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20 October 2006, Volume 26 Issue 10 Previous Issue    Next Issue
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Carotid endarterectomy with routine shunting and patch:a report of 45 cases. Yu Bo,Wang Tieping,Shi Weihao,et al. 2006, 26(10): 1-747.  Abstract ( )   PDF (443KB) ( )   Objective:To study the methods and skill of carotid endarterectomy (CEA) for reducing the stroke incidence perioperatively and restenosis of carotid artery after operation. Methods:Fortyfive patients with carotid stenosis,40 males and 5 females,with a mean age of 62±6yr,were underwent CEA in Huashan Hospital from Mar.2001 to Mar.2005.Among them,32 patients were performed for TIAs,7 for stroke and 4 for asymptomatic diseases.Duplex scanning,DSA (8 patients) and CTA (38 patients) were done before operation.The average percentage of carotid stenosis was 69%±12% with ECST criteria.The CEA were performed under general anaesthesia with routine intraluminal shunt and carotid patch.The mean time of CEA was 1 hour and 50 minutes and the mean clamping time was 2 min and 45 sec. Results:There was no mortality or stroke perioperative and 30 days postoperatively.Two patients were suffered from TIAs in 6 and 10 hours postoperatively.The TIAs symptoms disappeared in 28 patients and relieved in 2 patients.All patients were followed up for a mean interval of 31±20 months(range:6-42months) and no neurological events occurred during followup.One recurrent stenosis (<30%) was detected on followup Duplex scan. Conclusion:Carotid endarterectomy using routine intraluminal shunt and carotid patch is a safe and effective procedure with low mortality and stroke rates and reducing the restenosis of carotid artery.

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PTA and drug eluting stents of infrapopliteal arteries in senile patients with critical chronic limb ischemia. Liu Xiaoping*,Guo Wei,Yin Tai,et al. 2006, 26(10): 1-761.  Abstract ( )   PDF (462KB) ( )   Objective:To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) and endovascular drugeluting stent (DES) implantation for the treatment of the diseases. Methods:From August 2004 to April 2006,15 patients (18limbs) were treated with PTA,4 of them were treated with DES for intermittent claudication,rest pain and ischemic ulcer.The age of patients was from 69 to 89 years old,and the mean age was 76 years old. Results:The initial successful rate of PTA was 89% (16/18),4 of them were treated with 5 DES for simple,localized restenosis or occlusions.The followup period ranged from 2 to 20 months,and the cumulative patency was 56% (10/18). Conclusion:The PTA and endovascular DES implantation for the treatment of atherosclerotic occlusive in infrapopliteal arteries is safe and efficient.No serious complications are reported,and further study of the method may improve the results.

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Evaluation of two minimally invasive treatments for primary vein varicosis of lower extremity. Yin Henghui,Wang Shenming,Ye Caisheng,et al. 2006, 26(10): 1-751.  Abstract ( )   PDF (265KB) ( )   Objective:To evaluate the effects of two minimally invasive methods,percutaneous continuous circumsuture (PCCS) and transilluminated powered phlebectomy (TIPP)，in the treatment of primary vein varicosis of lower extremity. Methods:Retrospectively analyzed data of 138 patients (167 limbs) with primary vein varicosis of the lower extremity who underwent PCCS or TIPP in the First Affiliated Mespital of Sun Yatsen University by the same operation group from January 2004 to December 2005.Operation and hospitalization time,blood losing,complications,data of VPPG examination preand postoperative were compared. Results:The agonies of the patients were alleviated in both the two groups and no visible scars were left three months after surgery.In the TIPP group,operation time was greatly shortened but the blood losing,economic burden and complications obviously increased comparing with the PCCS group.Most of the patients in the PCCS group suffered from intensive pain after operation. The improvements of vein ability reflected by VPPG examination presented no statistical difference between the two groups. Conclusion:TIPP and PCCS are both effective minimally invasive methods in the treatment of primary vein varicosis of the lower extremity.Surgeons can choose either one according to the patient’s favorite.

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Catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter. Zhang Jingyong,Jin Xing,Wu Xuejun,et al. 2006, 26(10): 1-771.  Abstract ( )   PDF (452KB) ( )   Objective:To discuss the feasibility of catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter. Methods:Fiftyone cases of deep venous thrombosis of lower limbs from December 2002 to February 2005 were treated with catheter directed thrombolysis,the popliteal puncture under ultrasound guidance for the venous access,and the course of therapy was continued 10-14 days with anticoagulation. Results:The procedures of the popliteal puncture and catheter and guidewire exchanges were successful in all 51 cases,and were not permitted passing through iliac veins in 3 cases.Clinical manifestations were alleviated in all 51 cases.Implied by imaging examination before discharged from hospital,11 cases were completely cured,significantly improved in 34 cases,and improved in 6 cases.There were 5 cases accepted balloon dilatation in iliac venous, 3 cases accepted iliac venous stent,1 case accepted bypass surgery. Conclusion:The catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter can prevent pulmonary embolism,prolong the time of thrombolysis,decrease the dosage of urokinase and complication of hemorrhage,and it can take the chance of subsequent therapy.

