ABSTRACT
Objective:To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.
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OBJECTIVE:To optimize the decoction technology of Zhuanggufang decoction powder. METHODS:Central com-posite design with 2 factors and 5 levels was conducted to design the test,taking water (fold) and decoction time as independent variables,the extraction amount of icariin and extraction yield overall desirability value of as dependent variables,regression equa-tion were fitted;response surface method was used to optimize the decoction technology of Zhuanggufang decoction powder,and was verified. It was compared with the traditional decoction piece effect. RESULTS:The optimized technology was decocted twice with 16-fold water,20 min each time;relative error of predicted and theoretical value by overall desirability value was 2.97%;af-ter decoction powder and piece decocted in the same conditions,the extraction amounts of icariin were 1.2343 μg/g and 1.1324μg/g,extraction yields were 23.73% and 17.84%,respectively. CONCLUSIONS:Central composite design-response surface meth-od optimizing decoction technology is simple and reliable,the optimized decoction technology is stable and feasible,and the decoc-tion capability of Zhuanggufang decoction powder is better than the traditional pieces.
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Objective To explore the regularity of the distribution of traditional Chinese medical syndrome elements in early renal injury patients with type 2 diabetes mellitus ( T2DM) . Methods A total of 200 patients with T2DM early renal injury were enrolled into the study. Syndrome element differentiation was carried out for the analysis of the distribution of syndrome location and syndrome nature. Results ( 1) Kidney had the highest scores of syndrome location , and then came the spleen, and meridians and collaterals . The syndrome location scores of kidney, spleen, meridians and collaterals differed from those of liver, heart, lung, and stomach ( P<0.01) . ( 2) In excess syndrome elements, the percentage of syndrome elements of phlegm, blood stasis, dampness was in decreasing sequence. In deficiency syndrome elements, the percentage of syndrome elements of yin deficiency, qi deficiency, and yang deficiency was in decreasing sequence. ( 3) For the distribution of syndrome elements, kidney yin deficiency had the highest scores, next came spleen qi deficiency, and finally came blood stasis of meridians and collaterals. Conclusion In T2DM early renal injury patients, kidney, spleen, meridians and collaterals are the main affected location; yin deficiency, qi deficiency, and yang deficiency are the predominant deficiency syndrome elements, and phlegm, blood stasis, dampness are the predominant excess syndrome elements. Kidney yin deficiency, spleen qi deficiency , and blood stasis of meridians and collaterals are the commonly-seen syndrome patterns in T2DM patients with early renal injury.
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This study was aimed to explore the curative effect of Zhuo-Du-Qing (ZDQ) particles on diabetic cystopa-thy (DCP) based on the theory of turbid toxin. A total of 100 DCP patients were randomly divided into the control group with 47 cases and the treatment group with 53 cases. Mecobalamin tablets was given in the control group. And ZDQ particles were given to the treatment group. The treatment course was 3 months. The observation was made on the bladder residual urine (BRU), clinical manifestation integral, hemodynamic indexes, HOMA-IR and HbA1c before and after the treatment. The results showed that compared with pretreatment, the BRU, clinical manifestation integral, hemodynamic indexes, and HOMA-IR were significantly reduced (P < 0.01). Compared with the control group, the BRU, clinical manifestation integral, hemodynamic indexes, and HOMA-IR were also significantly reduced (P <0.01). The effective rate in the treatment group was 81.1%, which was significantly higher than 59.6% in the control group (P< 0.05). There were no obvious changes on the blood routine examination, urine routine examination, stool routine examination, liver function, renal function, electrocardiogram and so on before and after treatment. It was con-cluded that the treatment of DCP with ZDQ particles was safe and effective. To remove toxin and descend turbid may be another effective treatment method for DCP. The occurrence and development of DCP were closely related to the turbid toxin.