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Objective To investigate the feasibility and clinical significance of membrane anatomy theory in the application of thoracoscopic and laparoscopic radical esophageal resection.Methods A retrospective analysis was performed on 142 cases of thoracoscopic and laparoscopic radical esophagectomy based on membrane anatomy theory from December 2018 to October 2021.The esophageal mesangium,esophageal cancer,and nerves,blood vessels,lymphatic system,adipose tissue,upper stomach,left mesangium,and left gastric lymph nodes in the esophageal mesangium were removed as a whole.During the surgery,the space containing loose connective tissue around the esophagus was seen to be the esophageal fascial fusion space.The first 10 cases were labeled with nanocarbon tracer markers,showing esophageal lymphatic drainage to the left gastric lymph node.Results All the 142 patients had smooth surgery.The operation time was 150-230 min(mean,184.6±21.3 min),the intraoperative blood loss was 20-100 ml(mean,46.7±16.8 ml),the number of lymph nodes dissected was 12-41(mean,23.5±7.3),and the positive lymph nodes were found in 97 cases.The postoperative chest drainage time was3-10 d(mean,7.1±2.5 d),the postoperative oral intake time was 5-10 d(mean,7.6±1.7 d),and the total hospital stay was 9-20 d(mean,14.0±4.6 d).The total incidence of postoperative complications was 21.8%(31/142),including 7 cases(4.9%)of anastomotic leakage,9 cases(6.3%)of anastomotic stenosis,9 cases(6.3%)of hoarseness,and6 cases(4.2%)of residual gastritis.There was no postoperative bleeding,chyllevial leakage,infection,or death within 30 d after surgery.The follow-ups of the 142 patients lasted for 11-35 months,with a median of 26 months,and there was no recurrence and death.Conclusions There is a mesangial structure that constitutes an"envelope"around the esophagus.The membrane anatomy theory is suitable for the treatment of esophageal cancer,and radical resection of esophageal cancer based on the theory is safe,effective,and feasible.
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Objective:To investigate the morphological and hemodynamic stress characteristics of infundibular dilatation of the posterior communicating artery.Methods:From January 2018 to May 2020, 30 patients with infundibular dilatation of the posterior communicating artery (observation group) found by digital substraction angiography (DSA) for suspecting as having equivocal posterior communicating artery aneurysm in our hospital were selected. The angle between posterior communicating artery and internal carotid artery, and hemodynamics stress parameters at the infundibular dilatation of the posterior communicating artery (total pressure and shear force) were measured by DSA and quantitatively analyzed by computational fluid dynamics methods. Thirty patients without intracranial aneurysm and with normal posterior communicating arteries admitted to our hospital at the same period were used as control group.Results:The mean value of the bending angle between the posterior communicating artery and internal carotid artery in the control group was ([80.1±8.4]°), which was significantly higher than that in the observation group ([73.2±5.8]°, P<0.05). The shear force and total pressure of infundibular dilatation of the posterior communicating artery of the observation group ([8.32±0.70] Pa and [85.61±6.04] Pa), which were significantly higher than those of the control group at the same locations ([3.95±0.28] Pa and [25.72±7.18] Pa, P<0.05). Conclusion:There are significant differences in hemodynamic stress between the normal posterior communicating artery and the infundibular dilatation of the posterior communicating artery, which might play an important role in triggering the formation of aneurysms.
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Hemodynamics is a discipline that studies the effects of blood flow,blood flow volume and other factors on the arterial wall.Intracranial aneurysm is the main cause of death due to non-traumatic subarachnoid hemonhage,which has brought a heavy burden on society.Therefore,it is very important to make an intensive study of the pathogenesis of aneurysm.With the development of medical imaging technology and fluid mechanics software in recent years,it becomes possible to make the precise and scientific studies of the hemodynamics of intracranial aneurysms.In this paper,the hemodynamic factors inducing the formation of intracranial aneurysm that are proposed by medical experts at home and abroad are reviewed,and the hemodynamic mechanism is discussed.
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Objective To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents.Methods A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils.and 41(28.9%)of 142 patients with aneurysms in the intemal carotid artery had a recurrent aneurysm during the follow-up period.For this study,31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils(group A,n=20)or covered stents(group B.n=11)were analysed.Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery,improvement,no change or deterioration via clinical assessment.Data regarding technical success,initial and final angiographic results,final clinical outcome were collected and analysed postoperatively.Results Coil embolisation and covered stent placement.were technically successful in all recurrent aneurysms.The initial angiographic results showed complete occlusion in 11 patients(55%)in group A and in eight(72.7%)in group B(P=0.452),and the final angiographic results exhibited complete occlusion in 10 patients(50%)in group A and in 11(100%)in group B(P=0.005).There were no significant differences in technique success or final clinical outcome between the two groups.Conclusions Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement.However,covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.
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Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.
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Objective To evaluate the mid- and long-term radiological outcomes of cerebral aneurysms with GDCs embolization.Methods One hundred and sixty-two patients with 173 aneurysms embolized with GDCs underwent angiographic follow-up from 1 to 54 months post-operatively and were retrospectively reviewed. Three neuro-radiologists reviewed each angiogram and made a comparison between initial and follow-up angiograms. Morphological outcomes were evaluated as follows: unchanged; progressive thrombosis; and re-opening or re-growth. Results Of 173 aneurysms with GDC embolization, 142 aneutysms had total or nearly total occlusion, 23 subtotal occlusion and 8 partial occlusion shown on initial angiograms. The incidence of re-opening was 17.1% (13/76) in less than 3 months, and 6.2% (6/97) between 3 and 6 months postoperatively. Four aneurysms showed recurrency(2.3%) on second follow-up angiography in one year after procedure and one-year cumulative recurrent rate was 13.3% of 56 aneurysms with the third follow-up angiography in the post-operation period of 12 to 54 months, four showed a little enlargement and the cmnulative recurrent rate so far was 20.2% (35/173). Conclusions The direct and main causes for aneurysmal recurrence are incomplete and loosening packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier after the procedure, especially in aneurysms with initial incomplete occlusion. Re-treatment with balloon- or stent-assisted coil embolization is recommended in re-opening aneurysms. (J Intervent Radiol,2005,14:472-479)
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Objective Acute ischemic cerebral stroke is mainly caused by acute thrombi obstructing cerebral arteries, accounting for 50%-60% of acute cerebral vascular diseases, and is the most common cause of mortality and morbidity. The advancements of medical imaging and neuro-interventional technology, intraarterial thrombolysis have become the main therapeutic managements for acute cerebral arterial thrombosis. The authors also reviewed many issues in relation to the technique of intra-arterial thrmbolysis for acute cerebral thrombi.
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Arterial embolization of thyroid gland is a new way to treat Graves' disease. However, there exist some problems about this treatment and no normalized procedure techniques have been stated. The authors reviewed many research papers with regards to the current status of this treatment and its existing problems.
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Although the technologic development of interventinal neuroradiology is surprisingly fast,there still remain some kinds of intracranial aneurysms which cannot be completely obliterated from blood circulation.The advent of Onyx makes complete occlusion of many kinds of intracranial aneurysms possible including giant and irregular aneurysms.This paper reviews the use of Onyx in treating intracranial aneurysms with the advantages and disadvantages.