surgery (HALS) for colectomy.
Methods ：The data of 50 patiens with colonic cancer treated with hand-assisted laparoscopic technique between Mar 2002 and Aug 2006 were analyzed retrospectively.
Results：The rate of conversion from HALS to open surgery was 8.0%(4/50). The main reason for conversion was tumor invasion and large-sized tumor. The mean operation time was (163.8±15.1)min. The mean blood loss was (89.9±52.3)mL. The mean number of removed lymph nodes was (18.7±7.9). The mean length of the resected specimen was (30.1±6.1)cm. The mean postoperative hospital stay was (8.1±1.9) day and incision length was (6.9±0.1)cm. No operative death occurred. The mean time of follow-up was 18 months. No trocar site or incision recurrence was found.
Conclusions：These results suggest that HALS colectomy for colon cancer is mini-traumatic, has less postoperative pain and recovery is fast.

13 Clinical study of laparoscopic repair of acute peptic ulcer perforation

YI Shi-jian , LI Lan-lan , DENG Lian-xing , DAI Ping , GUO Rui-ping

2007, 16(6):13. DOI: 10.7659/j.issn.1005-6947.2007.06.013

[Abstract](890) [HTML](0) [PDF 924.90 K](839)

Abstract:
Abstract:Objective:To study the clinical value of laparoscopic treatment of acute peptic ulcer perforation.
Methods :Laparoscopic treatment group incluing 53 patients with acute peptic ulcer perforation and laparotomic treatment group including 54 cases.The operating time, volume of intra-operative blood loss, time to intestinal function recovery, length of postoperative hospital stay, the use of analgesics, the cost of hospitalization and the postoperative complications between the two groups were compared.
Results:There was a significant difference in the volume of blood loss, the time to intestinal function recovery, the length of postoperative hospital stay, and the use of analgesics between the two groups (all P<0.05).
Conclusions:Compared with laparotomic repair, laparoscopic repair has special advantages in the treatment of acute peptic ulcer perforation, such as less injury, less disturbance of celiac organs, faster recovery and a shorter postoperative hospital stay. This method does not increase the cost of hospitalization and it can replace the traditional laparotomic repair.

14 Clinical application of gasless laparoscopic surgery

WU Wei , RUAN Jing-de , XIA Zheng , OU Di-peng , ZENG Zhi-jun

2007, 16(6):14. DOI: 10.7659/j.issn.1005-6947.2007.06.014

[Abstract](1423) [HTML](0) [PDF 921.89 K](805)

Abstract:
Abstract:Objective:To evaluate the value of clinical application of gasless laparoscopic surgery.
Methods :The clinical data of 91 patients who underwent gasless laparoscopic surgery was analyzed retrospectively.
Results:fifty-one patients had cholecystectomy, 15 had appendectomy, 10 had combined operations and 15 had hand-assisted laparoscopic colectomy or rectectomy. The operations were all successful without serious complications such as anastomotic fistula, and no operative death.
Conclusions:Gasless laparoscopic surgery is practical, safe, and feasibile, and is highly worthy of clinical application.

15 Effect of leporine arterial wall shear stress change on matrix metalloproteinase 2 expression and aneurysm formation

LIU Sheng , SHU Chang

2007, 16(6):15. DOI: 10.7659/j.issn.1005-6947.2007.06.015

[Abstract](685) [HTML](0) [PDF 1.28 M](996)

Abstract:
Abstract:Objective:To observe the relation between the change of arterial wall shear stress and the expression of matrix metalloproteinase 2（MMP-2）, and analyze its role in aneurysm formation.
Methods :Forty-eight New Zealand rabbits were equally divided into experimental and control groups. During the operation of the experiment group, a homogenic patch was implanted to the abdominal aorta to form an aneurysm, while sham operation was done in the control group. The arterial wall was harvested 1d, 7d, 14d, and 28d after operation, respectively. The diameter of the aorta was measured before harvesting. The level change of MMP-2 was observed by immunohistochemistry.
Results:In experimental group, the diameter of the aneurysm and its inflow and outflow tracts were enlarged at the 7-day after operation (P<0.05). Large amount of inflammatory cells infiltrated the arterial wall, and with pathologic change of elastic fibers of the media. MMP-2 reached the peak value in 1d after operation (P<0.01), and remained at a high level of expression continually (P<0.01).
Conclusions:When shear stress changes, the diameter of arteries increases and the expression of MMP-2 in the vessel wall is up-regulated. The enlargement of the aneurysm has a relationship with the continuous high expression of MMP-2. MMP-2 may be involved in the relationship between arterial wall shear stress changes and the formation of the aneurysm.

