west china medical publishers
Author
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Author "熊辉" 10 results
  • 食管癌术后乳糜胸的治疗

    目的 探讨食管癌术后乳糜胸的治疗方法和效果。 方法 回顾分析湖北医药学院附属襄阳一医院684例食管癌术后并发乳糜胸18例患者的临床资料,其中男12例,女6例;年龄57.5 (38~66)岁。食管上段癌2例,食管中段癌15例,食管下段癌1例。所有患者均行左胸径路食管癌根治术,术中均未见明确的胸导管损伤,未行预防性胸导管结扎。 结果 18例均先行保守治疗,10例痊愈;再手术治疗8例,手术时间60~90 min,术后无感染等并发症发生,住院时间8~10 d;7例治愈,1例死于术后吻合口瘘。17例治愈患者3个月后复查无乳糜胸再发。 结论 食管癌术后乳糜胸患者有必要早期行10 d严格、正规的保守治疗,经保守治疗后乳糜液量仍>800 ml/d者应及时再手术治疗,手术方式以右胸径路、膈上低位胸导管结扎术为宜。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 输血申请不合格原因分析与对策

    目的 通过分析医院输血申请不合格的原因,探讨改进对策。 方法 对2009年1月-2010年12月发生的698例不合格输血申请原因逐一进行分析,并提出具体改进措施。 结果 不合格的输血申请各个科室均有,主要集中于输血量较大的血液科、胸外ICU、SICU等科室,不合格的原因包括申请单不合格(主治医师未审核盖章、护士未签名、申请单污染或打印不清晰)与合血标本不合格(血量不够、样本泄漏、标本联号与申请单不一致或不清晰、未重新抽合血标本、抽错患者),其中合血标本不合格占92%。 结论 加强对医务人员的责任感教育,强化操作培训以及细化临床使用手册,可减少输血申请环节的差错,以降低医疗风险。

    Release date:2016-09-08 09:14 Export PDF Favorites Scan
  • 颈部管状胃、食管器械吻合在中上段食管癌手术中的运用

    目的总结中上段食管癌手术经验,探讨管状胃、颈部器械吻合在中上段食管癌手术中的运用。 方法纳入襄阳市一医院心胸外科2010年1月至2013年3月手术治疗的中、上段食管癌患者122例,根据重建消化道手术方式不同分两组:管状胃器械吻合组68例,男38例、女30例,年龄(63.5±11.2)岁;左胸径路、食管肿瘤切除后,胃管状成形由食管床提至左颈部,采用国产管状吻合器行胃、食管吻合;全胃手工吻合组54例,男32例、女22例,年龄(62.6±10.7)岁;左胸径路、食管肿瘤切除后,全胃由食管床提至左颈部与近端食管行手工单层、宽边吻合。比较两种手术方式下患者的临床效果。 结果全组无手术死亡。管状胃器械吻合组在游离后胃的长度明显长于全胃手工吻合组(t=10.60,P=0.000),吻合时间(t=32.92,P=0.000)、总手术时间(t=5.75,P=0.000)及平均住院时间(t=9.58,P=0.000)较全胃手工吻合组缩短,吻合口瘘(χ2=4.75,P=0.029)、吻合口狭窄(χ2=6.01,P=0.014)、呼吸循环并发症(χ2=5.34,P=0.021)发生率较全胃手工吻合组低,而两组乳糜胸发生率差异无统计学意义(χ2=5.34,P=0.753)。 结论在中上段食管癌手术中,胃管状成形并颈部器械吻合能有效降低术后并发症的发生,是较为理想的消化道重建方法。

    Release date: Export PDF Favorites Scan
  • Research progress of adenocarcinoma of esophago-gastric junction

    Objective To summarize the research progress of the adenocarcinoma of esophago-gastric junction (AEG) in recent years, in order to improve the further understanding of this disease. Method The literatures about application and research progress of AEG were researched and reviewed. Results Siewert classification was a widely recognized classification for AEG, according to this classification, AEG was divided into typeⅠ, Ⅱ, and Ⅲ. Gastroesophageal reflux, Barrett’ sesophagus, and the infection of Helicobacter pylori may be the important pathogenic factors. For SiewertⅠAEG, thoracic approach was preferred commonly, and for SiewertⅡand Ⅲ AEG, total gastrectomy through abdominal approach and distal partial resection of esophagus through diaphragmatic hiatus approach were recommended. Endoscopic submucosal resection, neoadjuvant therapy, targeted therapy, and multidisciplinary team were becoming more and more important in the treatment of AEG. Conclusions The choice of surgical method and resection range should according to the types of AEG. Comprehensive assessment and comprehensive treatment would be performed, so that effect of treatment may be improved.

