Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.
ObjectiveTo analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery (LSVS).MethodsThe clinical data of 77 patients who suffered tricuspid regurgitation (TR) after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected. According to the operation method, the patients were divided into a right minithoracotomy group (n=32), including 13 (40.6%) males, aged 57.3±5.3 years and a median sternotomy group (n=45), including 17 (37.8%) males, aged 55.7±6.6 years. Preoperative and postoperative clinical data of the two groups were compared and analyzed.ResultsThere was no significant difference in preoperative data between the two groups. There were 24 patients of tricuspid valvuloplasty (TVP) and 8 patients of tricuspid valve replacement (TVR) in the right minithoracotomy group. There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group. The operation time, postoperative hospitalization time, intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group (P<0.001). The operative bleeding, postoperative drainage in 24 hours, postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group (P<0.05). The extracorporeal circulation time between the two groups was not significantly different (P=0.382). The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group (P<0.05).ConclusionThe procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy, and results in satisfied clinical efficacy.
摘要:目的:总结胸心血管外科慢性伤口换药的经验。方法：2008年11月2009年4月我科共发生12例手术切口裂开病例，使用贝复济喷洒创面，藻酸钙敷料填塞创面，外用二层敷料固定，根据渗液情况决定更换敷料的频率，高渗出时每天更换，中等渗出时每2天更换，少量渗出时每3天更换。结果：本组12例患者，11例患者伤口均达到二期愈合，平均愈合时间为（12±2）天，另外1例转烧伤科行植皮术，后愈合。结论：通过联合使用贝复济和藻酸钙敷料，使本组病例的渗出减少，创面肉芽生长迅速，伤口疼痛减轻或消失，伤口周围皮肤免受浸渍，伤口快速愈合。Abstract: Objective: To introduce the methods of using streptogenin spray and the alginate dressing on Cardiac wound disruption. Methods: Our department had 12 cases of wound disruption from the November 2008 to the April 2009, We sprinkled the streptogenin spray to wound, then filled wound with the alginate dressing, finally fix wound with gauze and adhesive tape.According to the volume of the exudation, we decided how often to change the dressings. When the exudation volume was high ,We changed the dressing every day; While medium, We changed every two days ; When low ,We changed every three days. Results:Eleven 11 of 12 wounds got second phase of healing, the average healing time was (12±2) days. Conclusion: Using of the Streptogenin spray and the alginate dressing on disruption wound can reduce the exudation volume and wound pain, meanwhile it can progress the growth of granulation , so the wounds healed quickly.
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
目的 总结应用原下腹部正中切口行腹膜前置网片修补腹股沟疝的经验。方法 回顾性分析19例腹股沟疝类型、手术方法和术后复发资料。结果 伤口均一期愈合。随访1～66个月,无远期伤口感染和疝复发。结论 经原下腹部正中切口行腹膜前置网片修补腹股沟复杂性疝是一种安全和有效的手术方法,但需要术者对腹股沟解剖有透彻的了解和具有丰富的疝手术经验。
Objective To investigate the effect of a new suturing method called two-layer closure and to compare this with the traditional four-layer suturing method. Methods A randomized controlled trial was conducted in patients admitted from January to April 2008. A total of 124 eligible patients were divided into 2 groups. Sixty-one patients in the trial group received two-layer closure, while 63 in the control group received four-layer closure. The baseline conditions before the operation, incision parameters, and the recovery of the body and incision after the operation were compared between the 2 treatment groups. Results The baseline characteristics of the groups were similar. No significant differences were observed in terms of the length of hospital stay, time to food intake, time to ground activity, and time to first passage of gas by anus (Pgt;0.05). However, the incidence of fever after the operation was significantly lower in the trial group compared with the control group (P=0.014). The healing level of the incisions was comparable between the 2 groups (Pgt;0.05). As for complications after the operation, no cases of incision infection or incision granuloma or sinus tract were reported. However, 3 cases of active hemorrhage and 2 cases of incision split occurred in the control group. Moreover, the incidence of incision liquefaction in the trial group was significantly lower than that in the control group (P=0.03). Conclusion For abdominal median incision, two-layer closure is associated with smaller incision trauma, less stimulation from extraneous materials, as well as more accurate anatomic replacement compared with the traditional four-layer closure. However, further studies need to be conducted to determine whether the new suturing method of twolayer closure is effective and safe for other kinds of incision.
Objective To investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Hospital of Tsinghua University from August 2004 to May 2017. ResultsA total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (39.3±19.2) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.