Abstract:Objective:To compare the outcome of composite sequential bypass and reversed autologous saphenous vein bypass for severe chronic lower limb ischemia.
:Methods :From 2003 to 2005, 41 patients presenting with critical limb ischemia were divided into 2 groups: In 25 cases composite sequential bypass was carried out,While in 16 cases reversed autologous saphenous vein bypass was done. The composite sequential bypass was done with PTFE anastomosed proximally to the common femoral artery and distally to the isolated popliteal artery, and autologous saphenous vein extended from the distal PTFE and anastomosed to tibial or peroneal artery. The results were analysed by life table methods to discover the difference of primary patency, secondary patency and limb salvage between the 2 groups.
:Results:There were 18 patients with gangrene and 23 patients with rest pain.The mean age of patients was　67 years (range, 48-86 years). The cohort consisted of 29 male and 12 female patients.The mean follow-up was 18.7 months. In the composite graft group the outflow involved the peroneal　artery in 6, the posterior tibial artery in 14, and the anterior tibial artery in 5.Primary graft patency at 1 y, 2 y and 3 y by lifetable analysis was 78%, 72% and 61%, respectively.Secondary graft patency of each year was 83%, 76% and 66%, respectively. Limb salvage rate was 83%, 73% and 73%, respectively. In the reversed saphenous vein group the outflow involved the peroneal artery in 3, the posterior tibial artery in 10, and the anterior tibial artery in 3. Primary graft patency at 1 y, 2 y and 3 y by lifetable analysis was 83%, 73% and 73%, respectively.Secondary graft patency of each year was 86%, 73% and 73%, respectively.Limb salvage rate was 93%, 79% and 79%, respectively.By the logrank test, there was not significent difference between the 2 groups.
:Conclusions:Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.

Abstract:Objective:To investigate the efficacy of ultrasound ablation combined with autologous transplantation of bone marrow mononuclear cells in treatment of arteriosclerosis obliterans.
:Methods :Clinical data of 39 patients with arteriosclerosis obliterans treated with ultrasound ablation and autologous transplantation of bone marrow mononuclear cells were analyzed. There were 21 male and 18 female patients,With average age of 63 years. At operation, 260 mL of autologous bone marrow was withdrawn, mononuclear cells were separated, and 40 mL supension fluid of stem cells was prepared.Through percutaneous approach or surgical approach the ultrasound ablation catheter was inserted into occluded arterial segments. After ablation was performed, autologous bone marrow mononuclear cells were directly injected into the skeletal muscles of the ischemic leg.
:Results:No complications were found in this group. Postoperatively, rest pain of all the patients was significiently improved and distance of claudication increased.The skin became warm in all legs.
:Conclusions:Ultrasound ablation and autologous transplantation of bone marrow mononuclear cells is a simple, safe and effective method for treating patients with arteriosclerosis obliterans.

Abstract:Objective: To explore the methods of the endovascular repair of aortic disease（aortic dissection and aortic aneurysm）.
:Methods :We retrospectively analysed 64cases of aortic diseases treated with endovascular repair, including 42cases of aortic dissection (38 were Stanford B, 4 were Stanford A) and 22 cases of aortic aneurysms. The stentgrafts were set into the aorta cavity to cover the damaged aortic intima through the femoral artery under local or general anesthesia; 4 cases also underwent bypass vascular operations. In 6 cases the left subclavian artery (LSA) was covered by stentgraft at the endovascular therapy without bypass operation.
:Results:Eighteen cases of immediate innerleak were found after the stent placement, a rate of 28.13 % ( 18/64). No other severe complications occurred, such as stentgraft shift or error placement, aortic rupture, conversion to openoperation or paraplegia.The blood flow of all the vital branches of aorta were obviously improved.The mortality in the perioperative period was 6.25 % (4/64 ), the time of followup was 1-78 months (mean 32 months).Reoperation was done in 2 cases of aortic aneurysm group and 2 cases of aortic dissection group.
:Conclusions:The endovascular repair is a good method for aortic disease. The short and middle term result is satistactory, and the long term followup needs to be studied.

