ObjectiveTo summarize experience of surgical treatment for hilar cholangiocarcinoma. MethodsFrom January 2009 to July 2011, 87 patients with hilar cholangiocarcinoma were enrolled into the department of Biliary and Pancreatic Surgery of the Second Affiliated Hospital of Harbin Medical University. The intra-and post-operative results were analyzed. ResultsOut of 87 cases, the resection rate was 67.8% (59/87). The radical (R0) resection rate was 48.3% (42/87), R1 resection rate was 11.5% (10/87), palliative (R2) resection rate was 8.0% (7/87). The patients were successfully got through the perioperative period, threre was no operative mortality. 1-year, 3-year, 5-year survival rates of the R0 resection group were 92.9% (39/42), 31.0% (13/42), 19.0% (8/42), respectively. No patient was alive more than 3 years in the groups of R2 resection and internal or external drainage. 1-year and 2-year survival rates of the R1 resection group were 70.0% (7/10) and 20.0% (2/10), respectively. 1-year survival rate of the R2 resection group was 57.1% (4/7). 1-year survival rate of the internal or external drainage group was 35.7% (10/28). 1-year, 3-year, and 5-year survival rates of the R1 resection group and R2 resection group were significantly lower than those of the R0 resection group (P<0.05). ConclusionFor hilar cholangiocarcinoma, radical resection is the only method to cure. Preoperative evaluation, percutaneous transhepatic cholangial drainage so as to relieve obstruction of biliary tract, proper liver resection and intraoperative pathology for resection margin are imperative guarantees lead to radical resection. Palliative resection might prolong survival time and improve quality of life.
ObjectiveTo explore the effect of the reimplantation procedure with the De Paulis Valsalva graft in patients with aneurysms. MethodsWe retrospectively analyzed the clinical data of 38 patients underwent valve-sparing aortic root replacement using De Paulis graft in our hospital between September 2005 and July 2013.There were 32 male and 6 female patients at age of 45.5±12.4 years. We compared the parameters of pre-operation and post-operation and followed up the patients for 5 years. ResultsThere were 2(5.3%) deaths in hospital. The follow-up time was 2-95 months with following-up rate of 92.1%(35/38). A total of 2 patients(5.3%) had grade 3 to grade 4 aortic insufficiency. And one of these patients received aortic valve replacement after 1 year. At 5 years of following-up, one patient died of septic shock due to pacemaker infection. One patient died of kidney failure due to renal artery dissection aneurysm affected with impaired renal function and long-term hemodialysis. ConclusionThe reimplantation type of valve-sparing procedure can be facilitated by the use of the De Paulis valsalva graft and can be performed with satisfactory perioperative and mid-term results.
ObjectiveTo explore the difference between minimally invasive direct and conventional thoracotomy off-pump coronary artery bypass surgery (CABG). MethodsWe selected 276 patients underwent off-pump CABG surgery in our hospital from June 2005 through June 2014. There were 55 patients with minimally invasive off-pump CABG surgery and 221 patients conventional thoracotomy surgery. By using the method of peopensity score matching, we selected 55 conventional thoracotomy patients as a control group in our study. There were 41 males and 14 females at age of 60.8±10.5 years with minimally invasive off-pump CABG surgery, 44 males and 11 females at age of 60.6±12.5 years with conventional thoracotomy. ResultsThere was no statistical difference in surgery time, stay in the intensive care unit (ICU) time between conventional thoracotomy surgery and minimally invasive off-pump CABG. Compared with conventional thoracotomy surgery, minimally invasive off-pump CABG patients had statistical improvement in post-operative hospital stay time (7.3±3.1 d vs. 8.8±3.9 d, P=0.01), postoperative drainage (684(0-2 790)ml vs. 739(50-4 460)ml, P=0.03), perioperative blood transfusion (1.91(0-20)U vs. 6.62(0-20)U, P=0.00), surgery incision length (5.6±1.1 cm vs. 26.3±4.5 cm, P=0.00). ConclusionOverlooking the learning curve, minimally invasive direct off-pump CABG surgery has more advantages than conventional thoracotomy surgery. It is a safe and effective procedure.
ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.