Volume 29,Issue 6,2020 Table of Contents

1 Proximal landing zone requirements in complex abdominal aortic aneurysms and evaluation of different techniques

GUO Wei , HE Yuan

2020, 29(6):645-648. DOI: 10.7659/j.issn.1005-6947.2020.06.001

[Abstract](267) [HTML](999) [PDF 1.04 M](1056)

Abstract:
With the rapid development of endovascular treatment and interventional instruments in recent years, endovascular aneurysm repair has gradually replaced traditional open surgery and has become the preferred method for the treatment of abdominal aortic aneurysms. However, the poor proximal landing zone is still the main factor restricting the application of endovascular aneurysm repair. Here, the authors briefly discuss the proximal landing zone requirements in complex abdominal aortic aneurysms and the relevant clinical evidences by combining the introduction of the "chimney stent-graft", "fenestrated stent" and "multi-branch stent-graft" techniques, so as to provide recommendations for the treatment of complex abdominal aortic aneurysms.

2 Current status of diagnosis and treatment of abdominal aortic dissection

WANG Tun , SHU Chang ,

2020, 29(6):649-653. DOI: 10.7659/j.issn.1005-6947.2020.06.002

[Abstract](792) [HTML](1972) [PDF 1.02 M](1264)

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Abdominal aortic dissection (AAD) is a rare and severe aortic disease that usually occurs in men and is closely associated with smoking, hypertension and hyperlipidemia. The clinical manifestations are diverse or even absent, which may easily lead to misdiagnosis, missed diagnosis and delayed treatment. Enhanced CT is the first choice for the diagnosis of AAD. Conservative treatment to control the blood pressure and heart rate combined with imaging follow-up is the most common initial treatment. When AAD progresses and has surgical indication, surgery treatment should be performed actively. Endovascular aortic repair (EVAR) is the first surgical choice. Open surgery is often used in patients with anatomic conditions that are not suitable for EVAR. A detailed preoperative evaluation and an appropriate operation plan are essential for the success of EVAR.

3 Advances in management of infected abdominal aortic aneurysm

LIN Changpo , FU Weiguo

2020, 29(6):654-658. DOI: 10.7659/j.issn.1005-6947.2020.06.003

[Abstract](699) [HTML](1126) [PDF 1.10 M](1023)

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Infected abdominal aortic aneurysm (IAAA) is a special type of aneurysm caused by infection of various pathogenic bacteria. IAAA is characterized by acute onset, rapid progression, high risk of aneurysmal rupture and dismal clinical prognosis. So, early diagnosis and treatment of this condition are extremely critical. Diagnosis can be made based on typical medical history, laboratory tests, CTA images, intraoperative findings, positive results of blood culture or tissue culture. After diagnosis, surgical treatment should be performed as soon as possible on the basis of adequate antibiotic therapy. However, there is no agreement on specific antibiotic treatment options and surgical options so far. It is currently recommended to use antibiotics for at least 6 months after surgery. With the development of minimally invasive techniques, the proportion of IAAA treated by endovascular repair has been increasing with favorable short-term results. Endovascular therapy is expected to be the first choice of options for IAAA in the future.

4 Progress in diagnosis and treatment of infected abdominal aortic aneurysm

CHEN Xiyang , ZHAO Jichun

2020, 29(6):659-663. DOI: 10.7659/j.issn.1005-6947.2020.06.004

[Abstract](382) [HTML](1002) [PDF 1.06 M](924)

Abstract:
Infected abdominal aortic aneurysm (IAAA) is a particularly challenging condition in the field of vascular surgery. It is resulted from the infection of the abdominal aorta directly or indirectly caused by pathogenic microorganism, characterized by rapid development, high risk of rupture, high mortality and poor prognosis. The treatment of IAAA currently is performed by means of endovascular aortic repair or surgical procedure on the basis of full course of antibiotic therapy. Here, the authors address the current experiences and advances in diagnosis and treatment of IAAA in China and abroad, so as to provide reference for optimum individualized therapy of the patients.

