γFⅦa for the treatment of intraoperaflve bleedings in abdominal surgery

Objective To investigate the efficacy of recombinant activated factor Ⅶ (γFⅦa)in the management or prevention of intraoporative bleeding in general surgery. Methods A retrospective analysis was made to investigate the effect of FⅦa in 56 surgical cases.There were 56 cases including 53 hepatobiliary cases,3 gastrointestinal surgical cflses.γFⅦa was used intraoperatively when bleeding was difficult to control in 12 patients,and in 30 liver transplant cases before a skin incision was made.γFⅦa was used in the other 14 cases postoperatively to control intraabdominal bleeding. Results Massive bleeding stopped in 11 out of 12 cases who used γFⅦa during the operation as a rescue regimen,though two of them eventually died intraoperatively for deteriorating hemedynamics,one died of intraoperative intractable bleeding in spite of the Use of γFⅦa.All the 30 liver transplant cases used γFⅦa in the prevention of intraoperative bleeding had a successful surgery.After γFⅦa was administered in 11 out of the 14 cases of postoperative bleeding,the drainage decreased by 50%.In 3 cases γFⅦa failed and hemodynamic and vital signs were still unstable.In brief,γFⅦa were safely used in bleeding control or prophylaxis.Its Successful rate reached 89% in 56 patients.No thrombus complication was found. Conclusion γFⅦ a controls perioperative hemorrhage complications.     

Resection and reconstruction of the inferior vena cava for neoplasms

AIM: To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS: The approach to caval resection depends on the extent and location of tumor involvement. The supraand infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS: The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION: There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.     

Laparoscopic liver resection for hepatocellular adenoma

AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.     

半肝血流阻断技术用于肝硬化肝癌的肝切除

Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.     

Clinical study of a new approach to thoracolumbar surgery

Objective： The conventional approaches for treatment of thoracolumbar diseases require extensive surgical exposure, often leading to postoperative pain and morbidity. Thoracoscopic-assisted surgery in these regions usually requires an extended recovery period due to the placement of drainage. We developed an innovative retroperitoneal-extrapleural approach to thoracolumbar involvement by an extra-diaphragmatic technique using dedicated instruments. Neither incision nor reconstruction of the diaphragm was necessary. Exposure to the lateral part of the thoracolumbar vertebrae could be achieved without crus resection. This study is aimed to evaluate the clinical outcomes of this new surgical procedure.
Methods： A total of 9 cases （5 cases of thoracolumbar fracture-dislocation, 1 each of spinal infection, tumor, thoracolumbar scoliosis and ossification of posterior longitudinal ligament） were subjected to the study. The average age of the patients was 52.3 years. The results were compared with the control group consisting of thoracoscopic surgery subgroup （5 patients, mean age 52.1 years） and conventional surgery subgroup （12 patients, mean age 61.3 years）.
Results： Compared with the control group, the average period of bed confinement and mean intra- and postoperative blood loss decreased significantly. Pulmonary complications were avoided in all cases. The surgical time was shortened, postoperative pain was reduced, and early postoperative ambulation became possible. Conclusion： The diaphragm-preserving retroperitoneal-extrapleural approach that we developed is a valid minimally invasive alternative for the treatment of thoracolumbar diseases.     

半肝血流阻断技术用于肝硬化肝癌的肝切除

Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.     

The effect of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery北大核心CSCD

Objective To observe the effect of insertion of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery for atlantoaxial subluxation or instability. Methods The data of 52 patients with atlantoaxial dislocation or instability were analyzed who had been treated by internal fixation with in-out-in pedicle screws in the posterior occipitocervical surgery from January 2015 to February 2021 at Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital. There were 30 males and 22 females, aged from 17 to 65 years (mean, 41.2 years). There were 26 cases of unilateral vertebral artery high-riding, 3 cases of bilateral high-riding, 19 cases of unilateral narrow pedicle due to C2 and C3 fusion, and 4 cases of bilateral narrow pedicles. X-ray, CTA and MRI were performed before and 3 days after surgery. The patients' clinical symptoms were recorded. CTA was used to measure the diameter of the vertebral artery at the transverse foramina of C2 and C3 and to observe the effect of in-out-in screws on the morphology of the vertebral artery. X-ray and CT examinations were performed at 6 months after surgery to observe the bone fusion. Results The surgery went on uneventfully in all the patients. In the 9 cases undergoing anterior and posterior surgery, the operation time averaged 271.2 min (from 213 to 352 min) and the bleeding volume 471.5 mL (from 230 to 830 mL). In the 43 cases undergoing posterior surgery, the operation time averaged 171.6 min (from 131 to 226 min) and the bleeding volume 395.9 mL (from 170 to 660 mL). There was no such complication as spinal or vascular injury. The CTA reexamination 3 days after surgery showed that the diameter of the vertebral artery was (2.92±0.55) mm and (3.04±0.54) mm, respectively at the cervical 2 and 3 transverse foramina, showing no significant change compared with the preoperative values [(2.91±0.68) mm and (3.11±0.50) mm] (P>0.05) and that the vertebral artery was displaced externally and inferiorly in 21 cases. Follow-ups for all patients ranged from 7 to 24 months (mean, 11 months). At 6 months after surgery, bone fusion was observed by imaging and no breakage or displacement of the internal fixation was observed. Conclusion The in-out-in pedicle screws in the posterior occipitocervical surgery may have little impact on the vertebral artery, leading to reliable clinical outcomes. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

Unstable mallet fractures: a comparison between three different techniques in a multicenter study

Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures： Kirschner wire fixation with extension block pinning （EBP） of the distal interphalangeal joint, Kirschner wires used as joysticks （KWJ） and interfragmentary miniscrews for open reduction and internal fixation （ORIF）.
Methods： Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old （average 42 years） were operated upon by EBP, 16 patients 22 to 56 years old （average 56 years） were operated upon using KWJ and 22 patients 22 to 54 years old （average 36 years） received OR/F. Follow-up time was 6 to 58 months （average 21 months）. The following intraoperative parameters were considered： intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion （ROM） test with a goniometer. Based on these measurements, a functional Crawford score was established.
Results： All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider （72° vs 58° and 54 °）; in the ORIF group, return to work was faster （2.7 weeks vs 7.2 weeks and 6 weeks） but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar.
Conclusions： We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding （longer intraoperative time and more complications） but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.     

