Application of extra-anatomic prosthesis bypass in the retroperitoneum for the treatment of infected abdominal aortic aneurysms / 中华普通外科杂志

Objective To assess the effectiveness of extra-anatomic prosthesis bypass in the retroperitoneum as a treatment for infected abdominal aortic aneurysms (iAAAs).Methods We retrospectively reviewed the records of 10 consecutive patients diagnosed with iAAAs and treated by an extraanatomic prosthesis bypass in the retroperitoneum over the past 7 years.All 10 patients were regularly followed up by outpatient observation after their discharge.Results Ten patients with iAAAs underwent an extra-anatomic prosthesis bypass in the retroperitoneum and debridement of the infected aneurysm.An emergency operation was performed for one patient who underwent concomitant gastrointestinal procedures for aortoduodenal fistula,the other 9 cases underwent an elective operation after an intravenous antibiotic therapy for 2-4 weeks.All 10 patients were definitely diagnosed by one or more sequential CT scans combining with other methods.All patients had at least a positive preoperative blood culture or intraoperative tissue culture during the perioperative period,including Salmonella in 5 cases,Burkholderia pseudomallei in 3 cases,Escherichia coli in 1 case,Klebsiella pneumoniae in 1 case.All patients were discharged in 4-6 weeks after their operations.Except 1 case who died 16 months after surgery,all other patients were alive and were free from graft infection during the follow-up period.Conclusions The extra-anatomic prosthesis bypass in the retroperitoneum for treating iAAAs are safe and effective.

Analysis of clinical management for severe and complicated pancreatic trauma / 中华肝胆外科杂志

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.

Twenty-year experience in the diagnosis and treatment of hepatic trauma / 国际外科学杂志

Objective To summarize the experience in the diagnosis and treatment of hepatic trauma. Methods The clinical data of 260 patients with hepatic trauma admitted from January 1988 to December 2007 were retrospectively reviewed with regard to degree of trauma, treatment methods, therapeutical effects, complications and SO on. Results One hundred and fifty-three eases were treated by operative management,1 07 cases by nonoperative management.236 cases were cured,24 cases died,and the case fatality rate was 10.2%.There were no death among 139 patients with hepatic trauma grades Ⅰ～Ⅱ,22 death among 119 grades Ⅲ～Ⅴ patients, all death of 2 in grade VI, which demonstrated the correlation between death and hepatic trauma grade was statistically significant. Complications appeared in 82 eases, mainly including Secondary hemorrhage, abdominal infection and so on. Conclusions Nonoperative management is suitable for hepatic trauma with stable hemodynamics. Operative management is rapidly selected when the hemodynamics aren't stable. The cooperation of many specialities can enlarge the application of nonoperative management and decrease complications.

Surgical treatment for pancreatic disrupture with major duct injury / 国际外科学杂志

Objective To investigate the selection and efficacy of operative medality for pancreatic transec-tion with major duct injury. Methods The clinical data were retrospectively analyzed in 21 patients with pancreatic disruption. They were treated in our hospital from Jan. 1995 to Feb. 2009. There were 14 males and 7 females in these cases with a mean age of 26 years (range 9-53 years). The trauma causes of them were blunt injuries in 13 and patent injuries in 8 cases. The injury grade (according to American Association for the Surgery of Trauma) distribution for these patients was grade Ⅲin 8 cases, grade Ⅳ in 8 cases, and grade V in 3. The early emergency operation was performed in eighteen within 12 hours, and delayed opera-tion was in three cases. Of these operative medalities, Roux-en-Y distal panereatojejunostomy was in 10 ca-ses, pancreatoduodenectomy was in 3, modified duodenal diverticulizatian was in 2, distal pancreatectomy was in 3, tube installing in major duct and external drainage, and suture of pancreatic section was in 2, su-ture of two broken sides in 1 (Roux-en-Y distal pancreatojejunostomy in second time). Results Twenty patients were cured, and one was died after a procedure of pancreatoduodenectomy. The postoperative pan-creatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusions For improving the outcome of pancreatic transection, the earlier exploratory laparotomy and carrying out concept of "Damage Control Surgery" are critical. The individual operative modality based on the grade should be a-dopted in the surgical procedure.

