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

Search

find Keyword "心胸外科" 6 results
  • Application of Double Flap Extension Technique in Complicated Arterial Switch Operation

    Abstract: Objective?To summarize the clinical experience,surgical technique and indication of coronary artery implantation with double flap extension technique in arterial switch operations (ASO) in D-transposition of the great arteries (D-TGA) and Taussig-Bing anomalies.?Methods?From January 2006 to June 2011, 21 patients (13 males and 8 females;age 110.0±84.5 d;weight 5.4±4.2 kg) with D-TGA or Taussig-Bing anomalies associated with complex coronary artery malformations underwent ASO with double flap extension technique for coronary artery implantation in Shanghai Children’s Medical Center affiliated to Medical College of Shanghai Jiaotong University. All the patients had a main trunk of right coronary artery or dilated right ventricular conus branch originated from the left or right aortic sinus,with abnormal course of anterior looping to the aorta. The double flap extension technique was described as followed: a long coronary button was excised as a flap from the aorta; another pedicle flap on the pulmonary artery (neoaorta) was cut to extend to the button of coronary artery with an equal distance; the side edges of the flap and the button were sutured together to form a lengthened coronary artery tube.?Results?No operative death occurred in hospital. The postoperative duration of mechanical ventilation was 101.6±53.6 h. The duration of ICU stay was 9.5±4.9 d. Postoperatively,low cardiac output syndrome occurred in 9 cases,pulmonary hypertension crisis in 2 cases,pneumonia in 6 cases,and acute kidney failure in 2 cases. Eleven patients underwent delayed sternum closure. All the patients were discharged after proper treatment. Follow-up was complete in 17 cases. The duration of follow-up was 2 months to 5 years. Growth and development were significantly improved in all the patients during follow-up. No patient had ischemic ECG changes. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years after ASO.?Conclusion?Double flap extension technique for coronary implantation in complicated ASO can significantly decrease postoperative death due to coronary artery malformations,especially for patients who have two-stage ASO and patients whose main trunk of right coronary artery or dilated right ventricular conus branch originates from the left or right aortic sinus with abnormal course of anterior looping to the aorta.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 左心瓣膜手术后重度三尖瓣反流的外科治疗

    目的 总结左心瓣膜手术后重度三尖瓣反流(TR)的外科治疗经验。 方法 回顾性分析自1999年2月至2009年12月上海交通大学医学院附属仁济医院31例左心瓣膜手术后重度TR患者的临床资料,男3例,女28例;年龄35~60岁(38.4 ± 8.3岁)。 31例左心瓣膜手术后重度TR患者均合并心房颤动,有不同程度的右心功能不全表现,其中心功能分级(NYHA)Ⅱ级3例,Ⅲ级24例,Ⅳ级4例。所有患者接受了三尖瓣手术,其中18例采用CarpentierEdwards半硬环行三尖瓣成形术(TVP),13例采用生物瓣行三尖瓣置换术(TVR)。对上述患者术前、术后的临床资料进行比较。 结果 围术期死亡2例,均死于心力衰竭,以右心功能衰竭为主。29例生存患者术后无严重并发症发生,均好转出院。随访29例,随访时间3个月~9年(5.3±2.5年),随访期间均给予强心、利尿等治疗。术后3个月患者心功能均有明显改善(NYHA分级Ⅰ级3例,Ⅱ级19例,Ⅲ级5例,Ⅳ级2例);超声心动图提示:TR明显改善,右心房内径(50.2±8.8 mm vs. 63.1±12.4 mm,P=0.005)、右心室内径(28.3±7.1 mm vs. 35.7±8.2 mm,P=0.008)较术前明显缩小。 结论 对左心瓣膜手术后重度TR患者,早期应积极地行外科手术治疗;手术方式应根据患者三尖瓣的具体情况和手术者的经验,以选择置入半硬成形环的TVP为主,必要时采用生物瓣行TVR。但对有严重右心功能衰竭(NYHA分级Ⅳ级)患者需慎重选择手术治疗,应以内科保守治疗为主。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Analysis of Risk Factors for Surgical Site Infection and Its Countermeasures in the Department of Cardiothoracic Surgery

    ObjectiveTo probe into the risk factors for postoperative surgical site infections in the Department of Cardiothoracic Surgery, and put forward correspondent preventive and treatment measures. MethodA total of 360 patients who underwent operations between February 2011 and March 2013 were the study subjects. The age, sex, basic diseases, surgical time, hospitalization time, surgical implants, and incision category were recorded carefully, and were analyzed for their correlation with surgical site infections. ResultsThere were 27 cases of surgical site infections with an infection rate of 7.50%. Age, hospitalization time, surgical time, basic diseases, surgical implants and incision category were risk factors for surgical site infections (P<0.05). ConclusionsBased on the analysis of risk factors for surgical site infections, we can help patients recover as early as possible by taking preventive measures beforehand.

    Release date: Export PDF Favorites Scan
  • Science and Ethics in Conducting Cardiothoracic Surgery with Da Vinci Surgical System in China: A Systematic Review

    ObjectiveTo systematically evaluate the effectiveness, safety and ethics of Da Vinci Surigcal System (dVSS)in the field of cardiothoracic surgery, and provide evidence for its clinical application. MethodsWe searched VIP, CNKI, WanFang Database, CBM, official website of National Health and Family Planning Commission of People's Republic of China, PubMed, Cochrane Library, Google Scholar, WHO ICTRP search portal, ClinicalTrials.gov, Chinese Clinical Trial Registration Center, Australian-New Zealand Clinical Trials Registry and ISRCTN to collect clinical trials of dVSS for thoracic and cardiovascular diseases to evaluate its effectiveness, safety and ethics. The search time was from the establishment of each database to January 2014. The quality of included literatures was evaluated by Grades of Recommendations Assessment, Development and Evaluation (GRADE). ResultsA total of 31 studies were identified including 4 case control studies and 27 retrospective studies involving 1 037 patients. The quality of included literatures was all very low. dVSS had been widely used in cardiothoracic surgery including coronary artery bypass grafting, valvuloplasty or valve replacement, thoracic tumor resection, etc. Compared with conventional surgery and thoracoscopy, the safety and effectiveness of dVSS was good, while its economic burden was heavier for the patients. dVSS could benefit patients and improve clinical level of cardiothoracic surgery. The disciplines and qualification of dVSS application was legal, but the maturity of its clinical use needed improvement, and relevant measures were required. The ethics in the research, introduction and application of dVSS had some problems which deserved more attention. ConclusionsClinical use of dVSS in cardiothoracic surgery is relatively safe and effective, but research quality needs to be improved. More studies on the economics and ethics of dVSS are needed in the field of cardiothoracic surgery. Relevant measures of precaution, accountability and patient protection are required to further improve clinical application of dVSS in cardiothoracic surgery, and whole-process ethical supervision should be conducted with the help of existing clinical ethical review platform.

    Release date: Export PDF Favorites Scan
  • Consideration about Academic Training Program Innovation for Cardiothoracic Surgery Resident

    Release date: Export PDF Favorites Scan
  • Tinking about Cardiothoracic Surgery Resident Training

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

Format

Content