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The impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection patients undergoing aortic surgery 术前双重抗血小板治疗对急性A型主动脉夹层手术患者早期预后的影响
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.006
Fucheng Xiao, Y. Ge, Chengnan Li, Z. Qiao, Haiou Hu, Li-Zhong Sun, Junming Zhu
Objective To evaluate the impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection(ATAAD) patients undergoing aortic surgery. Methods From December 2015 to November 2017, 45 consecutive patients with ingestion of aspirin and clopidogrel underwent aortic repair surgery at our center. 37 out of 45 patients(83%) were propensity-matched with 74 control ATAAD patients without antiplatelet therapy undergoing aortic surgery in 1∶2 fashion. Thereby, bleeding-related outcome(death, reoperation for bleeding, postoperative blood loss within 12 h ≥2 000 ml and usage of rFⅦa) and blood transfusion requirement were compared. Results Bleeding-related outcome occurred in 14(18.9%) and 9(24.3%) patients in control and antiplatelet group respectively(P=0.51). Postoperative blood loss within 12 hours was 490 ml in control group, compared to 500 ml in the antiplatelet group(P=0.85). There were no significant differences among the two groups in transfusion requirements of red blood cells, platelets and fresh frozen plasma. Multivariate regression analysis identified antiplatelet therapy as an nonsignifcant risk factor for bleeding-related outcome(OR=2.97, 95%CI: 0.87-10.21, P=0.08). Conclusion Preoperative dual antiplatelet therapy was not associated with increased risk of bleeding-related outcome and transfusion requirement, and was not a contraindication of emergent surgery for ATAAD patients. Key words: Aortic dissection; Aortic disease; Antiplatelet therapy
目的探讨术前双重抗血小板治疗对急性A型主动脉夹层(ATAAD)手术患者早期预后的影响。方法2015年12月至2017年11月,在我中心连续45例摄入阿司匹林和氯吡格雷的患者行主动脉修复手术。45例ATAAD患者中有37例(83%)与74例未接受抗血小板治疗且接受主动脉手术的ATAAD对照患者呈1∶2的倾向匹配。因此,比较出血相关结局(死亡、再出血手术、术后12 h内出血量≥2 000 ml和rFⅦa的使用)和输血需求。结果对照组和抗血小板组出血相关结局分别为14例(18.9%)和9例(24.3%)(P=0.51)。对照组术后12 h内出血量490 ml,抗血小板组术后出血量500 ml (P=0.85)。两组患者红细胞、血小板和新鲜冷冻血浆的输血需要量无显著差异。多因素回归分析发现抗血小板治疗是出血相关结局的非显著危险因素(OR=2.97, 95%CI: 0.87-10.21, P=0.08)。结论术前双重抗血小板治疗与出血相关结局和输血需求风险增加无关,也不是ATAAD患者紧急手术的禁忌症。关键词:主动脉夹层;主动脉疾病;抗血小板治疗
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引用次数: 0
Endovascular repair combined with fenestrated stent grafts in treating aortic arch lesions 血管内修复联合开窗支架移植治疗主动脉弓病变
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.007
Wentao Gao, Min Zhou, Guangmin Yang, Muzhapa Maihemutijiang, Ming Zhang, Wei Wang, Dian Huang, Xiaoqiang Li
