Abstract:

Objective: To construct a CT scan-based finite element model of thoracic aortic dissection and numerically simulate its hemodynamic profiles, so as to provide a theoretical basis for the hemodynamic mechanism study and clinical management of thoracic aortic dissection.
Methods: Based on the patient-specific CT data of thoracic aortic dissection, the optimized surface model of thoracic aortic dissection was constructed by using the image processing software (MIMICS 13.0), which was then imported into ANSYS 11.0 for finite element mesh dividing. The hemodynamic analysis of thoracic aortic dissection was finally performed by ANSYS CFX 11.0 softeare.
Results: A finite element model for hemodynamic analysis of patient-specific thoracic aortic dissection was successfully constructed. The distribution and changes of streamlines, velocity vector, pressure and wall shear stress were obtained for the patient-specific model.
Conclusions: This model has digital and patient-specific features and can be used to analyze the hemodynamics and mechanism of rupture of thoracic aortic dissection.

Abstract:

Objective: To investigate the impact of intravenous combination chemotherapy with 5-fluorouracil (5-FU) and cisplatin (DDP) on prosthetic vascular grafts in dogs.
Methods: The model of reconstruction of abdominal aorta using ePTFE prosthetic vascular graft was established in 12 dogs, which were equally randomized into chemotherapy group and control group. The chemotherapy group underwent intravenous combination chemotherapy with 5-FU (10 mg/kg) and DDP (1 mg/kg) once daily for 5 days during the 2nd week after operation, and the control group received transfusion with an equivalent volume of vehicle. Physiological parameters of the dogs during the period of intervention were recorded. Graft specimens from five levels were harvested at the 4th week after chemotherapy or vehicle transfusion (6th week after operation) to determine the intimal thickness, CD34 and proliferating cell nuclear antigen (PCNA) expression.
Results: One death (1/6) occurred in chemotherapy group and none (0/6) in control group. Two cases (2/5) in chemotherapy group developed a small amount of mural thrombus formation in prosthetic vascular graft, but that was not found (0/6) in control group. Between-group comparison results were as follows: No statistical difference was noted in intimal thickness of prosthetic vascular graft between the two groups (P＞0.05); the CD34+ cell ratio on the middle segment of prosthetic vascular graft of chemotherapy group was significantly lower than that of control group (P＜0.05), while the CD34+ cell ratio on other levels of prosthetic vascular graft showed no statistical difference between the two groups (P＞0.05); the PCNA expression of intimal area had no statistical difference between the two groups (P＞0.05). Within-group comparison results were as follow: The intimal thickness and CD34+ cell ratio on middle segment of prosthetic vascular graft were all lower than those on anastomotic stomas (P＜0.05 or P＜0.01); the PCNA expression levels of the proximal stomas were all higher than those of the distal stomas (both P＜0.05), and the PCNA expression levels in both sides of stomas were all higher than those of the middle segment of prosthetic vascular grafts (both P＜0.05).
Conclusions: Postoperative intravenous combination chemotherapy with 5-FU and DDP given during the 2nd week after prosthetic vessel replacement has transient retardant effect on the endothelial coverage of the middle segment of prosthetic vascular graft, resulting in the increased incidence of mural thrombus formation of prosthetic vascular graft. However, it has no significant influence on anastomotic healing, and does not increase the incidence of infection or rupture of the graft.

Abstract:Objective: To determine the efficacy of endovascular treatment of infrarenal abdominal aortic aneurysm (AAA) using domestic unibody bifurcated stent-graft. Methods: The clinical data of 27 patients with infrarenal AAA undergoing endovascular aneurysm repair (EVAR) using domestic unibody bifurcated stent-graft from September 2009 to June 2011 in our department were retrospectively analyzed. Results: Endovascular repair of AAA was successfully performed in all the 27 patients. CTA or DSA examination during the follow-up (2 to 20 months) after the operation revealed that the aneurysm body had been isolated completely, no stent displacement, distortion or endoleak occurred. Conclusions: Endovascular repair of infrarenal AAA using domestic unibody bifurcation stent-graft is safe and effective. It has the advantages of simple manipulation, low cost and less complications compared with the separated stent-graft.

