Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactive-inotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponin I and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduceshemodilution and perioperative blood transfusion.
目的 總結成人大腸套疊治療經驗。方法 回顧性分析我院1969～1998年收治的83例成人大腸套疊患者的臨床資料。結果 經鋇灌腸復位6例，手術治療77例。腫瘤性大腸套疊60.2%，其中惡性腫瘤性套疊占64.0%。惡性腫瘤套疊手術切除5年生存率43.8%。結論 對成人大腸套疊治療首選手術切除，慎用手術復位，不主張鋇灌腸復位。
Objective To investigate the long-term clinical results of treatment of adult unicameral bone cyst with cancellous allograft. Methods From 1993 to 1998, 15 patients with unicameral bone cyst were treated by allograft with lyophilized cancellous bone. Among 15 patients, there were 5 males and 10 females, aging 19-41 years with an average of 27 years. The average follow-up time was 7.5 years (6-11 years). The X-ray films were taken and the CT scanning were carried out. Results The X-ray films showed that the allograft particles became vague 2-3 months after operation, that the allograft particles fused and began to form new bone and the bone density increased 5 months after operation, and that new bone formation completed after 7 months of operation. At the end of follow-up, remodelling in new bone occurred. Reoccurrence was not found in all patients. The symptom of pain disappeared or relieved obviously. Conclusion Allograft of lyophilized cancellous bone is an effective treatment for adult unicameral bone cysts.
ObjectiveTo summarize the experience of treating adult recurrent pectus excavatum without plate turnover.MethodsTwenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.ResultsAll patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.ConclusionThe treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.
ObjectiveTo explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults. MethodsBased on the data from the China Health and Nutrition Survey (CHNS), as well as the consumption level and altitude data from the National Bureau of Statistics and government official website, a robust multilevel Poisson regression was performed to explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults, according to data and design types. ResultsAccording to the inclusion and exclusion criteria, 11 579 subjects and totaling 50 957 lines of data were enrolled. The 24 years follow-up results indicated that the crude incidence density of hypertension was 37.08/1 000 person years, with 40.51/1 000 person years for males and 34.13/1 000 person years for females. The robust multilevel Poisson regression results indicated that, by adjusting the high-level factors such as time, the proportion of the community mainly engaged in agricultural labor, and the consumption level of subjects, as well as sociodemographic characteristics such as age and gender, the Middle (RR=1.20, 95%CI 1.04 to 1.39), Northeast (RR=1.25, 95%CI 1.03 to 1.52), and Eastern (RR=1.25, 95%CI 1.05 to 1.48) China had a higher risk of developing hypertension than the Western China. The risk of hypertension in urban area was lower than that in rural area (RR=0.87, 95%CI 0.77 to 0.96). ConclusionThe incidence density of hypertension in China is relatively high, and male is higher than female. The incidence of hypertension in the Western China is lower than that in the Middle, Northeast and Eastern China, and urban area is lower than rural area.
Abstract: Objective To evaluate the results of surgical treatment of tetralogy of Fallot in adults． Methods From July 2002 to August 2009，75 adult patients with tetralogy of Fallot received surgical treatment in Xijing Hospital, ForthMilitary Medical University．There were 35 males and 40 females, with age at l7 to 37 years (23.30±3.50 years), and eoperativehemoglobin at 143 to 231 g/L(172.00±31.00 g/L)．All these patients were diagnosed by.echocardiograph before operation. All the patients were received tetralogy of Fallot of corrective operation in the hypothermia cardiopulmonary bypass. A total of 46 patients had a transannular right ventricular outflow tract patch，and 29 patients had a non ansannular patch． Results Operation time was 157 to 276 min(221.32±41.34 min), cardiopulmonary bypass time was 68 to 163 min(91.71±28.35 min) and aorta intercepted time was 37 to 96 min（55.47±23.61 min）. There were 6 operative deaths with an operative mortality at 8.00％. The causes of death were low output syndrome(n=3)，acute renal failure(n=2)， and multiple organ failure(n=1)．Nine patients needed reoperation for postoperative bleeding(12.00％)．We followed up 69 patients from 3 to 56 months (26.31±7.40 months). There were 2 patients with trivial residual shunt. The cardiac function status were New York Heart Association(NYHA) Ⅰ to Ⅱ in the 69 patients．No late death occured． Conclusion The effectiveness of surgical treatment for adults with tetralogy of Fallot is satisfactory．
Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure. Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed. Fourteen patients received laparoscopic procedure （laparoscopic group），whereas the other 19 patients received conventional open procedure （conventional group）. Results All the operations were carried out successfully through laparoscopic procedure. The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group （195min versus 130min，P＜0.01）. The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group （80ml versus 270ml，P＜0.01）. In contrast，the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group （time of bowel motion recovery：76h versus 104 h，P＜0.01；hospital stay：6.1 d versus 9.6 d，P＜0.01）. There were no differences in the early complications between two groups （P＞0.05）. Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe. It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.
The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success of modern medicine. With the development of diagnostic techniques, surgical procedures and interventional techniques, more than 90% of CHD children can survive to adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years. Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD. Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010, the new version was officially released in August 2020. The new version of guidelines updated the classification and stratification of diseases, comprehensive intervention methods and intervention timing, and put forward some new concepts, new intervention standards and methods. For adult CHD that has not been repaired or needs to be repaired again, the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis. The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases, and clarifies the management methods for high-risk groups. This article attempts to interpret this newly updated guideline from the perspective of a surgeon, sort out several key diseases introduced by the guideline, and strives to provide a concise and actionable guideline for domestic counterparts.