The noses of eight patients being dead for 2hours were dissected to investigate the layers andstructure of the nose, and the stability of theimplanted silicone noae prosthesis was tested.According to the structure and microstructure ofthe nose studied by us, we suggested a newconcept of nasal muscle and dorsal deepfasciacomplex. We confirmed the prcathesis should beimplanted in the space between the nasal boneand the complex. The reason for complicationhappened in this approach was that...
At present, the operative results of complex congenital heart disease are suboptimal which is closely correlated to the understanding of the anatomy and function of complex congenital heart disease, and operative techniques. With the further understanding to pathology and physiology of congenital heart disease, strategies and techniques in well-known operations and complex procedures have developed in recent years. Currently, designing and applying individual operative method in terms of patient’s characteristics of anatomy and physiology is very important trend. This article reviewed the advances of knowledgement and techniques in some representive complex congenital heart disease including complete atrioventricular septal defect, unifocalization for major aortopulmonary collateral arteries, transopsition of the great artery and Fontan type operation.
Fontan operation is still a main procedure for treatment of complex congenital heart disease, such as univentricular heart. Fontan procedure has undergone many revisions since its introduction in 1968. The earlyapplied atriumpulmonary connection has been replaced by total cavopulmonary connection. The midterm and late results of both the intraatrial lateral tunnel and extracardiac total cavopulmonary connections were compared and analyzed in this article. Extracardiac conduit is better. The Fontan circulation failure would appear at last because of nopump function of the right ventricle. Once Fontan circulation failure occurred and could not recover by medicine, heart transplantation is mandatory, but the source of donor heart is lacking. The study of mechanical cavopulmonary assist device, to “biventricularize” the univentricular Fontan circulation, has been developed, which is quite promising. Following the development of diagnostic and treatment techniques for fetal heart disease, the treatment procedure of complex congenital heart disease has been broadened in recent years, such as to prevent the severe aortic stenosis from developing into hypoplastic left heart syndrome with fetal cardiac intervention so as to increase the chance of biventricular repair, and to terminate gestation to decrease its birth rate of complex heart abnormalities, which could not be completely repaired to date.
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.
Objective To explore the in vitro osteogenesis of the chitosan-gelatin scaffold compounded with recombinant human bone morphogenetic protein 2 (rhBMP-2). Methods Recombinant human BMP-2 was compounded with chitosan-gelatin scaffolds by freezedrying. 2T3 mouse osteoblasts and C2C12 mouse myoblasts were cultured and seeded onto the complexes at thedensity of 2×104/ml respectively. The complexes were divided into two groups. Group A: 2T3 osteoblasts seeded, consisted of 14 rhBMP-2 modified complexes. Each time three scaffolds were taken on the 3rd, 7th, 14th, and 21st day of the culturing, then the expression of osteocalcin gene (as the marker of bone formation) in adherent cells was detected by semiquantitative RT-PCR with housekeeping gene β-tubulin as internalstandard. The other 2 rhBMP-2 modified complexes were stopped being cultured on 14th day after cell seeding, and the calcification of the complexes was detected by Alizarian Red S staining. Five scaffolds without rhBMP-2 modification as the control group A, they were stopped being cultured on 14th day after cell seeding. Of the 5 scaffolds, 3 were subjected tothe detection of osteocalcin gene expression and 2 were subjected to the detection of calcification. Group B: C2C12 myoblasts seeded, had equal composition andwas treated with the same as group A. Besides these 2 groups, another 2 rhBMP2 modified complexes with 2T3 osteoblasts seeding were cultured for 3 days and then scanned by electron microscope (SEM) as to detect the compatibility of the cell to the complex. ResultsSEM showed that cells attached closely to the complex and grew well. In group A, the expression level(1.28±0.17)of osteocalcin gene in cells on rhBMP-2 modified complexes was higher than that (0.56±0.09) of the control group A, being statistically -significantly different(P＜0.05) control. C2C12 myoblasts which did not express osteocalcin normally could also express osteocalcin after being stimulated by rhBMP-2 for at least 7 days. Alizarian Red S staining showed that there was more calcification on rhBMP-2 modified complexes in both groups. There were more calcification in the group compounded with rhBMP-2, when the groups were seeded with the same cells. Conclusion The complexmade of rhBMP-2 and chitosan-gelatin scaffolds has b osteogenesis ability in vitro.
Abstract： Objective To investigate the clinical results of offpump anatomic surgical repair for complex coarctation in adults. Methods We retrospectively analyzed the clinical data of 7 patients with complex coarctation who underwent onestage anatomic surgical repair between January 2005 and December 2008 in Fu Wai Hospital. There were 5 males and 2 females with the age ranged from 16 to 41 years, average at 24.4 years. Among all the patients, there were 2 patients of coarctation with hypoplastic aortic arch, 1 of coarctation with aortic arch aneurysm, 3 of coarctation with descending thoracic aortic aneurysm, and 1 of coarctation with B type aortic dissection. All patients were diagnosed by color echocardiography, CT or agnetic resonance imaging（MRI）. All off-pump operations were performed under general anesthesia and ambient temperature. Median sternotomy was performed in 1 patient and left thoracotomy in 6 patients. Aortic arch patching enlargement was performed in 4 patients and descending thoracic aorta replacement in 3 patients (including 1 combined with abdominal aorta replacement and 1 case of Stanford B type aortic dissection, trunk stent was transplanted at the same time). Results There was no hospital mortality or severe surgical complications. Seven patients were followed up for a period ranged from 6 to 49 months with an average time of 20.1 months. No late death or recoarctation occurred. Hoarseness occurred in one patient and presented no improvement during the 11 months follow-up. Conclusion Onestage offpump anatomic surgical repair is safe and feasible in treating adult patients with complex coarctation, and it shows a good immediate and longterm result.
