Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
Abstract： Compared with mitral valve replacement, there areseveral advantages in mitral valvuloplasty, so recently more and more sights are caught on mitral valve repair. According to different etiology, the surgeon can apply annuloplasty, triangular resection, quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation(MR). With the development of minimally invasive surgical technology, robotic mitral valve reconstruction evolve rapidly and percutaneous interventional therapy also commence from lab to bedside.We believe surgeons can repair MR safely and successfully in the majority of patients with proficiency in the basic techniques.
ObjectiveTo compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). MethodsBetween January 2010 and December 2013, 68 patients with single OVCF and IVC were treated, and the clinical data were retrospectively analyzed. Of 68 patients, 48 underwent PVP (PVP group) and 20 underwent PKP (PKP group). There was no significant difference in age, gender, disease duration, fracture level, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), and preoperative radiological parameters between 2 groups (P > 0.05). The intraoperative incidence of cement leakage, cement volume, and operative time were compared between 2 groups; VAS score was used for evaluation of back pain and ODI for evaluation of dysfunction; the incidence of adjacent vertebral fracture was observed within 2 years. The vertebral height and kyphotic angle were measured on X-ray films; the rate of vertebral compression (CR), reduction rate (RR), progressive height loss (PHL), reduction angle (RA), and progressive angle (PA) were calculated. ResultsThere was no significant difference in cement volume and the incidence of cement leakage between 2 groups (P > 0.05). The operative time in PVP group was shorter than that in PKP group, showing significant difference (t=-8.821, P=0.000). The mean follow-up time was 2.4 years (range, 2.0-3.1 years). The VAS scores and ODI were significantly reduced at 1 day, 1 year, and 2 years after operation when compared with preoperative scores (P < 0.05), but there was no significant difference between different time points after operation in 2 groups (P > 0.05). Adjacent vertebral fracture occurred in 5 cases (10.4%) of PVP group and in 2 cases (10.0%) of PKP group, showing no significant difference (χ2=0.003, P=0.963). BMD was significantly increased at 1 year and 2 years after operation when compared with preoperative BMD (P < 0.05), but no significant difference was found between 2 groups (t=0.463, P=0.642; t=0.465, P=0.646). The X-ray films showed that CR and kyphotic angle were significantly restored at immediate after operation in 2 groups (P < 0.05); but vertebral height and kyphotic angle gradually aggravated with time, showing significant difference between at immediate and at 1 and 2 years after operation (P < 0.05); there was no significant difference in CR and kyphotic angle between 2 groups at each time point (P > 0.05). RR, RA, PHL, and PA showed no significant difference between 2 groups (P > 0.05). ConclusionThere is similar clinical and radiological efficacy between PVP and PKP for treatment of OVCF with IVC. Re-collapse could happen after operation, so strict observation and follow-up are needed.
ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.
Objective To study the effectiveness of substitute valve at the popliteal vein in treatment of deep venous valve insufficiency of lower extremities. Methods From January 1996 to August 2002, 27 patients were diagnosed having deep venous valve insufficiency of lower extremities by color Doppler and radiography with an average disease course of 17.4 years.All 27 patients had varicose vein, 25 pain, 22 swelling,25 pigmentation in ankle area and 19 chronic ulcerations.Two cases had been treated with great saphenous vein ligation and striping.Averagevein pressure in resting position was (11.00±0.73)kPa,and the ambulatory venous pressure was (9.14±0.68)kPa.All patients were treated with substitute valve at the popliteal vein,and great saphenous vein ligation and stripping, some were treated with subfascial endoscopic perforating veins ablation. Results The average ambulatory venous pressure after operation was (5.94±0.82)kPa,were significantly different from that before operation(P＜0.01). The curative results were satisfactory,and all symptom and physical sign disappeared.After a mean follow-up period of2-6 years,21 cases had satifactory results. Conclusion Substitute valve at the popliteal vein have the value of widespread application.
【摘要】 目的 评价经皮冠状动脉成形术（percutaneous coronary interventions，PCI）术后，穿刺股动脉应用Perclose ProGlide血管缝合器止血的安全性、可靠性及对常见并发症的防范。 方法 2007年4月-2009年5月，收治217例经股动脉PCI术后患者，根据术后是否使用血管缝合器将患者随机分成血管缝合器组（105例）和对照组（经手法压迫止血112例）。观察记录两组患者下肢制动时间及血管并发症等。 结果 血管缝合器组103例操作成功（98.1%），2例失败；对照组成功112例（100%）。两组成功率比较，差异无统计学意义（Pgt;0.05）。血管缝合器组和对照组患者下肢制动时间分别为（4.1±1.2）和（25.0±3.1）h，两组比较，差异有统计学意义（Plt;0.01）。术后两组并发症发生率比较，差异无统计学意义（Pgt;0.05）。 结论 血管缝合器是一种安全、可靠的止血方法，可明显缩短制动时间，无明显的穿刺部位血管并发症，熟练操作可减少并发症的发生。【Abstract】 Objective To evaluate the safety of Perclose ProGlide Suture-Mediated Closure System applied to femoral artery puncture site after percutaneous coronary interventions (PCI) and to explore the prevention of possible common complications. Methods A total of 217 patients who underwent PCI from April 2007 to May 2009 were randomly divided into Perclose ProGlide group (105 patients, hemostasis by Perclose ProGlide Suture-Mediated Closure System) and control group (112 patients, hemostasis by compression). The Lower-limb braking time and the complications were recorded and analyzed. Results The successful rate was 98.1% (103 patients) in Perclose ProGlide group, and 100% (112 patients) in the control group; the difference between the two groups was not significant (Pgt;0.05). But there was a significant difference (Plt;0.01) in Lower-limb braking time between the two groups[(4.1±1.2) and (25±3.1) hours]. The post-operative complications between the two groups didn’t differ much. Conclusions Perclose ProGlide Suture-Mediated Closure System is a safe,effective and simple method after percutaneous coronary intervention to achieve immediate hemastasis. Skillfully processing may reduce the vascular complications.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
Nowadays, percutaneous pulmonary valve treatment is a hot topic in valvular heart disease, consisting of percutaneous balloon pulmonary valvuloplasty and percutaneous pulmonary valve implantation (PPVI). The percutaneous balloon pulmonary valvuloplasty is the prime intervention of pulmonary valve stenosis. The main indication of PPVI is pulmonary valve regurgitation and/or obstruction. PPVI is still the research focus, with the improvement of surgical indications and the development of surgical devices. However, compared with surgical pulmonary valve replacement, it still has limitations. This article reviews the treatment progress of percutaneous pulmonary valve treatment, especially PPVI.