Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.
This is the first successful case expriences,a method of the procurement of the fetal cadavertic multiple argans for transplantation of the pancreas and thyroid-pararthyroid glands was produced. The liver,pancreas,duodenum,spleen,and both kidneys were harvested en bloc by a group of surgeons,and the right hem-ithyroid-parathyroid glands with pedicle of thd blood vessels wre removed by another group.The pancreas together with the spleen were transplanted to a patient having diabetes mellitus. The thyroid-parathyroid glands were given to another case with bypothyroidism and hypoparathyroidism.Both cases had good results.This method had dicreased the warm ischemia of the transplants,and could provide liver,pancreas,spleen,kidneys and thyroid-parathyroid glands to solve the problem of shortage of fetal organs.
ObjectiveTo discuss the effect of palliative drainage operation on the life quality of hilar cholangiocarcinoma. MethodsCholangiocarcinoma data of our hospital in recent 21 years were analysed retrospectively. They were divided into four groups: RouxenY choledochojejunostomy group, bridge internal drainage group, PTCD (or ERBD) internal drainage group, and operative external drainage group. The operative mortality, incidence of postoperative cholangitis and survival period were compared among groups.ResultsThe total perioperative mortality of 193 cases of palliative operation was 9.3%, there was no difference among groups (P＞0.05). The rate of postoperative cholangitis in the bridge internal drainage group (10.0%) was lower than that of RouxenY choledochojejunostomy group (19.4%),P＜0.05, the rate of cholangitis in PTCD (or ERBD) internal drainage group (37.5%) and operative external drainage group (38.1%) were significantly higher than that of RouxenY choledochojejunostomy group (P＜0.01). There was no significant difference between RouxenY choledochojejunostomy group 〔(9.2±1.8) months〕 and PTCD (or ERBD) internal drainage group 〔(8.8±1.9) months〕 in survival period (P＞0.05)，but the survival period of the above groups were significantly higher than that of bridge internal drainage group 〔(6.5±1.6) months〕，P＜0.05, and operative (or PTCD) external drainage group 〔(4.3±2.0) months〕,P＜0.01.ConclusionThe life quality of RouxenY choledochojejunostomy group is better than that of bridge internal drainage group and PTCD (or ERBD) internal drainage group, the life quality of external drainage is worse than that of the other groups.
Objective To investigate the safety and reliability of ultrasonic bone curette in posterior cervical single open-door laminoplasty. Methods The clinical data were retrospectively analyzed, from 193 patients who underwent single open-door laminoplasty (C 3–7) from January 2012 to January 2016. The patients were divided into three groups according to different instruments: posterior single open-door laminoplasty was performed with ultrasonic bone curette in 61 cases (group A), with bite forceps in 73 cases (group B), and with micro-grinding drill in 59 cases (group C). There was no significant difference in gender, age, the course of disease, underlying disease and preoperative Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) between groups (P>0.05). The operative time, intraoperative blood loss, drainage volume at 48 hours, JOA score, improvement rate, VAS and perioperative com-plication were compared. Results The operative time, intraoperative blood loss, and drainage volume at 48 hours of group A were significantly less than those in groups B and C (P<0.05), but there was no significant between groups B and C (P>0.05). The follow-up time was 12-21 months (mean, 14.6 months) in group A, 24-36 months (mean, 27.5 months) in group B, and 28-47 months (mean, 38.1 months) in group C. There were no cerebrospinal fluid leakage and incision infection in three groups. No complications of internal fixation loosening and rupture occurred during the follow-up. Rediating pain occurred in 6 cases of group A, 8 cases of group B, and 6 cases of group C, and was cured at 1 week after dehydration and physical therapy. No nerve root palsy was found in three groups. Fracture of portal axis occurred in 5 cases (7 segments) of group B and was fixed by micro titanium plate. The JOA score and VAS score at last follow-up were significantly improved when compared with preoperative scores in three groups (P<0.05); there was no significant difference in JOA score and improvement rate and VAS score between groups (P>0.05). Conclusion It is safe and reliable to use the ultrasonic bone curette in posterior cervical single open-door laminoplasty. It can shorten the operative time and has similar clinical curative effect to the traditional operation, and the lateral rotation of the lamina can be avoided.
Objective To assess the acute high altitude sickness (AHAS) and its risk factors among public health emergency responders, so as to provide scientific proof for guaranteeing the safety and health of emergency rescue workers. Methods?The self-administered questionnaire aim at learning AHAS occurrence and its risk factors were distributed to 67 members from 4 teams at different altitudes selected among 35 rescue teams. The AHAS could be diagnosed by a total score of more than or equal to 5 within 3 days since arrival, as in the following detail: 1-3 score could be assigned in accordance with the following symptoms in degrees of the mild, moderate or severe, respectively: headache, nausea or vomiting, lassitude, dizziness and blurred vision, and sleep disorder; and 1 score could be assigned for each of the following symptoms: palpitation, shortness of breath, nosebleed, chest distress, diarrhea, constipation, cyanochroia of the lips, numbness in hands and feet, and dry cough. Results?A total of 54 among 67 (81%) responders completed the questionnaire, among whom 93% were males and the median age was 36 with the scope from 24 to 55, and 63% (34 respondents) developed AHAS. The univariate analysis showed that the altitude of the responders’ original residence (10 score for “lt;100 m” vs. 5.2 score for “gt;1 000 m”, P=0.005), experiences in high altitude areas (10 score for “having not” vs. 6.4 score for “having”, P=0.039), length of stay in an area over 2 000 m altitude before arrival (9.4 score for “≥3 days” vs. 5.7 score for “≤1 day”, P=0.011), luggage weight (9.8 score for “≥25 kg” vs. 5.5 score for “lt;25 kg”, P=0.002) were correlated with AHAS severity. The multivariate linear regression indicated that the lower altitude of the responders’ original residence and the short stay in an area over 2000m altitude before arrival were the factors influencing the severity of AHAS. The linear regression formulation was Y= 2.89 - 0.187 × the altitude of the responders’ original residence (pre 100m) + 2.43 × the length of stay in an area over 2000m altitude before arriving at Yushu (day). Conclusions?The past experiences and the pre-arrival preparation are critical factors of AHAS. Measures should be taken to protect the safety and health of responders dispatched to high altitude areas.
