Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity. Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time, number of the incision, postoperative pain, complications, postoperative hospitalized duration and 1-year recurrence rate. Results Endovenous laser treatment group had shorter operation time, fewer incisions, less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (Plt;0.05). The complications and 1-year recurrence rate had no significant differences between two groups (Pgt;0.05). Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars, endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.
Objective To investigate the application of abdominal aorta and bilateral abdominal perineal artery ligation in a hindlimb ischemia model of rats for research. Methods According to the random digits table, 38 SD rats were divided into 3 groups randomly, sham operation group (SO group, n=12), abdominal aorta ligation group (AAL group, n=12) and abdominal aorta and bilateral abdominal perineal artery ligation group (AAL+BAPA group, n=14). Rats were anesthetized by 6 mg/100 g ketamine via intraperitoneal injection. Blood vessels were ligated via laparotomy according to different procedures. Movement and pale skin color of rat’s hindlimb were observed on 2 and 4 weeks after operation, meanwhile venous blood from unilateral iliac vein was obtained for blood gas analysis and hindlimb skeletal muscle for HE stain. Results Two rats were dead during 3 d after operation in AAL+BAPA group, other rats survived. Rats in SO group had no obviously abnormal appearance. AAL group and AAL+BAPA group immediately presented hindlimbs pale, lower skin temperature, hypofrontality of limb motion after procedure. Symptoms above mentioned had improved gradually after 2 weeks and completely recuperated 4 weeks after operation in AAL group. Ischemia symptoms were still remained obviously such as cold, dried and thin on the 4th weekend in AAL+BAPA group. Each group had no hindlimbs necrosis. Two weeks after operation, pale limbs and muscle strength in AAL+BAPA group were more severe than those of SO group (Plt;0.05); Pale limbs was still worse than that of AAL group on 4 weeks after operation (Plt;0.05). There were no significant differences on different time in each group (Pgt;0.05). Venous blood partial pressure of oxygen of AAL+PABA group was significantly lower than that of the other two groups on 2 and 4 weeks after operation (Plt;0.05). Normal striated muscle structure was presented in SO group pathologically. AAL group revealed coloretur unevenness, swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus deeply stained on the 2nd weekend and no difference with the SO group on the 4th weekend. AAL+BAPA group presented skeletal muscles decoration unevenness, cells swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus stained deeply and intensively, intercellular space widening until the 4th weekend， but no obviously necrocytosis. Conclusion The method of ligating abdominal aorta and bilateral abdominal perineal artery can make a stable SD rat model of hindlimb ischemia
Objective To investigate the expressions of transforming growth factor (TGF) -α and -β1 after 90% portal branch ligation (PBL) in rats. Methods Ninety-six SD rats were randomly divided into sham operation group and portal vein branches ligation group. The weight of both ligated and unligated lobes of liver were measured on 0.5, 1, 3, 5, 7, 14, 21, and 28 d after operation. The morphological changes of the unligated liver lobes were observed by microscope. The expressions of proliferating cell nuclear antigen (PCNA), TGF-α, and TGF-β1 of the unligated liver lobes were detected by immunohistochemistry. Results After the ligation of 90% portal vein branches, hepatic lobe at the ligated side diminished progressively after ligation, whereas the lobes of the unligated side underwent compensatory regeneration. The ratio of unligated lobes weight to the whole liver increased slowly within 1 d, speeded up significantly during 1-5 d period, increased slowly on 5 d, and reached plateau phase on 7 d after operation. The expressions of PCNA protein markedly increased within 0.5-3 d (Plt;0.01), which reached the peak on 5 d and decreased slightly on 7 d after operation, but still higher than sham operation group level, and then gradually returned to the level of sham operation group lately. The expressions of TGF-α and TGF-β1 in the unligated liver lobes markedly increased on 0.5 d, and reached the peak on 3 d and 1 d respectively， and then gradually returned to the level of sham operation group in 7-28 d after operation. Conclusion Ligation of 90% portal branches can induce active regeneration of unligated liver lobes in rats, whose initiation and proliferation are involved in the expressions of TGF-α and TGF-β1 protein.
【Abstract】 Objective To study liver regeneration of the non-ligated liver lobes following portal branch ligation (PBL). Methods Sixty male Wistar rats were randomly divided into PBL group and sham operation (SO) group. Under ether anesthesia, the rats were subjected to PBL and sham operation, respectively. The animals were sacrificed on the 1st, 2nd, 3rd, 7th and 14th day respectively. The blood sample was collected from heart and the livers were harvested to determine serum alanine aminotransferase (ALT) levels and total liver weight, respectively. The hepatic histopathology was studied through light microscopy. The number of liver cell nuclear mitosis index was counted. The number of proliferative cell nuclear antigen (PCNA) index was counted by immunohistochemistry. The hepatic ultrastructural changes were studied under electron microscope. Results ①Elevated serum ALT level was observed in the first postoperative day in PBL group compared with SO group (P＜0.01)， but began to recover in the second day. ②No significant total liver weight change in PBL group and SO group were found. ③Liver cell nuclear mitosis index and PCNA index were markedly increased in PBL group compared with SO group in day 1-3 postoperative day (P＜0.01). It reached the peak in the second day and decreased slightly in the 3rd day, but still higher than SO group, then gradually return to normal lately. Conclusion The ligation of left portal branch can induce active regeneration of hepatic cell of non-ligated liver lobes in rats. The regeneration of non-ligated liver lobes may restore previous total liver weight. The ligation of 75% portal branch does not affect liver function and may be safely performed. The portal branch ligation in rats may be used as an animal model in study of liver regeneration.
