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22 January 2007, Volume 27 Issue 02 Previous Issue    Next Issue
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Endovascular aneurysm repair of the aortic arch lesions GUO Wei,LIU Xiaoping,YIN Tai,et al. 2007, 27(02): 1-153.  Abstract ( )   PDF (473KB) ( )   Objective:To discuss the methods of Endovascular aneurysm repair (EVAR) for artic arch aneurysm or dissection. Methods:From Sep.1998 to Feb.2006,63 cases related with the superarch branches.Three methods were used in the lesions with left subclavain artery (LSA) invasion only,covering the LSA without reconstruction,LSA bypass before EVAR or covering LSA completely and then reopen it by endovascular technique.To the lesions with LSA and left common carotid artery (LCCA) invasion,a traditional bypass of LCCA and LSA was done before EVAR,or covering most of LCCA first,and then reconstructed it through LCCA by endovascular technique.To the lesions with three superarch branches invasion,a bifurcated stentgraft was planted for reconstructing the artic arch. Results:LSA was treated in 54 cases,LSA and LCCA were treated in 8 cases and all of the superarch branch arteries were treated in 1 case.All of the auxiliary techniques were enforced successfully.The primary average systolic pressure of left brachial artery was （62.6±24.2）mmHg in cases without LSA reconstruction.The 30days endoleak rate was 17.5%. Conclusion:Covering the LSA is safe to the patients with normal contraliteral vertebral and basilar artery.EVAR combined with supplementary techniques can expand the EVAR indications of aortic arch lesions.The long term result still keep in follow up.

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Endovascular stentgrafts in the treatment of isolated iliac artery aneurysms:an analysis of 7 cases LAN Yong，FU Wei-guo，WANG Yu-qi,et al. 2007, 27(02): 1-153.  Abstract ( )   PDF (302KB) ( )   Objective:To summarize the therapeutic effects of endovascular repair for isolated iliac artery aneurysms (IAA). Methods:Seven patients were treated with transluminally placed endovascular stentgrafts from October 2004 to March 2006 and the results were analyzed. Among them,four cases were right common IAA and two cases were left common IAA.One case was left internal IAA with rupture. Results:Technical success was achieved in all cases.Three cases with right common IAA involved right internal iliac artery were treated with bifurcated aortailiac stentgrafts.One case with right common IAA involved the bottom of abdominal aorta was treated with AUI stentgraft and femorofemoral bypass.Two cases with left common IAA were treated with tubular stentgrafts.One case with left internal IAA rupture was treated emergently with tubular stentgraft after ipsilateral internal iliac artery embolization with coils.DSA carried out immediately after the procedure showed the IAA were completely excluded by stentgrafts and no serious endoleaks both on the proximal or distal connections.One case with acute left ventricular dysfunction and alveolar edema postoperatively was recovered after emergent treatment and there were no complications in another six cases.All patients were followed up for 1 to 19 months (a mean of 10.6±6.42 months),no aneurysms enlargement,no stentgrafts migration,no endoleak,femorofemoral bypass was patent. Conclusion:Endovascular repair of IAA is a minimally invasive,safe and feasible technique and provides good shortterm patency,but the longterm patency need follow up.

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Clinical analysis of patients with fungal septicemia in general surgery department GU Jun,REN Jianan,LI Weiqin,et al. 2007, 27(02): 1-151.  Abstract ( )   PDF (490KB) ( )   Objective:To study the clinical characteristics of fungal species,therapy and prevention of fungal septicemia.in general surgery department. Methods:A retrospective analysis of predisposing factors,distribution of fungi, treatment and outcome of 94 patients with fungal septicemia from March 2001 to December 2005 was done. Results:The most frequent predisposing factors were the use of broad spectrum antibiotics,indwelling central intravenous catheter,total parenteral nutrition,admission to intensive care unit.94 strains of fungal isolated from 94 patients.Candida was the predominantly pathogenic organism.NonCandida.albicans species were the most frequently isolated strains.Thirtyseven cases were dead among the 94 cases being treated with antifungal drugs. Conclusion:Fungal septicemia usually occurred in severe intra abdominal infectious patients.Non Candida albicans species are the major pathogens.Removing predisposing factors,isolation of pathogens,antibiotic susceptibility testing and correct choice of antifungal agents and enteral nutrition in high risk patients are important measurements to reduce the incidence and mortality of fungal septicemia.

