Abstract:

Objective:To explore the management of particular types of  abdominal aortic aneurysms(AAA).
Methods:The clinical data of 31 patients with particular types of AAA were reviewed retrospectively.
Results:Ruptured abdominal aortic aneurysms (RAAA) were found in 17 cases, mycotic abdomianl aortic aneurysms (MAAA), inflammatory abdominal aortic aneurysms (IAAA) and tuberculous AAA. were found in 3, 4 and 2 cases respectively. The lesions involved the suprarenal artery in 5 cases. One RAAA patient died of shock in emergency room.  Emergency operation was done in 16  patients, elective operation in 14 cases. Replacement of the aneurysm by vascular prosthesis  in 27 cases, and endoluminal treatment in 3 cases. Five cases developed mild postoperative complications. No paralysis or lower extremity arterial embolism occurred in any of the cases. Operative mortality was 6% (2 cases). Twenty-eiggy patients were followed-up for 3 months to 3 years, all of the patients were living well.
Conclusions:Timely surgical therapy for particular types of AAA is important, traditional operation is still effective with improvement of surgical skills, and endoluminal therapy is a new modality gradually applied in the treatment of particular types of AAA.

Abstract:

Objective:To study the clinical effects of endovascular stent-graft repair for thoracic aortic aneurysm (TDA).
Methods :The clinical records of 32 patients with thoracic aorta dissecting aneurysm, including 26 men and 6 women, who underwent endovascular repair were retrospectively analyzed. The characteristics,location,and anatomic condition of dissecting aneurysm were evaluated using CTA before operation. Under general or local anesthesia,32patients underwent endovascular repair under dynamic DSA. For those patient, 8 Talent,22 Yuhengjia(Beijing) and 2 Microinvasive(Shanghai) stent grafts were used.
Results: Among them 32 patients the distance between  entry tear and left subclavian artery was <1.0 cm in 7 patients, and the left subclavian artery was sealed by grafts in 3 patients after which, the anearysm disappeared and with no ischemia of brain or upper limbs in any of the patients, One of 32 patients with TDA died,and the other 31 patients were alive and well at followed up for 3 to 56 months,  but endoleak occurred in 5 patients discovered by CTA.
Conclusions:Endovascular stent graft repair for aortic anearysm is less invasive, has low complication and mortality rate, and is suitable for old high-risk patients. EVAR can replace conventional open operation for Stanford B dissecting aneurysm.

Abstract:

Objective:To evaluate the difference in perioperative conditions of open surgery and endovascular repair for abdominal aortic aneurysm in China.
Methods:Articles of non-randomized comparative studies(NRCs) of open surgical repair and endovascular repair for abdominal aortic aneurysm which were published in china before January 2009 were retrieved, and correlated indexes were extracted for meta-analysis.
Results:The mean quality score of the 6 articles selected was 18.83±0.98. Compared with open surgical repair, the endovascular repair was associated with a significantly less amount of blood loss (WMD=-689.24   mL,95%CI:-1077.61～-300.88,P＜0.05),less blood transfusion(WMD=-440.01 mL,95%CI:-488.96～-391.06,P＜0.05）during the operation, shorter time of fasting period(WMD=-5.21 d,95%CI:-6.23～-4.19,P＜0.05),shorter observation period in intensive care unit(WMD=-1.79 d,95%CI:-2.21～-1.46,P＜0.05) and shorter hospital stay after operation(WMD=-5.19 d,95%CI:-7.09～-3.28,P＜0.05). There was no statistically significant difference in operative time（WMD=-35.86 min,95%CI:-85.01～13.28,P=0.15） or complication rate(OR=0.92,95%CI:0.55～1.53,P=0.74)between the two groups.
Conclusions:The results of meta-analysis show that endovascular repair has the advantage of mild trauma, less blood loss and quicker recovery after operation. But there was no significant difference in operative time and complication rate between the two groups.