16 The effect of antisense mTOR gene mediated by nanoparticles on neointimal formation in vein graft in rats

HU Xin-hua , ZHANG Qiang , YANG Jun , LIU Cheng-wei , ZHANG Zhi-shen，YANG De-hua

2007, 16(6):16. DOI: 10.7659/j.issn.1005-6947.2007.06.016

[Abstract](1227) [HTML](0) [PDF 1.39 M](1017)

Abstract:
Abstract:Objective:To study the effect of antisense mTOR gene transfection mediated by nanoparticles(NP) on intimal perliferation after vein grafting.
Methods :Nanoparticle antisense mTOR gene complex was prepared with PLGA and PVA. Autogenous vein graft model was established in 72 rats by transplanting internal branch of jugular vein to carotid artery. Three groups were studied: (1) antisense mTOR group, antisense mTOR gene mediated by NP was transfected into the veins before anastomosis. (2) Empty vector group, the vein was transfected by empty vector mediated by NP. (3) Control group, no transfection. The grafted veins were harvested 3 days, 1 week, 2 weeks and 4 weeks after operation, respectively. The exogenous mTOR mRNA and protein expression were determined and intimal hyperplasia (IH) was observed. The presence of apoptotic VSMC was also detected.
Results:Antisense mTOR gene transfection mediated by nanoparticle complex inhibited the mRNA and protein expression of mTOR gene(P<0.05), and the IH was inhibited in the vein graft especially during 7d~28d(P<0.01).
Conclusions:Nanoparticle is an effective gene transfecting carrier, and antisense mTOR gene expression can prevent the IH and promote apoptosis after vein grafting.

17 Effects of trichostatin A on the growth of colon cancer cells

ZHANG Bo , LIU Ke , CHEN Dao-da

2007, 16(6):17. DOI: 10.7659/j.issn.1005-6947.2007.06.017

[Abstract](925) [HTML](0) [PDF 1.30 M](1013)

Abstract:
Abstract:Objective:To investigate whether trichostatin A (TSA) possesses antitumor activity against human colon cancer cells.
Methods :Human colon cancer cell line Lovo was treated with different concentrations of TSA. The growth of Lovo cells were observed by MTT assay before and after TSA treatment. The cell cycle of Lovo cells was analyzed by flow cytometry.
Results:Trichostatin A significantly inhibited the proliferation of colon cancer cells at 500 ng/ml. The inhibition rate increased sharply from day 2 to day 5 (57.21% to 82.76%). 20 ng/ml TSA treatment could induce cell cycle arrest at the G1 phase, but with no apparent increase in apoptotic cells. ≥100 ng/ml TSA could induce significant apoptosis as shown by flow cytometry.
Conclusions:The results indicate that TSA is able to inhibit colon cancer cell growth in vitro, possibly through G1 cell cycle arrest and induction of apoptosis. This study suggests that TSA may be a potential therapeutic agent for the target treatment of colon cancer.

18 Inhibition of prostaglandin E1 on accumulation of collagen type Ⅰ and Ⅲ in liver of rabbit with schistosoma japonicum

LI Liang， ZHU Hua-gang

2007, 16(6):18. DOI: 10.7659/j.issn.1005-6947.2007.06.018

[Abstract](666) [HTML](0) [PDF 1.32 M](1026)

Abstract:
Abstract:Objective:To investigate the inhibitory effect of prostaglandin E1 (PGE1) on production of collagen type Ⅰ and Ⅲ in liver of rabbit with schistosomia japonicum (SJ), and on expression of glucose regulatory protein/immunoglobulin heavy chain binding protein (Grp78/BiP).
Methods:Forteen rabbits were infected with cercaria of SJ by percutaneous patch. From 60th to 120th day after infection, 7 of them received PGE1 （2.5μg/kg.d-1）by intravenous injection. The mRNA expressions of collagen type　Ⅰ　and　Ⅲ, as well as Grp78/BiP were detected by reverse transcription-polymerase chain reaction (RT-PCR).
Results:Up-regulated expressions of collagen Ⅰ,Ⅲ mRNA(14.81±3.57 and 12.9±3.25) were observed during the process of liver fibrosis in rabbit with schistosomiasis. Grp78/BiP mRNA increased (P<0.05). Expression of collagen Ⅰ,Ⅲ mRNA (compared with models, 5.79±1.26 and 5.34±1.08, P<0.01) had been attenuated markedly in the group treated with exogenous PGE1. Expression of Grp78/BiP was inhibited from 0.43±0.07 in models to 0.29±0.02 in treated group (P<0.05).
Conclusions:These data in experimental models strongly suggest that PGE1 can inhibite the maturation of collagen and thus, can effectually decrease hepatic collagen formation in down-regulated the expression of Grp78/BiP in rabbits with schistosomiasis.

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Volume 16,Issue 6,2007 Table of Contents

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