Volume 18,Issue 6,2009 Table of Contents

1 Endovascular therapy for Stanford type B aortic dissections: a report of 158 cases

LI Quanming , SHU Chang , JIANG Xiaohua , LI Ming , LI Xin , HE hao

2009, 18(6):1. DOI: 10.7659/j.issn.1005-6947.2009.06.001

[Abstract](759) [HTML](0) [PDF 1010.00 Byte](401)

Abstract:
Objective:To evaluate the methods and results of endovascular therapy for Stanford type B aortic dissection.
Methods :A retrospective review was conducted of 158 patients with Stanford type B aortic dissection who were treated with endovascular therapy in the past six years. There were 19 cases of emergency operation and 139 cases of elective operation. Fellow-up was performed regularly after operation. Aortas were dynamically observed.
Results:After the stent-graft implantation, 92.4% blockade rate of the first tear of the Stanford type B aortic dissection was obtained.After operation, 22 cases were complicated by hemothorax,13 cases by ischemia of superior mesenteric artery,9 cases by acute renal insufficiency, and 5 cases by ischemia of artery of lower extremity. Three cases of huge chronic dissection aneurysm achieved clinical cure after operation. No subclavian steal syndrome occurred in the 19 cases whose left subclavian artery was sealed by the stent-graft during operation. There was no hospital death.One hundred and forty-one cases were followed up for 3～48 months. Continuous endoleaks were found in 2 cases; 1 case of the stent-graft migration was successfully treated after another stent-graft implantation; and 1 case of cerebral arteries infarction recovered well.
Conclusions:Endovascular therapy is safe and effective for the patients with Stanford type B aortic dissection in the early and mid-term periods of postoperation.

2 A comparision between endovascular aortic repair and open aortic surgery for treatment of abdominal aortic aneurysm

ZHANG Yongjie , HUO Xin

2009, 18(6):2. DOI: 10.7659/j.issn.1005-6947.2009.06.002

[Abstract](1029) [HTML](0) [PDF 860.00 Byte](284)

Abstract:
Objective:To evaluate the use of endovascular aortic repair(EVAR) and open aortic surgery(IAS) for treatment of abdominal aortic aneurysm.
Methods :A retrospective review of patients treated with EVAR or IAS between 2002 and 2007 was performed. The occurrence rate of perioperative complications, morbidity and mortality, survival rate, quality of life, and cost of treatment were compared.
Results:Forty-two patients(30INS,12EVAR) were treated. Operating time,the intraoperative blood loss, and intraoperative blood transfusion were less in EVAR group than in the IAS group (P<0.01), the occurrence rate of perioperative complicatines, the rate of survival after 2 years, and cost of treatment in ENAR group were higher than that of IAS group.
Conclusions:EVAR has the advantages of less invasion and short operating time, but with more complications on long-term follow up. The quality of life at 6 months after open operation is better than that of EVAR.

3 The treatment of Budd-chiari syndrome with inferior vena cava thrombosis

FENG Liushun , LI Jie , LI Dexu , XU Bing , DING Pengxu , DANG Xiaowei

2009, 18(6):3. DOI: 10.7659/j.issn.1005-6947.2009.06.003

[Abstract](1009) [HTML](0) [PDF 957.00 Byte](288)

Abstract:
Objective:To evaluate the treatment of Budd-chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis.
Methods :The clinical data of 75 cases of BCS with inferior vena cava thrombosis were retrospectively analysed.Among them, 22 cases underwent radical resection of lesion and thrombns extraction; 41 cases had cavocaval shunt or cavoatrial shunt; 12 patients had percutaneous transluminal angioplasty (PTA) and endoluminal metallic stent (EMS) placement.
Results:Successful operations were performed in 73 patients and 2 patients died. The vena cava pressure decreased narkedly after treatment. Seventy-three patients were followed-up from 6 months to 6 years, 4 patients had recurrence, of which 2 had artificial blood vessel obstruction, and 2 had restenosis of IVC.
Conclusions:The operative method selected for BCS with inferior vena cava thrombosis should be based on the segment of obstruction and the length of thrombosis, and the majority of patients can have a favorable outcome.

