目的:观察大剂量的激素联合丙种球蛋白治疗中毒性表皮坏死松解症(TEN)的治疗和护理效果。方法:收集我科2003年1月至2008年9月住院治疗的15例经大剂量激素联合丙种球蛋白治疗的TEN患者,观察治疗及护理效果。结果:15例患者平均住院约17天均痊愈出院。结论:大剂量激素联合丙种球蛋白治疗效果好,同时严格的消毒隔离及皮肤黏膜的护理,对治愈此病起着重要作用。
Objective To explore the feasibil ity, indications, and effects of vacuum seal ing drainage (VSD) combined with flaps for repairing skin and soft tissue defects of lower l imbs. Methods From June 2006 to November 2009, 15 patients with skin and soft tissue defects of lower l imbs were treated with VSD combined with flaps (VSD group, n=5) and only flaps (non-VSD group, n=10). In VSD group, there were 3 males and 2 females with an average age of 46 years (range, 32-69 years), including 3 cases of traffic accident injury, 1 case of skin necrosis after amputation, and 1 case of plate exposureafter operation. The locations were lower leg in 1 case, ankle in 2 cases, dorsum of foot in 1 case, and forefoot in 1 case. The defect size ranged from 6.5 cm × 6.0 cm to 23.0 cm × 17.0 cm. The disease course ranged from 2 hours to 2 months. In non- VSD group, there were 5 males and 5 females with an average age of 50 years (range, 23-58 years), including 6 cases of traffic accident injury, 1 case of crush injury in earthquake, 1 case of osteomyel itis, and 2 cases of plate exposure after operation. The locations were lower leg in 1 case, ankle in 3 cases, forefeet and dorsum of feet in 4 cases, and heel in 2 cases. The defect size ranged from 4 cm × 4 cm to 20 cm × 12 cm. The disease course ranged from 1 hour to 2 months. There was no significant difference in general data between 2 groups (P gt; 0.05). Results In VSD group, the preoperative hospital ization days, postoperative hospital ization days, and total hospital ization days were (11.8 ± 9.5), (35.4 ± 28.3), and (47.2 ± 35.8) days, respectively; the size of flap was (232.8 ± 142.0) cm2; and the infection rate after VSD-use was 0. In non-VSD group, the preoperative hospital ization days, postoperative hospital ization days, and total hospital ization days were (25.8 ± 12.4), (33.9 ± 28.1), and (59.7 ± 32.4) days, respectively; the size of flap was (97.3 ± 93.6) cm2; and the infection rate after 8 to 14 days of regular therapy was 80%. There were significant differences in the preoperative hospital ization days and the size of flap between 2 groups (P lt; 0.05). All flaps were al ive except 3 partial necrosis (1 case in VSD group, 2 cases in non-VSD group). The 3 flaps healed by skin grafting and suturing. The donor sites healed by first intention. All patients were followed up 5-41 months (22.1 months on average). All flaps were good in color, texture, and wear abil ity. Conclusion It is effective to apply VSD combined with proper flap to repair skin and soft tissue defects of lower l imbs, which can cut down infection rate, improve blood supply, shorten the preoperative hospital ization days, and facil itate heal ing, but whether it can shorten the postoperative hospital ization days and total hospital ization days need further research.
Objective To summarize the experience and prognosis of Cone reconstruction used in Ebstein's anomaly. Methods We retrospectively analyzed the clinical data of 10 consecutive patients with Ebstein's anomaly, who underwent Cone reconstruction in our hospital from January 1, 2012 through February 1, 2015. According to Carpentier's classification, there were 2 patients of type A, 4 of type B, 2 of type B-C and 2 of type C. Results There was no death. One patient had arrhythmia after operation. The mean regurgitation area was 1.4±1.8 cm2 after operation, 6.4±6.9 cm2 at the time of discharge, respectively. Both of them were lower than preoperative regurgitation area (18.7±11.4 cm2) with statistical differences (95%CI –25.154 to –9.573,P=0.001; 95%CI 6.567 to 18.113,P=0.001). Three months after operation, the regurgitation was improved significantly compared to the preoperative regurgitation (95%CI 4.523 to 12.052,P=0.004). While it was higher in the regurgitation area when the patients were discharged. However, there was no statistical difference (95%CI –5.783 to 1.039,P=0.126). The incidence of severe regurgitation was about 85.7% at end of 3 months after operation, while decreased to 32.1%, 13 months later. The size of right atrium was much smaller than preoperative size (95%CI 1.033 to 31.480,P=0.039) when the patients were discharged. Conclusion Cone technique with ringed annuoplasty permits a good leaflet-to-leaflet coaptation. Tricuspid competence after operation could be sustained for a long time. However, postoperative short term is the crisis period to severe regurgitation. Further investigation for more appropriate surgical strategy should be carried on.