5 Clinical follow-up of small abdominal aortic aneurysms: current status and outlook

ZUO Jian , LI Zilin

2020, 29(6):664-670. DOI: 10.7659/j.issn.1005-6947.2020.06.005

[Abstract](253) [HTML](1265) [PDF 1.10 M](1020)

Abstract:
The small abdominal aortic aneurysm is defined as an abdominal aortic aneurysm with a maximal diameter of 30-54 mm. Most patients are asymptomatic and have a low risk of rupture. However, there are still cases of small abdominal aortic aneurysm rupture in clinical practice. Once the aneurysm ruptures, the mortality rate is very high. Meanwhile, the proportion of surgical intervention during follow-up was also considerably high. At present, there are no established treatment strategies targeting the pathogenesis. So, how to carry out an adequate clinical follow-up, prediction of the risk of rupture, and timely prosthetic vessel replacement or endovascular graft exclusion are particularly important. In this paper, the authors describe the current status of clinical follow-up of abdominal aortic aneurysm and how to accurately predict the risk of rupture.

6 Clinical analysis of total laparoscopic-assisted retrieval of wall-penetrating conical filters

JIA Wei , LIU Jianlong , TIAN Xuan , JIANG Peng , CHENG Zhiyuan , ZHANG Yunxin , LI Jinyong

2020, 29(6):671-676. DOI: 10.7659/j.issn.1005-6947.2020.06.006

[Abstract](347) [HTML](946) [PDF 1.63 M](1065)

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Background and Aims: Conical filters are commonly used retrievable inferior vena cava filters in recent years. However, the filter tilting and retrieval hook embedded in or penetrating through the caval wall may possibly occur, which cause the failure of filter retrieval by routine interventional method and even the occurrence of severe complications. Therefore, this study was designated to investigate the safety and efficacy of total laparoscopic-assisted removal of conical filter with retrieval hook penetrating the wall of the inferior vena cava, so as to provide the treatment strategies and methods in clinical practice.
Methods: The clinical data of 15 patients with implantation of conical inferior vena cava filter admitted from December 2016 to November 2019 were retrospectively analyzed. Of these patients, the average age was (47.7±13.3) years; 12 cases (80%) were males and 3 cases (20%) were females; 12 cases (80%) had a Celect filter implantation, 2 cases (13.3%) had a Denali filter implantation, and one case (6.7%) had an Option filter implantation. All the filters could not be removed by intervention via the jugular vein, and the preoperative CT showed that the hook of the filter penetrated the wall of the inferior vena cava. All patients underwent total laparoscopic-assisted filter removal under general anesthesia.
Results: Nine patients (60%) underwent laparoscopic surgery through peritoneal approach and 6 patients (40%) through peritoneal approach. the filters in 14 patients (93.3%) were successfully removed by laparoscopic-assisted procedure, and a Celect filter in one patient (6.7%) failed to be removed by laparoscopic surgery, and then was successfully removed by open surgery. The indwelling time was (103.9 ± 70.3) d. During the perioperative period, one patient (6.7%) received blood transfusion due to intraoperative blood loss and one patient (6.7%) had an incision skin infection. The length of postoperative hospital stay was (7.4±2.8) d.
Conclusion: The laparoscopic-assisted removal of the conical filter with retrieval hook penetrating the wall of the inferior vena cava is safe and effective. It can avoid the complications caused by long-term implantation of the filter. Preoperative CT evaluation can improve the success rate of surgery.

7 Relationship between ABO blood group system and the risk of deep vein thrombosis: a case-control study and Meta-analysis

LI Guanqiang , WU Fan , WEI Li , GAO Qihang , LIU Jiaxin , ZHANG Xicheng

2020, 29(6):677-685. DOI: 10.7659/j.issn.1005-6947.2020.06.007

[Abstract](245) [HTML](991) [PDF 1.14 M](923)