Objective To evaluate endovascular repair combined with fenestrated stent grafts for the treatment of aortic dissection or aneurysm involving aortic arch. Methods From Jun 2017 to Dec 2018, 30 patients of complicated aortic arch lesions were treated with endovascular repair combined with fenestrated endografts. 26 male and 4 female, aged(53±16) years. All patients had hypertension. 12 cases were treated via needle based in situ fenestration, another 16 cases using physician modified stent grafts, while 2 cases combining these two methods to achieve optimal fenestration. Patients were followed by receiving CTA for mortality, patency of bridging stents, endoleaks and complications. Results Operations were performed successfully in all cases. The median follow-up is 8.5 months. There was no aorta-related mortality. 1 patient developed cerebral infarction and 1 had hydropericardium. Type Ⅲ endoleaks were observed in 5 patients, no reintervention. All target vessels were patent during the follow up. Conclusion Fenestrated stent grafts shows satisfactory short-term outcomes in treating aortic arch lesions. Key words: Aortic arch; TEVAR; Fenestrated stent grafts
目的探讨血管内修复联合开窗支架移植治疗主动脉夹层或累及主动脉弓的动脉瘤的疗效。方法2017年6月至2018年12月,对30例复杂主动脉弓病变患者行血管内修复联合开窗内移植术。男26例,女4例,年龄(53±16)岁。所有患者均有高血压。12例采用针基原位开窗治疗,16例采用医师改良支架,2例采用两种方法联合治疗达到最佳开窗效果。患者接受CTA随访,观察死亡率、搭桥支架通畅度、内漏和并发症。结果所有病例均手术成功。中位随访时间为8.5个月。无主动脉相关死亡。1例发生脑梗死,1例心包积液。5例患者出现Ⅲ型内漏,无再干预。随访时所有靶血管均通畅。结论开窗支架治疗主动脉弓病变短期疗效满意。关键词:主动脉弓;TEVAR;开窗支架移植
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引用次数: 0
Cystic aneurysm of the azygos vein-case series 奇静脉-病例系列的囊性动脉瘤
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.010
Xiaojun Du, Hong Xie, Yan Zhang, Lilian Tu, Fangfang Han, Fan Yang, Shi Zhou, Jiarong Xiao
囊状奇静脉瘤是少见的肿瘤样疾病,病因与发病机制待明确。多数患者为偶然发现,典型病例影像学表现可能有一定的特征性,需与纵隔内肿瘤相鉴别。治疗方法尚缺乏统一规范。本文报道我中心收治的3例囊状奇静脉血管瘤诊疗情况,结合已发表文献,对囊状奇静脉血管瘤的流行病学特点、发病机制、诊断和治疗做一回顾。
囊状奇静脉瘤是少见的肿瘤样疾病,病因与发病机制待明确。多数患者为偶然发现,典型病例影像学表现可能有一定的特征性,需与纵隔内肿瘤相鉴别。治疗方法尚缺乏统一规范。本文报道我中心收治的3例囊状奇静脉血管瘤诊疗情况,结合已发表文献,对囊状奇静脉血管瘤的流行病学特点、发病机制、诊断和治疗做一回顾。
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引用次数: 1
China transcatheter aortic valve implantation(TAVI) technology heart team model 中国经导管主动脉瓣植入术(TAVI)技术心脏团队模型
Pub Date : 2019-12-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.12.002
Xu Meng, Zhiyun Xu, Haibo Zhang
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引用次数: 0
Surgical treatment of severe aortic stenosis with septal hypertrophy 重度主动脉瓣狭窄合并间隔肥厚的外科治疗
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.006
Gongcheng Huang, Liliang Shu, Chen Huang, Z. Xiaohua, Ma Guofeng, Yue Wang, Fan Feng, Jing Xu
Objective To summarize the experience of surgical treatment of 18 cases of severe aortic stenosis with ventricular septum hypertrophy. Methods Clinical data of 18 patients with severe aortic stenosis admitted to the first affiliated hospital of zhengzhou university from January 2013 to December 2016 were collected. There were 7 males and 11 females. The mean age was (50.4±4.2) years old. All patients were diagnosed with severe stenosis of main artery valve by echocardiography before surgery, with mean