Mitral regurgitation (MR) with multi-pathogenesis is a common disease in cardiac surgery department. MR can be classified into two categories-primary mitral regurgitation and secondary mitral regurgitation. With the development of cardiac intervention, numerous patients who cannot tolerate open heart surgery for the reason of high risk of surgery receive the treatment of intervention and achieve the favorable endpoint. The technique of transcatheter therapy which could be used to treat MR is comprised of leaflet repair, annuloplasty and implantation of artificial chordae. Comparing to primary mitral regurgitation, surgical effect of secondary mitral regurgitation is not desirable for the reasons of complex pathophysiologic mechanism. Hence, based on the perspective of surgeon, we will introduce the research progress of transcatheter interventional mitral valve repair which is focused on the treatment of primary mitral valve regurgitation and reviewed from three aspects of surgical risks, surgical types and outlook.
摘要:目的:探討小切口全髖關節置換的療效及優缺點。方法:針對性選取我院行THA的病員48例,分為初期小切口THA組、熟練小切口THA組、傳統切口THA組,各組16例。記錄切口長度、術中出血量、術后12小時引流量、手術時間及Harris評分,對其治療效果進行回顧性分析。結果:初期小切口THA組平均出血量,術后12小時平均引流量,平均手術時間等指標均高于傳統組,術后Harris評分低于傳統組,熟練組與傳統組比較,切口長度較短、術中出血量略少,術后早期Harris評分高,遠期Harris評分接近。結論:熟練小切口THA與傳統切口THA比較遠期療效無明顯優點,初期小切口THA不具微創優勢,不必強求小切口THA,并應注重學習曲線。
目的:探討輔助后內側切口及抗滑鋼板治療復雜脛骨平臺骨折的臨床療效。方法:對我院2006年4月至2008年12月的28例復雜脛骨平臺骨折病患(男19例,女9例,平均年齡37歲)進行輔助后內側切口及抗滑鋼板的臨床手術治療。結果:術后隨訪,24例效果良好,4例出現不良反應,經修復后愈合。結論:術后關節功能及切口恢復良好,外側支撐鋼板+后內側抗滑鋼板的雙切口雙鋼板的手術方法是治療復雜脛骨平臺骨折安全、有效的方法,故在臨床上有推廣價值,但有待大規模病例來驗證。
目的:探討經后路椎弓根釘棒系統內固定治療胸腰椎骨折的臨床療效。方法: 對本組35例胸腰椎骨折行后路椎弓根釘棒系統內固定,其中20例行術中后路減壓, 8例經椎弓根行病椎植骨。35例均行關節突及橫突間植骨。并測量術前、術后傷椎前后緣平均高度(百分比)和Cobb’s角,椎管截面積.結果: 術后傷椎前后緣平均高度(百分比)和Cobb’s角,椎管截面積各項指標與術前相比較,差異有顯著性 (Plt;0.01)。術后隨訪9~21個月,平均13.2個月。無一例出現神經癥狀加重,2例出現內固定斷裂并完整取出。結論: 經后路椎弓根釘棒系統內固定治療胸腰椎骨折療效確切,是治療胸腰椎骨折的一種創傷小,操作簡單,固定可靠的手術方法。
Objective To investigate the role of endothelin（ET） in lung injury during cardiopulmonary bypass （CPB） and study the possible mechanism of ET-mediated lung injury and the protective effect of ferulic acid（FA） during the procedure. Methods Twelve dogs were randomly divided into 2 groups and models of CPB with pulmonary perfusion were established by perfusion of 4 C FA solution through proximal pulmonary artery in the experiment group while control group only received 4 C crystal cardiac arrest solution without pulmonary perfusion. Changes in the content of ET, NO, malonaldehyde （MDA）, dry to wet （D/W） in lung tissue and lung function- related indices PaO2/FiO2, airway pressure （AWP）, pulmonary vascular resistance （PVR）, lung compliance before and after CPB in both groups were measured respectively. Results ET content increased after CPB in control group （P〈0. 05） ,while experiment group had a lower level of ET than that of control group （P〈0.05）; D/W, MDA levels in experiment group decreased （P〈0. 05）, but NO content increased （P〈0. 05） as compared with control group. After pulmonary perfusion with FA, PaO2/FiO2 and lung compliance values in experiment group were higher than those of control group （P〈0.05）,AWP, PVR values lowered accordingly（P〈0. 05）. Lung injury was less severe in the experiment group. Conclusion ET is involved in pathogenesis of lung injury during CPB, FA can effectively reduce lung injury and improve lung function thus having a good protective effect on the lung.
