ObjectiveTo summarize the clinical advantages and the treatment of perineal defect of extra-levator abdominoperineal excision, and to discuss the treatments of postoperative complications. MethodsChinese or English literatures about extra-levator abdominoperineal excision were collected to summarize and analyze the clinical signifi-cance of it. ResultsExtra-levator abdominoperineal excision had a lot of advantages in reducing the circumferential resection margin involvement rate and intraoperative perforation rate for patients with low rectal cancer. The huge perineal defect caused by the operation could achieve good healing after appropriate treatment. At the same time, we should avoid the occurrence of urogenital system dysfunction and perineal pain. ConclusionExtra-levator abdomino-perineal excision is a safe and effective procedure aimed at patients with low rectal cancer, and can be applied during clinical practice.
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
Objective To investigate the management during offpump coronary artery bypass grafting (OPCAB) for patients with ascending aorta atherosclerosis and to find appropriate treatment for minimizing the postoperative cerebrovascular accidents. Methods 236 patients with ascending aorta atherosclerosis were retrospectively analyzed underwent OPCAB in this hospital from Sep.2004 to Dec.2007, 4 of them received “No-touch” technique, 35 of them had the proximal anastomoses with the Enclose assistant, and 197 of them had the proximal anastomoses with the assistant of Heartstring. Hemodynamic indexes were consecutively monitored, blood streams of grafts was monitored by transit time flow measurement (TTFM) to evaluate the quality. Results Distal anastomoses 881，proximal anastomoses 267, the blood stream of 881 grafts was monitored, the mean flow was 16.2±18.7 ml/min, and the pulsatility index (PI) were 4.9±2.3, indicating the good quality of all grafts. The change of hemodynamic indexes including mean artery pressure (MAP, 78.1±10.4 mmHg vs. 80.9±8.1 mmHg）, pulmonary capillary wedge pressure (PCWP, 11.9±3.6 vs. 10.9±2.1 mmHg）, mean pulmonary artery pressure (MPAP, 17.3±4.3 mmHg vs. 15.3±2.8 mmHg）, cardiac output (CO, 4.2±1.2 L/min vs. 4.5±1.6 L/min）, center vinous pressure (CVP, 9.2±2.3cmH2O vs. 9.3±1.8 cmH2O）, heart rate (HR, 71.4±14.0 beats/min vs. 73.4±16.5 beats/min）, there were no statistically difference between before and after proximal anastomoses (Pgt;0.05). Two patients died of low cardio output during operation, 4 patients with transient ischemic attack were improved by 2 months medical therapy, and others had no postoperative complications as perioperative myocardial infarction etc, and the time of stay hospital was 10.5±4.2d. Followup 3-24 months for 185 patients, all living patients had no myocardial or cerebrovascular accidents, the symptoms were alleviated and myocardiac function improved. Conclusion Assessing the degree of the ascending aorta atherosclerosis sufficiently before and during the operation, choosing different operational strategy, and decreasing the manipulation of aorta can decrease the incidence of cerebrovascular accident and get better clinical result.
Objective To investigate the application of the fibrous envelope of tissue expanders for the tension reduction. Methods Between June 2005 and May 2011, 21 patients with facial scar were treated with skin soft tissue expansion. There were 6 males and 15 females, aged 19-33 years (mean, 24.5 years), including 19 cases of hypertrophic scar and 2 cases of atrophic scar with disease duration of 1-31 years. The scars ranged from 4 cm × 2 cm to 25 cm × 10 cm. The tissue expander was implanted under normal skin adjacent to lesions in the first stage. And the post-expanded skin flap was designed as advance flap or transpositional flap as supplement in the second stage. Fibrous envelope at the base was fixed to the periosteum or fascia nearby first, and then sutures were used between envelopes at the base and on the skin flap or to the dermis of the skin flap to keep the mouth and lower eyelid in proper position. It reduced the tension of incision and maintained the contour of the face and neck. Results After the first stage operation, 2 cases had replaced expanders because of infection and leakage. No complication of infection or hematoma occurred after the second stage operation. The patients were followed up 1-18 months (mean, 10.2 months); of them,12 were followed up more than 1 year. No secondary deformity (deviation of mouth angle, eyebrows pulling, or eyelid ectropion) occurred. The flaps had good appearance and color. The satisfactory results were achieved. Conclusion In skin soft tissue expansion of the face, the fibrous envelopes at the base could reduce the tension of the incision and prevent the deformity of the mouth and lower eyelids.
Objective To evaluate the cl inical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty. Methods Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 ± 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 ± 2.7 before operation. According to Berry’s classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as sl ipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis. Results All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain rel ief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 ± 3.6 and 82.0 ± 5.2 respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postopera tively. Conclusion Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy,thus the good results of femoral reconstruction and cl inical results would be obtained.