aortic valve orifice area (0.57±0.11) cm2, cardiac function (NYHA classification) grade Ⅱ in 4 patients, grade Ⅲ in 9 patients, and grade Ⅳ in 5 patients. There were 8 patients with mild aortic valve insufficiency, 4 patients with mild to moderate mitral valve insufficiency, 2 patients with moderate to severe aortic valve insufficiency, 3 patients with ascending aorta dilatation (ascending aorta inner diameter>4.5 cm), and 1 patient with atrial fibrillation. Interventricular septum thickness (15.82±2.04)mm, left ventricular posterior wall thickness (14.04±1.28)mm, ratio of interventricular septum thickness to left ventricular posterior wall thickness (IVS/LVPW) 1.12±0.91, inner diameter of left ventricular outflow tract (19.01±1.74)mm, cross-lobe differential pressure (102±8.40) mmHg (1 mmHg=0.133 kPa), left ventricular ejection fraction (LVEF) mean 0.49±0.05. Left ventricular end-diastolic diameter (LVEDD) (53.33±4.00) mm, left ventricular end-systolic diameter (LVESD) (27.11±1.99) mm, and left ventricular mass index (277.1±37.3) g/m2. All patients underwent aortic valve replacement (AVR) and partial interventricular septum resection under general anesthesia and conventional extracorporeal circulation, 2 patients underwent mitral valve formation (artificial valve ring), 2 patients underwent ascending aorta formation, and 1 patient underwent ascending aorta wrapping. During the operation, the time of extracorporeal circulation, aortic occlusion, number of defibrillation during the operation, type of valve implantation and postoperative complications were recorded. Regular follow-up was conducted to analyze the changes of various indexes at different preoperative and postoperative time. Results There was no death in the whole group. 2 patients were treated with temporary pacemakers. After drug treatment, sinus rhythm was restored on the 3rd and 6th day after surgery, and temporary pacemakers were removed. Echocardiography reexamination 1 week after the operation showed that all patients had a good artificial valve function and 2 patients had minor regurgitation of mitral valve. The difference in pressure across the valve, inner diameter of the left ventricular outflow tract, cardiac function classification, ventricular septum thickness, valve orifice area, and left ventricular mass index were significantly improved compared with the preoperative level (P<0.05). LVEF, LVEDD, and LVESD were compared with the preoperative level (P<0.05). Af
