ObjectiveTo explore the application value of transoral snare traction in endoscopic submucosal dissection (ESD) for patients with early gastric cancer (EGC). MethodsA total of 90 EGC patients admitted to Xinxiang Central Hospital from January 2020 to April 2023 were selected and randomly divided into a study group and a conventional group using a random number table method. The conventional group was received ESD, while the study group was received transoral snare traction in combination with ESD. Baseline data, treatment efficacy, as well as the serum inflammatory-stress factors (tumor necrosis factor alpha, interleukin-6, adrenocorticotropic hormone, and cortisol) and gastrointestinal hormones (motilin and gastrin), surgical indicators, gastrointestinal function recovery indicators before surgery and on day 1 and 3 after surgery, postoperative complications, improvement in quality of life, and 2-year recurrence rate were compared between the two groups. The test level was set at α=0.05. ResultsThere were no statistically significant differences in age, gender, body mass index, disease duration, longest tumor diameter, lesion location, and tumor differentiation degree between the study group and the conventional group (P>0.05). The total effective rate in the study group was higher than that in the conventional group [95.6% (43/45) vs. 80.0% (36/45), χ2=5.075, P=0.024]. The results of repeated-measures ANOVA showed statistically significant between-group, time, and between-group-time interaction effects of serum inflammatory-stress factor and gastrointestinal hormone levels in the study and conventional groups (P<0.05), the effect of the time factor on inflammatory-stress factors and gastrointestinal hormones varied with intervention (P<0.001), postoperative inflammatory-stress factors levels in the study group exhibited aninitial increase followed by a decline, ultimately falling below those of the conventional group, the levels of serum motilin and gastrin in the study group continued to decrease than those before surgery and the reduction was smaller in the study group than in the control group. The operation duration, recovery of bowel sounds, the first exhaust, the first defecation, and the first meal time in the study group were shorter than those in the conventional group (P<0.05), and the intraoperative blood loss was less than that in the conventional group (P<0.05), the overall complication rate was lower than that in the conventional group [4.4% (2/45) vs. 17.8% (8/45), χ2=4.050, P=0.044], and the improvement rate in quality of life was higher than that in the conventional group [77.8% (35/45) vs. 57.8% (26/45), χ2=4.121, P=0.042]. There was no significant difference in the recurrence rate between the two groups after a 2-year follow-up [7.0% (3/43) vs. 17.1%(7/41), χ2=1.191, P=0.275]. ConclusionThe results of this study suggest that the treatment of early gastric cancer with transoral snare traction combined with ESD has significant efficacy, which can optimize surgical procedures, reduce inflammatory-stress reaction, improve gastrointestinal hormone levels, promote disease recovery, reduce the occurrence of complications, and achieve good short- and medium-term outcomes.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
Objective To summarize the revascularization method of infective femoral false aneurysm caused by drug injection. Methods Between November 2003 and May 2009, 84 patients with infective femoral false aneurysm caused by drug injection were treated, and the cl inical data were analysed retrospectively. There were 67 males and 17 females with anaverage age of 34.6 years (range, 19-51 years). The average duration of drug injection was 2.7 years (range, 1-11 years). In 13 cases, the defect of femoral artery was 3-10 cm; defect ranged from 1.0 cm × 0.3 cm to 3.0 cm × 0.7 cm in the others. The surgical treatment included bypass using synthetic grafts in 5 cases, great saphenous veins transplantation in 29 cases, repair of femoral artery in 24 cases, and l igation of femoral artery in 26 cases. Results Two cases died of intraoperative pulmonary embol ism. Eight cases had postoperative wound infection, which was cured after changing dressings. Incisions healed by first intention in the other paitents. A total of 82 cases were followed up 12-36 months (mean, 17.3 months). In 56 patients undergoing artery reconstruction or repair, dorsal pedis artery pulse was significantly improved, and no distal osteofascial compartment syndrome occurred. In 26 patients undergoing femoral artery l igation, angiography at 1 week after operation showed abundant collateral circulation from ipsilateral internal il iac artery, superior gluteal artery or contralateral internal il iac artery. Three cases had postoperative intermittent claudication which was improved after symptomatic treatment. Conclusion Infective femoral false aneurysm caused by drug injection should be treated surgerically as early as possible, and effective treatments include debridement, drainage, defect repair or bypass with synthetic graft or great saphenous vein from homonymy external il iac artery to superficial femoral artery. Ligation of femoral artery is an option in patients with serious infection when revascularization is impossible.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.
