摘要:目的: 探討自發性食管破裂的診斷和治療經驗。 方法 :對我院1996年2月至2009年8月收治的8例自發性食管破裂患者的診斷和治療作回顧性分析。 結果 :全組患者7例行手術治療,1例行保守治療。6例患者行修補手術,其中4例行分層縫合,2例行全層縫合。1例行食管切除胃食管吻合術。本組痊愈7例,死亡1例。 結論 :早期診斷和早期治療是自發性食管破裂的治療原則。確診患者,若病情允許,應首選手術治療。Abstract: Objective: To explore the clinical diagnosis and treatment of spontaneous esophageal rupture. Methods :The clinical features, diagnosis and surgical treatment of 8 patients with spontaneous esophageal rupture were retrospectively reviewed. Results :There were 7 cases treated by surgical therapy and 1 case for conservative treatment. 6 cases were treated by surgical repair including 4 cases of layered suture and 2 cases of singlelayer suture. 1 case was treated by esophagus resection and gastroesophagostomy. In the whole group, 7 cases were cured and 1 case died. Conclusion :The therapeutic principle of spontaneous esophageal rupture are early diagnosis and early treatment. For diagnosed patient, surgical procedure is the first choice if condition permitted.
ObjectiveTo analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). MethodsThe patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. ConclusionCommando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.
Objective To investigate effect of optimizing operation procedure (OOP) on surgical outcomes of complete endoscopic subcutaneous mastectomy (CESM) in treatment of gynecomastia. Methods A total of 217 patients with gynecomastia underwent CESM from January 2014 to March 2017 in the Third People’s Hospital of Chengdu were collected according to the criteria for inclusion and exclusion, further, based on a propensity score-matching model, a total of 94 patients were evenly assigned to OOP group (April 2015 later) and non-OOP group (before April 2015). The CESM with or without OOP was performed in the OOP group or the non-OOP group, respectively. The operative time, postoperative length of stay, treatment expenses, and favorable cosmetic effect were compared in these two groups. Results The differences in the general clinical data in both groups were not statistically significant (P>0.05). The operative time (min) was shorter (139.90±37.18versus 175.20±46.99, P=0.002), the postoperative length of stay (d) was shorter too (7.13±1.46 versus 8.47±2.71, P=0.021), and the treatment expenses (yuan) were more less (11 426.80±1 861.19 versus 12 315.75±1 306.64, P=0.036) in the OOP group as compared with the non-OOP group. Meanwhile the favorable cosmetic effect of the self-evaluation score in the OOP group was significantly higher than that in the non-OOP group (7.33±1.16 versus 5.97±1.16, P<0.05). Conclusion This study demonstrates that using optimizing standard CESM could shorten operative time, reduce treatment expenses, and improve satisfaction of patients.
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
Peripheral artery disease (PAD) of the lower extremities, which poses a major challenge in the field of global public health, has seen a rising trend in its incidence and disability rate year by year. With the continuous innovation of new diagnostic techniques, imaging evaluation methods, and treatment strategies, profound changes have taken place in the diagnosis and treatment paradigm in this field. Based on the “European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication” issued by the European Society for Vascular Surgery in 2024, we systematically reviewed the relevant international guidelines in recent years and conducted horizontal comparisons. Combining with the latest clinical research evidence, we conducted an in-depth analysis from the perspective of evidence-based medicine on the strategic evolution, technical key point updates, and clinical evidence levels of endovascular treatment for lower extremity PAD. The aim is to provide an evidence-based medical basis for clinical decision-making.
Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
Objective To summarize our experience and the early and midterm outcomes of stented elephant trunk procedure for right-sided aortic arch (RAA) with Kommerell's diverticulum (KD). Methods From April 2013 to July 2020, patients with RAA and KD who underwent stented elephant trunk procedure at our center were collected. Surgery was performed under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy. Results A total of 8 patients were included, including 7 males and 1 female with a mean age of 51.88±9.61 years. All patients had an aneurysmal KD and aberrant left subclavian artery. Preoperative comorbidities included acute Stanford type B aortic dissection in 1 patient, aortic arch pseudoaneurysm in 1 patient, acute type B intramural hematoma in 2 patients, and coronary artery disease in 1 patient. Concomitant procedures included reconstruction of the left subclavian artery in all patients and coronary artery bypass grafting in 1 patient. The mean time of operation, cardiopulmonary bypass, aortic cross-clamping, and selective cerebral perfusion was 6.25±1.16 h, 157.75±40.07 min, 77.75±33.10 min, and 28.50±5.55 min, respectively. No intraoperative death occurred. There was 1 in-hospital death. Follow-up was completed in all patients with a mean period of 3.58±2.08 years. No late death occurred. A persistent anastomotic leak of the proximal arch was detected in 1 patient, but reintervention was not performed because neither aortic dilatation nor symptoms of tracheal and esophageal compression were observed during the follow-up. The remaining 6 patients showed positive aortic remodeling with complete thrombosis of the aneurysmal KD, and neither aortic event nor tracheal and esophageal compression occurred. Conclusion Stented elephant trunk procedure is a safe and feasible technique for selected patients with RAA and KD, which can achieve favorable early and midterm outcomes.
Objective To study the mid-term and long-term postoperative results of Bentall procedure in patients with Marfan syndrome. Methods From February 2009 to July 2016, ten adolescent patients (mean age of 12.30±2.31 years ranged 9-16 years, mean height of 172.50±12.55 mm, mean weight of 48.60±17.08 kg) underwent Bentall procedure in our hospital. All these teenage patients were with Marfan syndrome, 6 boys and 4 girls. Five of them underwent mitral valve replacement procedure at the same time while 2 of them with tricuspid valvuloplasty. Results No mortality was found in hospitalization. One patient suffered respiratory failure after surgery. No renal failure, mediastinal infection or re-operation caused by bleeding were observed. All were well followed up for 62 months. One died of malignant arrhythmia, the other were in good condition with the latest interview. Conclusion Teenage patients with Marfan syndrome who underwent Bentall procedure have favorable outcomes in mid-term and long-term follow-up, they probably will not suffer anti-coagulation complications and restriction of growth.
Laparoscopic sleeve gastrectomy (LSG) is an effective and lasting method for treating obesity, type 2 diabetes and other obesity related metabolic diseases. The symmetrical three-port LSG has been proven to be a simple, safe, and effective surgical procedure. However, China still lacks standardized surgical operation guidelines for this method. This guideline provides a detailed description of the various steps and key details of the symmetrical three-port LSG, aiming to standardize and normalize the symmetrical three-port LSG in the bariatric and metabolic field in China, and to provide standardized surgical procedures for clinical surgeons in this field.
ObjectiveTo analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF).MethodsIn our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied.ResultsAll the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively.ConclusionThe recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.