目的总结18例重度主动脉瓣狭窄合并室间隔肥厚的手术治疗经验。方法收集2013年1月至2016年12月郑州大学第一附属医院收治的18例重度主动脉瓣狭窄患者的临床资料。男性7人,女性11人。平均年龄(50.4±4.2)岁。所有患者术前超声心动图均诊断为主动脉瓣严重狭窄,平均主动脉瓣口面积(0.57±0.11)cm2,心功能(NYHA)分级Ⅱ级4例,Ⅲ级9例,Ⅳ级5例。轻度主动脉瓣不全8例,轻度至中度二尖瓣不全4例,中度至重度主动脉瓣不全2例,升主动脉扩张3例(升主动脉内径>4.5 cm),心房颤动1例。室间隔厚度(15.82±2.04)mm,左室后壁厚度(14.04±1.28)mm,室间隔厚度与左室后壁厚度之比(IVS/LVPW) 1.12±0.91,左室流出道内径(19.01±1.74)mm,左叶间压差(102±8.40)mmHg (1 mmHg=0.133 kPa),左室射血分数(LVEF)平均值0.49±0.05。左室舒张末期内径(LVEDD)(53.33±4.00)mm,左室收缩末期内径(LVESD)(27.11±1.99)mm,左室质量指数(277.1±37.3)g/m2。所有患者均在全麻常规体外循环下行主动脉瓣置换术(AVR)和部分室间隔切除术,2例行二尖瓣成形术(人工瓣环),2例行升主动脉成形术,1例行升主动脉包裹术。记录术中体外循环时间、主动脉阻塞情况、术中除颤次数、瓣膜植入类型及术后并发症。定期随访,分析术前、术后不同时间各项指标的变化。结果全组无死亡病例。2例患者使用临时起搏器。经药物治疗,术后第3、6天窦性心律恢复,取下临时起搏器。术后1周复查超声心动图显示所有患者人工瓣膜功能良好,2例患者二尖瓣轻度返流。与术前相比,两组间瓣膜压差、左室流出道内径、心功能分级、室间隔厚度、瓣膜口面积、左室质量指数差异均有显著改善(P<0.05)。LVEF、LVEDD、LVESD与术前比较(P<0.05)。随访6个月后,LVEF、LVEDD与术前比较差异有统计学意义(P<0.05)。结论重度主动脉瓣狭窄合并室间隔肥厚合并部分室间隔肌切除是AVR过程中一种简单的附加手术,不增加手术风险,效果显著,有利于术后左心室功能恢复。关键词:重度主动脉瓣狭窄;隔肌切除术;基底间隔肥厚不对称
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引用次数: 0
Clinical research of reintervention for children with postoperative valve disease 儿童瓣膜病术后再干预的临床研究
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.007
K. Luo, Jinghao Zheng, Zhongqun Zhu, Qi Sun, Xiaomin He, Zhiwei Xu, Jinfen Liu
Objective The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease. Methods The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep. 2004 to Mar. 2019 were retrospectively analysed, including 85 males and 54 females. The age ranged from 8-175 months, and the weight ranged from 6.2-75.9 kg. With a mid-long term follow-up (2-133 months), the echocardiography result showed: 40 cases of aortic valve disease, 49 cases of mitral valve disease, 32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease. All patients underwent reintervetion treatment, the distribution of reintervention methods were shown as follow: 47 cases of valve replacement, 40 cases of valvuloplasty, 23 cases of annuloplasty and 29 case of valve reconstruction. Results There were 6 in-hospital deaths with a mortality of 4.3%. The death cases included 2 cases of aortic disease, 2 cases of mitral disease, 1 case of tricuspid disease and 1 case of pulmonary disease. The early postoperative causes of death were acute myocardial failure, multiple organ failure and severe hyoxemia. Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock. All survivors were under a follow-up of 4-148 months. The echocardiography showed the velocity of 92.3% valve stenosis patients had decreased significantly (P<0.05); the insufficient grades of 84.9% patients had reduced and maintained under morderate degree. 6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve, 2 cases of pulmonary valve and 1 case of mitral valve. The cardiac function of survival patients has been improved after reintervtion, 83.1% patients maintained cardiac function at NYHA Ⅰ/Ⅱ at follow-up. The long-term survival rates of 4 valve disease were all over 90%. Conclusion The anatomical structure of chilidren’s valve is complicated and various, valve insufficiency and stenosis often occured after operation. The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy, which could effectly correct abnormal valve structure, promote cardiac function and improve living quality. Key words: Valve disease of children; Valvular insufficiency; Valvular stenosis; Reintervention
