Volume 29,Issue 12,2020 Table of Contents

1 Progress in endovascular treatment of aortic arch diseases

ZHANG Hongpeng , GUO Wei

2020, 29(12):1415-1419. DOI: 10.7659/j.issn.1005-6947.2020.12.001

[Abstract](337) [HTML](1268) [PDF 1.03 M](1248)

Abstract:
Aortic arch lesions mainly include aneurysm and dissection. Traditional open surgery requires thoracotomy and cardiopulmonary bypass, which is huge traumatic and has a high incidence of complications. Therefore, elderly patients or those with high surgical risks often cannot tolerate the operation. With its minimally invasive and effective advantages, the endovascular technique has become the first choice for the treatment of the descending thoracic aorta aneurysm or type B dissection. However, due to the characteristics of arch lesions near the heart, many important branch vessels, and fast blood flow, endovascular treatment still faces many challenges. At present, some endovascular treatment techniques applied to the aortic arch are off-label use and the long-term efficacy is not clear. The branched endovascular arch repair technique is more in line with the normal anatomical structure and blood flow state of the human body. It usually does not require brain protection measures. Therefore, it is a hot research direction of scholars at home and abroad.

2 Technical evaluation of reconstruction of visceral vessel branches in complex abdominal aortic aneurysm

DIAO Yongpeng , LI Yongjun

2020, 29(12):1420-1425. DOI: 10.7659/j.issn.1005-6947.2020.12.002

[Abstract](447) [HTML](954) [PDF 581.46 K](1255)

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With the development of endovascular treatment and interventional instruments, endovascular aneurysm repair has become the preferred method for the treatment of abdominal aortic aneurysms. Poor proximal landing zone and abdominal aortic aneurysms involving visceral branch arteries are the main factors restricting the application and affecting the efficacy of this technique. The techniques such as parallel, fenestrated, branched and multi-layered flow-modulating stent grafts and aortic debranching are the main methods for the revascularization of visceral branch arteries at present. Here, the authors briefly discuss above techniques based on relevant research results, so as to provide recommendations for the endovascular treatment of complex abdominal aortic aneurysms.

3 Application of self-radiopaque markers guiding physician-modified fenestration in aortic arch endovascular repair: an international multi-center retrospective analysis of 113 cases

SHU Chang , , LI Xin , LI Quanming , HE Hao , LI Ming , WANG Tun , YANG Chenzi , WANG Mo , ZHOU Haiyang , José Fernando Teixeira , Suko Adiarto , Tao Fan , Bogdan Cherpark , Imaev Timur , Makhkamov Najmiddin , Pavel Charnahlaz , Giorgi Kheladze

2020, 29(12):1426-1434. DOI: 10.7659/j.issn.1005-6947.2020.12.003

[Abstract](919) [HTML](1281) [PDF 1.49 M](1379)

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Background and Aims: Thoracic endovascular aortic repair (TEVAR) has already become the “first-line” treatment for descending aorta pathologies. For lesions involving the aortic arch, physician modified fenestration (PMF) is one of the frequently used techniques for reconstruction of the branch arteries of the aortic arch at present, which refers that the artificial fenestrations are created by removing the membrane of the aortic stent-graft to correspond with the locations of branch arteries after selection of the proper aortic covered stent, and branch vessel stents are deployed through the fenestration-bearing stent in the large artery after it is accurately positioned. This article introduces a PMF method for fast and accurate positioning of the fenestrations corresponding to the branch vessels using the self-contained radiopaque markers of the aortic stent-graft—self-radiopaque marker guiding PMF (S-F PMF), and meanwhile to investigate the technical characteristics and clinical value of using S-F PMF in endovascular treatment of aortic arch pathologies by analyzing the clinical, surgical and follow-up data of a cohort of patients who underwent TEVAR with S-F PMF.
Methods: The general clinical information, intraoperative technical data and follow-up results of 113 patients with aortic arch diseases who underwent the TEVAR using S-F PMF in the Second Xinagya Hospital of Central South University in China's Hunan province and other state-level cardiovascular centers from 7 different countries during December 2015 to June 2020 were retrospectively analyzed.
Results: The standard S-F PMF TEVAR procedure was performed in all patients, and the instant success rate of the maneuver was 100%. A total of 118 aortic stent-grafts were implanted in these patients with bridging stents implanted in 35 cases. The operative time was (62.9±17.4) min, time for X-ray procedure was (23.1±9.8) min, the volume of contrast agent used was (81.2±22.5) mL. The accurate positioning rate of fenestration was 98.2%. A bailout stent-graft insertion was performed by chimney technique in one case (0.9%), and a malpositioned opening was successfully corrected in one case (0.9%). Two patients (1.8%) had successful fenestration for simultaneous preservation of the three supra-arch branch arteries, 6 patients (5.3%) had fenestration for simultaneous preservation of the left command carotid artery (LCCA) and the left subclavian artery (LSA), and the LAS was preserved in 110 patients (97.3%). There is no death and serious complications occurred within 30 d after TEVAR. Type I endoleak was noticed in 7 patients (6.2%). The median follow-up time was 24.5 months. death occurred in 2 patients (1.8%), and occlusion of the branch arteries occurred in 3 patients (2.7%) in postoperative 3 months (2 cases) and 6 months (1 case).
Conclusion: The S-F PMF is an alternative method for reconstruction of supra-arch branches in the treatment of lesion involving the aortic arch. It is a technical progress in methods of total endovascular reconstruction of aortic arch.

