Abstract:Objective: To determine the efficacy of hybrid approach for treatment of distal aortic arch diseases. Methods: The hybrid procedures (endovascular repair combined with extra-anatomic bypass procedure) were performed in 10 patients, of whom, 4 cases were type B aortic dissection involving the branches of aortic arch and 6 cases were true aneurysm of the distal arch. The bypass surgery of the patients included 1 case of left common carotid artery to left vertebral artery bypass, 5 cases of right common carotid artery to left common carotid artery bypass, 1 case of right common carotid artery to the left common carotid artery and left common carotid artery to the left subclavian artery bypasses, and 3 cases of ascending aorta to innominate artery and left common carotid artery bypasses. The covered-stent grafts of all patients were implanted via femoral artery. Results: Technical success was achieved in all patients, but there was one case of a minor type I endoleak that was left without intervention. Except for 1 patient who developed cerebral infarction complicated with pneumonia and renal failure after surgery and was discharged against medical advice, the remaining 9 patients were discharged from hospital after they were cured. Nine patients were followed up for 3 to 33 months. The CTA examination at 3 months after surgery showed no evidence of stent migration, the former endoleak in one case had disappeared, no new endoleaks occurred; thrombus formation was observed in the false lumen of aortic dissection and in aneurysmal cavity, no enlargement of the distal false lumen was found, and the bypass prostheses were patent. Conclusion: Hybrid treatment can avoid the complications of extracorporeal circulation, reduce the degree of surgical trauma and improve the therapeutic outcomes of the patients, and is an important method for treatment of distal aortic arch diseases involving the aortic branches.

Abstract:Objective: To investigate the application value of small covered self-expanding stent in treatment of arterial disease. Methods: The clinical data of 30 patients undergoing implantation of small covered self-expanding stent for artery related disease from October 2007 to May 2011 were retrospectively analyzed. Results: Of the patients, there were 5 cases of arterial bleeding, whose lesions were located on common iliac artery (2 cases), carotid artery (2 cases) and left subclavian artery (1 case) respectively, 2 cases of traumatic arteriovenous fistula of the lower limb, 3 cases of congenital arteriovenous fistula, 2 cases of subclavian artery aneurysm, 5 cases of acute aortic syndrome, 4 cases of chronic aortic dissection with a second tear and 9 cases of aortoiliac occlusive disease. Stents were successfully implanted in all patients and the primary lesions of the patients were substantially resolved. The follow-up period ranged from 3 to 36 months, with an average of 16 months. In the 2 patiants with carotid artery hemorrhage, stent occlusion occurred 12 months after operation, but no nervous system problems were noted. The stents in the remaining patients were all patent as shown by Doppler ultrasound and contrast-enhanced CT examination. Conclusion: Small covered self-expanding stent implantation for arterial disease is a fast performed operation, with minimal invasion and demonstrable efficacy, and is irreplaceable in some special cases.

Abstract:Objective: To investigate the clinical efficacy of endovascular treatment of subclavian steal syndrome (SSS). Methods: The clinical data of 86 patients with SSS undergoing endovascular treatment over the past 10 years were retrospectively analyzed. Of the patients, there were 11 cases of subclavian occlusion and 75 cases of subclavian stenosis (the stenosis degree of all the 75 cases greater than 70%). Results: Stents were deployed successfully in all patients and no intraprocedural complications occurred. Immediate postoperative angiography revealed that the stenotic or occlusive segments of the subclavian artery were patent and antegrade vertebral blood flow was restored. Arterial pulsations of the treated arm rapidly returned to normal and the differences in blood pressure between arms were less than 10 mmHg (1 mmHg=0.133 kPa). Follow-up was obtained in 72 patients with average period of 24 months. Of the follow-up patients, 2 cases died of malignant tumor, 4 cases died of myocardial infarction, and the symptoms of vertebral basilar insufficiency and upper extremity ischemia were improved or eliminated in the rest of the cases. The follow-up Doppler ultrasound examination showed that all the stents were patent and intact, with no evidence of stent migration. Conclusion: Endovascular treatment of SSS is safe and minimally invasive, with high success rate and good short-term efficacy. It should be the first choice of treatment for this condition.

