Objective To evaluate the surgical approach of left superior vena cava（LSVC） distal abnormalities in infant and young children. Methods From April 1999 to December 2004, 19 cases of LSVC distal abnormalities were corrected by primary repair. There were 10 males and 9 females. Their age ranged from 2.7 months to 6.5 years and body weight from 3. 1 to 15.0 kg. Diseases complicated with LSVC included complex congenital cardiac disease 9 cases, ostium secundum atrial septal defect 4, partial abnormal pulmonary venous drainage （PAPVD） with atrial septal defect（ASI）） 2, tetralogy of Fallot（TOF） 3, and double outlet of right ventricle （DORV） 1 case. The ways for surgical treatment of distal abnormalities of LSVC were reconstruction of atrial septum, translocation of LSVC and reconstruction of atrial septum, right atrium and LSVC anastomosis, cavopulmonary anastomosis and repair of partially unroofed coronary sinus. Results One patient died and the diagnosis for the patient was LSVC with DORV and pulmonary hypertension （PH）. This patient died from crisis of PH , obstruction of blood flow in the left cavopulmonary anastomosis, severe low cardiac output,low arterial oxygen saturation and abnormal function of kidney. The mean pressure of right atrium was 9 to 18 mmHg. The percutaneous oxygen saturation （SpO2） was 0.98 1.00 for biventricular repair and 0.79-0. 88 for single ventricular repair and palliative repair. The echocardiography showed no obstruction of the blood flow in LSVC and pulmonary veins. The results of follow-up were satisfactory, from 3 months to 2 years. Conclusions Key for success of surgical approach of LSVC distal abnormalities is precise evaluation of different kinds of LSVC and different surgical approaches. Cavopulmonary anastomosis can not be used in the case of LSVC with PH.
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To explore the effective surgical approaches in treating subclavian artery occlusion. Methods Between December 2005 and February 2010, 53 patients with subclavian artery occlusion were treated, including left subclavian artery occlusion (35 cases) and stenosis (5 cases), right subclavian artery occlusion (5 cases) and stenosis (4 cases), and bilateral subclavian artery occlusion (4 cases). There were 40 males and 13 females with an average age of 64 years (range, 22-77 years), including 49 cases of arteriosclerosis obl iterans and 4 cases of aortic arteritis. The disease duration was 15 days to 20 months (6.5 months on average). In 49 patients with unilateral subclavian artery occlusion, 39 cases compl icated by carotid or / and cerebral artery lesion underwent axillo-axillary bypass grafting, and 10 cases without carotid or /and cerebral artery lesion underwent carotid-subclavian bypass grafting. Ascending aorta to bisubclavian bypass graftings were performed on 4 cases with bilateral subclavian artery occlusion. After operation, patients received routine treatment with anticoagulant and antiplatelet agents. Results The operations were successfully performed in 52 cases with a successful rate of 98.11%. Thrombogenesis at anastomotic site occurred in 1 case of aortic arteritis after 48 hours. Two cases had brachial plexus crush injury and 4 had hematoma around the bilateral anastomosis after axillo-axillary bypass grafting, and all recovered with nonoperative therapy. A total of 52 patients were followed up 1-52 months (24.5 months on average). All patients survived and the symptoms of basilar and upper l imb artery ischemia disappeared. Doppler ultrasonography showed that the blood flow was patent through anastomosis and polytetrafluoroethylene graft, and the vertebral artery flow was normal. Pseudoaneurysm at anastomosis was found in 1 case after 18 months and treated by interventional embol ization. The postoperative graft patency rate was 100% at 1 year and at 2 years. Conclusion Both thoracic and extrathoracic surgical approaches are effective for treating subclavianartery occlusion. The reasonable surgical approach should be selected according to the arteriopathy and the patient’s condition. Perioperative treatment and strict intraoperative manipulation are important to guarantee the success of surgery.
Objective To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. Methods From June 2000 to December 2006, 61 cases with fracture of distal radius weretreated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and incl ination angle, group A were (—45.0 ± 53.0)º and (8.6 ± 3.1)º, respectively, and group B were (—40.0 ± 30.0)º and (7.3 ± 5.6)º, respectively. Preoperative radial shortened (12.0 ± 5.3) mm in group A, and (10.3 ± 4.2) mm in group B. Joint surface level was (4.3 ± 2.2) mm in group A, and (4.1 ± 3.3) mm in group B. Results All of the 61 cases were followed up for 6-27 months (16 months on verage). All the fractures were healed, the time to heal ing in group A was (8.2 ± 1.6) weeks, and in group B was (8.1 ± 1.2) weeks, and the difference was not significant (P gt; 0.05). As for the wrist function by Cartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P lt; 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P gt; 0.05). As for radiological assessment by Sarmiento, device and palm incl ination angles in group A were (9.5 ± 3.1)º and (18.0 ± 8.2)º, respectively, and in group B were (11.0 ± 4.7) º and (16.0 ± 7.6)º, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P gt; 0.05), but there was significant difference when compared with preoperation (P lt; 0.001). With regard to comparison of postoperative compl ications between the two groups, there was no significant difference (P gt; 0.05) in early postoperative compl ications, but there was in long-term compl ications (P lt; 0.01). Conclusion The volar and dorsal plate positions may offer effective stabil ity for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wris joint in the short run, while the dorsal plate position may cause more compl ications in the long run.