4 Analysis of peri-operative risk factors in patients with Budd-Chiari syndrome

SUN Yuling , XU Peiqin , MA Xiuxian , FENG Liushun , DANG Xiaowei , LI Dexu , XU Bing , YE Xuexiang

2009, 18(6):4. DOI: 10.7659/j.issn.1005-6947.2009.06.004

[Abstract](536) [HTML](0) [PDF 866.00 Byte](299)

Abstract:
Objective:To evaluate the peri-operative risk factors in patients with Budd-Chiari syndrome (B-CS).
Methods :Five hundred and forteen cases of B-CS with complete clinical data were analyzed retrospectively. All the patients underwent surgical procedures.
Results:The univariate analysis revealed that age, concomitant disease, smoking, drinking, ascites, jaundice, electrolyte disorder, nutrition, postoperative hypotension, operative blood loss, albumin level, operation time, operation timing, pathologic classification, level of blood sugar, history of hemorrhage and prothrombin time (χ=-5.089~234.858, P=0~0.028) were possible perioperative risk factors of Budd-Chiari syndrome. The multivariate logistic regression analysis demonstrated that alcohol drinking, pathologic classification, operation time, operative blood loss, nutritional status, postoperative hypotension, jaundice, electrolyte disorder, level of blood sugar and severe complications (χ=-0.912~2.147, P=0~0.07) were independent peri-operative risk factors of Budd-Chiari syndrome.
Conclusions:Peri-operative high risk factors of Budd-Chiari syndrome can reflect the risks of Budd-Chiari syndrome, and can be very valuable as clinical reference for selection of operation timing and evalution of prognosis.

5 Treatment of acute deep venous thrombosis of left lower extremity accompanied with Cockett syndrome

LI Dalin , YAN Jingqiang , CHEN Yunhui , ZHANG Kun

2009, 18(6):5. DOI: 10.7659/j.issn.1005-6947.2009.06.005

[Abstract](736) [HTML](0) [PDF 1.14 K](315)

Abstract:
Objective:To explore the effective treatment of acute deep venous thrombosis(DVT) of left lower extremity accompanied with Cockett syndrome.
Methods :The data of 16 patients with acute DVT of left lower extremity accompanied with Cockett syndrome, who were admitted to our hospital from August,2004 to January,2008, were analyzed retrospectively. Inferior vena caval filters were inserted and thrombectomy was done to all of the 16 patients; PTA and stent insertion were done in 13 patients and PTA only in the other 3 patients. Anticoagulation, thrombolysis and antiplatelet therapy were given postoperatively to all the patients.
Results:There was no death or pulmonary embolism in all 16 patients; Forteen patieats had good outcome, 2 had acute DVT of left lower extremity one day after surgery, and limbs swelling subsided after anticoagulation, thrombolysis and antiplatelet treatment before their discharge. Forteen patients were followed up from 1 month to 25 months(average 11 months),and 2 patients had post-DVT syndrome, but the others had no swelling or varicose veins of the lower extremity.
Conclusions:Most patients with acute DVT of left lower extremity accompanied with Cockett syndrome could get satisfactory outcome with thrombectomy,PTA and stent insertion.

6 The value of guide wire localization of renal veins to guide placement of inferior vena cava filter

WANG Mo , ZHANG Shiyi , JIN Xing , WU Xuejun , ZHONG Zhenyue , WANG Maohua

2009, 18(6):6. DOI: 10.7659/j.issn.1005-6947.2009.06.006

[Abstract](1034) [HTML](0) [PDF 1.17 K](280)

Abstract:
Objective:To study the feasibility of localization of renal veins by guide wire and its value in guiding IVCF placement.
Methods :In 35 adult patients with deep vein thrombosis (DVT) who required inferior vena cava filter (IVCF) placement, the renal veins were identified by guide wire, and then iodinated contrast cavography was done to determine the anatomy of the renal veins.The safety and accuracy of locailzation of renal veins by guide wire and iodinated contrast cavography prior to IVCF placement were compared.
Results:Guide wire successfullly entered the renal veins, and was verified by positive-contrast vena cavography. IVCF was accurately and safely inserted in the right position guided by the wire in renal veins. The tip of filter which was placed by guiding of guide wire in renal veins, and IVCF laid in inferior vena cava at 0~10 mm below lower margin of renal vein, as verified by positive-contrast vena cavography. Twenty-three IVCFs were removed successfully two weeks later.
Conclusions:In patients with contraindications to iodinated contrast material or ionizing radiation, localization of renal veins by guide wire is a safe and effective alternative to conventional positive-contrast vena cavography for guiding IVCF placement.

