ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.
Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
Abstract: Objective To invest igate the early and m iddle2long term clinical outcome of surgical t reatment for pulmonary th romboembo lism (PTE). Methods The data of 57 cases of surgical t reatment fo r pulmonary embolism from O ctober 1994 to O ctober 2007 in A nzhen Ho sp italw ere analyzed ret ro spect ively, of w h ich 47 casesw ere ch ronic PTE done w ith pulmonary th romboendarterectomy, and 10 w ere acute PTE done w ith pulmonary embo lectomy. Results There w ere 6 (12. 8%) perioperat ive death s in ch ronic PTE and 4 (40. 0%) death s in acute PTE (P =0.030). F ifteen cases suffered w ith residual pulmonary hypertension and 25 casesw ith severe pulmonary reperfusion injury. The pulmonary artery systo lic p ressure (PA SP) and the pulmonary vascular resistance (PVR ) of 41 cases with ch ronic PTE at 72 hours after surgery w ere low ered significant ly than tho se befo re surgery (52. 9±26. 1 mmHg vs. 91. 2±37. 4 mmHg; 410. 3±345. 6 dyn?s/ cm5 vs. 921. 3±497. 8 dyn?s/ cm5). The arterial oxygen saturat ion (SaO 2) and the arterial part ial p ressure of oxygen (PaO 2 ) at 72 hours after surgery w ere h igher significant ly than tho se befo re surgery (94.8% ±2.7% vs. 86.7% ±4.3%; 84. 4±5. 4 mmHg vs. 51. 8±6. 4 mmHg, P lt; 0. 05). With the fo llow -up of 44. 6±39. 3 month s (cumulat ive fo llow -up w as 160. 1 pat ient-years) of the 47 perioperative survivo rs, there w ere 5 late death s, of w h ich 4 ch ronic PTE and 1 acute PTE. A cco rding to Kap lan-Meier survival curve, the 5 years survival rate w as 89. 43%±5. 80% fo r ch ronic PTE and 83. 33%±15. 21% fo r acute PTE (Log rank test= 1.57, P = 0. 2103). The lineal bleeding rate related to ant icoagulat ion w as 1. 25% pat ient-years, and the lineal th romboembo lic rate related to ant icoagulat ion w as 0. 62% pat ient-years. A nd of the 42 mid-long term survivo r, the heart funct ion in 29 cases w as N ew Yo rk Heart A ssociat ion (NYHA ) class I , 10 cases NYHA class II , 3 cases N YHA class III. A cco rding to logist ic regression, the risk facto rs fo r the early death w ere acute PTE (OR = 3.28, peripheral type of PTE (OR = 2. 45) , unadop t ive of deep hypertherm ia and circulato ry arrest (OR = 2.86) ; and the risk facto rs fo r late death w ere peripheral type of PTE (OR = 2. 69) , lower limb edema p rep rocedure (OR = 2.79). Conclus ion The operat ive mo rtality in acute PTE is significant ly h igher than that in ch ronic PTE, and the mid-long term survival rate is agreeable in bo th acute and ch ronic PTE, and the comp licat ions rate related to ant icoagulat ion is relat ively accep table.
Objective To present and summarize the data concerning the treatment and prognosis of acute limb arterial embolism in West China Hospital. Methods Forty three patients with 52 limbs of acute arterial embolism were treated in West China Hospital from January 2003 to March 2006. There were 15 males and 28 females, aging from 26 years to 77 years 〔(58.88±13.90) years〕. The diagnosis was based on clinical manifestations and results of color Doppler sonography or DSA. The follow-up ranged from 1 month to 39 months. The following factors, which might influence the prognosis, were analysed through multiple linear regression of SPSS 10.0: age, sex, uper limb or lower limb, location of embolus, ischemic time, clinical categories of acute limb ischemia, history of smoking, atherosclerosis and other combined diseases, pervious history of acute limb arterial embolism, operative or nonoperative treatment, and postoperative complications. Results Clinical categories of acute limb ischemia include: Ⅰ (n=0),Ⅱa (n=16), Ⅱb (n=29), Ⅲ (n=7). The ischemic time varied from 3 h to 2 weeks. The sources of embolus: heart (n=39), vessle (n=7), iatrogenic origin (n=1), unidentidied origin (n=5). The therapies included embolectomy (n=38), catheter-directed thrombolysis (n=2) and medical treatment (n=12). The following postoperative complications occured: compartment syndrome (n=12), respiratory failure (n=3), alkalolsis (n=3), acute renal failure (n=2), wound infection (n=2) and pulmonary infection (n=1). Two patients died of cerebral infarction in hospital and one patient died of heart failure 3 months after discharge. Thirty-eight patients with 45 diseased limbs were followed up. The results were excellent in 13 limbs, good in 15 ones, fair in 8 ones and poor in 9 ones. The statistically significant influencing factors of prognosis include ischemic time, clinical categories of acute limb ischemia and history of smoking (P＜0.05). Conclusion The operation of embolectomy is the main treatment of acute limb arterial embolism. In selected patients, catheter-directed thrombolysis and medical treatment could be used to alleviate the limb ischemia. The treatment against the etiological factors should not be ignored. The prognosis of this disease could be influenced by ischemic time, clinical categories of acute limb ischemia and history of smoking.
１３１Ｉ was labeled on lipiodol molecule by an iodine exchange reaction. The labeling rate was 95%. No dehalogenation was detected within 15 days at room temperature or after slerilization. Animal experiments showed that after hepatic arteial injection, １３１Ｉ-lipiodol was selectively accumulated in the embolizated local area. No increased acti-vity was observed in thyroid, lung or other areas in the body. The blood radioactivity per ml was 0.09±0.04% of the injectd dose. The result suggest that １３１Ｉ-lipiodol is very stable and suitable for clinical application.
Objective To review the emergency management and perioperative strategies for ruptured neurofibromatosis type 1 (NF1)-related giant plexiform neurofibroma (PNF), providing a systematic treatment protocol to improve the therapeutic outcomes and quality of life for patients with giant PNF. Methods The literature on the management of giant PNF rupture and hemorrhage was reviewed, and the diagnosis, treatment, and perioperative management were summarized based on clinical experiences. Results By implementing an integrated diagnostic and treatment strategy that includes early diagnosis, imaging evaluation, emergency ultra-selective arterial embolization combined with surgical excision, acute hemorrhage can be effectively controlled while also reducing the risk of major intraoperative bleeding and minimizing postoperative complications. As a result, this approach significantly improves treatment success rates and patient quality of life. Conclusion For ruptured NF1-related giant PNF, employing emergency ultra-selective arterial embolization combined with surgical excision, under the collaboration of a multidisciplinary team, can effectively improve treatment success rates, rapidly control bleeding, reduce tumor size, and lower mortality. Future research should focus on assessing the long-term quality of life of patients treated for ruptured and hemorrhaging giant PNF and on further optimizing treatment protocols.
摘要:目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)后发生严重并发症的原因、治疗措施和经验教训。方法:分析 2007 年 8 月至2009 年 4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果:2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开(endoscopic sphincterotomy, EST)取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论:术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.