Objective To summarize the critical point of diagnosis and endovascular repairment (EVR) to thoracic aortic aneurysm (TAA), thoracic pseudoaneurysm (TPA) and aortic dissection (AD), by comparison the computerized tomography angiography (CTA) images before and after EVR to observe effects, so as to explore a unique index of imageology to assess the pathological development and evaluate therapeutically effect in dynamic and systemic reviews in pre, intra, postEVR and followup period. Methods Fortyeight patients involving aneurysm or dissection of thoracic aorta were treated with EVR based on the preoperative CTA imaging. Before and after the introducing of stentgraft, digital substation angiography (DSA) was taken place and sequential enhanced CTA was followed to evaluate the effects of the treatment. All imagings of CTA and DSA were collected and induced into e-FilmTM database to select key sections for analyses and measurement. Results Fortynine EVR were preformed and 54 stent grafts were implanted in 48 cases, with endothelial tears sealed in 42 cases of dissection, aneurismal cavities excluded in 2 cases of aortic aneurysm, and rupture site closed in 4 cases of pseudoaneurysm. Endoleakage happened in 9 cases, which were treated successfully by appropriate measures. One case suffered hemorrhage from introducing artery (iliac) which was controled by surgery, but he died of disseminated intravascular coagulation and then multiple organs failure. Fortyseven cases were followed up in 6-51 months with a satisfied clinical effect. Conclusion EVR is favorable in the effect of repairment to true, false and dissection of thoracic descending aorta. Chest pain and CTA scan is the key of early diagnosis of aortic dissection. Certain sections and leftanterior oblique viewing are the crucial profile for assessment and evaluation before and after operation.
Objective To identify the short ( lt;30 days) and intermediate ( 30 days to 6 months) benefits and risks of tracheobronchial stents in patients with malignant airway stenosis. Methods 55 cases with malignant airway disease who underwent tracheobronchial stents placement from January 2006 to May 2008 were followed up for 6 months. The efficacy rate, complication rate, reintervention rate, and survival were analyzed. Results There were 61 self-expanding metal stents placed in 55 patients with malignant disease, with no intraoperative mortality. The immediate efficacy rate was 100% , the short-term( lt;30 days) efficacy rate was 94. 5% , and the survival rate in 6 months was 32. 7% . The complications included tumor ingrowth, excessive granulation tissue, stent migration, and restenosis. A total of 14 cases of complicationswere observed, in which two occurred during the short-term period ( lt; 30 days ) and the remaining complications occurred after 30 days. Conclusions Tracheobronchial stents can improve symptoms immediately for the patients with unresectable malignant central airway obstruction with fairly safety. The benefit of airway stents is particularly seen in the short-termperiod and the complications occur mainly after 30 days.
ObjectiveTo analyze the impact of social resources on self-management in patients undergoing coronary stent implantation, and provide evidence for nurses to predict patients' self-management behavior and take intervening measures. MethodsA convenience sample of 359 patients undergoing coronary stent implantation between July and December 2013 was selected according to the criteria. Three instruments were used to collect data including general data scale, chronic illness resources survey (CIRS) and coronary artery disease self-management scale (CSMS). ResultsThe score of CIRS among 359 patients was 2.77±0.60, and the scores of six subscales in descending order were support of neighborhood/community, media and policy, and family and friends, and personal coping, and support of physician/health care team, and organizations. The total score of CSMS was 55.58±10.59, and the scores of three subscales in descending order were:daily management, emotion management, and medical management. The total self-management score and factor scores of CIRS were significantly correlated with the total and factor scores of CSMS (r=0.183-0.663, P<0.05), while the correlation of support of physician/health care team and family and friends with daily life management was negative (r=-0.215, -0.294; P<0.05). ConclusionIn this study, patients' total social resources are at a low level; the standard of self-management is at a moderate level, while medical management has the lowest score; good social resources can promote self-management, but supports from medical staff, family and friends are bad for patients' daily life management.
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
Objective To find out the follow-up results of early in-stent restenosis (ISRS) and develop effective way to improve clinical treatment and precaution of restenosis. Methods The data from a registry of 51 consecutive patients who underwent elective carotid artery angioplasty and stenting （CAS） at our institution between Jan. 2003 and Sept. 2005 were retrospectively reviewed. Complete data for 37 of these patients were available. All patients underwent duplex ultrasound scanning in follow-up period, which was used to determine the degree of restenosis. Results CAS was performed in 37 patients， 8.1% (3/37) were women. Mean age was (70.5±5.9) years. Mean time of follow-up was (12.2±7.7) months. Sixteen (43.2%) caces of ISRS （gt;30%） were found by color duplex ultrasound scanning， but only 1 (2.7%) ISRS was found gt;50%; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS （P=0.037, P=0.016）. Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.
