ObjectiveTo evaluate the application of artery first approach in pancreaticodudenectomy, aiming to explore superior mesenteric artery(SMA) and celiac axis in early stage of operation, confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA.
MethodsThe data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep, 2009 to Dec, 2013 in our hospital were retrospectively analyized.
ResultsEight cases received palliative drainage operation, while other 19 cases received radical pancreatectomy, including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy, with 5 cases portal vein or superior mesenteric vein resection and reconstruction, 1 case common hepatic artery resection, and 2 cases extended right pancreatectomy. The operative time was(281.28±78.53) min(133-354 min), and amount of bleeding was(352±537) mL(189-1 352 mL). There were no operative death, and no reoperation due to complications.
ConclusionArtery first approach is preferred for patients with borderline resectable tumors, pancreatic surgeon should be familiar to the various approach.
OBJECTIVE: To observe the architecture of elastic fiber of anastomosed artery. METHODS: The right femoral arteries of 60 Wistar rats were cut off transversely and end-to-end anastomosis were performed. On the 3rd, 7th, 14th, 21st, 30th and 90th days after operation, the anastomosed artery segments were harvested and fixed by 10% formalin. After routine processed, the architecture of elastic fiber of anastomosed artery was observed under scanning electronic microscope and was compared with that of normal artery. RESULTS: On the 3rd and 7th days after anastomosis, there was no the elastic fiber in the middle of the anastomosed area. From 14 to 90 days after anastomosis, the newborn elastic fiber connected the anastomosed area. The reconstruction of elastic fiber could be divided into quiescent stage, proliferation stage, and rebuilding stage. CONCLUSION: The reconstruction of elastic fiber occurs after arterious anastomosis and newborn elastic fiber originates from endoarterious layer. The structure of elastic fiber can return to normal 30 days after anastomosis.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To explore the feasibility of high-pressure injection to transfer human thrombomodulin (hTM) gene into arterial wall of rabbits.Methods Eighty-four healthy New Zealand rabbits were randomly divided into three groups: pcDNA3.1/hTM plasmid group (n=28), pcDNA3.1(+)/neo plasmid group (n=28) and untransfected group (n=28). After gene transfection, the model of arterial injury-blocking was established. Then, the expressions of hTM mRNA and protein in arterial wall were examined by RT-PCR and immunohistochemistry at 3 d, 7 d, 14 d and 28 d after operation. Results Seventeen rabbits died accidentally from the day of operation to 3 d after operation. The expressions of hTM mRNA of different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.01). For the expressions of hTM mRNA at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group, the difference of inter-group and intra-group was not significant (Pgt;0.05). hTM protein was expressed in every group and mainly localized in the inner lining of arterial wall. The expressions of hTM protein at different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.05). The expression of hTM protein at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group kept relative constancy, the difference of inter-group and intra-group was also not significant (Pgt;0.05). Conclusion High-pressure injection is feasible to transfer pcDNA3.1/hTM plasmid into arterial wall of live animals.
Objective To explore the clinical experience on treatment of thromboangitis obliterans (TAO) by embolectomy. Methods Fourteen of 121 patients with TAO treated in our hospital from March 2000 to March 2010 were included in this study. Total 14 limbs consisted of 2 upper extremities and 12 lower extremities. Among these cases, 8 cases underwent embolectomy and 6 cases received embolectomy combined the stem cell transplantation. Results Of 14 cases of TAO patients, 11 cases were successfully treated by surgery and 3 cases failed. After successful operation, patient’s pain disappeared and anklebrachial index improved obviously. Seven patients treated successfully by surgery were followed up from 5 months to 8.5 years (mean 4 years), in whom the intermittent claudication and rest pain disappeared in 4 cases, and disease deteriorated in 2 cases who always smoked, and one case had intermittent claudication who stopped smoking. For 3 cases patients failed to operation, one lost followup, one had to receive a below knee amputation due to keep smoking after operation, and one case who stopped smoking underwent alleviative symptoms for 3 years. Conclusion Embolectomy is a safe and effective technique for treating TAO.