Surgical treatment of Takayasu arteritis accompanied with aneurysms / 中国普通外科杂志

Objective To discuss the diagnosis and surgical treatment of Takayasu arteritis accompanied with aneurysms. Methods The clinical features and the effect of operation types in 14 patients were reviewed.Results All the 14 patients had history of Takayasu arteritis and had steroid therapy before the formation of aneurysms.Among the 14 patients,aortic aneurysms were found in 13(including 9 thoracoabdominal aneurysms),carotid aneurysm with subclavian aneurysm in 1 and multiple aneurysms in 5.All the 14 patients underwent operations ,including replacement of aorta in 11 cases,bypass of aorta in 3 cases,reconstruction of visceral vessels in 8, renal autotransplatation in 1 and replacement of carotid in 1.1case had heart failure and cured ;1 died postoperatively. Eight cases were followed up for 4 months - 18 years,of which, 1 died of heart failure,2 were excellent, 3 of 5 cases with hypertension preoperatively showed normal blood pressure,and the other 2 were controlled by medicines.Conclusions Operation should be performed as early as possible if the aneurysm is found in patients with Takayasu arteritis.The stenosis of renal artery should be resolved during the operation.

Correlation between HLA gene and Takayasu arteritis in the Chinese / 中国普通外科杂志

Objective To determine the correlation between HLA gene and Takayasu arteritis(TA) in the Chinese. Methods Forty four TA patients and 135 healthy controls were examined for HLA DQA 1 and HLA DQB 1 locus alleles by PCR/SSOP typing and mass genetics techniques. Results The frequency of DQA 1 0301 allele(14.8%) in TA patients was significantly decreased compared with the controls( 30.7% )(P0.05). Conclusions In Chinese, people with HLAⅡ DQB 1 0601 gene may be susceptible to TA, while people with HLAⅡ DQA 1 0301 gene may be resistant to TA.

Surgical treatment of vascular injury / 中国普通外科杂志

Objective To study the management of vascular injury.Methods Retrospective analysis was made on the clinical data of 59 cases of vascular injury,including 55 cases of vascular injury in neck and(extremity) and 4 cases of portal vein and vena cava injury.Among them,21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy.All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission.All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and(drainage) of abscess.Vascular anastomosis was performed in 11 cases,vascular grafting in 12 cases,and(vascular) repair in 14 cases.Results There were 2 deaths.5 cases had amputation(including a case of(femoral) embolism due to intervention trerapy).Postoperative intermittent claudication,decreased skin(temperature) and other signs of ischemia occurred in 21 cases of femoral artery injury with infection,but none developed limb gangrene. The other cases were discharged in good health.Conclusions In the treatment of vascular injury,wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation,with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury.Vascular ligation can be done in cases of femoral artery injury with infection.

Major vessels reconstruction after resection of retroperitoneal neoplasm / 中国普通外科杂志

Objective To summarize the experience in major vessels reconstruction after resection of retroperitoneal neoplasm invided major vessel. Methods Sixteen patients with retroperitoneal neoplarsm invading major vessels underwent resection of the tumor companying with the inviding major vessels, and the resected vessels were reconstructed.Of them, 13 artificial vessels were placed for the vascular reconstruction,and 3 underwent inferior vena cava partial resection and repair with or without PTFE patch;combined reconstruction of arteries and veins were performed on 6 patients,and combined resection and reconstruction of vessels and other invaded organs were performed on 3 patients. Results There was no operative mortality in this series. Fourteen patients were followed up for 3-71 months( averaged 30 months) .Five patients died,in which 3 patients died within 12 months, 1died at 64 months and 1died at 71 months after surgery,respectively.There were no obstruction of the reconstructed vessels during follow up. Conclusions Combined resection of retroperitoneal neoplasm with invided major vessel and vascular reconstruction is a safe, effective operation for retroperitoneal neoplasm companying with inviding major vessel.

Surgical treatment of acute deep vein thrombosis of lower extremity / 中国普通外科杂志

Objective To evaluate the effects of surgical treatment of acute deep vein thrombosis (DV T) of lower extremity. Methods Thirty-six patients with a cute DVT of lower extremity were treated by thrombectomy with thrombolytic,a nticoagulant and compression on the affected lower extremity during and after op eration. Results No death and serious complications happened i n this series. Thirty-one patients were followed-up for 2 to 20 months with a n average of 9 months. Symptoms disappeared totally in 23 patients , 8 patien ts had slight edema in the lower extremities. Conclusions Com bination of thrombectomy the thrombolytic and anticoagulant agent,and comp ression of the affected lower extremity is a safe and effective method in the t reatment of acute DVT of lower extremity.