4 Application of individualized extracorporeal circulation combined with in-situ needle fenestration technique in endovascular repair of aortic arch lesions

WEI Lichun , ZHENG Zhiyong , SU Yiming , XU Taifu , ZHANG Ke , LUO Changzhi , HOU Peiyong

2020, 29(12):1435-1444. DOI: 10.7659/j.issn.1005-6947.2020.12.004

[Abstract](282) [HTML](1016) [PDF 3.11 M](1142)

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Background and Aims: The treatment of aortic arch lesions is a difficult problem to be solved in clinical practice. The technology of complete endovascular repair is the important research direction of this condition. Because of the diversity and complexity of the local anatomical morphology of aortic arch lesions, reconstruction of the supra-arch vessels with effective cerebral circulatory protection is still a major challenge. This study was conducted to investigate the efficacy and safety of the application of selective establishment of individualized extracorporeal circulation mode combined with technique of in-situ needle fenestration in endovascular repair of aortic arch lesions, so as to provide certain reference and new research strategies for the treatment of this condition.
Methods: The clinical data of 8 patients with aortic lesions involving the arch (3 cases of Stanford type A aortic dissection, 3 cases of aortic arch aneurysm, and 2 cases of aortic arch penetrating ulcer) treated from January 2018 to June 2019 were retrospectively analyzed. According to the preoperative transcranial Doppler ultrasound (the anterior and posterior cerebral communicating arteries and arterial circle of Willis as well as the dominance of bilateral vertebral arteries), the selective application of right femoral vein-right axillary artery and left common carotid artery with (or without) left axillary artery diversion mode was determined to establish the individualized extra-cardiopulmonary bypass for intraoperative cerebral protection. According to the basic cerebral blood flow chart, the flow and pressure of extracorporeal circulation were reasonably and accurately controlled. After the release of the thoracic aortic covered stent, the supra-arch branches were reconstructed by endovascular in-situ needle fenestration followed by balloon dilation of the hole and then Viabahn covered stent insertion. CTA of the aorta was performed 3, 6, 12 and 24 months after operation for follow-up.
Results: Operations were successfully performed in all patients, and no surgical death occurred. The total of 14 Gore TAG thoracic aortic covered stents and 19 Gore Viabahn covered stents were implanted. Three branches were fenestrated in 3 cases and two branches were fenestrated in 5 cases during operation. In the whole group of patients, the operative time was 180–360 min, with an average of (240±30) min, the time for fenestration was 18–55 min, with an average of (35±5) min, and the intraoperative blood loss was 300–800 mL, with an average of (400±50) mL. The length of postoperative ICU stay was 2–5 d, with an average of 2.5 d. Mild lacunar cerebral infarction occurred in one case after surgery, and was recovered after symptomatic treatment with anticoagulation and improvement of cerebral circulation. All the 8 patients were discharged from hospital 5–10 d after operation. The follow-up period was 6–24 months. CTA showed that the aneurysmal sacs and tears of dissection and ulcers were satisfactorily occluded, and thrombus organization and remodeling were seen in the aneurysmal sacs and false lumens.
Conclusion: Individualized extracorporeal circulation mode combined with in-situ needle fenestration and branch reconstruction is a feasible, effective and safe as well as minimally invasive method for the treatment of aortic arch lesions, with the advantages of definite brain protection, accurate and rapid fenestration, fast postoperative recovery and fewer complications. Its short-term efficacy is excellent and long-term efficacy needs to be clarified by further followed-up observations.

