Objective By using a newly developed animal model of limited macular translocation (LMT) in rabbit eyes, to explore the complications,indications and predictability of LMT. Methods LMT models were performed in 15 rabbit eyes, and were divided into 4.5 mm group and 3.5 mm group by the length of scleral shortening.The effect of retinal translocation (distance and direction) and its complications were analyzed. In a separated group, postoperative corneal astigmatism was studied after release of scleral shortening suture 1 month after LMT. In order to study the impact of neuroretina-retinal pigment epithelium (RPE) adhesion on LMT, retinas and choroids in 4 pigmented rabbit eyes were pretreated with photocoagulation. Results Success rate of LMT was 86.7%. In these cases, retinal translocations were achieved［(distance of 610 to 2690 μm, [AKx-]±s=(1395±636)μm; translocation angle α of 10-38°, [AKx-]±s=(22.7±8.3) °］. The difference in scleral shortening between 4.5 mm and 3.5 mm groups did not significantly influence the final translocation. Major complications of LMT included intraocular bleeding, retinal break, and corneal astigmatism. Release of scleral shortening suture reduced corneal astigmatism and made it more regular, meanwhile, retinal translocation did not regress. The neuroretina-RPE adhesion induced by retinal photocoagulation made neuroretinal hydrodissection difficult, and led to retinal break readily. Conclusion Sufficient LMT models in rabbit eye were obtained with few postoperative complications. Direction of retinal translocation is an important factor influencing the effect of LMT, except for distance. Release of scleral shortening suture can effectively reduce corneal astigmatism without causing regression of retinal translocation. For the patients with a history of macular or para-macular photocoagulation, LMT should be performed carefully. (Chin J Ocul Fundus Dis, 2002, 18: 203-207)
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Composite grafting techniques is a commonly used strategy in coronary artery bypass grafting,especially suits elderly patients.It is an attractive myocardial revascularization strategy when the grafts are not sufficient to achieve complete myocardial revascularization.Furthermore,composite grafting in the presence of a diseased aortic wall seems a rational approach to reduce the incidene of postoperative neurological deficit or stroke by avoiding the manipulation of atherosclerotic aorta.Also,it gained excellent short and midterm results.This review provides an overview of the various surgical techniques,outcomes,concerns and controversies associated with composite grafting.
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.
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 review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
Objective To explore the effect, operational essential, and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity. Methods In the study, 255 patients with 363 lower extremities of varicose vein in our hospital between May 2006 and November 2009 were treated by transilluminated powered phlebectomy. According to revised clinical etiology anatomic and pathophysiological classification system (CEAP), there were 104 limbs in C2, 53 limbs in C3, 155 limbs in C4, 34 limbs in C5, and 17 limbs in C6. The patients were followed up to observe postoperative complications. Results All varicose vein labeled before operation were resected. Surgical time was (100±20) min in unilateral lower extremity and (147±19) min in bilateral lower extremities. Total 221 patients (302 lower extremities) were followed up in 4 to 46 months, median follow up time was 24.5 months. Total 167 cases (247 lower extremities) had accepted the operation more than 1 year, 154 cases (229 lower extremities) in which were followed up. In the 229 lower extremities above, recurrences occurred in 11 extremities, small amounts of residual small varices were observed in 2 extremities, the recurrence rate was 5.68% （13/229）. Twenty-one limbs with ulcer were healing in 3 to 6 weeks after operation. Postoperative complications: there was paresthesias or pain of ankle area in 16 limbs, which was improved in 3 to 6 months after physical therapy; there was ecchymosis of skin of leg in 112 limbs, which disappeared in 3 to 5 weeks after operation; there was light edema in 37 limbs, which disappeared in 1 to 2 weeks after operation; there was local hematoma in 2 limbs, incision light infection in 5 limbs, skin and subcutaneous tissue necrosis above medial malleolus in one limb, and back of knee popliteal skin lesion in 2 limbs, which were all cured by the symptomatic treatment. Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures. Varicose vein extraction using transilluminated powered phlebectomy is safe, efficacious, and cosmetically satisfactory.
Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.