改良Nikaidoh 手术治疗合并肺动脉瓣狭窄的右室双出口

目的:总结改良Nikaidoh手术治疗右心室双出口(DORV)患者的临床经验,以提高手术疗效。方法:2例先天性心脏病右心室双出口伴肺动脉瓣狭窄行改良Nikaidoh手术,游离主动脉根部及冠状动脉,重建左心室流出道,以带单瓣牛心包片补片重建肺动脉及右心室流出道。结果:术后患者紫绀消失,复查心脏彩超仅有轻度肺动脉瓣关闭不全,未发现左、右心室流出道梗阻,康复出院。结论:采用改良Nikaidoh手术治疗伴肺动脉瓣狭窄的右室双出口,术后可获得良好的血流动力学效果,早期临床结果满意。     

80岁以上老年人冠状动脉旁路移植术合并瓣膜置换手术的临床分析

目的:总结老年患者行冠状动脉旁路移植术(CABG)合并瓣膜置换(VR)手术的特点及经验。方法:上海交通大学附属第一人民医院心血管外科2001年11月至2010年3月对60例年龄大于80的患者施行冠状动脉搭桥+瓣膜置换手术,男33例,女27例。年龄80-87岁,平均年龄(83.77±2.45)岁。均为冠心病合并瓣膜病变患者。其中36例患者行冠状动脉旁路移植+二尖瓣置换手术,15例患者行冠状动脉旁路移植+主动脉瓣置换手术,9例患者行冠状动脉旁路移植+双瓣置换手术,同时8例患者行三尖瓣成形手术,3例患者行射频消融手术,1例升主动开成形术。置换生物瓣膜者51例,置换机械瓣膜者9例。CABG平均搭桥(2.13±0.75)根,搭桥材料为左乳内动脉与大隐静脉。结果:全组早期死亡9例(15%),1例死于术后出血,1例死于多器官功能衰竭,7例死于术后心衰。早期生存51例(85%),出现术后并发症10例,其中2例发生胸腔积液,1例心包填塞,3例肺部感染,1例心房扑动后发生室颤,3例二次开胸止血。给予相应对症治疗后痊愈出院。门诊随访49例,随访时间1～60个月,心功能I级2例、Ⅱ级29例、Ⅲ级18例、Ⅳ级0例(NYHA分级)。结论:对老年患者行冠脉搭桥+瓣膜置换手术,只要掌握手术适应证,充分作好术前准备、术中及术后处理,手术治疗可以取得良好效果。     

主动脉夹层患者围手术期的护理体会

目的:通过对患者的围术期护理,提高手术成功率,增强生活质量,降低并发症的发生.方法:在保守治疗期间通过血压控制、疼痛护理、心理护理以及生活指导等措施防止患者在主动脉夹层急性期发生瘤体破裂.手术治疗后的患者通过严密监测、及时治疗和有效护理减少术后并发症.结果:共32名患者,保守治疗期间3例死亡,14例手术治疗患者中12例(85.7%)痊愈出院,2例死亡.结论:对主动脉夹层患者进行严密的病情观察和护理有助于降低患者急性期死亡卒和术后死亡率.良好的心理护理和健康教育在患者治疗期间以及出院后的生活指导方面有着重要作用.     

急诊冠状动脉搭桥非停跳技术的应用体会

目的:探讨急诊非停跳冠状动脉搭桥术(OPCAB)临床应用价值.方法:对23例急诊非停跳冠状动脉搭桥术患者的临床资料进行回顾性分析.结果:2例因术中血流动力学不稳定改为体外循环下冠状动脉旁路移植术CCABG,其余21例OPCAB手术顺利完成.搭桥数目为2-6个,平均3.32±0.596个.围手术期死亡2例,一过性心房纤颤3例,低心排出量综合征1例,肺部感染1例,术后无神经系统并发症,无二次开胸止血、急性肾功能衰竭等并发症.随访8-15个月,无死亡病例,无心绞痛复发,无心肌缺血事件发生,患者生活质量明显提高.结论:OPCAB创伤小、恢复快,并发症少,可安全有效地应用于急诊冠状动脉搭桥术.     