Abstract:Objective:To evaluate surgical treatment of femoral pseudoaneurysms caused by injection of addictive drugs.
:Methods :Clinical data of 14 cases of femoral pseudoaneurysm caused by injection of addictive drugs were reviewed retrospectively. Nine patients underwent revascularization with expanded polytetrafluoroethylene(ePTFE) in situ;4 patients underwent revascularization with autologous saphenous vein in situ; 1 patient underwent ligation of profunda femoral artery.
:Results:The distal blood flow of all patients was patent immediately after operation. Eleven patients were followed up for 1 to 45 months, 1 patient had incision infection after discharge and it healed through aggressive antibiotic therapy; the other patients were asymptomatic.
:Conclusions:Revascularization with resection of pseudoaneurysm is an effective procedure for blood supply of limbs in the drug addict patients. When a suitable saphenous vein is not available for transplantation in situ, an artificial vessel graft is still an effective procedure for managing femoral pseudoaneurysms in the drug addict patients. Thorough debridement and avoidance of artificial vessel contamination during operation and sufficient drainage and aggressive antibiotic therapy after operation are the most important factors for preventing infective complications of the graft.

Abstract:Objective:To summarize our experience in management of infected femoral artery pseudoaneurysm caused by addictive drugs injection.
:Methods : Clinical data of 45 cases of infeted femoral artery pseudoaneursysm were reviewed retrospectively. When infected femoral artery pseudoaneurysm was diagnosed, the femoral artery or external iliac artery was ligated and the pseudoaneurysm was resected in all of cases. Anticoagulants and antibiotics were used after operation.
:Results:Lower limbs were salvaged in 44 patients. The ambulation function of affected limb was fine in the shortterm.One limb was amputated because of lower limb deep venous thrombosis and gangrene. Thirtyfour patients (75.6%) were followed up for 3-12 months, the results were satisfactory.
:Conclusions:Femoral artery or external iliac artery ligation is an effective procedure for management of infected femoral artery pseudoaneurysm.

Abstract:Objective:To study the feasibility and invasiveness of handassisted laparoscopic hepatectomy(HALH) for liver cancer.
:Methods :Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group. Data of patients of two groups,Which included operating time, intraoperative blood loss, length of incision, postoperative flatus time, hospital stay, complications and Creactive protein(CRP) were compared.
:Results:The mean intraoperative blood loss, length of incision, postoperative flatus time, hospital stay and CRP in HALH group were significantly less than that in OH group; but there was no significant difference in operating time, or complication and recurrence rate.
:Conclusions:HALH for liver cancer is less traumatic, and achieves faster patient recovery. It is feasible and safe in selected patients.

Abstract:Objective:To study the safety and feasibility of totally laparoscopic D2 gastrectomy for advanced gastric cancer.
:Methods :The clinical records of advanced gastric cancer patients who had totally laparoscopic or open D2 gastrectomy over a 6year period were compared and analysed retrospectively.
:Results:Seventyone cases were selected in this study, including 26 totally laparoscopic gastrectomy (laparoscopic group) and 45 open gastrectomy (open group). All the operations were performed successfully. There was no significant difference between these two groups in terms of number of lymph node dissection (P＞0.05). The operation time was longer, volume of bleeding was less, and postoperative time of bowel gas passage and hospital stay were shorter in laparoscopic group compared to those in open group(P＜0.05). In open group, 2 cases experienced postoperative complications, including 1 anastomotic bleeding and 1 anastomotic obstruction. This two patients recovered with conservative treatment. No complication was experienced in laparoscopic group. In laparoscopic group, patients were followed up for 4 to 63 months and 1 case was lost, and the 1, 3 and 5y survival rate was 100％（20/20）, 92.3％（12/13）, and 66.7％（2/3） respectively. In open group, patients were followed up for 3 to 65 months and 2 cases were lost, and 1, 3 and 5year survival rate was 100％（37/37）, 90.5％（19/21）, and 71.4％（5/7）respectively. There were no significant differences between these two groups in terms of 1, 3, 5year survival rates(P＞0.05).
:Conclusions:This study reveals that totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer, and it presents the superior character of minimal invasion.

Abstract:Objective:To investigate the feasibility and safety of laparoscopic surgical treatment of ulcerative colitis(UC).
:Methods :The clinical data of 5 cases who underwent laparoscopic surgery for the treatment of ulcerative colitis were reviewed.
:Results:All 5 cases successfully underwent laparoscopic surgery. Among them, 4 had total proctocolectomy and ileal pouchanastomosis(IPAA), and 1 had subtotal colectomy plus total proctectomy, and cecumanal anastomosis.The median operating time was 7.5(6.5-9)h, the median blood loss was 250(150-400)mL, the median time to begin semifluid intake after operation was 62(60-86)h, the median time of hospital stay was 12(10-14)d, Postoperative pelvic infection occurred in 1 case, adhesive intestinal obstruction occurred in another case. The median followup time was 22(10-34)months, and the average number of daily bowel movement was 6.5(4-10)d; they were relapsefree, and had normal daily living and work at followup.
:Conclusions:Laparoscopic surgical treatment of ulcerative colitis is associated with minor trauma and rapid recovery, and is safe and reliable, but further accumulation of cases is required.

