Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
ObjectiveTo explore the application value of transoral snare traction in endoscopic submucosal dissection (ESD) for patients with early gastric cancer (EGC). MethodsA total of 90 EGC patients admitted to Xinxiang Central Hospital from January 2020 to April 2023 were selected and randomly divided into a study group and a conventional group using a random number table method. The conventional group was received ESD, while the study group was received transoral snare traction in combination with ESD. Baseline data, treatment efficacy, as well as the serum inflammatory-stress factors (tumor necrosis factor alpha, interleukin-6, adrenocorticotropic hormone, and cortisol) and gastrointestinal hormones (motilin and gastrin), surgical indicators, gastrointestinal function recovery indicators before surgery and on day 1 and 3 after surgery, postoperative complications, improvement in quality of life, and 2-year recurrence rate were compared between the two groups. The test level was set at α=0.05. ResultsThere were no statistically significant differences in age, gender, body mass index, disease duration, longest tumor diameter, lesion location, and tumor differentiation degree between the study group and the conventional group (P>0.05). The total effective rate in the study group was higher than that in the conventional group [95.6% (43/45) vs. 80.0% (36/45), χ2=5.075, P=0.024]. The results of repeated-measures ANOVA showed statistically significant between-group, time, and between-group-time interaction effects of serum inflammatory-stress factor and gastrointestinal hormone levels in the study and conventional groups (P<0.05), the effect of the time factor on inflammatory-stress factors and gastrointestinal hormones varied with intervention (P<0.001), postoperative inflammatory-stress factors levels in the study group exhibited aninitial increase followed by a decline, ultimately falling below those of the conventional group, the levels of serum motilin and gastrin in the study group continued to decrease than those before surgery and the reduction was smaller in the study group than in the control group. The operation duration, recovery of bowel sounds, the first exhaust, the first defecation, and the first meal time in the study group were shorter than those in the conventional group (P<0.05), and the intraoperative blood loss was less than that in the conventional group (P<0.05), the overall complication rate was lower than that in the conventional group [4.4% (2/45) vs. 17.8% (8/45), χ2=4.050, P=0.044], and the improvement rate in quality of life was higher than that in the conventional group [77.8% (35/45) vs. 57.8% (26/45), χ2=4.121, P=0.042]. There was no significant difference in the recurrence rate between the two groups after a 2-year follow-up [7.0% (3/43) vs. 17.1%(7/41), χ2=1.191, P=0.275]. ConclusionThe results of this study suggest that the treatment of early gastric cancer with transoral snare traction combined with ESD has significant efficacy, which can optimize surgical procedures, reduce inflammatory-stress reaction, improve gastrointestinal hormone levels, promote disease recovery, reduce the occurrence of complications, and achieve good short- and medium-term outcomes.
Objective To summarize the revascularization method of infective femoral false aneurysm caused by drug injection. Methods Between November 2003 and May 2009, 84 patients with infective femoral false aneurysm caused by drug injection were treated, and the cl inical data were analysed retrospectively. There were 67 males and 17 females with anaverage age of 34.6 years (range, 19-51 years). The average duration of drug injection was 2.7 years (range, 1-11 years). In 13 cases, the defect of femoral artery was 3-10 cm; defect ranged from 1.0 cm × 0.3 cm to 3.0 cm × 0.7 cm in the others. The surgical treatment included bypass using synthetic grafts in 5 cases, great saphenous veins transplantation in 29 cases, repair of femoral artery in 24 cases, and l igation of femoral artery in 26 cases. Results Two cases died of intraoperative pulmonary embol ism. Eight cases had postoperative wound infection, which was cured after changing dressings. Incisions healed by first intention in the other paitents. A total of 82 cases were followed up 12-36 months (mean, 17.3 months). In 56 patients undergoing artery reconstruction or repair, dorsal pedis artery pulse was significantly improved, and no distal osteofascial compartment syndrome occurred. In 26 patients undergoing femoral artery l igation, angiography at 1 week after operation showed abundant collateral circulation from ipsilateral internal il iac artery, superior gluteal artery or contralateral internal il iac artery. Three cases had postoperative intermittent claudication which was improved after symptomatic treatment. Conclusion Infective femoral false aneurysm caused by drug injection should be treated surgerically as early as possible, and effective treatments include debridement, drainage, defect repair or bypass with synthetic graft or great saphenous vein from homonymy external il iac artery to superficial femoral artery. Ligation of femoral artery is an option in patients with serious infection when revascularization is impossible.
ObjectiveTo assess whether the geriatric nutritional risk index (GNRI) of elderly patients can be used as an evaluation index for complications after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).MethodsA total of 265 patients with EVAR who received abdominal aortic aneurysm between January 2011 to December 2017 were included in this study from West China Hospital of Sichuan University. All patients included in this study were subrenal arterial AAA. Statistical analysis of clinical data was performed. The value of GNRI in evaluating postoperative complications of EVER patients was evaluated.ResultsOf the 372 patients, 158 were included in the GNRI abnormal group (GNRI≤98), and 214 were included in the normal group (GNRI>98). Univariate analysis showed that the age (P=0.04), drinking (P=0.04), serum albumin level (P<0.001), BMI (P<0.001), GNRI (P=0.004), and stroke (P<0.05) were risk factors that affects postoperative complications of AAA. Multivariate analysis showed that preoperative GNRI [HR=0.687, 95%CI: (0.487, 0.968), P=0.032] abnormality was one of the risk factors affecting postoperative complications of AAA.ConclusionFor patients undergoing endovascular aneurysm repair of abdominal aortic aneurysm, the GNRI is one of the important indicator for predicting postoperative complications.
Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
ObjectiveTo evaluate the clinical features of the retroperitoneal paralangliomas. MethodClinical data of 34 patients with retroperitoneal paragangliomas who underwent surgery in our hospital between January 2005 and January 2015 were enrolled, all patients diagnosed by pathological examination. ResultsClinical manifestation: hypertension (n=4) and headache (n=1) were the main symptoms in all 5 patients with functional tumor. Abdominal distension (n=14) or abdominal pain (n=11) were the initial symptoms in patients with nonfunctional tumor, gastrointes-tinal obstruction was observed in 1 patient, the other 3 patients were diagnosed accidently among the 29 patients with nonfunctional tumors. Blood and urine catecholamines increased notly in 5 patients with functional tumor, increased mildly in 2 patients with nonfunctional tumor; and remained at a normal level in the other patients. All the 34 patients underwent surgery, 4 patients with nonfunctional tumors who suffered from vessel wrapped needed tumor resection combining with main vessel resection or reconstruction, 1 of the 4 patients presented with vascular wall invasion. Two patients presented with lymph-vascular invasion of patients didn't received vessel resection or reconstruction. The mean value of diameter of these tumors was (9.5±5.1) cm (3.5-18.5 cm). Twenty four tumors had complete capsule, the other 10 had partial capsule; 32 tumors were well differentiated, and other 2 patients had apparent strange nucleus. Among the 34 patients, G1 tumors were confirmed in 14 patients and G2 tumors were confirmed in 20 patients. All the 34 patients were followed up with a mean value of follow-up time of 52 months (1-105 months). During the follow-up period, 6 patients suffered from recurrence and 6 patients died. The 1-year and 5-year survival rates were 86.0% and 81.5%, respectively. ConclusionsRadical resection may be the only measure to cure retroperitoneal paragangliomas. Tumor combining with vascular resection or reconstruction provide a chance for patients with ‘unresectable tumors’.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.