加速康复外科理念在经尿道选择性绿激光前列腺汽化术围手术期的应用研究

目的:探讨加速康复外科(ERAS)理念对经尿道选择性绿激光前列腺汽化术(PVP)患者术后康复的安全性和有效性。方法:回顾2018年6月至2019年10月在河南科技大学第一附属医院行经尿道选择性绿激光PVP治疗的61例前列腺增生患者,其中采用加速康复理念进行围手术期管理30例(ERAS组),按照传统围手术期管理31例(对照组)。比较两组手术时间、术后6 h视觉模拟评分(VAS)、术后第1 d血白细胞计数、术后首次排气时间、国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、术后尿管留置时间、住院时间以及出院3个月内并发症发生情况等。结果:两组术后6小时VAS评分、术后排气时间、留置尿管时间、平均住院时间比较差异有统计学意义(P0.05)。两组术后3个月IPSS评分、术后3个月QOL评分、术后3个月Qmax比较差异均无统计学意义(P0.05)。两组术后并发症发生率比较差异无统计学意义(P0.05)。结论:ERAS应用于经尿道选择性绿激光PVP围手术期的管理满足安全性、有效性的要求,有助于缓解术后早期疼痛感,缩短肠道恢复、住院的时间,使患者能够更快地出院和康复。     

80岁以上老年人冠状动脉旁路移植术合并瓣膜置换手术的临床分析

目的：总结老年患者行冠状动脉旁路移植术（CABG）合并瓣膜置换（VR）手术的特点及经验。方法：上海交通大学附属第一人民医院心血管外科2001年11月至2010年3月对60例年龄大于80的患者施行冠状动脉搭桥＋瓣膜置换手术,男33例,女27例。年龄80-87岁,平均年龄（83.77±2.45）岁。均为冠心病合并瓣膜病变患者。其中36例患者行冠状动脉旁路移植＋二尖瓣置换手术,15例患者行冠状动脉旁路移植＋主动脉瓣置换手术,9例患者行冠状动脉旁路移植＋双瓣置换手术,同时8例患者行三尖瓣成形手术,3例患者行射频消融手术,1例升主动开成形术。置换生物瓣膜者51例,置换机械瓣膜者9例。CABG平均搭桥（2.13±0.75）根,搭桥材料为左乳内动脉与大隐静脉。结果：全组早期死亡9例（15%）,1例死于术后出血,1例死于多器官功能衰竭,7例死于术后心衰。早期生存51例（85%）,出现术后并发症10例,其中2例发生胸腔积液,1例心包填塞,3例肺部感染,1例心房扑动后发生室颤,3例二次开胸止血。给予相应对症治疗后痊愈出院。门诊随访49例,随访时间1～60个月,心功能I级2例、Ⅱ级29例、Ⅲ级18例、Ⅳ级0例（NYHA分级）。结论：对老年患者行冠脉搭桥＋瓣膜置换手术,只要掌握手术适应证,充分作好术前准备、术中及术后处理,手术治疗可以取得良好效果。     

改良Nikaidoh手术治疗合并肺动脉瓣狭窄的右室双出口

目的：总结改良Nikaidoh手术治疗右心室双出口（DORV）患者的临床经验,以提高手术疗效。方法：2例先天性心脏病右心室双出口伴肺动脉瓣狭窄行改良Nikaidoh手术,游离主动脉根部及冠状动脉,重建左心室流出道,以带单瓣牛心包片补片重建肺动脉及右心室流出道。结果：术后患者紫绀消失,复查心脏彩超仅有轻度肺动脉瓣关闭不全,未发现左、右心室流出道梗阻,康复出院。结论：采用改良Nikaidoh手术治疗伴肺动脉瓣狭窄的右室双出口,术后可获得良好的血流动力学效果,早期临床结果满意。     

冠状动脉支架植入术后行冠脉旁路移植术

目的:总结15例冠状动脉支架植入术后行冠状动脉旁路移植术的临床经验。方法:回顾分析行冠状动脉支架植入术后行冠状动脉旁路移植术15例患者的资料,男10例,女5例,平均年龄(61±5)岁。行冠状动脉支架植入术后再行冠状动脉旁路移植术时间间隔(24±4)月,冠状动脉内置入支架3-6枚,左室射血分数为43%-64%,其中50%为3例。全组行体外循环下冠状动脉旁路移植术3例,行非体外循环心脏跳动下冠状动脉旁路移植术12例。结果:全组共行动脉桥吻合13支,静脉桥33支;围术期并发低心排综合征3例,肺部感染4例,胸腔内出血行胸腔闭式引流术2例,本组患者无死亡病例。术后平均住院日(13±4)天。结论:对冠状动脉内支架植入术后再狭窄或(和)冠状动脉再血管化不足的病例进行冠状动脉旁路移植治疗,可使冠状动脉达到充分再血管化,提高冠心病患者生活质量及预后。     

