Abstract:

Objective:To discuss surgical treatment of carotid aneurysm.
Methods:The clinical data of 16 patients with carotid aneurysm treated in our department from August 2005 to May 2010 were retrospectively analyzed. The average interval from onset to hospitalization  was (31.0 ± 0.7) months. Of the patients, 15 cases were unilateral aneurysm and 1 case was bilateral aneurysm. The lesions were respectively located in common carotid artery (5 cases), internal carotid artery (9 cases) and external carotid artery (2 cases). The clinical findings of the patients included asymptomatic lesions in 7 cases, varying degrees of nerve compression in 5 cases and cervical mass after injury in 4 cases. All the patients underwent open surgery or endovascular treatment.
Results:One-stage operation was successfully performed in all patients that included 9 cases of surgical resection and 7 cases of endovascular therapy, and no operative death occurred. Eleven patients were followed up for an average period of (23.3 ± 0.7) months. Ultrasonic evaluation showed that all grafts were patent in the 5 cases undergoing great saphenous vein grafting; in the 4 other cases with placement of covered stents, the carotid arteries were patent and the aneurysms were completely occluded. In-stent thrombosis and carotid artery occlusion were detected in another 2 cases, but no further surgical treatment was performed because they caused no obvious symptoms.
Conclusions:The incidence of carotid aneurysm is relatively low, but it has high risk potential. Thus, it should be aggressively treated once diagnosed. Open surgery has obvious curative effect, while endovascular treatment is minimally invasive, and both procedures are effective treatments for carotid aneurysm.

Abstract:

Objective:To invesigate the effects of endovascular therapy on brachiocephalic pseudoaneurysm (BCPA) and carotid arteriovenous fistula (CVEF).
Methods:The clinical data of 7 patients with BCPA and 3 patients with CAVF, admitted to our department from September 2003 to March 2011, were analysed. Durations of the diseases ranged from 2 h to 40 years.  The causes of pseudoaneurysm were traumatic and iatrogenic injury, of CAVF were  2 cases of congenital CAVF and 1 case of traumatic CAVF. The main clinical manifestation of both was pulsatile mass in the neck or infraclavicular region. Firstly, all patient underwent femoral artery puncture and angiography to identify the natnre, location and size of the lesion. Then, memberane-covered stents were inserted to seal the arterial perforations and repair the vessels.
Results:Eight cases of pseudoaneurysm or traumatic arteriovenous fistula and 1 case of congenital arteriovenous fistula achieved satisfactory curative effect; another case of congenital arteriovenous fistula was substantially improved as evidenced by the obviously decreased blood flow through the fistula.
Conclusions:Endovascular treatment with covered stent is a practically valuable method for brachiocephalic pseudoaneurysm and caroted arteriovenous fistula, this technique is simple, rapid, minimally invasive, safe and effective.

Abstract:

Objective:To summarize the experiences in surgical and endovascular treatment for isolated iliac artery aneurysm (IAA).
Methods:The clinical data of 8 patients with isolated IAA treated in our department from January 2007 to May 2010, that included 4 patients who underwent open surgical repair after aneurysm resection and 4 aged patients with several comorbidities who underwent endovascular stent-graft placement, were retrospectively analyzed.
Results:All the 8 cases were treated successfully but 1 case of endovascular repair developed retroperitoneal abscess after operation that was cured by surgical drainage and anti-infectious therapy; no complications occurred in the other 7 cases. Follow-up periods ranged from 3 months to 2 years. All the patients survived well without recurrence.
Conclusions:Both open surgical and endovascular repair are safe and effective for IAA, and the selection of proper treatment in clinical practice is based on the specific circumstances of the patients. For the aged patients, who usually have several concomitant diseases, endovascular repair should be taken as the first option.