Objective To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 (1, 29) d. And the median body weight was 3.3 (2.1, 4.7) kg. There were 45 patients (63.4%) with supracardiac, 26 patients (36.6%) with infracardiac. Patients were divided into two groups: a conventional technique group (29 patients) and a sutureless technique group (42 patients). To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used. Results Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths (15.5%), 7 late deaths (96.%), total 18 deaths (25.4%). The mortality was 58.6% (17/29) in the conventional technique group, 2.4% (1/42) in the sutureless technique group (P=0.000). Kaplan-Meier survival curve showed a difference in mortality between the two groups (P=0.005). The patients were followed up for 25.5 (1.0-13.0) months.Postoperative anastomotic or pulmonary vein stenosis occurred in 12 patients, 8 of them died at a higher mortality than that of the patients with smooth anastomosis [66.7% (8/12) vs. 16.9% (10/59), P=0.001]. Conclusion The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.
Objective To analyze the use of modified pericardial oblique sinus approach in surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between May 2005 and December 2015, 67 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. The patients are divided into three groups according to the different approaches including a sulcus approach group (6 patients), a superior approach group (14 patients), and a modified pericardial oblique sinus approach group (47 patients). There were 53 males and 14 females at median age of 12.5 (7.0, 20.5) d. Results The time of cardiopulmonary bypass [88 (80.0, 107.0) min vs. 135 (121.0, 157.0) min, P<0.05] and aortic cross clamping of the modified pericardial oblique sinus approach group was significantly shorter than that of the sulcus approach group [45 (39.0, 53.0) min vs. 80 (73.0, 85.0) min, P<0.05]. Perioperative mortality (2.1% vs. 28.6%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the superior approach group. The long-term mortality (4.3% vs. 60.0%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group or the superior approach group . The rate of pulmonary venous stenosis was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group (2.1% vs. 50.0%, P<0.05) or superior approach group (2.1% vs. 35.7%, P<0.05). Conclusions In surgical correction of neonatal supracardiac and infracardiac total anomalous pulmonary venous, compared with the traditional surgical approach, the modified pericardial oblique sinus pathway can provide excellent surgical space and has a good surgical prognosis.
ObjectiveTo compare the effect of different treatment strategies of vertical vein on the postoperative efficacy of total anomalous pulmonary venous connection (TAPVC) in newborns.MethodsThe clinical data of 72 TAPVC newborns who underwent correction in our hospital from June 2008 to January 2018 were retrospectively analyzed. There were 59 males and 13 females, with an average age of 9.93±8.13 d. According to different vertical vein treatment strategies, the patients were divided into an unligated group (22 patients), a partially ligated group (23 patients) and a completely ligated group (27 patients). The mortality and incidence of common complications among the groups were compared.ResultsIn the completely ligated group, the aortic cross-clamp time was longer (P=0.001), intraoperative circulatory arrest cases were less (P=0.005), and the early velocity of pulmonary vein was faster (P=0.029), but there was no significant difference in the velocity of pulmonary vein for the last follow-up among three groups (P=0.393). There was no significant difference in other perioperative indicators among groups, including the early mortality, the incidence of pulmonary vein obstruction and the non-closure of vertical vein after surgery (P>0.05). The mean follow-up time was 4.47±2.63 years. The follow-up mortality was not significantly different among groups (P>0.05). The cardiac function (NYHA) of all the 64 survived patients was classⅠ-Ⅱ.ConclusionProper vertical vein treatment strategies may be conducive to a smooth transition after surgery, ensuring the success of surgeries.
ObjectiveTo characterize surgical outcomes of supra-cardiac total anomalous pulmonary venous connection (TAPVC), investigate risk factors for postoperative death, and explore informed LASSO machine learning methods to solve "small sample size problem" in research of rare congenital heart diseases.MethodsA retrospective analysis of 241 patients with supra-cardiac TAPVC who underwent surgical repair in Guangdong Provincial People's Hospital from 2009 to 2019 was conducted, including 179 males and 62 females with a median surgical age of 71 (33, 232) d.Detailed clinical data of the postoperative death-related factors were extracted. Univariable Cox proportional hazard models were used to initially screen potential risk factors for postoperative death. Factors with P≤0.05 were retained. To solve the limitation of small sample size and the "P>n" problem, we proposed a novel LASSO method for conducting multivariable Cox regression analysis that was capable of bringing in findings of related studies to improve analysis power and to reduce false-negative findings.ResultsUnivariable Cox analyses showed several potential clinical risk factors, among which highly significant factors (P<0.001) included: surgical weight≤2.5 kg (HR=16.00), main pulmonary artery diameter (HR=0.78), prolonged cardiopulmonary bypass time (HR=1.21), aortic block time (HR=1.28), and postoperative ventilator-assisted time (HR=1.13/d). LASSO multivariable analysis revealed that independent risk factors for postoperative death included cardiopulmonary bypass time (aHR=1.308/30 min), age (aHR=0.898), postoperative ventilator-assisted time (aHR=1.023/d), weight≤2.5 kg (aHR=2.545), right vertical venous return (aHR=1.977), preoperative pulmonary venous obstruction (aHR=1.633) and emergency surgery (aHR=1.383).ConclusionOur proposed informed LASSO method can use previous studies' results to improve the power of analysis and effectively solve the "P>n" and small sample size limitation. Cardiopulmonary bypass time, surgical age, postoperative ventilator-assisted time, weight, right vertical venous return, preoperative pulmonary venous obstruction, and emergency surgery are risk factors for postoperative death of supra-cardiac TAPVC.