Abstract:Objective: To investigate the efficacy of carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods: From January 2001 to May 2011, CEA was performed 93 times in 90 patients with carotid artery stenosis. Of whom, 78 cases were male and 15 cases were female, and the ages ranged from 50 to 78 years (average of 65.6 years). Of the patients, 62 cases experienced transient ischemic attack (TIA) and 31 cases suffered cerebral infarction before surgery. All the patients had confirmed diagnosis of carotid artery stenosis greater than 80% by cerebral angiography and/or CT angiography (CTA). Twenty-two patients had contralateral carotid stenosis or occlusion. Results: The clinical symptoms, such as the disappearance of TIA and the recovery of memory or language problems, improved after surgery in all the 90 patients. Eighty patients were followed up for one month to 36 months after surgery. Restenosis of the surgical site occurred in 15 cases (stenosis less than 25%), one of whom developed a stroke and another one had TIA that was improved by conservative treatment. The remaining 13 cases had no clinical symptoms. Conclusions: CEA is a safe and effective procedure for treatment of carotid artery stenosis.

Abstract:Objective: To investigate the technical features and clinical efficacy of endovascular treatment of femoropopliteal arteriosclerosis obliterans in elderly patients. Methods: The clinical data of 50 elderly patients (62 limbs) with femoropopliteal arteriosclerosis obliterans undergoing endovascular treatment using percutaneous transluminal angioplasty (PTA) and stent implantation from March 2009 to January 2011 in our hospital were retrospectively analyzed. There were 30 male patients (38 limbs) and 20 female patients (24 limbs), whose ages ranged from 70 to 88 years (average of 78.5 years), and whose disease durations ranged from three months to five years. The lesions were located at femoropopliteal and infrapopliteal arteries. Results: Fifty-eight limbs were successfully treated and the technical success rate was 93.5% (58/62). Perioperative complications occurred in five patients that accounted for 8.06% (5/62), including one case of pseudoaneurysm formation at the puncture site, one case of artery perforation, two cases of artery dissection and one case of heart failure, which were all resolved after treatment. No perioperative deaths occurred. The ankle-brachial index (ABI) increased from 0.58±0.22 before surgery to 0.88±0.25 one week after surgery (t=7.09, P＜0.001). The primary patency rate was 80% (32/40) and 68.8% (22/32), and the secondary patency rate was 95.0% (34/40) and 75.0% (24/32) at 12 and 24 months after surgery, respectively. The limb salvage rate was 93.8% (30/32) at 24 months after surgery. Two patients underwent metatarsal-phalangeal amputation due to diabetic foot with necrotic toe. Conclusions: For the elderly patients with femoropopliteal arteriosclerosis obliterans, the endovascular treatment has better short-term effect, high technical success rate and low complication incidence. Rigorous perioperative management can prevent the occurrence of complications, and its long-term efficacy needs to be assessed by further follow-up.

Abstract:Objective: To investigate the feasibility and short-term efficacy of long stent grafting for treatment of long or multiple stenotic/occlusive lesions of femoropopliteal artery. Methods: Sixty patients (70 limbs) with femoropopliteal arteriosclerosis obliterans, who were admitted to our department from November 2008 to October 2010, underwent long self-expandable stents implantation (length of 8-20 cm) following dilation angioplasty of the stenotic/occlusive lesions with a long balloon. The patients (24 limbs) who had concomitant arteriosclerosis obliterans of infrapopliteal artery underwent dilation angioplasty using DEEP balloon at the same time. The technical success rate, complication incidence during and after surgery and clinical efficacy was observed. Results: The technical success rate of the balloon dilation plus long stents implantation in femoropopliteal artery was 94.3% (66/70 limbs), and the success rate of balloon dilation in infrapopliteal artery performed at the same time was 83.3% (20/24limbs). The patients′ clinical symptom improved and rest pain disappeared after operation. The ankle-brachial index (ABI) of the patients increased from 0.45 (0.44±0.20) before operation to 0.84 (0.86±0.24) after operation (P＜0.01). Only two cases showed intramuscular hematoma due to local rupture of the ectopic superficial femoral artery, but no other complications occurred. Conclusions: Long stents implantation is a minimally invasive, safe and effective method for treatment of long or multiple stenotic/occlusive lesions of femoropopliteal artery, but its long-term outcome needs to be further assessed.

