Objective To investigate the relationship between changes of vascular elasticity and spontaneous rupture of hepatocellular carcinoma (HCC). Methods We examined the semiquantitatively expression of related angiogenesis factors including von Willebrand factor, elastin and neutrophil elastase in 30 specimens of HCC with spontaneous rupture by immunohistochemistry compared with 30 specimens of HCC without rupture. Results The results showed that there was a significant decrease of von Willebrand factor, overproliferation of elastin and abnormal distribution of neutrophil elastase around the small artery in ruptured HCC. These changes exacerbated weakness of the blood vessels and destroyed function of coagulation. The blood vessels split easily when the vascular load increased from hypertension or minor mechanical trauma. Conclusion The spontaneous rupture of HCC may be related to the vascular dysfunction.
ObjectiveTo study the mechanism, diagnosis and treatment of spontaneous rupture of hepatocellular carcinoma (HCC) for the purpose of screening out the effective methods of diagnosis and treatment. MethodsArticles have been reviewed to find out the difference among many kinds of diagnosis and treatment. ResultsThe mechanism of spontaneous rupture was not clear. Possible factors included tumor necrosis, coagulopathy, cirrhosis and portal hypertension. Diagnosis of spontaneous rupture of HCC can be made by abdominal paracentesis, ultrasonography and CT. Judging from the reported results the first choice of emergency treatment for hemostasis was transcatheter arterial embolization (TAE). The rational treatment of patients with ruptured HCC was TAE followed by hepatectomy if the lesion was resectable. ConclusionThe prognosis of patients with ruptured HCC could be improved if the correct diagnosis and treatment can be adopted.
Rupture is one of main complications of liver abscess. Seventy-seven patients with rupture of liver abscess are reviewed. Liver abscess may freely rupture into adjacent structures or organs or serous cavities and cause vatious complications. The causative factors of rupture of liver abscess in this series were late medical consultation in the course of the disease, delayed treatment due to misdiagnosis, and improper treatment. Measures that prevent rupture of liver abscess include raising clinical awareness of early diagnosis and timely effective drainage. The authors consider that transperitoneal surgical drainage is the best approach. Most patients with rupture of liver abscess should be treated by surgical drainage togather with transomental or transumbilital veno-catheterization for antibiotic infusion. Patients with rupture of liver abscess usually present a poor prognosis and a high mortality rate. The mortality in this group was 35.1%(27/77), which is closely related to the complications of the rupture of liver abscess.
Objective To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm （RSVA），and suggest different surgical approaches for corresponding types of RSVA. Methods Clinical data of 159 patients undergoing surgical repair for RSVA in Fu Wai Hospital between February 2006 and January 2012 were retrospectively analyzed. There were 105 male and 54 female patients with their age of 2-71 （33.4±10.7） years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve （n=66），including 84.8% patients with ventricular septal defect （VSD） and 53.8% patients with aortic valve insufficiency （AI）. TypeⅡ：rupture into or just beneath the crista supraventricularis of the right ventricle （n=17），including 88.2% patients with VSD and 23.5% patients with AI. Type Ⅲ：rupture into the right atrium （typeⅢ a，n=21） or the right ventricle （typeⅢv，n=6） near or at the tricuspid annulus，including 18.5% patients with VSD and 25.9% patients with AI. TypeⅣ：rupture into the right atrium （n=46），including 23.9% patients with AI but no patient with VSD. TypeⅤ：other rare conditions，such as rupture into the left atrium，left ventricle or pulmonary artery （n=3），including 100% patients with AI and 33.3% patients with VSD. Most RSVA originated in the right coronary sinus （n=122），and others originated in the noncoronary sinus （n=35） or left coronary sinus （n=2）. Results All the type V patients （100%） and 50% patients with typeⅢv received RSVA repair through aortotomy. In most patients of typeⅠ，II andⅣ，repair was achieved through the cardiac chamber of the fistula exit （71.2%，64.7% and 69.6% respectively）. Both routes of repair were used in 76.2% patients with typeⅢ a. The cardiopulmonary bypass time （92.4±37.8 minutes） and aortic cross-clamp time （61.2±30.7 minutes） was the shortest to repair typeⅣRSVA. There was no in-hospital death in this group. Two patients （type I andⅡrespectively） underwent reoperation during the early postoperative period because of restenosis of the right ventricular outflow tract. Most patients received reinforcement patch for RSVA repair （n=149），and only 10 patients received simple suture repair （including 5 patients with typeⅣ，4 patients with typeⅢ a and 1 patient with typeⅡ）. Aortic valve replacement was performed for 33 patients （66.7% of those with typeⅠ）. A total of 147 patients （92.5%） were followed up after discharge. Two patients （type I andⅢ a respectively） developed atrial fibrillation and received radiofrequency ablation treatment，1 patient （typeⅣ） underwent reoperation for residual shunt，and there was no late death during follow-up. Conclusion Modified Sakakibara classification system for RVSA provides a guidance to choose an appropriate surgical approach，and satisfactory clinical outcomes can be achieved for all types of RSVA.