Abstract:

Objective:To investigate the surgical treatment for patients with popliteal artery aneurysm (PAA).
Methods:The clinical data of 9 patients with popliteal artery aneurysm admitted to our department from 2004 to 2010 were retrospectively analyzed.
Results:Nine patients (6 males and 3 females) with average age was 53.8 years. Of the patients, 2 cases had bilateral PAAs (one of which coexisted with bilateral iliac artery aneurysms), 4 cases had left and 3 cases had right PAAs. One patient had asymptomatic PAA and 8 cases had symptomatic PAAs that presented with pulsating mass in 2 cases, a mass with local pain in 3 cases, and chronic and acute lower extremity ischemia in one and two cases, respectively. Seven patients underwent surgical repair and the other 2 patients received non-surgical treatment (one of which underwent surgery of bilateral iliac artery aneurysms initially). Aneurysm resection and eFTFE graft or autologous saphenous vein interposition was performed in the operated patients. Follow-up of 0.5 month to 6 years was available in 8 patients. Symptoms of the affected limbs were obviously ameliorated, and pulsating masses and limb pain were disappearred after operation. The dorsalis pedis artery could be palpated in all cases.
Conclusions:Atherosclerosis is the main cause of PAA. Early elective surgical repair is suggested for symptomatic PAA or asymptomatic PAA with diameter larger than 2 cm, and is especially indicated for thrombosed PAAs. There is no significant difference between eFTFE and autologous saphenous vein graft in short-term and long-term patency.

Abstract:

Objective:To investigate the influence of diabetes mellitus (DM) on revascularization (endovascular therapy and open surgery) for chronic critical lower limb ischemia (CLI).
Methods: The clinical data of 121 patients (130 affected limbs) undergoing revascularization for CLI in Chaoyang hospital within 3 years were retrospectively analyzed. Of the patients, 55 cases (60 affected limbs) with DM (DM group) were treated as follows: Twenty-seven limbs underwent artery shunting surgery, 9 limbs underwent percutaneous transluminal angioplasty (PTA), 20 limbs underwent PTA plus stent implantation and 4 limbs underwent artery shunting surgery combined with endovascular therapy. Sixty-six cases (70 affected limbs) of non-diabetic (NDM) patients (NDM group) were treated as follows: Twenty-eight limbs underwent artery shunting surgery, 10 limbs underwent PTA, 24 limbs underwent PTA plus stent implantation and 8 limbs underwent artery shunting surgery combined with endovascular therapy. All patients were followed up from 3 to 36 months, and the perioperative mortality, 1-year cumulative survival or limb salvage rate between the two groups were compared.
Results:Perioperative mortality in DM group and NDM group was 9.1% and 61%, respectively (P＞0.05); 1-year cumulative survival rate in DM group and NDM group was 881% and 93.1%, respectively (P＞0.05); Limb salvage rate in DM group and NDM group was 816% and 83.4%, respectively (P＞0.05).
Conclusions:DM has no influence on revascularization for CLI in respect to perioperative mortality, 1-year cumulative survival and limb salvage rate. Thus, these results suggest that revascularization shoud be aggressively perfomed in CLI patient with DM.

Abstract:

Objective:To investigate the effect of the combination of interventional and surgical treatment for patients with Cockett syndrome complicated with phlegmasia cerulea dolens (PCD).
Methods:The clinical records of 5 patients with Cockett syndrome complicated with PCD undergoing the combined treatment from 2005 to 2010 were retrospectively analyzed.
Results:Five patients manifested classical PCD with absence of pulsation of dorsalis pedis and posterior tibial arteries. The diagnosis of Cockett syndrome was confirmed by preoperative Doppler and intraoperative DSA, which showed no blood flow in the deep veins of the left lower extremity, and showed compression and stricture of the left iliac vein. All cases underwent inferior vena cava filter placement, left femoral vein incision and embolectomy, and balloon dilatation of the left iliac vein were performed; among them one received stent implantation. After operation, all cases were given anticoagulant and thrombolytic therapy. All patients recovered well, their dorsalis pedis artery pulsations were restored and lower limb swellings disappeared. Follow up (3 months to 5 years) showed no recurrent thrombosis or other complications occurred.
Conclusions:The combined interventional and surgical  treatment of Cockett syndrome complicated with PCD is effective, and has good therapeutic results.