Abstract:Objective: To investigate the early diagnosis and treatment method of popliteal artery injury so as to improve the limb salvage rate. Methods: The clinical data of 168 patients with popliteal artery injury treated in our hospital during January 2000 to December 2010 were retrospectively studied. Of the patients, 27 cases (16.1%) were penetrating injury, and 141 (83.9%) were blunt injury. The associated comorbidities included shock in 24 cases (14.3%), fracture/dislocation in 125 (74.4%), nerve injury in 81 (48.2%) and venous injury in 66 cases (39.3%), respectively. The outcomes of different mechanisms of injury and surgical or non-surgical treatment were compared, and the causes of disability and their relations with the comorbidities were analyzed. Results: The distal circulation was completely restored in 68 cases (40.5%), partially improved in 59 cases (35.1%), and the complete recovery rate of the patients who underwent surgical treatment (43.4%) was significantly higher than that of the patients who underwent non-surgical treatment (12.5%) (P＜0.05). Amputation was performed in 41 cases (24.4%). The amputation rate of the patients with blunt injury (28.4%) was significantly higher than that of patients with penetrating injury (3.7%) (P＜0.05), while there was no statistically significant difference between the patients who underwent surgical treatment (25.0%) or non-surgical treatment (18.8%). The amputation rate of patients with shock (41.7%) or with venous injury (33.3%) was significantly higher than that of the patients without shock (21.5%) or without venous injury (18.6%), respectively (both P＜0.05), while there was no statistically significant difference between the patients with fracture/dislocation or with nerve injury and the patients without fracture/dislocation or without nerve injury, respectively (both P＞0.05). Conclusions: The duration from injury to surgery is a main factor for prognosis, and the related comorbidities are main causes of disability. Early diagnosis, radical debridement, appropriate repair methods and favorable wound surface coverage are effective ways to limb salvage and avoidance of disability.

Abstract:Objective: To investigate the feasibility and efficacy of endovascular treatment of TASC II-C/D femoropopliteal arteriosclerosis obliterans. Methods: The clinical data of 74 patients with TASC II-C/D femoropopliteal arteriosclerosis obliterans undergoing endovascular treatment from September 2008 to February 2011 were retrospectively analyzed and the patients were followed up to ascertain their outcome. Results: The technical success rate was 92.6% and no severe perioperative complications occurred. The ankle-brachial index (ABI) and toe-brachial index (TBI) were both significantly increased compared with those before the procedure (both P＜0.01). Sixty-nine patients were followed up for two to 24 months after endovascular treatment. The patency rate of the affected limb at 6, 12 and 24 months after treatment was 81%, 63% and 51%, and the symptom relief rate was 92%, 83% and 76%, respectively. Conclusions: Endovascular treatment of TASC II-C/D femoropopliteal arteriosclerosis obliterans has satisfactory short-term efficacy, and it can be used as the first choice for elderly patients or those with poor tolerance to surgery. Its long-term results require further observation.

