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Risk factors and prevention strategies of spinal cord ischemic injury after thoracoabdominal aortic aneurysm repair 胸腹主动脉瘤修复后脊髓缺血性损伤的危险因素及预防策略
Pub Date : 2020-02-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.012
Yusong Wang, Guanglang Zhu, Ziyang Sun, Lei Zhang
Thoracic and abdominal aortic aneurysm repair has always been a challenging procedure in cardiovascular surgery due to its high mortality and complication rate. At present, there are traditional open surgery, hybrid surgery and intracavitary repair for thoracic and abdominal aortic aneurysms. The main postoperative complication of spinal cord ischemia injury is paraplegia, which seriously affects the long-term survival rate and quality of life of patients. This paper summarized and considered the pathogenesis, risk factors and prevention measures of spinal cord ischemia injury after thoracic and abdominal aortic aneurysm repair.
由于胸腹主动脉瘤的高死亡率和并发症发生率,其修复一直是心血管外科中一项具有挑战性的手术。目前胸腹主动脉瘤的治疗方法有传统的开放手术、混合手术和腔内修复。脊髓缺血损伤的主要术后并发症是截瘫,严重影响患者的长期生存率和生活质量。本文对胸腹主动脉瘤修复后脊髓缺血损伤的发病机制、危险因素及预防措施进行了总结和探讨。
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引用次数: 0
Advances in the accuracy of the frozen section (FS) identification for early-stage lung adenocarcinoma 冰冻切片(FS)鉴别早期肺腺癌准确性的研究进展
Pub Date : 2020-02-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.013
Xiaofan Wang, Donglai Chen, E. Zhu, Chang Chen, Yong-sheng Zhang, Yongbing Chen
The frozen section (FS) technology has been widely used in the process of surgical pathology since its time-saving nature exhibited superiority over traditional paraffin method. Therefore FS, of great value in providing preliminary pathological diagnosis, offers guidance in the extension of surgical resection. However, it remains controversial whether the early-stage lung adenocarcinoma could be accurately identified in FS. This review aims to generalize the studies concerning the accuracy of FS in identifying early-stage lung adenocarcinoma, analyzing the interference factors, comparing the similarities and differences between frozen sections and traditional paraffin sections. It also gives insight into whether FS can provide significant guidance for surgeons to perform resection on early-stage lung adenocarcinoma.
冷冻切片(FS)技术因其比传统石蜡法更省时的优点,在外科病理过程中得到了广泛的应用。因此,FS对提供初步病理诊断具有重要价值,对扩大手术切除具有指导意义。然而,早期肺腺癌能否在FS中准确鉴别仍存在争议。本文就FS鉴别早期肺腺癌的准确性研究进行综述,分析干扰因素,比较冷冻切片与传统石蜡切片的异同。这也为FS是否能对早期肺腺癌的手术切除提供有意义的指导。
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引用次数: 0
Retrospective analysis of 10 cases of right heart system uterine venous leiomyomatosis treated by one-stage operation 一期手术治疗右心系统子宫静脉平滑肌瘤病10例回顾性分析
Pub Date : 2020-02-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.011
Gaojun Xu, Shuai Hu, Baoen Wang, Jun-jie Sun, Dao-Kuo Zheng, Z. Ge
回顾性分析2015年4月至2018年12月收治的10例右心系统子宫静脉平滑肌瘤病女性患者的临床资料,年龄35~53岁,平均(45±6)岁。全组均联合妇科医师,在全麻下行一期肿瘤完整切除,其中6例取体外循环下胸腹联合切口,4例取非体外循环下单纯腹部切口。术后1例出现急性肾衰、肺部感染等并发症,家属拒绝继续治疗,术后第9天自动出院。余9例患者均康复出院。电话或门诊随访3~47个月,平均(29±13)个月,1例术后2月余因肠梗阻再次住院,予保守对症治疗后好转出院。子宫静脉平滑肌瘤病的诊断较困难,一期手术可取得较好的中长期生存率和生存质量,术后复发率较低。
回顾性分析2015年4月至2018年12月收治的10例右心系统子宫静脉平滑肌瘤病女性患者的临床资料,年龄35~53岁,平均(45±6)岁。全组均联合妇科医师,在全麻下行一期肿瘤完整切除,其中6例取体外循环下胸腹联合切口,4例取非体外循环下单纯腹部切口。术后1例出现急性肾衰、肺部感染等并发症,家属拒绝继续治疗,术后第9天自动出院。余9例患者均康复出院。电话或门诊随访3~47个月,平均(29±13)个月,1例术后2月余因肠梗阻再次住院,予保守对症治疗后好转出院。子宫静脉平滑肌瘤病的诊断较困难,一期手术可取得较好的中长期生存率和生存质量,术后复发率较低。
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引用次数: 0
To evaluate the extravascular lung water in patients of bilateral lung transplantation with lung ultrasonography and SDC-1 目的:应用肺超声和SDC-1评价双侧肺移植患者血管外肺积水
Pub Date : 2020-02-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.006
Song Gao, Ding-ye Wu, Gen-Hui Chen, K. Jin, Feng Zhang, Hong-yang Xu
