ObjectiveTo summarize the surgical technique and indications for liver masses involving the second and the third porta hepatis.MethodsThirteen cases of liver mass involving the second and the third porta hepatis, who underwent surgery in West China Hospital of Sichuan University from June 2013 to September 2016 were collected retrospectively, then made a statistical analysis, including patients’ information, characteristics of liver masses, operation information, and result of followed-up.ResultsOf the 13 cases, there were 3 cases of hepatic alveolar echinococcosis, 4 cases of hepatocellular carcinoma, 4 cases of intrahepatic cholangiocarcinoma, and 2 cases of liver metastasis induced by colon cancer. The mean tumor diameter was 12.5 cm (7–21 cm). Preoperative imaging examinations showed that mass had involved the second and the third porta hepatis, and all masses were resected by surgery without perioperative death, including 7 cases of right three hepatectomy resection, 1 case of left three hepatectomy resection, 4 cases of right hepatectomy resection, and 1 case of left hemi hepatectomy resection; among them, 9 cases were performed caudal lobectomy resection. The mean of operative time was 313 min (210–450 min), the mean of intraoperative blood loss was 592 mL (300–1 100 mL). Four cases received blood transfusion with 300–450 mL (mean of 338 mL). The total hepatic blood inflow occlusion time was 25–55 min (mean of 42 min). Five cases received venous reconstruction, and 1 case received hepatic vein reconstruction. After operation, ascites occurred in 6 cases, pleural effusion occurred in 6 cases, liver failure occurred in 2 cases, bile leakage occurred in 2 cases, pulmonary infection occurred in 3 cases, deep vein thrombosis occurred in 1 case. All of the 13 cases were followed-up for 1–39 months (median time was 14 months), during the followed-up period, 4 cases died, including 3 cases of intrahepatic cholangiocarcinoma and 1 case of liver metastasis induced by colon cancer.ConclusionIt is encouraging to apply the vascular reconstruction and skilled hepatic partition technique for resection lesions which involved the second and the third porta hepatis, through meticulous preoperative evaluation and preparation.
ObjectivesTo evaluate the learning curve of radical hepatectomy combined with vascular and/or bile duct reconstruction (RHVBR) in the treatment of hepatic alveolar echinococcosis (HAE), and to explore the feasibility and safety of RHVBR. MethodsThe clinical data of 203 patients who received RHVBR treatment for HAE complicated with vascular invasion in West China Hospital from 2010 to 2018 were analyzed retrospectively. Cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) were used to analyze the learning curve of RHVBR, determine the learning stage, and compare the differences of intraoperative and postoperative outcome indexes in different learning stages. ResultsThe average operative time was (537.9±207.6) minutes, with blood loss amounted to 617.3 (138.9, 1 094.2) mL. Postoperative complications occurred in 65 cases, and the incidence of complications was 32.0%. Among them, 29 cases (14.3%) had serious complications. Three cases (1.5%) died within 90 days after operation. The results of RA-CUSUM analysis showed that 54 cases of surgery were the cut-off point of learning curve for serious postoperative complications. According to the results of CUSUM analysis, the whole queue was divided into the first stage (n=53) and the second stage (n=150) based on the completion of 53 operations. Compared with the first stage, the operative time and total postoperative hospital stay in the second stage was shortened, the incidence of serious complications was reduced, and the number of resected liver segments was increased. The differences were statistically significant (P<0.05). ConclusionIt is feasible and safe to treat HAE with RHVBR, and the incidence of serious complications is obviously reduced after 54 cases of operation.
Objective By observation of the diameter, progression rate, wall thickness, and the opening angle of the abnormal aortic of abdominal aortic aneurysm (AAA) in rats, to observe the effect of saturated hydrogen saline on residual strain of AAA rats, and to investigate its inhibition effect on AAA formation. Methods Twenty healthy male Sprague Dawley rats (weighing, 200-220 g) were randomly divided into 2 groups, which was made the AAA model by infiltration of the abdominal arota with 0.5 mol/L calcium chloride. Saturated hydrogen saline (5 mL/kg) or saline (5 mL/kg) was injected intraperitoneally in the experimental group or control group respectively, every day for 28 days. At 28 days, the diameter, progression rate, wall thickness, and opening angle of the abnormal aorta were mearsured. The aortic tissue was harvested for histological examination (HE staining and aldehyde-fuchsin staining). Results At 28 days after operation, the diameter of abnormal aorta in 2 groups were significantly higher than preoperative ones (P lt; 0.05), the progression rate in experimental group (65% ± 15%) was significantly lower than that in control group (128% ± 54%) (t=3.611, P=0.005). The opening angle and the wall thickness in experimental group were (88.78 ± 29.20)° and (0.14 ± 0.03) mm respectively, had significant differences when compared with the values in control group [(44.23 ± 28.52)° and (0.36 ± 0.05) mm respectively] (P lt; 0.01). The integrity and continuity of the aortic wall in experimental group were superior to that in the control group. Compared with the control group, the injury of elastic fiber in aortic wall and the infiltration of inflammation were all reduced. Conclusion Saturated hydrogen saline can maintain good mechanical properties and reduce dilatation of the aorta by increasing residual strain and reducing the remodeling of it.
