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Objective To evaluate the application of the placement of titanium clips in the upper and lower tumor margins in precision radiotherapy for early esophageal cancer. Methods:Seventeen patients with early esophageal cancer underwent endoscopy-guided implantation of titanium clips to mark the upper and lower tumor margins. CT-based simulation was performed to delineate the gross tumor volume ( GTV) . The application value of this technology in precision radiotherapy was evaluated. Results:For all patients (including 13 cases with initial treatment and 4 patients requiring radiotherapy after endoscopic resection), the esophageal tumors were not explicitly displayed on CT and barium meal images and the GTV range could not be accurately determined. The esophageal tumors were marked by successful placement of at least one titanium clip in the upper and lower tumor margins. Subsequently, the esophageal tumors were successfully displayed on CT simulation and the target area was accurately delineated. No grade 3-4 adverse events, such as bleeding and perforation occurred. Conclusion Endoscopy-guided titanium clip placement is convenient and feasible for early esophageal cancer, which is of clinical significance for determining the target area of radiotherapy.
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Objective To introduce details of a new procedure of sleeve gastrectomy in mice by using titanium clip,and to observe whether this model has the same post-surgical metabolic effects as traditional procedure of sleeve gastrectomy in mice by using running stitch.Methods Thirt-one male FVB-Tg (NPY-hrGFP) mice,6 weeks (29-31 g) were randomly divided into SG (running stitch) group (n =8),SG (titanium clip) group (n =15) and Sham Operation (SO) group (n =8) by using random number table.Titanium clip was applied to close the side incision of stomachin SG (titanium clip) group,while running stitch was used in SG (running stitch) group which was detailed described in current references.Ligaments around stomach were detached without any stomach incision in SO group.Operation duration,mortality,and changes of post-surgical body weight and food intake were observed.Measured data were expressed as mean ± standard deviation ((x) ± s).Independent sample t test was used for comparison between the two groups.The variance of the data between the three groups was equal and analysis of variance (least significant LSD method) was used to compare each group.Preoperative and postoperative data were compared using a paired t test.Results Operation duration of SG (running stitch) group and SG (titanium clip) group were (44.60 ± 3.13) min and (28.25 ± 2.77) min,respectively.Compared with SG (running stitch) group,operation duration was significantly reduced in SG (titanium clip) group (P ≤ 0.01).Mortality of SG (running stitch) group and SG (titanium clip) group were 37.5％ and 20％,respectively,which has no significant difference (P =0.621).Compared with SO group,postoperative food intake was significantly reduced in both two SG groups (P ≤ 0.01),but there's no difference between two SG groups (P =0.149).At the end of the 6-week-postoperative,body weights of SG (running stitch) group and SG (titanium clip) group were reduced (17.67 ± 5.06) ％ and (18.76 ± 7.87) ％,respectively,while body weight of SO group increased (7.17 ± 2.31)％.Compared with SO group,postoperative change of body weight was significantly reduced in both two SG groups (P≤ 0.0 1),but there's no difference between two SG groups (P =0.746).Conclusions SG by using titanium clip in mice can reduce food intake and body weight as traditional SG by using running stitch does.But with shorter operation duration,this new model of SG in mice can provide a better and stable surgical model in research of mechanism of SG.
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Objective To summarize clinical experience and explore application value of endoscopic clipping with histoacryl using in management of type 2 gastroesophageal varices. Methods Clinical data of 30 patients with type 2 gastroesophageal varices patients (including acute hemorrhage and primary prevention) from May 2015 to December 2016 were collected. Then evaluate therapeutic effect and safety of endoscopic clipping adjuvant therapy. Results Average glue dosage was (1.46 ± 0.70) ml, average using of clips were (5 ~ 6), and intraoperative needle pulling hemorrhage occurred in 2 cases. 14 patients (46.7%) underwent endoscopic re-examination, 3 patients (10.0%) achieved varicose vein elimination, 11 cases (36.7%) remained residual. Rebleeding occurred in 4 cases (13.3%), and 2 cases died (6.7%), one because of postoperative hematemesis and hemorrhagic shock, the other one died of spontaneous peritonitis and septic shock. For general curative effect, 2 cases (6.7%) were healed, 22 cases (73.3%) were improved, and 6 cases were unhealed (20.0%, 4 cases occurred rebleeding, 2 cases died); 17 cases underwent CT portal venograpy, abnormal embolization was not found in any patients, glue extrusion bleeding occurred in 1 case (3.3%), no patients had severe postoperative complications. Conclusion Endoscopic clipping with histoacryl can be used in the prevention and treatment of type 2 gastroesophageal varices to improve the treatment effect and reduce postoperative bleeding risk, may have good clinical practice value.
