Objective To systematic evaluate the efficacy and safety of the endovascular aortic repair （endovascular stent placement） and open operation in treatment of acute Stanford type B aortic dissection. Methods The literatures about clinical controlled trials of endovascular aortic repair and open operation in treatment of acute Stanford type B aortic dissection that were included in CNKI， Wanfang data， VIP， Cochrane Central Register of Controlled Trials of the Cochrane Library， OVID， Pubmed Medline， EBSCO， EMBASE， Springer Link，Science Direct， and other databases from January 1991 to January 2013 were retrieved by computer. RevMan 5.1 software were used to analyze the clinical trial data. Results Eight trials （5 618 patients with acute Stanford type B aortic dissection） were included in the analysis.There was statistically significant difference of the 30 d mortality after operation between the endovascular repair group and the open operation group， which endovascular repair group was significantly better than the open operation group〔OR=0.55，95% CI （0.46-0.65）， P＜0.000 01〕. In addition， there were significant difference between the incidence of stroke 〔OR=0.57， 95% CI （0.39-0.84）， P=0.005〕， respiratory failure 〔OR=0.64， 95% CI （0.53-0.78）， P＜0.000 01〕， and cardiac complications 〔OR=0.49，95% CI （0.38-0.64），P＜0.000 01〕，which endovascular repair group was better than the open operation group. However，endovascular repair could not improve the postoperative outcomes of paraplegia〔OR=1.30，95% CI （0.82-2.05），P=0.26〕 and acute renal failure 〔OR=0.86，95% CI （0.41-1.80），P=0.69〕. Conclusion Endovascular repair for treatment acute Stanford type B aortic dissection is preferred method.
Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.
ObjectiveTo retrospective summarize the experience of endovascular repair and open surgery in the treatment of renal aneurysms in our single center.MethodsClinical data of 24 patients with renal aneurysm treated in our hospital from August 2012 to May 2018 were analyzed retrospectively. Nine patients undergoing surgical intervention were categorized as the open operation group, and ten patients who received endovascular repair were classified as the endovascular repair group. To compare and analyze the results of the two groups. Five patients who had refused surgery therapy will be analyzed separately.ResultsTwenty-four patients with seventeen females (70.8%) and seven males (29.2%) were enrolled in this study and nineteen patients with twenty-three aneurysms got repaired successfully. The endovascular repair group had shorter hospital stay compared with the open operation group [median: 10.5 (P25 6.3, P75 15.0) d vs. 21.0 (P25 17.0, P75 27.5) d］. One patient in the open operation group developed renal artery stenosis at 11 months after surgery and underwent reoperation by repair by successful stent placement. There were no other significant postoperative complications occurred in the two groups. No abnormal enlargement or rupture of the aneurysms were observed during the follow-up period in 5 unoperated patients.ConclusionsBoth open surgery and endovascular repair are effective means of treating renal artery aneurysms. Once the renal aneurysm ruptures, serious consequences will occur. Once a renal aneurysm is diagnosed, regardless of the size of the aneurysm, active surgical treatment is recommend.
Objective To discuss the differences of the effects on open colorectal cancer operation between using ultracision harmonic scalpel (UHS) and monopolar electrosurgery. Methods Fifty-nine patients from April to December in 2007, suffering colorectal cancer in the same treatment group, underwent open radical operation, 29 by GEN300 UHS (UHS group) and 30 by monopolar electrosurgery as control group. There was no significant difference between two groups among the factors of age, gender, tumor location, Dukes staging, gross morphology and degree of histological differentiation (Pgt;0.05). Results Shorter incision was applied in UHS group than in the control group. The mean operation time of UHS group and control group were 126 and 119 min, respectively (Pgt;0.05). The mean operative blood loss was 50 (20-140) ml in UHS group and 90 (40-200) ml in control group (Pgt;0.05). There were no significant differences among factors of bowel function recovery, mean hospitalization and incidence of complications between two groups (Pgt;0.05). The mean time for postoperative drainage fluid changing from bloody to serous was 8 (2-20) h in UHS group, however, 48 (16-80) h in control group (Plt;0.05). Conclusion In open colorectal cancer operation, benefits of using UHS are shorter incision and minimally invasiveness.