Abstract： Objective To investigate the methods of diagnosis and treatment for early and late cheobronchial rupture, in order to improve the understanding of this disease. Methods We retrospectively analyzed the records of 19 patients treated for traumatic tracheobronchial rupture in our hospital between October 1988 and August 2010. There were 9 males and 10 females with a median age of 28 years (ranged from 8 to 48 years). We analyzed the clinical characteristics of the disease, including clinical presentation, and the results of chest Xrays, computed tomography（CT）, and fibrobronchoscopy. There were 2 cases of tracheal repair, 1 case of tracheostomy, 8 cases of bronchial reconstruction, 7 cases of bronchial repair, and 1 case of pneumonectomy. Results Seventeen patients were cured by operation and 2 patients died of multiple organ failure. Blood oxygen saturation resumed normal in most patients after operation (9680%±159% vs. 8840%±390%，Plt;0.01). Postoperative followup time was ranged from 3 to 24 months, and no tracheobronchial stenosis was observed and no patients needed stent or dilatation for treatment. Conclusion The diagnosis of tracheobronchial rupture depends on history of trauma, chest Xray, CT and fibrobronchoscopy results. Surgical treatments should be based on the tracheobronchial reconstruction or repair, and the clinical outcome is satisfying.
Objective To compare the effectiveness between conventional open repair (OR) and endovascular repair (EVRAR) for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases (OR group) or by EVRAR in 8 cases (EVRAR group). There was no significant difference in age, sex, the neck length (less than 2 cm), the neck angulation of aneurysm (more than60°), il iac severe tortuosity, preoperative systol ic pressure, and preoperative comorbidity between 2 groups (P gt; 0.05). The blood transfusion volume, operation time, intensive care unit (ICU) stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups (P gt; 0.05). EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay (P lt; 0.05), but OR group was significantly better than EVRAR group in reinterventions and graftrelated complications (P lt; 0.05). Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.
Objective To explore the diagnosis and treatment of ruptured abdominal aortic aneurysm (RAAA). Methods Between January 1996 and December 2009, 14 patients with RAAA were treated. There were 13 males and 1 female with an average age of 65 years (range, 50-82 years). The main cl inical manifestations were abdominal pain and/or back pain. Ten cases had low blood pressure or shock. All cases were accurately diagnosed with CT, Doppler ultrasonography,or operation. The aneurysm diameter was from 4.5 cm to 8.0 cm. Eleven cases were treated by conventional operation, 1 by endovascular aortic repair, 1 by conservative treatment, and 1 case died after admission treatment. Results Perioperative death occurred in 6 cases (mortal ity rate was 50%) in 12 surgical patients. One case died after conservative treatment. The overall mortal ity rate was 57.14% (8/14). The causes of death included circulatory failure in 2 cases and multiple organ failure in 4 cases. The other 6 cases were cured. The postoperative hospital ization days were 12 to 34 days (14 days on average). A total of 4 cases were followed up 11 to 40 months without related compl ication. Conclusion Surgical treatment is still a main method to treat RAAA. Early diagnosis, appropriate resuscitation, and urgent surgical repair are crucial to reduce the mortal ity rate of RAAA.
OBJECTIVE To investigate the clinical result and influence factors of prognosis after repair of ruptured Achilles tendon with operative treatment. METHODS From 1961 to 1994, 62 cases with ruptured Achilles tendon were treated operatively. Among them, "8"-shaped suture was used in 8 cases, aponeurosis flap repair in 30 cases, transfer repair of tendon of peroneus longus muscle in 2 cases, reverse "V-Y" shaped tendon plastic operation in 10 cases, and mattress suture of opposite ends in 12 cases. RESULTS Followed up 3 to 33 years, there was excellent in 40 cases, better in 13 cases, moderate in 6 cases, poor in 3 cases, 85.5% in excellent rate. Postoperative infection and re-rupture were occurred in 6 cases respectively. CONCLUSION Different operative procedures are adopted to achieve better long-term clinical result according to the injury types.
Seventeen cases involving 18 fingers of acute rupture of flexor tendon within the Zone Ⅱ were repaired by microsurgical technique for reconstructing the digital sheath with biological membrane since 1989. The excellent/good rate based on Eaton grading was 89%. The main procedure of the operation. the early postoperative rehabilitation and active excercises were described.
Objective To explore the diagnostic methods, therapy and the prognostic factors for the ruptured abdominal aortic aneurysm (RAAA). Methods The clinical data of 23 patients (males 15, females 8, age range 35-78, mean age 65) with RAAA below the level of renal arteries, who were treated with surgery, were collected from April 1999 to December 2005 and were analyzed retrospectively. Seven cases had a history of RAAA, 6 cases had pulsating abdominal masses; 15 cases were diagnosed by emergency Doppler ultrasonic examination or CT. All of the patients underwent emergency surgical operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or using transluminal ballon according to conditions of each patient. The aritficial vascular graft was then taken after the control of hemorrhage. Results There were 9 (39%) patients died within 30 d after the emergency operation. The causes of death included acute renal failure because of hemorrhagic shock (4 cases), multiple organ failure (3 cases), and respiratory-circulatory failure (2 cases).Conclusion Surgery may be an effective treatment for RAAA. The critical step of the operation was to control hemorrhage by obstructing the proximal end of the aortic rupture according to the conditions of each patient. The main postoperative complications and causes of death include acute cardiovascular and cerebrovascular diseases, renal failure and pneumonia.