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Congenital hiatal hernia associated with gastric gangrene in a child 儿童先天性裂孔疝合并胃坏疽
Pub Date : 2020-01-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.01.012
Yuhao Wu, Yunni Ran, Jiangtao Dai, Gang Wang, Hongbo Li, Yonggang Li, Chun Wu
食管裂孔疝嵌顿并胃坏疽十分罕见。本文回顾1例9岁6个月女性患儿先天性食管裂孔疝嵌顿并胃坏疽的发病、诊断及治疗过程,总结该病的临床表现和诊治要点。患儿患先天性食管裂孔疝嵌顿,病情危重,胸部CT及上消化道造影可明确诊断,行胃大部切除及食管裂孔疝修补后出现食管远端出血及食管-胃连接处狭窄,早期手术解除嵌顿是降低术后并发症及病死率的关键。
食管裂孔疝嵌顿并胃坏疽十分罕见。本文回顾1例9岁6个月女性患儿先天性食管裂孔疝嵌顿并胃坏疽的发病、诊断及治疗过程,总结该病的临床表现和诊治要点。患儿患先天性食管裂孔疝嵌顿,病情危重,胸部CT及上消化道造影可明确诊断,行胃大部切除及食管裂孔疝修补后出现食管远端出血及食管-胃连接处狭窄,早期手术解除嵌顿是降低术后并发症及病死率的关键。
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引用次数: 0
Bilateral sequential pulmonary transplantation with closure of ventricular septal defect in a patient with Eisenmenger syndrome 双侧序贯肺移植合并室间隔缺损1例
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.012
Jun Pan, Zhenjun Xu, Cheng Chen, Jianqiu Xiong, Jingyu Chen, Dongjin Wang
艾森曼格综合征被视为先天性室间隔缺损修补的禁忌证,该类患者的外科治疗策略包括心肺联合移植或双肺移植同期矫治心脏畸形。1例27岁女性患者,剖宫产术后2周因先天性心脏病、室间隔缺损,艾森曼格综合征行双肺移植同期行室间隔缺损修补术成功。患者术后46天康复出院,治疗效果良好。提示双肺移植同期行室间隔缺损修补治疗室间隔缺损继发艾森曼格综合征患者有效。
艾森曼格综合征被视为先天性室间隔缺损修补的禁忌证,该类患者的外科治疗策略包括心肺联合移植或双肺移植同期矫治心脏畸形。1例27岁女性患者,剖宫产术后2周因先天性心脏病、室间隔缺损,艾森曼格综合征行双肺移植同期行室间隔缺损修补术成功。患者术后46天康复出院,治疗效果良好。提示双肺移植同期行室间隔缺损修补治疗室间隔缺损继发艾森曼格综合征患者有效。
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引用次数: 0
The factors associated with postoperative in-hospital adverse events in patients with aortic valve prolapse 主动脉瓣脱垂患者术后院内不良事件的相关因素
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.009
Y. Ruan, Xiaowei Liu, Xin Wang, Jiancheng Han, Haibo Zhang, Xu Meng, Yihua He
回顾性分析2009年1月1日至2017年12月31日期间在我院因主动脉瓣脱垂(AVP)和严重主动脉瓣关闭不全(AI)接受主动脉瓣置换术(AVR)患者135例。收集研究对象的基线临床特征,超声心动图参数以及手术参数。所有患者术后住院期间随访,评估与院内不良事件相关的危险因素,包括死亡、心功能恶化、术后发生完全性房室传导阻滞和再次手术。住院期间共发生25例不良事件,其中5例死亡,17例心功能恶化,2例完全性房室传导阻滞置入永久性起搏器,3例进行再次手术。多因素logistic回归模型显示女性(OR=7.89,95%CI:1.92~32.50,P=0.004),心功能(NYHA分级) Ⅲ~Ⅳ级(OR=3.72,95%CI:1.12~12.37,P=0.033)和基线左心室舒张期末内径(LVEDD)(OR=1.08,95%CI:1.02~1.15,P=0.010),或LVEDD≥67 mm(OR=5.50,95%CI:1.43~21.14,P=0.013)或体表面积校正的LVEDD(OR=1.11,95%CI:1.02~1.20,P=0.016)与院内不良事件独立相关。心功能(NYHA分级) Ⅲ~Ⅳ级,基线LVEDD或体表面积校正的LVEDD预测AVP患者进行外科瓣膜置换手术后院内不良事件发生的风险,但因样本量受限及混杂因素不能完全考虑到,结果推广需慎重。
回顾性分析2009年1月1日至2017年12月31日期间在我院因主动脉瓣脱垂(AVP)和严重主动脉瓣关闭不全(AI)接受主动脉瓣置换术(AVR)患者135例。收集研究对象的基线临床特征,超声心动图参数以及手术参数。所有患者术后住院期间随访,评估与院内不良事件相关的危险因素,包括死亡、心功能恶化、术后发生完全性房室传导阻滞和再次手术。住院期间共发生25例不良事件,其中5例死亡,17例心功能恶化,2例完全性房室传导阻滞置入永久性起搏器,3例进行再次手术。多因素logistic回归模型显示女性(OR=7.89,95%CI:1.92~32.50,P=0.004),心功能(NYHA分级) Ⅲ~Ⅳ级(OR=3.72,95%CI:1.12~12.37,P=0.033)和基线左心室舒张期末内径(LVEDD)(OR=1.08,95%CI:1.02~1.15,P=0.010),或LVEDD≥67 mm(OR=5.50,95%CI:1.43~21.14,P=0.013)或体表面积校正的LVEDD(OR=1.11,95%CI:1.02~1.20,P=0.016)与院内不良事件独立相关。心功能(NYHA分级) Ⅲ~Ⅳ级,基线LVEDD或体表面积校正的LVEDD预测AVP患者进行外科瓣膜置换手术后院内不良事件发生的风险,但因样本量受限及混杂因素不能完全考虑到,结果推广需慎重。
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引用次数: 0