Abstract:

Objective:To study the diagnosis and treatment of popliteal venous entrapment syndrome (PVES).
Methods:The clinical data of 61 patients with PVES were retrospectively analyzed. Of the patients, 39 were males and 22 females. Their ages ranged from 34 to 58 years with average age of 44.5 years. The lesions affected 31 left legs, 20 right legs and 10 bilateral legs. Twenty-five patients presented with calf swellings, hyperpigmentations and varicosities, and 36 patients presented with stasis dermatitides and calf pains including 8 cases of stasis ulcers in affected legs. The disease durations of patients ranged from 5 to 20 years. Forty-two patients were suspected to have lower extremity deep vein valve insufficiency, and 19 patients were diagnosed as varicosity of the greater saphenous vein. Ten patients had previously experienced high ligation and stripping of the great saphenous vein. Popliteal vein entrapment was suggested by B-mode Doppler ultrasound in 6 patients. All patients underwent anterograde low limb venography and the results showed stenosis ratios were more than 70% in all the patients. There were 11 cases of upper segment stenosis, 14 cases of middle segment stenosis and 36 cases of low  segment stenosis according to the venography. Popliteal vein release operation was performed in the 36 patients with severe symptoms, and the medical compression stockings were used in the remaining 25 patients with milder symptoms.
Results:The swellings and pains were lessened to varying degrees in the 25 patients undergoing conservative treatment after wearing the compression stockings. The symptoms were alleviated and venous ulcerations were resolved within 1 month after surgery in the 36 operated patients, among which 29 cases were followed up for 3 months to 5 years, 13 of them could have a normal work and life without the compression stockings, while 16 cases required intermittent use of the stockings due to mild swelling in the inner side of ankle after standing for long periods of time. Seven cases were lost to follow-up.
Conclusions:Clinical manifestations of PVES are similar to those of venous insufficiency of lower extremity and it is easy to be misdiagnosed. For severe cases of PVES,  satisfactory results can be achieved by surgical treatment.

Abstract:

Objective:To investigate the therapeutic effect of deep venous valve reconstruction using substitute valve in popliteal vein of patients with severe primary deep venous insufficiency (PDVI).
Methods:One hundred and six PDVI patients with CEAP classification of 4 to 6 class were included and randomly assigned as observation group and control group. Patients in the observation group underwent the combined treatment of substitute valve operation and superficial vein phlebectomy, and patients in the control group underwent superficial vein phlebectomy alone. The venous clinical severity scores (VCSS) of patients of the two groups were compared before surgery and 14 days and 2 years after surgery.
Results:The total VCSS，scores for pain, varicosity, inflammation and ulcer of all patients obviously decreased 2 weeks after surgery (P＜0.05), but no difference was noted between the two groups (P＞0.05). The total VCSS, and scores for varicosity and edema in the observation group were significantly lower than those in the control group (P=0.039, P=0.026 and P=0.021, respectively) 2 years after surgery.
Conclusions:For PDVI patients with CEAP classification of 4 to 6 class and complicated with severe venous edema, the combined treatment of substitute valve operation and superficial vein phlebectomy is better than superficial vein phlebectomy alone in long-term outcome.

Abstract:

Objective:To explore the prevention and feasibility of surgical and endovascular treatment of cardiac tamponade in or after the interventional management of Budd-Chiari syndrome (BCS).
Methods:The clinical data  of 7 BCS patients who developed acute or delayed cardiac tamponade during the interventional procedure were retrospectively analyzed. Pericardiocenteses were performed in all patients, of which 3 cases also underwent surgical decompression of the pericardium and repair of rupture of the inferior vena cava, and 1 case underwent endovascular stent-graft implantation.
Results:All patients were cured except one who died of multiple organ dysfunction syndrome due to misdiagnosis as acute right heart failure. Two patients undergoing pericardiocentesis received a second BCS interventional therapy 1 month later and were cured. The patients were followed up for 12 to 30 months with average of 18 months. All patients had no discomfort or lower extremities edema. No cardiac effusion or ascites was detected, and the hepatic veins and inferior vena cava were patent under ultrasound.
Conclusions:Cardiac tamponade is a severe complication of BCS interventional therapy. Once it has occurred, emergent surgical or endovascular treatment could save the patient′s life. Meanwile, an effective multidisciplinary cooperation is the important assurance of success.