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Background and Aims: Deep vein thrombosis (DVT) is a common complication of inpatients with complex etiology. How to prevent the occurrence of DVT is a major problem in clinical practice. This study was conducted to investigate the relationship between ABO blood groups and the risk of DVT through a case-control study and Meta-analysis, so as to provide evidence for the individual prevention and precise treatment of DVT.
Methods: Five hundred hospitalized patients with DVT from October 2012 to December 2018 in the Department of Vascular Surgery of North Jiangsu People's Hospital (only the first-time admission was counted in multiple-hospitalization patients), and 500 cause (no evident precipitating event, pregnancy, injury, surgery, cancer, and long-term bedridden) and sex 1:1 matched hospitalized patients without DVT during the same period were enrolled for a case-control study. The relevant case-control studies were collected by searching several national and international databases, and the retrieval time was limited from inception to October 1, 2019. After literature screening according to the inclusion and exclusion criteria, quality assessment and data extraction, Meta-analysis was performed by Review Manager 5.3 software.
Results: In case-control study, the results of overall analysis showed that the risk of DVT in individuals with O-type blood was significant higher than those with non-O-type blood (RR=2.859, 95% CI=2.142–3.817, P<0.01); the results of subgroup analysis stratified by causes showed that non-O-type blood was a possible risk factor for DVT in those with no obvious precipitating event (RR=2.845, 95% CI=1.819–4.282, P<0.05), having injury (RR=3.11, 95% CI=1.477–6.552, P<0.05), undergoing surgery (RR=2.613, 95% CI=1.271–5.373, P<0.05) and with cancer (RR=2.962, 95% CI=1.436–6.106, P<0.05), but had no significant significance in the those with pregnancy (RR=1, 95% CI=0.034–29.807, P>0.05) and the long-term bedridden (RR=5.714, 95% CI=0.528–30.325, P>0.05). Results of Meta-analysis showed that the risk of DVT in individuals with O-type blood was lower than those with non-O-type blood (RR=0.62, 95% CI=0.56–0.69, P<0.05).
Conclusion: For patients with no apparent cause, having injury, undergoing surgery or with cancer, incorporating the ABO blood groups into the comprehensive analysis of risk factors for DVT may have certain clinical value for individual intervention and precise treatment of thrombosis. For patients with pregnancy and long-term bedridden, ABO blood groups may not be of sufficient clinical value, which still need to be further verified.

8 Application value of deep vein anterograde venography in etiological diagnosis of lower limb varicose veins

WANG Xin , ZHANG Bowen , JIANG Yunfei , ZHU Yunfeng , GE Hongwei , WANG Hui

2020, 29(6):686-692. DOI: 10.7659/j.issn.1005-6947.2020.06.008

[Abstract](367) [HTML](1156) [PDF 3.63 M](980)

Abstract:
Background and Aims: Varicose veins of the lower extremities are the common clinical manifestations of peripheral venous diseases, which can be caused by variety of diseases such as venous reflux diseases, venous reflux disorders of the lower extremities, and venous malformations. The treatment principles of varicose veins caused by different etiologies are also different. Misdiagnosis and mistreatment of varicose veins of the lower extremities often occur in clinical practice, so it is very important to determine the pathogeny of varicose veins. At present, venography of the lower extremity is still the gold standard for the diagnosis of venous diseases of the lower extremity, which can provide a complete image of the lower extremity venous system, and provide a reliable basis for the clear diagnosis and selection of the appropriate treatment scheme. The purpose of this study was to summarize the results of anterograde venography of deep vein of lower extremity in Changzhou, Jiangsu Province, and to evaluate the significance of venography, and to analyze the main etiologies of varicose vein in this region.
Methods: From June 2013 to March 2019, 3 012 patients with varicose veins of the lower extremities (3 420 limbs) who were admitted to the Department of Vascular Surgery of the Third Affiliated Hospital of Suzhou University underwent anterograde venography with digital subtraction angiography (DSA). The morphology and patency of the deep veins from the ankle of the affected limb to segment in the pelvic cavity, as well as the reflow of the contrast material while the patient was performing the Valsalva maneuver were observed. Then, the etiologies of varicose vein of the patients were analyzed and classified.
Results: In the 3 420 limbs, there were 1 395 limbs with primary deep venous valve insufficiency (40.79%), 1 052 limbs with simple superficial varicose veins (30.76%), 569 limbs with iliac vein compression syndrome (16.64 %), 328 limbs with post-thrombotic syndrome (9.59%), and 76 limbs (2.22%) with other pathogenies that included malformation of double femoral veins, popliteal venous aneurysm, deep venous aneurysm, Klippel-Trenaunay syndrome, Budd-Chiari syndrome and pelvic tumor.
Conclusion: The lower extremity varicose veins in patients in Changzhou region is mainly caused by deep venous insufficiency, simple superficial venous valve insufficiency and iliac vein compression. The proper treatment scheme for lower extremity varicose veins is based on the identification of pathogeny. Deep venography of lower extremities is a reliable method for distinguishing the etiologies of lower extremity varicose veins, which can determine the uncommon diseases such as popliteal venous aneurysm and Budd-Chiari syndrome, and thereby effectively avoid misdiagnosis and mistreatment. So, it is of great application value in peripheral venous diseases and can be used as a routine examination for peripheral venous diseases.