Abstract:Objective: To study the therapeutic approach of alteplase to lower extremity deep vein thrombosis (DVT), as well as its efficacy and safety. Methods: The clinical data of 23 patients with lower extremity DVT admitted to our hospital and treated with altepalse from May 2005 to May 2010 were retrospectively analyzed. All the patients presented with a first onset of unilateral symptoms of lower-extremity DVT, their ages were less than 75 years and onset of illness had occurred within 21 days. Results: The thrombolytic therapy using alteplase resulted in short-term beneficial effects on DVT patients. Seventeen patients (73.9%) achieved clinical cure and 6 patients (26.1%) had clinical improvement. The major complication during infusion of alteplase was bleeding which was mainly seen at the needle puncture sites and gums, but no fatal bleeding events such as the massive visceral or intracranial hemorrhage occurred. All the 23 patients were followed up for a period of 3 to 48 months. Of whom, 17 cases (73.9%) recovered completely, 5 cases (21.7%) developed post-thrombotic syndrome, and 1 case died of cardiac infarction. Conclusions: The thrombolytic therapy using alteplase has remarkable efficacy for the treatment of DVT, and the clinical improvement may be obtaind even if the disease course of the patientis is more than two weeks. Although bleeding is the most common adverse event, it is safe for patients to receive the intermittent intravenous administration of alteplase in three days.

Abstract:Objective: To create a prosthetic abdominal aortic aneurysm in dogs and then determine its biological function and biocompatibility, so as to provide an animal model for the experimental study of abdominal aortic aneurysm. Methods: Two types of artificial blood vessels (29 mm and 6 mm in diameter) were anastomosed with 1-0 suture to fabricate a fusiform prosthetic aneurysm that was then interposed in the abdominal aorta of dog. The biological function and biocompatibility of the graft were detected 5 months after operation. Results: The success rate of model establishment was 76.9% (10/13). he whole operating time was (2±0.5) h, in which the vessel anastomotic time was (50±12) min. Five months later, the blood flow in prosthetic aneurysm was patent, and there was no bleeding in the body or blood clots in the lumen of the prosthetic aneurysm. The outer layer of prosthetic aneurysm was enclosed by soft tissue and the inner layer of the prosthetic aneurysm was covered with vascular endothelial cells. Conclusions: This prosthetic abdominal aortic aneurysm has satisfactory biological function and biocompatibility, and this animal model can be used for experimental study of abdominal aortic aneurysm.

Abstract:Objective: To investigate the effect of human eNOS (heNOS) gene transfection on the functions of canine bone marrow-derived endothelial progenitor cells (EPC). Methods: Canine EPCs were transfected with the recombinant adenovirus vector type 5 carrying heNOS gene (Ad5-heNOS) after directional culture and expansion ex vivo, and the untransfected canine EPCs were used as control. After transfection, the heNOS protein expression and NO production of EPCs were measured by enzyme linked immunosorbent assay (ELISA) and nitrate reductase assay, respectively. The EPCs functions including proliferation, adhesion, migration and anti-senescence as well as angiogenesis ability were also determined. Results: Forty-eight hours after transfection with Ad5-heNOS, the heNOS protein expression and NO production of transfected EPCs were significantly higher than those of the untransfected EPCs ［(2091.67±172.489) pg/mL vs. (158.00±30.914) pg/mL; (49.5±5.16) μmol/L vs. (39.7±7.24) μmol/L］ (both P＜0.01). The cell number of proliferation, adhesion and migration of the transfected EPCs were all significantly higher than those of the untransfected EPCs (0.52±0.03 vs. 0.31±0.02; 28.00±1.41 vs. 11.83±1.45; 109.67±6.95 vs. 72.67±6.29) (all P＜0.01), while the percentage of senescent cells of the transfected EPCs was significantly lower than that of the untransfected EPCs (0.22±0.02 vs. 0.32±0.01) (P＜0.01). The transfected EPCs assembled into primitive vascular tube-like structures when plated in Matrigel ex vivo. Conclusions: heNOS gene transfection can promote the proliferative ability of canine EPC and also enhance its functions.

