Objective Pulmonary embolism is a common cardiovascular emergency with the characteristics of high incidence,high mortality.This study compared pulmonary artery catheter thrombolysis with peripheral intravenous thrombolysis for acute pulmonary embolism in the mid-term clinical efficacy.Methods From June 2011 to September 2015,68 patients were given pulmonary artery interventional therapy,54 cases received peripheral intravenous thrombolysis;discharged patients were followed up for 3-12 months to evaluate the curative rate,effective rate,recurrence rate and the incidence of complications.Results Follow up rate was 79.5％.The cure rate of the treatment group was higher than that of the control group (47.3 ％ vs 23.8 ％,P ＜ 0.05);The significant effective rate of the treatment group was higher than that of the control group (81.8％ vs 52.4％,P ＜ 0.05);The incidence of Chronic pulmonary hypertension (1.8％) was lower than that of the control group (16.7％);There was no significant difference in improvement rate,recurrence rate and mortality.Conclusion The medium-term efficacy of pulmonary artery catheter directed thrombolysis is superior to that of peripheral intravenous thrombolysis;it can effectively reduce the incidence of chronic thromboembolic pulmonary hypertension.

Objective To evaluate laparoscopic splenectomy through amputation of secondary splenic pedicles.Methods From February 2010 to March 2016 33 patients underwent laparoscopic splenectomy.Patients were followed up by outpatient examination and telephone interview.Follow-up period ended in April 2016.Results All the 33 patients successfully underwent laparoscopic amputation of secondary splenic pedicle splenectomy.The operation time and volume of intraoperative blood loss were (155 ± 42) min and (210 ± 50) ml.Three patients had postoperative complications including two with ascites sand one with small amount splenic fossa bleeding.All the patients were followed up for a median time of 21 months (range,1-65 months).During the follow-up,1 patient died of hepatic encephalopathy and 32 patients were doing well.Conclusion Laparoscopic amputation of secondary splenic pedicle splenectomy is safe and feasible.

Objective To assess the surgical skills and clinical outcomes of selective splenic pedicle occlusion (SSPO) in laparoscoic partial splenectomy.Methods Between May 2011 and Nov 2016,40 patients undergoing laparoscopic partial splenectomy were devided into selective splenic pedicle occlusion group (14 cases) and conventional laparoscopic partial splenectomy group (26 cases).Results There were no significant differences in preoperative patient characteristics between the two groups.Significantly less intraoperative blood loss (82 ± 36) ml vs (178 ± 81) ml (t =-4.2,P =0.001) were observed in group of SSPD,There were no significant differences between the groups in operative time (111 ± 17) min vs (127 ±40) min(t =-1.4,P =0.19),transfusion rate (0/14,0/26) (P =1),conversion rate (0/14,0/26) (P =1),postoperative complications (1/14,2/26) (Fisher =0.063,P =0.80) and length of postoperative hospital stay (7.1 ± 2.3) d vs (6.0 ± 1.3) d (t =1.28,P =0.22).Conclusions SSPO is feasible and safe for patients receiving laparoscopic partial splenectomy.

Objective To investigate the diagnosis,preoperative examination and surgical treatment of carotid body tumor(CBT).Methods From December 2008 to December 2012 80 patients of carotid body tumor were treated in our center.The average age was(43:±:12)years,33 cases were male,47 cases were female.The lesions were unilateral in 68 cases and bilateral in 12.All tumors were surgically resected.In 26 of Shamblin Ⅰ,32 of Shamblin Ⅱ and 19 of Shamblin Ⅲ tumors were simply resected.One Shamblin Ⅱ and 2 Shamblin Ⅲ cases underwent tumor resection combined with external carotid embolization.3 Shamblin Ⅱ and 8 Shamblin Ⅲ cases were treated by tumor resection combined with internal carotid reconstruction,1 Shamblin Ⅲ was done with tumor resection combined internal carotid repair.Results All of 80 patients with 92 tumors were successfully resected.There was no death case during peroperative period,while one case developed hemiplegia and 14 cases suffered cranial nerve injuries.68 cases (85％) were followed-up from 1 year to 6 years.Thera were 14 patients with cranial nerve injuries,2 of them were lost to follow-up,11 with complete or partial recovery and 1 was still doing poorly.Conclusions Tumor size and its relation to the carotid artery form the basis upon which appropriate operation is adopted.

