Experimental study of rapid and effective magnetic artificial blood vessel transplantation for caval reconstruction in canines / 西安交通大学学报(医学版)

【Objective】 To evaluate the performance of the magnetic artificial blood vessel device for fast non-suture anastomosis of caval reconstruction with artificial blood vessel transplantation after resection in canines. 【Methods】 Sixteen adult mongrel dogs of either gender were randomly divided into two groups for vena cava reconstruction with artificial blood vessel transplantation after inferior vena cava (IVC) resection. Group MCA (n=8): magnetic artificial blood vessel device for IVC reconstruction; Group manual sewing (MS) (n=8): hand suturing for IVC reconstruction. Operation time and stoma errhysis were recorded during operation. Patency and stoma stenosis were confirmed via color Doppler ultrasound scanning and X-ray cholangiography at different time points as late as 4 weeks after surgery. 【Results】 The time required to perform the vascular anastomosis was significantly shorter for the magnetic artificial blood vessel device (6.25±2.25)min than for MS (27.32±5.12)min (P<0.001). There were four cases of stoma errhysis in MS group which had to be repaired (P=0.077). Vascular X-ray angiography and color Doppler ultrasound found normal blood flow and no stoma stenosis in MCA group, but three cases of stoma stenosis in MS groups (P=0.200). Compared with MS group, the magnetic ring device stoma was associated with smooth re-endothelialization and depressed infiltration of inflammatory cells at the anastomotic site. 【Conclusion】 The magnetic artificial blood vessel device offers a simple, fast, reliable, and efficacious technique for vena cava reconstruction with artificial blood vessel transplantation.

Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique / 器官移植

Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.

Clinical application of LDLT after reconstruction of IVC using artificial blood vessel in the treatment of HCC beyond Milan Criteria / 中华肿瘤杂志

Objective@#To assess application of reconstruction of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation (LDLT) in the treatment of hepatocellular carcinoma (HCC) beyond Milan Criteria.@*Methods@#The clinical data of 9 HCC patients who underwent right lobe liver transplantation after reconstruction of retrohepatic inferior vena cava using artificial blood vessel between June 2015 and Nov 2016 at Liver Transplantation Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The liver of the patients was removed with retrohepatic inferior vena cava, and then the right donor graft was implanted by conventional orthotopic liver transplantation.@*Results@#All 9 liver transplantations were performed successfully. The time of reconstruction of hepatic venous outflow of the donor graft was (22.6±3.0) min, anhepatic time was (45.0±7.1) min, and total operation time was (321.9±52.5) min. All patients recovered uneventfully, ICU and hospital stay day were (1.2±0.4) days and (18.4±3.0) days. 2 patients suffered from thrombosis of artificial blood vessel, one recovered after conservative treatment and another was treated by placement of vein stent. No abdominal/pulmonary infection and non-artificial blood vascular complications were found, and none died in perioperative period. Postoperative pathological results showed that all patients were hepatocellular carcinomas and vascular tumor thrombosis was found in 5 cases. All patients were follow up, 1 patient died of pulmonary and brain metastasis 10 months after operation. One patient survived with local recurrence of tumor in liver. The other patients had no tumor recurrence and metastasis.@*Conclusion@#Replacement of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation is safe and feasible in the treatment of HCC beyond Milan Criteria, and might improve the resection rate of diseased liver and the prognosis of HCC patients after living donor liver transplantation.

Perioperative nursing of patients with re-operation of complex type A aortic dissection / 现代临床护理

Objective To investigate the nursing experience of caring patients with second total aortic arch replacement with stent“trunk”.Method The nursing data of 28 patients undergoing total aortic arch replacement with stenttrunkwere analyzed to summarize the perioperative nursing experience.Results The operations were successful in all 28 patients.None of them died. Conclusion The nursing measures such as strengthened preoperative evaluation,strengthened body position and skin management, preparation of articles,strengthened blood recollection during operation to reduce blood loss and enhanced temperature monitoring are key to the success of total aortic arch replacement with stenttrunk.

Laparoscopic left renal vein extravascular stenting for treatment of left renal vein entrapment syndrome / 中华泌尿外科杂志

ObjectiveTo investigate the surgical management of left renal vein entrapment syndrome.MethodsEight cases with left renal vein entrapment syndrome (5 males and 3 female ; mean age 26 years) with history of gross hematuria for 3 to 46 months were reviewed.Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all cases.And the dilated segment of the left vein was three-fold than the stricture segment in diameter.CT scan showed the abnormal angle between aorta and superior mesentery artery in all cases.Bleeding from the left ureteral orifice was detected by cystoscopy in 6 cases.We treated 8 patients by extravascular stent immobilization with laparoscope.ResultsThe operation was successful in the 8 cases without surgical complications.The average operation time was 63 min.The average blood loss was 14 ml,and the average hospital stay after operation was 6 days.Follow-up of 3 -20 months,there was no hematuria relapse since been relieved in 7 cases,one case remained microscopic hematuria.Color Doppler ultrasound examination in all 8 cases showed the narrowest inner diameter of left renal vein was 7.4 mm (6.5 - 8.7 mm),the blood flow was smooth.The angle between abdominal aorta and superior mesenteric artery become normal.Conclusions Laparoscopic left renal vein extravascular stenting could be a new surgical method to treat left renal vein entrapment syndrome.The method of putting artificial blood vessel around renal vein is simple,safe and effective.

Artificial blood vessel sheath around renal vein for the treatment of left renal vein entrapment syndrome / 中华泌尿外科杂志

Objective To explore the clinical efficacy of artificial blood vessel sheath around re-nal vein for the treatment of left renal vein entrapment syndrome. Methods Eight cases with left re-nal vein entrapment syndrome (7 males and 1 female, mean age, 16 years) with history of gross hema-turia for 6 to 36 months were reviewed. Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all eases. CT scan showed the abnormal angle between aorta and su-perior mesenterie artery in 5 cases. Cystscopy showed hematuria from the left ureteral orifice in 5 ca-ses. All cases with left renal vein entrapment syndrome were treated ,with the method of putting artifi-cial blood vessel as a sheath around left renal vein. Results The operations were all successful. The average operation time was 150 min, the average blood loss was 50 ml, and the average hospital stay after operation was 9 d. No surgical complications occurred. The gross hcmaturia disappeared in 6 ca-ses and Doppler ultrasound showed that left renal vein outflow was normal in 7 when the patients dis-charged from the hospital. The gross hematuria disappeared during 2-24 months' follow-up in 7 pa-tients. Conclusions The surgical aim of renal vein entrapment syndrome is to reduce the compres-sion of renal vein. The method of putting artificial blood vessel around renal vein could be a simple, safe and effective method.