9 Endovascular interventional treatment of intravascular foreign bodies: a report of 4 cases and literature review

WANG Weiming , SHI Sen , ZENG Hong , ZHANG Lei , LIU Yong

2020, 29(6):693-698. DOI: 10.7659/j.issn.1005-6947.2020.06.009

[Abstract](830) [HTML](1180) [PDF 2.41 M](1123)

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Background and Aims: The occurrence of intravascular foreign bodies is relatively common in clinical practice, especially the intravascular foreign bodies caused by iatrogenic factors. With the increase of number of medical invasive procedures, the occurrence of iatrogenic intravascular foreign bodies is also increasing, which may lead to serious complications in patients. Therefore, the occurrence and development of intravascular foreign bodies as well as their diagnosis and treatment have also attracted attention and discussion from clinicians. Therefore, in order to optimize the diagnosis and treatment of such patients, and ensure the safety of the patients, this study conducted a comprehensive analysis and discussion based on the experience in diagnosis and treatment of intravascular foreign bodies in our department in the past two years, combined with the existing literature reports, so as to provide scientific theoretical basis and experience sharing for the diagnosis and treatment of similar cases in clinical practice.
Methods: The clinical data of 4 patients with intravascular foreign bodies diagnosed and treated in our center in the past two years were collected, and the sources and characteristics of foreign bodies, surgical procedures and experience were retrospectively analyzed and sorted out. The existing domestic and foreign literature reports concerning such diseases were retrieved, and then were reviewed and summarized.
Results: All the 4 patients had iatrogenic intravascular foreign bodies, which in one case was caused by the guide wire detachment during placement of the peripherally inserted central catheter (PICC), in two cases were caused by the fracture of the PICC catheter, and in another case was causes by undesirable detachment of the coils in the abdominal aortic lumen during endovascular embolization for a penetrating aortic ulcer. None of the four patients had clinical manifestations related to foreign bodies. All the foreign bodies were successfully removed by using a single-bent catheter and a gooseneck snare under interventional approach, and the integrity of each foreign body was acceptable. All patients recovered well after operation without any foreign body and operation-related complications.
Conclusion: In clinical practice, the occurrence of intravascular foreign bodies cannot be completely avoided, especially those caused by iatrogenic factors, and effective preventive measures should be taken. For the already occurred intravascular foreign bodies, timely and effective treatment is extremely important to reduce the risk of serious complications caused by foreign bodies. As the preferred treatment for intravascular foreign bodies, endovascular interventional therapy has the unique advantages of high retrieval rate, low surgical risk and fewer complications, and its efficacy has also been proven. In addition, a variety of appropriate interventional instruments should be selected and experienced surgeons are necessary during endovascular interventional procedures.

10 Efficacy observation of endarterectomy in treatment of carotid artery stump syndrome

HU Xintao , WANG Bing , WANG Yue , WU Fei , GUO Peng , WANG Hao , CHEN Jichong

2020, 29(6):699-705. DOI: 10.7659/j.issn.1005-6947.2020.06.010

[Abstract](288) [HTML](1182) [PDF 1.92 M](947)

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Background and Aims: After the chronic occlusion of unilateral internal carotid artery (ICA), there are 3%-5% of patients will still have symptoms of cerebral ischemia, such as black-outs and dizziness. However, there are few cases of clinically diagnosed this condition in China at present, and the understanding of its operation method is insufficient. Therefore, this study was conducted to preliminarily investigate the safety and efficacy of the endarterectomy of the external carotid artery (ECA), common carotid artery (CCA) or ICA as the main method combined with the occlusion or resection of the residual lumen of the ICA in treatment of the carotid stump syndrome (CSS).
Methods: The clinical and follow-up data of 9 patients diagnosed with CSS and treated by endarterectomy from August 2015 to June 2018 were analyzed retrospectively. Of the patients, 6 cases were males and 3 cases females, with an average age of 67.3 years. The changes in clinical symptoms before and after operation were compared. The scorers of the modified Rankin Scale (mRS) before and after operation were recorded.
Results: All procedures were uneventfully completed in the 9 patients. After operation, the neurological symptoms such as dizziness and limb weakness were relieved and improved, and the frequency of TIA was significantly reduced, but the visual loss in one patient could not be relieved due to the long period of blindness. Two patients (22.2%) had headache, dysphoria and other high perfusion manifestations, which were improved after decompression and dehydration treatment, without serious complications such as cerebral hemorrhage and cerebral infarction; two patients had choking cough when drinking water after operation, but basically recovered one week later. The scores of mRS for all patients were lower than those before procedure (≥1).
Conclusion: Endarterectomy of the ECA, CCA or ICA as the main method combined with the occlusion or resection of the residual lumen of the ICA is a safe and feasible method for CSS, with satisfactory short-term follow-up results. So, it can be used as a surgical method when the drug treatment fails.