Objective To compare microendoscopic discectomy (MED) with open discectomy (OD) for degenerative lumbar spinal stenosis in terms of cl inical outcomes, and provide experience and therapeutic evidence for cl inical appl ication.Methods From May 2002 to October 2007, 215 patients with lumbar spinal stenosis were randomized into two groups, and underwent either MED or OD. In group A, 105 patients underwent MED, including 56 males and 49 females aged 34 to 83 years old (average 45 years old); the duration of the disease ranged from 9 months to 26 years (average 50 months); the spinal stenosis involved one segment in 76 cases, two segments in 27 cases, and three segments in 2 cases. In group B, 110 patients received OD, including 57 males and 53 females aged 35 to 85 years old (average 47 years old); the duration of the disease ranged from 8 months to 25 years (average 48 months); the spinal stenosis involved one segment in 78 cases, two segments in 29 cases, and three segments in 3 cases. No significant difference was evident between two groups in terms of the general information(P gt; 0.05). Results Operation was successfully performed in all cases. Volume of intraoperative blood loss was (82.14 ± 6.18) mL in group A and (149.24 ± 11.17) mL in group B. Length of hospital stay was (7.0 ± 2.1) days in group A and (12.0 ± 2.6) days in group B. Significant difference was noted between two groups in terms of the above parameters (P lt; 0.01). All the wounds healed by first intention. The patients were followed up for 13-54 months (average 27 months) in group A and 12-55 months (average29 months) in group B. Four patients in each group suffered from spinal dural rupture during operation and recovered after corresponding treatment. Three patients in group B had lumbar instabil ity 3 years after operation and recovered using lumbar interbody fusion combined with general spine system internal fixation. No such compl ications as wrong orientation, nerve root injury, cauda equina injury and infection occurred in each group, and radiology exam showed no relapse. Therapeutic effect was evaluated by Nakai standard, 52 cases in group A were graded as excellent, 45 as good, 7 as fair, 1 as poor, and the excellent and good rate was 92.4%; 53 cases in group B were graded as excellent, 48 as good, 8 as fair, 1 as poor, and the excellent and good rate was 91.8%; there was no significant difference between two groups (P gt; 0.05). Conclusion Two methods have the similar therapeutic effect, but MED el iminates the shortcomings of traditional OD, so it is one of ideal minimally invasive operative approaches for degenerative lumbar spinal stenosis.
Objective To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach. Methods The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively. Results Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles. Conclusion Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.
Objective To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery. Methods A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference (P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed. Results All patients completed the surgery successfully, with no significant difference in surgical time between the two groups (P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences (P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant (P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery (P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups (P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups (P>0.05). Conclusion Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.
Objective To compare the effectiveness, complications, and follow-up results between endovascular recanalization (EVR) and open surgical revascularization (OSR) in the treatment of peripheral pseudoaneurysm, so as to provide a reference for choosing a appropriate surgical procedure. Methods Clinical data of 62 cases of peripheral pseudoaneurysm between January 2001 and January 2012 were analyzed retrospectively. EVR was performed in 28 patients (EVR group) and OSR in 34 patients (OSR group). There was no significant difference in gender, age, cause of injury, tumor location, and diameter of tumor between 2 groups (P gt; 0.05). Results The operation time, blood loss, ICU monitoring time, and hospitalization time in EVR group were significantly shorter than those in OSR group (P lt; 0.05). In OSR group, 12 cases (35.29%) had early postoperative complications, including 2 deaths due to acute respiratory distress syndrome, 5 cases of pulmonary infection, 3 cases of wound infection, and 2 cases of deep vein thrombosis; in EVR group, 2 cases (7.14%) had early postoperative complications, including 1 case of hematoma at puncture site and 1 case of thrombosis in stent. There was significant difference in early postoperative complication incidence between 2 groups (χ2=6.691, P=0.008). The patients were followed up 12-39 months (mean, 26 months). In OSR and EVR groups after operation, the patency rates of the reconstructed vessels were 96.88% (31/32) and 92.86% (26/28) respectively at 12 months, showing no significant difference (χ2=0.014, P=0.905); the patency rates were 89.29% (25/28) and 84.00% (21/25) respectively at 24 months, showing no significant difference (χ2=0.322, P=0.570). Conclusion Compared with OSR, EVR is a minimally invasive, safe, and effective therapy for peripheral pseudoaneurysm with the advantages of less bleeding, shorter hospitalization time, and less complications. Long-term effectiveness still needs further observation, and patients have to take antiplatelet drugs for long time after EVR.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.