Clinical technique of the magnetic sphincter augmentation for treating gastroesophageal reflux disease 磁括约肌增强术治疗胃食管反流病的临床技术
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.011
Yifeng Sun, Yu Yang, H. Gu, Yi He, Xiao-bin Zhang, Haoyao Jiang, Yang Yang, R. Hua, Xufeng Guo, B. Ye, T. Mao, Zhigang Li
探讨应用宁波胜杰康生物科技有限公司生产的磁括约肌增强器置入食管下端手术操作的临床技术要点。2018年8月至2018年11月共6例患者经严格筛选入组,患者平卧位,通过腹腔镜的方式游离胃-食管交接区左、右侧缘与食管裂孔左、右侧缘,显露左侧胃食管交接区。食管后壁迷走神经前套带将食管提起,游离食管后壁组织,观察裂孔发育情况;如裂孔较大,予以不可吸收线修补,测量器由副操作孔导入测量食管周径,根据测量数值决定磁力环大小。磁力环由主操作孔送入,食管后壁迷走神经前方、迷走神经肝支上方经食管后壁包绕食管,磁力环在食管前方自行锁紧。手术顺利,无术后并发症,中位手术时间61.5 min(58~101)min,术后第1天造影,无造影剂外泄,磁力环开闭良好,予以半流质饮食。患者中位总住院4.5天(3~7)天。术后住院时间最长4天,最短2天,中位时间3天,出院前均未发现不良事件。术后1年6例均完成GERD-HRQL评分,食管功能测试完成4例,24 h酸暴露时间、Demeester评分,结果显示GERD-HRQL,24 h酸暴露时间、Demeester评分均较术前显著下降。1例患者述仍时有反酸,间断服用PPI药物,其余5例患者停服PPI药物。磁力环装置可通过腔镜方便置入,术中关键点在于保留迷走神经肝支、食管裂孔的显露、迷走神经后干显露、磁力环选择。
探讨应用宁波胜杰康生物科技有限公司生产的磁括约肌增强器置入食管下端手术操作的临床技术要点。2018年8月至2018年11月共6例患者经严格筛选入组,患者平卧位,通过腹腔镜的方式游离胃-食管交接区左、右侧缘与食管裂孔左、右侧缘,显露左侧胃食管交接区。食管后壁迷走神经前套带将食管提起,游离食管后壁组织,观察裂孔发育情况;如裂孔较大,予以不可吸收线修补,测量器由副操作孔导入测量食管周径,根据测量数值决定磁力环大小。磁力环由主操作孔送入,食管后壁迷走神经前方、迷走神经肝支上方经食管后壁包绕食管,磁力环在食管前方自行锁紧。手术顺利,无术后并发症,中位手术时间61.5 min(58~101)min,术后第1天造影,无造影剂外泄,磁力环开闭良好,予以半流质饮食。患者中位总住院4.5天(3~7)天。术后住院时间最长4天,最短2天,中位时间3天,出院前均未发现不良事件。术后1年6例均完成GERD-HRQL评分,食管功能测试完成4例,24 h酸暴露时间、Demeester评分,结果显示GERD-HRQL,24 h酸暴露时间、Demeester评分均较术前显著下降。1例患者述仍时有反酸,间断服用PPI药物,其余5例患者停服PPI药物。磁力环装置可通过腔镜方便置入,术中关键点在于保留迷走神经肝支、食管裂孔的显露、迷走神经后干显露、磁力环选择。
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引用次数: 0
Combined epicardial and transapical endocardial radiofrequency ablation for ventricular tachycardia with ventricular aneurysm in a porcine model 心外膜与经根尖心内膜联合射频消融治疗猪室性心动过速伴室性动脉瘤
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.008
Bo Li, Changcheng Liu, Liangshan Wang, Haiming Li, Longsheng Dai, C. Gu
Objective To evaluate the feasibility and validity of combined directly epicardial and transapical endocardial substrate ablation guided by Carto mapping for ventricular tachycardia(VT) with left ventricular aneurysm(LVA) intra-operation in a swine model. Methods Twenty-four swine models with sustained VT and LVA were randomly divided into study group(radiofrequency ablation, RFCA, from epicardium via direct-view and endocardium via transapical access, 12 cases) and control group(endocardial RFCA via retrograde transaortic access, 12 cases). Substrate mapping for captured abnormal potentials via endocardium and epicardium was used to precisely locate the low-voltage areas. After ablation in two groups, VT was induced again to compare the effectiveness of different RFCA strategies. Results Three dimensional electro-anatomic mapping was implemented successfully in two groups under open chest. And VT substrates were largely located in the border zone of LVA. All objects in the study group underwent endocardial ablation via transapical access smoothly without operative failure. When VT inducing again, 2 cases of study group was with inducible VT, however, VT recurrence in control group was 5 cases, P=0.04. Conclusion Combined direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy. Key words: Tachycardia, ventricular; Ventricular aneurysm; Radiofrequency ablation; Animal model