ObjectiveTo evaluate the effectiveness of posteromedial double plates in the treatment of complex olecranal fracture. MethodsBetween September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years (range, 22-68 years). Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type ⅡB in 5 cases and as Mayo type ⅢB in 8 cases. Of 13 cases, 7 had Regan-Morrey type Ⅲ coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours (mean, 5.7 hours). At last follow-up, the elbow function was assessed according to the Broberg-Morrey evaluation criteria. X-ray films was performed to observe fracture healing. ResultsAll incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months (mean, 22.1 months). All patients achieved bone union at 3.0-5.5 months (mean, 3.7 months) according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion (ROM) of the elbow was 95-130° (mean, 116.4°); the rotation ROM of the forearm was 150-175° (mean, 170.8°); and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred. ConclusionFor complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.
Objective To investigate the methods and effectiveness of multi ple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch anddescending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Sl ight left subclavian steal syndrome occurred in 3 cases, but self rel ieved. Other patients recovered to normal l ife. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.
ObjectiveTo retrospectively compare and analyze the effect of myocardial protection between histidinetryptophane-ketoglutarate (HTK) and 4:1 blood cardioplegia in patients with complex coronary artery disease and left ventricular dysfunction. MethodsFrom January 2003 to July 2013, 2132 patients underwent isolated coronary artery bypass grafting (CABG) in our institution. Among them, 227 patients with complex coronary artery disease (left main or triple vessel disease) and left ventricular dysfunction (ejection fraction ≤ 50%) were included in this study. According to the category of cardioplegia utilized in the operations, the patients were divided into two groups: a HTK group (85 males and 4 females, n=89) and a blood cardioplegia group (113 males and 25 females, n=138). The average age was 62.78±9.30 years in the HTK group and 62.74±9.07 years in the blood cardioplegia group. The effect of myocardial protection between two groups was compared. ResultsAccording to the pre-operational data of these two groups, there was no significant difference identified in terms of basic characteristics and risk factors, even though more female patients were found in the blood cardiophegia group and more patients with renal dysfunction were found in the HTK group. In addition, the patients in the HTK group had more distal anastomosis, longer cardiopulmonary time and cross clamping time than those in the blood cardiophegia group. Based on the results measured by those primary assessment criteria,there was no significant difference being found between these two groups. However, on those secondary assessment criteria the pulmonary pressure and inotropic support after reperfusion were significantly higher in the HTK group than its counterpart. ConclusionFor patients with complex coronary artery disease and left ventricular dysfunction, HTK solution and blood cardioplegia provide similar effective myocardial protection. HTK doesn't significantly increase postoperative adverse cardiovascular events under the circumstance of longer ischemic time.
Objective To summarize the treatment experiences of Modified lateral tunnel(LT) Fontan operation on complex congenital heart disease in children and investigate the advantages of this operation. Methods From March 1999 to August 2008, 86 patients with cynosis complex congenital heart disease underwent LT Fontan operation in our hospital. There were 47 male and 39 female aged 1.9-11.5 years with a mean age of 4.7 years and weighed 8.6-52.0 kg with a mean weight of 17.0 kg. There were 33 cases with asplenia syndrome, 17 cases with polysplenia syndrome, 11 cases with tricuspid atresia(TA), 11 cases with double outlet right ventricle(DORV) of atrioventricular discordance, 8 cases with complete transposition of great arteries(D-TGA) complicated with pulmonary stenosis, 5 cases with corrected transposition of great arteries(cTGA) and 1 case with Ebstein’s anomaly. Unilateral superior bidirectional superior cavopulmonary anastomosis(BSCPA), bilateral bidirectional superior cavopulmonary anastomosis and hemiFontan opertion were done before operatipon. The time between two operations was 0.7-7.8 years（3.6±2.9 years）. LT Fontan operation(LT-group, 47cases) and Modified LT Fontan operation(M-LT group, 39cases) were used in operation to drain blood from inferior vena cava to right pulmonary artery. Partly completed secondstage M-LT Fontan operation. Results There were 7 deaths in two groups(9%), 5 in LT group and 2 in M-LT group. There was no statistical significance（χ2=0.865，P=0.448）. In stagemodified LT Fontan operation, there were significantly more cases who had BSCPA operation preoperatively in MLT group than that in LT group. Twentytwo cases had low cardiac output syndrome after operation, 13 cases underwent peritoneal dialysis because of renal dysfunction, and theirurine volume recovered after 2-5 days’ dialysis. There were significantly more cases who had arrhythmia in LT group than that in M-LT group（χ2=8.763，P=0.003）. The time of chest drainage was longer in LT group than that in M-LT group（t=2.970，P=0.003）. The follow-up time was 3 months8 years. No death was found. In M-LT group 33（85%） cases were followed up and in LT group 39（83%）cases were followed up. No severe complication was found. Patients’ activity ability improved significantly. Conclusion The M-LT Fontan operation is an advanced operation to improve the success rate of operation and reduce postoperative complications.