Abstract:Objective: To compare the efficacies, complications and follow-up results between open surgical revascularization and endovascular recanalization in treatment of chronic iliac arterial occlusive disease, so as to guide treatment selection of these patients. Methods: Sixty-seven patients with chronic iliac arterial occlusive disease were randomly designated to undergo open surgical revascularization or endovascular interventional therapy. The efficacies, complications and follow-up results between the two groups were analyzed and compared. Results: In the open surgical treatment group, 30 cases underwent bypass operation (anatomic vascular revascularization in 24 cases and left to right femoro-femoral bypass in 6 cases), and 4 cases underwent patch angioplasty. In the interventional treatment group, 7 cases underwent balloon dilatation alone, 23 cases underwent balloon dilatation plus stent implantation, and interventional procedure was unsuccessful in 3 cases. Thirty days after surgery, the patency rates of reconstructed vessels of open surgical treatment group and interventional treatment group were 100% and 96.7%, and their overall effective rates were 97.1% and 84.8%, respectively. The incidences of perioperative complications of open surgical treatment group and interventional treatment group were 35.3% (12/34) and 20.0% (6/30), respectively. The follow-up period ranged from 13 to 65 months. The patency rates of the reconstructed vessels and symptom relief rates between the two groups had no significant differences during the first year after surgery (all P>0.05), however, from second year after surgery, the patency rates of the reconstructed vessels and ABI value of open surgical treatment group were significantly higher than those of interventional treatment group, and the symptoms such as intermittent claudication and rest pain of open surgical treatment group were less evident (all P<0.05). Conclusion: Both open surgical revascularization and endovascular interventional therapy have substantial efficacy in treatment of chronic iliac arterial occlusive disease. By comparison, open surgical revascularization has better long-term efficacy but greater risk of complications, while endovascular interventional therapy is an ideal choice for patients of old age and poor general condition contraindicating surgery.

Abstract:Objective: To evaluate the efficacy of endovenous laser ablation combined with stripping for varicosities of the great saphenous vein (GSV). Methods: The clinical data of 128 patients (176 affected limbs) with GSV varicosities, who underwent thigh GSV stripping plus calf GSV endovenous laser ablation from April 2006 to March 2009, were retrospectively analyzed. Results: The operation results were satisfactory in all patients, and the symptom improvement rate was 100% without wound infection or deep venous thrombosis. The short-term complications included pretibial bruising and/or hematoma (12 limbs, 6.8%), strip skin burns (2 limbs, 1.1%), superficial periphlebitis (12 limbs, 6.8%), and ankle edema (2 limbs, 1.1%). No paresthesia or long-term complications were noted, and no recurrent varicose veins occurred during the 3-year follow-up period. Conclusion: Endovenous laser ablation combined with vein stripping has demonstrable efficacy and fewer complications in treatment of GSV varicosities, and is a safe, reliable, and mini-invasive procedure.

Abstract:Objective: To investigate the clinical features and management of deep venous thrombosis (DVT) in patients with malignant tumor. Methods: The clinical data of 45 patients with malignant tumor and complicated by DVT were reviewed to summarize and analyze the causes, prevention and treatment methods of thrombosis of these patients. Results: Of the patients, the clinical symptoms in 38 cases (84.4%) were improved after standard anticoagulation/thrombolytic treatment, and one of them developed subcutaneous ecchymosis; four cases (8.9%) developed pulmonary embolism (PE) during anticoagulation/thrombolytic therapy, of whom 3 cases had their PE symptoms relieved after aggressive treatment, and 1 cases died despite lifesaving efforts; the symptoms of 3 cases (6.7%) with risk of bleeding were relieved only by immobilization, symptomatic treatments and blood circulation promoting drugs. In the 8 patients with peripherally inserted central venous catheter (PICC)-related upper extremity DVT, the catheters were removed after treatment according to individual situations, and no obvious PE symptoms were noted. Conclusion: Patients with malignant tumor have a higher risk of DVT and aggressive treatment should be initiated as early as possible after the diagnosis of DVT in these patients. For patients with DVT without apparent predisposing cause should receive high vigilance for the possibility of to occult malignant tumor.

