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25 July 2022, Volume 27 Issue 04 Previous Issue    Next Issue

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301 classification of aortic dissection: conception and clinical use GE Yangyang, GUO Wei 2022, 27 (04):  281-283.  DOI: 10.16139/j.1007-9610.2022.04.001 Abstract ( 188 )   HTML ( 7 )   PDF (429KB) ( 126 )   Figures and Tables | References | Related Articles | Metrics

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Post-surgical imaging follow-up of aortic dissection: recent advances and standardization ZHOU Min, WANG Lixin, FU Weiguo 2022, 27 (04):  284-287.  DOI: 10.16139/j.1007-9610.2022.04.002 Abstract ( 162 )   HTML ( 2 )   PDF (393KB) ( 114 )   References | Related Articles | Metrics

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Interpretation of the Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) 2022 guidelines for management of type B aortic dissection LI Zhen 2022, 27 (04):  288-293.  DOI: 10.16139/j.1007-9610.2022.04.003 Abstract ( 240 )   HTML ( 15 )   PDF (703KB) ( 231 )   References | Related Articles | Metrics

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Endovascular repair of non-A-non-B aortic dissection WANG Lunchang, SHU Chang 2022, 27 (04):  294-298.  DOI: 10.16139/j.1007-9610.2022.04.004 Abstract ( 174 )   HTML ( 4 )   PDF (427KB) ( 119 )   References | Related Articles | Metrics

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Endovascular repair of type A aortic dissection: difficulty and breakthrough CHEN Mengze, LI Zhenjiang, ZHANG Hongkun 2022, 27 (04):  299-303.  DOI: 10.16139/j.1007-9610.2022.04.005 Abstract ( 143 )   HTML ( 6 )   PDF (542KB) ( 167 )   References | Related Articles | Metrics

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Aortic dissection complicated by malperfusion syndrome CHANG Guangqi, YANG Wenchao 2022, 27 (04):  304-308.  DOI: 10.16139/j.1007-9610.2022.04.006 Abstract ( 154 )   HTML ( 5 )   PDF (606KB) ( 119 )   Figures and Tables | References | Related Articles | Metrics

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Treatment of distal aortic aneurysm after operation of aortic dissection WANG Lixin, ZHANG Yuchong, FU Weiguo 2022, 27 (04):  309-314.  DOI: 10.16139/j.1007-9610.2022.04.007 Abstract ( 159 )   HTML ( 6 )   PDF (516KB) ( 118 )   References | Related Articles | Metrics

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Endovascular repair of type B aortic dissection with single-branched stent-graft LI Xiaoye, LU Qingsheng 2022, 27 (04):  314-317.  DOI: 10.16139/j.1007-9610.2022.04.008 Abstract ( 160 )   HTML ( 5 )   PDF (528KB) ( 154 )   Figures and Tables | References | Related Articles | Metrics

Original article

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Clinical application of 3D parametric surface planar topological guide plate in fenestrated/branched endovascular aortic repair technique FU Dongsheng, LIU Zhao, YANG Chao, LI Qin, CHEN Gezheng, SUN Lili, LI Wendong, ZHOU Minjie, LIU Chen, QIAO Tong, LI Yiqing, LI Xiaoqiang 2022, 27 (04):  318-323.  DOI: 10.16139/j.1007-9610.2022.04.009 Abstract ( 214 )   HTML ( 7 )   PDF (1036KB) ( 152 )   Objective To summarize the experience and effect using 3D parametric surface planar topological guide plate technology in fenestrated/branched endovascular aortic repair (F/B EVAR) to repair aortic arch and thoracoabdominal aortic lesions involving important aortic branches. Methods From August 2020 through April 2022, 17 patients [14 males and 3 females, mean age of(61.06±11.23)(39-78) years] with complex aortic lesions involving important branches were treated in both Nanjing Drum Tower Hospital and Union Hospital. There were 8 cases with aortic arch aneurysms 4 cases and dissections 4 cases, respectively, and 9 cases with thoracoabdominal aortic aneurysms 5 cases and dissections 4 cases, respectively. Six cases were urgent operation and 11 cases were selective operation. Before operation, 3D parametric surface planar topological guide plate was made according to aortic computed tomography angiography. Under the guidance of planar guide plate, pre-fenestrated and external/internal branched and other endovascular aortic repair was performed. Totally, 50 fenestrated/branched stent grafts were planted. Results All operations were completed without conversion to open surgery. Average operative time was (4.57±2.29)(1.50-10.67) h. There was no renal insufficiency, paraplegia and loss of branch arteries. One patient (5.88%) died during perioperative period. Within the follow-up, there were 2 cases (11.76%) of endoleak type Ⅰc and type Ⅲc, respectively. Conclusions F/B EVAR under the guidance of 3D parametric surface planar topological guide plate is a minimally invasive treatment. The technology is more accurate than traditional measurement and positioning, faster than 3D printing guidance, and safe and reliable shown in the follow-up. Figures and Tables | References | Related Articles | Metrics

