Abstract:

Abstract:

尽管近几十年来开放式胸腹联合大动脉瘤（TAAA）修补术进展显著，但技术上的挑战，及发症率和病死率问题仍然严峻，尤其是对于那些具有大范围动脉瘤或者已有主动脉弓手术史以及手术条件较差的患者。杂交型型胸腹大动脉瘤修补术是一种值得注意的技术并可能成为一种“过渡”的解决办法当我们等待演进中的全血管内应用网状带分支支架修复TAAA技术的大系列可重复的结果。

Abstract:此视频按步骤描述了使用分叉支架型血管完全腔内治疗胸腹部主动脉瘤的方法。我们比较了术前和术后CT上的变化并显示此项技术的3D及真实图像。

Abstract:Objective: To investigate the clinical efficacy of axillo-axillary crossover bypass grafting for subclavian steal syndrome and its effect on improvement of vertebral blood flow. Methods: The clinical data of 64 patients with arteriosclerotic subclavian steal syndrome undergoing axillo-axillary prosthetic bypass grafting over the past 7 years were retrospectively analyzed. Results: The success rate for bypass surgery was 100%, and no perioperative death occurred in the entire group. Five patients developed wound hematoma, 8 patients had symptoms of nerve injury, and no case of wound or graft infection was noted after surgery. Among the 55 patients followed up, the symptoms in 49 cases were improved, and vertebral blood flow improvement was seen in 94.87% (37/39) of the patients with stage IV retrograde vertebral flow and in 62.50% (5/8) of the patients with stage III retrograde vertebral flow, but no improvement was found in the two patients with stage II retrograde vertebral flow. No symptomatic improvement was observed after surgery in two patients, and 4 patients developed dizziness or limb numbness again during 3 to 25 months following surgery, and 5 of these 6 cases had improvement of vertebral blood flow. After surgery, the mean pressure gradient between upper limbs reverted to 10.22 mmHg, prosthetic thrombosis occurred in 4 cases and new cerebral infarction developed in 4 cases. Conclusion: Axillo-axillary crossover bypass grafting is a safe and effective procedure for patients with subclavian steal. This procedure can effectively improve blood flow in the vertebral artery, but the vertebral flow improvement is not always associated with symptomatic improvement.

Abstract:

Objective: To evaluate the therapeutic efficacy of reversed autogenous saphenous vein bypass for thromboangiitis obliterans of the lower extremities. Methods: The clinical data of 21 patients with thromboangiitis obliterans undergoing reversed antogenous saphenous vein bypass grafting from January 2007 to May 2012 were retrospectively analyzed. Of the patients, 9 cases underwent superficial femoral-posterior tibial bypass grafting, 5 cases underwent superficial femoral-peroneal bypass grafting, 4 cases underwent superficial femoral-distal popliteal bypass grafting, and 3 cases underwent popliteal-posterior tibial bypass grafting. Results: Attempt of superficial femoral-posterior tibial bypass procedure in one patient was aborted due to inefficient outflow found at the time of surgery. The operation was accomplished in 20 patients, so the success rate was 95.2%. After surgery, the patients showed improvement of the distal blood supply of the affected leg, no rest pain, prolongation of intermittent claudication distance, and ulcer healing. The average ankle brachial index (ABI) was increased from 0.46±0.12 before surgery to 1.05±0.07 after surgery (P<0.001). Eighteen patients were followed up for 5 to 59 months with an average of (30.6±7.5) months, and the improvements in these patients were sustained. Conclusion: The reversed antogenous saphenous vein bypass is an effective treatment for thromboangiitis obliterans of the lower extremities in patients with available outflow.