Abstract:

Objective:To study the pathogenesis, diagnosis and treatment  of vascular Ehlers-Danlos syndrome （EDS）.
Methods:Analysis of the clinical data of 2 patients with EDS and the EDS patients occurred in a fomily. The characteristics of pathogenesis, diagnosis and surgical treatment of EDS were reveiwed.
Results:One of the EDS patients had spontaneous rupture of aneurysm. At operation, the vessel was found to be fragile and the operative field had marked oozing of blood. Postoperative bleeding led to the patient death. Another case of  EDS underwent interventional treatment several times for thigh hematoma.but bleeding recurred quickly. Pedigree study of case 2 family showed autosomal dominant characteristics.
Conclusions:Vascular type EDS is a very rare kind of congenital disease.Its vascular complications often lead to disastrous consequences. Surgical therapy has a  high surgical complication and mortality rate.

Abstract:

Objective:To investigate the effects of central and peripheral injection of arginine vasopressin (AVP) on arterial baroreflex (ABR) function in septic rats.
Methods:Rat sepsis model  was induced by cecal ligation and puncture (CLP).  (1) The ABR function and AVP expressions in supraoptic and paraventricular nucleus of the 2 grous were measured at 4, 8 and 12 h after operation, respectively. The sham operated rats were used as control;  (2) Sepsis rats were given AVP (50 ng), and artificial cerebrospinal fluid of the same volume were given to control rats by intracerebroventricular injection 8 h after operation. The ABR functions of the 2 group rats were determined at 5 and 30 min after injection. (3)Sepsis rats were given AVP ［2 ng/(kg·h)］ and control rats were given saline of the same volume by continuous intravenous infusion 6 h after CLP. The ABR functions of the 2 group rats were determined at 5 and 30 min after infusion. 
Results:In sepsis rats showed gradual decrease in ABR function, as well as a gradual reduction of AVP expressions in supraoptic and paraventricular nucleus. Both intracerebroventricular injection and continuous intravenous infusion with AVP significantly improved the ABR functions in sepsis rats compared with control group rats (both P<0.05).
Conclusions:In sepsis, the reduction of AVP expression in supraoptic and paraventricular nucleus induces a decrease in ABR function, which may probably contribute to the development of sepsis. Use of exogenous AVP in the initial phase of sepsis can improve ABR function and delay the development of sepsis.

Abstract:

Objective:To investigate a simple and reliable mothod to construction an abdominal aortic aneurysm (AAA) model in rabbits.
Methods:Twenty male New Zealand rabbits were randomly assigned as experimental group (n=10) and control group (n=10). AAA model was induced by periarterial infiltration with of calcium chloride (CaCl2) in the experimental group and saline was substituted for CaCl2 in the control group. The dilation ratio, morphological and pathohistological changes of abdominal aorta of the two groups were observed at 6 weeks after operation.
Results: The dilation ratio of abdominal aorta was (124.12±8.11)% in the experimental group, which was statistically different from that of the control group (P＜0.01). The pathohistological examination of the abdominal aortas showed serious disruption of the elastic tissue and loss of smooth muscle cells in tunica media of aortic aneurysm in the experimental group.
Conclusions:The rabbit AAA model using periarterial  infiltration with CaCl2  is simple and easy to perform, and it provides an appropriate tool for  experimental therapeutic studies in AAA.