Objective The purpose of this study was to explore new method for evaluating the severity of extravascular lung water in patients after bilateral lung transplantation. Methods The study was performed in 50 patients after bilateral lung transplantation in our hospital from 2017 to 2018. Picco were implanted during the operation .Two hours after the operation, a doctor monitored the index of EVLWI and PVPI.At the same time, another doctor carried out examination of lung ultrasonography and Calculated the numbers of B line. After ultrasonography, the doctor used ELISA to determine the level of SDC-1. Results EVLWI were significantly correlated with the number of B-line and the level of SDC-1 (RS=0.833, RS=0.747, P<0.05), PVPI were significantly correlated with the number of B-line and the level of SDC-1 (RS=0.738, RS=0.626, P<0.05). Conclusion The number of B-line and the level of SDC-1 have a good correlation with extravascular lung water. The combination of the two indicators might be used as a reliable index for evaluating the degree of extravascular lung water after bilateral lung transplantation. Key words: Bilateral lung transplantation; EVLWI; Lung ultrasonography; SCD-1
目的探讨双侧肺移植术后肺血管外水严重程度评价的新方法。方法选取我院2017 ~ 2018年收治的50例双侧肺移植术后患者为研究对象。术中植入Picco,术后2小时监测EVLWI、PVPI指数。同时另一位医生进行肺部超声检查,计算B线数。超声检查后,医生用ELISA检测SDC-1水平。结果EVLWI与B-line数、SDC-1水平显著相关(RS=0.833, RS=0.747, P<0.05), PVPI与B-line数、SDC-1水平显著相关(RS=0.738, RS=0.626, P<0.05)。结论b线数目和SDC-1水平与肺血管外水有良好的相关性。两指标的结合可作为评价双侧肺移植术后肺血管外积水程度的可靠指标。关键词:双侧肺移植;EVLWI;肺超声;SCD-1
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引用次数: 0
Construction of Patient-level Prediction Model for In-hospital Mortality in Congenital Heart Disease Surgery: Regression and Machine Learning analysis 先天性心脏病手术患者水平住院死亡率预测模型的构建:回归与机器学习分析
Pub Date : 2020-02-25 DOI: 10.21203/rs.3.rs-35146/v1
X. Song, Xinwei Du, Shun-min Wang, Zhiwei Xu, Zhaohui Lu
Background: Prediction of in-hospital death is important for patient management as well as risk-adjusted evaluation of Congenital heart disease (CHD) surgery performance. Using a large database containing CHD surgery records of 12 years, we aim to establish patient-level in-hospital mortality prediction models.Methods: Patients with congenital heart disease who underwent surgery at Shanghai Children’s Medical Center from January 1, 2006, to December 31, 2017 were included in the study. Each procedure was assigned a complexity score based on Aristotle Score with modification. In-hospital mortalities for various surgery procedures were estimated. In-hospital death prediction models including a procedure complexity score and patient-level risk factors were constructed using logistic regression analysis and machine learning methods. The predictive values of the models were tested. Results: Among 24,684 patients underwent CHD operations, there were 595 (2.4%) in-hospital deaths. The results showed that AUC of the prediction model based on logistic regression is 0.864 (95% CI: 0.833-0.895, P <0.001), the sensitivity is 0.831 and the specificity is 0.786. The AUC of the Gradient boosting model is 0.884 (95 %% CI: 0.858-0.909, P <0.001), the sensitivity and specificity were 0.838 and 0.785 respectively. The feature importance analysis found that the variable (average score) that had the greatest impact on the model's prediction performance was operation score (95.6), and other variables (average scores) were Age (days) (95.5), Ultrasound MV (54.6), Ultrasound atrial level (54.5), Palliative operation (45.8), Operation history (38.8), Ultrasound TV2 (32.1), Urgent operation (30.8), Ultrasound ventricular level (30.5), and Spo2 ≤ 90% (30.3).Conclusions: Model constructed using machine learning method and logistic regression containing procedure complexity score and pre-operative patient-level factors had high accuracy in in-hospital mortality prediction. Operation score and age have the greatest impact on model prediction performance.