Abstract:

Objective:To investigate the effects of anticoagulant and thrombolytic treatment of deep venous thrombosis (DVT) of lower limbs on the prevalence of pulmonary embolism (PE).
Methods:The clinical records of 105 patients with DVT treated with anticoagulation and thrombolysis were reviewed and analyzed.The incidence of PE, the related risk factors including sex, age, the location and type of thrombosis was analysis to explore the relationship between them and the occurrence of PE.
Results:The incidence of PE in patients treated with anticoagulation and thrombolysis alone during hospitalization was 2.86% (3/105), while no patients suffered from PE after discharge from hospital. The occurrence of PE had no relationship with sex, age, or locations and types of thrombosis (P=0.086, 0.618, 1.0，1.0 respectively).
Conclusions:Strict adherence to the guidelines of anticoagulant and thrombolytic therapy can effectively reduce the incidence of PE in patients with DTV of lowe limbs. Thus, the indications for inferior vena cava filter placement should be strictly grasped by clinicians.

Abstract:

Objective:To investigate the management of acute limb ischemia.
Methods:The clinical data of 28 patients with acute limb ischemia were retrospectively analyzed. Four patients with arterial embolism underwent embolectomy. one patient with pseudoaneurysm underwent false aneurysm resection and revascularization with PTFE, 23 patieuts wiht arterial occlusive disease were treated by multiple means such as embolectomy，bypass,primary amputation, endovascular interventions，and pharmacologic therapy (n=23).
Results:The 5 patients with arterial embolism or pseudoaneurysm were all treated successfully.In the 23 patients with arterial occlusive disease, 5(21.7%) were  treated successfully, 12(52.2%) were improved,and 6(26.1%) had ineffective treatment. No inpatient died, but 4 patients underwent amputation.During follow-up of 6-45 months，there were 4 deaths and other 5 amputations.
Conclusions:Proper intervention of patients with acute limb ischemia should be chosen according to clinical evaluation of the illness,and includes embolectomy and revascularization, to get limb or life salvage.

Abstract:

Objective:To explore the effect of combined treatment of critical deep vein thrombosis of the lower extremity with inferior vena cava filter placement and thrombectomy,treatment of Cockett syndrome and use of anticoagulation and thrombolysis after thrombectomy.
Methods:We reviewed the clinical data of 9 patients with critical deep vein thrombosis of the lower extremity treated between 1996 to 2009. Eight patients were treated with inferior vena cava filter placement, thrombectomy,treatment of Cockett syndrome, and anticoagulation and thrombolysis after thrombectomy. Seven patients with critical deep vein thrombosis of the left lower extremity were found to have Cockett syndrome(2 patients were treated).One patient with critical deep vein thrombosis of the left lower extremity was treated with thrombolysis.
Results:There were no cases of pulmonary embolism in  these patients.Of the 8 patients with thrombectomy,1 patient with critical deep vein thrombosis of the left lower extremity developed gangrene of lower extremity and underwent amputation of the limb.The other lower extremities of 7 patients were salvaged, and the results were satisfactory. One patient died who was treated with thrombolysis.At 1 month after operation, color doppler ultrasound was performed on 5 patient whose Cockett syndrom was not treated, and showed that 2 patients had recurrence of deep vein thrombosis,but none of the 2 patients had recurrence of phlegmasia cerulea dolens.
Conclusions:The combined treatment of critical deep vein thrombosis of the lower extremity with inferior vena cava filter placement, thrombectomy, treatment of Cockett syndrome and anticoagulation,and  thrombolysis after thrombectomy is effective.Cockett syndrome is an important cause for the relapse of deep vein thrombosis of the lower extremity after thrombectomy.

Abstract:

Objective:To explore the effective methods for therapy of deep vein thrombosis of lower extremity(DVT).
Methods:We conducted a retrospective analysis of 411 patients with DVT  treated in our hospital from 2004 to 2009.In 8 cases with significant contraindications for thrombolysis and anticoagulation, only symptomatic local treatment for swelling was used. Combined therapy including thrombolysis,anticoagulation,and anti-platelet adhesion therapy was used in 391 cases, and combined therapy and thrombectomy with Fogarty catheter was used in 12 cases. Permanent implantation of inferior vena cava filter(IVCF)was done in 21 cases.
Results:The changes in clinical signs and symptoms were satisfactory in 382 cases,28 cases had no significant effect from therapy or had complications,and 1 case died.A total of 184（44.8%）cases were follow-up for 4-62 months(average 20 months),the results showed that 32 cases were excellent(17.4%),107 good（58.2%）, 42（22.8%） mild improment, and 3 no changes（1.6%）.
Conclusions: Combined therapy with thrombolysis,anticoagulation,and anti-platelet adhesion therapy is effective and safe  for treatment of DVT. Early thrombectomy could improve patients′ prognosis remarkably,and IVCF is an effective measure to prevent pulmonary embolism.