Objective To compare the therapeutic effect of one-stage direct revascularization and medicine therapy for the treatment of ischemic moyamoya disease. Methods From March 2002 to March 2008, 18 patients with ischemic moyamoyadisease (12 males and 6 females) were treated, aged 9 to 33 years old. Eighteen patients presented with ischemic stroke, including 11 cases of cerebral infarction and 7 cases of transient ischemic attack. According to Chinese ischemic cardiovascular diseases evaluation tools, 17 patients were classified as low risk ischemic stroke and 1 as modernte risk ischemic stroke. Different levels of occlusion branch of the intracranial carotid arteries and pathosis collaterals were identified by DSA. Fourteen patients and 4 patients were showed unilateral and bilateral hypoperfusion of cerebral blood flow by single photon emission computed tomography, respectively. Eleven patients received superficial temporal artery-middle cerebral artery anastomosis and 7 patients received medicine (anti-PLT agglutinin and calcium channel blocker). Results All incisions healed at stage I. There was no stroke events during perioperation. Anastomosis vessel vasospasm occurred in 2 patients 5 days after operation; and hyperperfusion syndrome in 1 patient 2 weeks afteroperation. All patients were followed up 13-32 months (mean 18 months). In 11 anastomosis patients, 6 underwent 6 stroke events within 12 months; in 7 medicine patients, 6 underwent 11 stroke events within 12 months; and showing a significant difference (P lt; 0.05). The stroke recurrence rate was 85.7% in medicine patients and 54.5% in anastomosis patients 12 months after therapy. DSA showed pathosis collaterals in 7 anastomosis patients and 6 medicine patients 6 months after therapy. After 12 months according to modified Rankin scale, the scores of anastomosis patients were 3 points in 1 case, 2 points in 6 cases and 0-1 point in 4 cases, and the scores of medicine patients were 2 points in 2 cases and 0-1 point in 5 cases; showing no significant difference (P gt; 0.05). Conclusion As long as onset of stroke occurred and ischemic moyamoya disease is diagnosed, one-stage direct revascularization should be performed, which can reduce the rate of stroke recurrence risk and slow down the progression of disease.
Objective To investigate the efficacy of minimally invasive osteotomy with preservation of blood supply to the transversely transported bone segment in the treatment of chronic ischemic lower limb diseases using tibial transverse bone transport. Methods A retrospective analysis was conducted on the clinical data of 12 patients with chronic ischemic lower limb diseases who met the selection criteria and were treated between June 2016 and December 2023. The cohort included 7 males and 5 females, aged 26-87 years (mean, 61.2 years). Among them, 7 patients had diabetic foot (DF), including 2 cases complicated by arteriosclerosis obliterans (ASO), with a DF duration ranging from 1.7 to 23.0 months (mean, 9.6 months) and ulcer sizes ranging from 3.2 cm×2.4 cm to 10.0 cm×6.6 cm. Three patients had ASO with a disease duration of 1.7-23.0 months (mean, 10.4 months) and ulcer or post-amputation wound sizes ranging from 2.2 cm×2.1 cm to 12.0 cm×7.7 cm. Additionally, 2 patients with thromboangiitis obliterans (TAO) had a disease duration of 7 and 12 months, respectively. Preoperatively, the mean foot skin temperature was (27.63±0.34)℃, and the visual analogue scale (VAS) score was 8.5±0.7. All patients underwent tibial transverse bone transport using minimally invasive osteotomy while preserving the blood supply to the transported bone segment. Postoperative complications and foot ulcer healing were observed. The effectiveness of tibial transverse bone transport was evaluated by comparing preoperative and postoperative foot skin temperature, VAS scores, as well as through CT angiography (CTA).Results One DF patient with ASO was lost to follow-up, while the remaining 11 patients were followed up 10-29 months (mean, 20.5 months). One DF patient had a displaced fracture at the site of tibial transport due to trauma, which healed after plaster immobilization; 1 DF patient had a small amount of pigmentation in the skin of the donor site, but the blood circulation was good; no complication such as pin tract infection, skin necrosis, or osteomyelitis occurred in the donor site of all patients. At 2-3 weeks postoperatively, the foot skin temperature was (34.21±0.65)℃, and the VAS score was 0.3±0.1, both significantly improved compared to preoperative ones (t=−31.578, P<0.001; t=49.000, P<0.001). Two TAO patients experienced recurrent, persistent, intolerable pain at 7-10 days postoperatively, with no reduction in ulcer size or necrotic areas; 1 underwent toe amputation, and the other required a mid-leg amputation. The remaining patients achieved complete ulcer healing, with healing time ranging from 5.1 to 9.2 weeks (mean, 6.8 weeks). CTA showed no new vascular occlusions or embolisms. X-ray films at 4 months postoperatively demonstrated proper repositioning and good healing of the transported tibial bone segment. ConclusionThe application of minimally invasive osteotomy with preserved blood supply to the transversely transported bone segment in tibial transverse bone transport for the treatment of chronic ischemic lower limb diseases effectively minimizes extensive soft tissue dissection, reduces surgical soft tissue damage, and better maintains local blood supply. This approach lowers the risk of postoperative infection and skin necrosis while accelerating postoperative recovery.