ObjectiveTo investigate the effect of drained versus nondrained pancreaticojejunostomy on prevention of the pancreatic leakage after pancreaticoduodenectomy. MethodsSeventysix patients underwent the standard pancreaticoduodenectomy including resection of the distal stomach,common bile duct, the head of pancreas and the duodenum.Pancreaticenteric reconstruction was accomplished via either pancreaticojejunostomy by endtoside anastomsis or pancreaticojejunostomy by ducttomucosa anastomsis.The stented external drainage of pancreatic duct was used in 45 of 76 patients. ResultsPancreatic leakage was identified in 1 patient in the drained group consisting of 45 patients,in 7 patients in the nondrained group consisting of 31 patients, the incidence of pancreatic leakage in the drained group (2.2%) was significantly less than in the nondrained group (22.6%,P＜0.05).ConclusionComparing the incidences of pancreatic leakage from both groups,the authors believe that the stented external drainage of pancreatic duct can significantly reduce the incidence of pancreatic leakage after pancreaticoduodenectomy.
ObjectiveTo investigate the value of different minimally invasive surgical techniques, stent placement, laparoscopic surgery, and sustained-releasing 5-fluorouracil, in solving intestinal obstruction due to colorectal cancer. MethodsFrom May 2000 to May 2010, total 68 patients with obstructed colorectal cancers in three centers were treated in two ways in terms of the stage: The first, patients with resectable tumors underwent colorectal stent placement as a ‘bridge to surgery’ guided by enteroscope under X-ray. After clinical decompression and bowel preparation, laparoscopic radical resection was performed. The second, patients with unresectable tumors underwent rectal stent placement just for palliation. Sustained-releasing 5-fluorouracil was implanted into the local cancerous intestinal tract through stent walls. ResultsFifty-one of 52 patients underwent laparoscopic radical resection successfully following stent placement, while one failed and died during follow-up 93 d postoperatively. Forty patients with successful laparoscopic surgery were followed up in 3 to 36 months (with an average of 15 months) without tumor planting in the incision, postoperative local recurrence or anastomotic stricture. Fifteen unresectable patients and one high-risk, intolerable patient underwent rectal stent placement and implantation of sustained-releasing 5fluorouracil. During follow-up 3 to 24 months (with an average of 14 months), 11 died, who survived for (350±222) d (range 101-720 d), and 5 were still alive for 3 to 13 months (with an average of 9 months) without intestinal obstruction. ConclusionsLaparoscopic surgery combined with stent placement is an effective and safe procedure for resectable obstructed colorectal cancer. For unresectal obstructed rectal cancer, rectal stent placement combined with sustained-releasing 5-fluorouracil can prolong survival time avoiding colostomy.
Objective To summarize treatment experience and evaluate clinical outcomes of surgical therapy for Stanford type A aortic dissection （AD）. Methods Clinical data of 48 patients with Stanford type A AD who underwent surgical treatment in General Hospital of Lanzhou Military Region from October 2006 to March 2013 were retrospectively analyzed. There were 41 males and 7 females with their age of 26-72 （47.6±9.2） years. There were 43 patients with acute Stanford type A AD （interval between symptom onset and diagnosis＜14 days） and 5 patients with chronic AD. There were 19 patients with moderate to severe aortic insufficiency and 6 patients with Marfan symdrome but good aortic valve function，who all received Bentall procedure，total arch replacement and stented elephant trunk implantation. There were 8 patients with AD involving the aortic root but good aortic valve function who underwent modified David procedure，total arch replacement and stented elephant trunk implantation. There were 10 patients with AD involving the ascending aorta who received ascending aorta replacement，total arch replacement and stented elephant trunk implantation. There were 5 patients with AD involving partial aortic arch who underwent ascending aorta and hemiarch replacement. Patients were followed up in the 3rd，6th and 12th month after discharge then once every year. Follow-up evaluation included general patient conditions，blood pressure control，chest pain recurrence，mobility and computerized tomography arteriography （CTA）. ResultsCardiopulmonary bypass time was 121-500 （191.4±50.6） minutes，aortic cross-clamp time was 58-212 （112.3±31.7） minutes，and circulatory arrest and selective cerebral perfusion time was 26-56 （34.8±8.7） minutes. Postoperative mechanicalventilation time was 32-250 （76.2±35.6） hours，and ICU stay was 3-20 （7.1±3.4） days. Thoracic drainage within 24 hours postoperatively was 680-1 600 （1 092.5±236.3） ml. Seven patients （14.5%） died perioperatively including 2 patients with multiple organ dysfunction syndrome，2 patients with low cardiac output syndrome，1 patient with renal failure，1patient with delayed refractory hemorrhage，and 1 patient with coma. Twenty patients had other postoperative complicationsand were cured or improved after treatment. A total of 38 patients ［92.7% （38/41）］ were followed up for 3-48 （13.0±8.9） months，and 3 patients were lost during follow-up. During follow-up，there were 36 patients alive and 2 patients who died of other chronic diseases. There was no AD-related death during follow-up. None of the patients required reoperation for AD or false-lumen expansion. CTA at 6th month after discharge showed no anastomotic leakage，graft distortion or obstruction.Conclusion According to aortic intimal tear locations，ascending aorta diameter and AD involving scopes，appropriate surgical strategies，timing and organ protection are the key strategies to achieve optimal surgical results for Stanford type A AD. Combined axillary and femoral artery perfusion and increased lowest intraoperative temperature are good methods for satisfactory surgical outcomes of Stanford type A AD.