Abstract:

Objective:To observe the responses of small mesenteric arteries to vasoconstrictors in diabetic patients.
Methods:The small mesenteric arteries in patients with diabetes undergoing abdominal surgeries were obtained and used as the observation group, and the corresponding small mesenteric arteries of nondiabetic patients were  obtained and used as control group. The dose-effect curves of small mesenteric arteries response to vasoconstrictors including K+, NA, 5-HT, S6c and ET-1 were recorded using BL-420 tension trace system.
Results:The vascular tension induced by K+ in the observation group and the control group was (5.39±1.19) mN and (2.92±0.78) mN, respectively (P＜0.01); Maximal contraction (Emax) and pEC50 induced by NA in observation group was (162±10)% and (6.57±0.14), and in control group was (97±19)% and 5.94±0.17 (P＜0.01), respectively. Emax and pEC50 induced by 5-HT in observation group and control group was (41±14)%, (6.21±0.19) mN,and (3±1)%,  (7.49±0.21) mN respectively (P＜0.01); Emax and pEC50 of observation group induced by S6c was (60±14)% and (7.81±0.76) mN; no response to S6c was noted in the control group (P＜0.01). The response of the observation group to lower concentration ET-1 (<10-11 mmol/L) was higher than that of the control group  (P＜0.01), and to higher concentration ET-1 was lower than that of the control group (P>0.05).
Conclusions:The response of small mesenteric arteries to vasoconstrictors in diabetic patients is higher than that in the nondiabetic individuals, which is probably due to increased receptor-binding affinity of the α-receptor, 5-HT and ETB.

Abstract:

Objective:To analyze the clinical epidemiological characteristics of Budd-Chiari syndrom (BCS), and provide an epidemiological basis for the etiological study on its underlying diseases.
Methods:The epidemiological data of 1148 patients with BCS from all area of our country, who treated in the affiliated Hospital, Xuzhou Medical College in the last 20 years, were collected. According to the pathogenic location, BCS was divided into three types ［hepatic vein (HV), inferior vena cava (IVC) and HV combined with IVC (MIX)］ and eight subtypes. A descriptive analysis was carried out by age, sex and regional distribution.
Results:The cases of BCS had gradually increased in the last 20 years, especially in adults. The ratio between male and female was 1.00∶1.25. The IVC type accounted for most of the cases,while  HV and MIX types were the second and the least, respectively. The majority of the patients came form the provinces of Jiangsu, Anhui, Shandong, Henan and Hunan. Among them, the patients of Jiangsu accounted for 50.61% of BCS cases. Restenosis developed in about 7.75 percent of patients after interventional treatment.
Conclusions: IVC is the main type of BCS admitted to the affiliated Hospital, Xuzhou Medical College. Most of the BCS patients live around the Yellow River region, and the cause of the disease is not clear. Our study may provide a reference for etiological study on underlying diseases of BCS.

Abstract:

Objective:To investigate the manifestations of multi-slice spiral CT (MSCT) imging in regional portal hypertension (RPH) and their clinical relevance.
Methods:The findings of MSCT (16- or 64-slice) and multi-slice spiral CT angiography (MSCTA) in 17 patients with RPH were retrospectively analyzed through observing the manifestations of splenic veins and the collateral vessels.
Results:Of the patients, 14 cases were caused by pancreatic diseases, 1 case by splenic disease and 2 cases by leukemia. The imaging studies demonstrated that splenic vein occlusion accounted for 35.3% and stenosis accounted for 64.7%. Furthermore, they showed the presence of varices in the fundus (70.6%) and (or) body (765%) of the stomach.
Conclusions:MSCT is of great value in diagnosis of RPH, and can reveal the collateral pathways and even the causes of RPH.

Abstract:

Objective:To summarize the experiences in diagnosis and treatment of the complicated renal artery aneurysm (RAA).
Methods:The treatment process and result of one male patient with complicated RAA who underwent retroperitoneal laparoscopic nephrectomy, ex-vivo aneurysmectomy, renal revascularization and minimally invasive heterotopic renal autotransplantation were record, and some related literatures were reviewed.  In a 27 year old male patient, the preoperative color Doppler ultrasonograph, CT and CTA showed an aneurysm (4.5 cm×4.0 cm ×3.0 cm) located in the main renal artery bifurcation and the six branches of the right kidney. After a successful retroperitoneal laparoscopic nephrectomy, the isolated kidney was perfused with 4 ℃ renal irrigating solution immediately to protect the kidney. Then, ex-vivo aneurysm resection and renal artery revascularization with autologous great saphenous vein were performed. Finally, with minimally invasive procedure, the reconstructed right kidney was re-implanted into the right iliac fossa via the original incision for removal of the kidney.
Results:The operative procedure was completed successfully in 6.5 hours, with renal warm ischemia time of 4 min and cold ischemia time of 2.5 hours, and blood loss of 50 mL. The patient recovered without perioperative complications. The postoperative renal function was normal, and CTA at 1 month and color Doppler ultrasonograph at 2 weeks and 3 months after operation showed that the shape of the heterotransplanted kidney was normal, the blood circulation in the transplanted renal artery and vein and its branches were patent, and there was no stenosis of the ureter.
Conclusions:The procedures of retroperitoneal laparoscopic nephrectomy, ex-vivo aneurysmectomy, renal revascularization and minimally invasive heterotopic renal autotransplantation for treating complicated RAA are safe, effective, feasible and minimally invasive.

Abstract:

Objective:To study the causes and treatment of delayed intra-abdominal hemorrhage after pancreatoduodenectomy (PD).
Methods:The occurrence of intra-abdominal hemorrhage among the 168 patients undergoing PD was retropectively analyzed.
Results:Of the 168 post-PD patients, delayed intra-abdominal hemorrhage occured in 38 cases (22.6%, 38/168). Eleven patients underwent reoperation due to severe intra-abdominal bleeding, and the mortality rate in reoperated patients was 27.3% (3/11). Pancreatic fistula and abdominal infection were the major causes attributed to bleeding of post-PD patients.
Conclusions: The delayed intra-abdominal hemorrhage in post-PD patients is closely related with pancreatic fistula and abdominal infection. The incidence of delayed intra-abdominal hemorrhage can be reduced by the improvement of perioperative management, the prevention, early detection, and treatment of pancreatic fistula and abdominal infection.

Abstract:

Objective:To study the feasibility and safety of transumbilical single-port laparoscopic cholecystectomy (TUSPLC).
Methods:The clinical data of 150 patients undergiong TUSPLC were retrospectively analyzed.
Results:Three cases were converted to standard two-port LC due to stones incarcerated in the neck of the gallbladder, which resulted in difficult exposure of the gallbladder, and drains were required after surgery. TUSPLCs were successfully perfomed in other 147 patients, thus the successful rate was 98%. Operating times were 30 to 100 min, and no bleeding, bile leakage or other complications occurred. Except for small umbilical skin folds, there were no visible abdominal scars when the patients were discharged.
Conclusions:TUSPLC approach is simple, safe and technically feasible. However, it requires the operation team to be skilled in using the equipment and to cooperate closely during the procedure.

Abstract:

Objective:To investigate the value of Shuertai in laparoscopic appendectomy for acute suppurative appendicitis.
Methods:A total of 196 patients with acute suppurative appendicitis were assigned into two groups randomly: The observation group (106 cases with Shuertai treatment) and the control group (90 cases without use of Shuertai). After appendectomy, the abdominal cavity of all patients was lavaged with large amount of warm saline until the returning fluid was quite clear,  then the residual liquid was aspirated. The patients in observation group were then additionally lavaged with Shuiertai and a small amount of Shuieratai was retained. The umbilical incision was closed and treated with iodophor in all the patients. The postoperative complications, including rate of incisional wound infection, abdominal distention at 72 h after operation, reoperation because of adhesive ileus, postoperative pain, nausea and vomiting, between the two groups were compared.
Results:The rate of incisional wound infection, abdominal distention at 72 h after operation and other postoperative complications such as pain, nausea, vomiting and intra-abdominal abscess was 0% (0/106), 3.7% (4/106), 9.4% (10/106), 5.6% (6/106) and 0% (0/106) respectively in the observation group, and was 3.3% (3/90), 17.8% (16/90), 51.1% (46/90), 31.1% (28/90), and 8.8% (8/90) in the control group, respectively.
Conclusions:The application of Shuertai in laparoscopic appendectomy can prevent incisional wound infection and intra-abdominal abscess, reduce postoperative pain, nausea and vomiting, and shorten the postoperative hospital stay.