Abstract:Objective: To assess the application value of color Doppler ultrasound in patients at risk for peripherally inserted central catheter (PICC)-related upper extremity venous thrombosis. Methods: From February 2010 to January 2012, 89 patients receiving PICC placement who presented with upper extremity symptoms underwent upper extremity venous color Doppler ultrasound scanning, and their sonographic features were analysed. Results: Of the 89 patients with PICC placement, 56 (62.9%) cases had the catheters placed in the right arm and 33 (37.1%) cases in the left arm. Ten (11.2%) patients developed PICC-related upper extremity thrombosis, of whom, 6 cases in the right arm and 4 cases in the left arm. Of the 10 patients, 7 were male, of whom, there were 3 cases of hematological malignancies, 2 cases of pulmonary malignant tumors, and one case each of malignant abdominal tumor and severe pneumonia; all of the 3 female cases were of breast cancer. Conclusion: Color Doppler ultrasound scanning is convenient, fast and non-invasive for diagnosis of upper extremity venous thrombosis in patients with PICC placement. Thus, it is recommended to be widely used.

Abstract:Objective: To assess the values of plasma levels of β2-microglobulin (β2-MG) and homocysteine (HCY) for risk rating and prognosis estimation in patients with lower extremity atherosclerotic disease (LEAD). Methods: One hundred and thirty-six patients with confirmed LEAD were enrolled and grouped according to the Fontaine staging as stage I (n=27), stage II (n=39), stage III (n=38) and IV (n=32) group, or according to the values of ankle-brachial index (ABI) as low-risk (0.7≤ABI<0.9, n=36), mid-risk (0.4≤ABI<0.7, n=60) and high-risk (ABI<0.4, n=40) group. In addition, 35 subjects undergoing health maintenance examination during the same period were enrolled as control population for the two hierarchic methods. The plasma levels of β2-MG and HCY were measured and compared among the groups, and the correlation between variables and survival rates were also analyzed. The patients were interviewed every 3 months over a 2-year period. Amputation and death from cardiovascular or cerebrovascular diseases were considered as end-point events, which were also used to determine the prognosis of the patients. Results: The plasma levels of both β2-MG and HCY increased with the progression of the Fontaine stage and with the increase of risk rating as well (both P<0.01). Furthermore, the ABI value was negatively correlated with the plasma levels of β2-MG and HCY (r=–0.867, –0.846). The area under ROC curve of HCY that was used to predict the prognosis of the LEAD patients was 0.831. With a cut-off value at 36.085 (μmol/L), the prediction sensitivity was 86.0%, specificity was 68.6% and Youden index (YI) was 0.546, respectively. COX regression analysis showed the HCY level and ABI value could be used as the independent risk factors to predict the end-point events of LEAD (P=0.018, P=0.001). Conclusion: The plasma levels of β2-MG and HCY increase with the progression of LEAD. HCY is a good index for predicting the occurrence and prognosis of LEAD, but the combined analysis of HCY level and ABI value (risk rating) yields a better judgment of prognosis of LEAD patients.

Abstract:Objective: To observe the inhibitory effect of rapamycin PLGA nanoparticles (RAPA-PLGA-NPs) on proliferation of vascular smooth muscle cells (VSMCs). Methods: Rat VSMCs were prepared by primary culture and identified by immunohistochemical staining for α-actin. Cell uptake of RAPA-PLGA-NPs was observed by using transmission electron microscopy (TEM). The effects of RAPA-PLGA-NPs on the growth and expression of the proteins downstream to mTOR (mammalian target of rapamycin) of VSMCs were determined by MTT assay and Western blot analysis, respectively. Meanwhile, the free rapamycin served as comparison. Results: Rat VSMCs were successfully cultured and identified. TEM results showed significant amount of RAPA-PLGA-NPs uptake into the cytoplasm of VSMCs. The MTT results showed that RAPA-PLGA-NPs (1, 10 and 100 ng/mL) inhibited the proliferation of VSMCs in a concentration dependent manner (all P<0.05), and the inhibitory effect of RAPA-PLGA-NPs at 1 ng/mL was similar to that of the free rapamycin at 10 ng/mL (P>0.05). Western blot results showed that RAPA-PLGA-NPs of both concentrations (1 and 10 ng/mL) markedly reduced phosphorylation levels of S6K1 and 4E-BP1 of VSMCs, and both effects were more obvious than that of the free rapamycin (10 ng/mL). Conclusion: RAPA-PLGA-NPs are of enhanced permeability, can be rapidly taken up by cells, and have better biological effects than their free forms.