In order to develope a new method to overcome the difficulties in anastomosis of blood vessels with different diameter, phleboplasty was utilized at the join-point to expand the diameter of branched vein graft, with a funnel-shaped stoma formed consequently. After successfully experimented in fresh blood vessels in vitro, the method was practised clinically to repair injured arteries in extremities, with the outcome that phleboplasty of branched vein graft could enlarge the diameter by 1-1.25 times, and with satisfied effects in 3 clinic cases. So, the conclusion was that: phleboplasty of branched vein graft was a new effective and convinient method to repair injured arteries with different diameters
This experiment consisted of removing a segment of femoral artery measuring 3cm from Japanese white rabbits. The arterial segments were divided into 3 groups and grafted as homograft at different periods of time. The segments in group 1 were grafted immediatly after their removals, those in the group 2 and group 3 were stored at -30 and -196 degrees centigrade before grafting, respectively. The results from gross and histological examinations, it was noted that following deep freezing the long term patency rate after grafting of the arterial homografts was superior to those not undergoing deep freezing. Those stored at 30 degrees centigrade for 12 weeks had the lowest patency rate.
ObjectiveTo investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT).
MethodsA retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually.
ResultsThe surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58±9.54) mm Hg (1 mm Hg=0.133 kPa) at pre-operation to (5.50±2.39) mm Hg at immediate after operation (t=15.492, P=0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17±6.24) mm Hg and (82.67±6.51) mm Hg from (152.83±14.80) mm Hg and (94.17±11.30) mm Hg at pre-operation (t=5.751, P=0.000; t=4.976, P=0.000).
ConclusionVascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.
ObjectiveTo evaluate short and medium term results of nitinol self-expending stent (LifeStent) implantation for iliac arteriosclerosis obliteran.
MethodsThe clinical data of 75 limbs iliac artery occlusions in 64 patients from June 2011 to June 2014 in this hospital were analyzed retrospectively. The postoperative ankle brachial index (ABI), limb salvage rate, primary and secondary patency rate, and postoperative complications were evaluated.
ResultsThere were 75 limbs iliac artery occlusions in 64 patients (54 males and 10 females), 11 lesions were type A of TASCⅡ, 26 lesions were type B of TASCⅡ, 29 lesions were type C of TASCⅡ, 9 lesions were type D of TASCⅡ. The postoperative ABI was significantly higher than that preoperative ABI (0.94±0.16 versus 0.29±0.20, t=-24.7, P < 0.01). The following-up time was (22±10) months, 5 patients were lost to follow-up. In 12 and 24 months after surgery, the cumulative primary patency rates were 79% and 60%, respectively, the cumulative second patency rates were 91% and 84%, respectively, the limb salvage rates were 96% and 94%, respectively. Complications occurred in 5 patients (7.8%). There was no severe complications and inhospital mortality.
ConclusionClinical efficacy of short and medium term is satisfactory by nitinol self-expending stents implantation (LifeStent) for iliac arteriosclerosis obliteran, but long term efficacy remains to be further studied.
Abstract During 1960 to 1995, 19 of the 269 casesof arterial injuries in limbs treated developed ischemic contracture (7.06%), in which 14 in the lower limbs and 5 in the upper limbs. In the 19 cases, 3 injured arteries were not treated; 1 had his injured arteries repaired infailure; 5 cases had the concomitant veins injured, and 3 of them had their injured veins ligated in the primary treatment. Only 1 case received fasciotomy in his former treatment in other hospital. Four cases were admitted in our Institute in 14 hours, 8 cases were 34 to 57 hours and 7 were 19 days to 19 months after injury. Seventeen out of the 19 injured ateries and 5 out of the 8 injured vein were repaired. Eight cases received fasciotomy. The follow up ranged from 3months to 28 years (averaged 5 years). Sixteen out of the 17 injured arteries remained patent after repair, and the patency were proved by Bultrasound. The causes of ischemic contracture in these cases were analyzed. It was concluded that in order to prevent the limb from ischemic contracture, it should be emphasized that the accurate diagnosis of the injury of the artery and its concomitant ein be made early, the proper treatment be given to the injured artery and vein,and fasciotomy be done immediately as indicated.
