Objective To explore micro-trauma and hig h effective method in treating arterial and venous obstruction diseases. Methods Seven patients with lower limbs arterial sclerosis obstruction (ASO) and 33 patients with deep vein thrombosis (DVT) had been treated by ultrasound thrombus ablation. The short-term curative effects were observed. Results All patients achieved vessels recanalization without puncture. Arterial straightness of seven ASO cases was reduced from 93%?12% to 35%?6%. While observing from angiogram, their symptoms and signs ameliorated remarkably. Venous straightness in thirty-three DVT patients was reduced from 100% to 28%?8% by observing from angiogram and disappearance of their limb tumidness. Conclusions Ultrasound thrombus ablation is an effective , safe and micro-trauma method for arterials and venous obstructive diseases.

50% of the diameter in 5(after receiving balloon dilation for vascular stenosis).In one patient,the opening of the left common iliac vein was still obstructed.Follow-up was achieved for 2 to 70 months(mean,34)in the patients,during which the symptoms and signs disappeared in 21 patients.In 3 cases,the perimeter of the disease limb was thicker than the opposite one by 0.5 to 1.0 cm.The situation was improved by conservative therapies.The patient who had obstructive left common iliac vein after the treatment,still complained of swelling of the limbs.Conclusions Multiple interventional methods can remarkably improve the therapeutic effectiveness for DVT caused by military training injuries.

To look for a novel micro traumatic and highly effective method to treat arterial and venous occlusive diseases, ultrasonic thrombus ablation technique was applied in 7 cases of arterio sclerosis obstruction (ASO) of the lower limbs and 15 cases of deep vein thrombosis (DVT) of the lower limbs. The indications, precautions during the operation, and postoperative treatment were summarized. Recanalization of the vessels was achieved in all the patients without perforation. Angiographic examination showed that the stricture of arteries of the patients with ASO was reduced from (93?12)% to (12?6)%, and their symptoms were remarkably ameliorated. In 15 DVT patient, venous occlusion was reduced from 100% to (8?2)% on angiogram, and edema of their limbs subsided. We consider ultrasonic thrombus ablation is an effective, safe, and minimally traumatic treatment modality for arterial and venous occlusive diseases.

Objective To review the experience in managing severe major jugular vascular injuries. Methods Fifteen cases (11 men and 4 women, aged 18～49 years) treated by operation were collected. The injuried vessels included common carotid artery, internal carotid artery, subclavian artery and accompanying veins, carotid reconstruction was performed by jugular vein transplantation and followed by wrapping with PTFE artificial blood vessel in 15 cases. Result All the fifteen patients were cured and the vasculars were well-functioning 3～12 weeks after the surgery. Conclusion The mortality of severe large cervical vascular injuries is very high because of acute bleeding, cerebral ischimia and suffocation. In managing this catastrophe, keeping the airway clear and stop bleeding effectively are fundamental. Good knowledge and expertise in vascular and microvascular surgery are mandatory for the success of the procedure.

Objective　To study the diagnosis, treatment and prognosis of hepatolithiasis combined with cholangiocarcinoma. Methods　The clinical, pathological and follow-up data of 17 cases of hepatolithiasis combined with cholangiocarcinoma were retrospectively analysed. Results　The results showed that the incidence of cholangiocarcinoma in hepatolithiasis was 5% in this series. 17.6% of the patients were diagnosed as cholangiocarcinoma preoperatively. Tumor occurring in intrahepatic ducts was 88.2% and in hepatic porta ducts 11.8%. Nine cases were well-differentiated adenocarcinomas. Only 7(41.2%) cases were radically resected and their average survival time was 26.0 months. Eight(47.1%) patients underwent internal drainage with average survival time 12.4 months. 2(11.7%) cases subject to external drainage with survival time 3.6 months. Conclusions　If patients with hepatolithiasis have a long history of recurrent cholangitis, weight-loss in a short period, progressive jaundice or intractable abdominal pain, the possiblility of combined with cholangiocarcinoma should be considered. Resection of the tumor has a better prognosis than that of tumor unresected; and the prognosis of internal drainage is better than that of external drainage.

Objective To evaluate the result of staged arteriovenous shunts for the treatment of thromboangiitis obliterans(TAO) and arterial sclerosis obstruction (ASO). MethodsData of 176 cases undergoing this procedure were retrospectively reviewed. ResultsIn this group, 147 cases (83 5%) were followed up with a median of 9 8 years. Pain and/or claudication disappeared in 86 out of 90 cases (95 5%) treated by low positioned shunt one week postoperatively, with a limb salvage rate of 100%. Among 57 cases treated by high positioned shunts of the lower limbs, pain and claudication disappeared in 43 cases (75 4%) 2~3 weeks postoperatively. Postoperative amputation has to be performed in 5 cases with a limb salvation rate of 91%. ConclusionsThe clinical result of this staged arteriovenous shunts is satisfactory for the treatment of thromboangiitis obliterans(TAO) and arterial sclerosis obstruction (ASO).