目的探讨Carto定位引导下心外膜直接与经心尖心内膜底物联合消融治疗猪左室动脉瘤合并室性心动过速(VT)的可行性和有效性。方法将24只持续VT和LVA的猪模型随机分为研究组(经心外膜直视和经根尖通道心内膜射频消融)和对照组(经主动脉逆行通道心内膜射频消融)12例。通过心内膜和心外膜捕获异常电位的底物映射,精确定位低压区。两组消融后再次诱发室速,比较不同RFCA策略的效果。结果两组均在开胸下成功进行了三维电解剖测图。VT底物主要位于LVA的边界区。研究组所有患者均顺利通过经根尖通道行心内膜消融,无手术失败。再次诱发室速时,研究组2例为诱导性室速,对照组室速复发5例,P=0.04。结论直接心外膜和经心尖心内膜底物定位联合消融治疗开胸LVA术治疗室性心动过速是可行和有效的。关键词:心动过速;室性;心室动脉瘤;射频消融术;动物模型
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引用次数: 0
Aorta-anonymous venous fistula due to pacing electrode lead: one case report 起搏电极导联所致主动脉匿名静脉瘘1例报告
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.013
Xiaocheng Gu, Shaoqin Li, Z. Jia
62岁女患者,置入起搏器14年,诊断为起搏电极导线所致主动脉-无名静脉瘘,外科手术修补。术后心力衰竭症状消失,患者恢复良好。本例提示,有起搏器置入史患者,起搏电极导线可导致主动脉-无名静脉瘘,引起心功能衰竭。
62岁女患者,置入起搏器14年,诊断为起搏电极导线所致主动脉-无名静脉瘘,外科手术修补。术后心力衰竭症状消失,患者恢复良好。本例提示,有起搏器置入史患者,起搏电极导线可导致主动脉-无名静脉瘘,引起心功能衰竭。
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引用次数: 0
Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants: surgical experiences and clinical results 双膜片和右心室尖排除技术修复婴儿瑞士奶酪型室间隔缺损9例:手术经验和临床效果
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.004
Qin Wu, Lei Shi, Yong Di, Yueyi Ren, Kuiliang Wang, Rui Chen
Objective To reviewe our clinical experience on biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants. Methods From March 2014 to March 2019, a series of 9 patients(M/F=2/7) with Swiss-cheese ventricular septal defects were admitted in our center to receive surgical treatment, with a median age of 4.8(2-12) months and a median body weight of 4.5(3.7-6.8) kg. All the 9 cases were symptomatic with shortness of breath and sweating. All the patients received echocardiography, ECG and chest X-ray. 3 patients with other intracardiac anomalies received CT angiography and 1 with severe pulmonary hypertension had transcatheter angiography. 4 cases of 9 had antenatal echocardiography but with no positive findings. The median cardiothoracic ratio was 0.63(0.58-0.72). 8 cases underwent one-stage surgical repair with the two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique following a previous pulmonary artery banding procedure. The surgical repair was carried out with cardiopulmonary bypass under moderate hypothermia and using HTK cardioplagia to stop the heart in all the 9 cases. 