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Laser in situ fenestration with thoracic endovascular aortic repair in treatment of aortic dissection involving arch branches: short-term result and complications WANG Ruihua, QIU Peng, LIU Junchao, WU Xiaoyu, QIN Jinbao, YE Kaichuang, LI Weimin, LIU Xiaobing, YIN Minyi, HUANG Xintian, LU Xinwu 2022, 27 (04):  324-329.  DOI: 10.16139/j.1007-9610.2022.04.010 Abstract ( 256 )   HTML ( 3 )   PDF (635KB) ( 179 )   Objective To evaluate the surgical effect and complication of laser in situ fenestration with thoracic endovascular aortic repair (TEVAR) in the patients with aortic dissection involving arch branches. Methods From December 2018 to December 2020, 181 patients with aortic dissection involving arch branches admitted to our hospital were analyzed retrospectively among whom 172 patients had laser in situ fenestration with TEVAR. The inclusion criteria were dissection involved aortic arch and the process of TEVAR required reconstruction of the branched vessels in arch. Patients both with aortic dissection lesions less than 15 mm from the coronary ostium and the diameter of ascending aorta more than 45 mm were excluded. Results All cases underwent laser in situ fenestration with TEVAR including 37 cases (21.51%) in acute stage and 135 cases (78.49%) in subacute stage and 165 cases (95.93%) with success of reconstruction of branch vessels. In-hospital death occurred in 6 cases (3.49%), stroke in 2 cases (1.16%), paraplegia in 4 cases (2.33%), proximal stent-graft induced new entry (SINE) in 2 cases (1.16%), and without distal SINE. A total of 168 cases (97.67%) were followed-up. There were 311 branch vessels reconstructed. Follow-up CT angiography was done(10.6±5.4) months which showed that 295 branch vessels were patency with patency rate 94.86%. The partial or complete false lumen thrombosis of thoracic aorta was found in 152 cases (88.37%). Conclusions Laser in situ fenestration with TEVAR was performed with high success rate and low complication rate for the patients with aortic dissection involving arch branches. Long-term follow-up and large sample studies are needed for long-term clinical effects. References | Related Articles | Metrics

