Postoperative complications of open abdominal aortic aneurysm surgery / 中华普通外科杂志

Objective To investigate the treatment and prevention for postoperative complications of abdominal aortic aneurysm(AAA)in open surgery.Methods 329 AAA patients received open surgery from January 1991 to August 2009.The postoperative complications were analyzed retrospectively.Results 30 d mortality rate was 0.91%,the incidence of postoperative complications was 19.1%(63/329),including cardiac dysfunction in 21 cases,respiratory insufficiency in 15 cases,myocardial infarction in 6 cases,renal failure in 5 cases,arrhythmia in 6 cases,cerebral infarction in 2 cases,artery embolism of lower extremity in 2 cases,wound dehiscence in 2 cases,incisional hernia in 1 case,ecchymoma in 1 case and deep vein thrombosis in 2 cases.One patient died of acute myocardial infarction,one died of renal failure after 20 d dialysis,1 patient died of premature ventricualr contraction and fibrillation ventricular.Other patients recovered well. Conclusions Cardiac dysfunction and respiratory insufficiency are the main postoperative complications of AAA.Preoperative evaluation.careful intraoperative maneuvre and postoperative care ale the key to improve the treatment effectiveness.

Superficial vein stripping in the treatment of varicosis concurrent with combination of superficial and deep venous reflux / 中华普通外科杂志

Objective To examine outcomes of superficial vein stripping for vein varicosis caused by combination of superficial and deep venous reflux and the effect on deep vein reflux. Methods From January 2004 to December 2006, twenty patients (22 lower extremities) with combined superficial and deep venous reflux were enrolled for evaluation, patients with superficial venous reflux alone worked as controls.All patients underwent superficial vein stripping and followed up for 2 years. Venous clinic severity score (VCSS) and color duplex ultrasound test were used to evaluate the change of clinic symptoms and valve reflux of deep veins. Results Preoperative VCSS of superficial and deep vein reflux group and superficial vein reflux group was 7.1 ± 2. 9 and 6. 6 ± 2. 0 respectively (P = 0. 44). At two years after operation the VCSS was 2. 3 ± 1.2 and 1.8 ± 0. 8 respectively without significant statistic differences, whereas comparing postoperative VCSS with individual preoperative parameters there was a significant decrease (P <0. 01). In combined superficial and deep vein group, deep venous reflux reduced in 7 limbs, progressed in 4 limbs, no change in 12 limbs. While in superficial reflux alone group, deep venous reflux occurred in 4 limbs.Conclusions Superficial vein stripping effectively improves symptoms of great saphenous vein varicosis of lower extremity caused by combination of superficial and deep vein reflux without a significant effect on the stares of deep vein reflux.

The treatment of acute infrarenal abdominal aorta occlusion / 中国普通外科杂志

Objective To sum up the experience in the management of acute infrarenal abdominal aorta occlusion. Methods We retrospectively analyzed 34 cases of acute infrarenal abdominal aorta occlusion treated during a period of 18 years. Cell saver was used intraoperatively in five cases.Results Twelve cases died postoperatively in this group (35 3%), with acute post operative renal failure, metabolic acidosis and hyperkalemia being the main causes of death. No acute renal failure and metabolic acidosis occurred in all cases treated by cell saver during operation. Limbs were salvaged in 36 out of 44 extremities of patients surviving the surgical procedure. ConclusionsPrompt diagnosis, proper surgery and correct management of post operative complications are necessary to decrease mortality. Perioperative application of cell saver is recommended to eliminate metabolic wastes from the body.

Diagnosis and treatment of acute lower extremity arterial injury:experience of 125 cases / 中国普通外科杂志

Objective To sum up the experience in the diagnosis and management of acute lower extremity arterial injury.Methods Between Jan 1988 and Feb 2004,125 cases of lower limb arterial injuries were admitted and undergoing surgery, including gunshot in 3 cases, blunt trauma in 56 and stabbing in 66 cases. Associated injuries included bony injury in 36 cases, nerve injury in 11 cases, and vein injury in 23 cases. Arterial primary or patch repair was performed in 28 cases, end-to-end anastomosis in 37 cases, saphenous vein graft used in 32 cases, prosthetic graft bypass in 23 cases, thrombectomy in 2 cases and blood vessel ligation in 3 cases.Results Limb salvage rate was 85.6% and patient survival of 98.4%. Massive bleeding and multiple organ failure caused mortality in one each. The rate of amputation is 10.4%(13/125), with preoperative gangrene being present in 8 cases.Conclusion Lower extremity arterial injury carries a high amputation rate. The use of Doppler scanner is helpful for early diagnosis. An ankle/brachial index of less than 1 in the affected limb was considered as a positive sign of arterial injury. Prompt revascularization and early fasciectomy are important to reduce amputation rate and mortality.

Experience in the management of extensive small bowel necrosis from acute superior mesenteric arterial embolism: report of 7 cases / 中国普通外科杂志

Objective To summarize our experience in the management of extensive small bowel necrosis from acute superior mesenteric arterial (SMA) embolism. MethodsSeven cases with extensive small bowel necrosis from acute SMA embolism were treated from 1991 to 1999. Results In this group small bowel of 28～ 30 cm and 70～90 cm were remained respectively in 3 and 4 cases after surgery. Two patients died of septic shock while the other 5 developed short or ultra short bowel syndrome and were finally cured by means of combined intravenous nutrition and oral feeding. 5 patients were followed up for 18～36 months, all are in good health. Conclusions Timely diagnosis and prompt operation are important to elevated survival rate. SMA embolectomy helps in preserving living intestine. For patients with short or ultra short bowel syndrome, comprehensive measures of intravenous nutrition and stepwise oral feeding in combination can quickly restore digestive and absorptive function of the residual intestine.

Surgical management for ruptured aortoiliac artery / 中国普通外科杂志

Objective To evaluate surgical therapy for ruptured aortoiliac artery. Method Between Apr 1984 and Dec 2003, 23 patients of ruptured aortoiliac artery were admitted with ruptured aortoiliac artery aneurysm in 18 cases and traumatic artery rupture in 5 patients. Two patients were treated with direct vascular repair and 21 patients underwent prosthetic grafts replacement. Result Four cases died perioperatively including 2 patients dying of acute renal failure, one of upper gastrointestinal heamorrhage caused by stress ulcer at 48 h after operation, and one of respiratory failure in 72 h. Conclusion Based on the etiology emergency operations should be performed on patients of ruptured aortoiliac artery by repairing or prosthetic grafts replacement.

Prosthetic graft occlusion and options of reoperative modality / 中国普通外科杂志

ObjectivesTo analyse the causes of occlusion of prosthetic grafts and to explore the appropriate modality of reoperation.MethodThe clinical data of 47 patients with occlusive prosthetic grafts were analyzed retrospectively. The procedure of treatment for patients with different causes of occlusive graft included thrombectomy alone in 9 cases, thrombectomy and anastomotic plasty in 16 cases, new bypass using prosthetic graft and saphenous autograft in 22 cases. ResultsThe reoccurrence of graft occlusion in patients undergoing thrombectomy alone or thrombectomy and anastomotic plasty was 67% and 56% respectively, which was siginificantly higher than that of 9% in patients treated by a new arterial bypass with prosthetic grafts and saphenous autografts. ConclusionsThe result of new bypass for occlusive prosthetic graft is superior to thrombectomy alone or thrombectomy and anatomotic plasty.