5 Efficacy analysis of surgical resection of carotid body tumor without preoperative embolization: a report of 65 cases in a single center

WANG Haohua , YANG Bin , ZHANG Chenglei

2020, 29(12):1445-1452. DOI: 10.7659/j.issn.1005-6947.2020.12.005

[Abstract](178) [HTML](885) [PDF 3.47 M](1084)

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Background and Aims: Carotid body tumor (CBT) is a very rare disease in clinical practice, and surgery is the gold standard for the treatment of CBT. As the blood supply of this lesion is extremely abundant, whether or not to employ preoperative embolization is controversial. Proponents of preoperative embolization believe that it reduces intraoperative blood loss, while opponents worry that the costs and risk of stroke outweigh the benefits. This paper summarizes the surgical treatment experience and postoperative follow-up results of CBT in our hospital without preoperative embolization, so as to provide data reference for the safety of surgical resection of the tumor without preoperative embolization.
Methods: The clinical and follow-up data of 65 patients with CBT undergoing surgical treatment in the Department of Vascular Surgery, the First Affiliated Hospital of Kunming Medical University from January 2017 to January 2020 were retrospectively analyzed (in the two patients with bilateral CBT, the data of the side undergoing the first surgery were selected). The size of the mass was 1.0 cm×0.5 cm×1.0 cm–8.0 cm×6.5 cm×8.5 cm. According to the Shamblin classification, 13 patients had type I lesion, 33 patients had type II lesion, and 19 patients type III lesion.
Results: Surgical resection was successfully performed in all the 65 cases, including simple tumor resection in 51 cases (78.46%), tumor resection combined with external carotid artery ligation was performed in 8 cases (12.31%) and tumor resection combined with external and internal carotid artery resection plus internal carotid artery reconstruction in 6 cases (9.23%). Lymph node dissection was performed in those with lymph nodes found in the operating field during operation. The intraoperative blood loss was 10–1 800 mL, with an average of 247 mL. A second elective surgery for the contralateral lesion was recommended to the two patients with bilateral lesions. Pathological examination revealed that all lesions were carotid paraganglioma. Perioperative death occurred in one patient (1.54%) after the occurrence of postoperative cerebral infarction. After operation, 14 patients (21.54%) had signs of vagus nerve damage, such as voice hoarse and choking when drinking water, 5 patients (7.69%) had symptoms of hypoglossal nerve injury, presented as tongue deflection and swallowing problems. Internal carotid artery occlusion was found in 2 patients (3.08%) with type III CBT undergoing internal carotid artery reconstruction during postoperative follow-up.
Conclusion: Surgical treatment should be the first choice after the diagnosis of CBT. Resection of the tumor without preoperative embolization is safe and effective.

6 Mini-laparotomy retrograde recanalization by transmesenteric puncture under ultrasound guidance for total ostial occlusion of the superior mesenteric artery

CHEN Yihui , HONG Xiang , FU Weiguo , WANG Lixin , LU Weifeng , HONG Shichai , HUANG Yulong , CHEN Gang

2020, 29(12):1453-1459. DOI: 10.7659/j.issn.1005-6947.2020.12.006

[Abstract](438) [HTML](923) [PDF 2.83 M](1226)