2 fresh autologous pericardium patchs were used to closure defects of the outflow tract area and the apex trabecular defects respectively by excluding the apex of the right ventricle from the right ventricular inflow. Other intracardiac anomalies were corrected simultaneously. Patients were strictly followed up with a stanard protocol. Results All the operations were successful. Median cardiopulmonary bypass time and aortic clamping time were 96(68-167)min and 68(43-122)min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The time of mechincal ventilation and ICU stay were 131.3(32-328)hours and 8.7(5-31)days respectively. All the patients were discarged in 11.5(9-42)days after operation. There was no mortality and major complication except for 1 case of low cardiac output syndrome, 2 cases of ventilator associated pnumonia and 2 cases of residual shunt(less than 2 mm). All the patients were followed up for 3.2 years(1 month-9 years). There was no death and major complication. The latest echocardiography results showed that the left and right heart function was normal in all the cases. Conclusion Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants can be relatively easy with favorable early and mid-term results. Long term results need to be evaluated with more cases. Key words: Ventricular septal defects; Surgical repair
目的总结应用双膜片和右心室尖排除技术修复婴儿瑞士奶酪型室间隔缺损9例的临床经验。方法2014年3月至2019年3月,我中心收治瑞士奶酪型室间隔缺损患者9例(M/F=2/7),接受手术治疗,中位年龄4.8(2-12)个月,中位体重4.5(3.7-6.8)kg。9例患者均以呼吸急促、出汗为主。所有患者均行超声心动图、心电图及胸片检查。3例其他心内异常行CT血管造影,1例重度肺动脉高压行经导管血管造影。9例中有4例进行了产前超声心动图检查,但未见阳性结果。中位心胸比为0.63(0.58-0.72)。8例患者采用双膜片和排除右心室尖技术进行一期手术修复,1例患者在先前的肺动脉绑扎手术后采用相同技术进行二期手术修复。9例患者均在中低温下行体外循环手术修复,并采用HTK心脏停搏术。采用2块新鲜自体心包片分别封闭流出道区缺损和小梁尖顶缺损,将右心室尖顶与右心室流入隔离。其他心内异常同时矫正。按照标准方案对患者进行严格随访。结果所有手术均成功。中位体外循环时间为96(68 ~ 167)min,主动脉夹持时间为68(43 ~ 122)min。2例在术后48 ~ 72小时内完成延迟闭胸。机械通气时间131.3(32 ~ 328)小时,ICU住院时间8.7(5 ~ 31)天。所有患者均于术后11.5(9 ~ 42)d弃体。除1例低心排血量综合征、2例呼吸机相关性肺炎和2例残余分流(小于2mm)外,无死亡和主要并发症。随访时间为3.2年(1个月-9年)。无死亡和主要并发症。最新超声心动图结果显示,所有病例左、右心功能均正常。结论采用新鲜自体心包双膜片及排除右心室尖技术修补婴幼儿瑞士奶酪型室间隔缺损相对容易,早期和中期效果良好。需要用更多的病例来评估长期结果。关键词:室间隔缺损;手术修复
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引用次数: 0
Conventional and sutureless techniques for surgical repair of supracardiac total anomalous pulmonary venous connection 常规与无缝线技术修复心上肺静脉全异位连接
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.003
Furong Liu, J. Zhuang, Jimei Chen, S. Wen, Gang Xu, J. Cen
Objective To review our experiences with conventional and sutureless techniques in patients with supracardiac total anomalous pulmonary venous connection. Methods From January 2004 to January 2016, 150 patients with suparacardiac total anomalous pulmonary venous connection underwent conventional or sutureless techniques. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model was used to identify risk factors for death and postoperative pulmonary venous obstruction(PVO). Results There were 9 in-hospital deaths and 2 late deaths. The survival rates at 30 days, 1 year, and 12 years were 94.0%, 93.3%, and 92.7%, respectively. Follow-up was completed in 95.7% of the survivors. Median follow-up was 47 months(range: 0-136 months). Twenty-one patients required reoperation for pulmonary venous