背景:院内死亡预测对于患者管理以及对先天性心脏病(CHD)手术效果的风险调整评估具有重要意义。利用包含12年冠心病手术记录的大型数据库,我们旨在建立患者层面的住院死亡率预测模型。方法:选取2006年1月1日至2017年12月31日在上海儿童医疗中心接受手术治疗的先天性心脏病患者。根据亚里斯多德评分对每个程序进行了修改,并给予了复杂度评分。对各种外科手术的住院死亡率进行了估计。采用逻辑回归分析和机器学习方法构建了包括手术复杂性评分和患者层面风险因素在内的住院死亡预测模型。对模型的预测值进行了检验。结果:24684例冠心病手术患者中,住院死亡595例(2.4%)。结果表明,logistic回归预测模型的AUC为0.864 (95% CI: 0.833-0.895, P <0.001),敏感性为0.831,特异性为0.786。梯度增强模型的AUC为0.884 (95% % CI: 0.858 ~ 0.909, P <0.001),敏感性为0.838,特异性为0.785。特征重要性分析发现,对模型预测性能影响最大的变量(平均得分)为手术评分(95.6),其他变量(平均得分)为年龄(天)(95.5)、超声MV(54.6)、超声心房水平(54.5)、姑息性手术(45.8)、手术史(38.8)、超声TV2(32.1)、急诊手术(30.8)、超声心室水平(30.5)、Spo2≤90%(30.3)。结论:采用机器学习方法和逻辑回归方法构建的包含手术复杂性评分和术前患者层面因素的模型对院内死亡率预测具有较高的准确性。操作评分和年龄对模型预测性能的影响最大。
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引用次数: 1
Comparison of the short-term and long-term outcomes between minimally invaisive Ivor-Lewis and minimally invaisive McKeown esophagectomy for middle or lower esophageal squamous cell carcinoma after propensity score matching analysis 倾向评分匹配分析微创Ivor-Lewis食管切除术与微创McKeown食管切除术治疗中下段食管鳞状细胞癌的近期和长期疗效比较
Pub Date : 2020-02-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.007
Xiaodong Zhu, Hanran Wu, Guang-Wen Xu, Chang-qing Liu, X. Mei
Objective The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME) for squamous cell carcinoma of middle and lower esophagus. Methods The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), was analyzed retrospectively. We divided the subjects into two groups according to the mode of the operation, each group was identified 81 patients after propensity score matching. We were using t test, χ2 test, Kaplan-Meier curve and Log-rank test to compare preoperative data and overall survival of the two groups. Results Compared with MIME, MIILE had lower complication in pulmonary infection and anastomotic fistula, also had less operating time, whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve(P<0.05). The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%, and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate. Conclusion For squamous cell carcinoma of middle and lower esophagus, minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival, but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time, decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve. Key words: Esophageal cancer; Minimally invasive esophagectomy; Survival
目的比较微创Ivor-Lewis食管切除术(MIILE)和微创McKeown食管切除术(MIME)治疗食管中下段鳞状细胞癌的近期和远期疗效。方法回顾性分析2010年8月至2014年3月在中国科学技术大学第一附属医院(安徽省立医院)胸外科行MIILE或MIME治疗的268例食管中下段鳞状细胞癌患者的资料。根据手术方式将受试者分为两组,每组81例经倾向评分匹配。采用t检验、χ2检验、Kaplan-Meier曲线和Log-rank检验比较两组术前资料和总生存率。结果与MIME相比,MIILE在肺部感染和吻合口瘘并发症发生率较低,手术时间较短,而MIME在喉返神经附近淋巴结清扫数量上具有优势(P<0.05)。MIILE的1年、3年、5年生存率分别为87.7%、59.2%、45.9%,MIME的1年、3年、5年生存率分别为86.4%、58.7%、42.8%。两组患者5年生存率差异无统计学意义。结论对于食管中下段鳞状细胞癌,微创Ivor-Lewis食管切除术与微创McKeown食管切除术的远期生存率无显著差异,但微创Ivor-Lewis食管切除术在减少手术时间、减少围手术期肺部感染和吻合口瘘等方面具有优势。然而,微创McKeown在喉返神经附近淋巴结清扫方面具有优势。关键词:食管癌;微创食管切除术;生存