Objective To observe the effects of sarpogrelate hydrochloride in prevention and treatment for ischemia of gluteal and limb following endovascular repair of abdominal aortic aneurysm （EVAR）. Methods Clinical data were analyzed in 174 patients with abdominal aortic aneurysm （AAA） who underwent EVAR from January 2006 to January 2011. The patients’ mean age was （71.8±8.2）years old （male： 148 cases， female： 26 cases）. The diameter of abdominal aortic aneurysm was （55.2±12.9） mm. AAA involving common iliac artery was in 52 （29.9%） patients. Bifurcated endografts and aorto-uni-iliac （AUI） endografts with crossover bypass were used in 169 patients （97.1%） and 5 patients （2.9%）， respectively. Sarpogrelate hydrochloride were used in 39 patients with gluteal and limb ischemia due to exclusion of bilateral and unilateral internal iliac arteries among 174 patients. Sarpogrelate hydrochloride， 100 mg， three times daily，was taken for 2-4 weeks. Symptoms of gluteal and limb ischemia were followed-up.Results All of patients with AAA was repaired by EVAR successfully and no conversion to open repair. General anesthesia 〔50.6%（88/174）〕， epidural anesthesia 〔30.0%（52/174）〕， and local anesthesia 〔19.5%（34/174）〕 were used. Blood loss was （125.2±43.1） ml and no blood transfusion during operation. Operative time was （145.5±38.7） min, ICU stay time was （14.7±5.2） h， and postoperative fasting time was （7.2±4.3） h. The duration of postoperative hospital stay was （9.1±2.7） d. The perioperative complication rate was 12.6% （22/174）. The 30-day mortality rate was 1.1% （2/174）. Gluteal and limb claudication occurred in 2 paients and 5 patients respectively among 29 patients with EVAR due to exclusion of unilateral internal iliac artery， intermittent claudication distance was 100-200 meters. Gluteal muscle pain and limb claudication for less than 200 meters occurred in 4 patients due to exclusion of bilateral internal iliac artery. The symptoms were relieved after Sarpogrelate hydrochloride， 100 mg， three times daily， was taken for 2-4 weeks. No gluteal gangrene occurred and claudication distances were more than 500 meters when walking， no any interventional and surgical procedures were required， all of them were doing well for median 16.1 months follow-up period. Conclusions Sarpogrelate hydrochloride has definite effects on prevention and treatment for gluteal and limb ischemia following endovascular repair of abdominal aortic aneurysm，especially for exclusion of bilateral and unilateral internal iliac arteries during EVAR
Objective To discuss the surgical management in resection of primary peritoneal tumors involving iliac vessels. Methods The clinical data of 124 patients with primary peritoneal tumors involving iliac vessels， that underwent surgical procedures from December 2006 to December 2011 were analyzed retrospectively. There were 68 menand 56 women with an age raging from 16-72 years old （mean 44 years old）. Results All patients underwent operative treatment. Fifty-two patients with tumors infiltrating or surrounding the major illiac vessels， 72 patients with tumors compressing the iliac vessels. Primary peritoneal tumors involving iliac vessels were completely resected in 90 patients， were incompletely resected in 31 patients， and were palliatively resected in 3 patients. Resectoin of primary peritoneal tumors and iliac vessel reconstruction were performed in 42 patients with tumors infiltrating or surrounding the major illiac vessels. There was no death during perioperative period. There were complications in 2 patients， that including urinary fistula in 1 patient and fat liquefaction of incision in 1 patient. Complications were not found in the rest of the patients. All patients were followed-up from 12-24 months （mean 16 months）. Thirty-eight patients relapsed locally in 90 patients with tumor completely resected. Nine patients died in those tumor incompletely resected（6 patients died because of recurrence， 3 patients died because of cadiovasuclar and cerebrovascular accidents）. Three patients follwing palliative resected were dead during the follow-up period （3 patients died because of recurrence）. Among the 42 patients underwent the procedure of iliac vessels， recurrence occured in 3 patients without involving iliac vessels， 1 patient relapsed involving inferior vena cava （IVC） which resulted in IVC obstruction and deep venous thrombosis following 7 months after operation. Recurrence occured in 2 patients involving common iliac veins following 8 months after operation. Venous thrombus of common iliac vein graft occured in 1 patientin in 10 months after operation. Conclusion Resection completely and involved iliac vessel reconstruction would reduce recurrence of tumor and promote long term survival in patients with primary peritoneal tumors involving iliac vessels
ObjectiveTo assess whether the geriatric nutritional risk index (GNRI) of elderly patients can be used as an evaluation index for complications after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).MethodsA total of 265 patients with EVAR who received abdominal aortic aneurysm between January 2011 to December 2017 were included in this study from West China Hospital of Sichuan University. All patients included in this study were subrenal arterial AAA. Statistical analysis of clinical data was performed. The value of GNRI in evaluating postoperative complications of EVER patients was evaluated.ResultsOf the 372 patients, 158 were included in the GNRI abnormal group (GNRI≤98), and 214 were included in the normal group (GNRI>98). Univariate analysis showed that the age (P=0.04), drinking (P=0.04), serum albumin level (P<0.001), BMI (P<0.001), GNRI (P=0.004), and stroke (P<0.05) were risk factors that affects postoperative complications of AAA. Multivariate analysis showed that preoperative GNRI [HR=0.687, 95%CI: (0.487, 0.968), P=0.032] abnormality was one of the risk factors affecting postoperative complications of AAA.ConclusionFor patients undergoing endovascular aneurysm repair of abdominal aortic aneurysm, the GNRI is one of the important indicator for predicting postoperative complications.