obstruction. The survival rates in neonate group is significantly lower than that in infants and children group(P=0.026). For those who were diagnosed with preoperative PVO, the survival rates(conventional group 92.3% VS sutureless group 93.9%, P=0.741) and incidence of freedom from reoperation(conventional group 55.6% VS sutureless group 90.9%, P=0.166) in both the conventional and sutureless group were similar. Multivariable analysis showed that preoperative pulmonary venous obstruction(P=0.015) and longer duration of ventilation(P=0.011) were incremental risk factors for death. Aortic cross-clamp time(P=0.038) was associated with postoperative pulmonary venous obstruction. Conclusion Both the conventional and sutureless techniques in surgical repair for supracardiac total anomalous pulmonary venous connection can achieve satisfactory outcomes. Key words: Total anomalous pulmonary venous connection; Surgical outcomes; Pulmonary venous obstruction; Sutureless technique
目的总结常规与无缝线技术治疗心上肺静脉全异位的经验。方法2004年1月至2016年1月,对150例心旁全异常肺静脉连接患者行常规或不缝合术。Kaplan-Meier曲线用于证明生存估计。采用Cox比例风险模型确定死亡和术后肺静脉阻塞(PVO)的危险因素。结果住院死亡9例,晚期死亡2例。30天、1年、12年生存率分别为94.0%、93.3%、92.7%。95.7%的幸存者完成了随访。中位随访时间为47个月(范围:0-136个月)。21例患者因肺静脉阻塞需再次手术。新生儿组生存率明显低于婴幼儿组(P=0.026)。对于术前诊断为PVO的患者,常规组和不缝合组的生存率(92.3% VS 93.9%, P=0.741)和再手术自由发生率(55.6% VS 90.9%, P=0.166)相似。多因素分析显示,术前肺静脉阻塞(P=0.015)和通气时间延长(P=0.011)是增加的死亡危险因素。主动脉交叉夹持时间与术后肺静脉阻塞相关(P=0.038)。结论常规和无缝线技术均可获得满意的效果。关键词:全异常肺静脉连接;手术结果;肺静脉阻塞;Sutureless技术
{"title":"Conventional and sutureless techniques for surgical repair of supracardiac total anomalous pulmonary venous connection","authors":"Furong Liu, J. Zhuang, Jimei Chen, S. Wen, Gang Xu, J. Cen","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.12.003","url":null,"abstract":"Objective \u0000To review our experiences with conventional and sutureless techniques in patients with supracardiac total anomalous pulmonary venous connection. \u0000 \u0000 \u0000Methods \u0000From January 2004 to January 2016, 150 patients with suparacardiac total anomalous pulmonary venous connection underwent conventional or sutureless techniques. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model was used to identify risk factors for death and postoperative pulmonary venous obstruction(PVO). \u0000 \u0000 \u0000Results \u0000There were 9 in-hospital deaths and 2 late deaths. The survival rates at 30 days, 1 year, and 12 years were 94.0%, 93.3%, and 92.7%, respectively. Follow-up was completed in 95.7% of the survivors. Median follow-up was 47 months(range: 0-136 months). Twenty-one patients required reoperation for pulmonary venous obstruction. The survival rates in neonate group is significantly lower than that in infants and children group(P=0.026). For those who were diagnosed with preoperative PVO, the survival rates(conventional group 92.3% VS sutureless group 93.9%, P=0.741) and incidence of freedom