91例主动脉夹层动脉瘤的临床治疗体会

目的:依据临床经验,熟练运用开放手术、腔内修复术及杂交手术方法治疗各类主动脉夹层动脉瘤。方法:收集2009年7月~2013年1月在我院手术治疗的主动脉夹层动脉瘤患者共91例,StanfordB型夹层动脉瘤36例(其中21例降主动脉瘤、9例腹主动脉及双髂动脉瘤行腔内覆膜支架隔绝术,6例行腹主动脉人工血管置换术),StanfordA型夹层动脉瘤55例(其中单纯Sun,s手术12例伴Bentall术6例,Bentall术伴部分主动脉弓人工血管置换36例,1例行Ⅱ型的主干与分支动脉人工血管转流+介入腔内隔绝降主动脉及左半弓杂交术),分别以不同的手术方法给予治疗。结果:顺利治愈出院85例,死亡6例,4例因全弓置换术后出现难以控制的大出血、肠坏死、肾功能不全、少尿等并发症而死亡,2例死于Bentall术后严重多功能脏器急性衰竭,1例杂交手术术后出现高血压伴神经系统并发症,1例伴肺部感染及低心排综合征,给予对症治疗后效果不佳,有2例出现肾功能不全,经过透析治愈。腔内修复术后有神经系统的并发症2例,下肢的功能障碍2例,少量内漏4例,以上并发症均经对症治疗后痊愈。术后随访76例,时间3~12个月,除2例于术后第9个月死亡、1例因脑梗塞、脑血管意外等与手术无关的疾病而死亡,2例因吻合口动脉瘤或动脉瘤破裂大出血死亡外,余患者生活状态良好,心功能在I~Ⅱ级。结论:根据主动脉瘤疾病的临床特点和定位诊断,合理选择和运用治疗方法使手术操作变得更为迅速、安全和方便,同时能够取得良好的临床治疗效果。     

肠外置术治疗结肠损伤并发症的护理体会

目的探讨肠外置术治疗结肠损伤并发症的护理体会。方法对2015年3月~2016年11月我院收治行造瘘口腹膜外还纳术7例患者的临床资料进行回顾性分析。结果 7例患者在初始手术时均行穿孔部肠外置术或吻合口近端肠双筒造瘘术,术后患者均一期愈合,顺利康复出院。结论优质护理措施用于肠外置术患者并发症护理中,可有效提高临床治疗效果,缩短患者康复时间,提高患者生活质量,提高护理满意度,值得临床应用。     

A case of 'contagious delusional parasitosis' in an adult pair of twin sisters

In July 1992, a 50-year-old married woman, who was a hospital administrative clerk with an adult daughter, stated that, for over 5 years, she had been parasitised by 'small animals coming out from her skin'. While physical and microscopical examinations did not show either lesions or parasites on the skin, both the patient's medical history and the conviction with which she reported the phenomenon, led to a diagnosis of Delusory Parasitosis, a condition which has been well-defined for over 50 years and considered of prevailingly psychiatric competence. The patient was examined several times during the course of 6 years. She exhibited varying levels of anxiety, and brought with her different species of insects which she had captured 'when she saw them coming out of her skin'. In July 1998 the patient returned with her twin sister, who 'had been infected by her'. Indeed, she too 'had discharged various insects from her skin' for more than a year. The authors provide information on the response of this hallucinatory syndrome to therapy which, as in this case, appears to be resistant to treatment, unless appropriate psychoactive drugs are used.     