11 Clinical characteristics and endovascular treatment of splenic artery aneurysm: a report of 30 cases

LE Tianming , WANG Xianwei , WANG Wei

2020, 29(6):706-714. DOI: 10.7659/j.issn.1005-6947.2020.06.011

[Abstract](384) [HTML](1422) [PDF 1.67 M](1045)

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Background and Aims: Splenic artery aneurysms (SAA) are a type of visceral aneurysmal disease, which are uncommon but potentially fatal if rupture occurs. The traditional treatment for SAA is open aneurysmectomy with splenectomy. In recent years, endovascular operation for SAA become increasingly popular with the development of interventional techniques and materials. Endovascular treatment has the advantages of minimal invasion, simple operation and fast postoperative recovery. Therefore, this study was conducted to assess the efficacy and safety of endovascular treatment of SAA.
Methods: The clinical data of 30 patients with SAA treated in the Department of Vascular Surgery, Xiangya Hospital, Central South University during Janurary 2012 to December 2019 were reviewed, and three interventional methods used for the treatment of SAA in our department were also introduced.
Results: Definitive diagnosis of SAA was made by abdominal CTA in all the 30 patients. The lesions were located in the proximal splenic artery in17 cases, in the middle segment of the splenic artery in 9 cases, and in the distal splenic artery in 4 cases; 19 lesions were fusiform and 11 lesions were saccular. All patients received endovascular repair, of whom, 21 cases underwent SAA embolization, 6 cases underwent splenic artery stenting, and 3 cases received splenic artery bare stent placement plus embolization. The average length of hospital stay was 4 d, and average medical expense was 50 000 yuan. The symptoms such as abdominal pain, vomit and fever occurred in 10 patients after operation, and were alleviated within 3 d without any sequelae. One patient had puncture site bleeding and was recovered and discharged after conservative treatment. No acute splenic infarction and complications requiring re-operation occurred during hospitalization. Postoperative follow-up was conducted in 22 patients, and the CTA showed that the aneurysms were occluded completely by thrombosis without endoleak of contrast agent, and asymptomatic focal splenic infarction was found in 5 patients.
Conclusion: Interventional endovascular treatment can cure the SAA with preservation of the spleen. It has demonstrable efficacy with minimal invasiveness and quick recovery, low incidence of complications, and short length of hospitalization, and without increase in cost compared to open surgery. Endovascular therapy can be considered as the first choice for majority of SAA, and the specific procedure selection should be based on the morphology and position of the SAA shown by CTA.

12 Prediction of target gene of miR-486-5p and bioinformatics analysis of their roles in pancreatic adenocarcinoma

REN Tianyu , ZHOU Xintong , DANG Shengchun

2020, 29(6):715-722. DOI: 10.7659/j.issn.1005-6947.2020.06.012

[Abstract](523) [HTML](1105) [PDF 1.19 M](1089)

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Background and Aims: Pancreatic cancer is one of the main causes of cancer-related death. It is the most malignant tumor of the digestive system. Its main pathological type is pancreatic adenocarcinoma (PAAD), which has a dismal prognosis. MiR-486-5p plays an important role in different cancers, but there is still no research report on miR-486-5p in PAAD so far. This study was conducted to explore the target genes of miR-486-5p and analyze the expression and significance of its target genes in PAAD by bioinformatics approaches.
Methods: The correlation between miR-486-5p and the prognosis of PAAD was analyzed using the PROGmiRV2 database. The target genes of miR-486-5p were predicted by combined use of multiple data platforms, and then, the gene ontology (GO) enrichment analysis and Kyoto Gene and Genome Encyclopedia (KEGG) signal pathway analysis were performed for the selected target genes using the DAVID online database. After that, the protein-protein interaction (PPI) network of the target genes was constructed using the STRING database, and visualized using Cytoscape software for to screen the core genes in the PPI network. Finally, the candidate genes were verified and picked up to find the core genes related to the prognosis of PAAD.
Results: The overall survival time of PAAD patients with low miR-486-5p expression was shorter than that of PAAD patients with high miR-486-5p expression (P<0.05). A total of 187 target genes were obtained, which were predicted by at least 3 different databases. Go analysis showed that the predicted target genes were mainly involved in the biological processes such as protein stability, protein phosphorylation, positive regulation of RNA polymerase II promoter transcription and negative regulation of apoptosis; KEGG analysis showed that the target genes were mainly involved in FOXO signaling pathway, p53 signal pathway, Ras signaling pathway, and PI3K-Akt signaling pathway. Protein network analysis of potential target genes of miR-486-5p showed that SIRT1, PTEN, SMAD2, CSNK2A1 and SERPINE1 were key target genes in PPI network. Further GEPIA verification revealed that CSNK2A1 and SERPINE1 were significantly up-regulated in PAAD tissues (all P<0.05). The high expressions of these genes were associated with the overall and disease-free survival in patients with PAAD (all P<0.05), and those with high expressions of CSNK2A1 and SERPINE1 had worse prognosis.
Conclusion: MiR-486-5p acts on the network of multiple signaling pathways in PAAD patients through the regulation of targeted genes, participates in the occurrence and development of PAAD, and affects the prognosis of PAAD patients.