    Release date:2017-06-19 11:08 Export PDF Favorites Scan
  • 三尖瓣前叶血性囊肿一例

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • 利用实验室信息系统加强输血科管理

    【摘要】 目的 为使输血管理达到美国病理师协会(CAP)的认可标准,利用实验室信息系统(Laboratory Information System,LIS)加强输血科管理。 方法 电子化输血申请在医生工作站完成,血型标本、合血标本及输血申请单送往输血科后,通过LIS进行标本接收,信息处理(信息处理包括血型结果、抗体筛查结果录入、交叉合血结果录入、发血),记费。 结果 实现了输血申请的电子化,标本的自动接收,血型结果前后自动核对,血液扫描出库,系统自动记费,血液出入库管理,信息查询和统计功能。 结论 建立输血科LIS系统,能优化输血科工作流程,提高工作效率,降低差错率,完善管理,保证血液安全,从整体上提高输血科的工作质量和管理水平。

    Release date: Export PDF Favorites Scan
  • Surgical Treatment for Aortic Dissection Manifesting as Pure Aortic Regurgitation

    ObjectiveTo explore clinical features and surgical strategies for patients with aortic dissection (AD) manifesting as pure aortic regurgitation (AR), avoid preoperative misdiagnosis, and provide reference for clinical diagnosis and treatment. MethodsClinical data of 5 AD patients who were preoperatively diagnosed as pure AR in Beijing Fu Wai Hospital from January 2005 to May 2012 were retrospectively analyzed. There were 4 male and 1 female patients with their median age of 41 (34-53) years. All the 5 patients were diagnosed as AD during the operation. One patient received aortic valvuloplasty, 1 patient received Wheat procedure, and 3 patients received Bentall procedure. Clinical manifestations, accessory examinations, intraoperative findings, surgical strategies and follow-up results were summarized. ResultsNo postoperative death or complication occurred in this study. Echocardiogram of patient 1 before discharge showed that transverse diameters of the ascending aorta and aortic sinus decreased with satisfactory closure of aortic valves but no AR. Echocardiogram and CT all showed normal function in mechanical valves and patent blood vessel prosthesis in the other 4 patients. All the 5 patients were followed up for 4 (1-5) years and were alive during follow-up. Echocardiogram showed normal function in mechanical valves and patent blood vessel prosthesis without paravalvular leak in 4 patients and mild AR in 1 patient. ConclusionAD manifesting as pure AR is rare and easily misdiagnosed preoperatively. Careful analysis of medical history and accessory examinations can reduce the risk of misdiagnosis. Appropriate surgical strategies should be chosen according to intraoperative findings of intimal tears and aortic sinus damage of AD.

    Release date: Export PDF Favorites Scan
  • Mitral Valvuloplasty for the Treatment of Infective Endocarditis and Mitral Regurgitation

    ObjectiveTo investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). MethodsFrom March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. ResultsOne patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). ConclusionMVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.

    Release date: Export PDF Favorites Scan
  • Simultaneous hybrid coronary revascularization versus off-pump coronary artery bypass grafting for diabetic patients with multivessel coronary artery disease

    Objective To compare the in-hospital and midterm outcomes after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) in diabetic patients with multivessel coronary artery disease. Methods One hundred thirty-two diabetic patients with multivessel coronary artery disease underwent one-stop HCR at Fuwai Hospital from January 2010 to January 2015. These patients were 1∶2 matched with those who underwent OPCAB using propensity score matching. Results Simultaneous HCR had less chest tube drainage (618 (420, 811) ml vs. 969 (711, 1 213)ml, P<0.001), lower transfusion rate (19.7%vs. 34.1%, P=0.026), shorter mechanical ventilation time (11.6 (8.2, 14.8) h vs. 16.0 (12.1, 18.7) h, P<0.001), and shorter stay in intensive care unit (21.5 (18.8, 42.0) hvs. 44.6 (23.7, 70.1) h, P<0.001) than OPCAB. During over median 40 months follow-up, simultaneous HCR offered similar major adverse cardiac or cerebrovascular events (MACCE) rate (6.8%vs 9.0%, P=0.826), but lower stroke rate (0% vs 3.0%, P=0.029), compared with OPCAB. Conclusion For selected patients with diabetes, simultaneous HCR provides a safe and effective revascularization alternative. It decreases perioperative invasiveness and incurred similar and favorable midterm outcomes with OPCAB.

    Release date:2017-12-04 10:31 Export PDF Favorites Scan
  • Primary practice of transcatheter edge-to-edge repair for mitral regurgitation: Early results of MitraClip in multiple centers

    ObjectiveTo investigate the early clinical results of MitraClip system in domestic patients. Methods We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. ResultsAll procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. ConclusionMitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.

    Release date: Export PDF Favorites Scan
1 pages Previous 1 Next

Format

Content