急性肠系膜缺血性疾病36例治疗体会

摘要 目的：探讨急性肠系膜缺血(acute mesenteric ischemia,AMI)的诊断和治疗方法。方法：回顾性收集并分析36 例AMI患者的临床资料,均术前行MDT讨论,血管外科及胃肠外科联合手术治疗。所有治疗病例均行手术探查。其中3例病人术中使用荧光内镜判断肠道血供。统计诊治过程中腹部CT、白细胞计数、D-二聚体相关数据,应用SPSS软件分析其与肠道坏死的相关性。结果：腹部CT特异表现、白细胞计数升高与肠道坏死有相关性关系。治疗病例有11例行肠切除、 8例为外院行手术治疗后,在我院行术后康复治疗。术后8例发生短肠综合证。1例病人自动出院。1例死亡。1例病人术后出现肠道坏死、肠瘘,3个月后行肠瘘切除术,术后恢复良好。5例病人术后6个月行造口还纳。荧光内镜判断肠道血供及生机效果良好。结论：AMI 病情凶险,提高对疾病的认识,早期诊断,尽早重建小肠血运是提高疗效、改善预后的关键。多学科讨论后精准治疗,可提高治疗效果。术前腹部CTA对AMI的诊断及判断肠道坏死有重要意义。术中使用吲哚箐绿荧光显影剂、配合荧光导航内镜,判断肠道缺血范围,值得进一步探讨。临时性肠道双造瘘有利于及时发现肠管血运恢复情况,远端造瘘可早期进行肠内营养,值得推广。     

Coincidence of mature cystic teratoma and serotonin-producing neuroendocrine tumor of the ileum

Mature cystic teratomas are often found in gonadal sites, but are very rarely located extragonadally, for example, in retroperitoneum, mediastinum, central nervous system, lung, or liver. In the literature, only 10 cases of cystic teratoma originating from the diaphragm have been reported. Here, we report for the first time a metachronous occurrence of a benign mature cystic teratoma in the left diaphragm together with a serotonin-producing neuroendocrine tumor of the ileum. The 51-year-old, female patient received a partial resection of the ileum due to a neuroendocrine tumor (pT3N1M0) 4 years ago. Furthermore, she was operated for a benign cystadenoma of the right ovary 3 years ago. In her past medical history, she had an appendectomy in her childhood and a subtotal thyroidectomy 10 years ago. To our knowledge, this is the first report describing the metachronous occurrence of benign mature cystic teratoma in the diaphragm and a highly differentiated neuroendocrine tumor of the ileum. The possible coincidence of both diseases is discussed.     

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.     

A case of sparganosis in the leg

The life-span of the sparganum in humans is not exactly known, but it may survive longer than 5 years in some patients. We experienced a case infected with a sparganum that is presumed to have lived for 20 years in a patient's leg. The patient was a 60-year-old woman, and she was admitted to a hospital due to ankle pain that was aggravated on dorsiflexion. She had noticed a mass on her knee some 20 years ago, but she received no medical management for it. The mass moved into the ankle joint 3 months before the current admission, and then the aforementioned symptoms appeared. A living sparganum was recovered by surgery, and the calcified tract near the knee was proved to be the pathway along which the larva had passed.     

Pulmonary sclerosing hemangioma: report of two cases

ABSTRACT: Pulmonary sclerosing hemangioma (PSH) is a rare benign tumor of the lungs. These tumors are composed of cuboidal surface cells and polygonal stromal cells and show four histological manifestations: hemorrhagic, papillary, solid, and sclerotic. PSH predominantly affects asymptomatic middle-aged women. The tumor often occurs at the intralobar site, and less commonly in the bronchus and mediastinum. PSH is easy to be misdiagnosed preoperatively. In this study, we present in detail the treatment procedures followed for two atypical cases of PSH. Case 1 was a 62-year-old woman bearing a tumor for 15 years. The tumor lesion was found to be located in the oblique fissure of the left lung. PSH was confirmed by surgical resection and postoperative pathological diagnosis. There was no sign of recurrence and metastasis 1.5 years after surgery. Case 2 was a 54-year-old woman diagnosed with bilateral multiple nodules by physical examination. This patient was diagnosed with definite PSH through computed tomography-guided percutaneous lung biopsy. Surgical resection was not performed. The patient also showed no sign of enlarged tumor and metastasis after 2 years of follow-up. Although PSH can be cured by surgical resection, the findings in our cases indicate that surgical resection need not be considered the preferred course of treatment. If PSH is diagnosed before surgery, the patients may survive while bearing the tumor.     

