Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
ObjectiveTo evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect (ASD) patients. MethodsWe retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass (CPB) in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8 (range, 9-56 years). All the patients were divided into two groups depending on different surgical approach:a median sternotomy group (a MS group, 15 patients)and a parasternal minimally incision group (a PMI group, 40 patients). There was no statistical difference in age, gender, weight, cardiac function classification (NYHA), and atrial septal defect diameter between the two groups (P>0.05). We analyzed the clinical data of the patients and followed up for 6 months. ResultsAfter operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time (P=0.007) and cardiopulmonary bypass (CPB) time (P < 0.001), higher cost in hospital (P=0.040), less intraoperative blood loss, less postoperative drainage volume on the first day (both P < 0.001). There was no statistical difference in aortic clamp time (P=0.500) mean hospital stay (P=0.290) after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time (P=0.275) and hospitalization cost (P=0.188) between the two groups. While there was a statistical difference in CPB time between the two groups (P=0.007). There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuous activities with a statistical difference (P < 0.001). ConclusionParasternal minimally incision in the treatment of atrial septal defect is safe, effective, minimally invasive, with easy operation and shorter learning curve. It can be used as an important part of minimally invasive treatment procedure of congenital heart disease.
ectus exeavatum is the most common chest wall deformity. The impairment of cardiopulmonaryfunction, severe psychological injury and other complications will be caused by the deformity. ″TheSternal Turnover″and″ The Sternal Elevation″are respective difference in indications andcharacteristics to treatment of pectus exeavatum. Pectus excavatum deformity will be repaired with theproper procedure and postoperative treatment. Their exercise tolerance and cardiac function will alsobe impro...
Abstract： Objective To find out goodness and weakness by comparing totally thoracoscopic surgery （TTS）and median sternotomy （MS）with cardiopulmonary bypass for pediatric open heart operation. Methods One hundred and fortyseven patients with ventricular septal defect(VSD) and atrial septal defect(ASD) were randomly divided into two groups according to operative methods, TTS group: patients were operated by totally thoracoscopy; MS group: patients were operated by median sternotomy with cardiopulmonary bypass. The clinical records from two groups were compared on operative effect, complications, hospitalization, ventilation time,variations of main data of blood routine test, drainage of pleura cavity, blood loss and transfusion, and pulmonary function. Results There were no death in two groups. There was VSD residual leak the same day after operation which was cured by TTS in one patient of TTS group. There was one case which bleeding was stopped by second operation in MS group. Followup visit were made to 41 patients for 3 months, no heart murmur was detected. The ultrasonic cardiography (UCG) showed that correcting of VSD and ASD were good and had no residual leak. The hospitalization,aortic clampping time, ventilation time and variations of main data of blood routine test, drainage of pleura cavity, blood transfusion and blood loss in TTS group had no significant difference to those in MS group (Pgt;0.05). Operating times was longer in TTS group than that in MS group, while stays in the intensive care unit were shorter in TTS group than that in MS group (Plt;0.01). Preoperative and 3 months postoperative pulmonary function of both teams had no statistically significant difference in two groups (Pgt;0.05). Conclusion TTS is a safe and effective method to pediatric VSD and ASD as MS is.
Objective To investigate the application of delayed sternal closure (DSC) following arterial switch operation for neonates with transposition of great arteries (D-TGA). Methods We retrospectively analyzed clinical data of 172 neonates underwent arterial switch operation with transposition of great arteries (D-TGA) between June 1st 2009 and December 31st 2015. These neonates were divided into 2 groups including a DSC group (118 patients with 99 males and 19 females) and a non-DSC group (54 patients with 47 males and 7 females). The outcome of the two groups were compared. Results Preoperative mechanical ventilation(P<0.001), emergency surgery (P=0.023) and extracorporeal circulation time (P<0.001) were the risk factors for delayed sternal closure. The incidence of complications of median sternotomy incision in the DSC group was not higher than that in the non-DSC group. The mortality rate in the DSC group was markedly higher than that in the non-DSC group (P<0.001). However, DSC was not a risk factor for the death of the neonates. Conclusion Delayed sternal closure does not increase the incidence of complications of the median sternotomy incision, nor is it a risk factor for the death of the neonates. Reasonable application of delayed sternal closure is helpful for early postoperative recovery of the neonates.
Objective To explore a surgical method for chronic osteomyel itis of sternum after thoracotomy. Methods From January 2006 to February 2009, 11 cases of chronic osteomyelitis after thoracotomy (2 cases of coronary bypass, 6 cases of mitral valve replacement, and 3 cases of ventricular defect repair) were admitted. Of them, there were 6 males and 5females, aged from 6 to 62 years (median 34 years), including 6 cases of simple osteomyelitis of sternum, 2 cases of osteomyelitis of sternum with suppurative infection of mediastinum, and 3 cases osteomyel itis of sternum with costal chondritis. Necrotic sternum were excised and defect was from 4 cm × 3 cm to 7 cm × 4 cm. Greater pectoral muscle flap was designed from 8 cm × 5 cm to 10 cm × 6 cm on one side and was transferred to defect. Negative drainage and sensitive antibiotics were administered after operation. Results Healing by first intention was achieved in 10 patients except 1 patient who had a few discharge at the drainage outlet and whose incision healed 1 week later. The follow up was from 3 to 10 months with an average of 6 months. The formed scars were flat with soft texture in 8 patients and moderately hypertrophy in 3 patients. The wounds healed without pain, relapse or abnormal function of donor upper limb. Conclusion Transplantation of greater pectoral muscle flap is an effective way to repair chronic osteomyelitis of sternum after thoracotomy.
Objective To summarize experiences of surgical treatment and long-term results of myasthenia gravis (MG). Methods Two hundred thirty-six patients underwent thymectomy for MG in our department from Jan.1978 to Dec. 2002. The perioperative management, relative factors of postoperative crisis and long-term results were analysed. Results In 236 patients postoperative crisis took place in 44 cases accounted for 18.6%. The occurrence of postoperative crisis was related to preoperative management, modified Osserman clinical classification and combination with thymoma. Three cases died in the postoperative periods. Among them, one died of acute respiratory distress syndrome induced by aspiration and the other died of crisis. The effective rate in 1, 3, 5 years was 84.6%, 91.0% and 89.0% respectively. Conclusions Thymectomy for MG is safe and effective. Delayed extubation could decrease the needs of tracheotomy in patients with high risk factors for postoperative crisis. The partial sternotomy approach is less traumatic but the long-term effects of surgery are identical to those reported by the most authors.