ObjectiveTo compare the influence of intrathoracic and retrosternal esophagogastric anastomosis on pulmonary function in aged patients after esophagectomy. MethodsForty patients (older than 62 years) with upper or middle thoracic esophageal carcinoma (EC) who underwent esophagectomy in Fengtian Hospital of Shenyang Medical College between February 2009 and May 2011 were enrolled in this study. According to different surgical approach, all the patients were divided into an intrathoracic esophagogastric anastomosis (IEGA) group and a retrosternal esophagogastric anastomosis (REGA) group. There were 20 patients in IEGA group including 16 males and 4 females with their age of 62-79 (64.70±11.47) years, who received cervical anastomosis after EC resection and intrathoracic gastric tube reconstruction. There were 20 patients in REGA group including 17 males and 3 females with their age of 63-77 (65.90±12.72) years, who received cervical anastomosis after EC resection and retrosternal gastric tube reconstruction. Pulmonary function test (PFT) was performed preoperatively and on the 15th and 30th postoperative day, and compared between the 2 groups. ResultsThere was no statistical difference in preoperative PFT between the 2 groups (P > 0.05). PFT of IEGA group on the 15th and 30th postoperative day was significantly worse than preoperative PFT (P < 0.05). PFT of REGA group on the 15th and 30th postoperative day was not statistically different from preoperative PFT (P > 0.05). PFT of REGA group on the 15th and 30th postoperative day was significantly better than PFT of IEGA group (P < 0.05). In IEGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, pneumonia in 5 patients and atelectasis in 1 patient. In REGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, gastric outlet obstruction in 1 patient and pneumonia in 3 patients. All the patients were followed up for 1 year. There was no statistical difference between PFT at 1 year after discharge and PFT on the 30th postoperative day in either group. ConclusionsIEGA can significantly reduce postoperative PFT. REGA has less negative influence on postoperative PFT, is suitable for aged patients and patients with unsatisfactory preoperative PFT, can reduce postoperative complications and improve postoperative quality of life.
ObjectivesTo systematically review the efficacy of hypothermia intervention on adult severe craniocerebral injury.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of hypothermia intervention on severe craniocerebral injury from the establishment of the database to July 2nd, 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 949 patients were included. The results of meta-analysis showed that the mortality of hypothermia intervention group was lower than that of normal body temperature group (RR=0.72, 95%CI 0.58 to 0.89, P=0.003), and the prognosis of hypothermia intervention group was better than that of normal body temperature group (RR=1.29, 95%CI 1.15 to 1.46, P<0.000 1).ConclusionsCurrent evidence shows that the hypothermia intervention has a lower mortality rate and a higher prognosis rate in the treatment of adult severe brain injury. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 years and a median weight of 41.9 kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 years, and the median weight was 50.5 kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 min, the median aortic cross-clamping time was 45.0 min, the median mechanical ventilation time was 22.5 h, the median postoperative hospital stay was 29.5 d, and the median intensive care unit stay was 6.0 d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.