Objective To discuss the optimal approach to treat suprascapular nerve compression syndrome. Methods From January 2000 to June 2003, 8 cases of suprascapular nerve compression syndrome were treated by surgical intervention to cut the transverse scapular ligament through posterior approach. Of the 8 patients, there were 2 males and 6 females (age ranged from 21 to 53) with duration of 6 months to 3 years. The change of symptom, muscle power, and muscle atrophy after operation were observed. Results One week after operation, pain around the scapular disappeared, muscle power of supraspinatus and infraspinatus muscles recovered to normal. One, 6, 12 and 16 months after the operation, the patients were followed up. No recurrence was observed. Muscle atrophy didn’t recover.Conclusion To treat suprascapular nerve compression syndrome with operation through posterior approach is easy to operate. When the suprascapular nerve is entrapped in scapular notch, this approach is a good choice.
Objective To explore a method of treating Madelung deformity. Methods Seven cases of Madelung deformity had been treated with the excision of ulnar carpi ulnaris segment and distal osteotomyof radius and tight constrict of extensor carpi ulnaris from Mar. 2000 to Nov. 2003. The angle of ulnar tilting was 37-70° and the angle of volar tilting wasover 16°. A longitudinal incision on each side of the radius and ulnar was made, the ulna was excised about 2-3 cm segment. Then the fracture of ulna was fixed by double across vertical steel wire and the radius was fixed with medullarywire. Lastly the extensor carpi ulnaris was shortened and sutured after the wrist was located restposition. Results After surgery, the deformity of wrist was improved and pain-free in the seven cases. The angle of ulnar tilting was reduced to 22-24°. The angle of volar tilting was reduced to 15° below. Follow-ups were conducted inthe 7 patients for 2 years in average. The activity of wrist joint and the rotation of forearm recovered from those before operation. The wrist joint could stretch fully. Conclusion This method of treating Madelung proves to be effective inrecovering deformity, releasing pain, improving function, and reducing traumatic osteoarthritics of the distal radioulnar joint.
Objective To examine the length of hospital stay and expenses associated with hysterectomy in China and to compare the results with those from developed counties, so as to provide comparative information about hysterectomy in China. Methods Hospital discharge data on hysterectomies performed in Peking Union Medical College Hospital from 2002 to 2006 were retrieved. The cases were classified into 3 groups, namely abdominal, laparoscopic and vaginal hysterectomy. The length of hospital stay and expenses associated with hysterectomy were analyzed retrospectively. Results Records of 5975 women who underwent hysterectomies were analyzed, including 3295 cases (65.7%) of abdominal hysterectomy, 1543 (25.8%) cases of laparoscopic hysterectomy (25.8%) and 507 (8.5%) cases of vaginal hysterectomy. The median (mean) postoperative length of stay were 6 (6.4) days, 4 (4.8) days and 5 (5.6) days in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. These were approximately 2 days longer than those in developed countries. The median total expenses were 6109.0, 7296.3 and 5265.2 RMB in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. After adjustment for the differences in Gross National Income (GNI) per capita between China and developed countries, the expenses associated with hysterectomy in China were 8.7 and 1.8-4.9 times higher than those in UK and USA, respectively. Conclusion Compared with abdominal and vaginal hysterectomies, laparoscopic hysterectomy is associated with a shorter postoperative length of stay, but with higher hospital cost. Compared with developed countries, hysterectomy is actually more expensive and associated with a longer hospital stay in China.
ObjectiveTo discuss the pattern of lymph node metastasis for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and its appropriate surgical approach. MethodsWe retrospectively analyzed the clinical data of 162 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction who underwent curative resection in West China Hospital of Sichuan University from January 2007 through February 2010. The patients were divided into three groups based on their surgical approach, including 96 patients in a left thoracic group, 20 patients in an Ivor-Lewis group and 46 patients in an abdominal group. ResultsThere were 120 patients with lymph node metastasis. The lymph node metastatic rate was 74.1%. Simple thoracic lymph node metastasis was observed only in 2 patients (1.7%), 98 patients (81.7%) with simple abdominal lymph node metastasis, and 20 patients (16.6%) with both capacity lymph node metastasis. The thoracic approaches had an advantage in dissection lower mediastinal lymph node over the abdominal approach, while for the abdominal lymph node the result was reversed. There are 11 groups of lymph node with a more than 10% metastatic rate. ConclusionsThe abdominal lymph nodes are the dominating metastatic area of Siewert type Ⅱ AEG, but some important groups of lower mediastinal lymph node should be removed. In terms of curative resection of tumor, the Ivor-Lewis operated by a thoracic surgeon who is more familiar with the abdominal lymph node may be a reasonable choice.