Objective To investigate the application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect. Methods Between March 2016 and April 2017, 21 cases of skin and soft tissue defects were repaired with the modified adjustable skin stretching and secure wound-closure system (the size of regulating pressure and the times of adjustment were determined according to the color, temperature, capillary response, and swelling degree of the skin edge). There were 11 males and 10 females, with an average age of 49.2 years (range, 21-67 years). Among them, 1 case was the residual wound after amputation of leg; 18 cases were the wounds after traumatic injury operation, including 4 cases in the lower leg, 3 cases in the knee joint, 7 cases in the upper limb, and 4 cases in the foot; and 2 cases were diabetic feet. The skin defect area ranged from 4.0 cm×2.5 cm to 21.0 cm×10.0 cm. Results Skin defect wounds closed directly in one stage in 4 cases; 12 cases were closed after continuously stretching for 5-14 days (mean, 10 days); 5 cases were reduced to less than one-half area, and the wound healed after the second skin grafting or flap repairing. All the 21 patients were followed up 3-12 months (mean, 5.2 months). The wound was linear healing with small scar, and no invasive margin, poor blood flow, necrosis, and poor sensory function happened. Conclusion The modified adjustable skin stretching and secure wound-closure system can reduce the skin and soft tissue defects or close the wound directly, and even replace the skin graft and skin flap repairing. It was a good method for the treatment of skin and soft tissue defect.
Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.
Objective To study the method of treating hemifacial atrophy withfree serratus muscle flap. Methods Three patients diagnosed as having serious hemifacial atroph was treated with free serratus muscle flap. The root of the flap was thoracodorsal artery and thoracodorsal vein, which was anastomosed with superficial temporal artery and vein, facial artery and vein, lingual artery and vein,and so on.During the operation, long thoracic nerve was dissected and anastomosed with facial nerve. The sizes of the flaps were 12 cm×8 cm16 cm×12 cm.Results All free-muscle flaps healed well after the transplant. The face and buccal area looked chubby and rounded. There were no obvious protuberance and discontentment on the buccal area. The shoulders of all patients moved well. The facial contourof the patients recovered well during the follow-up period (1.3 years). Conclusion The method has a good result, The long-term effect needs further study.
摘要:目的:探討慢性硬膜下血腫(chronic subdural hematoma, CSDH)鉆孔沖洗引流術后的復發因素。方法：回顧性分析165例CSDH鉆孔沖洗+閉式引流術的治療效果,并結合患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向等因素進行相關分析。結果:本組治愈151例,血腫復發14例。〖HTH〗結論〖HTSS〗:患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向是影響復發的主要因素。Abstract: Objective: To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient’s age,drainage volume,thickness of hematoma, septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence. Conclusion : Age, drainage volume, thickness of hematoma, septal hematoma cavity and direction of drain pipe would affect the prognosis.
Objective To analyze the surgical techniques for the procurement and back-table surgery of the graft in living-related small bowel transplantation. Methods Eligible donor was chosen according to the donor selection criteria of living-related small bowel transplantation, and preoperative plan was designed. A segment of ileum of 120 cm was procured 20 cm proximal to the ileocecal valve which was preserved in the donor. The techniques for the procurement and back-table surgery of the graft were summarized, which included measurement of entire small bowel length from Treitz to ileocecal valve, palpation and transillumination to identify the distal branch of the superior mesenteric artery， and transient blockage of isolated blood vessels with vascular clamps in order to observe the influence on the blood circulation of graft and residual ileum. The detailed manipulation techniques in processing the graft blood vessels were discussed. Results The operations were successful both on the donor and the recipient. The functions of implanted segment of bowel were well. The donor had no other complications, such as mesenteric thrombi and anastomosis leakage of intestine, except for transient moderate diarrhea. She was discharged 14 days after operation. In the next 8 months of following-up, the donor has not experienced significant alteration in bowel habits or weight loss. Now she is in good appetite, without any changes in the habit and amount on diet. No changes have been found in lifestyle, work habits, or psychosocial conditions after the small bowel donation. Conclusion The procurement of a segment of ileum as graft and preservation of 20 cm proximal to the donor ileocecal valve may be ideal protocol. Using a standardized technique with attention presents little recent or long-term risks for the donor and brings satisfied effect for the recipient.