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Study on treatment of hepatolithiasis using cholangioscopy through percutaneous trans-choledochojejunal anastomotic channel guided by ultrasound KONG Xiangyu, LIANG Ting, ZHANG Cheng, HU Hai, TIAN Fuzhou, XIANG Yukai, Zhang Honglei, LÜ Beining, YANG Yulong 2022, 27 (04):  330-333.  DOI: 10.16139/j.1007-9610.2022.04.011 Abstract ( 224 )   HTML ( 3 )   PDF (559KB) ( 80 )   Objective To investigate the procedure and efficacy in treatment of hepatolithiasis by percutaneous cholangioscopy through choledochojejunal anastomotic channel guided by ultrasound. Methods From June 2021 to January 2022, 6 patients with hepatolithiasis combined with stenosis of both intrahepatic duct and anastomosis after surgery with choledochojejunostomy were included in this study. The treatment including the removal of hepatolithiasis and dilation of intrahepatic duct and anastomotic stoma was performed by soft fiber-optic cholangioscopy through percutaneous trans-choledochojejunal anastomotic channel under ultrasound guidance. Results There were different procedures of channel establishment through percutaneous trans- choledochojejunal anastomosis for 6 cases. The ultrasound-guided percutaneous trans-choledochojejunal anastomotic channel was set up in 3 patients. There were 2 cases with cholangioscopy through percutaneous transhepatic cholangial drainage channel under ultrasound guidance. The other case after fail of percutaneous cholangioscopy was converted to laparotomy which showed choledochojejunal anastomosis located in the back of colon and the establishment of percutaneous trans-choledochojejunal anastomotic channel was done then. The cholangioscopy could reach the left or the right intrahepatic bile duct convenient through the channels for all 6 cases. There were no abdominal bleeding and infection, intestinal fistula, biliary leakage and other short-term complications postoperatively. During 1 to 6 months of follow up, the channels could be passed repeatedly for the procedures for stone removal, and dilation of intrahepatic duct stenosis and anastomotic stenosis. Conclusions The main advantages of percutaneous trans-choledochojejunal anastomotic channel under ultrasound guidance would be minimally invasive, safe, and effective for treatment of hepatolithiasis, intrahepatic duct stenosis and anastomotic stenosis. Figures and Tables | References | Related Articles | Metrics

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Economic cost analysis of cholecystectomy based on development of specialization SHEN Sheng, GAO Zhihui, XIN Yanlei, ZHENG Bohao, LIU Houbao, SUO Tao 2022, 27 (04):  334-339.  DOI: 10.16139/j.1007-9610.2022.04.012 Abstract ( 175 )   HTML ( 3 )   PDF (665KB) ( 53 )   Object To analyze the difference of economics cost between biliary surgeons and general surgeons in performing cholecystectomy for gallbladder benign diseases and the influence of specialization of surgery on patients. Methods The general information, hospitalization expenses and postoperative hospital stay of the patients with gallbladder benign diseases undergoing cholecystectomy from 2009 to 2018 in Zhongshan Hospital were analyzed retrospectively. Results There were 11 635 cases included in this study through the searching notes and manual review dividing 4 350 cases in biliary surgeon group and 7 285 cases in general surgeon group. There was no significant difference in ratio of laparosco-pic surgery between two groups(P=0.198). Total cost in biliary surgeon group was significantly higher than that in general surgeon group during 2009—2018, (15 721.60±9 888.82) yuan vs.(12 529.88±9 382.23) yuan. The increase in operative cost, (5 110.43±1 416.40) yuan vs. (4 601.24±1 601.65) yuan, material cost, (4 458.73±2 967.35 ) yuan vs. (4 080.49±2 377.83) yuan, drug cost, (1 808.32±2 771.20 ) yuan vs. (1 562.51±3 648.92) yuan, self-paying drug cost, (806.63±1 285.11) yuan vs. (637.14±1 071.00) yuan, and nursing cost, (165.24±296.55 ) yuan vs. (129.24±398.01) yuan, P<0.001 were higher significantly in biliary surgeon group than those in general surgeon group. Postoperative hospital stay was longer in biliary surgeon group than that in general surgeon group, (2.51±2.39) d vs. (2.50±2.87) d, P<0.001. After specialized grouping in 2015, the ratio of laparoscopic surgery in biliary surgeon group increased significantly. Total fee and operative cost in biliary surgeon group were higher than those in general surgeon group. However, both drug and nursing cost were lower in biliary surgeon group than those in general surgeon group, and postoperative hospital stay was shorter than that in general surgeon group (All P<0.05). Conclusions Compared with general surgeon group, total cost of cholecystectomy is higher in biliary surgeon group which might be due to the patients with complex disease. Drug and nursing cost are lower, and length of stay is shorter in recent years suggesting a faster recovery. Figures and Tables | References | Related Articles | Metrics