Abstract:Objective: To investigate the inhibitory effects of the liposome- and adenovirus-mediated early growth response gene-1 DNA enzyme (EDRz) through regional external application on the vascular smooth muscle cells (VSMCs) proliferation and intimal hyperplasia of the autogenous vein graft. Methods: The autogenous vein graft model was established in rats, which were then randomly divided into liposome group, adenovirus group and control group. In vivo transfection was conducted in the two experimental groups by regional application of liposome-EDRz and adenovirus-EDRz on the vein graft, respectively. The vein graft samples were harvested at 1, 2, 6 and 24 hours, and also 3, 7, 14, 28 and 42 days after surgery, respectively. The transfection status of vein graft was detected with fluorescent microscope, Egr-1mRNA and protein expression was measured by in situ hybridization and immunohistochemical staining, respectivcely. Meanwhile, the histomorphology of the vein graft was also observed. Results: At one hour after surgery, EDRz was mainly located in media, adventitia and part of endothelial cells of the vein graft. The fluorescent intensity of liposome group and adenovirus group was 70.3±13.5 and 60.5±11.2, respectively. In 2 to 24 h after surgery, EDRz was located in the media of the vein graft, and it was mainly located in the intima of the vein graft at 7 h after surgery. No EDRz was detected in the vein grafts at the later postoperative period. In the early postoperative period, Egr-1 protein mainly expressed in the medial VSMCs, and in some monocytes and endothelial cells, but it could not be detected in either the media or neointimal VSMCs of the vein graft at the later postoperative period. At 2 h after surgery, the positive expression rate of Egr-1 protein of liposome group and adenovirus group was (15.3±4.2)% and (20.7±2.6)%, respectively. The degree of proliferation of VSMC and intima thickness of liposome group and adenovirus group were obviously decreased compared with control group. Conclusions: EDRz has inhibitory effect on VSMCs proliferation and intimal hyperplasia of the autogenous vein graft through its Egr-1 expression. Liposome transfection is more efficient than adenovirus transfection.

Abstract:

Objective: To investigate the therapeutic effect of the combination treatment of bone mesenchymal stem cells (BMSC) and hepatocyte growth factor (HGF) gene therapy on limb ischemia of rabbits. Methods: Ischemic model of hind limb was induced in the right hind limb of 32 New Zealand rabbits by ligation of the deep femoral artery and complete excision of the superficial femoral artery. After the model was established, the rabbits were equally randomized into empty plasmid treatment group (control group), BMSC treatment group (BMSC group), HGF gene therapy group (HGF group) and BMSC treatment plus HGF gene therapy group (BMSC+HGF group). All treatment regimens were administered by direct intramuscular injection into the operated limb. The collateral vessel count was performed using angiography 28 days after treatment, and the expression of CD31 and HGF in the muscle tissues surrounding the injection sites was detected by immunohistochemical staining and Western blot analysis respectively, 30 days after treatment. Results:The collateral vessel count showed no statistical difference in BMSC group or HGF group compared with control group, but it increased significantly in BMSC+HGF group compared with other 3 groups (P＜0.05 or P＜0.01). The immunohistochemical staining showed that the CD31 expression level of all the treated groups was significantly higher than that of the control group (P＜0.05 or P＜0.01), and CD31 expression had no significant difference between BMSC group and HGF group, but both of which were significantly lower than that of BMSC+HGF group (both P＜0.05). The Western blot demonstrated that the HGF expression level of all the treated groups was significantly higher than that of the control group (P＜0.05 or P＜0.01), and it was increased in the order of BMSC, HGF and BMSC+HGF group that all had statistical differences (all P＜0.05). Conclusions: The combination treatment with BMSC and HGF gene therapy has synergistic effect that can effectively promote collateral vessel development, and thereby improve the perfusion of the ischemic limb of rabbit.