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Background and Aims: For patients with superior mesenteric artery (SMA) occlusion, especially those with no obvious stump due to atherosclerotic occlusion of the orifice, retrograde open mesenteric stenting (ROMS) is an effective treatment method. However, the surgical trauma of this procedure is relatively large, so it may not be feasible in some patients with poor physical status. Here, the authors present a surgical technique of modified minimally invasive ROMS through reporting the treatment process for a case with total SMA occlusion, so as to provide a treatment option for some clinical situations.
Methods: The clinical data of a patient with total SMA occlusion treated in October 2019 in the Department of Vascular Surgery of Xiamen Branch, Zhongshan Hospital, Fudan University were reviewed. The patient was a 64-year-old woman, was diagnosed as chronic mesenteric ischemia caused by SMA occlusion, and then underwent hybrid procedures for SMA recanalization.
Results: The patient had a flush ostial SMA occlusion without stump, and also no collateral vessels connecting the celiac artery and splenic artery were observed, so either antegrade or retrograde total endovascular revascularization attempt failed. In addition, the patient was unlikely to tolerate an open revascularization procedure or the traditional ROMS due to poor general condition. Then, a mini-laparotomy was made and a pathway to the distal portion of the SMA was created by transmesenteric puncture under ultrasound guidance. A retrograde guidewire successfully passed the occlusion of the SMA and was advanced into the descending aorta. An antegrade catheter from the right brachial artery access was successfully passed the occlusion of the SMA after engaging with the retrograde guidewire. After that, balloon predilation and stenting were performed. The patient recovered uneventfully after operation, with total alleviation of symptoms. The follow-up CTA on 3 months after operation demonstrated undeformed shape and accurate position of the stent as well as excellent patency of the vessel.
Conclusion: For patients with the SMA total occlusion and poor general condition following failed endovascular intervention, mini-laparotomy retrograde recanalization by transmesenteric puncture under ultrasound guidance is a feasible strategy.

7 Application of prosthetic arteriovenous grafts in lower extremity and its mid- and long-term efficaccy

PENG Jiaxin , WAN Heng

2020, 29(12):1460-1467. DOI: 10.7659/j.issn.1005-6947.2020.12.007

[Abstract](449) [HTML](1333) [PDF 1.35 M](1313)

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Background and Aims: End stage renal disease (ESRD) is the final stage of the progression of chronic kidney disease caused by various etiologies. Most patients with ESRD choose hemodialysis as a renal replacement therapy, for which maintaining the good function and satisfactory patency of the vascular access is extraordinarily critical. The upper extremity is the first choice for patients to construct hemodialysis access. However, some patients with problems such as exhaustion of upper extremity vascular or central venous resources due to various reasons, are unsuitable for upper limb vascular access creation. Therefore, creation of a lower extremity arteriovenous grafts (AVG) can be considered as a long-term hemodialysis access for patients. This study was conducted to review the clinical data and follow-up results of patients with AVG creation in lower extremity, so as to provide empirical evidence for this field.
Methods: The clinical and follow-up data of 32 ESRD patients undergoing construction of lower extremity AVG in Nanfang Hospital of Southern Medical University from March 2014 to November 2018 were reviewed. The relevant clinical variables of the patients were analyzed, and the postoperative primary and secondary patency rates were determined by Kaplan-Meier method.
Results: AVG tremor was palpable in all patients after the operation. One patient developed an acute attack of chronic cardiac insufficiency during the perioperative period, and then died due to no obvious improvement after drug administration and intensive dialysis treatment. Two patients developed graft thrombosis, and underwent incision of the catheter and thrombus removal. After that, no stenosis in the anastomotic stoma or in the outflow venous was observed in the angiography. The patency of the AVG was resumed and the dialysis was maintained. During the perioperative period, no complications such as infection, hemodialysis access-induced distal ischemia (HAIDI), or pseudoaneurysm occurred in all patients. Postoperative follow-up was conducted for 1 month to 6 months, with a median time of 14.1 months. During the follow-up period, AVG stenosis occurred in 13 patients (40.6%), and AVG occlusion occurred in 10 patients (31.3%), and AVG patency was restored after surgical or endovascular repair. Prosthetic vascular graft infection occurred in 3 patients (9.4%), of whom, one case had a local graft infection, and AVG was successfully retained for dialysis after removal of the infected part and transplantation of autologous vein; 2 patients underwent completely resection of the graft due to whole graft infection. No complications such as pseudoaneurysm and HAIDI occurred during this period. The average primary patency time was (20.4±3.32) months, and the 1-, 2- and 3-year primary patency rates were 64.6%, 44.7% and 19.6%, respectively. The average secondary patency time was (38.7±5.52) months, and the 1-, 2- and 3-year secondary patency rates were79.6%,79.6% and 54.6%, respectively.
Conclusion: The lower extremity AVG can achieve a satisfactory secondary patency rate after repairment, and is a feasible alternative for patients with exhausted options for creating an upper extremity vascular access. Standard preoperative evaluation, strict aseptic operating during surgery and puncture, and regular follow-up are important factors to ensure long-term patency.