Abstract:Objective: To observe the effects of different doses of urokinase, given at different times after thrombus formation, on the vascular wall of the affected vessels in rats with deep vein thrombosis (DVT). Methods: Ninety-six SD rats were equally randomized into stage I, stage II, stage III and stage IV groups according to the time elapsed since thrombus formation (1, 3, 7, and 14 d) after the establishment of DVT model. The rats of each stage group were equally randomized again into model group, low-dose urokinase [20 000 U/(kg?d)] group, mid-dose [40 000 U/(kg?d)] urokinase group and high-dose [80 000 U/(kg?d)] urokinase group. Urokinase was administered by tail vein injection for 7 days. The affected vessels of the rats were harvested at the end of the experiment, and the alterations of endothelial cell number and collagen amount were measured via H&E staining and picrosirius red staining, respectively. Results: In stages I, II and III, the numbers of endothelial cells of the three urokinase treated groups were all significantly higher than that of model group (all P<0.05), but no statistical significances were noted between the urokinase groups (P>0.05). The percentages of the collagen-positive staining area of the three urokinase treated groups were all significantly lower than that of model group (all P<0.05), and this percentage was reduced with the increasing dose of urokinase. In stage IV, the numbers of endothelial cells of all of the three urokinase treated groups had no significant differences compared with model group (all P>0.05), while the percentages of the collagen-positive staining area of the three urokinase treated groups were all still significantly lower than that of model group (all P<0.05). Conclusion: Urokinase has significant protective effect on the endothelial cells and inhibitory effect on the collagen proliferation of the affected vessels within the first 14 days after thrombus formation. However, beyond 14 days after thrombus formation, urokinase has no effect on endothelial cells but still has inhibitory effect on collagen proliferation.

Abstract:Objective: To investigate the expression of podoplanin in rectal cancer tissues and its relation with lymph node metastasis. Methods: The expression of podoplanin and lymphatic microvessel density (LMVD) in 110 cases of rectal cancer tissues was evaluated by imrnunohistochemical analysis, and 90 cases of benign disease rectal tissues were used as the control. Results: The positive expression rate of podoplanin in the rectal cancer tissues was significantly higher than that in the benign disease rectal tissues (P<0.01). The podoplanin positive LMVD of the stage III-IV cases was significantly higher than that of the stage I-II cases (P<0.01), and the LMVD of the cases with lymph node metastases was significantly higher than that of the cases without lymph node metastasis (P<0.01). The podoplanin expression was irrelevant to the age, sex and tumor differentiation degree of the rectal cancer patients. Conclusion: Podoplanin may play an important role in lymph vessel neogenesis, and can be used as an immunohistochemical marker for the diagnosis and estimation of prognosis of rectal cancer.

Abstract:Objective: To investigate the clinical effect of selective devascularization and combined devascularization operation for portal hypertension. Methods: Two-hundred and forty-seven patients with portal hypertension admitted to our hospital from June 2009 to December 201 were designated into two groups according to their operative procedures, namely, the selective devascularization group (126 cases) and combined devascularization group (121 cases). The clinical data of the patients before and after surgery, and the clinical efficacies between the two groups were compared and analyzed. Results: The free portal pressures (FPP) of the patients in both groups were decreased significantly after surgery (both P<0.05), and the FPP in selective devascularization group decreased more significantly than that of the combined devascularization group (P<0.05). Except for the Child-Pugh score, the other indexes that included the incidence of postoperative recurrent hemorrhage, hepatic encephalopathy, portal venous thrombosis and portal hypertensive gastorpathy as well as degree of gastroesophageal varices of the selective devascularization group were all better than those of the combined devascularization group (all P<0.05). Conclusion: Selective devascularization is an ideal surgical procedure for portal hypertension because it is of favourable efficacy with fewer complications.