13 Effects of microRNA-124 on proliferation and apoptosis of gastric cancer cells and its relation with PI3K/Akt signaling pathway

WEI Wei , HUANG Haige , LU Jiaming , ZHOU Li

2020, 29(6):723-730. DOI: 10.7659/j.issn.1005-6947.2020.06.013

[Abstract](256) [HTML](971) [PDF 1.99 M](1068)

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Background and Aims: Previous studies have demonstrated that microRNA-124 (miR-124) plays an important role in a variety of cancers, and is down-regulated in gastric cancer cells and tissues. This study was conducted to investigate the influences of miR-124 on proliferation and apoptosis of gastric cancer cells and its association with PI3K/Akt signaling pathway.
Methods: The expressions of miR-124 in human gastric cancer cells MGC803, AGS, MNK-45 and SGC-7901 as well as in normal gastric mucosa epithelial GES-1 cells were determined by qRT-PCR. In MGC803 cells after transfected with miR-124 mimics (miR-124 mimics group) and negative control sequences (negative control group), the cell proliferation was detected by CCK-8 assay and cell clone assay, the apoptosis was measured by flow cytometry, the protein expressions of PI3K, Akt, p-PI3K and p-Akt were examined by Western blot, and mRNA expressions of PI3K and Akt were analyzed by qRT-PCR.
Results: The expressions of miR-124 in all studied gastric cancer cell lines were all significantly lower than that in normal gastric mucosa epithelial GES-1 cells (all P<0.05). In miR-124 mimics group compared with negative control group after transfection, the OD450 values of and numbers of cell clone formation were all significantly reduced (all P<0.05); the apoptosis rates were all significantly increased (all P<0.05); the expression levels of PI3K, Akt, p-PI3K and p-Akt proteins from PI3K/Akt signaling pathway were significantly down-regulated (all P<0.05) and the gene expression levels of PI3K and Akt were also significantly down-regulated (all P<0.05).
Conclusion: Down-regulation of miR-124 can promote proliferation and inhibit apoptosis of gastric cancer cells, and the mechanism may probably associated with the activation of PI3K/Akt signaling pathway.

14 Establishment and application of self-quality control system of laparoscopic pancreatoduodenectomy for radical treatment of distal cholangiocarcinoma

LIU Xiaoti , MAO Xianhai , YANG Jianhui , LIU Changjun , JIANG Bo , DUAN Xiaohui ,

2020, 29(6):731-738. DOI: 10.7659/j.issn.1005-6947.2020.06.014

[Abstract](289) [HTML](966) [PDF 1.09 M](778)