8 Safety and feasibility of laparoscopic retrieval of inferior vena cava filters

WANG Haidong , LIU Jianlong , ZHU Xiaofei , WANG Hai , LI Guizhong , ZHOU Ning , JIA Wei , JIANG Peng , MAN Libo

2020, 29(12):1468-1474. DOI: 10.7659/j.issn.1005-6947.2020.12.008

[Abstract](609) [HTML](1022) [PDF 2.33 M](1203)

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Background and Aims: Since the authors’ hospital initially conducted laparoscopic retrieval of inferior vena cava (IVC) filters in 2016, a number of cases of this operation have been performed. The aim of this article is to summarize the surgical experience of two approaches (transperitoneal approach and retroperitoneal approach) of laparoscopic retrieval of IVC filters by analyzing the clinical data of 10 patients undergoing this operation, so as to provide a reference for its popularization and promotion.
Methods: The clinical data of 10 patients undergoing laparoscopic retrieval of IVC filters during December 2016 and November 2018 were retrospectively analyzed. Among these patients, 7 were males and 3 were females, aged from 24 to 66 years, with an average age of (47±12.5) years. CT findings were that the head of the IVC filter dislocated above the renal vein in 1 case, at the renal vein level in 4 cases, and inferior to renal vein in 5 cases; the head of the IVC filter located close to the anterior or anterior lateral wall of the IVC in 5 cases, posterior lateral wall of the IVC in 4 cases, and in the lumen of the IVC in 1 case. All IVC filters were retrievable filters, including Celect filter used in 9 cases, and Denali filter in 1 case. All filters were inserted in others hospital. Seven patients underwent prophylactic placement of IVC filters due to iliac and lower extremity venous thrombosis, one case underwent prophylactic placement of IVC filters due to multiple traumatic rib and pelvis fractures, and IVC filter placement for 2 patients was in the setting of acute pulmonary embolism due to deep venous thrombosis. All patients were transferred to our hospital after previous endovascular retrieval failure for 1-3 times in other hospitals. All the 10 patients underwent laparoscopic IVC filter retrieval through transperitoneal approach in 6 cases and through retroperitoneal approach in 4 cases. Using a standard 3-port or 4-port technique, the IVC was dissected, the location of filter hook was found according to CT scan, a longitudinal incision in the wall of the IVC over the filter hook was made, and the filter was then retrieved. After operation, the volume and color of drainage were checked carefully. If the 24-h drainage volume was less than 50 mL for transperitoneal approach or less than 20 mL for retroperitoneal approach, the tube could be removed. Patients were given subcutaneous heparin 24 to 48 h after operation depending on surgical drainage for prevention of lower extremity deep venous thrombosis. Patients were started on a liquid diet the following day after operation, then slowly return to a normal diet and were encouraged to ambulate as much as tolerable.
Results: IVC filter retrieval was successfully performed in 9 cases, and failed in one case. IVC occlusion was performed in one patient for 20 min, and was not required in other patients. the operative time was 150–420 min, with an average time of (253.5±86.7) min, the blood loss was 10–500 mL, with an average of (67.0±152.6) mL, 9 patients did not need a blood transfusion small for amounts of blood loss (10–50 mL), and one patient blood loss of 500 mL was transfused with 4 U of red blood cell suspension. The length of hospital stay was 7-15 d, with an average of (12.3±2.4) d. No operation-related complications occurred in all patients. No deep venous thrombosis recurred during the follow-up period.
Conclusion: Laparoscopic retrieval of IVC filters is a complex and technically demanding operation. Careful preoperative preparation, rich operative experiences and proficient skills might improve the safety and success rate of the operation. According to CT scan and hook location of each patient, choosing different laparoscopic retrieval technique is important for improving the success rates.