Objective To evaluate the effect of distal splenorenal shunts (DSRS) in treatment of portal hypertension.Methods A retrospective analysis was made on 16 patients undergoing DSRS between 2009 and 2015 in a single institution.Perioperative free portal pressure (FPP),blood routine,liver function were collected and analyzed.Postoperative complications,long-term anastomotic status and the rate of re-bleeding were observed.Results Before and after DSRS,FPP were (43 ± 9) cmH2O and (31 ± 6) cmH2 O,a decrease of 29.1％ (t =7.326,P ＜ 0.01).Postoperative serum total bilirubin and peripheral blood leukocyte increased significantly (t =-3.462,t =-2.822,P ＜ 0.05).There was no significant difference in the changes of platelet and albumin before and after surgery.7 patients (7/16,43.8％) had one or more complications including 5 cases (31.3％) of portal vein thrombosis,massive ascites in 4 cases (25.0％),1 case (6.3％) of pulmonary infection and 1 case (6.3％) of wound infection.There was no inhospital mortality and all the 16 cases were followed up with no shunt anastomotic stenosis as showed by enhanced CT scan,meanwhile postoperative re-bleeding occurred in 1 case (6.3％) and 1 case (6.3％) died from liver failure.Conclusions Distal splenorenal shunts provides an effective method for the treatment of portal hypertension.

Objective To evaluate laparoscopic partial splenectomy (LPS) for benign splenic tumors.Method Data of 55 patients undergoing laparoscopic partial splenectomy (20 cases) vs total splenectomy (LTS in 35 cases) at Peking University Third Hospital from August 2008 to July 2016 were collected and retrospectively analyzed.Results There was no difference in sex,BMI,preoperative H GB,preoperative PLT,operation time,operative blood loss and hospital stay between two groups.Age in LPS cases was younger than LTS group,while the tumor size was larger.On the 4th day postoperatively,PLT level was significnatly higher in LTP group.More patients in LTS group suffered from thrombocytosis.Conclusions Laprtoscopic partial splenectomy is a safe and effective procedure for the management of splenic benign tumors.

Objective To investigate the development and influence factors of collateral circulation between spleen and lung in patients with portal hypertension after modified splenopneumopexy.Methods Data of 59 patients from January 2009 to December 2014 were analyzed,and the development of collateral circulation between spleen and lung after surgery were evaluated with ultrasound.Patients were divided into obvious collaterals group (maximum collateral diameter ≥ 2 mm,n =43) and non-obvious collaterals group (maximum collateral diameter ＜ 2 mm,n =16) according to ultrasound examination 3 months after surgery.Gender,age,type of disease,Child-Pugh classification,free portal pressure,portal vein diameter,splenic vein diameter,splenic artery diameter,splenic length,ejection fraction,forced vital capacity rate of one second (FEV1％),whether partial splenectomy was performed,and management of splenic upper pole were recorded and analyzed between the two groups.Results 3 months after surgery obvious collateral circulation could be observed in 43 patients,6 months after surgery the number increased to 53 (x2 =4.526,P ＜ 0.05).Splenic length (t =2.092) and FEV1％ (t =2.233) were significantly higher in obvious collaterals group (all P ＜ 0.05),and there were no statistical differences in gender (x2 =0.092),age (t =-1.254),type of disease (x2 =1.565),Child-Pugh classification (Z =-1.821),free portal pressur (t =0.912),portal vein diameter (t =0.008),splenic vein diameter (t =-0.485),splenic artery diameter (t =0.397),ejection fraction (t =-0.852),whether partial splenectomy was performed (x2 =0.002),and management of splenic upper pole (x2 =1.731) between the two groups (all P ＞ 0.05).Conclusions Obvious collateral circulation can develop between spleen and lung in patients with portal hypertension after modified splenopneumopexy,and the development of collateral circulation is associated with splenic length and FEV1％.

