ObjectiveTo investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients. MethodsWe retrospectively analyzed clinical data of 47 elderly patients undergoing HVR in Affiliated Hospital of Xuzhou Medical College from January 2011 to May 2014. There were 19 male and 28 female patients with their age of 60-79 years. There were 35 patients with rheumatic heart disease, 10 patients with degenerative valvular disease, and 2 patients with congenital bicuspid aortic valve. Preoperatively, there were 23 patients in NYHA functional class Ⅱ, 19 patients in class Ⅲ, and 5 patients in class Ⅳ. All the patients received HVR under cardiopulmonary bypass (CPB), and some patients received concomitant tricuspid valvuloplasty (TVP), left atrial thrombectomy or coronary artery bypass grafting (CABG). Postoperative mortality, morbidity and heart function improvement were evaluated. ResultsTwenty-seven patients received mitral valve replacement (MVR), 15 patients received aortic valve replacement (AVR), and 5 patients received MVR+AVR. Concomitantly, 4 patients received TVP, 3 patients received left atrial thrombectomy, and 6 patients received CABG. Operation time was 138-412 (196±52)minutes, CPB time was 48-301 (108±33)minutes, aortic cross-clamping time was 34-196 (87±21)minutes, and length of hospital stay was 12-31 (19±5)days. There was no intraoperative death, and 2 patients (4.3%)died postoperatively because of left ventricular failure and multiple organ dysfunction syndrome respectively. Twenty-three patients (51.1%)had postoperative complications including respiratory failure in 6 patients, pulmonary infection in 5 patients, arrhythmias in 5 patients, wound infection in 2 patients, pleural effusion in 2 patients, low cardiac output syndrome in 2 patients, and acute renal failure in 1 patient. Forty-five survival patients were followed up by telephone, online video and at the outpatient department for 1-32 months, and follow-up rate was 100%. There were 11 patients in NYHA functional classⅠ, 32 patients in class Ⅱ, and 2 patients in class Ⅲ. ConclusionAccording to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.
目的 討論多窗技術+凝血酶封閉在CT導向下經皮肺穿刺活檢中的應用價值。 方法 2009年6月－2010年3月收集分析由同一工作組連續完成的CT導向下肺穿刺活檢患者共128例，其中A組58例，采用雙窗技術+注射生理鹽水；B組70例，采用多窗技術+注射凝血酶）。比較兩組患者的診斷陽性率、氣胸及肺出血發生率的差異。 結果 128例均穿刺成功，A組的穿刺診斷陽性率、氣胸發生率及肺出血發生率分別為87.9%、13.8%、17.5%。B組的穿刺診斷陽性率為92.9%，氣胸發生率為8.6%，肺出血發生率為5.7%。兩組穿刺診斷陽性率和氣胸發生率的差異無統計學意義（P＞0.05）；B組肺出血的發生率均明顯低于A組，兩組間肺內出血的發生率差異有統計學意義（P＜0.05）。 結論 多窗技術+凝血酶針道封閉技術能有助于減少氣胸、肺出血等肺穿刺活術的并發癥，具有重要的臨床應用價值。
ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.