9 Meta-analysis for assessing the application of transjugular intrahepatic portosystemic shunt in patients with cavernous transformation of the portal vein

ZHANG Yuxin , LIAO Yang , ZHAO Chenghui

2020, 29(12):1475-1486. DOI: 10.7659/j.issn.1005-6947.2020.12.009

[Abstract](411) [HTML](1025) [PDF 1.27 M](1040)

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Background and Aims: The common treatment methods for cavernous transformation of the portal vein (CTPV) include medical treatment and surgery, while interventional surgery is not usually used in this field, and this disease has long been considered to be a contraindication for transjugular intrahepatic portosystemic stent-shunt (TIPSS). With the improvement of technology and the upgrading of relevant operating devices in recent years, TIPSS is increasingly carried on in CTPV patients. However, the implementation of TIPSS for CTPV patients is not widespread at present, and it is only conducted in some vascular intervention centers with extensive experience. Meanwhile, there is also a lack of evidence-based data to prove its application value. This study was conducted to evaluate the feasibility, efficacy and safety of application of TIPSS in CTPV patient through a Meta-analysis, so as to obtain evidence-based information for clinical decision-making.
Methods: The relevant literature was collected by searching a number of national and international database. The retrieval time was limited from the inception of each database to February 2020. After extraction of the relevant data, the success rate of surgery, the incidence of major complications, porto-systemic pressure gradient (PPG) before and after surgery, postoperative rebleeding rate, incidence of postoperative hepatic encephalopathy, 12-month stent patency rate and 12-month survival rate were recorded as clinical outcome parameters. Meta-analysis of the data was performed by RevMan 5.1 software. Stata 14 software was used for quantitative analysis of publication bias detection.
Results: Nine studies were included based on inclusion and exclusion criteria, involving a total of 188 CTPV patients who underwent TIPSS treatment. The pooled results of Meta-analysis showed that operation success rate was 77% (95% CI=63%–87%, I2=67%, P=0.000 5), the incidence of major surgical complications was 22% (95% CI=11%–40%, I2=59%, P=0.004), the PPG was significantly reduced after operation (WMD=13.19, 95% CI=11.86–14.52, I2=58%, P<0.000 01), the rebleeding rate was 12% (95% CI=7%–21%, I2=0%, P<0.000 01), the incidence of postoperative hepatic encephalopathy was 17% (95% CI=11%–25%, I2=0%, P<0.000 01), the 12-month patency rate of stent was 81% (95% CI=73%–86%, I2=0%, P<0.000 01), and the 12-month survival rate was 89% (95% CI=81%–94%, I2=16%, P<0.000 01).
Conclusion: TIPSS is feasible, effective and safe in CTPV patients. However, the successful implementation of this technique cannot be achieved without relevant experience and specialized skills of the surgeon. It is also necessary to fully evaluate and weigh the risks and advantages of the operation based on the relevant preoperative examinations and the patient's condition, strict consideration of indications, and appropriate treatment plan making, so as to maximize the benefits of the target patient group. It is expected that TIPSS treatment will become a routine treatment for suitable CTPV patients, and a relatively unified consensus and operating standards will be reached in the future. At present stage, more large sample, multicenter randomized controlled trials are urgently needed to fully compare various factors to guide clinical decision-making in this field.

10 Comparison of efficacy and safety of dose-dense anthracycline followed by paclitaxel liposome and anthracycline followed by docetaxel in neoadjuvant chemotherapy for locally advanced HER-2 negative breast cancer

XIAO Zhi , LUO Shayang , MAO Jie , HAI Jian ,

2020, 29(12):1487-1493. DOI: 10.7659/j.issn.1005-6947.2020.12.010

[Abstract](353) [HTML](1228) [PDF 502.77 K](1135)