7 The treatment of hemangioma and vascular malformation: a report of 863 cases

GUO Yuanyuan , SHU Chang

2009, 18(6):7. DOI: 10.7659/j.issn.1005-6947.2009.06.007

[Abstract](966) [HTML](0) [PDF 865.00 Byte](294)

Abstract:
Objective:To explore ideal treatment strategy for hemangioma and vascular malformations.
Methods :The clinical data of 863 cases of hemangioma and vascular malformation were analyzed retrospectively. There were 414 male and 449 female patients, The ages ranged from 2 weeks to 55 years. Among these cases, 742 were hemangioma while 121 were vascular malformation.The different treatment methods were selected based on the type, location, and extent of the lesion and the patient′s individnal situation.Seven hundred and forty-six patients underwent surgical treatment, 89 patients underwent operation combined with sclerotherapy,and 28 patients received embolization of feeding arteries with or without operation.
Results:Early postoperative results showed that 772 cases (89.46%) were cured, 78 cases (9.04%) markedly improved and 13 cases (1.5%) improved. A total of 620 cases were followed up for 0.5-3.0y, of which, 556 cases (89.68%) were cured, 51 cases (8.23%) markedly improvod, and 13 cases (2.09%) had improved.
Conclusions:Operation is ideal strategy for the limited disease focus, while non-surgical treatment is necessary for patients with extensive and deep lesions or who are not fit for surgical treatment. Combining surgical treatment and non-surgical treatment can achieve better therapeutic efficiency.

8 Effect of preoperative irradiation on neointima of the ePTFE blood vessel prosthesis in dogs

ZHOU Xiao , GUO Yuanyuan , OUYANG shang , ZHU Xiaoshuang , YUANG Liqing , SHU Chang

2009, 18(6):8. DOI: 10.7659/j.issn.1005-6947.2009.06.008

[Abstract](714) [HTML](0) [PDF 1.38 K](275)

Abstract:
Objective:To observe the effect of fractionated preoperative irradiation on neointima of the replaced ePTFE blood vessel prosthesis in dogs.
Methods :Eigteen mongrel dogs were equally divided into irradiated group and control group at radom according to whether or not preoperative irradiation was given. Six weeks after preoperative irradiation, subrenal abdominal aorta and inferior vena cava of the irradiated group were replaced by ePTFE blood vessel prosthesis. Specimens were harvested at 4 weeks after operation, and H-E staining, immunohistochemistry test of PCNA and CD34 were done.
Results:Two dogs died after operation. Three grafts implanted into IVC in irradiated group and 2 in control group were completely occluded, but no graft was obstructed in AA. The neointima of vascular graft formed completely, but the coverage of vascular endothelial cells was incomplete in both groups. The expression of CD34 of irradiated group was statistically less than control group in the middle of the graft (P<0.05), while there were no statistical difference at the distal and proximal anastomosis. The intimal thickness in distal, proximal and middle of the graft was thinner in irradiated group than that in control group (P<0.05). The PCNA proliferation in irradiated group was lower than in control group (P<0.05).
Conclusions:Fractionated preoperative irradiation showed inhibition of the intima hyperplasia 4 weeks after vessels replacement and has no negative effect in patency of graft both in veins and aortas.

9 Construction and evaluation of rat hindlimb acute ischemia model

YANG Shengjia , CHEN Bin , LUO Tao , TONG Zhu , ZHANG Shuwen , SHI Xiaolin , XU Qin , ZHANG Bin , QI Bin , LI Jianxin , YU Hengxi , ZHANG Jian

2009, 18(6):9. DOI: 10.7659/j.issn.1005-6947.2009.06.009

[Abstract](755) [HTML](0) [PDF 1.17 K](474)

