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Objective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting.Methods The retrospective descriptive study was conducted.The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected.The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein.Observation indicators:(1) intra-and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patient's postoperative survival and swelling reduction of affected extremity up to April 2019.Results (1) Intra-and post-operative situations:the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully.The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes.The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein,80 minutes of exposure time of iliac vein,40 minutes of great saphenous vein harvesting time,70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein,10 minutes of subcutaneous tunnel construction,90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein,60 minutes of suturing except vessel closure,102 minutes of preparation time,check and washing time).The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred.The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting.There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm.The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm,respectively.At the discharge time,the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission.The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm.No postoperative complications occurred.Duration of hospital stay after surgery was 3 days.(2) Follow-up and survival situations:the patient was followed up for 1 month,with good survival.The patient had swelling subsided of affected extremity.The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm.Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible,with good short-term outcomes.
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Objective To establish a stable animal model of implanted main portal vein tumor thrombus (MPVTT) in rabbits and to evaluate its usefulness in research so as to provide the basis for clinical treatment. Methods Twenty-four New Zealand white rabbits were randomly divided into group A (control group,n=10) and group B (study group,n=14). For the rabbits of the study group, a sac-like pouch was sewed up in the anterior wall of the main portal vein, and then the tumor slice was injected into the portal vein through the pouch and it was hung and fixed on the inner wall of the main portal vein with the help of the reserved suture. For the rabbits of the control group, only a sac-like pouch was sewed up in the anterior wall of the main portal vein after opening the abdomen. After the treatment, the animals were kept under observation on the general condition, body weight and survival time. Postoperative multi-slice spiral CT scan was performed once a week to check the growth of portal vein tumor thrombus and the metastasis. The experimental rabbits were separately sacrificed for pathologic examination, the volume of MPVTT was determined and the metastasis was evaluated. The survival time of the remaining rabbits were analyzed. Results The tumor formation rate of the study group was 100%. The mean body weight of the rabbits of the study group (No.9-No.14 rabbits) and the control group at 35 days after the procedure was (1.48±0.19) kg and (2.08 ±0.17) kg respectively. The mean survival time of the study group (No.9-No.14 rabbits) was (41.7 ±4.72) days. Multi-slice spiral CT scan revealed MPVTT, metastasis and collateral circulation due to portal vein obstruction. Pathological examination confirmed the presence of thrombus in the portal vein and metastasis . Conclusion Stable MPVTT in animal models that can be used for imaging evaluation are successfully established. This study proves that multi-slice spiral CT scan is of great value in diagnosing and monitoring the growth of MPVTT and metastasis, which provides useful basis for clinical research and treatment of MPVTT.
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@#ObjectiveTo study the features of lower limb vein thrombus patients after spinal cord injury and the effects of thrombolysis therapy.MethodsWe practiced ultrasonography on 207 patients with lower limb swelling after spinal cord injury. ResultsAmong the 207 patients, 66 had thrombus, the positive rate was 31%: acute thrombus 58 cases, subacute thrombus 1 cases and chronic thrombus 7 cases. Conclusions Ultrasonography provides an important basis for the qualitative diagnoses of lower limb vein thrombus. It has certain clinical guiding effects in choosing methods of treatment.