Abstract:

Objective:To compare the effect on revascularization of bone marrow mononuclear cells （BM/MNCs）and endothelial progenitor cells （EPCs） transplantation, and investigate  the roles of non-endothelial progenitor cells in angiogenesis.
Methods:BM/MNCs were harvested from Lewis rats bone marrow. The EPCs were obtained after BM/MNCs were cultured by EBM-2 medium for seven days. Lower limb ischemic model was made on Lewis rats。After limb ischemic model were made, 0.8ml D-Hanks, 8×106 BM/MNCs and 8×106 EPCs were injected into control group (n=6), BM/MNCs group (n=6) and EPCs group (n=6) respectively. At 3 weeks after cells transplantation, the quantity of collateral vascularization was observed with digital subtraction angiography(DSA). Meanwhile, CD31and α-SMA immunohistochemical stain were used to count the capillary and arteriolar density of the excised gastrocnemius muscle of the ischemic limb.
Results:There was no significant difference between BM/MNCs group and EPCs group in the density of the capillaries［（31.67±7.87）/HP vs(32.83±5.38)/HP，P＞0.05］,the number of collaterals ［（4.17±0.75）vs(4.50±1.38)，P＞0.05）］ and density of arterioles ［（4.83±1.47）vs(5.50±2.35)，P＞0.05）］, which were higher than those in control group, respectively.
Conclusions:Non-endothelial progenitor cells in angiogenesis has the same effects as EPC in the treatment of stem cells transplantation for ischemic disease of the limbs.

Abstract:

Objective:To investigate the feasibility of human VEGF165 gene transfection into endothelial progenitor cells (EPCs) derived from human peripheral blood,and the influence of transfusion on EPCs.
Methods:EPCs were isolated from human peripheral blood, cultured in vitro，identified by FITC-UEA-I and Dil-ac-LDL. EPCs was transfected with pcDNA3.1-hVEGF165 by liposomal，with  pcDNA3.1 by liposomal and EPCs without transfection. After transfection, the expression of VEGF and NO in culture supernatants were detected by using ELISA and nitrate reductase method.The proliferation of EPCs after gene transfection was detected by MTT methods.
Results:Cells that expressed double FITC-UEA-I and Dil-ac-LDL fluorescence were EPCs.The expression of VEGF and NO in the medium of EPCs transfected with pcDNA 3.1-hVEGF165 was obviously more than that in the other two transfected groups(P＜0.01). No influence of EPCs proliferation could be found after transfection.
Conclusions:EPCs from human peripheral blood can be successfully transfected with VEGF165 gene, and can express a certain concentration of VEGF protein and promote the secretion of NO，but no influence of EPCs proliferation. This provides experimental evidence for further study of the combined treatment of VEGF165 gene and EPCs for ischemic disease.

Abstract:

Objective:To explore the effect of high dose external beam radiation on the ePTFE prosthesis-arterial anastomosis.
Methods:The infrarenal abdominal aorta was replaced by ePTFE prosthesis graft in 20 dogs, and all the animals were randomly divided into 2 groups, including of irradiated groups and the control groups, which were or were not associated post-operative external radiation(35 Gy) to the anastomosis. All the animals were sacrificed at 4 weeks and 8 weeks after operation for histological and immunohistochemical examination of the prosthesis-arterial anastomosis.
Results:There was marked histological changes caused by 35 Gy external irradiation at the prosthesis-arterial anastomosis,but no disunion, rupture, or aneurysm was found at the anastomosis. Radiation did not increase the rate of thrombosis at the prosthesis. The result of immunohistochemical examination showed that two side of the anstomosis were CD34 positive. 
Conclusions:High dose of external beam(35 Gy) can cause marked histological changes at the prosthesis-arterial anastomosis, however, it will not exert negative effect on anastomosis in the short term.

