ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
ObjectiveTo investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.MethodsBentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.ResultsThere was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.ConclusionBentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.
Objective To summary the clinical experience of liver retransplantation （RLT）， and to improve the effect. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively. The survival rates of patients with different interval between two liver transplantation （LT） were calculated， and the data of patients who died and survived during perioperative period after operation were compared and analyzed. Results The 1-， 2-， and 5-year cumulative survival rates of 62 patients were 67.7%， 59.7%， and 56.4%， of early stage RLT patients were 38.5%， 38.5%， and 30.8%， of later stage RLT patients were 75.5%， 65.3%， and 63.3%， respectively. There were 28 patients died after operation， and 20 patients （71.4%） died during perioperative period， whose major cause of death were infection （65.0%， 13/20）， in addition， 4 cases （20.0%） died of multiple organ failure， 2 cased （10.0%） died of hepatic artery complication， 1 case （5.0%） died of portal vein complication. Eight cases （28.6%） died after perioperative period in reason of tumor recurrence. The model for end-stage liver disease （MELD） score 〔（26.95±9.28） score vs. （14.23±9.06） score〕， creatinine （Cr） level 〔（157.3±88.0） μmol/L vs.（69.8±35.9） μmol/L〕， international normalized ratio （INR） value 〔（1.676±0.744） vs.（1.124±0.286）〕， and total bilirubin （TBiL） value 〔431.8 μmol/L vs. 248.2 μmol/L〕 of patients died during perioperative period were higher than that of patients survived after perioperative period （P＜0.05）. The ratio of abnormal Cr of patients died during perioperativeperiod and survived after perioperative period were 60.0% （12/20） and 7.1% （3/42）， respectively. The 34 patients who had survived after perioperative period were all got followed-up for 3-104 months （average 49 months）. There were no tumor recurrence during the followed-up， and liver function of them were normal. Conclusions RLT is an effective method for irreversible graft failure after LT. Optimum operative time and reasonable individual immunosuppressive regimen to decrease the infection rate are all contribute to the increase of the survival rate.
目的探讨腹腔镜胆道再次手术的适应证、手术方法及临床效果。方法回顾性分析我院2003年2月至2010年11月期间46例腹腔镜胆道再次手术患者的临床资料，对术中及术后结果进行总结。结果本组45例在腹腔镜下完成手术，1例中转开腹。手术时间为45～270 min(平均120 min)，残株胆囊切除时间为(40±10) min，胆总管切开取石+T管引流时间为(150±50) min，胆总管切开取石+等离子碎石+T管引流时间为(180±40) min，术后出血及漏胆腹腔镜探查术时间为（40±15）min。结石一次性取尽23例，术后残余结石2例，住院4～21 d，平均8.6 d。胆管残余结石患者在术后1个月后经T管瘘道用胆道镜取石。术中十二指肠球部损伤3例，及时发现修补; 术后出现右侧胸腔积液4例、肺部感染2例和漏胆1例，均经非手术治疗痊愈。术后电话随访6～24个月（平均15个月），未见异常。结论腹腔镜胆道再次手术可行，并具有创伤小、恢复快等优点，但术前应严格掌握手术适应证，对手术医生的技术要求也较高。
ObjectiveTo analyze the reason of 45 patients with cardiac valve reoperation and to evaluate the safety of redo heart valve replacement. MethodsWe retrospectively analyzed the clinical data of 45 patients in our hospital between January 2010 and January 2015. There were 45 patients with 14 males and 31 females at an average age of 51.21± 8.36 years. ResultsThree of 45 patients (6.67%) were died after surgery. Mean follow-up was 36 (4-68) months. A total of 42 patients were alive and without reoperation again. The main reasons of heart valve reoperation included lesions of untreated valve, paravalvular leakage, thrombosis associated with valvular dysfunction, bioprosthesis degeneration, endocarditis, valvular lesions after angioplasty. ConclusionTricuspid regurgitation should be treated aggressively when the mitral valve involved in the first operation. Patients received the secondary heart valve replacement is safe and effective. Strict follow-up system should be established and surgical intervention should be taken timely and appropriately.
Objective To explore the factors associated with the occurrence of unplanned reoperations. Methods Surgical cases at Peking University Shenzhen Hospital from 2015 to 2023 were collected. After excluding unplanned reoperations, according to whether unplanned reoperation occurs, the included surgeries would be divided into the generate unplanned reoperation group and the non-generate unplanned reoperation group. Based on gender and age, the included surgery was matched with a propensity score of 1∶4 ratio. A logistic multiple regression model was established to investigate the influencing factors of unplanned reoperations. Results A total of 4 485 surgeries were included. Among them, there were 891 cases in the generate unplanned reoperation group and 3 594 cases in the non-generate unplanned reoperation group. The logistic regression analysis of the influencing factors of unplanned reoperation showed that different surgical levels, American Society of Anesthesiologists grades, surgical types, anesthesia methods, surgical time, and whether the unplanned reoperation discussion system can all affect unplanned reoperation (P<0.05). Conclusions The surgical level, American Society of Anesthesiologists grades, surgical types, anesthesia methods, surgical time, and whether the unplanned reoperation discussion system are influencing factors for the occurrence of unplanned reoperation. The occurrence of unplanned reoperation involves multiple levels of both the medical side and the patient side. It is necessary to formulate patient classification and early warning management and procedural prevention of unplanned reoperation based on each factor to ensure patient safety.