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Percutaneous ablation for small hepatocellular carcinoma equal to or less than 2 cm in diameter KUANG Ming,XU Zuo-feng,LV Ming-de,et al. 2007, 27(02): 1-153.  Abstract ( )   PDF (426KB) ( )   Objective:To investigate the therapeutic effects of percutaneous ablation for hepatocellular carcinoma (HCC) which the diameter was less than 2 cm. Methods:Thirtythree cases of pathologically conformed HCC were treated with percutaneous microwave ablation (MWA) or percutaneous ethanol injection (PEI). Results:The complete ablation rate was 93.9%,the local recurrence and distant recurrence rates were 9.1% and 33.3%,respectively.One,two,and threeyear diseasefree survival rates were 62.6%,62.6% and 62.6%,respectively and overall survival rates were 84.0%、74.5% and 63.9%,respectively.By univariate analysis,only preablation αfetoprotein (AFP) level was significantly related to recurrencefree survival,while AFP level and distant recurrence were significantly related to overall survival. In multivariate analysis,AFP level and distant recurrence were independent risk factors to overall survival. Conclusion:Percutaneous ablation is capable of eradicating HCC which the size is less than 2 cm.Preablation AFP level and posttreatment distant recurrence are significantly related to prognosis.

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Diagnostic value of monitoring intraabdominal fluid for postoperative pancreatic fistula XU Bin,LOU Wenhui,WANG Dansong,et al. 2007, 27(02): 1-153.  Abstract ( )   PDF (412KB) ( )   Objective:To investigate the diagnostic value of monitoring drained intraabdominal fluid for postoperative pancreatic fistula (POPF). Methods:Drained fluid around the anastomosis was collected from 42 patients,who underwent pancreatoenterostomy during November 2005 to July 2006,for detecting amylase value.The definition of an international study group,which consisted of 37 institutions, was used to diagnose POPF.Clinical data and the drained fluid characteristics of all the patients were recorded. Results:Among the 42 patients,12 patients suffered POPF.By univariate analysis,it was found that color change of drained fluid from light yellow bloody to grey brown（P=0.002），increased value of amylase in the drained fluid (P=0.001),the color of drained fluid and the percentage of granulocyte in WBC (P<0.05) as well as the fasting blood glucose (P=0.009) on the 7th day after surgery were significant relevant factors.Color change of drainage fluid and the amylase value change were both independent risk factors for POPF by multivariate analysis (odds ratio are 11.62 and 11.18，respectively).By ROC curve analysis,color change of drained fluid （P=0.017）,increased value of amylase (P=0.007) and the percentage of granulocyte in WBC on the 7th after surgery （P=0.004）had good diagnostic values for POPF.Combination of the increased value of amylase and N %> 80% had a better diagnostic value with a 0833 area under the ROC curve (P=0.001). Conclusion:By color change,increased amylase value of drained intraabdominal fluid and granulocyte percentage on the 7th after surgery.POPF may be diagnosed in an early stage effectively.Active intervention should be adopted to prevent serious complications.

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Diagnosis and surgical treatment of hepatoblastoma in childhood XU Ye-chuan，TONG Zhong，QIAN YE-ben，et al. 2007, 27(02): 1-151.  Abstract ( )   PDF (275KB) ( )   Objective:To investigate the diagnosis experience,effects of Surgical treatment and prognosis of hepatoblastoma (HB) in childhood. Methods:The clinicopathological and follow-up data in 29 cases treated by hepatectomy from Jan 1992 to Jan 2005 were analyzed retrospectively. Results:A retrospective analysis was made on 29 cases of TNM/s stage.There were 8 cases of stageⅠ,14 cases of stage Ⅱ,6 cases of stage Ⅲ and 1 case of stage Ⅳ.25（86%）cases underwent radical resection,4 （14%）cases of palliative resection.The overall postoperative complication rate was 13.7％ (4/29).The liver function was recovered within 10 d;Twentytwo patients were followed-up.The overall 1-,3-,4-year survival were 19,15 and 8 cases,with survival rate of 86.4％,68.2％ and 36.4％. Conclusion:Radical resection should be the first recommended treatment for hepatoblastoma in childhood.The clinical stage, differentiation and pathological type of the tumor impact prognosis significantly.

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Experience of endoscopic total extraperitoneal hernioplasty with nonstapling of mesh:a study of 34 cases SHUAI Jian,DAI Liping，YU Xiaofang,et al. 2007, 27(02): 1-153.  Abstract ( )   PDF (282KB) ( )   Objective:To summarize therapeutic effect and experience of nonstapling of mesh during endoscopic total extraperitoneal inguinal hernioplasty. Methods:From February 2004 to March 2006,34 inpatients suffered inguinal hernia, underwent endoscopic total extraperitoneal (TEP) hernioplasty under general anesthesia,with non-stapling of mesh. Results:All patients were performed successfully by endoscopic TEP hernioplasty,with operating time from 60 to 120 minutes for unilateral hernioplasty, from 100 to 150 minutes for bilateral hernioplasty. Losing blood volume was 10～50 mL.Postoperative complications include 2 cases of hematoma of scrotum and 2 cases of seroma of scrotum.The patients were discharged 3～5d after operation. There was no recurrence after 3-18 months followup. Conclusion:The simplified endoscopic TEP hernioplasty can be performed safely and reliably without stapling the mesh.The nonstapling strategy also helps to reduce the cost and complication rates of the operation.