Abstract:Objective: To investigate the clinical efficacy of stent-assisted angioplasty for atherosclerotic renal artery stenosis (ARAS). Methods: The clinical data of 27 ARAS patients undergoing stent-assisted angioplasty over 3 years were retrospectively analyzed. All patients were regularly followed after surgery (1 month, and 3, 6, and 12 months, postoperatively), for determination of the stenosis ratio of the renal artery, renal arterial resistive index (RI), blood pressure, serum creatinine (SCr), glomerular filtration rate (GFR) and number of antihypertensive drugs required. Results: Operation was successfully performed in all the 27 patients, and technical success rate was 100%. All the observed parameters of the patients were markedly improved at each observation time point after surgery, and all differences between pre- and post-operative parameters reached statistical significance (all P<0.05). During the 1-year follow-up, the incidence for restenosis of the renal artery was 14.8% (4/27), improvement rates for SCr and GFR were 92.6% (25/27), 85.2% (23/27), 74.1% (20/27), 66.7% (18/27) and 81.5% (22/27) respectively, and number of antihypertensive drugs used was decreased 63.0% (17/27). Conclusion: Application of stent-assisted angioplasty can significantly improve renal function, decrease blood pressure and also reduce the number of antihypertensive medications in ARAS patients, and it has satisfactory safety and efficacy results.

Abstract:Objective: To investigate the efficacy and safety of anticoagulant and thrombolytic treatment for deep venous thrombosis (DVT) of lower extremity. Methods: The clinical data of 139 patients with lower limb DVT were retrospectively analyzed. Of the patients, 106 cases had DVT in the left leg, 28 cases in the right leg and 5 cases in both legs, and all of them were diagnosed by lower extremity venous Doppler examination. All patients underwent anticoagulant treatment with subcutaneous injection of low molecular weight heparin calcium (4 100 U/12 h), 57 cases of whom received thrombolytic therapy with urokinase (100 000 U/12 h) based on the length of onset to admission interval and the absence of contraindications to the medication, and all patients had antiaggregant therapy with intravenous infusion of low molecular dextran (250–500 mL/d). Cephalosporin antibiotics were used for patients with evident redness and swelling of the affected leg or an increased white blood cell count. Warfarin anticoagulant therapy was continued for at least 6 months after discharge. Results: Except for one patient with an advanced malignant tumor who was discharged from hospital on request, all the other patients were discharged from the hospital after their swelling and pain in the affected legs were relieved. One patient complicated by pulmonary embolism at admission refused the inferior vena cava filter placement due to economic reasons, and recovered after anticoagulant and thrombolytic treatment. No complications such as evident bleeding were noted in any of the patients during therapy. Follow-up for one month to three years (average of 14 months) was obtained in 121 patients, and all of them had recovered and returned to normal life. Conclusion: Anticoagulant and thrombolytic treatment with low molecular weight heparin and urokinase is safe and effective for lower limb DVT.

Abstract:Objective: To evaluate the outcomes of minimally invasive endovascular treatment for post-thrombotic syndrome (PTS) following deep vein thrombosis (DVT) of the lower extremity. Methods: The clinical data of 262 PTS patients (275 limbs) after lower extremity DVT treated within 7 years were retrospectively analyzed. All patients underwent minimally invasive endovascular treatment under local anesthesia. In these patients, 74 limbs underwent percutaneous transluminal angioplasty (PTA), and 201 limbs received PTA plus stent placement. Results: Two-hundred and sixty-eight legs (97.5%) were successfully treated, with complete recanalization of the occluded vessel and restoration of the normal blood flow. Seven legs (failure to traverse the left common iliac vein segment) were partially recanalized via ascending lumbar vein or collateral veins. Two-hundred and forty patients (91.6%), 253 legs were followed up for 8 to 96 months with mean period of (48.3±20.2) months, and 94 limbs (37.2%) achieved complete relief, 152 limbs (60.0%) obtained significant relief, and 7 limbs (2.8%) had minor relief. Conclusion: Endovascular management is an effective treatment for PTS following lower extremity DVT with minimal invasiveness and fast recivery.

