To evaluate the development prevention and treatment of pneumonic injury after operation on aged patients with abdominal infection. We analyzed 77 aged patients (＞60 y) admitted from Jan. 1991 to Dec. 1992: 38 cases of which with abdominal infection (infection group), 39 cases without abdominal infection (non-infection group). All patients were given oxygen therapy and continuous SaO2 monitoring. Results: There were 28 patients with hypoxemia (SaO2＜95%) in infection group, with an occurrence rate of 73.7%. In non-infection group (12 patients), the rate of hyoxemia was 30.8%, which has significant difference between two groups (Ｐ＜0.001). All patients with hypoxemia were given oxygen therapy and 31 patients′ SaO2 was elevated. The efficient rate was 77.5%. Other 9 patients developed ARDS, the rate was 2.5% (9/40). In the infection group 8 patients developed ARDS with an occurrence rate of 21.1%. There was one patient with ARDS in the non-infection group, the rate was 2.6%. There was significant difference between two group (Ｐ＜0.05). Conclusions: The results suggest that hypoxemia is liable to occur in aged patients with abdominal infection after operation and these patients were liable to develop ARDS. Oxygen therapy and SaO2 monitoring is the important managements to these patients in prevention of pneumonic injury.
From march 199 to marxh 1994, 25 patients sustained acute gastroduodenal muncosal hemorrhage after liver surgery of 1519 cases in this hospital. Among all patients, 24 cases were primary liver carcinoma with hepatocirrhosis and one was cavernous hemangioma of the liver gt;all were treated by non-operative method, including nutritional support, liver function protection, blood transfusion and infusion to increase the blood volume and administration of hemostatic and antagonist of H2-receptor or H+/K+ATP enyme. Twenty one patients recovered and 4 deaths were cases of severe hepatocirrhosis. The result indicates that there is a direct relationship between acute gastroduodenal mucosal lesions and hepatic cirrhosis. The severer the degree of hepaticcirrhosis and the worse the general condition after surgery is the more severely the liver function impaired, there will be more chance of developing acute gastricmucosal erosion and bleeding.
Objective To improve the treatment effectiveness of coronary artery fistula by summarizing and analyzing the clinical experiences of its surgical procedures. Methods We retrospectively analyzed the clinical data of 47 patients, 25 males and 22 females, with coronary artery fistula who were hospitalized from January 2003 to December 2008. The age of the patients ranged from 9 months to 63 years old(mean age of 34 years). Thirtytwo cases without associated intracardiac abnormalities were given surgical closure of fistula without cardiopulmonary bypass. Ten cases with largesize fistula were repaired directly or with a patch under cardiopulmonary bypass. Coexisted heart abnormalities were treated simultaneously. Results There were 26 cases of right coronary artery fistula,17 cases of left coronary artery fistula and 4 cases of fistula of both coronary arteries; 17 cases of coronary artery fistula opening into the right ventricle, 8 cases opening into the right atrium, 12 cases opening into the pulmonary artery, 2 cases opening into the sinus of coronary veins, 3 cases opening into the left atrium, 5 cases opening into the left ventricle; and there were 4 cases of multiple fistulas. No death happened during the operation. All patients received surgical treatment successfully, except for one multiplefistula patient who had remaining fistula after operation. Followup was conducted on 47 patients with the time period ranging from 1 month to 5 years. The color ultrasonic cardiography showed that all patients recovered well except for one multiplefistula patient who had a small remaining fistula. Conclusion Coronary artery fistulas can cause hemodynamic problems with indication for surgical intervention. Surgical operation is quite effective for fistulas of coronary artery.
Objective To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increasethe accuracy of the primary THA prosthetic fixation. Methods From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62.3 years and 60.5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fracture (Garden Ⅲ,Ⅳ) in 23 patients (23 hips) in Group I and 25 patients (25 hips) in Group S, acetabular dysplasia (Campbell Ⅰ, Ⅱ) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Grouop S, osteoarthritis in 16 patients (17 hips)in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat Ⅲ,Ⅳ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group S, 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoralneck length, and femoral offset distance. The items compared betweem Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prostheric position of postoperative X-ray imaging. Results The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatly better than those of Group S. Conclusion The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if Carm fluoroscopy can be provided.