目的探讨和评价儿童瓣膜术后疾病再干预的时机和效果。方法回顾性分析2004年9月至2019年3月在SCMC行再介入治疗的139例瓣膜病术后患者的临床资料,其中男85例,女54例。年龄8 ~ 175月龄,体重6.2 ~ 75.9 kg。经中长期随访(2 ~ 133个月),超声心动图结果显示:主动脉瓣病变40例,二尖瓣病变49例,三尖瓣病变32例,肺动脉瓣病变18例。所有患者均接受再介入治疗,再介入方式分布如下:瓣膜置换术47例,瓣膜成形术40例,瓣膜成形术23例,瓣膜重建术29例。结果住院死亡6例,死亡率4.3%。死亡病例包括主动脉疾病2例,二尖瓣疾病2例,三尖瓣疾病1例,肺部疾病1例。术后早期死亡原因为急性心肌衰竭、多脏器功能衰竭和严重低氧血症。3例术后8 ~ 26个月因心功能不全和心源性休克延迟死亡。所有幸存者随访4 ~ 148个月。超声心动图显示92.3%的瓣膜狭窄患者血流速度明显降低(P<0.05);84.9%患者的不良评分降低并维持在中度以下。中期随访中出现严重功能不全或狭窄6例再次手术,其中主动脉瓣3例,肺动脉瓣2例,二尖瓣1例。存活患者的心功能在再干预后得到改善,83.1%的患者在NYHA随访时维持心功能Ⅰ/Ⅱ。4例瓣膜疾病的远期生存率均在90%以上。结论儿童瓣膜解剖结构复杂多样,术后常发生瓣膜功能不全和狭窄。再干预时机应根据临床症状和心功能选择。根据瓣膜解剖特点,个性化设计手术,可有效纠正瓣膜结构异常,促进心功能,提高生活质量。关键词:儿童瓣膜病;瓣膜闭锁不全;瓣膜狭窄;Reintervention
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引用次数: 0
Application of vacuum bell in the treatment of pectus excavatum 真空钟在漏斗胸治疗中的应用
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.015
Qian Zhang, Na Zhang, Cheng-hao Chen, Jie Yu, Q. Zeng
The treatment of pectus excavatum has always given priority to surgical treatment, the vacuum bellis used as aconservative treatment and auxiliary operationin the treatment of pectus excavatum at present. And its role in the treatment of pectus excavatum is gradually accepted by doctors at home and abroad. We also have more and more recognition and understanding about its application. In this paper, we review vacuum bell on the usage, indications and contraindications, side effects, using effects, intraoperative use, optimum age for use, correlation study of negative pressure and mechanics.
对于漏斗胸的治疗一直以手术治疗为主,目前在漏斗胸的治疗中采用真空腹部作为保守治疗和辅助手术。其在治疗漏斗胸中的作用逐渐被国内外医生所接受。我们对它的应用也有了越来越多的认识和了解。本文就真空钟的用法、适应症、禁忌症、副作用、使用效果、术中使用、最佳使用年龄、负压与力学的相关性研究等方面进行综述。
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引用次数: 0
A control study of measuring thoracic cage indexes in 3-17 years old healthy children and children with pectus excavatum 3-17岁健康儿童与漏斗胸儿童胸廓指数测定的对照研究
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.001
Qian Zhang, Q. Zeng, Na Zhang, Cheng-hao Chen, Jie Yu, Jihang Sun, Yun Peng
Objective To provide data references for Nuss procedure biomechanics research, and to understand morphological pathological changes in children with pectus excavatum. Methods A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution. The anterior rib width(RW), anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient. The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic. The measurement indexes were compared between healthy children and children with pectus excavatum. Results The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm). Children with pectus excavatum compared with healthy children, the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P<0.05), the 3rd and 4th RT were greater than healthy children (P<0.05). Conclusion The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research. By morphology contrast, it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function. Key words: Pectus excavatum; Ribs; Nuss procedure; X-ray