Abstract:
Objective:To investigate the effect of dynamic changes of blood fiow and blood pressare, and changes of muscle tissues on rat hindlimb acute ischemia,and provide conditions for study on consequent intervention.
Methods :An acute hindlimb ischemia model was prepared in 10 rats by ligation and excision of left femoral artery and its branches. Doppler scan blood flow and pressure analysis were performed 2 d 7 d, 14 d, 28 d, 42 d, and 49 d after operation. The animals were sacrified post-angiography. H.E stain of muscles was then done.
Results:All the animals survived after operation. Some showed intermittent claudication and cyanosis(n=2), pallor (n=3),and muscle atrophy (n=1). Tissue examination showed there was necrosis and inflammation of skeletal muscle. The blood flow markedly decreased 7days after operation, reached to the lowest point at 4weeks, and recovered almost 90% at 49days after operation. The blood pressure, which reached the lowest at 14days, recovered to normal at 49days.
Conclusions:It is feasible to establish rat hindlimb ischemia model by ligation and excision of femoral artery, but blood flow and pressure can recover after 49days,and the time for intervention is 2-4 weeks after operation,when is the most serious ischmia time.

10 Experimental study on stimulation of angiogenesis with combination of hepatocyte growth factor and fibroblast growth factor in limb ischemic disease

YANG Jiwu , LIU Weiping , ZHOU Yeting , ZHANG Lifei , JIANG Zhiliang , XING Zhuangjie

2009, 18(6):10. DOI: 10.7659/j.issn.1005-6947.2009.06.010

[Abstract](1138) [HTML](0) [PDF 1.10 K](770)

Abstract:
Objective:To study the effect of combination of recombinant human hepatocyte growth factor (rhG-HGF) and fibroblast growth factor (bFGF) on angiogenesis in limb ischemic mouse model.
Methods :Eighty unilateral ischemic lower extremity mouse models established by operation were randomly divided into four groups:saline group(n＝20), bFGF group (n＝20), rhG-HGF group (n＝20), and rhG-HGF and bFGF group; ischemic/normal limb Doppler blood flowmetry ratio and capillary density were campared, postoperatively.
Results:At 4 weeks after operation, the ischemic/normal limb Doppler blood flowmetry ratio and capillary density Were as follows: rhG-HGF+bFGF group>rhG-HGF group>bFGF group>saline group (all P<0.05).
Conclusions:The stimulatory effect of rhG-HGF on angiogenesis is stronger than that of bFGF,while the combination of rh-HGF and bFGF has a significant synergistic effect and can more markcdly improve the vascular condition in limb ischemia.

11 Cultivation and allogenic vein transplantion of venous endothelial cells

WANG Xuehu , ZHAO Yu , FU Zhongxue , XIANG Dongzhou , YANG Bing

2009, 18(6):11. DOI: 10.7659/j.issn.1005-6947.2009.06.011

[Abstract](585) [HTML](0) [PDF 1.14 K](308)

Abstract:
Objective:To study the feasibility of cultivaed venous endothelial cells (VEC) transplanting to allogenic vein.
Methods :Endothelial cells were gained from veins after digestion with 0.2％collagenase. After VEC was cultivated,they were seeded into allogenic vein, which was lack of endothelium, with high density, and continuitly cultured in endothelial cell medium. The multiplied cells were lined in vitro onto the luminal surface of allogenic vein that was disposed by freeze-drying and radiation. The cultivated cells were confirmed as endothelial cells by von Willebrand factor.
Results:Primary endothelial cells were obtained after the in vitro cultivation, and their number was successfully expanded to meet the needs of the experiment. The function to secrete von willebrand factor showed no significant change (P>0.05). After allogenic vein transplantation, the cells grew normally. The funtion to excrete von Willebrand factor was same as before.
Conclusions:Endothelial cell can grow well in vitro with no change in secretory function, and have exellent growth on allogenic vein.

12 Preparation and measurement of magnetic adriamycin-verapamil-albumin nanoparticles

WANG Zhiwei , YANG Qiang , ZHAO Yu , WANG Beilei

2009, 18(6):12. DOI: 10.7659/j.issn.1005-6947.2009.06.012

[Abstract](616) [HTML](0) [PDF 1.16 K](361)