Abstract:Objective: To establish a rat model of chronic hindlimb ischemia and compare it with its acute hindlimb ischemia model, and then analyze the differences in blood perfusion and gene expressions between the two models. Methods: Forty SD rats were equally randomized into two groups to create the chronic (procedure: in the right hindlimb of the rat, an anticoagulant silicon tube was inserted into the femoral artery and fixed in position after the ligation and division of the branches of the iliacofemoral artery) and acute (procedure: in the right hindlimb of the rat, the femoral artery was ligated and excised after the ligation and division of the branches of the iliacofemoral artery) hindlimb ischemia models. The blood perfusion of the hindlimbs was measured using Laser Doppler perfusion imaging before and during the following four weeks after operation. The gene expression of hypoxia-inducible factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF) 24 hours after operation in adductor femoris muscle of the ischemic limb was detected by Real-time PCR. Results: Twenty-four hours after operation, the expression levels of both HIF-1α and VEGF in adductor femoris muscle of the ischemic limb of the acute ischemia group were significantly higher than those of the chronic ischemia group (both P＜0.05). In acute ischemia group, the blood perfusion of the pathological limb dropped to 24% of the contralateral healthy limb but restored rapidly, which reached and stabilized at 82% after 28 days. In chronic ischemia group, the blood perfusion decreased gradually to the minimum level (48%), and then recovered slowly to the highest level (67%) at 28 days after operation. The blood perfusion levels at each observation time point between the two groups were significantly different (all P＜0.05). Conclusions: The pathological characteristics and gene expression profiles of rat model of chronic hindlimb ischemia is different than that of the acute one, and the chronic model is more clinically relevant to the pathological process of critical limb ischemia.

Abstract:Objective: To evaluate the efficacy of high mesocaval shunt (HMCS) plus portal-azygous disconnection for treatment of portal hypertension. Methods: The clinical date of 144 patients with portal hypertension undergoing HMCS plus portal-azygous disconnection in our hospital from 2001 to 2011 were retrospectively analyzed. Results: Of the patients, 89 cases were male and 55 cases were female, whose ages ranged from 19 to 55 years. There were 119 cases of posthepatitic cirrhosis and 25 cases cirrhosis secondary to other causes. All the patients had moderate or severe esophageal and gastric fundal varices, and 128 cases had the history of bleeding more than once. Eighty-six cases were Child′s grade A and 58 cases were Child′s grade B in terms of liver function grades before operation. All the patients underwent HMCS plus portal-azygous disconnection. The free portal pressure of the patients decreased 9 cm H2O in average, and their white blood cells and platelet count significantly increased or returned to normal after surgery. The postoperative complications comprised four cases of wound infection, one case of intra-abdominal infection, 12 cases of fever, two cases of hepatic encephalopathy, 1 case of graft thrombosis and 14 cases of chylous leakage. All the complications mentioned above were resolved by non-surgical therapy. Only 1 patient died of hepatorenal syndrome. One hundred and six patients were followed up for 6 months to 10 years, of whom the subjective symptoms were obviously improved in 95 cases after surgery and they had no gastrointestinal rebleeding, hepatic encephalopathy, ascites or other symptoms, the total effective rate was 89.6% (95/106). Hepatic encephalopathy occurred in four cases and graft thrombosis in three cases, which were all resolved by non-surgical treatment. Upper gastrointestinal rebleeding occurred in four cases, of whom three cases died, and 1 patient was cured by non-surgical treatment. Conclusions: High mesocaval shunt plus portal-azygous disconnection is an effective treatment for portal hypertension, it with low complication incidence and better short as well as long term results.

Abstract:Objective: To evaluate the effect of the treatment of infected femoral artery pseudoaneurysm using bypass grafting with vascular prosthesis. Methods: The clinical data of 40 patients with infected femoral artery pseudoaneurysm admitted to our hospital from January 2005 to December 2010 were analyzed retrospectively. All the 40 patients were drug abusers, and underwent pseudoaneurysm excision, radical debridement and vascular prosthesis bypass grafting operation. Results: No death occurred and the patients′ limbs were all successfully salvaged during the perioperative period. All wounds were healed by secondary intervention. Thirty-four patients were followed up for 3 to 12 months (average of 7.4 months). Prosthetic graft infection occurred in three patients (8.8%) during the follow-up period, two of whom had their limbs salvaged after removal of the infected graft, and one finally underwent amputation because of ischemic limb necrosis. Thrombus formation was detected by color Doppler ultrasound in some parts of the lumen of prosthetic graft in four patients (11.8%), however, no ischemic necrosis occurred in the affected limbs of the four patients after antiplatelet therapy. Conclusions: Bypass grafting using vascular prosthesis is a safe and effective method for treatment of infected femoral artery pseudoaneurysm secondary to illegal drug injections.