Objective To evaluate complications from two anal stapling operations of anorectal surgery,the procedure for prolapse and hemorrhoids (PPH) and the stapled transanal rectal resection (STARR).Methods The data of 1 276 patients undergoing PPH for hemorrhoids and 149 patients having STARR for ODS from January 2010 to January 2015,in Beijing Chaoyang Hospital were studied.More than six months of follow-up was done.Statistics used included t Test and Chi-square test,Logistic regression analysis.Results Complications of PPH and STARR included hemorrhage in 27 cases (2.1％) vs.3 cases (2.0％);pain in 285 cases (22.3％) vs.6 cases (4.0％);uroschesis in 96 cases (7.5％) vs.12 cases (8.1％);edema in 227 cases (17.8％) vs.16 cases (10.7％);defecatory urgency in 194 cases (15.2％) vs.38 cases (25.5％);anastomotic infection in 17 cases (1.3％) vs.2 cases (1.3％);mild anal incontinence in 11 cases (0.9％) vs.2 cases (1.3％);anastomotic stenosis in 11 cases (0.9％) vs.1 case (0.7％).There was a positive correlation between dry stool,defecatory urgency and hemorrhage after PPH.PPH compared to STARR:The post-operative pain,edema and defecatory urgency and overall complication rate was significantly different (t =26.51,x2 =4.69,x2 =10.38,x2 =37.12,P ＜ 0.05).Conclusions PPH and STARR have rare serious complications and easy to handle.Abnormal defecation such as dry stool and defecatory urgency is an important risk of hemorrhage.

Objective To investigate factors impacting on local recurrence in cases of primary retroperitoneal liposarcoma (RPLS) after complete enbloc resection.Methods The clinical data of 47 cases of primary retroperitoneal liposarcoma were retrospectively analyzed.Results 3-year local recurrence rate was 62％.Single and multiple regression analysis showed preoperative needle biopsy,histological subtype,tumor size and capsular invasion were all risk factors related to postoperative local recurrence in primary retroperitoneal liposarcoma undergoing complete resection (P ＜ 0.05).Conclusion Preoperative aspiration biopsy,tumor poor differentiation,large tumor size tumor extracapsular spread all lead to high local recurrence rate after complete resection of primary retroperitoneal liposarcoma.

Objective To evaluatate the impact of different anastomotic location and preventive ileostomy on postoperative anastomotic fistula in rectal cancer patients.Methods The clinical data of 316 cases of rectal cancer patients after total mesorectal excision from January 2015 to January 2016 were analyzed retrospectively.Patients were divided into anterior resection (AR) group,low anterior resection (LAR) group,uhra-low anterior resection (ULAR) group according to the anastomotic location.There were 33 cases of anastomotic fistula with preventive ileostomy or without and anastomotic leakage varied from mild to severe as grade A,B,C.Results There was no statistically significant difference in the incidence of anastomotic fistula between the different anastomotic location (x2 =3.829,P =0.147).In anterior resection group and low anterior resection group,there was no statistically significant difference in the incidence of anastomotic fistula whether or not a preventive ileostomy was performed (x2 =0.606,1.096,P =0.436,0.326).While in uhralow anterior resection group,preventive ileostomy helped dicrease the incidence of anastomotic fistula (x2 =11.667,P =0.001),and once happened the severity of the anastomotic fistula tended to be less severe.Conclusion The incidence of anastomotic fistula does not vary with anastomotic level in our study.Preventive ileostomy reduces the incidence of anastomotic fistula in patients with ultralow anterior resection.