二尖瓣成形术与二尖瓣生物瓣置换术治疗风湿性二尖瓣重度关闭不全的效果比较

目的:探讨二尖瓣成形术(Mitral valve plasty,MVP)与二尖瓣生物瓣置换术(Mitral valve replacement,MVR)治疗风湿性二尖瓣重度关闭的临床疗效和安全性。方法:选择我院2014年1月至2019年1月收治的因风湿性二尖瓣重度关闭而行二尖瓣成形术或二尖瓣生物瓣置换术的患者60例,其中二尖瓣成形术组(MVP组)27例,二尖瓣生物瓣置换术组(MVR组)33例。比较两组患者的围手术期各项指标,治疗前后的心功能指标(左心室射血分数,左心房内径、左心室收缩末期内径、左心室舒张末期内径)及二尖瓣反流情况以及术后并发症的发生情况。结果:(1)MVP组患者的手术时间、体外循环时间均明显长于MVR组(P0.05);而术中出血量、呼吸机使用时间、住院时间MVP组均显著低于MVR组(P0.05);(2)术后,MVP组的LVEF和LVEDD水平高于MVR组,而LAD和LVESD水平则低于MVR组(P 0.05);(3)出院前及末次随访时,MVP组二尖瓣反流发生率与MVR组相比差异均无统计学意义(P0.05)。(4)MVP组患者的术后并发症发生率低于MVR组(P 0.05)。结论:二尖瓣成形术治疗风湿性二尖瓣重度关闭的临床疗效和安全性优于二尖瓣生物瓣置换术,但术者需严格掌控MVP的手术适应症。     

Mitral Valve Replacement in a 14-Month-Old Child

In a 14-month-old child with severe congenital mitral insufficiency, the mitral valve was replaced with a Starr-Edwards valve. This resulted in dramatic improvement and the child continues to thrive one year after surgery. The authors conclude that valve replacement should be considered in a child of any age if other methods of valve repair cannot be relied upon to produce a good result.     

Total Replacement of the Mitral Valve: Results of Insertion of a Starr-Edwards Valve in Five Patients

In five patients the mitral valve was resected and total valve replacement undertaken. The Starr-Edwards prosthesis was inserted. The first patient died, two and one-half months after operation, of a wide massive left-atrial clot and peripheral embolization. The second and third patients are well and back at work at eight months after operation, and the fourth patient is well at two and one-half months after operation. The fifth patient died suddenly at three weeks from massive peripheral embolization originating from the left side of the heart. The technical details of the insertion of the valves are described and the importance of careful postoperative anticoagulant management is stressed.     

二尖瓣置换术后左心室破裂2 例并文献复习

目的:总结二尖瓣置换术后左心室破裂2例临床经验教训,方法:回顾性分析我院2006,1-2009,12二尖瓣置换术后左心室破裂2例的临床资料,两例均在监护室里发生突然大出血,紧急输血,输液,机械呼吸,抗休克治疗,并行开胸手术。结果:一例心外修补抢救成功,术后2周顺利出院,一例CPB下心内外修补,因低心排综合症死亡。结论:左心室破裂是二尖瓣置换术最严重的并发症,一旦发生死亡率极高,因此预防,避免其相关因素更关键。     

微创技术在腰椎固定、融合术中的临床应用

近几年来,随着脊柱基础研究的发展以及各种新理论、新方法、新技术相继出现,微创技术在,临床中治疗各种腰椎疾患取得了很大进步.脊柱微创外科,具有创伤小、出血少、术后疼痛轻、恢复快等优点,受到腰椎疾病患者的欢迎.目前用于腰椎椎间融合的微创手术方法有前路腰椎椎体间融合术、后路腰椎椎体间融合术、经椎间孔腰椎椎体间融合术、极外侧椎体间融合术、轴向椎体间融合术以及多种微创技术联合应用.不同微创技术各有其优缺点,具有不同手术适应征,在临床应用中需要根据腰椎疾患的具体特征,选用合适的腰椎微创手术,以达到最佳临床效果.本文从腰椎微创手术入路改进、手术器械的创新以及在临床应用的效果方面作一综述.     