Left atrial appendage occlusion is a common procedure for patients with atrial fibrillation history when they underwent cardiac surgery. Before the LAAOS Ⅲ research results, this operation has been lacking strong evidence-based support. LAAOS Ⅲ is a prospective, double-blind, international multicenter, randomized blinded trial. According to the results of LAAOS Ⅲ, the left atrial appendage occlusion can reduce the risk of stroke and systemic embolism. This article will perform detailed interpretation of LAAOS Ⅲ research.
In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.
ObjectiveTo analyze the platelet (PLT) count, coagulation function, and portal vein thrombosis (PVT) in the patients underwent splenectomy due to different etiologies. MethodsThe patients who underwent splenectomy in the Affiliated Hospital of Southwest Medical University from January 2013 to December 2022 were collected. According to the etiology, the patients were assigned into the occupying group (splenic and pancreatic occupying lesions), hypersplenism group (portal hypertension and hypersplenism), and splenic rupture group (traumatic splenic rupture). The changes of PLT, white blood cells (WBC), red blood cells (RBC), neutrophils (Neut), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (DD), and PVT were observed after splenectomy. ResultsA total of 166 patients were collected, including 42 in the occupying group, 22 in the hypersplenism group, and 102 in the splenic rupture group. There were no statistically significant differences in the age and preoperative Child-Pugh score among the patients of the three groups (P>0.05). There were 12 (7.2%) patients with PVT, including 2 in the occupying group, 6 in the hypersplenismn group, and 4 in the splenic rupture group. The PVT incidence among the three groups had a statistical significant difference (Fisher exact test, P=0.003), which in the hypersplenismn group was higher than the occupying group (P=0.016) and the splenic rupture group (P=0.002), while there was no statistically significant difference between the occupying group and the splenic rupture group (P=1.000). The overall trend was that the PLT, RBC, WBC, and various coagulation function indicators such as PT, APTT, and Fib among the three groups all showed an upward trend immediately after splenectomy, but the postoperative peak time and change trends had no markedly regular among the three groups. The PLT of the patients with and without PVT changed over time during the observation period (patients without PVT: F=60.238, P<0.001; patients with PVT group: F=9.700, P=0.043), and which showed a continuous upward trend after surgery, reaching a peak on the 14th day and then beginning to decline in the patients of both 2 groups. However, there was no statistically significant intergroup effect between the 2 groups (F=0.056, P=0.816). ConclusionsThe results of this study suggest that the peak value of PLT in the hypersplenism group is lower as compared with the occupying group and the splenic rupture group, and the PVT is more likely to occur. However, no difference of the PLT level is found in the patients without and with PVT.
【摘要】 目的 觀察自制富血小板血漿治療難治性創口的臨床療效。 方法 2007年4月-2009年11月對38例難治性創口患者進行自制富血小板血漿治療，觀察創面愈合變化情況。 結果 38例患者中30例愈合，2例顯效，2例有效，總有效率為90%。 結論 自制富血小板血漿治療難治性創口是一種簡便、安全、價廉、有效的治療方式，特別適合中小（25~60 cm2）創面的難治性創口。【Abstract】 Objective To observe the clinical effect of homemade platelet-rich plasma on refractory wound. Methods Thirty-eight patients with refractory wound from April 2007 to November 2009 were treated by homemade platelet-rich plasma, and the changes in wound healing were observed. Results Thirty patients were healed, two patients were markedly effective, two patients were effective and the total effective rate was 90%. Conclusion Homemade platelet-rich plasma is a simple, safe, inexpensive and effective treatment on refractory wound, especially for small and medium refractory wounds (25-60 cm2).
Objective To explore the impact of diabetes on coronary artery bypass grafting （CABG） in clinical representations, operative morbidity and mortality in this hospital. Methods Data was collected as a part of prospective registry of CABG through Sep. 2001 to Jul. 2003. Four hundreds and eighty-two patients were recruited. They were divided into diabetic group （n= 135） and non-diabetic group （n=347） depended on if the patients with diabetes or not. All patients were treated with insulin for hyperglycemia. Clinical representations, operative morbidity and mortality in this hospital between two groups were compared by using chi-square tests, t tests and logistic regression. Results Re-exploration in diabetic group was higher than that in non-diabetic group （4.4% vs. 0. 9%; x2= 6. 769, P = 0. 009）. There was no significant difference in the operative morbidity and mortality in hospital between two groups. Multi-variance logistic regression showed that the lower left ventricular ejection fraction （〈 0. 40,OR 15.96）, re-exploration （OR 32. 77） and re-intubation （OR 124.17） were the predictors of perioperative mortality in hospital. Conclusions There are no significant difference in the operative mortality and complication between patients with diabetes and patients with non-diabetes. Strict glucose control in perioperative period would reduce hospital mortality and morbidity.