Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years, ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132 (98.5±35.7) minutes, and average aortic cross-clamping time was 56-97 (68.40±23.78) minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.
Objective To evaluate therapeutic effect of tile shape perineal stapled prolapse resection in treatment of rectal prolapse. Methods The clinical data of 31 patients with rectal prolapse underwent tile shape perineal stapled prolapse resection in the Renmin Hospital of Wuhan University from December 2013 to August 2015 were retrospectively analyzed. All the patients with rectal prolapse were performed the tile shape perineal stapled prolapse resection with general anesthesia and (or) epidural anesthesia. The prolapse was completely pulled out and then axially cut open with a linear stapler in the lithotomy position. Finally, the prolapse was resected stepwise with the curved stapler at the prolapse’s uptake. Results There were 8 males and 23 females in the 31 patients. The age was (65.8±3.2) years old. There were 14 patients with Ⅱ degree and 17 patients with Ⅲ degree prolapses. The median course was 5.8 years. The 31 patients were followed up for 0.5–7.0 months. Of 31 cases, the 24 cases were cured and 7 cases were better. It was found out that there was a significant difference between the number of axially cut open with a linear stapler and the weight of specimen (P<0.05). And there was a significant difference between the number of axially cut open with a linear stapler and the recurrence (P<0.05) too. When the number of axially cut open with a linear stapler were 4 for Ⅱ degree and 3 for Ⅲ degree, the treatment had been proved to be the highest efficacy. Conclusions Preliminary results of limited cases in this study show that tile shape perineal stapled prolapse resection is safe and effective in treatment of rectal prolapsed. Key of operation is that prolapse is completely pulled out and then axially cut open with a linear stapler at some o’clock for 2–4 points and rectal valves are formed. Prolapsed is resected stepwise with curved stapler at prolapse’s uptake. When number of axially cut open with a linear stapler are 4 for Ⅱ degree and 3 for Ⅲ degree, it could achieve the best therapeutic effect.
ObjectiveTo investigate the efficacy of macrolide antibiotics on patients with lower respiratory tract infection. MethodsA total of 146 patients with lower respiratory tract infections were selected from January 2011 to January 2014 in the Department of Respiratory Medicine of our hospital and divided into low risk and high risk group. Based on the clinical characteristics of the patients, low risk treatment plan was erythromycin capsule 0.25 g once, 3 times/day plus compound liquorice mixture, followed by clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture or clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture; high risk group treatment was macrolide antibiotics (erythromycin, clarithromycin) 0.25 g once, 3 times/day and second generation cephalosporins (cefaclor or cefuroxime) 0.25 g once, 3 times/day plus compound liquorice decoction. ResultsThe clinical seven-day curing rate was 54.1%, and the total effective rate was 93.1%. For low risk treatment regimen, the sevenday curing rate was 63.6%, and the total effective rate was 94.9%; for high risk treatment regimen, the seven-day curing rate was 34.0%, and the total effective rate was 89.4%. Acute bronchitis had high curing rate which was 70.1%. ConclusionMacrolide antibiotics (erythromycin, clarithromycin) oral administration in the treatment of lower respiratory tract infection is reliable and effective, which is worth promoting in clinical application.
ObjectiveTo analyze the clinical efficacy of right midaxillary straight incision surgery in the treatment of doubly committed subarterial ventricular septal defect. MethodsThe clinical data of children with doubly committed subarterial ventricular septal defect who received surgeries in our hospital from August 2020 to July 2023 were analyzed retrospectively. All the children underwent surgical repair and were divided into two groups according to the incision position, including a right midaxillary straight incision group and a median incision group. The outcomes were compared between the two groups. ResultsA total of 187 patients were enrolled. There were 102 patients in the right midaxillary straight incision group, including 55 males and 47 females with a median age of 26.0 (5.0, 127.0) months and a median weight of 12.5 (5.1, 32.8) kg at surgery. There were 85 patients in the median incision group, including 37 males and 48 females with a median age of 4.0 (2.0, 168.0) months and a median weight of 6.7 (4.8, 53.9) kg at surgery. No mortality occurred in the study. There was no statistical difference between the two groups in the cardiopulmonary bypass time [(50.0±18.4) min vs. (46.1±15.7) min] or aortic cross-clamping time [(31.3±18.6) min vs. (26.3±17.5) min] (P>0.05). Compared to the median incision group, the time from the end of cardiopulmonary bypass to the closure of chest [(22.3±15.6) min vs. (37.1±13.4) min, P<0.001], postoperative hospital stay [(6.9±3.9) d vs. (8.6±3.6) d, P=0.002], the length of incision [(4.3±2.7) cm vs. (8.5±3.2) cm, P<0.001], drainage volume [(79.0±32.2) mL vs. (100.2±43.1) mL, P<0.001], and the pain score on the 2nd and the 3rd day after the operation were statistically better in the right midaxillary straight incision group (P<0.05). The medical experience and incision satisfaction scores at discharge of the right midaxillary straight incision group were higher (P<0.05). During the follow-up of 21.0 (1.0, 35.0) months, no residual shunt was detected and all patients in both groups had a normal cardiac function and mild or less valve regurgitation. ConclusionCompared to the median incision, minimally invasive right midaxillary straight incision for the repair of doubly committed subarterial ventricular septal defect offers comparable efficacy and reliability, with the added advantages of being minimally invasive, cosmetically superior, and promoting faster postoperative recovery.
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
Objective To analyze pathologic features and surgical procedures for patients with unroofed coronary sinus syndrome (UCSS) associated with endocardial cushion defect (ECD). Methods The clinical data of 44 patients with UCSS and ECD from May 1998 to July 2016 were retrospectively reviewed. There were 18 males and 26 females with a mean age of 10.4±12.1 years (range: 5.0 months to 44.0 years) and mean weight of 25.2±20.9 kg (range 5.2-80.0 kg). According to the Kirklin and Barratt-Boyes classification, 28 patients were categorized into type Ⅰ, 5 typeⅡ , 4 type Ⅲ and 7 type Ⅳ. Among them 25 patients suffered partial ECD, 10 complete ECD, 9 transitional ECD, and 27 were associated with single atrium, 34 involved persistent left superior vena cava (PLSVC), and in 27 of the 34 patients PLSVC directly drained into the left atrium (LA). Among the 44 patients, 1 patient associated with complex anomalies underwent palliative operation, and other cardiac malformations were corrected simultaneously by surgical correction. PLSVC was ligated in 2 patients, and the intracardiac tunnels or baffles to drain PLSVC to right atrium (RA) were reconstructed in 25 patients. The associated cardiac lesions were corrected concomitantly. Results In-hospital death occurred in 2 patients, among whom 1 died of low cardiac output syndrome on postoperative day 8 and the other pulmonary infection on postoperative day 21. Thirty-one were followed up from 1 month to 10 years, and there was no death or severe complications. Conclusion When ECD is associated with PLSVC and a single atrium, UCSS may develop. Repair according to the type of UCSS is effective.