west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "微创小切口" 8 results
  • Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional Mitral Valve Replacement

    Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy (mini-MVR) and traditional mitral valve replacement (MVR). Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively, there were 21 patients with mitral stenosis (MS), 17 patients with mitral insufficiency (MI), 30 patients with MS and MI, and 19 patients with tricuspid insufficiency (TI). Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively, there were 85 patients with MS, 66 patients with MI, 49 patients with MS and MI, and 76 patients with TI. Hospital mortality, aortic crossclamp time, length of intensive care unit (ICU) stay, postoperative chest tube drainage, reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality, cardiopulmonary bypass time, incidence of reexploration for bleeding, postoperative arrhythmias, dialysis-requiring acute renal failure and wound infection between the two group (P>0.05). Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time (10.2±3.1 h vs. 15.2±7.1 h, P=0.008), chest tube drainage(92.0±28.0 ml vs. 205.0±78.0 ml, P=0.000), blood transfusion (0.8±1.6 U vs. 1.9±2.1 U, P=0.006), length of ICU stay (14.0±8.0 h vs. 26.0±12.0 h, P=0.003) and length of hospital stay (14.8±4.6 d vs. 19.7±3.2 d, P=0.006)of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities, while the postoperative recovery after mini-MVR is better than traditional MVR.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 微创小切口肋骨内固定术治疗多根多处肋骨骨折及连枷胸

    目的 总结微创小切口肋骨内固定术治疗多根多处肋骨骨折及连枷胸的临床经验。 方法 回顾性分析2009年1月至2010年1月上海交通大学附属第六人民医院奉贤分院54例胸部创伤患者行爪型钛板微创小切口肋骨内固定术的临床资料,其中男39例,女15例;平均年龄48.7 (19~75)岁。4例患者入院即刻手术,50例于入院1~9 d内手术。手术方式:行单纯肋骨内固定手术34例,同期固定胸骨2例,行肺修补手术6例,膈肌修补术1例,肺叶切除术1例,心包开窗手术1例,骨科手术9例。经肩胛骨下、内侧切口手术16例,侧胸壁切口手术31例,前胸壁切口手术7例。切口长度4~20 cm,肋骨骨折固定范围第2~12肋骨。 结果 本组患者无死亡,均在术后1~3 d内拔除气管内插管,全部治愈出院。术后发生肺部感染4例,气管切开1例,精神障碍1例,经相应的处理治愈。平均住院时间20.6 (12.0~38.0) d。术后随访47例。随访时间3~6个月,骨折全部愈合,无肋间神经压迫症状,患者恢复正常生活和工作;失访7例。 结论 采用爪型钛板进行肋骨内固定,不苟于传统,根据骨折部位采用微创小切口,钛板不接触骨折处,不破坏骨折处局部血运,不影响骨折愈合,可对包括第2肋骨在内的所有部位的肋骨骨折进行内固定。如骨折处位于胸骨或胸椎体结合部,则不宜用钛板固定。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Minimally Invasive Cardiac Valve Surgery: Report of 134 Cases

    Objective To summarize the clinical experience of cardiac valve surgery with minimally invasive procedure. Methods Cardiac valve surgery with less invasive techniques were performed in 134 cases. Five aortic valve operations and 2 mitral valve operations were performed through para-sternotomy. Forty-six mitral valve operations and 15 tricuspid valve operations were performed through right anterolateral thoracotomy. Eleven aortic valve operations were performed through limited reversed Z sternotomy. Fifty-five mitral valve operations were performed through limited lower sternotomy. Results Three cases died postoperatively, the mortality was 2.2%, 2 patients died of low cardiac output syndrome, and one died of acute hepatic and renal failure. One hundred and fourteen patients were followed-up from 2 months to 7 years. The follow-up results were excellently. The scar of minimally invasive valve surgery was limited. Conclusion Minimally invasive valve surgery can accelerate recovery, while maintaining overall surgical efficacy. The advantages include a better cosmetic scar, less surgical trauma, minimal respiratory discomfort and a potentially lower risk of infection. It is extremely effective and has become our current technique of choice in every mitral and aortic valve patient.

