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find Keyword " 外科" 57 results
  • Clinical Characteristics and Surgical Treatment of Thoracic Hemangioma

    Abstract: Objective To investigate the clinicopathological characteristics, improve the accuracy of clinical diagnosis, and reduce postoperative complications of thoracic hemangioma. Methods Clinical records of 9 patients with thoracic hemangioma who underwent surgical resection in West China Hospital of Sichuan University from January 2006 to August 2012 were retrospectively analyzed. There were 2 males and 7 females with their average age of 47.9±19.3 (18-71)years. Six patients underwent thoracotomy, 1 patient underwent complete video-assisted thoracoscopic surgery (VATS), 1 patient underwent video-assisted mini-thoracotomy, and 1 patient underwent staged operations which were performed by neurological surgeons and thoracic surgeons separately. Imaging characteristics, intraoperative gross tumor features, and pathological characteristics of resected hemangioma specimens were analyzed. Clinical outcomes of different surgical strategies for the treatment of hemangioma were compared. Results Nine patients with thoracic hemangioma were included in this study. Imaging studies showed the tumor as a round-shaped mass in 66.7% (6/9) of these patients and a lobulated mass in the remaining 33.3% (3/9) patients. Magnetic resonance imaging (MRI) assessment was helpful for preoperative diagnosis of hemangioma, with T2 weighted imaging tumor enhancement as the main MRI feature. Thoracic operation time was 106.3±60.1 (60-192) min, and intraoperative blood loss was 91.1±43.7 (30-150) ml. All the patients were followed up for 3-6 years except 1 patient who was followed up for 1 month. None of the patients had hemangioma-related death, recurrence or metastasis during follow-up. Conclusions Thoracic hemangiomas are usually benign entities and often locate in the mediastinum. Surgical strategies should be determined by the size and location of the tumor as well as the surgeon’s technique level. VATS has the advantages of being minimal invasive, causing less intraoperative blood loss and shorter length of hospital stay for the treatment of hemangioma. Resection of a dumbbell-type hemangioma may need cooperation between neurological and thoracic surgeons.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 老年危重心瓣膜病的外科治疗与围术期处理

    目的 总结老年危重心瓣膜病患者的手术治疗和围术期处理经验。 方法 回顾性分析 2008年6月至2010年6月中国医科大学附属第一医院37例60岁以上老年危重心瓣膜病患者手术治疗的临床资料,其中男21例,女16例;年龄60~79 (67.3±6.9)岁。二尖瓣病变15例,主动脉瓣病变8例,主动脉瓣+二尖瓣病变14例;合并左心房血栓9例,三尖瓣反流11例。 结果 围术期死亡3例,其中死于术后肺部感染1例,多器官功能衰竭1例,脑梗死1例。术后发生并发症18例,包括呼吸道并发症、室性心律失常、低心排血量综合征和急性肾功能衰竭等,经相应的治疗治愈。随访26例,随访时间6~23个月,心功能分级(NYHA)Ⅰ级13例,Ⅱ级12例,Ⅲ级1例。 结论 完善的术中操作、加强围术期处理,可有效降低老年危重心瓣膜病患者术后并发症的发生和病死率。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 青年非小细胞肺癌患者临床特点与预后因素分析

    目的 探讨青年(≤40岁)非小细胞肺癌(NSCLC)患者的临床特点、手术疗效,分析影响预后的因素。 方法 回顾性分析苏州大学附属第四医院2000年1月至2009年12月经手术治疗48例40岁以下青年NSCLC患者的临床资料,其中男31例,女17例;年龄(32±6)岁。29例术前明确为NSCLC,12例术前高度怀疑为肺癌,7例误诊为肺良性疾病;手术根治性切除37例,姑息性切除9例,手术探查2例。 结果 术后并发症发生率12.5% (6/48),1例死于探查术后呼吸衰竭,病死率2.1% (1/48)。术后组织病理学检查示腺癌26例,鳞癌16例,腺鳞癌5例,大细胞肺癌1例。术后病理分期示Ⅰ期3例,Ⅱa期9例,Ⅱb期15例,Ⅲa期17例,Ⅲb期3例, Ⅳ期1例。随访45例,随访率93.8% (45/48),随访时间23 (3~120) 个月。总的3年和5年生存率分别为39.6%和25.0%。肿瘤TNM分期、淋巴结转移状况、肿瘤直径、手术性质、术前新辅助化疗及术后规则放化疗是影响预后的重要因素,肿瘤TNM分期是影响患者预后最主要的因素。 结论 青年NSCLC误诊率高,恶性程度高,分期偏晚,手术根治性切除率偏低,应加强早诊早治意识。手术根治仍是青年NSCLC患者治疗的首选。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗

    目的 探讨先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗方法和效果。 方法 2009年1月至2012年1月第二军医大学长海医院收治先天性心脏病合并肺动脉瓣感染性心内膜炎患者6例,男1例,女5例;年龄8~41 (24.8±11.8)岁。动脉导管未闭(PDA)4例,PDA合并先天性主动脉瓣狭窄1例,室间隔缺损(VSD)合并三尖瓣反流1例。3例行PDA结扎+肺动脉内赘生物清除术,1例行PDA结扎+肺动脉瓣赘生物切除术,1例行PDA结扎+肺动脉瓣赘生物切除术+主动脉瓣置换术(AVR,置换19 mm CarboMetics环上机械主动脉瓣),1例肺动脉瓣膜破坏严重,行VSD修补+右心室流出道赘生物清除+右心室流出道拓宽+三尖瓣成形术+肺动脉生物瓣置换术(置换27 mm HancockⅡ型生物瓣)。 结果 6例患者术后均恢复良好,无围术期死亡和心内膜炎复发。所有患者复查超声心动图提示,未见赘生物、残余漏、瓣周漏等并发症。术后随访6个月~3年中,患者临床症状完全消失,均无明显不适。术后心功能恢复至Ⅰ级5例,Ⅱ级1例。 结论 对于先天性心脏病合并肺动脉瓣感染性心内膜炎患者,正确把握手术时机,积极行外科手术治疗是最有效的治疗方法。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 复杂先天性心脏病右心室流出道重建困难的处理

    目的 探讨复杂先天性心脏病在纠治过程中右心室流出道(RVOT)重建困难的处理方法和其适应证、手术方法、应用中的注意要点。 方法 回顾性分析2008年1月至2010年12月广州市妇女儿童医疗中心26例复杂先天性心脏病患者行手术治疗的临床资料。其中男14例,女12例;年龄(2.9±2.0)岁;体重(12.2±6.0) kg。所有患者在纠治过程中RVOT重建困难,分别采用以下方法进行处理: (1)肺动脉从根部切断与主动脉交叉后吻合于右心室切口; (2)肺动脉从根部切断直接下拉吻合于右心室切口; (3) 肺动脉切断后远心端与右心室切口间的后壁用左心耳或右心耳做后壁,人工补片做前壁,重建RVOT; (4)肺动脉与右心室切口间用自体心包做成的心包卷管道连接。 结果 无手术死亡,无Ⅲ°房室传导阻滞。10例患者因尿少行腹膜透析治疗,心脏压塞和/或胸腔出血开胸止血4例。所有患者随访0.5~3.0年复查:应用肺动脉从根部切断与主动脉交叉后吻合于右心室切口和肺动脉从根部切断直接下拉吻合于右心室切口两种方法的7例患者中肺动脉血流速度加快3例,2.5~3.0 m/s;残留中度以上肺动脉高压5例;中至重度肺动脉反流6例,其中肺动脉血流速度增快2例,残留中度肺动脉高压4例。 结论 以上4种RVOT重建方法在复杂先天性心脏病RVOT重建中应用得当有良好的手术效果;前2种方法有肺动脉血流速度增快的可能性;肺动脉瓣反流与术后肺动脉高压或肺动脉梗阻有关。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 二尖瓣置换术后左心室后壁破裂修补二例

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 血气胸手术后对侧迟发性肺水肿一例

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  • 重症心脏瓣膜病合并巨大左心室患者的外科治疗

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery

    Abstract: Objective To summarize our surgical experience of tetralogy of Fallot(TOF) with anomalous coronary artery(ACA), explore diagnostic method of ACA, and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract(RVOT) reconstruction. Methods From January 2004 to January 2010, 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years (5 months to 33 years)and median body weight of 18 (5 to 51) kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement, repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation (REV) technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above, below or beside coronary arteries (single patch or two patch technique). Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results  The median cardiopulmonary bypass time was 78 (65-102) min, median aortic crossclamp time was 50(40-82) min, and median operation time was 150 (126-178) min. There was no early death or severe coronary artery injury. Two  patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 (21-83)months and there was no late death during  follow-up. All the patients were in New York Heart Association (NYHA) classⅠduring follow-up, their left ventricular ejection fraction was normal, there was no sign of myocardial ischemia in electrocardiogram, and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient (△P) was 19 (8-38) mm Hg, and the RVOT gradient (△P) did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography (64-MSCT). Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 肺切除术后心脏疝一例

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
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