目的为Nuss手术生物力学研究提供数据参考,了解儿童漏斗胸的形态病理变化。方法对我院2009年1月至2015年12月收治的434例漏斗胸进行回顾性分析。测量3 ~ 7根肋骨右侧前肋宽(RW)、前肋间隙宽(IS)和中肋厚度(RT)。比较了儿童漏斗胸的胸廓宽度与目前临床使用的胸廓宽度。比较健康儿童与漏斗胸儿童的各项测量指标。结果青春期前儿童漏斗胸的IS小于目前临床使用的横条宽度(12.7 mm)。漏斗胸患儿与健康儿童比较,漏斗胸患儿4 ~ 6、5 RW小于健康儿童(P<0.05), 3、4 RW大于健康儿童(P<0.05)。结论该测量值对胸大肌的改良和Nuss手术生物力学研究具有一定的指导意义。通过形态学对比,反映出漏斗胸畸形对胸部发育和心肺功能有一定的限制。关键词:漏斗胸;肋骨;主犯过程;x射线
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引用次数: 0
The clinical application of extracorporeal membrane oxygenation in the perioperative period of general thoracic surgery 体外膜氧合在普通胸外科围手术期的临床应用
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.012
Weizhao Huang, Hong-yu Ye, Ying-meng Wu, Z. Cheng, X. Liao, Yi Liang, Binfei Li, Hai-ming Jiang
回顾性分析体外膜肺氧合(ECMO)技术在普胸外科中的应用,总结临床经验。2012年1月至2018年10月共21例普胸外科患者采用ECMO救治,其中男16例,女5例;年龄24~65岁,平均(48.3±10.7)岁。术后急性呼吸窘迫综合征(ARDS)6例,肺移植4例,复杂胸部手术4例,胸部外伤3例,心肺复苏和急性肺栓塞各2例。9例心肺支持患者采用V-A ECMO方式,12例呼吸支持患者采用V-V ECMO方式,平均支持(71.7±42.4)h。2例不能顺利撤机,其中1例因缺氧致中枢神经系统严重损害,且有严重血液破坏,放弃治疗;另1例死于严重出血、循环衰竭。住院死亡5例,分别为术后ARDS 2例,心肺复苏、肺栓塞、胸部外伤各1例。主要并发症为严重出血3例、感染3例、严重血液破坏1例。1例肺移植患者因出血行二次手术。本组研究结果显示ECMO辅助可为胸外科危重症患者的围手术期治疗提供有效的呼吸循环支持,严格掌握适应证、控制并发症有助于提高整体疗效。
回顾性分析体外膜肺氧合(ECMO)技术在普胸外科中的应用,总结临床经验。2012年1月至2018年10月共21例普胸外科患者采用ECMO救治,其中男16例,女5例;年龄24~65岁,平均(48.3±10.7)岁。术后急性呼吸窘迫综合征(ARDS)6例,肺移植4例,复杂胸部手术4例,胸部外伤3例,心肺复苏和急性肺栓塞各2例。9例心肺支持患者采用V-A ECMO方式,12例呼吸支持患者采用V-V ECMO方式,平均支持(71.7±42.4)h。2例不能顺利撤机,其中1例因缺氧致中枢神经系统严重损害,且有严重血液破坏,放弃治疗;另1例死于严重出血、循环衰竭。住院死亡5例,分别为术后ARDS 2例,心肺复苏、肺栓塞、胸部外伤各1例。主要并发症为严重出血3例、感染3例、严重血液破坏1例。1例肺移植患者因出血行二次手术。本组研究结果显示ECMO辅助可为胸外科危重症患者的围手术期治疗提供有效的呼吸循环支持,严格掌握适应证、控制并发症有助于提高整体疗效。
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引用次数: 0
Summary and treatment of special situations in subxiphoid uniportal VATS surgery 剑突下单门VATS手术特殊情况的总结与处理
Pub Date : 2019-11-25 DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.11.005
Jichen Qu, Xin Huang, Deping Zhao, Jian Chen, G. Jiang, Lei Jiang
Objective To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. Methods In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. Results Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known. Key words: Thoracoscopy; Uniportal; Subxiphoid; Operative complications
目的探讨剑突下单门静脉导管内固定术的特殊情况,总结治疗策略。方法于2014年9月行剑突下单门静脉血管辅助手术。截至目前,我课课组已完成剑突下单门VATS手术300余例,其中剑突下单门VATS节段切除术242例,剑突下单门VATS纵隔肿瘤切除术22例。术中遇到心脏骤停、心包填塞、不明原因静脉损伤、严重心律失常、肺段定位困难、小结节定位困难等特殊情况。结果部分患者因术中出现严重心律失常、心脏问题、术中出血等紧急情况而改变手术方式。术后并发症主要有开胸止血、术后持续漏气、肺血肿、心律失常,无围手术期死亡。结论剑突下单门静脉内固定术是胸部微创技术的重要体现。选择合适的病例,掌握胸腔镜技术和特殊的手术技术是安全可行的。在剑突下单门静脉血管辅助手术中的特殊情况应了解。关键词:胸腔镜;Uniportal;Subxiphoid;手术并发症
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Chinese Journal of Thoracic and Cardiovaescular Surgery
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