Treatment of six cases of left renal nutcracker phenomenon: surgery and endografting / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>A retrospective study was undertaken to examine therapeutic strategies used in 6 patients with left renal venal nutcracker phenomenon.</p><p><b>METHODS</b>Three patients underwent surgical transposition of the superior mesenteric artery. Three patients underwent endograft stent implantations with intervention.</p><p><b>RESULTS</b>All 6 cases were completely relieved of left renal vein compression after the operations, leading to improved clinical symptoms and normal urine tests.</p><p><b>CONCLUSIONS</b>Transposition of the superior mesenteric artery is a feasible method, but leads to complications and great trauma. Treating left renal venal nutcracker phenomenon with endografting techniques is minimally invasive in certain cases, and seems to have a prospective future.</p>

Surgical treatment of carotid body tumor / 中国普通外科杂志

Objective To explore the surgical treatment of carotid body tumor(CBT). Methods The clinical data of 78 patients with CBT were retrospectively analysed. Results Seventy eight patients had 88 tumors (10 patients had bilateral CBT),of which 83 were resected. The operations included:CBT enucleation (28 tumors);CBT resection along with the external carotid artery resection(12 tumors); CBT enbloc resection with partial carotid artery(CA) resection and interposition grafting(3 tumors) or end to end anastomosis (1 tumor), and external to internal CA anastomosis (1 tumor); CBT enbloc resection with CA reconstruction(30 tumors), and CBT resection and CA ligation (8 tumors). The operative mortality was 3.8%(3/78). 65 tumors were followed up for 1～21 years,and one patient died of pulmonary metastasis seven years after the surgery. In the follow up period, 1 patient had a local recurrence two years after the surgery,and reoperation was performed,the patient did well 8 years after the reoperation. One patient with family CBT had an opposite lesion 10 years after the first lesion resection. Conclusions CBT may be bilateral,family occurrence,malignant changes and endocrine secretion charateristics. For small CBT, enucleation can be done first.If CA is involved, external CA remove along with CBT and end to end anastomosis may be a better choice . For tumors invading the internal CA, it is better to resect the lesion with reconstruction of the CA with, an autogenous internal jugular vein graft or prosthesis. For large CBT or CBT adhensed to nearby tissues seriously, end to end anastomosis can be carried out to internal CA at a transversely cutting surface of CBT.

The treatment of left renal entrapment syndrome / 中国普通外科杂志

Objective To explore the treatment of left renal entrapment syndrome. Methods A retrospective analysis was made on the treatment of left renal entrapment syndrome. Diagnosis was established with ultrasonography, magnetic resonance angiography ( MRA) and left renal venography. The transposition of the superior mesenteric artery(SMA) was performed in three cases, the transposition of left renal vein( LRV) in two, and the stent implantation of the LRV in 15. Results Ultrasonography showed that the flow velocity of the proximal end of the LRV at horizontal position accelerates remarkably, and the acceleration is more obvious after standing for 15 minutes; The inner diameter ratio of the broadest place to the narrowest of the LRV at horizontal position is 4. 4?1. 6, while it is 8. 1?1.7 after standing for 15 minutes. MRA illustrated the angle between the abdominal aorta and the SMA was (30?5)?, the control was (64?16)?. The average pressure difference between the LRV and the inferior vena cava (IVC) was ( 14?5) mmHg and (2. 9?1. 4) mmHg before and after stent implantation. The surgical and interventional therapy was successful in all 20 cases. Follow-up from 6 months to 6 years revealed that macroscopic hematuria and symptom disappeared in all patients. Conclusion Ultrasonography, MRA and renal venography are decisive for the establishment of final diagnosis of left renal entrapment syndrome. The stent implantation is the choice of therapy because of less invasion.

Diagnosis and treatment of aorta pseudoaneurysms due to deceleration injury / 中国普通外科杂志

Objective To summarize our preliminary experience on diagnosis and treatment of aorta pseudoaneurysms due to deceleration injury. Methods Retrospective analysis was made on 8 cases of aorta pseudoaneurysms due to deceleration injury regarding its clinical findings, imagines and surgical operations or endografting treatment. Results Diagnosis was confirmed by imaging examinations. Among two cases who refused a surgery one died and the other lost follow-up after discharge. Surgery was successful in the remaining six cases including two cases treated by open surgery and four cases by intervensive endografting. Conclusions Aorta pseudoaneurysms due to deceleration injury can be correctly diagnosed by imaging examinations. Aorta pseudoaneurysms should be treated timely since spontaneous cure is almost impossible. Traditional surgical operations is effective, however, endografting is a relatively safe, less traumatic procedure.

A comparative study on radiofrequency endovenous obliteration (RFO) and saphenous veins stripping for the treatment of varicose veins / 中国普通外科杂志

Objective To evaluate therapeutic results of radiofrequency endovenous obliteration (RFO) for the treatment of varicose veins of the lower limbs. Methods Fifty six cases (56 limbs) of primary greater saphenous vein tributary varicose veins were randomly assigned to RFO group (n=28) and conventional stripping operation group (n=28). In RFO group, the wall of the greater saphenous vein was treated at 85℃ with the catheter to occlude the whole length of the vein. The other 28 cases underwent stripping procedure. The scattered superficial varicose veins in calf in both groups were managed by phlebectomy. The number of surgical incision, postoperative pain, average hospital days and the short-term results were compared. Results Patients in RFO group have less surgical incisions and less postoperative pain, without subcutaneous hematoma. The average hospital stay was 2.5?1.00 days in RFO group compared to 4.14?0.85 days in stripping operation group. Conclusions RFO effectively obliterates the whole length of the great saphenous vein and is of less trauma,faster recovery, and less scars.