Abstract:Objective: To investigate the efficacy of early detection and intervention in borderline lower-limb deep venous thrombosis (DVT). Methods: The clinical data of 23 patients with borderline lower-limb DVT were retrospectively analyzed. All the patients were confirmed having positive "snowstorm sign" in the deep veins of lower limb by duplex ultrasonography, and the central velocity of axial blood flow of femoral and popliteal veins as well as the center of snowstorm sign of the patients was measured. These hemodynamic parameters before and after treatment were compared to determine the therapeutic effect. Results: All patients were discharged from hospital after basic anticoagulation, antiplatelet and volume expansion therapy for five to seven days. The peak velocity of femoral and popliteal venous axial blood flow of the patients increased after treatment (all P＜0.01), and their snowstorm signs disappeared or lessened. Conclusions: Duplex ultrasonography screening for early detection and intervention of borderline low-limb DVT is helpful to prevent the thrombus converting to a solid state, and it thereby avoids surgical intervention (such as thrombus and inferior vena cava filter implantation) and the risks and adverse effects of long-term anticoagulation and/or thrombolysis.

Abstract:Objective: To investigate the anatomic characteristics and surgical treatment methods of the C5-C6 grade varicose of great saphenous vein (GSV). Methods: The clinical data of 69 patients with C5-C6 grade varicose GSV (84 limbs), who underwent surgery between August 2008 and September 2010, and were available for follow-up were analyzed. The patients were divided into deep vein stripping and deep vein plus superficial vein stripping groups, the skin flap necrosis rate, thrombophlebitis recurrence rate and clinical symptom relief rate after surgery between the two groups were compared. Results: There was no significant difference between the two groups in terms of sex, age and disease duration. Of the deep vein stripping group, skin flap necrosis was found in three limbs, thrombophlebitis recurrence occurred in seven limbs and the symptoms were completely alleviated in 21 limbs after surgery. Of the deep vein plus superficial vein stripping group, the skin flap necrosis was found in 38 limbs, thrombophlebitis recurrence occurred in one limb and symptoms were completely alleviated in 42 limbs. The skin flap necrosis rate of the deep vein plus superficial vein stripping group (84.44%) was higher than that of the deep vein stripping group (7.69%) (P＜0.01). The thrombophlebitis recurrence rate of the deep vein plus superficial vein stripping group (2.22%) was lower than that of the deep vein stripping group (17.95%) (P＜0.05). The clinical symptom relief rate of the deep vein plus superficial vein stripping group (93.33%) was higher than that of the deep vein stripping group (53.85%) (P＜0.01). The healing time of skin flap necrosis of the deep vein plus superficial vein stripping group was significantly prolonged compared with the deep vein stripping group (P＜0.01). Conclusions: The superficial veins have importance to the prognosis and survival of skin flap of patients with varicose GSV severer than C4 grade, so individualized treatment should be employed for those patients during operation.

Abstract:Objective: To explore the diagnosis and management of acute mesenteric ischemia(AMI). Methods:The clinical data of 29 patients with AMI treated in our hospital were analyzed retrospectively. Results:All 29 cases presented with initial symptom of severe acute abdominal pain, 13 cases had signs of peritoneal irritation and 5 cases had peritonitis combined with shock. In 20 cases, a definite diagnosis was made by CT. Fourteen cases were cured by anticoagulation/ thrombolytic therapy, 13 patients underwent operatin (7 recovered，6 died), and 2 cases, who refused treatment, died. Conclusions: AMI lacks specific clinical manifestations. Ultrasound, Conventional angiography and mesenteric CT/CT angiography are effective examinations for the early diagnosis of AMI. According to the individual situation of patients, early application of anticoagulation/thrombolytic therapy or operation are essential to reduce the mortality of AMI.

