Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced sk...Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.展开更多
目的系统评价经股动脉穿刺介入诊疗术后应用血管缝合器的安全性。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、EBSCO、SinoMed、中国知网(CNKI)、万方数据库、维普数据库公开发表的中、英文有关经股动脉穿刺介入...目的系统评价经股动脉穿刺介入诊疗术后应用血管缝合器的安全性。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、EBSCO、SinoMed、中国知网(CNKI)、万方数据库、维普数据库公开发表的中、英文有关经股动脉穿刺介入诊疗术后应用血管缝合器的随机对照试验或类实验性研究,检索时间为2010年1月—2018年9月。按纳入标准和排除标准筛选文献、提取资料,系统评价文献,参照Cochrane Handbook(5.1.0)评价偏倚风险的方法评价文献的研究质量,采用Revman 5.3软件进行Meta分析。结果共纳入3项随机对照研究,6项类实验性研究。Meta分析结果显示,与常规压迫止血方法比较,应用血管缝合器进行介入诊疗术后止血,可降低皮下血肿、假性动脉瘤、腹股沟出血的发生率,差异均有统计学意义(P<0.05)。但在降低动静脉瘘、腹膜后出血、穿刺部位感染的发生率上,与常规压迫止血相比,差异无统计学意义(P>0.05)。结论血管缝合器与常规压迫止血相比,在预防经股动脉穿刺介入诊疗术后血管并发症是安全、有效的,能降低部分血管并发症的发生率。展开更多
BACKGROUND As the population ages and people’s living standards gradually improve,the incidence of cerebrovascular disease in China is increasing annually,posing a serious threat to people’s health.The incidence of ...BACKGROUND As the population ages and people’s living standards gradually improve,the incidence of cerebrovascular disease in China is increasing annually,posing a serious threat to people’s health.The incidence of brachiocephalic artery stenosis in ischemic cerebrovascular disease is relatively low,accounting for 0.5% to 2% of patients,but its consequences are very serious.Herein,we report a case of brachiocephalic artery stenting through the carotid artery.CASE SUMMARY The patient was a 66-year-old man.He came to our hospital because of repeated dizziness and was diagnosed with ischemic cerebrovascular disease (stenosis at the beginning of the brachiocephalic artery).Cerebral angiography suggested that the stenosis of the brachiocephalic artery had almost occluded it.Contrast agent threaded a line through the stenosis,and there was reversed blood flow through the right vertebral artery to compensate for the subclavian steal syndrome in the right subclavian artery.To improve the symptoms,we placed an Express LD (8 mm × 37 mm) balloon expanding stent in the stenosis section.After the operation,the patient’s dizziness significantly improved.However,after 6 mo,the patient was re-admitted to the hospital due to dizziness.A computed tomography scan of the head revealed multiple cerebral infarctions in bilateral basal ganglia and the right lateral ventricle.An auxiliary examination including computerized tomography angiography of the vessels of the head and cerebral angiography both showed severe stenosis in the brachiocephalic artery stent.During the operation,the guidewire and catheter were matched to reach the opening of the brachiocephalic artery.Therefore,we decided to use a right carotid artery approach to complete the operation.We sutured the neck puncture point with a vascular stapler and then ended the operation.After the operation,the patient recovered well,his symptoms related to dizziness disappeared,and his right radial artery pulsation could be detected.CONCLUSION In patients with brachial artery stenosis,when the femoral artery approach is difficult,the carotid artery is an unconventional but safe and effective approach.At the same time,the use of vascular suturing devices to suture a carotid puncture point is also commendable.Although it is beyond the published scope of the application,when used cautiously,it can effectively avoid cerebral ischemia caused by prolonged artificial compression,and improper suturing can lead to stenosis of the puncture site and improper blood pressure,resulting in the formation of a hematoma.Finally,satisfactory hemostasis can be achieved.展开更多
文摘Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.
文摘BACKGROUND As the population ages and people’s living standards gradually improve,the incidence of cerebrovascular disease in China is increasing annually,posing a serious threat to people’s health.The incidence of brachiocephalic artery stenosis in ischemic cerebrovascular disease is relatively low,accounting for 0.5% to 2% of patients,but its consequences are very serious.Herein,we report a case of brachiocephalic artery stenting through the carotid artery.CASE SUMMARY The patient was a 66-year-old man.He came to our hospital because of repeated dizziness and was diagnosed with ischemic cerebrovascular disease (stenosis at the beginning of the brachiocephalic artery).Cerebral angiography suggested that the stenosis of the brachiocephalic artery had almost occluded it.Contrast agent threaded a line through the stenosis,and there was reversed blood flow through the right vertebral artery to compensate for the subclavian steal syndrome in the right subclavian artery.To improve the symptoms,we placed an Express LD (8 mm × 37 mm) balloon expanding stent in the stenosis section.After the operation,the patient’s dizziness significantly improved.However,after 6 mo,the patient was re-admitted to the hospital due to dizziness.A computed tomography scan of the head revealed multiple cerebral infarctions in bilateral basal ganglia and the right lateral ventricle.An auxiliary examination including computerized tomography angiography of the vessels of the head and cerebral angiography both showed severe stenosis in the brachiocephalic artery stent.During the operation,the guidewire and catheter were matched to reach the opening of the brachiocephalic artery.Therefore,we decided to use a right carotid artery approach to complete the operation.We sutured the neck puncture point with a vascular stapler and then ended the operation.After the operation,the patient recovered well,his symptoms related to dizziness disappeared,and his right radial artery pulsation could be detected.CONCLUSION In patients with brachial artery stenosis,when the femoral artery approach is difficult,the carotid artery is an unconventional but safe and effective approach.At the same time,the use of vascular suturing devices to suture a carotid puncture point is also commendable.Although it is beyond the published scope of the application,when used cautiously,it can effectively avoid cerebral ischemia caused by prolonged artificial compression,and improper suturing can lead to stenosis of the puncture site and improper blood pressure,resulting in the formation of a hematoma.Finally,satisfactory hemostasis can be achieved.