Minimally Invasive Cryosurgery-Technological Advances

The technological advances which have caused renewed interest in cryosurgery are the development of intraoperative ultrasound to monitor the therapeutic process and the development of new cryosurgical equipment designed to use supercooled liquid nitrogen. The thin, highly efficient probes, available in several sizes, can be placed in diseased sites via endoscopy or percutaneously in minimally invasive procedures. The manner of use is to place the probe in the desired location in the diseased tissue with ultrasound guidance. If required by the size or location of the tumor, as many as five probes can be inserted and cooled to −195°C simultaneously. The process of freezing is monitored by ultrasound which displays a hypoechoic (dark) image when the tissue if frozen. Rapid freezing, slow thawing, and repetition of the freeze/thaw cycle are standard features of technique. Clinical applications which have become common in the past 4 years include the treatment of prostatic cancer and liver tumors. The cases selected for cryosurgery are generally those for which no conventional treatment is possible. However, especially in prostatic cancer, the operative morbidity is so low and the results of therapy are sufficiently good in the short term to merit consideration of use in earlier stages of the disease. Diverse tumors in other sites, such as the brain, bronchus, bone, pancreas, kidney, and uterus, have also been treated in small numbers by cryosurgery. Judging from this experience, further expansion in the use of cryosurgical techniques seems certain.     

微创小切口主动脉瓣置换术对主动脉瓣狭窄患者临床效果、心功能及术后时间的影响

目的:探讨微创小切口主动脉瓣置换术对主动脉瓣狭窄患者临床效果、心功能及术后时间的影响。方法:选择2017年5月-2018年11月我院收治的98例患者,随机分为观察组(n=49)和对照组(n=49)。对照组患者给予传统开胸主动脉瓣置换术,观察组患者给予微创小切口主动脉瓣置换术。观察比较两组临床疗效,心功能指标变化,术后时间变化。结果:观察组有效率为93.88%,明显高于对照组71.43%,两组疗效比较差异有统计学意义(P0.05)。观察组术后左室射血分数(LVEF)、左室舒张末期直径(LVEDD)、平均跨瓣压差(MVPG)明显低于对照组,差异均具有统计学意义(P0.05);观察组术室间隔厚度(IVST)高于对照组,但差异无统计学意义(P0.05)。观察组术后机械通气时间,ICU时间,住院时间明显低于对照组,差异均具有统计学意义(P0.05)。结论:微创小切口主动脉瓣置换术治疗主动脉瓣狭窄临床疗效显著,可有效改善患者心功能,缩短治疗时间,提高患者生活质量,值得推广应用。     

Triple Starr Valve Replacement

Of nine patients who have had triple valve replacements for organic rheumatic triple valve disease two died in the postoperative period from inadequate myocardial reserve, and a third died four months later from cerebral embolism originating from clot on the left atrial wall. The remainder are well and, except for one, leading normal lives. Though cardiac transplantation has been recommended and used successfully for triple valve disease by Cooley, it is suggested that the long-term outlook today of triple valve replacement is likely to be better than that of transplantation.     

Long-term Results of Aortic Valve Replacement with the Starr-Edwards Valve

Review of the 74 patients undergoing aortic valve replacement with a Starr–Edwards ball-valve prosthesis between October 1963 and December 1967 showed that 16 died during surgery or within the first month after operation, usually owing to myocardial failure; and there were nine late deaths. The remaining patients developed few major complications, and the long-term results of operation are considered satisfactory, no patient being grossly incapacitated and most of them are leading active, symptom-free lives.     

Complex Bileaflet Mitral Valve Repair (Barlow's) Using the da Vinci Robotic Surgical System

Robotic mitral valve repair (RMVR) is less invasive and potentially more precise. However, RMVR lengthens both cardiopulmonary bypass and arrested heart times. In our initial experience, only posterior leaflet repair and/or annuloplasty were performed. With increasing experience, we have performed more complex bileaflet RMVR. A 50-year-old man presented with severe mitral regurgitation. Transesophageal echocardiography (TEE) demonstrated a complex bileaflet prolapse and preserved left ventricular function. Through a 4 cm working port and with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) RMVR was performed. Details of the technique and patient's hospital course are described. The repair comprised closure of clefts between A3 and P3, quadrangular resection of P2, transfer of multiple chords from P2 to A2/A3 and a #38 Cosgrove-Edwards (Edwards Lifesciences, Irvine, CA) band annuloplasty. Nitinol U-Clips (Medtronic, Minneapolis, MN) were used to complete the annuloplasty. Postoperative TEE showed no mitral regurgitation. The patient was discharged on the third postoperative day. Cardiopulmonary bypass and arrested heart times were 3 hours and 29 minutes and 2 hours and 59 minutes, respectively. Complex bileaflet repair of mitral valve with Barlow's disease can be successfully performed with the da Vinci Robotic Surgical System. Long-term follow-up is needed to assess the durability of repair.