Abstract:Objective: To investigate the diagnosis and management of acute mesenteric venous thrombosis (AMVT). Methods: A historically controlled analysis was conducted in the clinical data of 13 AMVT patients from July 1995 to September 2002 undergoing surgery-based therapy (group A) and 14 AMVT patients from January 2003 to September 2010 undergoing anticoagulant thrombolytic-based therapy (group B). The length of hospital stay, cure rate and mortality between the two groups were compared. Results: The length of hospital stay, cure rate and mortality of group A was (22.38±2.81) days, 69.2% and 30.8%; and that of group B was (12.21±2.32) days, 100% and 0, respectively. The differences of all the above mentioned parameters between the two groups were statistically significant (P＜0.05 or P＜0.01). Conclusions: Early diagnosis and aggressive therapy with anticoagulants and thrombolytics can increase the cure rate of AMVT, and are also the key faetors to improving the prognosis of this disease.

Abstract:Objective: To compare the clinical efficacy of laparoscopy-assisted gastrectomy and conventional open gastrectomy in treatment of early gastric cancer (EGC). Methods: The clinical data of 112 EGC patients undergoing surgical treatment at our department from February 2006 to February 2011 were retrospectively analyzed. Of the patients, 55 cases underwent laparoscopy-assisted gastrectomy (laparoscopy group) and 57 cases underwent open gastrectomy (open surgery group). The operative time, blood loss, tumor resection margins, and the time to flatus passage, starting time of the liquid diet, hospital stay and complications after surgery, as well as the pathological findings and follow-up data between the two groups were compared. Results: The operative time ［(196.5±48.9) min］, blood loss ［(142.3±142.7) mL］, postoperative flatus passage time ［(2.8±1.1) d］, starting time of the liquid diet ［(5.1±1.8) d］ and postoperative hospital stay ［(10.3±1.1) d］ of the laparoscopy group were significantly reduced compared with those of the open surgery group ［(216.8±47.1) min, (246.0±148.4) mL, (4.5±1.5) d, (7.2±3.4) d and (13.2±3.6) d］ (all P＜0.05). No statistical difference was noted in tumor resection margins, number of lymph nodes removed, postoperative complication incidence ［(4.1±1.6) cm/(3.5±1.5) cm, (13.2±6.9), 9.1% vs. (4.0±1.8) cm/(3.6±1.7) cm, (14.3±7.7), 10.5%］ between the two groups (all P＞0.05). No tumor recurrence or metastasis occurred in the laparoscopy group during a median follow-up period of 24 (2-66) months, while one patient died of peritoneal metastasis in the open surgery group during a median follow-up period of 23 (2-63) months. Conclusions: Laparoscopy-assisted radical gastrectomy is safe and effective for EGC, and it has the advantages of minimally invasive, less operative time, quick recovery of postoperative gastrointestinal function and short postoperative hospital stay compared with open radical gastrectomy.

Abstract:Objective: To compare the efficiency of hand-assisted laparoscopic splenectomy (HALS) and open splenectomy (OP) for massive splenomegaly. Methods: The clinical data of patients undergoing splenectomy in our hospital between 2004 and 2010 were retrospectively analyzed to compare the clinical efficacy of HALS and OP in patients with spleen size larger than 20 cm. Results: Forty-one patients with spleen size larger than 20 cm underwent splenectomy, of whom, 21 cases underwent HALS and 20 cases underwent OP. The conversion rate to open surgery of the HALS group was 4.7%. The average blood loss of the HALS and OP group was 227 mL and 887 mL (P=0.01), and blood transfusion was 0 and 0.6 units (P<0.05), respectively. The length of hospital stay of the HALS group was significantly reduced compared with that of the OP group (4.3 days vs. 8.4 days) (P=0.001), and no significant difference was noted in complications between the two groups (P＞0.05). Conclusions: HALS is a safe and effective splenectomy procedure for patients with spleen size larger than 20 cm, and it is a feasible alternative procedure to OP with shorter hospital stay, less blood loss and fewer blood transfusions.