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Objective To investigate the effect and clinical application of two kinds of endoscopic titanium clip in treatment of iatrogenic or iatrogenic perforation of duodenal descending part. Methods For 15 cases of perforation of duodenal descending part, according to the specific location of the perforation, select different endoscopic, compare the closing efficiency and success rate. Results 8 cases closed under gastroscopy in 15 cases of descending part of duodenum perforation, successfully closed in 7 cases, success rate was 87.5 %; 7 cases closed under duodenoscopy, successfully closed in 7 cases, the success rate 100.0%. 14 cases successfully closed by endoscopic titanium clip in 15 cases, 1 case failed, the success rate was 93.3 %. The effective titanium clip quantity, invalid (loss) titanium clip quantity and the closing time between the two groups has no statistically significance (P > 0.05). Conclusion It is safe and effective to use two kinds of endoscopic titanium clips in treatment of iatrogenic or iatrogenic duodenal per-foration.
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Objective To investigate the clinical efficacy of the titanium clip in endoscopic treatment of the transverse colon pol‐yps and discuss the incidence of postoperative complications .Methods A retrospective analysis of 47 patients with the diameter of the transverse colon polyps with the diameter of 1 .0 cm above for EMR treatment .47 patients divided into titanium clip group (EMR preoperative using the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution ,n=21) and no titanium clip group (EMR preoperative no using the titanium clip ,n=26) .Analysis one‐time complete resection ,intraoperative blood loss and the hemorrhage after 7 days of two groups .Results There were one‐time removal of the tumor in the titanium clip group ,and no one‐time removal of the tumor in the no titanium clip group due to the large blood loss with poor visibility ,three cases can not be a one‐time complete resection ,the two groups were significantly different (P< 0 .05);the average amount of bleeding (20 .0 ± 5 .6)mL in titanium clip group ,that was (80 .0 ± 8 .2)mL in the on titanium clip group ;compared with the two groups , there was statistically significant (P<0 .01) .There was not complication of hemorrhage after 7 days ,but three cases were that in no titanium clip group ,the difference was significant (P<0 .05) .Conclusion EMR preoperative use the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution in trement of benign tumor of the transverse colon ,which can signifi‐cantly improve the clinical efficacy of EM R technique ,and significantly reduced the intraoperative and postoperative bleeding occur‐rence ,thus it's worthy of promotion .
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Objective To investigate the clinical effects of surgical small incision treatment of patent ductus arteriosus (PDA) in premature infants with titanium clip.Methods One hundred children received and cured by our hospital from January 2010 to January 2013 were divided into two groups.Group A:body weight ＞ 1.5 kg of patent ductus arteriosus (PDA),71 cases of premature children; group B:body weight ＜ 1.5 kg of low body weight preterm the children PDA,29 cases.The operations were performed in the newborn intensive care unit (NICU).The patient was placed in a lateral position with the left arm abduction under general anesthesia.A 1.5-2.5 cm long posterolateral mini-thoracotomy was made and the pleural cavity was entered via the 2-3rd intercostal space.The PDA was closed with two titanium clips.Results Ninety-nine cases were cured,1 died.2 residual shunt postoperatively.One patient on postoperative 5 day was found wound infected,wound healing after the use of antibiotics by intravenous.There was no significant difference in incidence of postoperative complications and mortality rate between group A and group B (P ＞ 0.05).Majority of children successfully weaned from the ventilator due to the rapid improvement of hemodynamics and lung conditions.In group B,mechanical ventilation time (12.6 ± 7.5) d and postoperative hospital stay (21.0 ± 15.4) d was significantly longer than group A ((9.6 ± 4.2) d and (12.0 ± 10.8) d),the difference between the two groups was significant (t =7.35,9.12,P ＜ 0.05).Conclusion (1) It is a viable treatment that bedside minimally invasive titanium clip closed ductus arteriosus in preterm children PDA.(2) As the treatment of low body weight premature children is poor,the tolerance of the surgical trauma of the surgery as a minimally invasive,simple method is particularly suitable for low body weight premature children PDA.
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Objective To investigate the feasibility of video-assisted thoracoscopic sympathetic trunk clipping in the treatment of craniofacial hyperhidrosis. Methods A total of 10 patients were operated on under general anesthesia with double-lumen endotracheal intubation. The patients were placed in lateral recumbent position with one-lung ventilation. A 7 mm trocar and a 4.5 mm trocar were inserted at the 2~3 intercostal space on the midaxillary line and at the 4~5 intercostal space on the posterior axillary line, respectively, to introduce surgical instruments and thoracoscopic camera. Alongside the sympathetic chain, the sympathetic nerve trunk immediately below the second costal margin was blocked with small-sized titanium clips. Then the lung was inflated and the incision sutured. Afterwards, the procedure in the contralateral hemithorax was performed using the same method. Results The operating time was 55~130 min (mean, 110 min). Symptoms of craniofacial hyperhidrosis disappeared in the 10 patients, all of who were satisfied with curative results. The postoperative hospital stay was 2~3 days. Neither Horner’s syndrome nor other serious complications were observed. Seven of the patients developed slight compensation hyperhidrosis in their chest, abdomen, back or legs. All the patients had normally returned to work and physical exercises in 7~10 days. Postoperative follow-up for 1~9 months (mean,6.3 months) in all the patients found no recurrence. Conclusions Video-assisted thoracoscopic block of sympathetic trunk below the second costal margin for craniofacial hyperhidrosis is safe and effective.
