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Objective To evaluate percutaneous transampulla stent implantation in treating lower malignant obstructive jaundice, and to discuss the related factors that may influence the stent patency time. Methods The clinical data of a total of 104 patients with lower malignant obstructive jaundice, who received percutaneous transampulla stent implantation during the period from January 2010 to March 2016, were retrospectively analyzed. The parameters, including gender, age, primary tumor type, preoperative external drainage, total bilirubin (TBIL), albumin (ALB), glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), white blood cell (WBC) count, platelet (PLT) count, hemoglobin (HGB) and length of biliary stricture, were used to evaluate the risk factors related to postoperative patency time. Results Single Cox regression analysis showed that primary tumor type, ALB, WBC count, length of biliary stricture were the related factors that significantly affected the stent patency time. The Cox regression analysis further indicated that primary tumor type and length of biliary stricture were the important related factors that significantly affected the stent patency time. Conclusion In treating lower malignant obstructive jaundice with percutaneous transampulla stent implantation, primary tumor type and length of biliary stricture may be the important related factors that affect the stent patency time. These parameters are of great value in estimating the stent patency time.
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Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.
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Objective To evaluate the feasibility and safety of establishing benign proliferative esophageal stenosis model by using stent implantation in experimental rats.Methods A customized self-expanding,metallic and straight tubular stent was used in this experiment (5 mm in diameter and 15 mm in length),on both sides at the stent's middle part there was a protruding barb that was used as a fixation device.Twelve healthy Sprague Dawley (SD) rats were randomized divided into group A (blank control group) and group B (stent implantation group),with 6 rats in each group.Esophageal stent implantation was employed in the rats of group B,and esophageal radiography was separately performed immediately,one and 4 weeks after stent implantation.All the experimental rats were sacrificed 4 weeks after stent implantation.The normal esophageal tissue of the rats in group A and the esophageal tissue at stent site of the rats in group B were collected and sent for pathological examinations,including gross morphology,light microscopy,etc.Results Successful stent implantation was achieved in all rats of group B,and the esophageal radiography performed immediately,one and 4 weeks after stent implantation showed no esophageal stent displacement;no severe complications occurred during the operation or follow-up period.Compared with group A,esophageal radiography reexamination performed 4 weeks after stent implantation in group B revealed that esophageal stricture at stent segment,caused by benign tissue hyperplasia,could be observed.The esophageal stent segment was taken out,its lumen was obviously narrowed under gross observation,and typical benign hyperplasia could be seen under optical microscope examination.Conclusion Using esophageal stent implantation to establish esophageal stenosis model is safe and feasible in experimental rats.The use of esophageal stent with barbs can significantly reduce the incidence of stent displacement.
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Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.
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@#Objective To explore the effect of acupuncture combined with facilitated technique on lower limb function and activities of daily living of stroke patients.Methods 120 stroke patients with lower limb palsy were divided into the group Ⅰ (treated with acupuncture combined with facilitated technique), group Ⅱ (treated with acupuncture), third group Ⅲ (treated with facilitated technique) and the group Ⅳ (treated with medicine). The lower limb function and ADL of four groups were evaluated with Functional Ambulation Classification (FAC), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) before and 10 weeks after treatment.Results The scores of FAC, FMA and MBI of all the groups improved significantly, but it was more significantly in the first group than the in other groups (P<0.01), in group Ⅰ, Ⅱ, Ⅲ than in group Ⅳ (P<0.01). The difference between the group Ⅱ and Ⅲ was insignificantly(P>0.05).Conclusion Acupuncture combined with facilitated technique can improve the lower limb function and activities of daily living of stroke patients more effectively.