Abstract:Objective: To investigate the efficacy of splenectomy for refractory idiopathic thrombocytopenic purpura (ITP) and its affecting factors. Methods: The clinical data of 62 patients with refractory ITP undergoing splenectomy over 15 years were reviewed, and the relations of the efficacy of splenectomy with age, gender, preoperative bleeding, preoperative response to hormone treatment, spleen enlargement, and platelet peak were analyzed. Results: Of the 62 patients, 34 were very effective cases, 13 were favorably effective cases, 10 cases were improved, and 5 cases were completely ineffective. The efficacy rate ( very effective cases plus favorably effective cases) was 75.8%. The efficacy of splenectomy was unrelated to gender and whether the spleen was enlarged (both P<0.05). However, the differences between the groups classified according to whether the patients had bleeding symptoms, age, postoperative platelet peak and bone marrow megakaryocyte count had statistical significance. Multivariate analysis indicated that preoperative hormone response and preoperative platelet count were the main factors affecting the efficacy of splenectomy for refractory ITP (both P<0.05). Conclusion: Preoperative hormone response and preoperative platelet count can be used as the prediction indexes for the efficacy of splenectomy in patients with refractory ITP.

Abstract:Objective: To analyze the clinicopathological characteristics and outcomes of gastric neuroendocrine neoplasms. Methods: The clinical and pathological data of 52 patients with gastric neuroendocrine neoplasms admitted to our hospital in recent 11 years were retrospectively analyzed. Results: There were 38 males and 12 females in the whole group, with average age of 54 years. According to the new WHO classification (2010) of neuroendocrine neoplasms, there were 19 cases of neuroendocrine tumor (NET) (12 cases of G1 and 7 cases of G2), 29 cases of neuroendocrine carcinoma (NEC) and 4 cases of mixed adenoneuroendocrine carcinoma (MANEC). The lesions of the patients were located on the cardia/fundus (n=31, 59.6%), corpus (n=11, 21.2%) and antrum (n=10, 19.2%) of the stomach, respectively. The main clinical manifestations were epigastric distension/discomfort and dysphagia. Fifty patients underwent surgical treatment. Among the NET patients, 5 cases underwent endoscopic excision, 3 cases underwent local full-thickness excision of the gastric wall and 11 cases underwent radical gastrectomy, and the postoperative pathology demonstrated that the lesions of 14 cases were confined to the mucosal or submucosal layer (73.7%), 4 cases had lymph node metastases (21.1%) and intravascular tumor thrombus occurred in 1 case (5.3%). Among the NEC and MANEC patients, 17 cases underwent open radical gastrectomy,13 cases underwent palliative surgical treatment and 1 case had a surgical exploration only, and the postoperative pathology showed that the lesions of 29 cases infiltrated or penetrated the serosal layer (96.7%), 27 cases had lymph node metastases (90%) and intravascular tumor thrombi were found in 16 cases (53.3%). The follow-up period ranged from 2 to 106 months. Of the 19 NET patients, 2 cases had local recurrence (10.5%), 3 cases had distant metastases (5.8%) and 2 cases died (10.5%), and the 1, 3, 5-year survival rate was 100%, 89% and 82%, respectively; of the 29 NEC patients, 1 case had local recurrence (3.4%), 25 cases had distant metastases (86.2%) and 21 cases died (72.4%), and the 1, 3, 5-year survival rate was 69%, 43% and 21%, respectively; of the 4 MANEC patients, distant metastases occurred in 3 cases and 3 cases died. Conclusion: The clinicopathological characteristics and prognosis of gastric neuroendocrine neoplasms vary considerably among different types. Most NETs are of early stage disease and have favorable therapeutic efficacy. However, NECs and MANECs are of a high degree of malignancy and invasiveness, and have a poor prognosis.