Objective To evaluate the cl inical effect of percutaneous transluminal angioplasty (PTA) and PTA and stenting (PTAS) in treating multilevel arteriosclerosis obl iterans (ASO) of lower extremities. Methods Between January 2007 and October 2009, 29 cases of multilevel ASO of lower extremities were treated with PTA or PTAS. There were 17 males and 12females with an average age of 71 years (range, 56-83 years). The cl inical manifestations were l imbs numb with cold sensation, intermittent claudication (lt; 100 m), and 19 patients had rest pain. According to Fontaine stages classification, there were 7 cases of stage II, 14 cases of stage III, and 8 cases of stage IV. Concomitant diseases included hyperl ipidemia in 13 cases, diabetes in 6 cases, hypertension in 12 cases, chronic heart failure in 5 cases, chronic obstructive pulmonary disease in 3 cases, cerebral infarction in 5 cases, and toe ulcer in 15 cases. The preoperative ankle/brachial index (ABI) was 0.28 ± 0.13. Results In 3 cases of below knee lesions for the guide wire puncturing through the artery wall, 1 case gave up, and 2 cases continued recanal ized other arteries without serious bleeding compl ications. After operation, cerebral infarction occurred in 1 case, pulmonary infection in 2 cases, and groin puncture site hematoma in 2 cases. All patients were followed up 3 to 36 months. Limb skin temperature was significantly improved, and intermittent claudication disappeared or claudication distance lengthened, rest pain disappeared or significantly reduced in 27 patients (30 l imbs). The wound of amputee achieved good heal ing in 2 cases (2 l imbs). In 27 patients undergoing endovascular treatment, the postoperative ABI was 0.72 ± 0.19, showing significant difference when compared with the preoperative one (P lt; 0.05). Conclusion The PTA and PTAS treatment for multilevel ASO of lower extremities is a safe and effective option, and the short-term effect is good. Different treatments should be chosen according to the location and length of vascular occlusion.
Objective To design a novel stentless porcine aortic bioprosthesis and test the feasibility and its function in vitro after the valve was implanted by a modified method. Methods Six stentless porcine aortic bioprosthesis were divided into two groups according to different implantation, single layer suture group: new improvement stentless porcine aortic bioprosthesis sutured with single layer was implanted; double layer suture group: stentless porcine aortic bioprosthesis developmented by our laboratory used double layer suture was implanted. Each group contained three scales: 23 mm ,25 mm and 27 mm. Analogue ex vivo aortic valve replacement was performed , the feasibility of the new implantation was detected. Effective orifice area, transvalvular pressure gradient and regurgitation ratio were recorded at the cardiac output of 2.0 L/min, 3.5 L/min, 5.0 L/min and 7.0 L/min under the guideline of International Organization for tandardization （ISO）5840. Results The average aortic valve implantation time used for single layer suture and tradition double layer suture were 50 min and 70 min respectively. The transvalvular pressure gradient in the single layer suture group were significantly lower than those in double layer suture group under the flow of 5.0 L/min in 23 mm valve and 27 mm valve （13.51±0.51 mm Hg vs. 14.44±0.99 mm Hg, 7.36±0.19 mm Hg vs. 7.53±0.28 mm Hg；P＜0.01）;and the effective orifice area in the single layer suture group were larger than those in double layer suture group in the same case(1.87±0.06 cm2 vs. 1.76±0.08 cm2, 2.26±0.07 cm2 vs. 2.16±0.05 cm2；P＜0.01). There was no statistically difference in other parameters between both groups. Conclusion The novel design of new improvement stentless porcine aortic bioprosthesis used single layer suture has good hemodynamic characteristics as the nature structure . The modified suture method decrease the implantation time.Nemerical data of the evaluation in vitro show that the difference between single layer suture group and double layer suture group in effective orifice area,transvalvular pressure gradient and regurgitation ratio haveno statistical significance. This experiment is the foundation of the animal and clinical experiment in the future.