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OBJECTIVE: The three-dimensional computed tomographic angiography(3D-CTA) images are not commonly used than the conventional digital subtraction angiography(DSA) as a postoperative examination to identify a remnant neck or whether the parent and branching arteries and the cerebral aneurysm are clipped together. We suggest that the neurosurgeons themselves can reconstruct 3D images using 3D reconstruction program in their personal computers and evaluate the aneurysm neck clipping state more precisely than DSA. METHODS: Both 3D-CTA and DSA images were obtained postoperatively on 40 patients with 45 cerebral aneurysms. 38 aneurysms were clipped by single clip, 6 by double clips, and 1 by triple clips. We compared 3D-CTA images, which are made by easy and noninvasive method of the new software to ascertain postoperatively the perfection of aneurysm neck clipping performed with titanium clips, with DSA. RESULT: Out of the total 45 cerebral aneurysms clipped with titanium clips, 3D-CTA clearly showed the state of the clipped necks and the parent and branching arteries of 44 aneurysms in 39 cases. There were three cases in which the remnant necks were found in 3D-CTA, but two of them were not identified in DSA. There was one patient who had cerebral aneurysms requiring 3 clips, resulting in a poor view of the remnant necks since the clips covered the necks. CONCLUSION: In case using one or two titanium clips for the aneurysmal clipping, 3D-CTA may be a reliable alternative method to DSA in the postoperative evaluation to define the cerebral aneurysm neck and the surrounding vessels after clipping.
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Humans , Aneurysm , Angiography, Digital Subtraction , Arteries , Intracranial Aneurysm , Microcomputers , Neck , Parents , Titanium , Tomography, Spiral ComputedABSTRACT
PURPOSE: We compared the results of micovascular anastomoses using a titanium clip and a conventional suture method to determine the possibility of clinical applying titanium clips for the anastomosis of small vessels. MATERIALS AND METHODS: In 15 New Zealand white rabbits, jugular veins on both sides were cross-sectioned. One side was repaired with a titanium clip and the other with 10-0 nylon sutures. Macroscopic and microscopic results of anastomoses were evaluated. RESULTS: All of the anastomsed vessels were patent at postoperative 1 day, 1 week and 1, 2 and 3 months. The time required for vessel repair was 16.0 minutes for suture repair and 8.9 minutes for clips. Microscopic evaluation revealed that the titanium clips didn't penetrate the intima of the vein. Foreign body reaction was less at the clipped anastomoses sites than at those with suture repair. CONCLUSION: Microvascular anastomosis can be performed more rapidly with titanium clips than conventional suture repair in operations of major limb replantation or free flap surgery where ischemic time is critical. This device minimizes intimal injury and foreign body reaction, and could reduce the failure rate after microvascular anastomosis.
Subject(s)
Rabbits , Extremities , Foreign-Body Reaction , Free Tissue Flaps , Jugular Veins , Nylons , Replantation , Sutures , Titanium , VeinsABSTRACT
PURPOSE: To evaluate the usefulness of titanium clips applied for the repair of transected peripheral nerve. MATERIALS AND METHODS: The results of neurorrhaphy using a titanium clip (VCS) was compared with the conventional technique of neurorrhaphy with a nylon suture. In fifteen New Zealand white rabbits, transected sciatic nerves were repaired with VCS clips on one side and interrupted 9-0 nylon suture on the other. RESULTS: The time required for the neurorrhaphy was 14.9+/-3.55 minutes for suture closure and 8.7+/-2.6 minutes for clip closure (p<0.01). Electromyographic studies were performed at 1, 2 and 3 months after the initial operations. No significant differences in the amplitudes of the complex motor action potentials were noted between the groups. In the microscopic study, no significant differences in the numbers and the extents of myelinization of the regenerated axons of both methods of nerorrhaphy were evident. CONCLUSION: The titanium clip that was initially designed for microvascular anastomosis can be applied successfully for the microscopic neurorrhaphy of the peripheral nerve. Microscopic neurorrhaphy with titanium clips can be performed more rapidly than conventional suture repair.
Subject(s)
Rabbits , Action Potentials , Axons , Myelin Sheath , Nylons , Peripheral Nerves , Sciatic Nerve , Sutures , TitaniumABSTRACT
Objective To investigate endoscopic clipping in treating acute gastroduodenal perforation. Methods Endoscopic clipping was carried out in 22 patients with acute gastroduodenal perforation as the complication of peptic ulcer or endoscopy. Results The clipping was successful in 19(86. 4% ) of 22 patients with acute gastro duodenal perforation, and surgical therapy was performed in 3(13. 6% ) of 22 cases. A single clipping was performed in 14(73. 7% ) of 19 patients resulted in satisfactory closure of perforation. An additional clipping was needed in 5(26. 3% ) patients 24 h after the first endoscopes procedure. The effectiveness of endoscopic clipping was related to location, cause and size of the perforation. Conclusion Endoscopic clipping is an effective method for acute gastroduodenal perforation as the complication of peptic ulcer or endoscopy.