Abstract:

Objective:To investigate the effects of ePTFE cuff on arterialization of vein after bypass surgery in dogs.
Methods:Thirty-six healthy dogs were randomly divided into 2 groups (n=18 in each group). The implanted veins in experimental group were enclosed by ePTFE, and that of the control group were not enclosed. Common carotid artery was reconstructed with ipsilateral external jugular vein. Animals were sacrificed at 2, 6 and 10w postoperatively, respectively. The vein graft was separated and using pressure perfused by formalin. The explanted vein was cut at the middle, then the proximal segment was divided into two segments, the segment near the anastomosis was as "a" segment, the other was "b" segment. Segments a and b were sliced into 3mm sections, respectively. Thickness of the vascular wall was analyzed and measured.
Results:In control group, basic value of lateral wall thickness of the a segment was （0.46±0.09）mm,and  it increased to （0.64±0.06）,（ 2.20±0.51）,（ 3.23±0.38）mm,respectively, at 2, 6 and 10w. Basic value of medial wall thickness of the b segment was （0.46±0.09）mm, which increased to（ 0.59±0.05）, （2.46±0.41）,（ 2.01±0.11）mm, respectively at 2, 6 and 10w. In experimental group, basic value of the lateral wall thickness of the a segment was （0.41±0.09）mm,and the value was  （0.75±0.22）, （1.31±0.21）mm, respectively, at 6 and 10w. Basic value of the medial wall thickness of the b segment was （0.41±0.09）mm, which was （0.70±0.04）, （1.24±0.28）mm, respectively, at 6 and 10w. Compared with the control group, the vessel wall thickness in experimental group was decreased significantly(P<0.01).
Conclusions:ePTFE cuff can retard the arterialization process of implanted vein.

Abstract:

Objective:To study the expresion and significance of CXCR4 in gastric cancer (GC) and intra-abdominal metastasis.
Methods:Immunohistochemistry and PT-PCR were used to detecte the expresion of CXCR4  protein and CXCR4 mRNA in GC, lynph node metastasis (LNM), peritoneal metastasis (PM) and normal stomach (NM) tissues.
Results:There was no CXCR4 expression in normal gastric mucosa cell.The expression rate of CXCR4 in GC and PM was 59.4%,100% respectively（P＜0.05）. The expression of CXCR4 in primary tumor was correlated with tumor stage,depth of tumor invasion and lymph node metastasis(P＜0.05), but not with age,gender,location of tumor, tumor size and pathological differentiation of patients (P＜0.05). (2)Semi-quantatitive RT-PCR analysis showed that there was no CXCR4 mRNA expression in normal gastric mucosa. Low quantity of CXCR4 mRNA was detected in 5 early cancer samples, high quantity of CXCR4 mRNA was detected in specimens of all advanced cancer tissue; the quantity of CXCR4 mRNA in LNM and PM was the highest （P＜0.05）.  
Conclusions:CXCR4 is expressed in both primary and metastic lesion in gastric cancer.Moreover, CXCR4 is upregulated when the tumor cell metastasize to lymph node and peritoneum.  CXCR4 expression in primary tumor is correlated with tumor stage, invasion depth,  LNM and PM. As the cancer progress, the expression of CXCR4 is upregulated, which implies that tumor cell with high expression of CXCR4 have more aggressive and metastatic capacity.   

Abstract:

Objective:To investigate the inhibiting effects of shRNA (short hairpin RNA, shRNA) on COX-2 gene expression, the cell cycle and growth of gastric carcinoma SGC-7901 cells.
Methods:Specific shRNA plasmid to COX-2 were constructed, and then transfected into SGC-7901 cells by lipofectamine methods. Tests were divided into three groups: untransfected gastric carcinoma SGC-7901 cells group, negative control HK group and pshRNA-COX-2 group. Gastric carcinoma SGC-7901 cells were transfected with LipofectamineTM 2000. Expression of COX-2 mRNA and protein were detected with reverse transcriptional polymerase chain reaction (RT-PCR) and Western blot respectively. Cell cycle analysis and cell growth chart were detected with flow cytometry and cell count respectively.
Results:Compared with negative control HK group, recombinant expression vector pshRNA-COX-2 resulted in the reduction of COX-2 mRNA and protein expresion by 70.1% and 43.2% respectively; cells in G0-G1 phase  increased from 61.5％to 70.2％, cells in S phase decreased from 27.3％ to 21.7％, and the growth of SGC-7901 cells cells was slowed significantly.
Conclusions:Recombinant expression vector  pshRNA-COX-2 can significantly inhibit the expression of COX-2 gene, result in the  increase of cells in G0-G1 phase and decrease of cells in S phase, and suppress proliferation of gastric carcinoma SGC-7901 cells.