Abstract:Objective:To compare the clinical efficiency of laparoscopic right hemicolectomy with conventional open right hemicolectomy in a nonrandomized study.
:Methods :The clinical records of 26 patients who underwent laparoscopic right hemicolectomy (laparoscopy group) and 37 patients who underwent conventional open laparoscopic right hemicolectomy(open group) were analyzed.The operative time, blood loss, drainage volume, drainage time, analgesic requirements, time of passage of flatus and stool, time of postoperative stay, and postoperative complications were compared.
:Results:One patient in the laparoscopy group was converted to open surgery. There were no significant differences in operative time, drainage volume and drainage time.Blood loss was significantly less in laparoscopy group（113.20±60.60）mL than in open group（295.95±76.72）mL（t=-9.982, P=0.000）. The analgesic requirement was significantly less in laparoscopy group (48.0％) than in open group（83.8％）（χ2 =7.384, P=0.007）. The postoperative time of passage of flatus and stool, and postoperative stay in laparoscopy group were respectively significantly shorter than those in open group (P＜0.05).
:Conclusions:Laparoscopic right hemicolectomy is a feasible and safe procedure,With excellent minimally invasive effect.

Abstract:Objective:To explore the significance of gene mutation of methylenetetrahydrofolate reductase (MTHFR) C677T in the development of acute mesenteric venous thrombosis(AMVT).
:Methods :Sixtythree cases of AMVT (AMVT group) and 128 healthy controls (control group) were recruited in the study. The concentrations of plasma Hcy and folic acid were respectively measured by reverse phase high performance liquid chromatography and radioimmunity method. The polymorphism of MTHFR C677T was detected by PCR-restriction fragment length polymorphism (PCR-RFLP).
:Results:The plasma Hcy level of the AMVT patients was (23.5±8.8) μmol/L,Which differed significantly from that of the controls,Which was (12.7±6.9) μmol/L (P＜0.01). There was obvious negative correlation between the plasma Hcy and folic acid levels (AMVT: r=-0.42, P＜0.01, control: r=-0.39, P＜0.01). The prevalence of TT genotypes of MTHFR (C677T) between AMVT group and normal control group had significant difference (33.3% vs. 17.2%, χ2=6.31, P＜0.05).
:Conclusions:The higher plasma Hcy level might be a risk factor in the onset of AMVT. The homozygote of MTHFR C677T (TT) may be an important risk factor of AMVT.

Abstract:Objective:To investigate the effect of combined use of antisense oligonucleotide （cmyb ASON） and vascular endothelial growth factor (VEGF) on restenosis after angioplasty.
:Methods :China rabbits were randomly divided to control group, VEGF treatment group, cmyb ASON treatment group, cmyb ASON +VEGF treatment group. Each group consisted of 7 rabbits with the same lesion of left common carotid artery. Evaluation on restenosis was done by pathological section and immunohistochemistry, and WesternBlotting for the expression of PCNA.
:Results:All groups had varying degrees of vascular endothelial and smooth muscle hyperplasia, especially in control group. The hyperplasia in cmyb ASON and VEGF groups were better than control group (P＜0.01), and cmyb ASON + VEGF combination group was baller than cmyb ASON or VEGF groups (P＜0.01). The results of WesternBlotting were similar to those of pathological section.
:Conclusions:Combined use of cmyb ASON and VEGF has definite effect in preventing restenosis after angioplasty, but cmyb ASON and VEGF do not have interrelated synergism.

Abstract:Objective:To search the effect of venous thrombosis (VT) on the endothelial cells (ECs) of nonthrombosis vein segment (ECNT).
:Methods :Ninty rats were divided into a normal group, a thrombosis group established by ligating a section of iliac vein, and a sham operation control group. An electroscope was used to detect the ECs of target vessels morphological changes. The Ecs were collected from nonthrombotic superior vena cava and iliac veins by enzymolysis and studied by flow cytometer to detect the positive rate of apoptosis.
:Results:The morphology of endothelial cells in the nonthrombus vein segments of the thrombosis group showed marked changes compared to those of sham operation control group. Comparison of thrombosis group and sham aperation control group showed significant difference in early apoptosis rate at 1, 2, 4, and 7 d after operation (all P＜0.05, 0.01, P＜0.01).
:Conclusions:Local deep vein thrombosis can lead to endothelial cell injury and early apoptosis of distant vein segment.

