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Objective To explore the significance of comprehensive treatment including anticoagulation,inferior vena cava filter implantation,mechanical thrombectomy,iliac vein angioplasty and stent placement and catheter-directed thrombolysis (CDT) in the treatment of acute iliac femoral vein thrombosis on the basis of left iliac vein compression.Methods In this study 61 patients were enrolled at Beijing Luhe Hospital,Capital Medical University between Mar 2013 and Mar 2019 in anticoagulation combined with CDT group and comprehensive treatment group.Short-term venous recanalization rate scores and long-term proximal valvular function of left femoral vein were compared.The survival curve was drawn using kaplan-meier method,and incidence of PTS was compared with the Log rank test.Results The short-term venous recanalization rate scores of the patients in the comprehensive treatment group were higher than scores of the patients in the traditional treatment group(t =9.872,P ＜ 0.001).16 patients developed PTS.The incidence of PTS in the comprehensive treatment group was lower than that in the traditional treatment group(x2 =7.146,P =0.008).Patients in comprehensive treatment group kept a better function of the proximal valvular of left femoral vein than patients in the traditional treatment group (x2 =23.834,P ＜0.001).Conclusions The comprehensive treatment can effectively reduce the occurrence of long-term PTS in patients with acute iliac femoral vein thrombosis complicated with left iliac vein compression,and improves the quality of patients' life.
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Objective To evaluate different methods in detecting intraperitontal free cancer cells (IFCCs) in patients with gastric cancer and to clarify the relationship between positive IFCCs and short-term prognosis.Methods A total of 119 gastric cancer patients who underwent surgical treatment were enrolled.Peritoneal lavage was performed with 300-400 ml saline respectively at three points of time:immediately after abdominal cavity entry;when surgical operation was completed;when extensive intraoperative peritoneal lavage was done.The IFCCs were detected with methods of traditional centrifugal cytology,membrane cytology,ICC and RT-PCR.The survival curve of patients with gastric cancer was drawn using Kaplan-Meier method.Results The positive rate of PLC was 16.8％,20.7％ and 11.2％ respectively at 3 timepoints (P ＜ 0.05).The positive rates of ICC were 28.6％,38.8％ and 20.7％ respectively at 3 timepoints.The positive rates of RT-PCR were 39.3％,69.5％ and 50.8％ respectively at 3 time points.The positive rate of IFCCs detected through RT-PCR was higher than that of PLC and ICC (P ＜ 0.05).The short-term prognosis of patients with positive IFCCs was worse than those with negative results detected with any three method at the timg point immediately after opening the abdomen (P ＜ 0.05).At the timg point immediately after removing the tumors,the short-term prognosis of patients with positive IFCCs detected with PLC was worse (P ＜ 0.05).Conclusion The short-term prognosis was poor in patients with positive IFCCs.It is the best time to detect IFCCs before radical resection.Surgical procedures increase the risk of shedding of IFCCs.
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Objective To explore the early predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive disease and its significance for the decision of exploratory laparotomy.Methods This retrospective study enrolled 29 patients diagnosed with acute superior mesenteric artery embolism or thrombosis in Peking University People's Hospital between July 1995 and June 2015.Results 12 patients developed intestinal necrosis.Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (x2 =14.867,P =0.000).In univariate analysis,the early predictive factors for intestinal necrosis were D-Dimer ≥ 600 μg/L (x2 =11.455,P =0.002),INR≥1.2 (x2 =3.948,P =0.047),pH values ＜7.4 (x2 =8.191,P =0.004),BE ＜ -1.0 mmol/L (x2 =8.191,P =0.004),blood lactate ≥ 2.2 mmol/L(x2 =7.535,P =0.006),BUN ≥ 6 mmol/L (x2 =10.076,P =0.002),CK ≥ 80 U/L (x2 =8.191,P =0.004),LDH ≥ 210 U/L (x2 =13.079,P=0.000),AST ≥25 U/L (x2 =10.076,P =0.002),SIRS (x2 =10.076,P =0.002).Multivariate logistic regression analysis found no independent predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive diseases.Conclusion Intestinal necrosis in acute mesenteric arterial occlusive diseases indicates a poor prognosis.Coagulation abnormalities,liver or kidney dysfunction,metabolic acidosis and SIRS necessitates an immediate exploration.
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<p><b>OBJECTIVE</b>To explore the predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases and its significance for the timing of exploratory laparotomy.</p><p><b>METHODS</b>This retrospective study enrolled 63 patients diagnosed as acute mesenteric vascular occlusive diseases at Peking University People's Hospital between July 1995 and June 2015. Univariate analysis and multivariate logistic regression analysis were used to identify predictive factors for intestinal necrosis.</p><p><b>RESULTS</b>Of 63 patients, 39 were male and 24 were female, with a mean age of (58.8±12.7)(31 to 82) years. The overall rate of intestinal necrosis was 46.0%(29/63). Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (χ=5.908, P=0.015). In univariate analysis, the predictive factors of intestinal necrosis were systemic inflammatory reactive syndrome (SIRS) (χ=18.535, P=0.000), shock (χ=7.775, P=0.007), peritoneal irritation sign (χ=11.533, P=0.001), changes of intestinal wall and blood signals on ultrasound or CT scans (χ=14.344, P=0.000), international normalized ratio(INR) (prothrombin time) ≥1.2 (χ=4.498, P=0.034), D-dimer ≥1 000 g/L(χ=6.680, P=0.010), low-density lipoprotein ≥270 U/L (χ=6.513, P=0.011), serum albumin <35 g/L (χ=3.914, P=0.048), blood urea nitrogen ≥6.2 mmol/L (χ=11.377, P=0.000), pH values <7.35 (χ=15.887, P=0.000), blood lactate ≥2 mmol/L(χ=17.134, P=0.000), base excess <-1.0 mmol/L (χ=6.674, P=0.010). According to multivariate logistic regression analysis, SIRS(OR=28.945, 95%CI:2.294 to 365.199, P=0.009), pH values <7.35(OR=13.174, 95%CI:1.157 to 150.027, P=0.038), changes of intestinal wall and blood signals on ultrasound or CT scans(OR=4.857, 95%CI:1.110 to 21.253, P=0.036) were independent predictive factors of intestinal necrosis in patients with acute mesenteric vascular occlusive diseases.</p><p><b>CONCLUSIONS</b>Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis. When patients with acute mesenteric vascular occlusive diseases are found to have acidosis, SIRS and changes of intestinal wall and blood signals on ultrasound or CT scans, surgeons should be alert to the occurrence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management.</p>