ObjectiveTo investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.MethodsFrom January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.ResultsThe operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).ConclusionIn situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
Objective To investigate the indication and possibility of orthotopic liver transplantation for patient with alveolar hydatid disease. Methods An orthotopic liver transplantaion was successfully performed on two cases with unresectable alveolar hydatid disease using the new approach of venovenous bypass first.Results The recovery of liver graft function was good after the operation in these patients. Following up for nine and three months, the patients returned to his work without any complications. Conclusion It suggests that the case with advanced alveolar hydatid disease are an indication for liver transplantation. The new technique of venovenous bypass prior to mobilization of liver is feasible and safe.
Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
Objective To summarize and analyze the research progression of zinc deficiency in patients with type 2 diabetes mellitus or obesity after Roux-en-Y gastric bypass （RYGB） surgery. Method The domestic and international published literatures about zinc deficiency after RYGB in recent years were reviewed. Results There was a degree of zinc deficiency after RYGB surgery， its mechanisms had not been fully clarified， which were related to reduced intake and absorption of zinc， protein malnutrition， dietary factors， and specific ways of surgery and the zinc supplementation programmes after operation would also affect the postoperative zinc nutritional status. Conclusions Reasons for zinc deficiency after RYGB surgery are multifaceted and have not been clarified. Further research is needed to provide experimental and theoretical basis for management of zinc nutritional status after RYGB surgery.
ObjectiveTo summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome (PAES).MethodThe clinical data of 10 patients (10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed.ResultsAmong 10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and (or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography (DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction (distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to 1-year of following-up. ConclusionSurgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
临床肝移植始于1963年，1983年美国国家健康委员会对肝移植技术的接受和认可，为全球的肝移植发展注入了活力。目前全球有150余个移植中心，并每年以1万余例的速度开展这项手术，总的手术次数已超过8万例次，最长存活达30余年。与西方国家相比，我国肝移植工作起步晚，发展慢，并曾一度停滞了多年，这与当时的经济状况等因素有关。就早年不多的临床肝移植而言，患者多于术后短期内死亡，这与手术技术的不成熟、有效免疫抑制剂的缺乏、术后管理经验不足等有关。可喜的是，随着近20年来与国外合作交流的增加，许多中青年学者学成后回国，为我国肝移植基础与临床工作的第二次发展奠定了基础。我院肝移植开展于90年代初，近3年来发展迅速，目前已完成了102例。自20世纪90年代以来，肝脏移植在临床上已日渐成为终末期肝病的治疗方法之一，随着外科技术和围手术期管理水平的不断提高，以及各种新型免疫抑制剂的不断开发，肝移植的指征也从早期肝肿瘤扩大到良性终末期肝病，并已成功用于治疗暴发性肝功能衰竭患者。目前，肝移植的手术死亡率在5%以下，1年生存率超过80%，5年生存率在75%左右，患者术后生活质量满意。
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
Objective To investigate the procedure and clinical effect of revascularization for arterial occlusion in lower extremity. Methods From July 1998 to March 2005, 29 cases of arterial occlusion were treated by microsurgery. Of 29 cases, there 22 males and 7 females, aging 22-86 years, including 9 cases of thromboangiitis obliterans(TAO), 17 cases of arterial sclerosis obstruction(ASO) and 3 cases of diabetic foot(DF). The location was the left in 17 cases, the right in 11 cases and both sides in 1 case. All cases were inspected by color-Doppler ultrasonic scanning before operation. The cases of ASO and DF were checked with MRA. The results of examinations showed that the locations of arteriostenosis and obstruction were: in 9 cases of TAO, the distal superficial femoral artery in 3 cases, popliteal artery in 5 cases, bilateral dorsal metatarsal artery in 1 case; in 17 cases of ASO, common iliac artery in 2 cases, external iliac artery in 4 cases, femoral artery in 10 cases and popliteal artery in 1 case; and were all superficial femoral artery in 3 cases of DF. DSA examination confirmed that there was appropriate outflow in 15 cases. Basing on the location and extent of the arterial occlusion, 11 cases were treated by the primary deep vein arterializing, 16 cases by arterial bypass distribution and 2 cases of extensive common iliac arterial occlusion were amputated in the level of 1/3 distal thigh. Results The postoperative duration of follow-up for all cases was 3 months to 7 years. In 9 cases of TAO, 2 healed by first intention after deterioration, 4 healed after changing dressing and 3 had fresh soft tissue growth after debrided superficial secondary necrosis. In 17 cases of ASO, 13 healed by first intention, 2 healed after changing dressing and 2 were amputated. In 3 cases of DF, 2 healed after changed dressing and debrided, 1 was aggravated with the second toe necrosis. Conclusion Performing primary deep veinarteriolization and arterial bypassdistribution is effective for treatment of arterial occlusion of lower extremity. The arterial reconstructive patency rate can be improved by microsurgical treatment.