Abstract:Objective: To investigate the complications of integrated interventional treatment for mixed type of lower extremity deep vein thrombosis (LEDVT) and their management. Methods: The clinical data of 488 patients with acute or subacute mixed type LEDVT treared during 7 years were retrospectively analyzed. All patients underwent inferior vena cava filter placement, and subsequently underwent mechanical thrombus fragmentation and aspiration, catheter-directed thrombolysis and anticoagulant therapy. Intrapulmonary catheter-directed thrombolysis was performed in patients with symptomatic pulmonary embolism (PE), and balloon dilation angioplasty (percutaneous transluminal angioplasty, PTA) or post-PTA stent insertion was performed in patients with iliac vein stenosis or occlusion. Results: The incidence of symptomatic PE was 7.58% (37/488), and 2 of the PE patients (2/37) died in spite of aggressive salvage attempts. The incidence of vascular injury and large thrombus trapped by the filter during the integrated interventional treatment was 9.22% (45/488) and 16.60% (81/488), respectively. The incidence of abnormal bleeding during postoperative anticoagulation was 5.53% (27/488), and 2 of these patients died due to intracerebral hemorrhage. Four hundred and fifty-one patients were followed up for 4 to 94 months with average period of 41 months, during which time, the incidence of post-thrombotic syndrome (PTS) was 11.53% (52/451), and the incidence of post-PTA restenosis and reocclusion after stent placement was 40.19% (43/107) and 6.6% (7/106), respectively. Conclusion: Integrated interventional treatment for mixed type of LEDVT carries a certain risk of complications, so several preventive measures should be taken.

Abstract:Objective: To observe the influences of ligation or non-ligation of the five main tributaries of the great saphenous vein (GSV) on the efficacy of endovenous microwave ablation for GSV varicose veins. Methods: Endovenous microwave ablation was performed in 600 patients with GSV varicose veins. Of the patients, 400 cases (635 limbs) underwent GSV high ligation plus endovenous microwave ablation of the main GSV trunk, and percutaneous microwave ablation of the superficial varicose veins and pathological perforating veins of the legs (observational group), while another 200 cases (313 limbs) were subjected to ligation of the five main GSV tributaries in addition to the above mentioned procedures (control group). Results: Satisfactory clinical efficacy was obtained in both groups of patients after operation. No significant differences were noted between the two groups in the improvement of the superficial varicose veins, leg swelling, pigmentation and ulcers, as well as the incidence of postoperative complications and 5-year recurrence rate (all P>0.05). Ultrasound imaging showed that the flow velocity and inner diameter of the common femoral vein in observational group were significantly reduced after operation versus those before operation (both P<0.05); while in control group, the flow velocity of the common femoral vein was significantly decreased (P<0.05), but the decreased level of the inner diameter did not reach a statistical significance compared with that before operation (P>0.05). Conclusion: Whether the five main GSV tributaries are ligated or not does not substantially influence the outcomes of endovenous microwave ablation in treatment of GSV varicose veins.

Abstract:Objective: To investigate the significance of the valvular incompetence of the popliteal vein in primary chronic venous insufficiency (PCVI) of the lower extremities. Methods: The data of 268 PCVI patients that met the inclusion criteria were divided, according to the lesion’s location, into sapheno-femoral valve incompetence group, superficial femoral vein valve incompetence group, popliteal vein valve incompetence group, and femoral-popliteal vein valve incompetence group, with 67 cases in each group. The differences in Kistner’s classification, venous segmental disease score (VSDS), clinical (C) classification, venous clinical severity score (VCSS) and venous disability score (VDS) among the groups were determined. Results: The Kistner’s classification, VSDS, C classification, VCSS and VDS in popliteal vein valve incompetence group were all higher than those in sapheno-femoral valve incompetence group or superficial femoral vein valve incompetence group, with all differences achieving statistical significance (all P<0.05), but were all lower than those in femoral-popliteal vein valve incompetence group, with some differences reaching statistical significance (Kistner classification and VSDS) (both P<0.05). The correlation between lesion’s location and Kistner’s classification had statistical significance (r=0.926, P=0.000), and the correlationship between Kistner’s classification and C classification were affected by the factors such as sex, age, and course of disease (all P<0.05). Conclusion: Valvular incompetence of the popliteal vein can aggravate the venous reflux in lower limbs, expand the range of venous disease, exacerbate the clinical symptoms and decrease working ability.

