ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.
ObjectiveTo explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. MethodThe data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. ResultsA total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. ConclusionsFrom the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.
【摘要】目的探討急危重膽總管囊腫的治療。方法對我院1984~2001年收治的41例急危重膽總管囊腫患者的臨床資料進行回顧性分析。結果41例患者均行囊腫切除、膽道重建術，其中3例患者分兩期完成，全部病例均獲治愈，隨訪9例近、遠期效果均較好。結論囊腫切除、膽道重建術已成為根治膽總管囊腫的首選術式，但必須做好高危因素的處理，以提高手術安全性及療效，只要度過圍手術期，其預后較好。
【Abstract】Objective To investigate the operative methods and the factors affecting the prognosis of congenital intestinal atresia. Methods The clinic data of 40 cases of congenital intestinal atresia was reviewed, including duodenal atresia (6)， jejunal atresia (12)， ileum atresia (20) and colonic atresia (2). The types of atrasia were septal type (10)，blindend type (26), and multisegmental type (4). All had been diagnosed before operation, 4 patients refused the treatment and 26 cases accepted the operation. Results Twenty-six cases of the 36 which accepted operation were cured and survived，the rate of postoperative survival were 72%，postoperative follow-up of 20 patients for 1-21 years had well-pleasing curative effect.Ten cases died postoperatively. Conclusion Operation is the only treatment of this disease，the mode of operation should be selected depending on the site and the type of atresia. The curative effect and the prognosis of this disease are affected by multiple factors.