ObjectiveTo explore an individualized treatment program to prevent the initial bleeding of a patient with cirrhosis and esophageal varices by the methods of evidence-based medicine. MethodsOne patient with cirrhosis and esophageal varices was admitted into our hospital on November 2, 2013. After evaluating the patient's condition adequately, we proposed the problem according to the PICOS principles. Then, we assessed the clinical evidence from the Cochrane Library (1990-2012), Medline (1950-2012), Embase (1991-2012), VIP (1989-2013), and CBM (1990-2013). The individualized treatment plan was made through doctors' experiences and analysis of those high-quality evidences from the databases. ResultsEight studies (randomized controlled trials and 5 meta-analysis) were included. We evaluated a series of associated problems:whether we should take measurement to prevent initial bleeding of esophageal varices; which one (β-blockers or ligation of esophageal varices) was the best method to prevent the initial bleeding based on efficacy, complication and cost-effectiveness. Then, according to the evidences and the patient's view, we gave non-selectiveβ-blocker as the primary prevention. After one-year followed-up, the initial bleeding of the patient did not occur. ConclusionMaking the prevention plan for a patient with cirrhosis and esophageal varices can not only find out the individualized program, but also push the patient to make decision for their own health.
ObjectiveTo compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. MethodsThe clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). ConclusionsCurative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.
ObjectiveTo summarize the latest research progress of intersphincteric fistula ligation in the treatment of anal fistula. MethodsThrough the retrieval of CNKI and PubMed literature database, the principle, clinical application and related improvement of LIFT were reviewed. ResultsLigation of intersphincteric fistula tract is a sphincter preserving surgery in recent years. Because it has the advantage of ensuring the integrity of the sphincter, less damage to the anal function after operation, the wound healing quickly and so on, it has been accepted by domestic and foreign scholars. ConclusionLIFT to cure anal fistula while ensuring the anal function integrity, is the development trend of anal fistula surgery, is worthy to be popularized.
Objective To investigate the security and feasibility of silk ligating for pulmonary artery in video-assisted thoracoscopic lobectomy, and to summarize the clinical skills. Methods We retrospectively analyzed the clinical data of 68 patients underwent the video-assisted thoracoscopic lobectomy from April 2013 to March 2015. There were 49 males and 19 females with the mean age of 59.6±10.3 years, ranging from 38 to 76 years. We divided the patients into an ECR60W cut-up group (31 patients) and a silk ligation group (37 patients). There were 22 males and 9 females patients with the average age of 59.3±9.9 years with ECR60W. There were 27 males and 10 females patients with the average age of 59.9±10.5 years with silk ligation. We observed the effect of hemostasis, and analyzed the amount of bleeding loss during operation, postoperative suction drainage and the cost of operation material between the two groups. Results There were 4 patients out of 68 converted to the open lobectomy, and all of them used ECR60W. The application of silk ligation for pulmo-nary artery could effectively control bleeding loss and avoid massive amount of bleeding due to the vascular tear in opera-tions. Furthermore, the application can reduce the rate of severe complications such as massive bleeding resulting from postoperative silk ligation slippage. There was a statistical difference between the two groups on the cost of operation mate-rials (P < 0.01). Conclusions Silk ligation for pulmonary artery in video-assisted thoracoscopic lobectomy is simple and prac-tical to apply. Compared with the ECR60W, it can significantly reduce the cost of operation material. It's worth to popularize in clinic.
Thoracic duct is the largest lymphatic vessel in the body. It originates from the chyle pool in the abdominal cavity, upward across aortic hiatus of the diaphragm into the right thoracic cavity, and finally importing into the left jugular vein angle. Thoracic duct plays a very important role in the transporting process of the body's lymph and chylous fluid. More than 70% of the lymph and chylous fluid transport through it into the blood. If the thoracic duct was damaged, it would lead to fluid and electrolyte imbalance, immune dysfunction, malnutrition and the patient's life would be endangered when it was serious. Therefore, the clinical significance of the thoracic duct is always a hot research issue. Through unremitting exploration in recent years, we have a further understanding about structure and function of the thoracic duct. And we used this to remould and ligate it to cure some intractable disease. Now we summarize the research progress as follows.