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Objective:To comparae the accuracy of imaging examination in preoperative parathyroid localization, and the safety and effect of total parathyroidectomy on secondary hyperparathyroidism complicated by chronic renal failure.Method:A total of 257 patients with secondary hyperparathyroidism who underwent total parathyroidectomy at the Department of General Surgery , Zhongshan Hospital, Dalian University from Mar 2012 to Mar 2022 were analyzed retrospectively.Result:Six hundred fourty parathyroid glands were found by color Doppler ultrasound and 954 parathyroid glands were by enhanced CT before the operation. Among them, the number of patients with accurate location of all 4 parathyroid glands by color Doppler ultrasound was 54, while that by enhanced CT was 216. The parathyroid detection rate by enhanced CT was significantly higher than that of color Doppler ultrasound ( χ2=325.480, P<0.001), and the accuracy rate was significantly higher tnan that of color ultrasound ( χ2=215.146, P<0.001). The average values of iPTH before operation, on the day after operation, on the 1st day and 7th day after operation were (1 880±890), (137±82), (66±46) and (34±23) pg/ml, respectively. The clinical symptoms of all patients were significantly relieved. Conclusions:Enhanced CT is superior to color Doppler ultrasound in the overall detection rate and individual localization accuracy of preoperative parathyroid localization. Total parathyroidectomy is safe and reliable in the treatment of secondary hyperparathyroidism complicated by chronic renal failure.
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Objective:To evaluate the safety and long-term effect of total parathyroidectomy in patients with secondary hyperparathyroidism.Methods:One hundred fifty-four patients with secondary hyperparathyroidism who underwent total parathyroidectomy in Zhongshan Hospital,Dalian University from Mar 2012 to Mar 2018 were followed up for 3-9 years,including the level of iPTH, serum calcium and phosphorus and dosing of calcium supplement.Results:Among the 154 patients, the iPTH level in 149 patients fluctuated within 15-60 pg/ml. After oral calcium carbonate, the blood calcium fluctuated in 1.8-2.4 mg/ml, and serum phosphorus was 0.8-1.6 mg/ml. The level of iPTH in 5 patients was between 80-150 pg/ml, which was higher than the normal value 10-70 pg/ml. The clinical symptoms of all patients were significantly relieved.Conclusion:Total parathyroidectomy is safe and reliable in the treatment of secondary hyperparathyroidism with low recurrence rate and stable long-term effect.
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Objective To evaluate the way of under local anesthesia hernia ring without tension hernia repair filling type surgical treatment the groin hernia surgery value of clinical application.Methods The clinical data of 256 cases were analyzed retrospectively for inguinal hernia in local anesthesia downside hernia ring filling type without tension hernia repair.Results All patients were recovered,under local anesthesia hernia ring without tension filling type hernia repair operation convenient operation,postoperative pain were light,the recurrence rate was low,less complications.Only 2 cases appeared the liquefaction of fat,1 case appeared urinary retention.Follow-up so far without recurrence.Conclusion Local anesthesia hernia ring without tension hernia method is safe and rehable,simple operation,and complex human anatomy,it is a kind of ideal choice to the ones who can't tolerate epidural anesthesia patients.
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Objective Study of the effects of hepatocyte growth factor on inhibit Intimal hyperplasia of the anastomotic stoma after carotid artery bypass grafting.Methods Thirty-two New Zealand white rabbits were randomly divided into control group and the experimental group.The veins were pretreated with saline solution(control group)only or pretreated with HGF(experimental group ;100ng/ml).The vein grafts were harvested at 14 days,28days after operation,HE Stain and Elastic fibrin Stain,The thickness of Intima and media in the vein grafts,intima-media ratio(I/M) was calculated by computer image analysis system.PCNA Immunohistochemistry was performed.Results The thickness of Intima and media in the vein grafts of control group surpassed experimental group significantly(P ＜0.01).At 14d I/M in the vein grafts of control group (0.81 ± 0.05) surpassed experimental group (0.47 ± 0.05) (P ＜ 0.01),At 28d I/M in the vein grafts of control group(0.73 ± 0.01)surpassed experimental group (0.65 ± 0.01) (P ＜ 0.01).The vascular smooth muscle cell proliferation in experimental group was significantly lower than that in control group (P ＜ 0.01).Conclusion Treatment of veins grafts with HGF can significantly inhibit intimal hyperplasia in a rabbit carotid artery bypass grafting model.
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Objective Discusses the peeling carotid endarterectomy tcchnique(CEA) operation methods and main points,around the time of surgery to reduce the incidence of stroke and postoperative restenosis rate.Methods Retrospectively analyzed and summarized for the CEA 21 cases in vascular surgery in our hospital from March 2006 to November 2011.Conventional Doppler ultrasonography,preoperative CTA.All the patients were under general anesthesia CEA,conventional set neck artery bypass tube surgery and vascular patch for carotid angioplasty.Results Around the time of surgery and postoperative 30 d were no deaths and stroke occurred and the follow-up both not again hair.In 3 6 months after mild carotid artery stenosis (＜40％),patients were no more than the carotid artery stenosis again.Conclusion Carotid endarterectomy exfoliative procedure the routine use carotid artery flow pipe and the blood vessels to patch do artery figuration,which can effectively improve the safety of the procedure and reduce postoperative restenosis happen.
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Objective To study the surgical treatment of multilevel arterial occlusion of lower extremities. Methods Single or jumping arterial bypass using grafting and percuteneous transluminal angioplasty(PTA)and stenting combined with infrainguinal revascularization were used for the multilevel arterial occlusion in 25 lower extremities. Results 25 cases showed satisfactory results in 6 months to 3 years follow-up. Postoperatively,the ischemia symptoms of limbs were improved or disappeared,4 toes were amputared because of preoperative dry gangrene,the wounds received eurement in a 2 to 4 months,2 graftings became occluded in 6 months postoperation. There were no procedural or postoperative morbidity or mortality.The cumulative patency rate of grafting was 92%(23/25),The rate of curement was 100%.Conclusion According to the individual principle,it is an effective therapy method to choose single or jumping arterial bypass and PTA and stenting combined with infrainguinal revascularization for high risk patients with multilevel arterial occlusion.