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

Objective To study the effective surgical methods for the sequela of deep vein thrombosis(DVT) of lower extremity . Methods The clinical data of 32 patients with the sequela of DVT of lower extremity in 36 limbs treated by surgery since 1992 were analysed retrospectively. Results Diagnosis accuracy rate of angiography in sequela of DVT was 100%. There were type I in 5 limbs, type IIA in 4, type IIB in 12,and type III in 15. External constriction valvuloplasty of superficial fomoral vein(SFV) was performed on 16 limbs,valvuloplaasly of SFV on 3 limbs,great saphenous vein popliteal vein anastomosis in situ in 6 limbs,muscular loop plasty on popliteal vein in 4 limbs,common iliac vein SFV anastomosis with artificial vessel interposition in 3 limbs,great saphenoas vien ansatomosed to opposite SFV in 4 limbs. After treatment,symptoms totally disappeared in 28 limbs ( 77.8% ), and improved in 8 limbs. Conclusions The vasography is diagnostic chrysindicatrix of the DVT sequela. Different operations based on the damage of valves should be chosen.

Prevention and treatment of postoperative recurrence of Budd-Chiari syndrome :a report of 223 cases / 中国普通外科杂志

Objective To investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.

Treatment of Budd-Chiari syndrome with percutaneous transluminal angiography and expandable metallic stent / 中国普通外科杂志

Objective To study the therapeutic effect of percutaneous transluminial angiography (PTA) and expandable metal stent (EMS) on the treatment of Budd Chiari syndrome(BCS). Methods One hundred and twenty patients with BCS confirmed by color Doppler ultrasonography, inferior vena cava venography and hepatic veins venography. All the 120 patients underwent PTA and EMS. All the 120 patients were followed up for 6 to 108 months. Results The treatment results in 115 patients(95.8%) were satisfactory,and 5 cases had recurrent during follow up . Conclusions PTA with EMS is an excellent method to treat the cases of BCS with non long segment occlusion of IVC.

Endoluminal therapy guading by ultrasonography or plus portosystemic shunts for Budd-Chiari syndrome: a report of 36 cases / 中国普通外科杂志

Objective To evaluate the effect of endoluminal treatment for Budd Chiari syndrome (BCS) .Methods In 36 patients with BCS were treated by inferior vena cava(IVC) dilation and endoluminal stent placement guaded by ultrasonography, including self expanding mental Giaturco stent placement in 33 patients and pure dilation in 3 patients. Portosystemic shunts(PSSs) were followed in 13 patients with hepatic venous occlusion a week after the endoluminal treatment, including splenorenal(S R) shunts in 5 cases,and mesocaval (M C) shunts in 8 cases. Results After endoluminal procedures ,slight heart dysfunction appeared in 3 cases . After shunting ,acute pancreatitis occurred in 1 case, and upper gastrointestinal hemorrhage occurred and finally resulted in death in another case on the 10th day after PSS.All the 36 patients were followed up for 1 month to 8 years. Restenosis of the distal part of stent was found in 1 case 2 years after the operation,hepatic vein occlusion occurred in 1 case 1 year after the treament, hepatoma occurred in 1case 3 years after the treatment,and 1 patient died of C type hepatitis a year later; and 2 cases with infertility had babies 1 year later. All patients had no stent migration or occlusion of shunts .Conclusions Endoluminal therapy guarding by ultrsonography is a convenient, safe and effective method for Budd Chiari syndrome. For patients with hepatic venous occlusions, a portosystemic shunt is recommended.The above mentioned methods provide a feasible and effective means for some kinds of Budd Chiari syndrome.

Treatment of primary hepatic cancer with portal venous tumor thrombosis / 中国普通外科杂志

Objective To investigate an effective method of treating primary hepatic cancer(PHC) with portal venous tumor thrombosis (PVTT). Methods The clinical data Of 23 patients with PHC and PVTT were retrospectivly analysed. Results Of the 23 patieats after hepatoma resection and PVTT extraction, continuous micro dose infusion chemotherapy or perfusion chemotherapy by DDS was adopted. In 8 patients with main portal vein tumor thrombus, 2 died, 4 recured in 6 months. In 8 patients with the first class branch of portal vein tumor thrombus, 2 recurrd in 6 months and 6 recurred in 12 months. In 4 patients with secondary class branch of portal vein tumor thrombus, l recurred in 12 months (P

Mesocaval C-shunt plus ligation of splenic artery and esophagogastric (devascularization) in the treatment of type II Budd- Chiari syndrome / 中国普通外科杂志