手助腹腔镜与开腹脾切除、贲门周围血管离断术的临床分析

Objective To investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. Results There was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. Conclusions Compared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.     

Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury

Purpose:To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury.Methods:Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed.All the injuries have been confirmed by intraoperative exploration,computed tomography angiography or digital subtraction angiography.Complete or partial amputation injuries were excluded.Mild artery defect or partial intimal damage was treated by interventional implantation,while other patients received open surgeries,including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm.Patients were divided into open surgery group and stent implantation group based on the treatment they received.Patients were followed up at 2 weeks(first stage)and 6 months(second stage)after operation to investigate limb salvage.Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage.Results:Altogether 50 cases of subclavian artery injury were treated,including 36 cases of open surgery and 14 cases of stent implantation.Combination of nerve injury was observed in 27 cases(75.0%)in open surgery group and 12 cases(85.7%)in stent implantation group.Amputation developed in 3 cases with open surgery and 1 case with stent implantation.Consequently the rate of successful limb salvage was respectively 91.7%(33/36)and 92.9%(13/14),revealing no significant difference(p>0.05).Conclusion:Rapid reconstruction of blood circulation is crucial following subclavian artery injury,no matter what kinds of treatment strategies have been adopted.Interventional stent implantation can achieve a good effect for limb salvage.     

Severe hepatic trauma：surgical strategies

Objective:To probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury.Methods:A retrospective study involving 113 patients with severe hepatic trauma(AAST grade IV and V) during the past 12 years was carried out.Ninety-eight patients underwent surgical treatment.Surgical interventions including hepatectomy or direct control of bleeding vessels by finger fracture technique with Pringle maneuver, selective ligation of hepatic artery,retrohepatic caval repair with total hepatic vascular occlusion,and perihepatic packing were mainly used.Results:In the 98 patients treated operatively,the survival rate was 69.4%(68/98).Among 40 patients with juxtahepatic venous injury(JHVI),15 were cured with the maximum blood transfusion of 12 000 ml.Eight cases of Grade IV injury treated nonoperatively were cured.The percentage of failure of nonoperative management was 42.9%(6/14).The overall mortality rate was 32.7%(37/113),and 57% of the deaths were due to exsanguinations.Conclusions:Reasonable surgical procedures based on classification of hepatic injuries can increase the survival rate of severe liver trauma.Accurate perlihepatic packing is effective in dealing with JHVI.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

Results of the open surgery after endoscopic basket impaction during ERCP procedure

AIM:To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography(ERCP) procedure.METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients.These patients were immediately operated for removal of stone(s) and impacted basket.The postoperative course,length of hospital stay,diameter of the stone,complication and the surgical procedure of the patients were reported retrospectively.RESULTS: Six patients(M/F,0/6) were operated due to impacted basket during ERCP procedure.The mean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediately after the failed ERCP procedure by making a rightsubcostal incision.The baskets containing the stone were removed through longitudinal choledochotomy with the stone.The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients.All patients were also performed cholecystectomy additionally since they had cholelithiasis.In patients with T-tube placement it was removed on the 13 th day after a normal T-tube cholangiogram.The patients remained stable at postoperative period and discharged without any complication at median 7 d.CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.     

Emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture北大核心CSCD

Objective To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture. Methods The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up. Results The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time (P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons (P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups (P>0.05). Conclusion Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures

Purpose: Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures. Methods: This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure 90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test. Results: The patients’ average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05).After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67). Conclusions: Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

A reliable auditing of postop complication in gastric cancer surgery

Background Auditing of surgical outcome is controversial due to lack of standard auditing system. POSSUM （ Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality） system provides a risk adjusted auditing in surgical practice, which is a reliable scoring system. However it has not been generalized in China, especially in gastric surgery. Present study evaluates the application of POSSUM system to compare surgical outcome of malignant gastric disease between specialized unit and general unit. Methods Retrospective study was performed on 394 patients who underwent surgical intervention for gastric cancer and malignant gastric lymphoma. POSSUM data were collected according to standard criteria described by its original authors. Exponential analysis method was used for data analysis. Observed to Expected morbidity （O：E） ratio was calculated for each unit to give risk adjusted comparison. All the complications were categorized into minor to severe to give an objective view of complications. Results There was significant difference in surgical outcome between specialized unit and general unit. POSSUM predicted morbidity well and O： E ratio of specialized unit was better than general unit. Further more postop stay was significantly shorter（P 〈0. 001 ） in specialized unit and number of moderate and severe morbidity was significantly lower （ P 〈 0.001 ） than general unit. Conclusions Surgical outcome of specialized unit was better than general unit. POSSUM can be used for risk adjusted auditing of postop complications in malignant gastric disease, which provides a reliable audit. However morbidity definition in POSSUM should be amended and modification in POSSUM formula may be necessary to fit major surgical interventions like gastric cancer surgery.     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.