ObjectiveTo sum up the experience of the primary modified single-patch (MSP) technique applied in our hospital for children with complete atrioventricular septal defect (CAVSD).MethodsThe clinical data of 141 children who underwent primary MSP technique for CAVSD between June 2009 and December 2017 were retrospectively analyzed, including 62 males and 79 females with a median age of 6 (3, 11) months and a median weight of 5.8 (4.5, 7.0) kg. According to Rastelli classification, there were 116 patients in type A, 14 in type B and 11 in type C. Among them, 15 patients were diagnosed with Down’s syndrome. Cardiopulmonary bypass time, aortic cross clamp time, atrioventricular valve regurgitation and other clinical data were recorded during and after operation. ResultsPostoperatively, 17 patients suffered from severe left atrioventricular valve regurgitation (LAVVR) and 6 patients severe right atrioventricular valve regurgitation (RAVVR). In the follow-up period, 5 patients suffered from severe LAVVR and 1 patient severe RAVVR. Left ventricular outflow tract obstruction (LVOTO) appeared in 1 patient during follow-up period and none at the end of follow-up. There were 5 early deaths and 2 late deaths. Twelve patients underwent reoperation with a median interval time of 268 (8, 1 270) days.ConclusionMSP technique is a wise surgical strategy for CAVSD children with good outcomes, improved postoperative mortality and decreased atrioventricular valve regurgitation.
ObjectiveTo compare the benefits and drawbacks of primary patch expansion and pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). MethodsA retrospective study was conducted on the patients who were diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD) and underwent primary right ventricular-pulmonary artery connection surgery at our center between January 2010 and December 2020. The patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: the whole pericardial tube right ventricular-pulmonary artery connection group (pericardial tube group), and the patch expansion right ventricular-pulmonary artery connection group (patch expansion group). The patients' general clinical data and cardiopulmonary bypass data were documented, and the cardiac CT data obtained before and after the surgery were compared with the clinical and imaging data. ResultsFinally 51 patients were collected, including 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. There were 19 patients in the pericardial tube group, with a median age of 17.17 (7.33, 49.67) months, and 32 patients in the patch expansion group with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter, McGoon index, and Nakata index were significantly increased after treatment (P<0.001). However, the pericardial tube group required a longer occlusion time (P<0.001). The rate of reoperation was high, with 72.5% of patients requiring further surgery. Specifically, 26 (81.3%) patients in the patch expansion group and 12 (63.2%) patients in the pericardial tube group finally completed radical resection. There was no statistical difference observed in the long-term cure rate or mortality between the two groups. Conclusion In patients with PA/VSD, the use of patch expansion or pericardial tube right ventricular-pulmonary artery connection as the initial palliative treatment strategy can promote the development of pulmonary vessels and provide a favorable basis for subsequent radical operations. However, compared to pericardial tube, patch expanded right ventricular-pulmonary artery connection is a simpler procedure to perform and retains some of the intrinsic pulmonary artery development potential, thus making it a preferred procedure.
ObjectiveTo evaluate early outcomes of transthoracic pulmonary valve implantation for the treatment of moderate and severe pulmonary regurgitation by using homemade self-expanding valve (SalusTM). MethodsPatients with severe pulmonary regurgitation who underwent transthoracic pulmonary valve implantation in Guangdong Provincial People’s Hospital from September 2, 2021 to November 25, 2022 were prospectively enrolled. The early postoperative complications and improvement of valve and heart function were summarized and analyzed. ResultsA total of 25 patients were enrolled, including 16 males and 9 females, with an average age of 24.5±1.5 years and an average weight of 57.0±3.0 kg. The mean systolic diameters of the bifurcation near the main pulmonary artery, the stenosis of the middle segment of the aorta and near the valve of the right ventricular outflow tract of the patients were 31.8±7.4 mm, 30.6±5.9 mm and 38.4±8.0 mm, respectively. All patients were successfully implanted with valves, and there were no serious complications such as death, coronary compression, stent fracture, valve displacement and infective endocarditis in the early postoperative period. The indexed left atrial longitudinal diameter, indexed right atrial longitudinal diameter, and indexed right ventricular outflow tract anteroposterior diameter decreased significantly after the operation. The degree of tricuspid and pulmonary valve regurgitation and the indexed regurgitation area decreased significantly. The above differences were statistically significant (P<0.05). ConclusionThe early outcomes of transthoracic pulmonary valve implantation with homemade self-expanding pulmonary valve (SalusTM) in the treatment of severe pulmonary regurgitation is relatively good, and the long-term outcomes need to be verified by the long-term follow-up studies with large samples.