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Multivariate analysis of prognosis of patients with malignant bowel obstruction CHENG Wei, HUANG Yuhua, WANG Jian, LI Yousheng 2022, 27 (04):  340-345.  DOI: 10.16139/j.1007-9610.2022.04.013 Abstract ( 230 )   HTML ( 3 )   PDF (620KB) ( 97 )   Objective To analyze the risk factors for prognosis of patients with malignant bowel obstruction (MBO) using multiple factors, and establish the nomogram model for predicting the survival of patients with MBO. Methods The clinical data of 203 patients with MBO from June 2013 to June 2019 who were followed up in our hospital were analyzed retrospectively. Results A total of 143 (70.4%) patients have been followed up. It was shown with univariate analysis that indexes of gender, age, platelet, C-reactive protein, and total protein levels, comorbidities, the treatment with somatostatin, enteral nutrition, and parenteral nutrition, length of hospital were not related to the survival of patients with MBO. There were some factors including late TNM stage of tumor (P<0.001), tumor metastasis (P<0.001), anemia (P=0.001), lower albumin (P<0.001), higher white blood cell(P=0.023), non-surgical treatment(P=0.013), low quality of life score (P<0.001) and poor liver function [including high alanine aminotransferase (P=0.023), high aspartate aminotransferase (P=0.005)] which related with poorer prognosis in patients with MBO. Multivariate analysis showed that tumor stage (P=0.003) and albumin level(P=0.001) were independent risk factors affecting the prognosis of MBO. Nomogram was constructed using 4 indexes including late TNM stage, tumor metastasis, lower hemoglobin and lower albumin. It was indicated that the results of internal prognosis were better for the prediction of survival of 3 to 12 months of 40 cases. Conclusions The study on poor prognosis of patients with MBO combined with nomogram showed that both late stage of tumor and malnutrition were main factors. Figures and Tables | References | Related Articles | Metrics

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Total parathyroidectomy with forearm autotransplantation in treatment of secondary hyperparathyroidism LI Rongguo, ZHANG Weijun, XU Tingyan, DU Qiwei 2022, 27 (04):  346-350.  DOI: 10.16139/j.1007-9610.2022.04.014 Abstract ( 198 )   HTML ( 6 )   PDF (574KB) ( 93 )   Objective To analyze the clinical effect of total parathyroidectomy with forearm autotransplantation on secondary hyperparathyroidism. Methods From January 2017 to December 2020, calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase and clinical symptoms of 26 patients who received total parathyroidectomy with forearm autotransplantation in our hospital were studied. The patients with end-stage renal disease in this study had persistent dialysis in the treatment of secondary hyperparathyroidism before admission. Results A total of 105 parathyroid glands of all patients were removed. The symptoms including ostalgia and itch of skin were improved or removed in all cases. Amount of calcium, phosphorus, alkaline phosphatase and intact parathyroid hormone in serum decreased significantly post-operative 3 and 6 months than before (P<0.05). The operation was performed all successful. One case(3.85%) recurred with postoperative complications in 2 cases(7.69%). Conclusions Total parathyroidectomy with forearm autotransplantation would be safe and effective for the treatment of refractory secondary hyperparathyroidism. Figures and Tables | References | Related Articles | Metrics

