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 outcomes of complicated congenital heart diseases (CCHD) patients accepting multiple (>2) re-sternotomy operations.MethodsWe retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center. There were 95 males and 51 females with an age of 4.3 (3.1-6.8) years and a weight of 15.3 (13.4-19.0) kg at last operation.ResultsThe top three cardiac malformations were pulmonary atresia (n=51, 34.9%), double outflow of right ventricle (n=36, 24.7%) and functional single ventricle (n=36, 24.7%). A total of 457 sternotomy procedures were performed, with 129 (88.3%) patients undergoing three times of operations and 17 (11.7%) patients undergoing more than three times. Fifty-two (35.6%) patients received bi-ventricular repair, 63 (43.1%) patients received Fontan-type procedures, and 31 (21.2%) patients underwent palliative procedures. Ten (6.8%) patients experienced major accidents during sternotomy, including 7 (4.8%) patients of urgent femoral artery and venous bypass. Eleven (7.5%) patients died with 10 (6.8%) deaths before discharge. The follow-up time was 20.0 (5.8-40.1) months, and 1 patient died during the follow-up. The number of operations was an independent risk factor for the death after operation.ConclusionSeries operations of Fontan in functional single ventricle, repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation. Multiple operations are a huge challenge for CCHD treatment, which should be avoided.
目的 探讨胆管良性疾病再次手术的原因及其诊断与治疗。方法 回顾性分析1991年1月至2005年12月期间我院收治的胆管良性疾病再次手术91例患者的临床资料。结果 91例中接受2次手术者87例（95.60%），3次手术者4例（4.40%），无手术死亡。再次手术原因： 结石残留或复发42例（46.15%），胆管损伤36例（39.56%），残留胆囊5例（5.49%），胆肠吻合口狭窄2例（2.20%），返流性胆管炎2例（2.20%），胆总管下端炎性狭窄2例（2.20%），肠瘘2例（2.20%）； 再次手术方式： 胆肠Roux-en-Y吻合、T管支撑56例（61.54%），肝叶切除13例（14.29%），肝门整形、肝管空肠Roux-en-Y吻合10例（10.99%），残余胆囊切除5例（5.49%），胆总管切开取石、T管引流3例（3.29%），胆管修复、T管支撑2例（2.20%），胆管对端吻合、T管支撑2例（2.20%）。结论 降低结石残留以及预防胆管损伤是防止再次胆道手术的关键。进行胆道再次手术时应积极术前准备，制定合理治疗方案，以避免多次手术。
ObjectiveTo evaluate mid-term outcomes of pulmonary valve replacement surgery after repair of tetralogy of Fallot.MethodsA total of 73 patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement surgery in our hospital from January 2010 to January 2020 were enrolled, including 42 males and 31 females. The median age was 3.9 (0.2-42.8) years at initial repair and 20.0 (2.0-50.0) years at pulmonary valve replacement. The clinical data of the patients were recorded and analyzed.ResultsThere was no death in postoperative 30 d. The average follow-up time was 35.6±28.5 months, and no death occurred during the follow-up. One patient underwent a second reintervention after initial pulmonary valve replacement. The 1- and 5-year survival rates were both 100.0%, the 1- and 5-year reintervention-free rates were both 100.0%, and the 1- and 5-year valve failure-free rates were 100.0% and 67.1%. There was no significant difference in valve failure-free rates between different age groups (P=0.49) and different type of valve groups (P=0.74). The right (P=0.006) and left (P=0.002) ventricular ejection fractions were significantly improved, and the QRS duration was shortened after pulmonary valve replacement (P=0.006).ConclusionMid-term outcomes of surgical pulmonary valve replacement were satisfactory in patients with repaired tetralogy of Fallot, while the long-term effects should be further emphasized in clinical practice.