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Background and Aims: Dose-dense neoadjuvant chemotherapy is increasingly used in locally advanced breast cancer. However, there are few studies of using paclitaxel liposome in dose-dense neoadjuvant chemotherapy. Therefore, this study was conducted to compare the safety and efficacy of dose-dense anthracycline followed by paclitaxel liposome regimen and anthracycline followed by docetaxel regimen for neoadjuvant chemotherapy in patients with locally advanced HER-2 negative breast cancer.
Methods: The clinical data of patients with resectable locally advanced HER-2 negative breast cancer treated from January 2017 to December 2018 were retrospectively collected. All patients received 8 cycles of neoadjuvant chemotherapy. There are 196 cases received anthracycline followed by docetaxel regimen (docetaxel group), and 48 cases received dose-dense anthracycline followed by paclitaxel liposome regimen (paclitaxel liposome group). After the baseline characteristics between two groups were adjusted using 1:1 propensity score matching (PSM) approach, the pathological completed response (pCR) and clinical efficacy as well as the incidence of adverse were compared between the two groups of patients.
Results: There were 48 patients in each group after a 1:1 PSM analysis. There was no significant difference in pCR rates between the two groups (22.9% vs. 18.8%, P>0.05); the objective response rate (ORR) and disease control rate (DCR) were 93.7% and 100.0% in docetaxel group, and both ORR and DCR were 100.0% in paclitaxel liposome group, which showed no statistical differences between the two groups (P>0.05). The incidence rates of grade III-IV leucopenia and neutropenia, as well as the incidence rates of nausea, vomiting, fatigue and oral mucositis in docetaxel group were significantly higher than those in paclitaxel liposome group (all P<0.05), but no significant differences were noted in incidence rates of other adverse reactions between the two groups (all P>0.05).
Conclusion: Anthracycline followed by docetaxel regimen and dose-dense anthracycline followed by paclitaxel liposome regimen have similar efficacy in neoadjuvant chemotherapy for locally advanced HER-2 negative breast cancer. The safety of dose-dense anthrancycline followed by paclitaxel liposome regimen is obviously superior to that of anthrancycline followed by docetaxel regimen. Paclitaxel liposome can be used as a first choice of paclitaxel options in neoadjuvant chemotherapy regimen for HER-2 negative breast cancer.

11 Application of laparoscopic trasanal total mesorectal excision combined with modified Bacon’s operation in anus-preserving treatment of low rectal cancer

LUO Henggui , TANG Bin , MAO Yuefeng , OUYANG Jun , CHEN Wei , WANG Li , LI Shaojie , ZHANG Quanan , GUO Jin , CAO Shenghui , ZHENG Kankan , ZHANG Xiaoling , LIN Hui , ZHANG Shuixiang

2020, 29(12):1494-1502. DOI: 10.7659/j.issn.1005-6947.2020.12.011

[Abstract](614) [HTML](1117) [PDF 1.18 M](1328)

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Background and Aims: With the concept of total mesorectal excision (TME), the establishment of 2-cm distal margin rule, the application of stapler, and the development of intersphincteric resection (ISR) and other techniques, the anus-preserving rate of low rectal cancer has significantly increased. However, in "difficult pelvis" such as male, obesity, prostatic hypertrophy, post-radiotherapy, pelvic stenosis patients, achieving both goals of radical resection and anal preservation at the same time is still a big challenge. In recent years, the "bottom-up" laparoscopic transanal total mesorectal excision (TaTME) has emerged, and become a hot spot in the treatment of low rectal cancer. However, with the generalization of TaTME, anastomotic complications have remarkably increased. Therefore, how to improve the anastomotic technique and methods becomes the essential solution for reducing the anastomotic leakage after TaTME. This study was conducted to evaluate the effect and safety of TaTME combined with modified Bacon’s operation (pull-through procedure) in anus-preserving treatment of low rectal cancer.
Methods: The clinical data of 62 patients with low rectal cancer who underwent TaTME from October 2016 to March 2019 were retrospectively analyzed. Of the patients, 32 cases underwent combined modified Bacon’s operation (observation group), and the other 30 cases underwent routine coloanal/rectal anastomosis. The relevant postoperative clinical variables were compared between the two groups of patients.
Results: There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, length of specimen, length of distal margin, number of lymph node dissection, rate of positive circumferential resection margin, time to postoperative feeding, and time to ambulation (all P>0.05). The length of hospital stay in observation group was significantly longer than that in control group (10.33 d vs. 22.22 d, P<0.001). There was no significant difference in the incidence of sexual dysfunction, voiding dysfunction, and perianal infection between the two groups (all P>0.05). The incidence of anastomotic leakage in observation group was significantly lower than that in control group (0 vs. 16.7%, P=0.022); anastomotic stenosis occurred in 1 case (3.1%) in observation group and 4 cases (13.3%) in control group, which had no significant difference (P=0.189). There were no significant differences in Xu Zhongfa scores and Wexner scores 7 months and 12 months after operation between the two groups (all P>0.05).
Conclusion: TaTME combined with modified Bacon’s operation has the advantages of two procedures, which not only guarantees the distal margin and circumferential resection margin of radical tumor resection, but also reduces the occurrence of anastomotic leakage, and its influence on anal function is not greater than that that of direct anastomosis. Its disadvantage is prolonged hospital stay. It is an appropriate alternative operation for low rectal cancer.