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Study on transanal tube drainage after endoscopic resection of giant colorectal polyp HAN Huazhong, XU Chunhua, FAN Wenjie, QI Zhipeng, LI Bing, ZHOU Pinghong, YAO Liqing, ZHONG Yunshi, LU Pinxiang 2022, 27 (04):  351-356.  DOI: 10.16139/j.1007-9610.2022.04.015 Abstract ( 325 )   HTML ( 3 )   PDF (1019KB) ( 151 )   Objective To investigate the clinical effect of transanal tube drainage and anal decompression after endoscopic submucosal dissection (ESD) of giant colorectal polyp for postoperative recovery and the prevention of complication. Methods Prospective clinical randomized control study was done. Enrolled patients with giant colorectal polyps (diameter ≥3 cm) were divided into 100 cases in endoscopic treatment group(endoscopic group) and 92 cases in endoscopic treatment with prophylactic anal tube implantation group (endoscopic anal tube group). Postoperative recovery and complication between 2 groups were compared. Results Delay bleeding from anal of postoperative complications was present 5(5.0%) cases in endoscopic group and 2(2.2%) cases in endoscopic anal tube group. There were electrocoagulation syndrome of complications 7 (7.0%) cases in endoscopic group and 1(1.1%) case in endoscopic anal tube group. The difference in postoperative complication rate was significant statistically(P<0.05). The temperature 3 days after surgery of patients in endoscopic group and endoscopic anal tube group was (37.2±0.8) ℃ and (37.1±0.6) ℃, respectively without significant diffe-rence (P>0.05) between two groups. Intestinal peristalsis returned (22.5±5.9) h after operation in endoscopic anal tube group and (39.3±10.4) h in endoscopic group with statistically significant differences (P<0.01) between two groups. Abdominal pain score was (2.2±1.3) in endoscopic anal tube group, which was lower than that (4.7±2.2) in endoscopic group statistical significantly (P<0.01). On the first day after operation, intestinal cavity of endoscopic group expanded significantly more compared with that of endoscopic anal tube group by abdominal plain radiograph. Conclusions Anal decompression and drainage after ESD of giant colorectal polyp could be simple and safe preventive measures with low rate of postoperative complications and better recover which would be worth use during ESD. Figures and Tables | References | Related Articles | Metrics

Clinical research

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Postoperative wound infection of Lichtenstein operation for inguinal hernia YU Fan, WU Bo, KANG Jie 2022, 27 (04):  357-358.  DOI: 10.16139/j.1007-9610.2022.04.016 Abstract ( 162 )   HTML ( 2 )   PDF (284KB) ( 74 )   References | Related Articles | Metrics

Case report

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Transcatheter splenic artery embolization for pancreatic sinistral portal hypertension with gastrointestinal blee-ding: a case report CHEN Xiaojuan, ZHANG Wen, CAI Yu 2022, 27 (04):  359-362.  DOI: 10.16139/j.1007-9610.2022.04.017 Abstract ( 204 )   HTML ( 3 )   PDF (809KB) ( 84 )   Pancreatic sinistral portal hypertension (PSPH) is a rare entity resulting from splenic vein obstruction and is characterized by splenomegaly, gastric and/or esophageal varices with normal liver function. PSPH-related gastric varices is one of severe complications with high incidence and is difficult for prompt diagnosis and treatment. To date, there is no consensus on treatment strategy. Splenic artery embolization (SAE) has been considered as an alternative strategy to splenectomy with satisfactory safety and efficacy for treatment of gastric bleeding caused by PSPH. Here we reported one case with autoimmune pancreatitis-related PSPH with gastric bleeding in Department of Gastroenterology Zhongshan Hospital. Treatment with transcatheter SAE led to gradual stop of gastric bleeding and much improvement of gastric varices. Follow-up study indicated that recurrence of upper gastrointestinal bleeding was not present without postoperative complication. The results suggest that SAE is a minimally invasive, safe and effective treatment strategy for controlling PSPH-related gastric variceal bleeding in the patient with autoimmune pancreatitis. Figures and Tables | References | Related Articles | Metrics

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Gallbladder stone with congenital heart disease and situs inversus totails: a case report ZHANG Junzhe, CHEN Wei 2022, 27 (04):  363-364.  DOI: 10.16139/j.1007-9610.2022.04.018 Abstract ( 165 )   HTML ( 3 )   PDF (308KB) ( 73 )   The incidence of situs inversus totalis is low. Localization of symptoms and signs will change for the patient with this anomaly when complicating abdominal disease. One patient with cholecystolithiasis in our hospital coexistence with congenital heart disease and situs inversus totalis had abdominal surgery, and more attention should be paid to maintaining the stability of circulation during operation. In this case report we discussed treatment of this patient with situs inversus totalis. References | Related Articles | Metrics

