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25 July 2019, Volume 24 Issue 04 Previous Issue    Next Issue

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Combination of Rotarex debulking with drug coated balloon in treatment of superficial femoral artery in-stent restenosis LIU Zhen, ZHANG Guodong, ZHANG Tao, LI Cheng, JI Donghua 2019, 24 (04):  311-314.  DOI: 10.16139/j.1007-9610.2019.04.008 Abstract ( 447 )   PDF (412KB) ( 124 )   Objective To evaluate the efficacy of Rotarex debulking combined with drug coated balloon (DCB) in the treatment of superficial femoral artery in-stent restenosis(ISR). Methods Nineteen patients with superficial femoral artery ISR treated with Rotarex combined with DCB were analyzed retrospectively in our hospital from June 2016 to June 2018. Postoperative follow-up was carried out for 3, 6 and 12 months with Doppler ultrasound examination. Results All 19 patients were treated successfully by Rotarex debulking with DCB and were followed up (13.5+6.1) months. Ultrasonography showed that patency was 100% in the first 6 months and 84.2% (16/19) in the first 12 months. No revascularization was found 89.5% (17/19) in 12 months. Mortality and amputation did not occur during the follow-up period. Conclusions Combination Rotarex debulking with DCB could be safe and effective in the treatment of superficial femoral artery ISR. References | Related Articles | Metrics

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Severe stenosis and more severe stenosis of carotid artery: treatment strategies and complications HAN Tonglei, WANG Shiying, SUN Yudong, WEI Xiaolong, ZHU Jiang, LU Minhao, ZHAO Bin, ZHAO Zhiqing, JING Zaiping 2019, 24 (04):  315-319.  DOI: 10.16139/j.1007-9610.2019.04.009 Abstract ( 536 )   PDF (519KB) ( 154 )   Objective To compare the efficacy and complications of carotid endarterectomy (CEA) with carotid sten-ting (CAS) in treatment of patients with severe carotid artery stenosis from 70% to 90% and more severe stenosis >90%. Methods The clinical data of 463 patients with carotid stenosis 70% and more who underwent surgical treatment from January 2015 to December 2017 at Changhai Hospital were retrospectively analyzed. Results There were 202 patients with severe carotid stenosis from 70% to 90% including 62 cases in CEA group and 140 cases in CAS group and no significant difference was present in the incidence of postoperative recurrent stroke between two groups (3.2% vs 6.7%, P=0.181). Restenosis was found 2.2% in CAS group and none in CEA group(P=0.240). Patients with tongue deviation (4.8%) and speech function disorder(3.2%) were found in CEA group and none in CAS group(P=0.009, P=0.033). There were 261 cases with more severe stenosis >90% including 95 cases in CEA group and 166 cases in CAS group. There was no significant difference in the incidence of recurrent stroke between two groups (P=0.135) with 1.1% in CEA group and 4.5% in CAS group respectively. The incidence of restenosis in CAS group was 5.7% and none in CEA group (P=0.017). The occurrence of tongue deviation and speech function disorder in CEA group were 4.2% and 3.2% respectively, and none in CAS group (P=0.008, P=0.021). Conclusions The result of treatment using CEA or CAS was similar for patients with severe carotid stenosis, with no postoperative nervous complication in CAS group. However, the effect of CEA was better than CAS for the patients with more severe carotid stenosis. References | Related Articles | Metrics

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Learning curve for robotic thyroidectomy: a single surgeon experience SUN Hanxing, GAO Haoji, YING Xiayang, HUANG Haiyan, LÜ Tian, CHEN Xi, LI Qinyu, QIU Weihua, YAN Jiqi 2019, 24 (04):  320-324.  DOI: 10.16139/j.1007-9610.2019.04.010 Abstract ( 536 )   PDF (655KB) ( 136 )   Objective To summarize the experience of robotic thyroidectomy in our hospital and the learning curve of robotic thyroidectomy. Methods The first 200 cases with robotic thyroidectomy using bilateral axillo-breast approach (BABA) in our hospital from May 2015 to August 2017 were retrospectively studied. Clinical data including operation time and pathological data were analyzed. Results The operative time decreased significantly and reached the plateau after first 35 cases. Eighty cases later, further decrease in operative time and second plateau were found. The patients then were divided into three groups including group A (first 35 cases), group B (36 th to 80 th cases) and group C (81 st to 200 th cases). There was no significant difference in gender, age and maximum tumor size among three groups (P>0.05). Operative time reduced sequentially from groups A (145.6±42.6 min) to group B (116.2±29.2 min) to group C (88.2±26.1 min) (P=0.001). The decrease in both hospital stays (P=0.031) and intraoperative blood loss (P=0.001) and the increase in number of lymph node dissected (P=0.001) were present among three groups. Conclusions The learning curve of robotic thyroidectomy with BABA was about 35 cases. When the cases reached to 80 cases, the procedure would be safe and effective. References | Related Articles | Metrics