Abstract:Objective: To investigate the alteration patterns of matrix metalloproteinases (MMP-2, MMP-9) and transforming growth factor β1 (TGF-β1) in inferior vena cava (IVC) after injury and the effects exerted by granulocyte colony-stimulating factor (G-CSF). Methods: Forty-eight rabbits were randomly divided into experimental group (treated with G-CSF after operation) and control group (treated with normal saline) after IVC balloon injury was performed. The injured vascular segments (n=6) in both groups of rabbits were excised on postoperative day (POD) 3, 7, 14, and 28 respectively, for immunochemical staining of MMP-2, MMP-9 and TGF-β1. Results: In uninjured rabbit IVC, there was a small amount of MMP-2 and MMP-9 expression, and nearly no TGF-β1 expression. After injury, the expressions of all the three factors in IVC were significantly increased, and all of them reached their maximal degrees on POD 7 and then declined. G-CSF treatment showed no effect on the expression of the three factors during the course of their increase (3 and 7 d) (both P>0.05 vs. control group), but markedly accelerated the decreasing tendency of their levels (14 and 28 d) (both P<0.05 vs. control group). Conclusion: There are short-term increased expressions of remodeling-associated factors in IVC after intimal injury. G-CSF cannot inhibit the increase of these factors but can accelerate their decrease, and may be favorable for the inhibition of excessive proliferation of the vascular smooth muscle cells and acceleration of the reendothelialization process.

Abstract:Objective: To observe the expression alterations of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in the endothelial cells of rabbits with thrombosis of posterior vena cava (PVC) and the effects exerted by thrombolytic and anticoagulant therapy. Methods: Sixty healthy adult New Zealand white rabbits were equally randomized into model group and treatment group after the establishment of PVC thrombosis model with the coarctation procedure. After the confirmation of model establishment by contrast examination on the second postoperative day, rabbits in treatment group received thrombolytic and anticoagulant therapy while those in model group were given normal saline of the same volume. At the 1, 4 and 7 d after dosing administration, 10 rabbits at each time point were randomly selected from each group, and the expressions of VEGF and bFGF in the endothelial cells of the involved PVC were detected by immunohistochemical staining. Meanwhile, 10 normal New Zealand rabbits served as control. Results: There was only a small amount of VEGF and bFGF expression in the endothelial cells of normal rabbits. In the two experimental groups, the VEGF expressions in the endothelial cells of the involved PVC were significantly increased versus control (all P<0.05), and the increases were progressively greater during the observation period, but the increasing amplitude at each time point in treatment group was significantly greater than that of model group (all P<0.05); the alteration pattern of bFGF was generally similar to that of VEGF, but it reached the peak at 4 d after administration and did not continue to rise. Conclusion: The increased VEGF and bFGF expressions in the endothelial cells may be an endogenous protective action following acute venous thrombosis, and thrombolytic and anticoagulant therapy can promote this action.

Abstract:Objective: To observe the expression alterations of SM22α, osteopontin (OPN) and cytoskeletal proteins including α-SMA, β-tubulin and desmin in human abdominal aortic aneurysm (AAA) tissues. Methods: The tissues from normal abdominal aortic wall and AAA wall were harvested, and then mRNA and protein expression levels of SM22α, OPN, α-SMA, β-tubulin and desmin in the two types of tissues were determined by real-time PCR assay and immunohistochemical staining, respectively. Results: Compared with normal abdominal aortic tissue, in AAA tissue, both mRNA and protein expressions of SM22α, α-SMA, β-tubulin and desmin were significantly decreased, especially that of SM22α, whereas the mRNA and protein expression levels of OPN were significantly increased (all P<0.05). Conclusion: There is decreased expression of SM22α and cytoskeletal protein level, and increased OPN level in AAA tissue, which may be closely associated with the occurrence of AAA.