目的:探讨胃癌术后复发的临床特点及再手术适应症。方法:回顾性分析我院2000年1月至2009年1月收治的46例复发性胃癌再次手术病例的临床资料。结果:术中探查发现30例侵及毗邻器官,16例淋巴结转移,术后生存5年以上1例、3年以上18例、1年以上3例、1年以内死亡15例。结论:术后定期胃镜检查有助于复发性胃癌的早期诊断和提高手术率。选项择身体素质好、肿瘤复发局限者采取再次手术治疗,可延长生存时间,提高疗效。
ObjectiveTo investigate the value of carbon nanoparticle adopted in reoperation for thyroid cancer recurrence. MethodsFrom July to November of 2015, patients diagnosed with thyroid cancer recurrence in department of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University were enrolled in the research. All enrollment patients underwent carbon nanoparticles location guided by ultrasonography before reoperation. Relative data about surgery and location were analyzed retrospectively. ResultsTwenty-two patients were enrolled in the research. Mean operation time was (60.45±12.91) minutes. During surgery, a total of 405 (average 18.4) lymph nodes were harvested, and the staining rate was 71.9% (291/405). The pathological examination showed that there was a significant difference in the positive rate between carbon nanoparticles stained lymph nodes (45.0%, 131/291) and non-stained lymph nodes (5.3%, 6/114), P < 0.001. In addition, the positive rate in non-targeted stained lymph nodes was 30.2% (62/205). By contrast, it was 5.3% (6/114) in non-targeted non-stained lymph nodes. The difference showed significant significance (P < 0.001). ConclusionsAdoption of carbon nanoparticles in reoperation for thyroid cancer, which improves efficiency of dissection for the non-palpable lymph nodes metastasis, is worth generalizing in clinical practice.
ObjectiveTo evaluate the clinical efficacy of tricuspid valve re-operation after left cardiac valve surgery. MethodsWe retrospectively analyzed the clinical data of 23 patients underwent tricuspid valve re-operation in the Affiliated Drum Tower Hospital of Medical School, Nanjing University from January 2009 to November 2014. There were 3 males and 20 females with a mean age 53.48±10.79 years ranging from 34 to 71 years. The average body mass index of the 23 patients was 21.77±2.42 kg/m2. We followed up all the patients in outpatient department or through telephone for 3 months to 5 years. ResultsAll surgeries were operated under cardiopulmonary bypass. There were 15 patients underwent operation through medisternal incision and 8 patients underwent operation through the fourth intercostal incision of right anterolateral side. The mean operation time was 284.35±56.16 minutes and the mean time of cardiopulmonary bypass was 138.61±46.91 minutes. One patient died postoperatively and 2 patients chose to discharge automatically after operation. The other 20 patients recovered and discharged uneventfully. We followed up the patients for 3 months to 5 years. One patient underwent permanent pacemaker therapy for atrioventricular block, 3 patients accepted pharmaceutical therapy for atrial arrhyttmia, 1 patient underwent re-operation for infectious endocarditis of left cardiac artificial valve. and the follow-up conditions of the rest patients were well. Besides, the follow-up data showed that there was a mild regurgitation in 3 patients underwent tricuspid valve plasty. ConclusionTricuspid valve re-operation after left cardiac valve surgery can take multiple surgical pathways and strategies. The clinical effect has been proved and the midterm follow-up condition is well, but we still need the long-term follow-up for the further effect.
Abstract:Objective To investigate the reoperation indication,surgical timing and the key point of surgical treatment of prosthetic valve endocarditis （PVE） after valve replacement. Methods From February 2000 to July 2005,18 patients with PVE underwent surgery ,their clinical manifestation ,process of treatment and their prognosis outcome were analyzed. Results There were 3 patients （16.7 %） of early-death, 1 patient died of septic shock, and 2 patients died of multiple organ failure. Since 2003,there was no operative death for all 11 patients. There were 6 patients with respiratory insufficiency, 2 patients with renal insufficiency,which were recovered after treatment. The 15 survivors were followed up from 1 month to 5years. There was recurrence of infection in 1 patient who died after ineffective medical treatment. The other 14 patients recovered well. Conclusion It has high risk and high mortality for reoperation for PVE. Accurate reoperative indication,optimal surgical timing,radical debridment of infected tissue and correct perioperative use of antibiotics are the key factors to improve the reoperative result for PVE.