{"title":"Comparison of the short-term and long-term outcomes between minimally invaisive Ivor-Lewis and minimally invaisive McKeown esophagectomy for middle or lower esophageal squamous cell carcinoma after propensity score matching analysis","authors":"Xiaodong Zhu, Hanran Wu, Guang-Wen Xu, Chang-qing Liu, X. Mei","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.007","url":null,"abstract":"Objective \u0000The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME) for squamous cell carcinoma of middle and lower esophagus. \u0000 \u0000 \u0000Methods \u0000The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), was analyzed retrospectively. We divided the subjects into two groups according to the mode of the operation, each group was identified 81 patients after propensity score matching. We were using t test, χ2 test, Kaplan-Meier curve and Log-rank test to compare preoperative data and overall survival of the two groups. \u0000 \u0000 \u0000Results \u0000Compared with MIME, MIILE had lower complication in pulmonary infection and anastomotic fistula, also had less operating time, whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve(P<0.05). The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%, and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate. \u0000 \u0000 \u0000Conclusion \u0000For squamous cell carcinoma of middle and lower esophagus, minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival, but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time, decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve. \u0000 \u0000 \u0000Key words: \u0000Esophageal cancer; Minimally invasive esophagectomy; Survival","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"771 1","pages":"98-103"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83390255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancein surgicaltreatment of congenital tracheal stenosis in children 儿童先天性气管狭窄的外科治疗进展
Pub Date : 2020-01-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.01.015
X. Song, Zhaohui Lu, Shun-min Wang
Congenital tracheal stenosis is a rarebut life-threatening disorder. In recent years, the improvement of surgical skills has significantly reduced the incidence of postoperative complications and mortality in children. Through researching the relevant published articles and books, this review introduces the pathology, types, commonsurgical methods of congenital tracheal stenosis, summarizes the surgical indications for tracheoplasty, and prospects for providing some suggestions for thetreatment of congenital tracheal stenosis.
先天性气管狭窄是一种罕见但危及生命的疾病。近年来,手术技术的提高显著降低了儿童术后并发症的发生率和死亡率。本文通过查阅相关文献和书籍,介绍了先天性气管狭窄的病理、类型、常见的手术方法,总结了气管成形术的手术指征,并对先天性气管狭窄的治疗提出了一些建议。
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引用次数: 0
Analysis of influencing factors for rapid postoperative recovery of young lung cancer patients 影响青年肺癌患者术后快速康复的因素分析
Pub Date : 2020-01-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.01.005
Ya-Nan Song, Y. Qi, Chunyang Zhang, Sheng Yinliang, Song Zhao
Objective To explore the influencing factors of rapid postoperative recovery in young(≤40 years old) lung cancer patients. Methods Retrospective analysis was performed on 82 young patients with lung cancer diagnosed by postoperative pathology admitted to the department of thoracic surgery of the first affiliated hospital of Zhengzhou University from March 2013 to March 2019, the patients were divided into two groups according to their postoperative hospitalization time(hospitalization time≤7d, hospitalization time >7d). The preoperative medical history and examination data, intraoperative(operative method, embedding materials), postoperative complications and postoperative treatment