Abstract:

Objective:To summarize the main early complications after pancreatoduodenectomy and analysis of the probable causes.
Methods: The clinical data of 576 cases who underwent pancreatoduodenectomy (PD) in our department between Feb 1990 and May 2009 were analysed retrospectively.
Results:There were 92 early postoperative complications occurred in 85 patients（14.8%）. Gastrointestinal dysfunction, pancreatic leakage, intra-abdominal infections and hemorrhage were the most of complications, and 7 cases died during perioperative period(mortality 1.22%), among which 3 died of multiple system organ failure, 2 died of hemorrhagic shock and 2 died of toxic shock. Preoperative hypoproteinemia and hyperbilirubinemia complicated with a high incidence of postoperative complications on multivariate analysis.
Conclusions:Meticulous preoperative preparation,delicate intraoperative technigne and close postoperative observation are the key points to decrease early complications and improve the prognosis of the patients who undergo PD.

Abstract:

Objective:To evaluate the effects of laparoscopic choledochal cyst excision for treatment  of congenital choledochal cyst.
Methods:Forty patients with congenital choledochal cyst were randomly divided into control group and observation group: the control group underwent open abdominal excision of choledochal cyst, while the observation group had laparoscopic resection of choledochal cyst.
Results:The operations of all the 40 cases in the 2 groups were successfully completed.The operative time was longer in the observation group (P＜0.01), but the amount of blood loss,  time to passage of flatus and time for oral intake after operation, postoperative hospitalization time, and the size of incision in the observation group were significantly better than the control group(P＜0.001). The all cases of two groups during treatment and follow-up had no serious complications directly related to surgery.
Conclusions:Laparoscopic choledochal cyst excision is effective and safe in treatment of patients with congenital choledochal cyst，although the operative time is longer, and the cost is higher than the open operation.

Abstract:

Objective:To evaluate the therapeutic effect of total mesorectal excision in radical operation of rectal carcinoma.
Methods:From 1997 to 2007,126 consecutive patients with middle and inferior rectal carcinoma underwent surgical operation according to the principle of total mesorectal excision.
Results:Two patients （1.6%） died of postoperative pulmonary infection, and postoperative anastomotic leakage occurred in 2 cases (1.6%). The postoperative follow-up of 1-5 years showed that local recurrence rate 2 years after surgical operation was 4%(5/126), the 3-, 5-year survival rate was 93.6%（116/124） and 84.7%（105/124）, respectively.
Conclusions:Total mesorectal excision can decrease the frequency of postoperative local recurrence of rectal cancer without increasing complications as long as its correct indications are selected.

Abstract:

Objective:To explore the diagnosis and re-operation of the recurrent retroperitoneal soft tissue sarcoma (RPS).
Methods:Clinical data of 25 patients with recurrent RPS were retrospectively analyzed.
Results:All of 25 cases of recurrent RPS were diagnosed by operation and postoperative pathologic examination. They underwent a total of 42 time operations, with mean time of re-operations was 1.68. Of the 42 time operations, 26 time were complete resection, 11 time partial resection and 5 time only biopsy. A total of 19 cases underwent removal of contiguous intra-abdominal organs and 5 underwent resection of major invaded blood vessel. The 1-, 3-and 5-year survival rate of recurrent RPS was 52.0%, 40.0% and 28.0% respectively. The rate of complete resection in recurrent RPS with major blood vessel invasion was 35.7%. In contrast, the complete resection rate in recurrent RPS without major blood vessel invasion was 75%（P=0.013）. On the other hand, there was no significant difference in complete resection rate between the recurrent RPS with adjacent organs invasion and the recurrent RPS with no adjacent organs invasion（P=0.462）.
Conclusions:Preoperative imaging results are crucial factor for assessment of operative resectability. Unless there are obvious comtraindications, recurrent RPS should undergo aggressive surgical excision.