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Evaluation of purge parathyroidectomy in treatment of secondary hyperparathyroidism LI Wei, LIU Bingyang, SHAN Chenxiang, RAO Wensheng, ZHANG Wei, QIU Ming 2019, 24 (04):  325-329.  DOI: 10.16139/j.1007-9610.2019.04.011 Abstract ( 440 )   PDF (531KB) ( 100 )   Objective To compare the results after purge parathyroidectomy (PPTX) and traditional approaches performed for secondary hyperparathyroidism (SHPT). Methods A total of 49 patients with SHPT who underwent parathyroidectomy from January 2010 to November 2017 were retrospectively analyzed. We compared outcomes between PPTX group and traditional parathyroidectomy group including total parathyroidectomy and total parathyroidectomy with autotransplantation. Results There was no difference in the rate of persistent or recurrent SHPT between 2 groups during follow-up (P>0.05). Analysis of the patients with successful surgery revealed that patients in PPTX group had a lower level of intact parathyroid hormone (iPTH) at 6 months postoperatively compared with that in traditional parathyroidectomy group (P=0.013). No significant difference was found between 2 groups in the rate of transient or persistent lower iPTH (P>0.05). Patients in PPTX group required more calcium supplementation(P=0.003), while no difference was present in the extent of hypocalcemia between 2 groups (P>0.05). Conclusions PPTX would be more effective in lowering iPTH. However, the patients need more calcium supplementation to prevent hypocalcemia after PPTX. References | Related Articles | Metrics

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Internal mammary artery perforators as recipient vessels for deep inferior epigastric perforator flap breast reconstruction using CT angiography JIN Yiting, CHU Chengyu, ZHANG Wei, FU Lina, TANG Weijun, DONG Jiasheng, XU Hua, ZOU Qiang 2019, 24 (04):  330-336.  DOI: 10.16139/j.1007-9610.2019.04.012 Abstract ( 380 )   PDF (1319KB) ( 119 )   Objective To study the anatomy of internal mammary artery perforator (IMAP) in Chinese patients and the utilization rate of IMAP as recipient vessels for deep inferior epigastric perforator(DIEP) flap breast reconstruction. Methods Ninty-eight consecutive cases with DIEP flap in immediate breast reconstruction from January 2016 to December 2018 were analyzed, 32 cases in IMAP group and 66 cases in internal mammary artery group. All cases had preoperative mapping of perforator with ultrasound. A total of 73 cases had preoperative mapping of perforator with CT angiography (CTA) simultaneously since January 2017. The location and diameter of IMAP were analyzed as well as the utilization rate of IMAP as recipient vessels. Results In 98 cases, IMAP was located in the second intercostal space (ICS) in 66 (67.3%) cases, diameter (1.33±0.66) mm, in the third ICS in 24 (24.5%) cases, diameter (0.86±0.28) mm, and in the fourth ICS in 8 (8.2%) cases, diameter (0.65±0.15) mm. IMAP was used in DIEP flaps in 32 (32.7%) case. A total of 28 (87.5%) perforators were located in the second ICS and 4 (12.5%) perforators in the third ICS. There was no significant difference between IMAP group and internal mammary artery group in patient characteristics and flap complications. The utilization rate of IMAP was 39.7% (29/73) in patients using CTA which was much higher than 12.0% (3/25) in patients without using CTA(P=0.01). Conclusions IMAP as recipient vessel is viable alternative for immediate DIEP flap breast reconstruction when applicable. Preoperative CTA can improve the utilization rate of IMAP. This strategy offers the advantages of decreasing recipient site morbidity, reducing operative time and simplifying procedures. References | Related Articles | Metrics

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Differential diagnosis of breast intraductal papilloma from other benign lesion with dynamic contrast-enhanced MRI LI Xinyue, LI Ya, CHAI Weimin 2019, 24 (04):  337-343.  DOI: 10.16139/j.1007-9610.2019.04.013 Abstract ( 702 )   PDF (816KB) ( 212 )   Objective To assess the value of magnetic resonance imaging (MRI) in differential diagnosis of breast intraductal papilloma (IDP) from other benign lesions. Methods A retrospective analysis of breast MRI was performed in 96 patients with IDP and 200 patients with other benign lesions of breast. The lesions were detected as MRI BI-RADS category 4 or higher. Time-signal intensity curve and apparent diffusion coefficient (ADC) were achieved from the 1.5T Siemens Aera workstation and were used in differential diagnosis of breast lesions. Results The mean age was (49.9±12.0) years in IDP group and (41.2±11.8) years in other benign lesions group. The enhanced mass lesions with smooth margin were predominated in both groups. Spiculated margin was found in IDP group only. More lesions in IDP group had diameter less than 1 cm and the diameter of other benign lesions was 1-5 cm (P<0.001). The lesions in IDP group presented homogeneous enhancement and located in retroareolar region more than those in other benign group. There were 146 enhanced mass lesions in other benign group and 70 (47.7%) lesions presented dark internal septations which included 64 (60.4%) of 106 fibroadenoma, 3 (60.0%) of 5 benign phyllode tumors and 1 lipoma, 2 adenoma disease. In non mass enhancement lesions, lesions in IDP group tended to appear segmental distribution 57.1% and lesions in other benign group appeared focal distribution 44.4%. Wash-out curve was 44.7% in IDP group and persistent curve was 56.5% in other benign group. Ductal dilation was seen more in IDP group than in other benign group. Mean ADC was [(1.15±0.19) ×10-3 mm2/s vs (1.30±0.29)×10-3 mm2/s] in IDP group and other benign group respectively. The best discriminative value of ADC was (1.30×10-3 mm2/s) and area under the curve 0.710 with the sensitivity 56.5%, specificity 79.2% and accuracy 63.9%. Conclusions There are size, location and enhancement pattern of the mass, the distribution of non mass enhancement, ductal dilation, time-signal intensity curve and ADC values which have value in differential diagnosis of breast IDP from other benign lesions. References | Related Articles | Metrics

