[Prevention of restenosis with a new modified fully-covered retrievable esophageal stent].
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To observe and evaluate the effectiveness of a new modified fully-covered retrievable esophageal stent in preventing restenosis at the proximal end of the stent.From January 2008 to October 2011, 380 consecutive patients who underwent placement of a conventional stent or a new modified stent for benign or malignant dysphagia were divided into two groups: conventional stent group 193 patients (male 137, female 56) and modified stent group 187 patients (male 125, female 62). The granulation formation and restenosis rate one month after stenting were evaluated. Data such as patient demographics, outcomes and complications were collected. The results were statistically analyzed by Student t test, chi-squared test, Fisher's exact probability or rank sum test. A P-value less than 0.05 was considered statistically significant.All stents were successfully implanted. They were highly effective in palliating dysphagia. The dysphagia score decreased from 3 (1) to 0 (1) in conventional stent group (P < 0.01), and that from 4 (1) to 0 (1) in modified stent group (P < 0.01). The modified stent group were superior to the conventional stent group in severe granulation formation rate (0 vs 4.7% (9/193), P = 0.004) and restenosis rate (2.7% (5/187) vs 7.3% (14/193), P = 0.041) within one month after stenting, and the modified stent was easier to retrieve. Postoperative remission rate of dysphagia, and complications such as chest pain, bleeding, perforation, stent migration had no statistical differences between the two groups (all P > 0.05).The new modified fully-covered retrievable esophageal stent can significantly reduce granulation formation at the proximal end of the stent. Using of this stent seems to be a better choice in treating patient of dysphagia, with lower restenosis rate and easier to retrieve.Cite
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To observe and evaluate the effectiveness of a new modified fully-covered retrievable esophageal stent in preventing restenosis at the proximal end of the stent.From January 2008 to October 2011, 380 consecutive patients who underwent placement of a conventional stent or a new modified stent for benign or malignant dysphagia were divided into two groups: conventional stent group 193 patients (male 137, female 56) and modified stent group 187 patients (male 125, female 62). The granulation formation and restenosis rate one month after stenting were evaluated. Data such as patient demographics, outcomes and complications were collected. The results were statistically analyzed by Student t test, chi-squared test, Fisher's exact probability or rank sum test. A P-value less than 0.05 was considered statistically significant.All stents were successfully implanted. They were highly effective in palliating dysphagia. The dysphagia score decreased from 3 (1) to 0 (1) in conventional stent group (P < 0.01), and that from 4 (1) to 0 (1) in modified stent group (P < 0.01). The modified stent group were superior to the conventional stent group in severe granulation formation rate (0 vs 4.7% (9/193), P = 0.004) and restenosis rate (2.7% (5/187) vs 7.3% (14/193), P = 0.041) within one month after stenting, and the modified stent was easier to retrieve. Postoperative remission rate of dysphagia, and complications such as chest pain, bleeding, perforation, stent migration had no statistical differences between the two groups (all P > 0.05).The new modified fully-covered retrievable esophageal stent can significantly reduce granulation formation at the proximal end of the stent. Using of this stent seems to be a better choice in treating patient of dysphagia, with lower restenosis rate and easier to retrieve.
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Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05). In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.
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Objective To investigate the clinical efficacy, indications and complications of esophageal metallic stent in patients with dysphagia. Methods Analysis included 38 patients who received metallic stent placement in our hospital.The strictures were caused by esophageal carcinoma( n =26), stenotic anastomosis ( n =11) ,radiotherapy ( n =1) and restenosis after the placement of stent. Results and Conclusion Successful stent placements were achieved and symptoms of dysphagia were considerably relieved. There were no serious stent related complications in all patients. In summary ,the esophageal stent appears to be effective and safe, and is valuabic in the treatment of dysphagia due to benign or malignant esophageal stricture.
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Objective:To study the clinical value of assessment stent patency using MSCT.Methods:76 stents in 52 patients were evaluated by MSCT,and compared with conventional angiography as the standard of reference.Results:Using MSCT on average,40% of the stent lumen diameter was visible.Lumen visibility was not sufficient for stenosis evalu tion in 4 stents.MSCT showed 57 stents without in-stent restenosis,55 stents accorded with conventional angiography;MSCT showed 14 stents with in-stent restenosis,1 stents with occlusion and conventional angiography proofs stents occlu sions.Conclusion:Although the stent lumen may be partly visualized,MSCT might provide valuable information for stent patency,it can be used for follow-up of patients after stenting.
