Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.
Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
目的 探讨经皮经肝穿刺胆道引流术（PTCD）联合胆道支架置入术治疗恶性梗阻性黄疸的操作技巧及其临床应用价值。方法 2009年8月至2011年5月期间中国医科大学附属第四医院介入科对39例恶性梗阻性黄疸患者施行了PTCD联合胆道支架置入术，对其临床资料和效果进行回顾性分析。结果 39例患者全部穿刺成功，穿刺成功率为100％。穿刺左叶胆管11例，穿刺右叶胆管19例，左右胆管均行穿刺9例；单纯外引流22例，内外引流17例；引流管保留7～14d后均成功行胆道支架置入术。 33例患者自觉症状有缓解。患者术后14d时，其白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素水平均较术前降低（P＜0.05）。术后发生胆道感染3例（7.69％），发生急性胰腺炎4例（10.26％），发生支架脱落移位1例（2.56％），无胆汁性腹膜炎等并发症发生。本组32例患者获访，随访时间为8d～16.5个月，平均9.4个月。随访期间，27例患者死于肿瘤进展及多脏器功能衰竭；5例患者存活，无黄疸加重症状。结论 PTCD联合胆道支架置入术是一种姑息治疗恶性梗阻性黄疸的有效方法，具有简便、有效、安全、可重复性等优点，但需注意其适应证的选择和并发症的预防。
Objective To explore primary surgical treatment experience of typeⅣ hilar cholangiocarcinoma. Methods From April 2008 to April 2011，20 patients with type Ⅳ hilar cholangiocarcinoma were enrolled into the same surgical group in Department of Hepatobiliary and Pancreatic Surgery of West China Hospital of Sichuan University.The intra- and post-operative results were analyzed.Results The total resection rate was 75%，which was consisted of 10 cases of radical excision and 5 cases of non-radical excision.Seven patients received left hepatic trisegmentectomy and caudate lobe resection including anterior and posterior right hepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy.Six patients received enlarged left hepatic trisegmentectomy and caudate lobe resection including left intrahepatic and extrahepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy. Two patients received quadrate lobe resection including two cholangioenterostomies after anterior and posterior right hepatic duct reconstruction，and left intrahepatic and extrahepatic duct reconstruction.After percutaneous transhepatic cholangial drainage （PTCD） and portal vein embolization （PVE），two patients with total bilirubins ＞400 mmol/L received radical excision and non-radical excision，respectively.Three patients only received PTCD during operation due to wide liver and distant metastasis，and two patients received T tube drainage during operation and postoperative PTCD due to left and right portal vein involvement. All 15 patients who received lesion resection survived more than one year， whereas another five patients whose lesions can not been resec ted only survived from 3 to 6 months with the mean of 4.2 months.No death occurred during the perioperative period. Conclusions For patients with type Ⅳ hilar cholangiocarcinoma， preoperative evaluation and tumor resection shall conducted so as to relieve obstruction of biliary tract，otherwise PTCD and PVE prior to the final lesion resection shall be performed.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.
目的 总结分析普通B超监测引导PTCD方法改进后的优点及经验。方法 用普通B型超声诊断仪，腹部扇扫探头和国产配套的专用PTCD套针及引流管，改进监测引导PTCD的方法，总结分析其方法的优越性。结果 95例梗阻性黄疸患者PTCD成功率为100%，引流效果良好，并发症发生率为零。结论 用改进普通B超监测引导的方法进行PTCD，能克服在X线下进行PTCD的盲目性，对碘过敏者无禁忌，避免了长时间X线对人体的伤害。同时具有定位准确、费时少、成功率高、并发症少、价格便宜、适宜在基层医院推广应用等优点。