Objective To evaluate the effect of combined multiple interventional methods in treatment of acute deep venous thrombi (DVT) in lower extremities caused by military training. Meth-ods All 25 patients with DVT were treated with embolectomy by using Fogarty catheter. Of all, three pa-tients were treated only with embolectomy, six underwent embolectomy plus percutaneous transluminal an-gioplasty (PTA), 11 received PTA plus ultrasound ablation and five were implanted with stent-grafts. The clinical results were analyzed retrospectively. Results Based on angiography during operation, the ob-structed iliofemoral vein received complete recanalization in 24 patients, with the perioperative luminal di-ameter ≥71%. Partial recanalization of the entrance of common iliac vein to inferior vena cava was failed in one patient. All 25 patients were followed up for an average 34 months after operation, which showed that 24 patients received satisfactory results with normal military training and that the other one with failed recanalization of vena iliaca still felt swelling pain in lower extremity after training. Conclusion Com-bined multiple interventional methods can remarkably improve the therapeutic effect for DVT caused by military training.

Objective In order to explore the effects of rehabilitation training and acupuncture on the neural function deficit and motor function in patients with ischemic streke.Methods Eighty patients with ischemic stroke were randomly divided into rehabilitation and acupuncture groups.According to different recovery stages,the rehabilitation group received purposeful rehabilitation training for 28 days while the acupuncture group received scalp needling combined with body acuptmcture.The neural deficit scores(NDS)and motor fimction comprehensive assessment(FCA) were evaluated at the recruitment(M_0),the 28~(th)(M_1)and 56~(th)(M_2)days after treatment.Results No significant difierences were found in the NDS and motor FCA between the rehabilitation and the acurluncture groups at the recruitment.The significant differences appeared at the 28~(th) and the 56~(th) days comparing with baseline assessments in each group.There was no significant difference in the changes of NDS and motor FCA between the two groups at 28~(th) day,however,the NDS and motor FCA in rehabilitation group revealed better outcome than the acupuncture group at the 56~(th) day.Conclusion The study indicated that both rehabilitation training and acupuncture could improve the neural function and enhance the motor function in patients with ischemic stroke.

Objective To explore the safety and feasibility of extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy in the treatment of esophageal carcinoma. Methods Clinical data of 125 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy (TLE) in West China Hospital of Sichuan University between May 2009 and December 2011 were retrospectively analyzed . Patients were divided into 2 groups: non-extensive mediastinal lymphadenectomy group (non-extensive group, n=53) and extensive mediastinal lymphadenectomy group (extensive group, n=72). Perioperative outcomes of these two groups were compared. Results No significant differences were found in the time of thoracic operation , length of intensive care unit stay and postoperative hospital stay , postoperative complication and the overall mortality between the two groups. Compared with non-extensive group , extensive group showed less blood loss during thoracic operation[(140.6±62.1) ml vs. (167.7±69.2) ml, P=0.023], more thoracic lymph nodes harvested (12.2 ±4.2 vs. 9.0 ±4.1, P<0.01). Seventeen patients (23.6%) in extensive group were found to have positive recurrent laryngeal nerve lymph nodes , which resulted in upstaging of TNM in 7 patients (9.7%). The incidence of recurrent laryngeal nerve palsy was higher in extensive group as compared to non-extensive group, but the difference was not statistically significant (6.9% vs. 1.9%, P=0.240). Conclusion Extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy is a feasible and safe procedure for esophageal carcinoma patients , which can increase the number of harvested lymph node and the accuracy of tumor staging.

Objective To investigate the clinical efficacy and learning curve of thoracoscopic and laparoscopic esophagectomy (TLE) in the treatment of esophageal carcinoma. Methods Clinical data of 350 consecutive patients with esophageal carcinoma undergoing TLE in the West China Hospital between February 2008 and October 2013 were retrospectively analyzed. Patients in the early stage (n=150) were chronologically and evenly divided into three groups, and perioperative outcomes were compared between the three groups in order to evaluate the learning curve. Results There were no intraoperative deaths. Intraoperative complications occurred in 29 (8.3%) patients. Thirteen (3.7%) cases were converted to open operation including 9 thoracotomy and 4 laparotomy. The mean operative time was 332.5 (range 230-780) min and the mean blood loss was 160.8 (range 15-4000) ml. The tumor free resection margins (R0) were completely in 333 (95.1%) cases. The mean lymph nodes harvested was 21.6(range 6-42). The average length of postoperative hospital stay was 11.6(range 7-93) d. Postoperative complications occurred in 75(21.4%) patients, and 3(0.8%) patients died within 30 days after surgery. Compared with TLE 1 group, TLE 2 group presented shorter operative time, less blood loss, shorter postoperative hospital stay, lower postoperative complication rate, and more lymph nodes harvested (all P<0.05). Only blood loss was less in TLE 3 group as compared to TLE 2 group, and other perioperative results were found to be of no statistical differences between the two groups. There was no significant difference in 30-day mortality between the three groups. Conclusions TLE is a technically feasible and safe procedure and provides comparable oncological outcomes with open esophagectomy, thus suggesting that TLE is an alternative approach in the treatment of esophageal carcinoma. A plateau of TLE skill can be reached after 50 surgical procedures.