Risk factors of neurologic complications after surgical resection of carotid body tumor / 中华普通外科杂志

Objective:To investigate risk factors of nerve injury after carotid body tumor resection.Methods:From 1991 to 2016, the clinical data of patients with neurologic complications after resection of carotid body tumor was retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors of nerve injury.Results:A total of 132 patients with 142 tumors underwent surgery. 45 patients (46 sides) suffered nerve injury, including 4 strokes and 44 nerve injuries. After active rehabilitation, 18 cases were left with permanent nerve injury, and the 4 patients with strokes regained self-care ability. By multivariate regression analysis, high-lying tumors ( OR=4.345, P=0.005), Shamblin Ⅲ tumor ( OR=4.382, P=0.047) increase the risks of postoperative nerve injury. Resection of high-lying tumors carried a higher risk of developing permanent nerve injury ( OR=7.290, P=0.001). Conclusions:Neurologic complication could be alleviated by rehabilitation. Intraoperative abrupt rupture of carotid artery is the leading cause of stroke. Shamblin Ⅲ and high-lying tumor are the predictors of postoperative nerve injury.

Endovascular treatment of aortic lesions involving branch vessels with multi-layer bare stents / 中华外科杂志

Aortic lesions involving branch vessels have always been a great challenge for vascular surgeons. Endovascular repair are growing to take place of traditional open repair for less invasion and lower complication rates. Despite rapid developments in endovascular instruments have been achieved in the last decade, and endovascular techniques such as fenestration stents have been applied in the treatment of aortic lesions involving branch vessels. However, endovascular repairing aortic lesions involving branch vessels remains being restricted by rigorous indication selection as well as requirements of advanced experiences and sophisticated skills. Recently, several studies about treating aortic lesion involving branch vessels with multi-layer bare stents have been reported, the primary results were encouraging and brought new visions for the management of such disease. More approving clinical evidences about the safety and efficacy of multi-layer stents are anticipated.

Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.</p><p><b>METHODS</b>It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.</p><p><b>RESULTS</b>Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.</p><p><b>CONCLUSIONS</b>Endovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.</p>

Hybrid treatment of aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.</p><p><b>METHODS</b>From January 2002 to June 2013, 10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital, Sun Yat-sen University. There were 9 male and 1 female patients with a mean age of (54 ± 14) years (ranging from 34 to 71 years). Of the 10 patients, 8 were aortic dissection and 2 were thoracic aortic aneurysm. All aortic arch debranching was performed with mid-sternotomy, including 7 ascending aorta to innominate artery and left common carotid artery bypass, and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently, simultaneous (n = 5) and staged (n = 5, mean interval (7 ± 4) days) endovascular repair were performed via femoral artery.</p><p><b>RESULTS</b>Technical success rate was 10/10. The 30 day-mortality was 3/10, including 1 brain stem infarction, 1 circulatory failure and 1 aorto-tracheal fistula. Complication included 1 type II endoleak. The median time of follow-up was 24 (14) months. CT scanning was performed at 1, 3 months and annually thereafter. There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type II endoleak.</p><p><b>CONCLUSION</b>Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.</p>

Epidermal growth factor-like domain 7 expression in arteriosclerosis obliterans and abdominal aortic aneurysm / 中华普通外科杂志

Objective To investigate the expression characteristics of epidermal growth factor-like domain 7 ( egfl 7 ) in arteriosclerosis obliterans ( ASO) tissues and abdominal aortic aneurysm ( AAA ) tissues, and it's role in atherosclerosis (AS).Methods In this study, 8 normal artery, 11 lower extremity ASO and 34 AAA samples were collected.Immunohistochemistry and in situ hybridization were performed in artery sections to investigate the expression characteristics of egfl 7 at protein and mRNA levels.The relative quantitative detection of egfl 7 mRNA was detected by qRT-PCR.The effect of egfl 7 was examined by RNA interference.Results In ASO and AAA samples, the expression of egfl 7 protein was mainly in the tunica media; The expression site of egfl 7 mRNA was the same as that of egfl 7 protein.Compared with normal artery samples, the expression of egfl 7 mRNA was significantly upregulated in the early stage of ASO samples and AAA samples (325 ± 120 vs.100 ± 36, P ＜ 0.01, 216 ± 133 vs.100 ± 36, P ＜ 0.05 ).Compared with the control group, the proliferative ability of smooth muscle cells was significantly down regulated after egfl 7 interference (0.85 ± 0.05 vs.1.34 ± 0.04, P ＜ 0.01).Conclusions egfl 7 might be a gene that regulates the pathogenic process of atherosclerosis through promoting vascular smooth muscle cell proliferation.

Clinical analysis of colon ischemia complicating with operated abdominal aortic aneurysm / 中华外科杂志

OBJECTIVE To investigate the etiology, prevention and treatment of colon ischemia after operation for abdominal aortic aneurysm (AAA). METHOD Seven of 140 cases complicated with colon ischemia who had received AAA operation were analyzed retrospectively. RESULTS Three cases underwent emergency operation. The seven cases were subjected to removal of AAA, implantation of prosthesis, and ligation of the inferior mesenteric artery. Two cases had the ligation of the bilateral internal iliac artery (IIA). Epilateral IIA was ligated in 2 cases. Bowel resection was carried out in 3 cases, 1 of which received reconstruction of the inferior mesenteric artery (IMA). Three cases received conservative therapy, but died from multiply organ failure. CONCLUSION Correct prevention and management of colon ischemia can effectively reduce the operative morbidity of AAA patients.

Microcarcinoma of the thyroid: clinically missed diagnosis and management / 中国普通外科杂志

ObjectiveTo investigate the cause of clinically missed diagnosis of thyroid microcarcinoma(TMC) and the management. Methods Clinical diagnostic and therapeutic data of 110 cases with TMC operated and confirmed by pathology from Jan. 1985 to Dec. 2000 were analysed. Results Diagnostic positive rates by ultrasonography and freezing section were respectively 58%(15/26) and 66 7%(14/21) in 26 cases diagnosed preoperatively. Diagnostic positive rate of freezing section was 80%(24/30) in 30 cases discovered intraoperatively. Through postoperative pathologic exam,54 cases were confirmed as TMC that was not discovered in 19 cases by intraoperative freezing section.Total or near total thyroidectomy was only performed on 35 cases,lobectomy of one or both lobes on other cases. Follow up rate was 80 1% with time ranging from 6 months to 15 years. One case recurred without mortality.Conclusion The clinical diagnosis of TMC is often difficult to establish. Careful palpation, ultrasonography with fine needle aspiratiou cytology before operation, and thorough exploration of the suspected nodules in operation will help to heighten the diagnostic rate. Total or near total lobectomy fulfils the eradication of TMC.

Endovascular repair and open surgery for abdominal aortic aneurysm / 中国普通外科杂志

Objective To compare the early result of endovascular repair and conventional open repair for abdominal aortic aneurysm. Methods We analyzed the clinical data of 34 patients with infrarenal AAA. Among them, 15 patients were treated with endovascular repair ( EVR group), 19 with conventional open repair ( COR group). Pre-operative status, intra-operative variables, post-operative outcomes and laboratory findings of the two groups were compared. Results Blood loss and blood transfusion in EVR group were significantly less than COR group (P =0.005, P =0.015). The median fasting period and post-operative hospital stay were shorter in EVR group (P