ObjectiveTo explore the vascular conditions and the necessity of vascular reconstruction in the treatment of chronic ischemic diseases of lower extremities with tibial transverse transport (TTT) from the perspective of vascular surgery.MethodsA clinical data of 59 patients with chronic ischemic disease of lower extremities treated by TTT between February 2014 and July 2019 were analyzed retrospectively. Among them, there were 41 patients with diabetic foot (DF), including Wagner grade 3-4, Texas grade 2-3, and stage B-D lesions; the disease duration ranged from 0.7 to 2.4 years, with an average of 1.5 years, and 5 cases complicated with arteriosclerosis obliteran (ASO). There were 14 patients with ASO (Fontaine stage Ⅳ and Rutherford stage Ⅲ-Ⅳ) with an average disease duration of 10.8 months (range, 1.5-23.4 months). There were 4 patients with thromboangiitis obliteran (TAO) with an average disease duration of 12.3 months (range, 2.1-18.2 months), and the clinical stages were all in the third stage. In 18 patients that ankle brachial index (ABI) of anterior or posterior tibial artery was less than 0.6 before operation, or the blood flow of the three branches of inferior anterior tibial artery did not reach the ankle by imaging examination, vascular reconstruction was performed before TTT (5 cases of DF combined with ASO, 12 of ASO, 1 of TAO). After operation, the effectiveness was evaluated by ulcer wound healing, skin temperature, pain visual analogue scale (VAS) score, ABI, and CT angiography (CTA) examination.ResultsThe patients with DF were followed up 8-16 months (mean, 12.2 months); the ulcer wounds healed with a healing time of 5.1-9.2 weeks (mean, 6.8 weeks); CTA examination showed that the branches of inferior anterior tibial artery were opened in 5 patients after revascularization; and the tibial osteotomy healed for 5-14 weeks (mean, 8.3 weeks). The patients with ASO were followed up 13-25 months (mean, 16.8 months); the ulcer wounds healed with a healing time of 6.2-9.7 weeks (mean, 7.4 weeks). CTA examination showed that the branches of inferior anterior tibial artery were opened in 12 patients after revascularization; all tibial osteotomy healed, and the healing time was 4.5-14.4 weeks (mean, 10.2 weeks). The patients with TAO were followed up 12-23 months with an average of 12.3 months, and toe/limb amputation was performed after ineffective treatment. The patients were divided into two groups according to whether they were combined with revascularization or not. The ABI, VAS score, and skin temperature in the combined revascularization group significantly improved at 6 months after operation (P<0.05); while there was no significant difference in ABI at 6 months after operation in the TTT group (P>0.05), but the skin temperature and VAS scores significantly improved when compared with those before operation (P<0.05).ConclusionThe ABI of anterior or posterior tibial artery is more than 0.6, radiological examination shows that at least one of the three branches of inferior anterior tibial artery leads to ankle artery, which is a prerequisite for successful TTT in the treatment of chronic ischemic disease of lower extremities. DF is the indication of TTT. ASO can choose TTT, and TAO should use this technique cautiously.
Objective To investigate the safety and feasibility of transcatheter arterial chemoembolization (TACE) assisted by transradial approach and cone beam computed tomography (CBCT) three-dimensional vascular reconstruction in the treatment of primary liver cancer. Methods The clinical data of 124 patients with primary liver cancer who underwent precision TACE via radial artery in our hospital from May 2018 to December 2019 were retrospectively collected. Results Among the 124 patients, 118 patients were successfully punctured through the left radial artery and completed the TACE operation. The operation time was (109.57±31.32) min, and the median of postoperative hospitalization was 3 d. One patient changed to the right radial artery to complete TACE due to chronic renal failure and left brachial artery and vein puncture and catheterization before operation. The operation time was 119 minutes, and the patient was discharged after 5 days of hospitalization. After successful puncture of the left radial artery in one patient, the forearm artery was twisted into a loop and the guide wire catheter failed to pass, and the right femoral artery was used to complete TACE. The operation time was 123 minutes, and the patient was discharged after 4 days of improvement. The radial artery puncture was unsuccessful in four patients, and the right femoral artery approach was used to complete the operation; the operation time was (111.66±32.77) min, and the median of postoperative hospitalization was 3 d. One of the patients successfully completed up to 5 consecutive TACE via the radial artery. All patients underwent precision TACE with superselective cannulation assisted by CBCT three-dimensional vascular reconstruction. No vascular injury andocclusion, urinary retention, subcutaneous hemorrhage, and other complications occurred in all patients. Conclusions Trans-radial arterial precision TACE is safe and effective, which can be repeated many times and has few complications and high patient comfort. It can be used as one of the routine approaches of TACE.