Abstract:
Objective:To prepare magnetic adriamycin-verapamil-albumin nanoparticles(MAVANs) and measure the physical property of the MAVANs，such as magnetism，drug loading(DL)and size of nanoparticles in order to direct its further experimental study on animals and its application in clinical practice.
Methods :Commercial cottonseed oil was refined, then mixed with adriamycin,verapamil, human albumin and Fe3O4 magnetic powder according to appropriate proportion, and MAVANs was prepared by using a heat denaturation technique. The size and shape of nanoparticles were determined by electron transmission micro-photography.The magnetic response and structure of the MAVANs were analyzed by upside-down microscope.The standard curve was plotted. The drug loading of verapamil in the MAVANs was quantified by high performance liguid chromatography. The drug loading of adriamycin was quantified by a standard spectrophotonuorometry.
Results:The nanoparticles featured homogenous size, regular and spherical shape, and good magnetic response.The mean diameter of nanoparticles was 0.5μm. The loading amount of verapamil was 0.8%.The drug loading of adriamycin was 1.25%.
Conclusions:The heat denaturation technique is feasible to prepare the nanoparticles which can load two kinds of drug with good physical property.The process is simple and the testing condition is easy to control.

13 The effect of fascin 1 on proliferation and apoptosis in gastric cancer cell line MKN45

FU Hua , HU Zhongliang , LI Jinghe , JIANG Haiying , LIU Ying , WEN Jifang

2009, 18(6):13. DOI: 10.7659/j.issn.1005-6947.2009.06.013

[Abstract](744) [HTML](0) [PDF 1.51 K](364)

Abstract:
Objective:To investigate the effect of fascin 1 on proliferation and apoptosis in gastric cancer cell line MKN45.
Methods :RNA interference (RNAi) was used to inhibit fascin 1 expression in human gastric cancer cell line MKN45. Expression of fascin 1 was examined by western blotting and RT-PCR. Cell growth ability was evaluated by MTT and clone formation assays. Cell apoptosis was examined by flow cytometry and Hochest 33258 staining method.
Results:Knockdown of fascin1 expression in MKN45 cells resulted in decreased cellular proliferative ability, but not apoptosis. The cloning efficiency of cells transfected with small interfering RNA(siRNA) was significantly lower ［(36.5±8.1)%］ as compared to that in MKN45(79±6.3)% (P<0.05).
Conclusions:Expression of fascin 1 is related to the proliferation of gastric cancer cell line MKN45, but has no significant relationship to apoptosis.

14 Diagnosis and treatment of acute mesenteric venous thrombosis

LI Xuefeng , GU Yongquan , YU Hengxi , ZHANG Jian , SUNG Jiabang , DONG Zongjun , LI Jianxin , WANG Zhonggao

2009, 18(6):14. DOI: 10.7659/j.issn.1005-6947.2009.06.014

[Abstract](631) [HTML](0) [PDF 868.00 Byte](368)

Abstract:
Objective:To study the methods of diagnosis and treatment of acute mesenteric venous thrombosis (AMVT).
Methods :The clinical data of 11 cases of AMVT were analyzed retrospectively. Computed tomography(CT) was diagnosed in 9 of 11 patients. Seven patients with AMVT were initially treated with anticoagulation and thrombolysis, while the other 4 patients underwent surgical operation.
Results:Three of 11 patients died(mortality rate 27.3%). Seven patients were initially treated nonoperatively and one of them died(14.3%); 4 patients underwent surgical operation and two of them died(50%).Eight survivors were treated with long-term warfarin therapy. Seven of 8 patients survived in long-term (mean,64.7 mouths) and one patient had recurrence.
Conclusions:CT scanning appears to be the first and primary diagnostic test of choice when AMVT is suspected. If diagnosed and treated early, AMVT is not likely to progress to cause gangrenous bowel and thus the mortality rate can be decreased. Long-term anticoagulant therapy can increase survival rate and has a low recurrence rate.

15 Diagnosis and management of splenic artery aneurysms

CHANG Qing , HU Haidi , CHEN Zhe , LIU Chong , ZHANG Hao , ZHANG Jian , DUAN Zhiquan , XIN Shijie

2009, 18(6):15. DOI: 10.7659/j.issn.1005-6947.2009.06.015

[Abstract](799) [HTML](0) [PDF 1.21 K](257)