from reoperation(conventional group 55.6% VS sutureless group 90.9%, P=0.166) in both the conventional and sutureless group were similar. Multivariable analysis showed that preoperative pulmonary venous obstruction(P=0.015) and longer duration of ventilation(P=0.011) were incremental risk factors for death. Aortic cross-clamp time(P=0.038) was associated with postoperative pulmonary venous obstruction. \u0000 \u0000 \u0000Conclusion \u0000Both the conventional and sutureless techniques in surgical repair for supracardiac total anomalous pulmonary venous connection can achieve satisfactory outcomes. \u0000 \u0000 \u0000Key words: \u0000Total anomalous pulmonary venous connection; Surgical outcomes; Pulmonary venous obstruction; Sutureless technique","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"47 1","pages":"721-725"},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78631553","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
Application of modified David technique to aortic sinus repair in acute type A aortic dissection 改良David技术在急性A型主动脉夹层主动脉窦修复中的应用
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.005
Long Wu, K. Zhang, Xiaofan Huang, Xianqing Feng, Yu Song, Baoqing Liu, Xionggang Jiang, N. Dong
Objective To summarize the effect of modified David technique on acute type A aortic dissection sinus formation. Methods From March 2018 to September 2018, modified David technique was applied to aortic sinus remodeling in acute A-type aortic dissection in 19 patients, 13 males and 6 females. The age was 45-67(50.42±15.37) years old and the weight was 45-112(60.32±25.18) kg. Single sinus(noncoronary sinus) was repaired in 15 cases, double sinus formation(noncoronary sinus+ right coronary sinus+ coronary artery transplantation) in 2 cases, left sinus Florid sleeve technical treatment plus double sinus formation(noncoronary sinus+ right coronary sinus+ coronary artery transplantation) in 1 case, Single sinus(noncoronary sinus) repaired and aortic vavle replacement in 1 case. Frozen elephant trunk and total arch replacement in 13 cases, hemiarch replacement in 3 cases. Results There were no deaths in this group. The cardiopulmonary bypass time was 176-245(193.27±32.46) minutes, the aortic cross clamp time was 105-187(122.36±18.57)minutes, and the operation time was 6.5-11.0(7.63±1.31) hours. The mechanical ventilation time was 18-122(48.27±34.73)hours, the intensive care unit stay time was 2-10(5.35±2.62) days, and the postoperative hospital stay was 7-22(12.63±3.25)days. There was no delayed sternal closure during operation, and there was no secondary thoracotomy after operation. One patient developed a transient advanced atrioventricular block. Transient neurological dysfunction was observed in 5 patients. All patients were followed up for more than half a year. The color Doppler echocardiography and computed tomography angiograph(CTA)showed no aortic regurgitation or residual dissection. Conclusion The application of modified David technique in the remodeling of aortic root sinus in acute type A aortic dissection is an effective technique with relatively simple process, which is worth promoting. Key words: Aortic dissection; David procedure; Aotic sinus repair