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Objectives This paper is aimed to explore the value of double source CT angiography (DS-CTA) for diagnosing in-stent restenosis in lower limb artery. Methods From January 2016 to October 2018, all patients with stent in lower limb artery in our hospital were investigated by both DS-CTA and digital subtraction angiography. We measured the minimum lumen diameter and the diameter of the proximal normal vessels under each stent placement. The in-stent restenosis is defined as restenosis when the lumen area decreased by more than 50%. Digital subtraction angiography was performed within 1 week after DS-CT scan. Relationship between DS-CTA and digital subtraction angiography for diagnosing in-stent restenosis in lower limb artery was analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DS-CTA for diagnosis of in-stent restenosis were analyzed with digital subtraction angiography as the reference standard. A total of 68 stents were placed in 51 patients. Among these patients, 27 cases were diagnosed as in-stent restenosis, presenting as endovascular contrast agent bias or crescent filling defect with the lumen area reducing over 50%, 6 cases of which had no significant in-stent restenosis by digital subtraction angiography analysis. Furthermore, 12 cases were occlusion, in which there was no high density contrast agent in stents; the remaining 41 stents were unobstructed and the contrast agent was filled well, 8 cases of which had significant in-stent restenosis by digital subtraction angiography analysis. In addition, four stents were deformed or distorted. Statistical analysis demonstrated the concentrations of DS-CTA and digital subtraction angiography in diagnosing in-stent restenosis for lower limb artery were closely related, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DS-CTA were 72.4%, 84.6%, 77.8%, 80.5%, and 79.4%, respectively. Conclusion DS-CTA has a potential reliability for diagnosis of in-stent restenosis in lower limb artery, which may be further improved to be used for clinical interventional treatment of vascular diseases.
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Objective To evaluate the mouth-retrofitted stent in preventing esophageal restenosis after esophageal stent implantation,and to discuss its safety in clinical use.Methods Mouth-retrofitted stent implantation was carried out in 10 patients with pathologically and radiologically confirmed esophageal carcinoma.The mouth part of the stent used in the treatment was covered with silica gel membrane.After the treatment,the patients were followed up monthly to determine the severity of dysphagia,which was assessed by using Stooler's score,X-ray.Chest CT scanning and esophagography were performed to observe the location of the stent and to clarify if there was any obstruction.The gastroscopy was bimonthly performed in all patients to see whether or not stent restenosis occurred.If stent restenosis occurred,biopsy examination was used in order to determine its etiology.During the follow-up period,the related complications such as serious chest pain,hemorrhage,pneumonia,trancheoesophageal fistula,etc.were closely observed.Results All the 10 patients were followed up for 4 ～ 10 months.The Stooler's score for dysphagia was 0 to 1 grade in 9 cases.The severity of dysphagia was gradually increased in one case and its grade reached 3 at 5 months after the procedure.After operation,no stent migration occurred in 9 cases;in 1 case who had received treatment with the stent loaded with 125I seeds the stent migrated into the stomach after 8 months although both esophagography and gastroscopy showed that the esophageal inner wall of the former stenotic lumen was smooth with no stenosis.In the patient who had gradual increased dysphagia,chest CT scanning showed that the lesion exceeded the superior edge of the stent,and both esophagography and gastroscopy confirmed that the restenosis was caused by tumor proliferation.In the remaining 8 patients,the length of lesions was not obviously increased,and the mouth part of the stent showed no stenosis.Esophagographic and gastroscopic examinations showed that no esophageal obstruction existed.After the therapy the thickness of lesions was increased in 4 patients who used the stent without 125I seeds and the thickness of lesions was decreased in other 4 patients who used the stent with 125 I seeds.After operation,all patients experienced slight chest pain and throat discomfort,which were relieved after symptomatic medication.No serious complications occurred.Conclusion Mouth-retrofitted stent is very effective in preventing the esophageal restenosis occurred after the esophageal stent implantation.Besides,this technique is quite safe.
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Abstract A multicentre randomized prospective trial compared minimal surgery (under-running the vessel or ulcer excision and adjuvant ranitidine) with conventional ulcer surgery (vagotomy and pyloroplasty or partial gastrectomy) for the treatment of bleeding peptic ulcer. This report is based on 137 patients (eight withdrawn through misdiagnosis or lost data), of whom 62 received conservative surgery and 67 conventional operation. Twenty-nine patients died, 16 (26 per cent) after conservative surgery and 13 (19 per cent) after conventional operations. The only significant difference between the groups was the incidence of fatal rebleeding, which occurred in six patients after conservative surgery compared with none after conventional surgery (P < 0.02, Fisher's exact test).
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