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.
Objective To explore the clinical experience of endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities. Methods Endovascular treatment were performed on 22 patients (26 limbs) suffering from ASO which were diagnosed by magnetic resonance angiography (MRA). The clinical efficacy after operation was analyzed. Results Twentytwo lower extremities of 18 patients successfully accepted endovascular treatment with 12 stents planted without major complications. Four cases failed to endovascular treatment and 2 of them converted to bypass surgery. The clinical symptoms of limb ischemia vanished or significantly improved after treatment. The ankle brachial index (ABI) of affected extremities increased from 0.35±0.13 (before operation) to 0.70±0.15 (after operation), Plt;0.01. During the follow-up of 2-18 months, 3 cases suffered re-occlusion of artery of lower extremity, in them one case received drug treatment and 2 cases resolved by percutaneous transluminal angioplasty (PTA) and stenting again. Conclusion Endovascular treatment for ASO of lower extremities has such advantages as minimal invasiveness, reduced complications and repeatability. It may serve as a more promising choice of method to clinical treatment of ASO.
Objective To compare the long-term efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the treatment of carotid artery stenosis by meta-analysis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and SinoMed were searched, for randomized controlled trials comparing the efficacy of CAS and CEA in the treatment of carotid artery stenosis published before September 2nd, 2021. Stata 15.1 software was used to analyze the long-term outcome data, including any stroke, ipsilateral stroke, fatal or disabling stroke, any death, combined endpoint of stroke or death, and carotid artery restenosis. Results A total of 20 English articles from 9 studies were included, involving 8551 patients (4658 in the CAS group and 3893 in the CEA group). The medians of the follow-up time of these studies were 2-10 years. The meta-analysis showed that the risks of any stroke [hazard ratio (HR)=1.33, 95% confidence interval (CI) (1.16, 1.52), P<0.0001], ipsilateral stroke [HR=1.26, 95%CI (1.02, 1.55), P=0.034], and the combined endpoint of stroke or death [HR=1.17, 95%CI (1.02, 1.33), P=0.021] in the CAS group were significantly higher than those in the CEA group, while the risks of fatal or disabling stroke [HR=1.19, 95%CI (0.94, 1.51), P=0.152], any death [HR=1.06, 95%CI (0.95, 1.18), P=0.302], and restenosis [HR=1.20, 95%CI (0.96, 1.49), P=0.111] were not significantly different between the CAS group and the CEA group. Conclusions CAS and CEA have similar risks in terms of long-term fatal or disabling stroke, death, and carotid artery restenosis, but the long-term risks of any stroke, ipsilateral stroke and combined endpoint of death or stroke of CAS are higher than those of CEA. CEA is still the preferred non-drug method for carotid artery stenosis.
Objective To introduce the experience of treating 85 cases of stanford type B aortic dissection by endovascular implantment of stent-grafts，to provide more clinical evidence for endovascular repairment for stanford B type aortic dissections.Methods Imaging examination by computed tomography angiography （CTA） were done to obtain anatomical detail of dissection. Stent-grafts were implanted under the guide of DSA in all cases. The patients were followed-up for 3 months，6 months，12 months，and then annually by CTA examination to observe the complications and morphological changes of the aneurysm.Results The technical success rate was 95.3%（81/85），and the clinical success rate was 91.8%（78/85）. Eight patients died after operation in hospital，who were all in acute phase，and no patients of chronic phase died，there had statistic differences （P＜0.05）. The perioperative complications’ incidence of endovascular repair which happened in patients of acute phase was higher than that patients of chronic phase （38.2% vs.13.3%，P＜0.05）. Left subclavian artery were covered completely for 13 cases，and partially covered for 22 cases，there was no obvious cerebralvascular insufficiency. There were 41 patients of whom other tears which were not covered during operation exsited at abdominal aortic and one year following-up showed that at those section thromblization of false cavity was not clear. The rest of patients whose abdominal aortic didn’t exist tears hadn’t new tears appeared.Conclusions Regardless in the acute or chronic stage，endovascular therapy is an effective mathod of treating stanford type B dissection. However，implanting stent-grafts have a higher security in chronic period than doing that in acute period. If the right carotid artery，vertebra and Willis ring are smoothly，there is little need to set up a by-pass to left subclavian artery before endovascular repairment. For those patients that other uncovered tears exited，following-up should be a must，and further strategy should be studied and prepared in advance.
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 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 summarize the progress of endoscopic diagnosis and therapy for pancreatic cancer. Methods Domestic and international publications online involving progress of diagnosis and therapy for pancreatic cancer by using endoscope in recent years were collected and reviewed. Results Recently, early diagnostic rate of pancreatic cancer increased with the development of endoscope and endoscopic technique such as endoscopic ultrasound, endoscopic ultrasound-guided fine needle aspiration, peroral pancreatoscopy, optical coherence tomography, ERCP, and cytology in pancreatic juice. Furthermore, varied therapies such as endoscopic ultrasound guided celiac plexus neurolysis, implantation of iodine 125-particles or pancreatic duct/bile duct stents were performed by endoscope for advanced pancreatic cancer. Conclusion Early diagnostic rate and novel therapeutic alternative of pancreatic cancer are supplied by digestive endoscopy.
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 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.
Tracheal stents are often used to maintain the patency of the trachea and bronchia in patients suffering from central airway lesions. Metallic tracheal stents are now widely used in the clinical setting, but these types of stents can cause many intractable material-related complications. Biodegradable tracheal stents are made of biodegradable polymer materials with good mechanical strength for maintaining the patency of the lesion segment during a certain period of time, and then they can be gradually degraded into harmless products in human body. Compared with conventional metallic tracheal stent, biodegradable tracheal stents have a good prospect in clinic. In this article, we review the choice of biodegradable tracheal stent materials, experimental progress in biodegradable tracheal stent as well as the challenges we are facing.