Abstract: Objective To explore the surgical procedures and cerebral protection and improve surgical results by summarizing the experiences of surgical treatment of 68 patients of De Bakey Ⅰ aortic dissection. Methods We retrospectively analyzed the clinical data of 68 patients (including 45 males and 23 females aged 29 to 72 years with an age of 44.5±17.2 years) with De Bakey Ⅰ aortic dissection who were treated in the General Hospital of Shenyang Command between May 2004 and April 2010. Acute aortic dissection (occurring within 2 weeks) was present in 57 patients and chronic aortic dissection in 11. The intimal tear was located in the ascending aorta in 45 patients, in the aortic arch in 12 and in the descending part of the aortic arch in 11. Thirtyfive patients underwent emergency operation and 33 underwent selected or limited operation. The operations were performed under hypothermic circulation arrest plus selective antegrade cerebral perfusion or right vena cave retrograde cerebral perfusion to protect the brain. Total arch replacement and stented elephant trunk were performed in 25 patients, Bentall operation with concomitant total arch replacement and stented elephant trunk in 16 patients, pure right semi aortic arch replacement and stented elephant trunk in 15 patients, total aortic arch replacement in 7 patients, right semi aortic arch replacement and stented elephant trunk in 3 patients, and Cabrol operation with concomitant aortic conduit with valve and total arch replacement and stented elephant trunk in 2 patients. Results Five patients (4 with acute aortic dissection and 1 with chronic aortic dissection) died with an operative mortality of 7.4%(5/68). The causes of death were anastomotic bleeding during surgery in 1 patient, postoperative low cardiac output syndrome and malignant arrhythmia in 2, acute renal failure in 1 and cerebral complications in 1. During perioperative period, psychotic symptoms occurred in 5 patients, pericardial effusion in 2 patients, hoarseness in 6 patients and poor wound healing in 1 patient. All of them were cured before dehospitalization. Sixty patients (95.2%, 60/63) were followed up for 2 months to 6 years with the other 3 patients lost. During the ollow-up, sudden death occurred to 1 patient with unknown reasons, and 1 patient had pericardial effusion and symptoms improved with relevant treatment. All the other patients followed up had a good quality of life with significant improvement of heart function. Fiftyfour patients had a heart function of New York Heart Association class Ⅰ and 5 had a function of class Ⅱ. Conclusion The surgical treatment for De Bakey Ⅰ aortic dissection should be active. The beneficial results can be obtained with best choice of operative procedures, methods of cerebral protection, and adequate treatment of complications of operation.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Objective To compare the postoperative outcomes of modified single-patch technique and one-and-a-half-patch technique for complete atrioventricular septal defect (CAVSD) with a large ventricular component (>1 cm). Methods We retrospectively reviewed clinical data of 79 CAVSD patients with a large ventricular component (>1 cm) in Shanghai Children's Medical Center from January 2005 through January 2016. There were 37 males, 42 females with a median age of 8 months (range, 1.5 months to 10.2 years). Among the patients, 45 patients (20 males, 25 females) with a median age of 6 months(range, 1.5 months to 10.2 years) received modified single patch technique and 34 patients (17 males, 17 females) with a median age of 5.3 months (range, 2.5 months to 8.3 years) underwent one-and-a-half-patch (1.5-patch) technique. All the patients complicated with complex malformation such as double outlet of right ventricular, single ventricle, and transposition of great arteries were excluded. Results The mortality and reoperation rate in modified single-patch group were higher than those of the one-and-a-half-patch group. There were 2 postoperative early deaths in the modified single-patch group (4.4%). Among them, one patient died of postoperative valvular regurgitation and heart pump failure. The other one died of respiratory failure caused by severe pneumonia. There were 3 reoperations. Two patients performed valve plastic surgery because of valve regurgitation and one patient because of residual ventricular septal defect. There was no death and reoperation in the one-and-a-half-patch technique group. No left ventricular outflow tract obstruction and atrioventricular block in both groups were developed. Conclusion The 1.5-patch technique is an attractive clinical option in CAVSD patients with a large ventricular component.
ObjectiveTo evaluate the application of stereotactic electrode implantation on precise epileptogenic zone localization. MethodRetrospectively studied 140 patients with drug-resist epilepsy from March 2012 to June 2015, who undergone a procedure of intracranial stereotactic electrode for localized epileptogenic zone. ResultsIn 140 patients who underwent the ROSA navigated implantation of intracranial electrode, 109 are unilateral implantation, 31 are bilateral; 3 patients experienced an intracranial hematoma caused by the implantation. Preserved time of electrodes, on average, 8.4days (range 2~35 days); Obseved clinical seizures, on average, 10.8 times per pt (range 0~98 times); There were no cerebrospinal fluid leak, intracranial hematoma, electrodes fracture or patient death, except 2 pt's scalp infection (1.43%, scalp infection rate); 131 pts' seizure onset area was precisely localized; 71 pts underwent SEEG-guide resections and were followed up for more than 6 months. In the group of 71 resection pts, 56 pts were reached Engel I class, 2 were Engel Ⅱ, 3 was Engel Ⅲ and 10 were Engel IV class. ConclusionTo intractable epilepsy, when non-invasive assessments can't find the epileptogenic foci, intracranial electrode implantation combined with long-term VEEG is an effective method to localize the epileptogenic foci, especially the ROSA navigated stereotactic electrode implantation, which is a micro-invasive, short-time, less-complication, safe-guaranteed, and precise technique.
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 the effectiveness of rotation-embedding technology for treatment of moderate to severe inverted nipples. MethodsBetween March 2012 and March 2014, 24 patients (39 nipples) with moderate to severe inverted nipples were treated using rotation-embedding technology. The age ranged from 28 to 42 years (mean, 32 years). The bilateral nipples involved in 15 cases, unilateral nipple in 9 cases, including 30 moderate inverted nipples, 9 severe inverted nipples. The first time operation was performed in the other patients except 1 patient who had received corrective operation of bilateral nipples. ResultsThe operation was successfully performed in all patients; primary healing of incision was obtained; no swollen, bleeding, dehiscence, or blood flow obstacle occurred. All patients were followed up 5-24 months (mean, 12 months). The shapes of nipples were satisfactory; bilateral nipples were symmetrical basically; no nipple inversion recurred, and the nipple skins had good sensation. ConclusionUsing rotation-embedding technology can correct moderate to severe inverted nipples effectively.