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • 锁定加压钢板微创治疗Pilon 骨折

    目的 总结Pilon 骨折采用微创小切口显露关节面、锁定加压钢板(locked compression plate,LCP)内固定的手术治疗效果。 方法 2006 年12 月- 2009 年4 月收治Pilon 骨折104 例,采用微创小切口显露关节面,填充自体骨或人工骨,恢复关节面平整及骨折的对位对线,经皮插入LCP 内固定治疗。其中男73 例,女31 例;年龄21 ~ 74 岁,平均47.5 岁。闭合性骨折83 例;开放性骨折21 例,其中Gustilo Ⅰ型13 例,Ⅱ型8 例。骨折按AO 分型:43-B2 型20 例,43-B3 型19 例,43-C2 型37 例,43-C3 型28 例。受伤至手术时间6 h ~ 14 d,平均7.8 d。 结果 术后发生切口感染4 例,经换药后愈合;余切口均Ⅰ期愈合。104 例均获随访,随访时间12 ~ 28 个月。X 线片示骨折均达临床愈合,愈合时间为4 ~ 10 个月,平均7 个月。无钢板松动、断裂、螺钉拔出及再骨折等并发症发生。术后3 个月参照Mazur 等的评价标准对踝关节功能进行评价,获优69 例,良26 例,可7 例,差2 例,优良率91.3%。 结论 采用微创小切口显露关节面,经皮插入LCP 内固定治疗Pilon 骨折,疗效确定。

    Release date:2016-09-01 09:03 Export PDF Favorites Scan
  • 颅耳沟小切口微创手术治疗先天性隐耳畸形

    目的 总结颅耳沟小切口微创手术治疗先天性隐耳畸形的疗效。 方法 2011 年 1 月—2015 年 5 月收治先天性隐耳畸形 8 例,其中男 6 例,女 2 例;年龄 5~13 岁,平均 10 岁。单侧 3 例,双侧 5 例。13 只隐耳均可用外力牵拉复位至正常大小形态及颅耳沟。于颅耳沟内设计长约 3 cm 弧形切口,并充分松解耳廓软骨与颅侧面、耳廓上部软骨间及软骨和皮肤之间的纤维粘连,游离颅侧面皮肤向颅耳沟推进修复创面缺损,术后纱布卷固定支撑耳廓 3 周。 结果 术后 8 例患者 13 只隐耳畸形均矫正满意;术后 3 周拆除支撑纱布卷后耳廓无回缩,形态正常。8 例患儿均获随访,随访时间 1~3 年,平均 1 年 6 个月。耳廓外形无明显回缩。1 例术后 1 周耳后皮肤部分坏死,为纱布卷偏大致皮肤长期受压缺血所致,去除纱布卷后换药愈合。 结论 颅耳沟小切口微创手术是治疗先天性隐耳畸形有效而简便的手术方法。

    Release date:2017-04-12 11:26 Export PDF Favorites Scan
  • Perioperative results of minimally invasive direct coronary artery bypass grafting for left anterior descending artery revascularization

    ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.

    Release date:2021-03-05 06:30 Export PDF Favorites Scan
  • Robot-assisted bilateral internal mammary arteries harvesting for off-pump coronary artery bypass grafting with 5 grafts by minimally invasive small incision: A case report

    ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.

    Release date:2021-07-02 05:22 Export PDF Favorites Scan
  • Prospective randomized controlled trial on the effectiveness of low-dose and high-dose intravenous tranexamic acid in reducing perioperative blood loss in single-level minimally invasive transforaminal lumbar interbody fusion

    Objective A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group (n=39), high-dose TXA (HD) group (n=39), and placebo-controlled (PC) group (n=38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups (P>0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups. Results There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups (P>0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group (P<0.05), and TBL and HBL in HD group were significantly lower than those in LD group (P<0.05); the decreased value of HGB between LD group and HD group showed no significant difference (P>0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group (P<0.05); there was no significant difference between LD and HD groups (P>0.05). There was no significant difference in other hematological indexes between groups (P>0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups. ConclusionIntravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.

    Release date: Export PDF Favorites Scan
1 pages Previous 1 Next

Format

Content