Nonfunctioning Parathyroid Carcinoma: Case Report and Review of Literature

ObjectiveTo report a case of nonfunctioning parathyroid carcinoma that was incidentally found during a thyroidectomy for multinodular goiter.MethodsWe present a case report, detailing the clinical course and histologic findings in a patient with a nonfunctional parathyroid carcinoma. The related literature is also reviewed.ResultsA 67-year-old woman presented with a 30-year history of a multinodular goiter that was symptomatic. A total thyroidectomy was performed. Histologic examination revealed not only a multinodular thyroid but also a mass in the left lobe, which was diagnostic of a parathyroid carcinoma. Serum calcium and parathyroid hormone levels were normal postoperatively. Eleven months after the initial operation, a suprasternal mass developed, and she underwent neck reexploration and subtotal resection of an invasive recurrent nonfunctioning parathyroid carcinoma. The serum parathyroid hormone and calcium levels were normal before and after the operation. Postoperatively, the patient underwent radiation therapy. Twenty-three months after the initial operation, a computed tomographic scan of the chest revealed an interval increase in size of a nodule in the left lower lobe of the lung, and 30 months after her initial operation, she underwent resection of an isolated, 1-cm (greatest diameter), metastatic parathyroid carcinoma in the left lower lobe of the lung. The patient is currently doing well without evidence of recurrent disease.ConclusionNonfunctioning parathyroid carcinomas are difficult to diagnose and to treat. Recurrent disease after operation is common, and radiation therapy may help stabilize tumor growth. Patients with nonfunctioning parathyroid carcinomas appear to have a poorer prognosis than do those with functioning parathyroid cancers. (Endocr Pract. 2007;13:750-757)     

Bilateral Ovary Adrenal Rest Tumor in a Congenital Adrenal Hyperplasia Following Adrenalectomy

Objective:In contrast to the high incidence of testicular adrenal rest tumors in adult male patients with congenital adrenal hyperplasia (CAH), ovarian adrenal rest tumors (OARTs) in female CAH patients are rare. In this case report, we describe a case of bilateral OART in a female patient with CAH due to 21-hydroxylase deficiency.Methods:We present a detailed case report with the clinical, imaging, and laboratory findings of the patient. The pertinent literature is also reviewed.Results:A 17-year-old patient was known to have CAH due to 21-hydroxylase deficiency. Since the second month of her gestational age, her mother was treated with cortisone-replacement therapy. The patient was treated with hydrocortisone and fludrocortisone since the neonatal period. Her pertinent history included a bilateral adrenalectomy at the age of 13 years in 2006, and for 3 years she led a normal puberty life with no complaint with hormonal replacement therapy. Nevertheless, in 2009, she developed a virilizing syndrome. Subsequently, she underwent surgery in December 2009 for right adnexectomy. However, the regression of the masculinizing mass was not complete and worsened several months after the surgery. A new pelvic magnetic resonance image showed the activation of a contralateral ovarian mass, necessitating a left adnexectomy in August 2010.Conclusion:This case demonstrates some interesting features of OART that pose challenges to its management. If an OART is detected early enough and glucocorticoid therapy is received, it is possible that the OART will decrease in size following suppression of adrenocorticotropic hormone levels. (Endocr Pract. 2014;20:e69-e74)     

糖尿病性下肢缺血性血管病的外科治疗

目的:探讨糖尿病性下肢缺血性血管病的治疗方法。方法:对24例Ⅰ型糖尿病患者合并下肢动脉缺血性疾病的39条肢体体进行了手术,其中动脉旁路手术31例,占79%。对3例患者进行了下肢截肢处理。结果:接受动脉旁路手术的患者出院时动脉血流均保持通畅。一例51岁男性患者四肢肿胀、变黑,经治疗无效死亡。结论:糖尿病性缺血性血管病可以通过外科手术治疗。如下肢远端动脉旁路移植、腔内血管成型术等。外科治疗的方法正在探讨阶段,研究方法不断进展。外科治疗不仅可以挽救肢体或降低截肢平面,而且可为足部创面的愈合提供较好的营养环境,有利于创面的愈合和提高生活质量。     

Pregnancy in a woman with treated bladder extrophy, split pelvis and hypoplasia of ischial bones. Case report

We present a case of a pregnancy in a 24 year old woman who was born with ectopia vesicae, split pelvis and hypoplasia of ischial bones. From childhood to adulthood she had undergone reconstructive surgeries of the abdomen and perineum, as well as urine diversion surgery. During pregnancy she experienced recurrent urinary tract infections which were treated with antibiotics. In spite of tocolysis, she delivered by cesarean section a premature baby boy at 35th week of gestation due to premature uterine contractions. The postoperative period was uneventful and they were discharged from the hospital in a good general condition.