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Background and Aims: Laparoscopic pancreatoduodenectomy (LPD) has been widely used for the radical treatment of distal cholangiocarcinoma. However, the level of technical difficulty and incidence of postoperative complications of performing LPD for distal cholangiocarcinoma are still high, due to the clinicopathologic features of distal cholangiocarcinoma. So, making a self-quality control system for this operation is necessary. The aim of the present study was to explore the establishment and implementation effect of the self-quality control system of LPD for distal cholangiocarcinoma.
Methods: A historical control analysis of the relevant clinical variables was performed between 37 patients undergoing LPD for distal cholangiocarcinoma before self-quality control system establishment from January 2013 to December 2018 (control group) and 30 patients undergoing LPD for distal cholangiocarcinoma after self-quality control system establishment (observation group). The components of the self-quality control system included: “en-block” resection for lymphadenectomy; lymph node sortation performed by surgeons after surgery; properly handling gastroduodenal artery, coronary vein, Helen's trunk and "dangerous triangle", and simultaneously paying attention to avoid the omission of the right gastric artery; ensuring the attachment of the jejunal seromuscular layer to the posterior wall of the pancreas and using 5-0 vicryl line to fix the pancreatic duct during pancreaticojejunostomy; protecting blood supply of biliary tract and using 4-0 PDS suture to complete the anastomosis during choledochojejunostomy; all-directional drainage of the anastomosis area.
Results: There were no significant differences in baseline characteristics between the two groups of patients (all P>0.05). In terms of lymph node harvest, the proportion of cases with the number of resected lymph nodes reaching the minimum requirement of AJCC version 8 (≥12 lymph nodes) in observation group was significantly higher than that in control group (96.7% vs. 78.4%, P=0.029). The intraoperative blood loss in observation group was significantly lower than that in control group [(151.0±59.7) mL vs. (176.2±39.5) mL, P=0.042]. The overall incidence of postoperative complications in observation group was lower than that in control group, but the difference did not reach a statistical significance (26.7% vs. 37.8%, P=0.333); the incidence of postoperative bleeding in observation group was lower than that in control group, but no statistical significance was reached (3.3% vs.
8.1%, P=0.412); there was no significant difference in incidence of pancreatic fistula between observation group and control group (23.3% vs. 21.6%, P=0.867), but the incidence rates of pancreatic fistula over grade B in observation group was significantly lower than that in control group (P<0.01); bile leakage occurred in only one patient in control group; the incidence of abdominal infection in observation group was significantly lower than that in control group (0 vs. 5.4%, P<0.01). No perioperative death occurred in both groups.
Conclusion: The self-quality control system covering each aspect of LPD for distal cholangiocarcinoma may help improve the oncological outcomes of the patients, and also reduce the postoperative complications, and thereby, ensure the safe and effective performance of LPD for distal cholangiocarcinoma.

15 Comparison of operative time and surgeon's subjective assessment in 3D and 2D laparoscopic gastric bypass surgery

THAPA Dil Momin , WANG Mofei , , ZHOU Yong , WANG Yong , LIU Jingang

2020, 29(6):739-744. DOI: 10.7659/j.issn.1005-6947.2020.06.015

[Abstract](280) [HTML](909) [PDF 1.06 M](1171)

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Background and Aims: The prevalence of obesity is growing at alarming rate, and has become a major global health problem. Laparoscopic gastric bypass surgery is the most common type of weight loss surgery. With the development of technology and equipment, 3D laparoscopic system has increasingly entered the field of general surgery. The three-dimensional stereo vision overcomes the shortage of the traditional 2D laparoscopic vision system that lacks the vertical perception and stereo views of the anatomy, and thereby provides a better surgical visual field for the primary surgeon, which allows more procedural accuracy and reduces the surgical difficulty to some extent. However, as a major renovation in laparoscopic technique, there are few reports on application of 3D laparoscopic system in gastric bypass surgery, and its advantages and disadvantages comparing with 2D laparoscopic system are unknown. Therefore, this study was designated to assess the superiority of 3D laparoscopic system in gastric bypass surgery and its application value by a single-center randomized controlled trial.
Methods: Between August 2017 and March 2019, 60 patients seeking weight-loss treatment in the 4th Affiliated Hospital of China Medical University were enrolled, and were randomly assigned to two groups, with 30 cases in each group, and then underwent 2D laparoscopic gastric bypass surgery (2D group) and 3D laparoscopic gastric bypass surgery (3D group), respectively. The time for the completion of each surgical procedure (creating the small stomach pouch, gastrojejunostomy, and jejunojejunostomy) and the total operative time were compared between the two groups, and the subjective perceptions in operability and operating comfort of the surgeon under laparoscope were scored by questionnaire survey.
Results: There were no significant differences in the general data between the two groups of patients before operation (all P>0.05). In 3D group compared with 2D group, except the time for making small stomach pouch which showed no significant difference (P=0.120), the time for gastrojejunostomy (P=0.015) and the time for jejunojejunostomy (P=0.012) as well as the total operative time (P=0.023) were significantly reduced. The subjective scores of the surgeon for accuracy, layering perception and vertical perception and the scores for eye-fatigue sensation and neck-fatigue sensation under 3D laparoscope were all superior to those under 2D laparoscope (all P<0.05).
Conclusion: Compared with 2D laparoscopic system, 3D laparoscopic system can significantly shorten the operative time and increase the operating comfort of the surgeon in performing gastric bypass surgery. So, it has excellent application prospects.