Objective To study a new operative method for treatment of hepatic venous occlasion without (associated) pathologic change of inferior vena cava or long-segment stricture. Methods A total of 44 cases of Budd-chiari syndrome with hepatic venous occlusion without pathologic change or long-segment stricture of (inferior) vena cava underwent combined mesocaval C-shunt, ligation of splenic artery, and esophagogastric (devascularization).Results Pre-shunt portal venous pressure was 36cmH2O(31~45 cmH2O, 1cmH2O=0.0098kPa) and post-shunt pressure fell to 26 cmH2O(21~33 cmH2O),the mean reduction was 10 cmH2O. One patient died of liver failure. A slight degree of hepatic encephalopathy occurred in 2patients who recovered after conservative treatment.Chylorrhea occurred in 4 patients, and it spontaneously disappeared 7d to 3.5months after operation. 39 patients(88.6% follow up) were followed up for 6months to 7years , and there was no case of recurrent bleeding nor hepatic encephalopathy. Ascites disappeared in 31cases,and was markedly reduced in 7 cases .The prosthetic grafts were patent as shown by color Doppler ultra sound in all followed-up patients.Conclusions This operation is simple and effective for B-CS with hepatic venous (occlusion) but not associated with inferior vena caval pathologic change or long-segment stricture.

Clinical analysis of mistakes in treatment of Budd-Chiari syndrome by stent placement in inferior vena cava:a report of 21 cases / 中国普通外科杂志

Objective To investigate the indications for interventional therapy of Budd-Chiari syndrome((B-CS)) and surgical treatment after stent failure. Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of B-CS by stent placement in inferior vena cava(IVC).Results (Among) the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was (displaced) in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P

Surgical treatment of acute lower extremity ischemia:a report of 96 cases / 中国普通外科杂志

Objective To study methods of salvage therapy for acute lower extremity(ALEI) ischemia.(Methods) A restrospectively analyzsis was made on the clinical data of 96 patients with consecutive 106 ALEI limbs.In which Fogarty catheter embolectomy was used as the initial treatment for ALEI in a regular(operating) room or in an intervention therapy room under DSA monitoring,and graft bypass after embolectomy was performed on 8 cases(12 limbs).Results In 70 cases(75 limbs) successful embolectomy of the(iliac),femoral,popliteal and tibial artery was achieved.In 11 cases(12 limbs) embolectomy at distal to the popliteal artery was unsuccessful.Eight cases(12 limbs) with obstruction proximal to the femoral artery were treated by axillofemoral bypass in 4 cases,and femorofemoral bypass in 4 cases.One case of thoracoabdominal aortic dissection aneurysm and lower extremity ischemia had fenestration of the abdominal aoric dissection.Proximal embolectomy and distal amputation was performed in 6 cases.Fimally,76(79.2%) cases had(salvaged) limbs,11(11.4%) patients had amputated limbs,and 9(9.4%) patients died.Seventy-six(patients)(85 limbs) were followed up for 1 to 38 months,7 cases(7 limbs) were reoperated on because of recurrent embolism.Conclusions Embolectomy is the effective treatment method for ALEI.Embolectomy(under) DSA monitoring can improve therapeutic results.The prognosis lies on the duration and extent of(ischemia),and management of complications.

Management of severe Budd-Chiari syndrome(a report of 95 cases) / 中国普通外科杂志

Objective To investigate the treatment of severe Budd-Chiari syndrome (BCS) . Methods The clinical data of 95 patients with severe BCS from November 1994 to June 1999 were retrospectively analyzed . Results Mesocaval C shunt with artificial graft was performed in 51 cases , splenojugular shunt with artificial graft in 23 cases ,mesojuglar shunt with artificial graft in l case , percutaneous transhepatic recanalization and dilation and/or stent placement of main hepatic vein (MHV) in 10 case, and combined PTA and stent placement of inferior vena cava (IVC) and mesocaval shunt in 10 cases . 5～60 months follow-up showed excellent result in 65 patients , good results in 25 and 5 cases dead. Conclusions Good results could be obtained by most of the severe BCS patients treated by different procedures according to the pathological changes of IVC and main hepatic vein.

Multiple stent inplantation for thrombotic membranous obstructive Budd-Chiari syndrome / 中国普通外科杂志

Objective To evaluate the effect of rediological intervention on thrombotic membranous obstructive Budd-Chiari syndrome(TMOB-CS) .Methods Seventeen cases of TMOB-CS were treated with mutliple stent inplantation to press the thrombus with PTA.Results The inferior vena cave(IVC) pressure declined from(29.4?3.13)cm H 2 O to (3.45?3.20)cm H 2 O after the multiple stent inplantation.There was no severe complication such as pulmonary thrombembolism occurrence in this series.All the patients had been followedup for 3 to 40 months and showed good results.Conclusion Multiple stent inplantation pressing the thrombus with PTA can be used to treat the patients with TMOB-CS.