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Exosomal miRNA146b-5p promotes migration and invasion of papillary thyroid carcinoma cell YE Weidong, DENG Xianzhao, FAN Youben 2019, 24 (04):  344-348.  DOI: 10.16139/j.1007-9610.2019.04.014 Abstract ( 390 )   PDF (790KB) ( 99 )   Objective To isolate and identify the exosomes secreted by papillary thyroid carcinoma (PTC) KTC-1 cells, and to investigate the effects of miRNA146b-5p in exosomes on the migration and invasion in vitro. Methods Exosomes secreted by KTC-1 cells were collected and identified. miRNA 146b-5p and its inhibitor were electroporated into exosomes and co-cultured with KTC-1 cells. Migration and invasion in vitro were examined. Results Exosomes secreted by KTC-1 cells were successfully isolated and identified. Exosomal miRNA146b-5p could enter KTC-1 cells and promote migration and invasion of KTC-1 cells in vitro. Conclusions Exosomal miRNA146b-5p can promote the migration and invasion of PTC in vitro. miRNA146b-5p silencing in exosomes might represent a potential approach against PTC. References | Related Articles | Metrics

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Clinical analysis of type 1 autoimmune pancreatitis: a report of 9 cases HUANG Xia, LU Zhiping, XU Beili, CAI Yu, ZHANG Shuncai 2019, 24 (04):  349-355.  DOI: 10.16139/j.1007-9610.2019.04.015 Abstract ( 556 )   PDF (769KB) ( 181 )   Objective To summarize the clinical characteristics, diagnosis and therapy of type 1 autoimmune pancreatitis (AIP). Methods Totally 9 patients diagnosed with type 1 AIP in Zhongshan Hospital from October 2012 to October 2018 were enrolled. Retrospective analysis of clinical manifestations, laboratory tests, imaging, histopathological examination, treatment and prognosis was conducted. Results Patients commonly presented jaundice, bloating, abdominal ache, both appetite and weight loss. The most common other organ involvements (OOI) were bile duct, lymph nodes, kidney and retroperitoneal tissue in order. All 9 cases had increased serum immunoglobulin G4 levels and 8 cases had 2 times higher than upper limits of normal levels. Upper abdominal MRI showed pancreatic enlargement in 7 cases, pancreatic mass in 2 cases and envelope-like edges in 3 cases. No histopathological diagnosis was obtained with tissues from fine needle aspiration in 2 cases. All the patients received steroid treatment with well results. Two cases who underwent endoscopic retrograde biliary drainage were found liver abscesses and common bile duct stone respectively. Recurrent cases still were improved after steroid retreatment or steroid combined with immune inhibitor usage. Conclusions Only less patients with type 1 AIP have typical imaging findings. Type 1 AIP needs to be diagnosed carefully and evaluated systematically. Treatment of type 1 AIP with steroid could be effective. References | Related Articles | Metrics

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Diagnosis and treatment of incarcerated hernia in elderly patients with intestinal necrosis LI Shaochun, HUANG Lei, CAI Zhao, LI Shaojie, HU Xingchen, MENG Yunxiao, TANG Jianxiong 2019, 24 (04):  356-358.  DOI: 10.16139/j.1007-9610.2019.04.016 Abstract ( 471 )   PDF (409KB) ( 95 )   Objective To investigate the cause and treatment of incarcerated hernia in elderly patients with intestinal necrosis. Methods A retrospective study was conducted using the data of 20 elderly patients more than 80 years old with incarcerated hernia combined with intestinal necrosis from January 2013 to December 2017 in our department. Emergency surgery was performed for all cases. Intestinal necrosis was diagnosed operatively and intestinal resection was performed combined with intestinal anastomosis. Two cases were processed with tension-free hernia repair and the other 18 cases were operated with Bassini repair. Drainage was placed under external abdominal oblique muscle fascia. Results The operation was completed successfully for all patients. Two patients died of pulmonary infection on postoperative 5 day and 11 day, respectively. The other patients were cured. During the period of postoperative follow-up, neither complication nor recurrence was found. Conclusions Surgical treatment could be considered as safe procedure for elderly patients with incarcerated hernia combined with intestinal necrosis. Early diagnosis and active prevention of pulmonary infection have positive effects on the prognosis of elderly patients. References | Related Articles | Metrics