Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
Abstract： Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation. Some patients had rheumatic tricuspid valve diseases. Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation. Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods. However, the indications for treatment of secondary tricuspid regurgitation remain controversial. The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging. In this article, we review the assessment of tricuspid valve lesions, criteria for correction, and surgical management of secondary tricuspid insufficiency.methods. However, the indications for treatment of secondary tricus
Objective To summarize the clinical experiences in treating primary tracheal tumors by surgery, so as to improve the results of surgical treatment. Methods The clinical data concerning 22 surgically treated patients were retrospectively analyzed. Four patients tumor were benign and eighteen cases’s tumor was malignant. Tracheal resections and end to end anastomosis were performed in 14 cases, carinal resection was performed in 4 cases, lateral tracheal wall resection was performed in 1 case, local scrape were performed in 2 cases, tumor was resected transfiberoptic bronchoscopy in 1 case. Tracheal resectable length was from 2.0cm to 5.2cm，and the average resectable length was 3.8cm in operation. Results 17 cases had been misdiagnosised ( 77.3%) in outpatient department. It was easy to be misdiagnosised as asthma. One case died of respiratory failure after operation in 30 days. The complication rate was 31.8%, complications consist of pneumonia in 4 cases, anastomosis leakage in 1 case and chylothorax in 2 cases. Anastomosis stenosis was found in 3 cases, the syndromes were improved after treatment.Twenty cases were followed up from 1 month to 8 years. Four cases with benign tumors were still alive. Among 16 cases with malignant tumors, 6 cases had survived more than 5 years， 3 cases died of brain, liver, bone metastasis of malignant tumors. Conclusion Surgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the main choice of primary tracheal tumors treatment. Benign tumors can be resected conservatively. The reductions of operative complications are the key points of good surgical results. To know the characteristic of primary tracheal tumors well can reduce the misdiagnosis rate.
Objective To analyze the strategy and skill of resection for lung cancer invading the superior vena cava (SVC) and improve the surgical treatment results. Methods An analysis of 35 patients who underwent surgery for lung cancer invading the SVC was performed. The pressure of SVC before and during operation, and the time of clamping the SVC were recorded. The conjunctival oedema was observed. 14 mm or 16 mm diameter terylene or expanded polytetrafluoroethylene graft artificial vessel were used to replace SVC.The continuous everted suture was applied with 4-0 Prolene. The embolism of artificial vessel and stomal hemorrhage were observed after operation. Results The SVC replacement with prothesis were performed in 20 patients in which the SVC hadn’t clamped in 5 patients. The clamping time was 8-35 mins for another 15 patients with SVC clamped.The clamping time were 1735 mins and 8-20mins respectively for patients with or without conjunctival oedema.The pressure of SVC was 20-45cmH2O before operation and the maximal pressure was 37-56cmH2O during operation for patients with clamping SVC. The maximal pressure during operation was 48-56cmH2O and 37-47cmH2O for patients with or without conjunctival edema, the difference was significant (P=0.000).No mortality or embolism of artificial vessel,but the stomal hemorrhage was found for one patients cured by reoperation. Thirtytwo patients was followed up for 4-130 months,the median survival time was 35 months. Conclusion No clamping of SVC or short time clamping with some operative skill can avoid the occurrence of cerebral edema. Selecting suitable length and roughness of the expanded polytetrafluoroethylene artificial vessel and continuous everted suture with suitable slide suture is important for avoiding the occurrence of embolism and the stomal hemorrhage.
Objective To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome (UCSS), a rare congenital disorder. Methods The clinical, echocardiographic, operative, and followup data on 44 patients with unroofed coronary sinus syndrome (typeⅠin 15，typeⅡin 9，type Ⅲ in 5 and type Ⅳ in 15) between May 1998 and January 2008 were reviewed retrospectively. The initial diagnosis of unroofed coronary sinus syndrome was made by echocardiography in 12 patients, by the surgeon at repair of other congenital cardiac anomalies in 32 patients. The patients underwent cardiovascular surgery at Fu Wai hospital. Left superior vena cava(LSVC) directly drains into the left atrium (LA) were found in 15 cases, LSVC was ligated in 1 case, the intracardiac tunnel to drain LSVC to right atrium (RA) were reconstructed in 14 cases. The associated cardiac lesions were corrected concomitantly. Results There were 3 hospital deaths. One patient died of low cardiac output syndrome and 2 patients died of pulmonary infection. One case was applied diaphragm plication because of right diaphragm paralysis after the heart operation and the hospital stay was 70 days.The other 40 cases had good surgical result. The average time of extubation was 11.7±12.1 h and hospital stay was 8.1±2.8 d. In the 32 cases, who have been followed up from 4 months to 10 years, there was no death and severe complications. Conclusion Unroofed coronary sinus syndromes are often missed in the preoperative evaluation of congenitally malformed hearts. When associated with LSVC, unroofed coronary sinus syndrome should be considered as a possible additional finding.We performed different surgical approaches to deal with the different kinds of LSVC with a good result.
