目的 總結前交通動脈瘤栓塞治療的經驗。 方法 2008年1月－2011年8月，23例前交通動脈瘤患者均在全身麻醉下行動脈瘤內栓塞治療。其中4例在導絲或導管保護動脈瘤頸情況下行栓塞治療；1例術中導絲刺破動脈瘤，繼續快速填塞至動脈瘤完全栓塞；1例栓塞后彈簧圈突入載瘤動脈，行A1-A2段支架后置入。 結果 23例患者手術技術成功率100%。術后即刻造影，動脈瘤完全栓塞11例，＞90%栓塞8例，＜90%栓塞4例。支架后置入患者術后出現腦梗死，經治療1個月后康復出院。所有患者臨床隨訪6～24個月，未見再出血。16例患者行全腦血管數字減影血管成像復查，動脈瘤未見復發，其中3例＞90%栓塞、2例＜90%栓塞患者動脈瘤完全閉塞。 結論 彈簧圈栓塞治療前交通動脈瘤是一種安全、有效的治療方式。但其技術難度相對較大，需要細致操作。
Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.
ObjectiveTo evaluate the safety and efficacy of gasless endoscopic thyroidectomy via transaxillary approach in treating papillary thyroid cancer (PTC). MethodsThe patients who underwent gasless endoscopic thyroidectomy (Abbreviated as the “endoscopic group”) and neck open surgery (Abbreviated as the “open group”), in the Zhejiang Provincial People’s Hospital from January 2018 to June 2023, were collected. The intraoperative and postoperative outcomes of the patients in the two groups were compared after propensity score matching (PSM). Statistical analysis was conducted using SPSS 26.0 software, with a test level of α=0.05. ResultsAfter PSM, there were 409 patients in the endoscopic group and 421 patients in the open group. There were no statistically significant differences in the baseline data between the two groups (P>0.05), except for tumor location, vascular invasion, intraglandular dissemination, and preoperative levels of total triiodothyronine and thyroid hormone (P<0.05). Compared with the open group, the patients in the endoscopic group had less intraoperative blood loss (P<0.05), higher points of incision satisfaction and cosmetic effect (P<0.05), but the number of lymph nodes dissected was less (P<0.05) and the operation time was longer (P<0.05) in the endoscopic group. The incidence of postoperative overall complications had no statistically significant difference between the endoscopic group and open group (3.6% versus 5.8%, P=0.127). There was no statistically significant difference in the recurrence rate between the endoscopic group and open group within one year of follow-up (0.2% versus 0.5%, P=0.099). ConclusionsFrom the results of this study, the gasless endoscopic thyroidectomy is safety and reliability in treatment of PTC. It can achieve the same effect as traditional open thyroidectomy. However, it can also be seen that young female patients are more willing to choose gasless endoscopic thyroidectomy as long as their condition permits (such as early tumor stage, low invasiveness).
Objective To verify whether hybrid surgical and interventional ablation(HA) for the treatment of persistent atrial fibrillation (AF) is superior to video-assisted thoracoscopic surgical radiofrequency ablation (VATS-RA). Methods From September 2010 to December 2017, 79 consecutive patients with persistent AF underwent VATS-RA or HA in Fuwai Hospital. VATS-RA was performed in sixty patients (a stand-alone surgical group, 48 males and 12 females, at average age of 56.0±7.6 years, and HA was performed in nineteen patients (a hybrid group, 14 males and 5 females, at average age of 58.0±7.3 years). Follow-up was completed at 3 months, 6 months, 1 year and annually thereafter. Postoperative sinus rhythm was defined as sinus rhythm recorded in 24-hour or 7-day Holter during follow-up, without exhibited rapid atrial tachyarrhythmia≥30 s including AF, atrial flutter, or atrial tachycardia. Results Seventy-eight patients (98.7%) completed the follow-up. Although the preoperative left atrial diameter (49.1±5.3 mm) in the hybrid group was significantly greater than that in the stand-alone surgical group (41.7±6.2 mm, P<0.001). Overall sinus rhythm maintenance rate in the hybrid group was significantly greater than that in the stand-alone surgical group (94.7% versus 64.4%,P=0.011). And sinus rhythm maintenance rate free from anti-arrhythmic drugs (AADs) and catheter ablation in the hybrid group was significantly greater than that in the stand-alone surgical group (84.2% versus 50.8%, P=0.010). Conclusion HA is superior to VATS-RA in the treatment of persistent AF, but a larger sample size is needed for further validation in prospective randomized studies.