12 Research progress of animal models of thoracic aorta dissection

YANG Jun , WU Guangmin , FU Pinting , GUO Yuanyuan

2020, 29(12):1503-1508. DOI: 10.7659/j.issn.1005-6947.2020.12.012

[Abstract](309) [HTML](967) [PDF 1.97 M](1316)

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Aortic dissection (AD), especially the thoracic aortic dissection (TAD), is a complex and fatal disease. At present, the knowledge and treatment of AD are still under continuous development, and both theory and practice need to be developed by translational studies in animal models. As a result, various models have emerged, which are complementary and supplementary to each other. The creation of an ideal animal model firstly requires overall understanding of the advantages and limitations of each model, and then integrating the superiorities of each model, so as to achieve the purpose of the experiment. The small animal models of TAD are induced mainly by chemical induction or genetic modification, while the large -animal models of TAD are created mainly by surgical procedure or endovascular approach. Here, the authors present a brief overview on above modeling methods of the TAD animal models.

13 Recent advances in relationship between inflammatory reactions and clinical outcomes of aortic dissection

ZHU Hongqiao , LI Yiming , ZHOU Jian , JING Zaiping

2020, 29(12):1509-1514. DOI: 10.7659/j.issn.1005-6947.2020.12.013

[Abstract](270) [HTML](960) [PDF 1.03 M](1366)

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Aortic dissection (AD), also known as aortic dissecting aneurysm, is characterized by sudden and severe onset and high mortality. In recent years, studies involving changes in inflammatory variables throughout the longitudinal course of AD have suggested that inflammation is closely related to the clinical outcomes of AD, and therefore has a great significance. Here, the authors address the research progress about the association of the characteristics of the time-course of inflammatory response in AD and inflammatory response markers with the clinical outcomes of AD, as well as the connection of inflammatory responses to the aortic wall remodeling after a review of the current literature concerning the relationship between AD and inflammation, so as to provide a basis for implementing inflammation intervention strategies in clinical practice.

14 Advances in animal models of deep vein thrombosis

LUO Dan , ZHANG Li , QIN Xiaohui , ZHANG Chunxia

2020, 29(12):1515-1520. DOI: 10.7659/j.issn.1005-6947.2020.12.014

[Abstract](464) [HTML](1126) [PDF 1.05 M](1299)

Abstract:
Deep venous thrombosis (DVT) is a venous reflux disorder caused by abnormal coagulation of blood in the deep veins, and often occurs in the lower extremities, characterized by a high incidence rate, high disability rate and high recurrence rate as well as insidious clinical manifestations. The disease itself and complications can significantly affect the patients’ quality of life, increase the economic burden, and also increase the social medical risk and consumption. At present, the main treatment methods include thrombolysis, anticoagulation and surgical thrombectomy, which are designated to control the disease, delay its progress and promote the recanalization of deep vein lumen. The pathogenesis of DVT is complex, and there are still many unsolved problems regarding its pathological and treatment mechanism, especially the mechanism of drug therapy needs to be solved by establishing a targeted animal model of DVT. There are many animals and methods for DVT modeling, each of which has its own advantages and disadvantages. Thus, a comprehensive comparison should be made, so as to select the most appropriate modeling method for different research purposes.

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Volume 29,Issue 12,2020 Table of Contents

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