Abstract:Objective: To investigate the diagnosis and treatment of abdominal compartment syndrome (ACS) in critical surgical patients. Methods: The clinical data of 26 critical surgical patients with ACS undergoing surgical or non-surgical treatment in our hospital from April 2007 to December 2011 were retrospectively analyzed. The intra-abdominal pressure alteration of the patients before and after treatment and its relations with alterations of abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE II score were analyzed. The clinical efficacies of the two treatment modalities were compared, and the prognostic factors of the patients were also determined. Results: The intra-abdominal pressure of the patients decreased by either surgical or non-surgical approaches, meanwhile, the physiochemical indexes (abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE II score) of the patients were also improved (all P<0.05). The intra-abdominal pressure of the patients undergoing surgical treatment reduced more significantly than that of the patients undergoing non-surgical treatment (P=0.011). Intra-abdominal pressure level, high-sensitivity C-reactive protein level and APACHE II score were independent risk factors affecting the prognosis of patients. Conclusion: Surgical intervention should be performed aggressively to the critical surgical patients with ACS. Furthermore, the inflammatory response is an important factor affecting the prognosis of those patients.

Abstract:

Objective: To investigate the effects of enteral nutrition (EN) support on the recovery process and laboratory indexes of elderly patients after abdominal surgery. Methods: Two hundred and thirty-eight elderly patients undergoing abdominal surgery were randomly divided into EN group and parenteral nutrition (PN) group, and the nutrition support was continued for 7-9 days. Postoperative recovery process and complications of the patients were observed, and the laboratory indexes such as prealbumin (PA), albumin (ALB), globulin (GlO), hemoglobin (Hb) and lymphocyte count were detected before operation and before hospital discharge. Results: The time to flatus, to ambulation and to drainage tube removal, length of hospital stay after surgery and incidence of complications of EN group were reduced compared with PN group, and all differences had statistical significances (all P<0.05). PA, ALB, GLO, Hb and lymphocyte count of EN group were increased before hospital discharge compared with those before surgery, and all the indexes were significantly higher than those of PN group (all P<0.05). The incidence of postoperative complications of EN group was lower than that of the PN group, and the difference had statistical significance (χ2=8.279, P=0.004). Conclusion: For elderly patients undergoing abdominal surgery, EN support can effectively improve their nutrition status and immune function, as well as promote postoperative recovery and reduce complications.

Abstract:Chronic venous leg ulceration (CVLU) is a frequent complication of lower limb venous insufficiency. Many cases of CVLU, which are slow to heal and frequently recur, and finally develop into refractory ulcers, have become a difficult problem in clinical practice. This paper reviews the recent progress in the etiology of CVLU, and its staging and individualized treatment.

Abstract:Numerous experimental and clinical studies indicate that stem cell transplantation (SCT) may be a promising way for dealing with critical limb ischemia (CLI). This article reviews the indications of SCT for CLI, sources as well as methods for isolation of SCT, administration route, and evaluation of safety and efficacy.

Abstract:Budd-Chiari syndrome is a post-hepatic portal hypertension due to occlusion of the hepatic veins and/or the suprahepatic inferior vena cava (IVC), often accompanied with IVC syndrome. The causes of BCS are variable, and its clinical manifestations are also diverse. This paper reviews the current literature concerning the clinical manifestations, diagnosis and management of BCS, and endovascular and surgical treatment of this disease are highlighted.

Abstract:

The surgical treatment of portal hypertension has come a long way over the past century and currently, there are two relatively accepted procedures, namely, the shunt and devascularization operation. However, these two procedures have their own shortcomings, and limitations of applicability. The combined shunt and devascularization procedure for portal hypertension, which was originally proposed by Chinese scholars since the 1980s, has shown significant efficacy. This paper addresses the current status of surgical treatment of portal hypertension by combined shunt and devascularization procedure.

Abstract:Acute abdomen caused by connective tissue diseases (CTD) is rare in clinical practice, and can easily lead to misdiagnosis or missed diagnosis. This paper mainly addresses the manifestations, diagnosis and treatment of acute abdomen due to CTD, among which, those related to lupus erythematosus, polyarteritis nodosa and Behcet disease are highlighted.