Abstract:Objective:To study the diagnosis and operation timing of acute mesenteric ischemia (AMI).
:Methods :A retrospective analysis based on the clinical characteristics, the methods of diagnosis and treatment, and operative results of 21 patients with AMI admitted in our hospital from January 1997 to December 2007 was performed.
:Results:The diagnosis were certified by color doppler ultrasonography in five cases, spiral CT in eleven cases, DSA in two cases, and abdominal exploration in three cases. One case was cured by anticoagulation / thrombolytic therapy; and one case was confirmed with selective vascular angiography and cured by urokinase perfusion via the catheter; after removing the thrombus followed by anticoagulation / thrombolytic via Fogarty balloon catheter, ischemia of intestine completely recovered in three cases, partial small bowel resection were performed in eight cases, “secondlook” operation in two cases, and subtotal small bowel resection in six cases. Three cases developed shortgut syndrome and three cases died after operation.
:Conclusions:Imageological examination is essential for diagnosis of doubtful cases of AMI, and adequate treatments and timely selection of operation are critical to attain early diagnosis and good results.

Abstract:Objective: To study the diagnosis and management of acute primary superior mesenteric venous thrombosis （APSMVT）.
:Methods :The clinical records of 19 cases of APSMVT treated in our hospital in the recent 3 years were retrospectively analyzed.
:Results:Preoperative diagnosis of APSMVT was suspected in only 7 cases. All the cases received emergency operation and 3 cases had reoperation. Among them 17 cases were cured and 2 cases died. Seventeen cases were followed up for 0.5-4 y, and all of them were alive and in good health.
:Conclusions:The diagnosis of APSMVT lacks specificity. Doppler ultrasonography, CT and selective angiography are of great importance for early diagnosis. Total resection of necrotic intestines and appropriate anticoagulation after operation can decrease the mortality and recurrence rate.

Abstract:Objective:To investigate the effect of comprehensive therapy for Cockett syndrome.
:Methods :We retrospectively compared and analyzed the curative effects of comprehensive treatments involving cava filter placement, embolectomy and venous thrombolysis on 7 cases of Cockett syndrome complicated with phlegmasia cerulea dolens (PCD).
:Results:The 7 cases showed classical PCD manifestations with absence of pulsation of dorsalis pedis and posterior tibial arteries, and the diagnosis of Cockett syndrome with associated PCD was confirmed by doppler ultrasound All cases received embolectomy combined with venous thrombolysis, 3 underwent cava filter placement, 3 underwent Fogarty catheter interruption, and 1 underwent PALMA operation. After operation, the dorsalis pedis artery pulsation was restored, pain and swelling disappeared, and there were no postoperative complications in all the 7 cases. Six months to three years followup showed no recurrent thrombosis or other complications occarred.
:Conclusions:Comprehensive therapy with intervention procedure, open operation and thrombolysis for treatment of Cockett syndrome complicated with phlegmasia cerulea dolens is effective and safe, and with high shortterm success rate.

Abstract:Objective:To discuss the efficiency and influential factors that can improve the function of deep venous valve after superficial vein surgery of lower extremity.
:Methods :Sixty (70 limbs) patients with primary deep venous insufficiency were enrolled to accept surgical management of superficial vein systems. All patients were examined with color Doppler ultrasonography, and their deep venous hemodynamics index was measured, recorded and compared before operation and six months after operation.
:Results:The total improvement rate of the deep venous hemodynamics after superficial vein surgery was 65.7%. For those patients with disease course longer than 20 years, the rate of inefficiency was 4.355 times more than those whose course was less than or equal to 20 years, and for those patients with reflux both in superficial femoral vein and popliteal vein, the rate of inefficient improvement was 4.247 times more than those with reflux only in a single vein. For those patients who were older than 60 years, the rate of inefficient improvement was 3.516 times more than those younger than 60 years.
:Conclusions:This study demonstrates that the superficial vein operation for varicose veins of lower extremity can improve deep vein valve function to some extent. It has a good shortterm effect, and can be used selectively in the patients with early deep venous insufficiency.