Abstract:
Objective:To summarize an experience in the management of 16 cases of splenic artery aneurysm.
Methods :The clinical data of 16 patients with splenic artery aneurysm treated from January 1980 to April 2008, were retrospectively reviewed. There were 12 female and 4 male patients. Fifteen patients were diagnosed by Doppler ultrasonography and CT angiography (CTA) and 1 patient was diagnosed during operation. Four patients with ruptured splenic artery aneurysm underwent emergent operations, 7 patients underwent elective surgery or interventional therapy, and 2 patients received close follow-up without surgical treatment. The surgical procedures included aneurysmectomy and splenectomy in 9 patients, distal pancreatectomy in 3cases; aneurysmectomy and reconstruction of splenic artery in one patient; aneurysmectomy and splenic artery ligation in one patient; interventional embolization of the splenic aneurysm in 3 patients.
Results:All of the 14 patients who underwent surgical treatment recovered well postoperatively; there were no deaths or severe complications in the perioperative period. Of the 14 patieuts,11were followed up for 0.5~0.9.0 years with average 8.4 years. 9 patients well alive well. 2 patients died of other disease. Two patients undergoin non-operative management were observed for 3, 5 years,respectively,the aneurysms were no change.
Conclusions:Splenic artery aneurysm is more common in females. CT angiography (CTA) and Doppler ultrasonography are useful examinations to confirm the diagnosis. Aneurysmectomy or interventional embolization is effective treatment to prevent lethal rupture.

16 Effect of different body position and different CO2 pneumoperitoneum pressure on femoral venous hemodynamics

WANG Yu , WANG Yanting , ZOU Zhongdong , JIANG Yanyan , LIN Yahua

2009, 18(6):16. DOI: 10.7659/j.issn.1005-6947.2009.06.016

[Abstract](758) [HTML](0) [PDF 867.00 Byte](327)

Abstract:
Objective:To study the effect of different laparoscopic surgery position and different CO2 pneumoperitoneum pressure on femoral venous hemodynamics.
Methods :Color Doppler ultrasound was adopted to evaluate the diameter、blood velocity and volume of the blood flow in the lower extremity of thirty patients undergoing laparoscopy in three different of positions(supine, head-down tilt position and feet-down tilt position) before the establishment of pneumoperitoneum and with three different pressure of pneumoperitoneum(8 mmHg,12 mmHg,16 mmHg).
Results:Compared with supine position before the pneumoperitoneum,the femoral vein diameter decreased (P<0.05),the velocity and the volume of blood flow increased (P<0.01,P<0.05) with head-down tilt position;the femoral vein diameter increased (P<0.01),the velocity and the volume of blood flow decreased (P<0.01,P<0.05) with feet-down tilt position on the establishment of pneumoperitoneum. Furthermore,with the increase of pneumoperitoneum pressure,the femoral vein diameter increased,the velocity and the amount of blood flow decreased (P<0.05).
Conclusions:The head-down tilt position is conducive for the blood to recirculate,which could decrease the risk of deep vein thrombosis after laparoscopy.The feet-down tilt position and high CO2 pneumoperitoneum pressure can interfere with the recirculation of blood,and could increase the risk of deep vein thrombosis after laparoscopy.

17 Antioxidant vitamin status in patients receiving enteral or parenteral nutrition after upper gastrointestinal surgery

HUANG Dongpin , HUANG Jianwei , ZHOU Genren , FENG Yi , TANG Qingya

2009, 18(6):17. DOI: 10.7659/j.issn.1005-6947.2009.06.017

[Abstract](601) [HTML](0) [PDF 879.00 Byte](266)

Abstract:
Objective:To study the plasma antioxidant vitamin status in patients receiving enteral nutrition (EN) or parenteral nutrition (PN) after upper gastrointestinal surgery.
Methods :One hundred and twenty patients who underwent upper gastrointestinal cancer surgery were randomized into EN and PN group. The plasma vitamin A, vitamin E and β-carotene levels pre-and post-operation and one week after clinical nutrition supplement were studied.
Results:Vitamin A and β-carotene levels decreased significantly after surgery (P=0.03 and P=0.01, respectively). Vitamin E decreased 10 weeks after the nutrition, and it was significantly lower in the EN group than in the PN group (P<0.01), whereas vitamin A and β-carotene changed only slightly after nutrition (P>0.05).
Conclusions:A decrease of antioxidant vitamins is induced by surgery and vitamin E is recommended to be given in nutrition supplement patients, especially in the patients receiving EN.

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Volume 18,Issue 6,2009 Table of Contents

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