Abstract:Objective: To observe the apoptotic level alterations in the wall of different segments of great saphenous varicose vein. Methods: Twenty great saphenous varicose veins (observation group) and 12 normal great saphenous veins (control group) were collected, and the apoptosis in their upper, middle and lower segments were determined by TUNEL assay and immunofluorescence staining, respectively. Results: In observation group, only scattered apoptotic cells were found in the venous walls (tunica intima and tunica media), which were almost uniformly distributed at the three segments, while there were considerably more apoptotic cells in the venous walls (tunica intima and tunica media) in control group, and the apoptosis was more evident in the upper segments than those of the lower segments. The quantitative analysis showed that the apoptotic rates in either the tunica intima or tunica media in observation group were significantly lower than those in their corresponding regions in control group (all P<0.05); statistical significances in apoptotic rate were found between some of the segments after intra-group comparison for each group (P<0.01 or P<0.05), but generally, the apoptotic rate was higher in the upper segment than that in the lower segment and higher in the tunica intima than that in the tunica media. Conclusion: In the wall of great saphenous varicose vein, the apoptotic level is decreased, and there was no apoptotic rate difference between segments in the normal great saphenous vein.

Abstract:Objective: To investigate the influence of survivin gene silencing on chemotherapy sensitivity of drug resistant cell line of human hepatocellular carcinoma to doxorubicin. Methods: Three siRNA sequences targeting human survivin gene were designed and synthesized, and then were transfected into hepatocellular carcinoma BEL-7402 cells (3 groups of cells) by liposome-mediated method, respectively. Using the untransfected BEL-7402 cells as control, the expressions of survivin gene and protein as well as sensitivity to doxorubicin in each group of cells were determined by RT-PCR method, immunocytochemical staining and MTT assay, respectively. Results: Compared with control group of cells, both survivin gene and protein expressions in each transfected group of cells were significantly decreased (all P<0.05). The value of half inhibitory concentration (IC50) of doxorubicin for control group of cells was (20.60±2.86) μg/mL, while the IC50 values for the three groups of transfected cells were (11.53±1.46) μg/mL, (14.13±1.82) μg/mL and (15.53±0.46) μg/mL respectively, all of which had statistical differences versus control (all P<0.05). Conclusion: Inhibition of survivin gene expression can increase the chemotherapy sensitivity of BEL-7402 cells to doxorubicin.

Abstract:Objective: To compare the clinical efficacy of oxaliplatin plus tegafur-gimeracil-oteracil potassium (S-1) and XELOX (oxaliplatin+capecitabine) regimen in adjuvant chemotherapy for postoperative gastric cancer patients. Methods: Eight-one stomach cancer patients were randomly assigned to observational group (n=41) and control group (n=40) after surgery. Patients in observational group received oxaliplatin+S-1 regimen, while those in control group were treated with XEOLX regimen. Results: The 1- and 2-year recurrence-free survival (RFS) for observational group was 51.3% and 61.5%, and for control group was 25.6% and 20.5%, while the 1- and 2-year overall survival (OS) for observational group was 64.1% and 69.2%, and for control group was30.8% and 25.6% respectively, and all differences had no statistical significance (P=0.361, 0.591; P=0.631, 0.615). The toxic and side effects seen in both groups were mainly myelosuppression, gastrointestinal reactions, hand-foot syndrome, oral mucositis, and peripheral neuropathy as well as hepatic and renal function damage, among which, the incidence of hand-foot syndrome in control group was significantly higher than that in observational group (P=0.001); all the toxic and adverse reactions were resolved by symptomatic treatment. Conclusion: Oxaliplatin+S-1 regimen has an efficacy equivalent to XELOX regimen in adjuvant chemotherapy for postoperative gastric cancer.