and other data of the enrolled patients were collected to analyze the relationship between various factors and postoperative hospitalization time.Univariate analysis used t test or Fisher exact probability method, multivariate analysis used logistic regression model to analyze the data . Results All 82 patients successfully completed the operation, and no death occurred during the perioperative period. There were no significant differences(P>0.05)according to the two groups of patients in the preoperative pulmonary function(FEV1) operation history, history of hypertension, diabetes, history of preoperative chemotherapy and surgery in the patients' position, blood transfusion, pleural adhesion, Czech, nai d, the use of xanthan gum, operation time, the maximum diameter and postoperative tumor thermal perfusion, fever, vomiting, choking cough, abdominal distension, etc.And it has significant differences(P<0.05). In the preoperative antibiotic use(P=0.002), the improvement of lung function(P=0.018), smoking history(P=0.024), medical reasons(P=0.011) and the operation(P<0.001), the lymph node excision scope(P<0.001), the lymph node dissection(P=0.017), hemostatic material use(P=0.023), blood loss(P=0.001) and postoperative average white blood cell count(P=0.033). Conclusion Preoperative and postoperative prophylactic use of antibiotics and drugs to improve pulmonary function were beneficial to postoperative recovery.Smoking was an independent risk factor for prolonged postoperative hospital stay.Minimally invasive operation and application of hemostatic materials can effectively shorten the postoperative hospitalization time of patients. Key words: Carcinoma, non-small-cell lung; Youth; Postoperative recovery; Influence factors
目的探讨青年(≤40岁)肺癌患者术后快速康复的影响因素。方法回顾性分析2013年3月至2019年3月郑州大学第一附属医院胸外科收治的82例经术后病理诊断的年轻肺癌患者,根据患者术后住院时间(住院时间≤7d,住院时间≤7d)分为两组。收集入组患者的术前病史及检查资料、术中(手术方式、包埋材料)、术后并发症及术后治疗等资料,分析各因素与术后住院时间的关系。单因素分析采用t检验或Fisher精确概率法,多因素分析采用logistic回归模型对数据进行分析。结果82例患者均顺利完成手术,围手术期无死亡病例发生。两组患者在术前肺功能(FEV1)手术史、高血压史、糖尿病史、术前化疗史及手术中患者体位、输血、胸膜粘连、捷克、nai、黄原胶的使用、手术时间、最大直径及术后肿瘤热灌注、发热、呕吐、呛咳、腹胀、差异有统计学意义(P<0.05)。术前抗生素使用情况(P=0.002)、肺功能改善情况(P=0.018)、吸烟史(P=0.024)、医学原因(P=0.011)、手术情况(P<0.001)、淋巴结切除范围(P<0.001)、淋巴结清扫情况(P=0.017)、止血材料使用情况(P=0.023)、出血量(P=0.001)、术后平均白细胞计数(P=0.033)。结论术前术后预防性使用抗生素及改善肺功能的药物有利于术后恢复。吸烟是术后住院时间延长的独立危险因素。微创手术及止血材料的应用可有效缩短患者术后住院时间。关键词:肺癌,非小细胞肺;青春;术后恢复;影响因素
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引用次数: 0
Early and midterm results of the Rastelli operation in Fuwai hospital 阜外医院拉斯泰利手术的早期和中期结果
Pub Date : 2020-01-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.01.002
Xiaodong Lyu, Ke-ming Yang, Shoujun Li, Hongyang Fan
Objective To describe eraly and midterm outcome of the Rastelli repair in Fuwai hospital Patients. Methods From May 2010 to March 2017, 71 patients with transposition of the great arteries(TGA)with ventricular septal defect(VSD)and right ventricular outflow tract obstruction(RVOTO) or double outlet right ventricle(DORV)with VSD and RVOTO underwent Rastelli repair. 48 cases male , 23 cases female . Age at operation is(4.7±2.7) years. There are 10 TGA cases, 27 DORV cases, 34 CTGA cases in this group. 30 patients(42.3% , 30/71)received palliative operation prior to the Rastelli procedure, including 13 BT shunt and 17 bi-Glenn operation. 