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Analysis of the clinicopathologic factors and clinic outcomes for gastric cancer patients with pancreatic body/tail invasion. Wang Zhao,Zhan Wenhua,He Yulong,et al. 2006, 26(10): 1-751.  Abstract ( )   PDF (394KB) ( )   Objective:To investigate the clinicopathologic factors of gastric cancer with pancreatic body/tail invasion and the clinic outcomes of pancreatic body/tail resection for these patients. Methods:Based on our database built from August 1994 to March 2006,the clinicopathologic data and the outcomes of the followup were analyzed respectively using the software of SPSS. Results:Among the 870 gastric cancer patients,73 patients had pancreatic body/tail invasion.The clinicopathologic factors correlated with pancreatic body/tail invasion included primary tumor penetrating through the serosa,Borrmann IV,peritoneal dissemination and N2 lymph node metastasis (P<0.05).Major postoperative complication rate was 2.3% (1/44),and the mortality was 0.The 1,3,and 5year survival rate of the patients undergoing the radical operation combined with pancreatic body/tail excision (RO group) was 63%,24% and 19%,respectively.The overall survival rates of RO group within 1 year after the operation were higher than those undergoing palliative resection (PR group) and those undergoing palliative operation (PO group),respectively (P<0.05). Conclusion:The radical operation combined with pancreatic body/tail resection has an acceptable morbidity,and could improve the shortterm survival rate of the patients with pancreatic body/tail invasion.

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Experience on the management of intestine during mesenteric vascular occlusion. Zhu Weiming,Li Ning,Wu Xingjiang,et al. 2006, 26(10): 1-768.  Abstract ( )   PDF (430KB) ( )   Objective:To summarize the management experiences of intestine during mesenteric vascular occlusion. Methods:Five cases of intestinal ischemia or mesenteric venous thrombosis from 2001 to 2006 were retrospectively analyzed and a discussion was made on the avoidance of massive intestinal resection in different circumstances. Results:Three of five patients were treated adequately with excellent results.1 patient received inadequate intestinal resection,a relaparotomy and intestinal resection was made with satisfactory result.1 patient was dead with intestinal bleeding. Conclusion:For patients with minor area of mesenteric vascular occlusion,anastomosis should be established on the healthy intestine to avoid intestinal fistula.For patients with massive intestinal ischemia/congestion,care should be taken to avoid loss of too much intestine,enterostomy is helpful for the evaluation of intestinal viability and a planned reanastomosis to reestablish the continuity of the intestine is suggested.For patients with mesenteric thrombosis, thrombectomy and anticoagulant therapy are necessary to avoid further development of the thrombus.

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The effect of pelvic autonomic nerve preservation and total mesorectal excision in male rectal carcinoma patients for presersing anus. Li Leping,Jing Changqing，Lin Liming,et al. 2006, 26(10): 1-735.  Abstract ( )   PDF (387KB) ( )   Objective:To study the effect of pelvic autonomic nerve preservation and total mesorectal excision in male rectal carcinoma patients for presersing anus. Methods:The distance from tumor’s edge to anus,3 year’s survival rate,local recurence rate,urinary function and sexual function were propectively analysed in control groups, toltal mesorectal excision （TME） groups and pelvic autonomic nerve preservation （PANP）+TME groups. Results:The distance from tumor’s edge to anus in TME groups and PANP+TME groups was shorter than one in control groups.The rate of urinary dysfunction and sexual dysfunction was gradualy reduced from control groups,TME groups to PANP+TME groups.Those three groups had signifcant difference. Conclusion:TME technique could signifcantly reduce the local recurence rate,urinary dysfunction and sexual dysfunction. PANP combined with TME could reduce urinary dysfunction and sexual dysfunction much more.

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The relationship between xanthogranulomatous cholecystitis and cholecystolithiasis. Yang Tian,Yang Liqun,Zhang Baihe,et al. 2006, 26(10): 1-768.  Abstract ( )   PDF (416KB) ( )   Objective:To study the relationship between xanthogranulomatous cholecystitis (XGC) and cholecystolithiasis,and to investigate the effect of cholecystolithiasis on the pathogenesis of XGC. Methods:The clinical data of 33 patients with XGC diagnosed definitely by pathological examination over a period of 10 years were analyzed retrospectively.20 were men and 13 were women. Results:Abdominal ultrasonography was performed in all patients,and computed tomography (CT) in 20 cases.In the operations of all patients,XGC was associated with cholecystolithiasis in 32 patients (97%),which quantity,size,and quality varied from person to person.Among these 32 patients，11 patients were XGC with solitary gallbladder stone,and 21 patients with multiple gallbladder stones;26 patients had gallbladder calculus which diameter were more than 10 cent;and 20 patients (62.5%) had impacted stones in neck of gallbladder.In addition,15.2% of all were associated with choledocholithiasis,Mirizzi syndrome was observed in 9.1% of the patients, and no one was associated with intrahepatic bile duct stone. Conclusion:XGC is a rare and special type of chronic cholecystitis associated with Xanthogranuloma,proliferative fibrosis and foam cells,which is difficult to be diagnosed preoperatively.Definite diagnosis depends on pathological examination.Gallbladder stones could result in silting of bile,and make bile leak into damaged wall of gallbladder，which possibly sacrifices to XGC.Calculus incarcerated in neck of gallbladder,probably plays an important role in onset of XGC.