Abstract:Objective: To analyze the factors affecting the tumor-free survival of primary liver cancer (HCC) patients undergoing postoperative transarterial chemoembolization (TACE). Methods: The clinical and follow-up data of 121 HCC patients undergoing TACE within 1-2 months after hepatectomy were retrospectively analyzed. The cumulative tumor-free survival rates of the patients after treatment were calculated, and the associated factors for tumor-free survival were determined. Results: The 1-, 2- and 3-year tumor-free survival rates for the 121 patients were 72.73%, 46.21%, and 28.93%, respectively. Among the clinical variables that entered the COX proportional hazards model after screen by univariate analyses, the degree of tumor differentiation (P=0.040), tumor size (P=0.002) and the absence or presence of vascular tumor thrombus (P=0.039) made statistically significant contributions to the model. Conclusion: Degree of tumor differentiation, tumor size and the presence of vascular thrombus are independent risk factors for HCC recurrence within a short period of time after postoperative TACE treatment.

Abstract:Objective: To compare the clinical effects between hand-assisted laparoscopic splenectomy and open splenectomy by means of systematical review. Methods: The domestically published literature of studies (1991 to 2012) regarding hand-assisted laparoscopic splenectomy versus open splenectomy was collected, and the studies that met the inclusion criterion were reviewed by Meta-analysis. Results: Eight studies were finally included after screen, with a total of 419 patients, of whom, 202 cases received hand-assisted laparoscopic splenectomy (hand-assisted group) and 217 cases underwent open splenectomy (open surgery group). The results of Meta-analysis showed that the operative time was prolonged, but the intraoperative blood loss, time to gastrointestinal function recovery and length of hospital stay were all reduced in hand-assisted group compared with open surgery group (all P<0.05). Conclusion: Hand-assisted laparoscopic splenectomy has the advantages of less bleeding, fast gastrointestinal function recovery and short hospital stay. However, this conclusion should be considered cautiously, due to the risk of bias created by many non-randomized studies included in this review. So it remains to be confirmed by further multi-center, large sample size and randomized controlled trials.

Abstract:The most efficient treatment for acute lower extremity arterial embolism is thromboembolectomy with Fogarty balloon catheter, but incomplete restoration of perfusion, due to existence and propagation of residual thrombi or presence of underlying atherosclerotic steno-occlusive lesions, can lead to poor clinical outcome and the hybrid therapeutic strategies may be solutions to this problem. The hybrid surgery combined with the advantages of open and endovascular treatment may overcome the limitations that characterize the traditional approaches. This review article summarizes the common hybrid treatment options for acute lower extremity arterial embolism.

Abstract:For prevention of the bypass vein graft stenosis, the gene-level investigations are obviously of great importance. This paper reviews the current literature regarding the gene-level investigations on vein graft stenosis, both at home and abroad. Its main focus is on the studies towards application of the genes involved in reendothelialization acceleration, anti-thrombosis, and inhibition of the vascular smooth muscle cell proliferation or extracellular matrix deposition, as well as multi-gene combination for vein graft restenosis. There is also a speculation on the direction of future development in this field.

Abstract:Stomach cancer is one of the most common malignant tumors, so the establishment of a reliable animal model of this disease has important significance in elucidating its causes and pathogenesis as well as screening the prevention and treatment drugs. At present, the animal models of gastric cancer, according to the level and purpose of study, are classified into long-term induction model, rapid xenograft tumor formation model and other specific models. This paper overviews the current status of the available animal models with regard to the animal selection, creation methods, and scope of application, etc.

Abstract:According to the current stem cell theory of the origin of cancer, the tumor growth results from the proliferation of a small amount of cancer stem cells, and the proliferation of cancer stem cells is regulated by a number of signaling pathways. In this paper, the authors present the research progress concerning the signaling pathways associated with the growth of gastrointestinal cancer stem cells.