16 Prevention and treatment of in-stent restenosis of lower extremity arteriosclerosis obliterans: current status and application prospects of sulodexide

JI Zhongjie , ZHANG Tianhua , JIANG Weiliang

2020, 29(6):745-751. DOI: 10.7659/j.issn.1005-6947.2020.06.016

[Abstract](404) [HTML](1108) [PDF 1.08 M](928)

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Endovascular treatment of lower extremity arteries is a common treatment method for patients with arteriosclerosis obliterans of the lower extremities. The treatment of balloon dilation plus stent implantation is often unsatisfactory due to its high in-stent restenosis (ISR) rates. ISR seriously affects the prognosis and quality of life of the patients after operation. Patients with ISR usually need a second operation. However, due to a series of problems such as high cost, poor long-term patency rates, and stent fracture, the prevention of ISR is particularly important. Sulodexide has extensive biological effects on cardiovascular system, and its anti-inflammatory, anti-thrombotic, and vascular endothelial protection exerts important beneficial effects on prevention and treatment of ISR. The authors review the current status in diagnosis and treatment of ISR and the application prospects of sulodexide in treatment of ISR.

17 Research progresses of chitosan and its derivatives in treatment chronic leg ulcer

LIU Jiaxin , ZHANG Xicheng , GAO Qihang , WEI Li , LI Guanqiang

2020, 29(6):752-758. DOI: 10.7659/j.issn.1005-6947.2020.06.017

[Abstract](477) [HTML](1376) [PDF 1.05 M](1104)

Abstract:
Chronic leg ulcer (CLU) is a common surgical disease. Its prevalence is 0.12 to 1.1% in the general population, is 0.5% to 3% in people older than 60, and reaches 5% in those over 80 years of age. According to the pathogenesis, it can be divided into vascular ulcer, diabetic foot ulcer, pressure ulcer, traumatic ulcer, neurotrophic ulcer, and malignant ulcer, etc. The wound healing stages include inflammatory response phase, hyperplasia phase and repair phase. Proper microenvironmental conditions can promote cell proliferation and migration, which is helpful for early wound healing and preventing inflammation and scar tissue generation. Ulcer wound treatment has a vital role in the wound healing process. At present time, the treatment for CLU mainly includes debridement and skin grafting, vacuum sealing drainage, anti-infection, local active factors, stem cell transplantation and dressing coverage, etc. The selection of appropriate wound dressings plays a crucial role in accelerating the wound healing of CLU. In addition to the good ability to absorb wound exudate, these dressings should also have the abilities of maintaining appropriate microenvironment, anti-bacteria, hemostasis, analgesia and other abilities for promoting wound healing. Chitosan is the product of partial deacetylation of chitin by the action of strong alkali. It possesses the characteristics of infection resistance, hemostasis, immune regulation, inducing tissue repair and cell proliferation, as well as good biocompatibility and biodegradability. At the same time, chitosan has effect on white blood cells and macrophages chemotaxis, enhancing macrophage phagocytosis, and stimulating neutrophils and macrophages to secrete interleukins and tumor necrosis factor, and thereby promoting "self-purification" of the wound surface. Chitosan has a good prospect in the treatment of CLU.

18 Actions of endothelial progenitor cells in angiogenesis and the related diseases

SUN Lili , LI Wendong , LI Xiaoqiang , JIANG Xudong , JIAO Jian

2020, 29(6):759-764. DOI: 10.7659/j.issn.1005-6947.2020.06.018

[Abstract](292) [HTML](1109) [PDF 1.02 M](966)

Abstract:
Angiogenesis is closely related to the development and progression of many refractory diseases, and its imbalance can lead to angiogenesis-related diseases. Endothelial progenitor cells (EPCs) play essential roles in the processes of angiogenesis and disease progression, and in-depth studies of their specific actions and molecular mechanisms will give new hope to these diseases. Here, the authors address the roles and mechanisms of EPCs in angiogenesis-related diseases, so as to provide novel insights and research directions for prevention and treatment of clinical diseases.

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Volume 29,Issue 6,2020 Table of Contents

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