STEPPING TOWARDS NON-SURGICAL MANAGEMENT: STUDY IN A TERTIARY CARE CENTRE IN A DEVELOPING NATION

Objective: To assess the emerging trend of Non-operative Management and image guided interventions over surgery in a tertiary care hospital in a developing nation. Data regarding patients who underwe Methods: nt Non-Operative Interventions (NOI) or Non-Operative Management (NOM) in VMMC and Safdarjung hospital, New Delhi, India over past 3 years was collected retrospectively from hospital database. Max diameter of liver abscess mana Results: ged nonoperatively ranged from 3.5 to 14 cm. Mean diameter was 7.15 +/- 3.20 cm. Mean volume of the abscess was 538 ml. 43.33% of the abscesses were ruptured. 73.33% of the patients underwent pigtail insertion and the rest underwent ultrasound guided aspiration. 12 patients underwent PTBD in the center over past 3 years. All the patients had malignant etiology of some sort. 75% patients had carcinoma of Gall bladder, and the rest had biliary stricture of malignant nature. Conclusion: NOIs have revolutionized management of several entities for which surgery was sole resort until few decades back. However, these facilities come with their own set of limitations. There is a paucity in literature in the developing world regarding outcome of NOI

Radiation dosimetric study of patients and professionals in an intervention procedure based on PBU-60 anthropomorphic phantom / 中国辐射卫生

Objective Based on the anthropomorphic phantom experiment and Monte Carlo simulation, the patients’ skin dose, professionals’ dose, and spatial distribution of DSA (Digital Subtraction Angiography) radiation field in an intervention procedure, was performed, in order to provide the basis for the inference of patients’ skin injury and professionals’ radiation protection in intervention procedure. Methods In the simulation experiment, a PBU-60 anthropomorphic phantom was used as the patient and the skin dose of patient’s abdomen was measured by TLD (Thermoluminescence Dosimeters). X-ray and gamma radiation dosimeter (AT1121) was applied to measure the spatial distribution of DSA radiation field, which was verified using Monte Carlo software MCNP meanwhile. Furthermore, the radiation dosimetry of operative staffs at different stations and under different protection conditions was studied experimentally. Results The experimental measurements showed that the maximum skin dose of patients every 5-minute fluoroscopy was 18.62 mGy under the irradiation of PA in an abdominal interventional procedure. The results of Monte Carlo simulation and measurement experiments showed that the spatial distribution of DSA radiation fieldis similar to the butterfly distribution, which is related to distance and angle. The experimental results showed that the dose rate decreases exponentially with the increase of lead equivalent. Conclusion It is very significant to carry out skin dose measurementof patients during interventional surgery and follow-up patients with high dose after surgery. In interventional surgery, doctors should try to avoid the station of high dose rate. However, it is necessary to strengthen the radiation protection of the operator and the first assistant. Under the dual protections of bedside lead protective equipment and personal protective equipment, the exposure dose of intervention personnel can be significantly reduced.

Endovascular aortic repair for Stanford type B aortic dissection: learning curve analysis / 介入放射学杂志

Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 70 patients with Stanford type B aortic dissection,who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years,were retrospectively analyzed.According to the sequence of operation date,the patients were equally divided into group A,B,C,D and E with 14 patients in each group.The operation time,procedure-related complications,postoperative hospitalization days were compared among the 5 groups,and the curative effects at different stages were evaluated.Results No statistically significant differences in the age,sex,classification,concurrent hypertension,concurrent diabetes,active smoking,maximum diameter of false lumen,viscera artery supplied by the false lumen,etc.existed between each other among the 5 groups (P＞0.05).The operation time of group A and group B was (3.29±0.61) hours and (2.87±0.37) respectively (P＜0.05),while the operation time of group C,group D and group E was (1.80±0.62) hours (1.74±0.34) hours and (1.52±0.39) hours respectively (P＞0.05).The operation time of group A and group B was significantly longer than that of group C,D,and E (P＜0.001).The difference in the occurrence of complications was not statistically significant between each other among the 5 groups (P＞0.05).The hospitalization time was gradually shortened from group A to group E,although the difference was not statistically significant (P＞0.05).The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively,with an operation frequency being 3.3 patients per year and 7 patients per year respectively;while the surgeries of 42 patients in group C,group D and group E were completed within 2.2 years,1.2 years and 0.5 years respectively,with an operation frequency being 6.4 patients per year,11.7 patients per year and 17.5 patients per year respectively.Conclusion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases;after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist,the operation time becomes significantly shortened,and the surgical skills of theinterventional physician team can been significantly improved.

Hepatobiliary Interventions

Hepatobiliary interventional procedures are most important and commonly practiced procedures in Korea. These procedures comprise about 60~80% of procedures in interventional radiology. We can do percutaneous transhepatic biliary drainage(PTBD), percutaneous cholecystostomy in patients with bile duct and cystic duct obstruction. These procedures prevent high-risk operation and are performed on an emergency basis in some patients with bile infection. A residual biliary stone after operation can be removed with basket and shock wave without reoperation and multiple intrahepatic stones also can be removed through the PTBD tract without operation. Transarterial chemoembolization is a very effective method and has the widest range of indications in treatment of hepatocellular carcinoma(HCC). Also we can treat HCC percutaneously with local injection of absolute ethanol and radiofrequency ablation. Transjugular intrahepatic portosystemic shunt(TIPS) has replaced surgical shunt operation in variceal bleeding in liver cirrhosis. Resection of a large volume of liver is a very safe method after portal vein embolization of a lobe to be resected due to hypertrophy of the remaining lobes of the liver. Metallic stenting of kinking vessels always shows excellent results and we can employ this technique for hepatic vein and portal vein kinking after living-donor liver transplantation.

Effect of pecutaneous transhepatic biliary internal external drainage in treatment of malignant biliary obstruction / 临床外科杂志

Objective To evaluate the clinical value of percutaneous transchepatic biliary internal external drainage (PTBIED) in treatment of malignant biliary obstruction.Methods Forty-three patients with malignant biliary obstruction,including 14 cases with hilary metastasis cancer 8 with carcinoma of gallbladder,8 with hilary biliary cancer,13 with pancreatic cancer were treated with PTBIED.Results The technical success rate was 90%.The serum total bilirubin almost fell to normal level in 40 patients.Four cases (9.3%) died within 1 month, twenty (46.5%) cases died within 6 months,thirteen (30.2%) cases are still alive 12 months later.The complications cases mild hemobilia (8 cases,18.6%),bacteriemia(10 cases,23.3%),retrograde infection(6 included,14.0%).Conclusion PTBIED is an effective and safe therapeutic method for palliation of malignant biliary obstruction.

Stenosis-occlusion of Shunt Tract after TIPSS:Angiographic Manifestatioss in 58 Patients / 介入放射学杂志

Purpose:To study the angiographic characteristics and mechanism of shunt stenosis-occlusiion after TIPSS.Materials and methods:Eighty-nine portal venograms were obtained in 58 patients.Venograms analysis had been performed according to shape,position and degree of shunt stenosis.Results:Thirty-six shunt abnormaloties were found in the portal venograms of 58 patients,Shunt stenosis(diameter