目的总结改良David技术在急性A型主动脉夹层窦形成中的应用效果。方法2018年3月~ 2018年9月,对19例急性a型主动脉夹层患者(男13例,女6例)应用改良David技术进行主动脉窦重构。年龄45 ~ 67(50.42±15.37)岁,体重45 ~ 112(60.32±25.18)kg。单窦(非冠状窦)修复15例,双窦形成(非冠状窦+右冠状窦+冠状动脉移植)2例,左窦花式套筒技术治疗+双窦形成(非冠状窦+右冠状窦+冠状动脉移植)1例,单窦(非冠状窦)修复+主动脉瓣置换术1例。冷冻象鼻及全弓置换术13例,半弓置换术3例。结果本组无死亡病例。体外循环时间为176 ~ 245(193.27±32.46)min,主动脉交叉夹持时间为105 ~ 187(122.36±18.57)min,手术时间为6.5 ~ 11.0(7.63±1.31)h。机械通气时间18 ~ 122(48.27±34.73)小时,重症监护病房住院时间2 ~ 10(5.35±2.62)天,术后住院时间7 ~ 22(12.63±3.25)天。术中无延迟闭合胸骨,术后无二次开胸。一名患者出现了一过性晚期房室传导阻滞。5例患者出现短暂性神经功能障碍。所有患者均随访半年以上。彩色多普勒超声心动图和计算机断层血管造影(CTA)显示无主动脉反流或残余夹层。结论改良David技术应用于急性A型主动脉夹层主动脉根窦重构是一种有效的技术,过程相对简单,值得推广。关键词:主动脉夹层;大卫过程;耳窦修复
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引用次数: 0
Current status of surgical diagnosis and treatment of pulmonary malignant ground glass nodules 肺恶性磨玻璃结节的外科诊断与治疗现状
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.014
Liang Cheng, Zhong Jiang, Wei Gao, Yongsheng Zhao, M. Fu
In recent years, with the development of imaging technology, more and more ground-glass Nodule (GGN) in the lungs have been discovered. After GGN is detected, it should be further judged whether it is benign or malignant by combining with existing inspection methods. Common diagnostic and examination methods include PET/CT, fiberoptic bronchoscopy, CT-guided puncture biopsy and High Resolution CT (HRCT), each of them with its own advantages and disadvantages. For GGN with high malignant risk, minimally invasive surgical intervention is needed to prevent the progress of the disease. The hot issues of surgical treatment include the selection of minimally invasive surgical methods, the precise positioning of GGN in the lung, the accuracy and limitations of intraoperative freezing examination, lymph node dissection of GGN, and postoperative follow-up of malignant GGN diagnosed as cancer. Under the premise that surgical diagnosis and treatment play an increasingly important role in the management of GGN, this paper will review the existing GGN related studies and make a summary of the surgical diagnosis and treatment of malignant GGN.
近年来,随着影像技术的发展,越来越多的肺部磨玻璃结节(GGN)被发现。检测到GGN后,应结合现有的检查方法进一步判断其是良性还是恶性。常用的诊断和检查方法有PET/CT、纤维支气管镜检查、CT引导穿刺活检和高分辨率CT (HRCT),各有优缺点。对于恶性风险高的GGN,需要微创手术干预,防止病情发展。手术治疗的热点问题包括微创手术方式的选择、GGN在肺部的精确定位、术中冷冻检查的准确性和局限性、GGN淋巴结清扫、恶性GGN诊断为癌症的术后随访等。在手术诊断和治疗在GGN的治疗中发挥越来越重要的作用的前提下,本文将回顾已有的GGN相关研究,对恶性GGN的手术诊断和治疗进行总结。
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引用次数: 0
期刊
Chinese Journal of Thoracic and Cardiovaescular Surgery
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