Abstract: Objective To summarize onestage repair of coarctation of the aorta(CoA) with intracardiac malformation in infants. Methods From January 2001 to January 2006, 28 patients with CoA and associated intracardiac malformation underwent onestage repair. There were 18 patients with preductal and another 10 patients with juxtaductal CoA. Six patients were accompanied by diffuse hypoplasia of aortic arch and 22 patients were associated with patent ductus arteriosus (PDA). Associated cardiac malformation included ventricular septal defect in 16 patients, ventricular septal defect and atrial septal defect in 5 patients, atrioventricular canal defect in 3 patients, transposition of great artery and ventricular septal defect in 2 patients and double outlet right ventricle in 2 patients. Left posterolateral thoracotomy combined with median sternotomy were used in 12 patients and single median sternotomy was used in 16 patients. End to end anastomosis of aorta with removal of the coarctated segment were performed in 20 patients, Gore-Tex patch graft aortoplasty were performed in 4 patients and aortoplasty with left subclavain flap were performed in 4 patients. Results There was no death.The lasting time of intubation was 7h to 13d, and intensive care unit (ICU) staying time was 3 to 18d. Four patients received delayed sternal closure in 48 to 72h after surgery because of cardiac dilatation. Three patients received peritoneal dialysis for acute renal failure following cardiac surgery. Three patients received inhalation of nitric oxide for treatment of postoperative pulmonary hypertension. The systolic pressure difference between lower limb and upper limb measured after operation was 10 to 20mmHg in 18 patients.There were no obvious systolic pressure difference between arm and leg in 8 patients.The systolic pressure of upper limb was higher than that of lower limb in 2 patients, and the pressure difference was 15mmHg and 20mmHg. All patients were followed up from 3 to 50 months. They were all survival except one died of severe tricuspid regurgitation, pulmonary infection and respiratory failure 3 months after surgery which diagnosis was transposition of great artery and ventricular septal defect. The results of other 27 patients were satisfactory. Recoarctation occurred in 1 patient with end to end anastomosis and 1 patient with Gore-Texpatch graft aortoplasty. The pressure difference through the measurement of echocardiography was 25mmHg and 28mmHg. No reoperation were undergone. Conclusion CoA with intracardiac malformation can be repaired by single median sternotomy or left posterolateral thoracotomy combined with median sternotomy in onestage. This operative approach is beneficial, not only with shorten period of therapy and less operative cost, but also advantageous for the recovery of cardiac and pulmonary function.
Objective To summarize the experiences of surgical treatment of sinus venosus atrial septal defect （SVASD）. Methods There were 32 patients of SVASD, all of them were associated with totally or partially right anomalous pulmonary venous connection. There were 25 cases of superior SVASD, 22 cases underwent double-patch procedure, 3 cases underwent Warden procedure. In 7 cases of inferier SVASD, 3 cases of Scimitar syndrome underwent ASD repair by pericardial patch and at the same time the anomalous pulmonary vein was divided and reimplanted to the posterior wall of left atrium, 4 cases of them underwent single-patch ASD repair. Results The surgical results were satisfying and no patient died, 28 patients were in sinus rhythm and echocardiography showed neither obstruction of caval vein and right pulmonary vein nor residual interatrial shunt. Conclusion SVASD mostly associated with right anomalous pulmonary venous connection according to its special anatomic structure. Preserving the function of sinus node and avoiding of obstruction of caval vein should be routinely considered when superior SVASD was repaired. The heart function of Scimitar syndrome should be followed-up for a long time for it usually associated with right lung hypoplasia.
Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
Objective To observe the related complications of 23G pars plana vitrectomy (PPV). Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study. There were 98 patients (65.3%) with macular diseases, 46 patients (30.7%) with proliferative diabetic retinopathy, four patients (2.7%) with vitreous hemorrhage, one patient (0.7%) with rhegmatogenous retinal detachment, and lens nucleus falling off in cataract surgery in one patient (0.7%). Among 98 patients with macular diseases, 21 patients (21.4%) underwent topical anesthesia, 77 patients (78.6%) underwent retrobulbar anesthesia. DORC "twostep method" was performed in three patients, and Alcon 23G PPV "onestep method" was performed in 147 patients. The operation times ranged from 20 to 100 minutes, with a mean of (51.1±18.9) minutes. The follow-up ranged from three to 12 months. The intraoperative and postoperative complications were observed. Results Intraoperative complications was found in seven patients (4.7%), which included iatrogenic retinal breaks in one patient (0.7%), macular damage in one patient (0.7%), suprachoroidal perfusion in one patient (0.7%), puncture leakage and closure incision in two patients (1.3%), vitreous hemorrhage in one patient (0.7%) and stopper broken off in cannula in one patient (0.7%). Postoperative complications was found in 34 patients (22.7%), which including retinal detachment in one patient (0.7%), vitreous hemorrhage in three patients (2.0%), cataract in three patient (2.0%), intraocular pressure ＜10 mm Hg（1 mm Hg=0.133 kPa） in 20 patient (13.3%), and transient ocular hypertension in seven patients (4.7%). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.
Objective To evaluate the clinical characteristics of end oscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients (20 eyes) suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed. The patients (18 males and 2 females) aged from 5 to 79 years with the average age of 35.9 years. There were 16 post-trauma and 4 post-cataract endophthalmitis. The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes. During the operation, posterior vitreous detachment was induced, vitreous at the base and bands over the ciliary body was removed, and membrane at the anterior or posterior surface of the iris was also removed after lensectomy. The median of the duration of hospita lization to operation was 1.5 days, and the follow-up period was 6～42 months (mean=23 months). Results Positive cultures were obtained in 9 (45%) cases. Seven intraocular foreign bodies were extracted from 6 eyes. Ora serrata was separated at one place in 2 cases, iatrogenic retinal tear at one, two place in 1 case respectively. Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery. Ten eyes (50%) retained useful vision (ge;0.05). The visual acuity was decreased, maintained and improved in 1, 3 and 16 eyes, respectively, and 4 cases over than 0.08. Cornea was clear in 11 (55%) eyes after operation; 9 cases with silicon oil in; ocular pressure was slanting low in 2 cases , but more than 5 mm Hg（1 mm Hg=0.133 kPa）; intraocular hypertension in 1 case , controlled by medicine; local and questionable retinal detachment in 1 case respectively, without surgery again. The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers, only one eye in 11 eyes without silicon oil in was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitrectomy is useful, safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time. （Chin J Ocul Fundus Dis，2008，24：202-205）