31 patients(43.7%, 31/71 )underwent the Rastelli procedure with VSD enlargement. Right ventricle-to-pulmonary artery connection were created with the use of 9 homografts, 56 valved bovine jugular vein, 6 man-made valved Gore-Tex conduit. The overall mean right ventricle-to-pulmonary artery conduit size was(17.9±3.3)mm. Results CPB time was(209.0±83.4)minutes, aortic crossclamping time was(132.0±71.1)minutes, mechanical ventilation time was(102.6±81.7)h. Early mortality was 1.4%(1/71). morbidity in hospital was 16.9%, 4 patients with Ⅲ AVB implanted permanent pacemaker, Subxiphoid pericardial window drainage in 3 cases, delayed sternal closure in 3 and re-thoratomy for hemaostsis in 2.Follow up is from 4 months to 6.8 years. Overall survival was 97.2% and 97.2% at 1 and 5 years, respectively. Freedom from RVOTO was 98.6% and 84.1% at 1 and 5 years, respectively. Freedom from reintervention was 98.6% and 90.0% at 1 and 5years, respectively. 1 patients performed a conduit replacement. Seven patients performed 10 times balloon dilatation . Time-related freedom from recurrent LVOTO on echocardiogram in all patients, and the pressure gradient of the LV to the aorta was(10.5±8.8 )mmHg at the most recent follow-up. Conclusion The Rastelli operation remains the preferred procedure for part of the DORV , CTGA , TGA with VSD and severe fixed valvular or subvalvular PS. The Rastelli procedure can be performed with low early mortality. There is frequent need for late reoperation, especially for conduit replacement. Key words: Heart diseases, congenital; Rastelli procedure; Transposition of the great arteries; Duble outlet right ventricle
目的探讨阜外医院Rastelli修复术患者的早期和中期预后。方法2010年5月至2017年3月,对71例大动脉转位(TGA)合并室间隔缺损(VSD)合并右室流出道梗阻(RVOTO)或双出口右心室(DORV)合并VSD和RVOTO患者行Rastelli修复术。男48例,女23例。手术年龄为(4.7±2.7)岁。本组TGA 10例,DORV 27例,CTGA 34例。Rastelli手术前行姑息性手术30例(42.3%,30/71),其中BT分流13例,bi-Glenn手术17例。31例(43.7%,31/71)患者行Rastelli手术并发室间隔增大。采用同种异体移植物9条,带瓣牛颈静脉56条,人工带瓣Gore-Tex导管6条,建立右心室-肺动脉连接。右心室至肺动脉总平均导管直径为(17.9±3.3)mm。结果CPB时间为(209.0±83.4)min,主动脉交叉夹持时间为(132.0±71.1)min,机械通气时间为(102.6±81.7)h。早期死亡率为1.4%(1/71)。住院发病率16.9%,4例植入ⅢAVB永久起搏器,3例剑突下心包窗引流,3例延迟胸骨闭锁,2例再次开胸止血。随访时间为4个月至6.8年。1年和5年的总生存率分别为97.2%和97.2%。1年和5年RVOTO的自由度分别为98.6%和84.1%。1年和5年再干预率分别为98.6%和90.0%。1例患者行导管置换术。7例患者行10次球囊扩张术。超声心动图显示,所有患者均无复发性左室血栓,且最近随访时左室至主动脉的压力梯度为(10.5±8.8)mmHg。结论对于部分DORV、CTGA、TGA合并VSD及严重的固定瓣或瓣下PS, Rastelli手术仍是首选手术方式,早期死亡率低。经常需要后期再手术,特别是导管更换。关键词:心脏病;先天性;拉斯泰利的过程;大动脉转位;右心室双出口
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引用次数: 0
A meta-analysis of the incidence of acute aortic disection with lower limb malperfusion 急性主动脉夹层合并下肢灌注不良发生率的荟萃分析
Pub Date : 2020-01-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.01.010
Zengkai Xu, Bin Li, Haisheng Chen
近年来,国内外学者对急性主动脉夹层合并器官灌注不良越来越重视,但缺乏相关的流行病学数据。为明确下肢缺血在急性主动脉夹层的发病率,通过meta分析合成后,统计出下肢缺血在急性A型主动脉夹层(TAAD)和急性B型主动脉夹层(TBAD)的发病率分别为11%和10%;TAAD和TBAD合并下肢缺血的患者中男性分别占77.17%和84.35%。下肢缺血在急性主动脉夹层中占一定的比例,不论A型夹层还是B型夹层,男性患者发病率均高于女性。
近年来,国内外学者对急性主动脉夹层合并器官灌注不良越来越重视,但缺乏相关的流行病学数据。为明确下肢缺血在急性主动脉夹层的发病率,通过meta分析合成后,统计出下肢缺血在急性A型主动脉夹层(TAAD)和急性B型主动脉夹层(TBAD)的发病率分别为11%和10%;TAAD和TBAD合并下肢缺血的患者中男性分别占77.17%和84.35%。下肢缺血在急性主动脉夹层中占一定的比例,不论A型夹层还是B型夹层,男性患者发病率均高于女性。
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Chinese Journal of Thoracic and Cardiovaescular Surgery
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