Objective To investigate the impact of three kinds of palliative operation on the body and growth of pulmonary artery in patients with congenital heart diseases of diminutive pulmonary blood. Methods Clinical data was reviewed in 28 cases of congenital heart diseases with diminutive pulmonary blood who had been performed cavopulmonary connection （n = 9）, systemic-pulmonary shunt （n = 8 ）, and palliative reconstruction of right ventricular outflow tract （n=11）. The period between re-hospitalized and the first was 5-54 months （19.07±10. 06 months ）. Hematocrit （HCT）, hemoglobin （Hb）, percutaneous oxygen saturation （SpO2）, body surface area （BSA）, and pulmonary artery index （PAI） etc. were observed both before palliation and before the second operation. Results After the second hospitalization, there were 7 cases of death from hemorrhage, failure of circulation and extracorporeal circulation accident etc. The time of respirator, intensive care unit and total amount of dopamine in patients of palliative reconstruction of right ventricular outflow tract were longer and more than those in patients of cavopulmonary connection （P〈0. 05）. HCT, Hb before the second operation were decreased than thoes before palliative operations in all patients, SpO2, BSA and PAI increased significantly （P 〈 0. 01 ）. Before the second operation, BSA of patients with cavopulmonary connection, BSA and PAI of patients with systemic-pulmonary shunt, SpO2, BSA and PAI of patients with palliative reconstruction of right ventricular outflow tract were increased than those before palliative operations（P〈0. 01）. HCT of palliative reconstruction of right ventricular outflow tract was decreased（P〈0. 05）. Conclusion This results suggests that pulmonary blood of patients with congenital heart diseases of diminutive pulmonary blood can be increased, development of pulmonary arteries can be improved efficiently by systemic-pulmonary shunt and palliative reconstruction of right ventricle outflow tract, but it can not be found in cavopulmonary connection patients.
ObjectiveTo discuss the treatment methods and outcome of hilar cholangiocarcinoma. MethodsFrom January 2002 to December 2008, 81 cases of hilar cholangiocarcinoma were retrospectively analyzed. ResultsAmong 81 patients, there were 55 males and 26 females, ages were from 38 to 72 years with an average age 57.5 years. In BismuthCorlette classification, 5 cases were type Ⅰ, 15 cases type Ⅱ, 14 cases type Ⅲa, 14 cases type Ⅲb, 33 cases type Ⅳ, according to the preoperative results of MRCP, but the classification of 15 cases were not consistent to the preoperative results (5 cases type Ⅱ, 8 cases type Ⅲ, 2 cases type Ⅳ) according to the results of intraoperative exploration. The rates of complications of radical operation, palliative operation, internal biliary drainage, and external biliary drainage were 54.5%(12/22), 58.8%(10/17), 23.8%(5/21), and 66.7%(14/21), respectively. The rate of complications of internal biliary drainage was lower than that of the other three methods (Plt;0.01), there were no significant differences among the other three methods. The 1, 2, 3, and 5year survival rates of 22 patients with radical operation, 17 patients with palliative operation, 21 patients with internal biliary drainage, 21 patients with external biliary drainage were 75.0%, 60.0%, 38.3%, 2.6%; 72.7%, 26.5%, 4.2%, 0; 50.5%, 15.8%, 2.2%, 0; 30.6%, 8.5%, 0, 0, respectively. The median survival time was 29.5 months, 13.8 months, 10.5 months, and 8.3 months, respectively. Survival rate of radical operation was higher than that of palliative operation (χ2=14.20, P=0.000 3), palliative operation was higher than that of internal biliary drainage (χ2=4.50, P=0.040 5), and internal biliary drainage was higher than that of external biliary drainage (χ2=4.45, P=0.040 1). ConclusionsThe BismuthCorlette classification is a guide to the required surgery, but the results of intraoperative exploration decides the final classification and operative method. Radical resection is the main related factors influencing the therapy efficacy of hilar cholangiocarcinona. Basinstyle anastomosis and T type supportingtube is the first choice of palliative operation. External drainage, to the full, is avoided.
ObjectiveTo evaluate the surgical outcomes of modified Blalock-Taussig shunts in the patients with congenital heart diseases of diminutive pulmonary blood. MethodsWe retrospectively analyzed the clinical data of 39 patients with congenital heart diseases of diminutive pulmonary blood, who underwent modified Blalock-Taussig shunts with Gore-Tex vessels in the First Affiliated Hospital, Hunan University of Chinese Medicine between June 2007 and June 2013. There were 23 male and 16 female patients at age of 6 months to 16 years (4.64±3.85) years, body weigh at 4.5-43.0 (14.81±8.69) kg. ResultsThere were 4 postoperative deaths. The early mortality was 7.69% (3/39). The arterial oxygen saturation increased from 64.28%±8.05% to 81.07%±5.76% (P < 0.01). Ideal pulmonary flow in each patient was obtained. Pulmonary arteries were significantly improved compared with those before operation. McGoon ratio (1.11±0.16 versus 1.58±0.22, P < 0.01) and Nakata index (113.98±14.84 mm2/m2 versus 160.98±26.65 mm2/m2, P < 0.01) increased with a statistical difference. Two-stage radical operations were performed in 8 patients. ConclusionsModified Blalock-Taussig shunt is effective in promoting development of the pulmonary arteries and improving cyanosis significantly. Modified Blalock-Taussig shunt can correct hypoxia to prepare for the radical operation．