Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
ObjectiveTo summarize experience of surgical treatment of ascending aortic aneurysm and analyse related problems.MethodsOne hundred and fourteen (containing 62 cases had aortic dissection) consecutive cases underwent replacement of diseased ascending aorta alone (9 cases) or Bentall operation.ResultsThere were seven operative death (6.14%). The cardiac function, in six of them, was in class Ⅳ(NYHA) preoperatively. Follow up was completed in 107 patients, with a duration of 40±30 months. Eight patients succumbed due to intracranial hemorrhage (3 cases), rupture of abdominal aortic lesion (3 cases), cardiac failure after coronary artery bypass grafting (1 case), and sudden death of unknown cause (1 case),respectively. All 99 long term survivors (86.8%) were in NYHA class Ⅰor Ⅱ.ConclusionThe results indicate that Bentall operation for treating ascending aortic aneurysms and aortic insufficiency, or aortic replacement alone for treating ascending aortic aneurysm gives good functional recovery and an active life for the vast majority of survivors.
【摘要】 目的 探討老年肝門膽管癌的圍手術期處理方法。 方法 回顧性分析1992年6月-2004年10月收治的60歲以上的肝門膽管癌患者臨床資料。 結果 78例患者合并有多臟器儲備功能改變，施行手術切除12例，外引流手術11例，內引流手術55例。17例出現并發癥，以肺部感染、肝腎功能衰竭和吻合口瘺為多見。根治性切除、 姑息性切除和姑息性引流組手術后中位生存時間分別為12、8、5個月。 結論 肝門膽管癌的手術復雜，創傷大，對老年患者更容易產生心肺功能異常及各種并發癥；但通過圍手術期內合理、充分的綜合治療措施，仍能取得較好的治療效果。【Abstract】 Objective To investigate the perioperative therapy for the elder patients with hilar cholangiocarcinoma. Methods The clinical data of over 60 years old patients with hilar cholangiocarcinoma who were treated in the hospital from June 1992 to October 2004 were retrospectively analyzed. Result Seventy-eight patients with multiple organs liver functional changes, 12 patients received surgical excision, 11 patients received external drainage surgery, 55 patients received internal drainage surgery. Postoperative complications occurred in 17 patients, wost of which were lung infection, liver and kidney failure and anastomotic leakage. The median survival time were 12, eight and five months for the patients who received radical resection, palliative resection and drainage, respectively. Conclusions The surgical treatment for hilar cholangiocarcinoma is complicated with major surgical trauma. The postoperative complication and the cardio-pulmonary dysfunetion are easily happened especially in the aged patients. Intensive supportive therapy is needed all over the course.