Review

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Clinical significance of diagnostic laparoscopy on precision staging in advanced gastric cancer NIE Mingming, ZHU Zhenggang 2022, 27 (04):  365-370.  DOI: 10.16139/j.1007-9610.2022.04.019 Abstract ( 230 )   HTML ( 8 )   PDF (571KB) ( 89 )   Gastric cancer is the leading cause of cancer-related deaths in human. More than 70% patients present with advanced gastric cancer or with metastasis in clinic. There are three “higher ratio” of phenomenons at present includ-ing higher ratio of advanced gastric cancer, higher ratio of unnecessary laparotomy, and higher ratio of non-R0 radical gastrectomy. Diagnostic laparoscopy can be used: ① to discover occult and micro enough metastatic lesions in the abdo-minal cavity which could not be diagnosed by current imaging examinations; ② to determine whether gastric cancer invaded adjacent organs; ③ to identify intraperitoneal free cancer cells using peritoneal lavage. Then the precision staging would be gotten for reasonable treatment strategy. T4b stage is diagnosed for positive preoperative treatment. Intraperitoneal occult metastatic lesions are found to avoid unnecessary gastrectomy. Separate cancer cells are screened for conversion therapy. The prognosis of patients with gastric cancer could be improved further when the neoadjuvant therapy is selected. References | Related Articles | Metrics

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Recent advance in neoadjuvant chemotherapy for rectal cancer GUO Yang, GUO Tian′an, XU Ye 2022, 27 (04):  370-374.  DOI: 10.16139/j.1007-9610.2022.04.020 Abstract ( 251 )   HTML ( 7 )   PDF (428KB) ( 108 )   Rectal cancer is an important global public health problem and a huge economic burden. The clinical guideline was recommended by the National Comprehensive Cancer Network in America that neoadjuvant chemoradiothe-rapy, total mesorectal excision, postoperative adjuvant chemotherapy is the standard treatment for the patients with locally advanced rectal cancer. Neoadjuvant chemotherapy is an emerging option that has not yet been widely applied in the treatment of rectal cancer. In theory, this strategy is supposed to avoid the toxin of radiotherapy and increase patient survival. Neoadjuvant chemotherapy in rectal cancer was reviewed in this article including the development, basic theory, treatment strategy and course, compliance, adverse reactions and efficacy assessment, the direction of future optimization was explored. Figures and Tables | References | Related Articles | Metrics

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Study on hernia repair materials: progress and prospect YU Fan, WU Bo, KANG Jie 2022, 27 (04):  375-379.  DOI: 10.16139/j.1007-9610.2022.04.021 Abstract ( 387 )   HTML ( 17 )   PDF (571KB) ( 250 )   Hernia is one of common diseases diagnosed and treated in clinic by general surgeons with surgery as major procedure of treatment. Hernia repair materials are used in conventional and laparoscopic tension-free repair. Classification of repair materials based on material quality includes non-absorbable or absorbable man made synthetic mesh, biologic mesh and compound mesh. The mesh would also be classified according to woven way, pore size and density. The hernia repair material in future will be prospected which may have the maximized biologic inertia, minimized overall area, the most excellent surface nature, the most optimized weight of mesh, and biomechanical strength. Further study will be needed on the base of recognition of pathophysiology and material property of mesh. References | Related Articles | Metrics

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Laparoscopic intragastric surgery in treating of gastric submucosal tumor and early gastric cancer GUO Liangqi, YAN Zhilong, ZHANG Moucheng 2022, 27 (04):  380-383.  DOI: 10.16139/j.1007-9610.2022.04.022 Abstract ( 213 )   HTML ( 4 )   PDF (514KB) ( 145 )   The detection rate of gastric submucosal tumor (SMT) and early gastric cancer has been increasing year by year. The type of treatment should be selected to keep gastric function as more as possible because of both SMT and early gastric cancer with good prognosis. Endoscopy and the combination of laparoscopic and endoscopic cooperative surgery can be the choice. Laparoscopic intragastric surgery (LIGS) contains the advantages of both laparoscopy and endoscopy and can be performed by the surgeon only. LIGS has been applied to gastric submucosal tumors and early gastric cancer based on the continuous improvement of the procedure and instruments of LIGS. The application including the advantage and disadvantage of LIGS were reviewed in this paper. Figures and Tables | References | Related Articles | Metrics