Search

腋下小切口電視胸腔鏡手術治療自發性氣胸82例

Analysis of 85 infants of minimal median sternotomy for cardiac surgery under cardiopulmonary bypass

目的 探討胸部正中小切口在嬰幼兒先天性心臟病手術治療中的可行性及效果。 方法 將我院 2016 年 5 月至 2016 年 10 月 170 例行手術治療的常見先天性心臟病嬰幼兒患者分為兩組：常規組，85 例，男42例、女43例，年齡（6.9±2.1）個月，采用常規胸部正中切口；小切口組，85 例采用胸部正中小切口，男43例、女42例，年齡（6.4±1.8）個月。小切口手術切口于平第 3 肋間切開，止于劍突起始處上 0.5 cm，剛好放入小胸骨撐開器為好。 結果 兩組患兒體外循環時間差異無統計學意義（P>0.05）。小切口組手術時間略長（P<0.05）。兩組預后沒有差別，但是小切口組傷口長度顯著縮短[（7.8±0.8） cmvs. （4.0±0.5）cm，P<0.05]。 結論 正中小切口基本具有胸骨正中切口的優點，可顯露心臟各部位，滿足絕大部分心臟探查和手術操作需要，必要時仍可向上延長切口使心內操作不受限制等優點，故認為正中小切口在嬰幼兒心臟手術中具有良好的安全性和美觀性。

Unilateral Exploration in Primary Hyperparathyroidism (Report of 26 Cases）

目的探討原發性甲狀旁腺機能亢進（PHPT）小切口單側探查的適應證和探查經驗。方法對我科1992年1月至2001年12月所作的26例小切口單側探查病例的臨床病理資料進行回顧性分析。結果小切口單側探查26例，成功25例。結論對診斷明確且準確定位者先采取定位側小切口； 冰凍切片證實為甲狀旁腺腫瘤，且病理學特點與其臨床表現、實驗室檢查和定位診斷相符者可僅行單側探查。

Combined Mini-open Anterior Apical Vertebral Excision and Posterior Correction for Severe and Rigid Scoliosis

目的　探討前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸的可行性及療效。 方法　2009 年7月－2010年9月，采用前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸18例。其中男9例，女9例，年齡10～24歲，平均14.5歲。其中15 例特發性脊柱側凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱側凸，1 例Chiari畸形合并脊柱側凸。術前剃刀背高度（6.8 ± 2.3）cm，主胸彎Cobb角（99.6 ±10.0）°，主胸彎頂椎偏距（7.3 ± 1.3）cm。 結果　前路手術切口10～13 cm，平均（11.4 ± 1.0）cm；前路手術時間170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者隨訪25～39個月，平均30.7個月。末次隨訪時，剃刀背高度（1.0 ± 0.6）cm，矯正率86.7%；主胸彎Cobb角（31.4 ± 11.4）°，矯正率68.7%；主胸彎頂椎偏距（2.2 ± 0.9） cm，矯正率69.6%。上胸彎、胸腰彎/腰彎的Cobb 角及頂椎偏距亦明顯矯正，冠狀面及矢狀面平衡與術前相比，差異無統計學意義（P＞0.05）。未發生神經系統并發癥，1例患者在前路手術后入ICU行呼吸支持治療12 h，1例患者出現椎弓根螺釘穿透椎弓根上壁，2例患者出現鈦網位置不佳，隨訪未見鈦網位置改變。 結論　采用前路小切口頂椎切除聯合后路矯形治療重度僵硬性脊柱側凸安全可行，矯形效果滿意。

右側腋下直切口在二次心臟瓣膜手術中的應用

目的 探討右側腋下直切口在二次心臟瓣膜手術中的應用效果。 方法 回顧性分析2014 年 1 月至 2016 年 12 月我院經右側腋下直切口行二次心臟瓣膜手術 23 例患者的臨床資料，男 9 例、女 14 例，年齡 37～67 歲，平均（54.0±9.1）歲，體重 43～73 （56.0±9.8）kg。手術方式包括二尖瓣置換（MVR）7 例，二尖瓣成形（MVP）1 例，主動脈瓣置換（AVR）3 例，三尖瓣成形術（TVP）4 例，三尖瓣置換術（TVR）2 例，MVR+TVP 2 例。 結果 本組平均手術時間 3～6（4.6±0.9）h，體外循環時間 55～140（104.8±22.3） min。心臟停跳術后自動復跳 17 例（17/23），氣管插管時間 4～24（12.2±6.0）h，手術后住院時間平均（7.5±1.9）d。手術后首日引流量平均（404.3±204.0）ml。17 例患者術后無輸血（17/23）。本組患者無圍術期死亡，無明顯并發癥出現。出院時心功能 Ⅰ 級 13 例、Ⅱ 級 10 例。 結論 經右側腋下直切口在二次心臟瓣膜手術中的近期手術效果良好，手術安全性高，適用于常見二次心臟瓣膜手術。

EFFECTIVENESS COMPARISON OF MODIFIED PERCUTANEOUS MINI-INCISION AND OPEN Achilles TENDON LENGTHENING FOR TREATMENT OF Achilles CONTRACTURE SYNDROME

Objective To explore the effectiveness of modified percutaneous mini-incision Achilles tendon lengthening for the treatment of Achilles contracture syndrome by comparing with traditional open Achilles tendon lengthening. Methods Between May 2008 and May 2012, 42 patients with Achilles contracture syndrome were treated and the clinical data were retrospectively analyzed according to the inclusion criteria. The modified percutaneous mini-incision Achilles tendon lengthening was used in 19 cases (19 feet, trial group); 0.5 cm incisions were designed at medial and lateral Achilles tendon according to the degree of Achilles contracture syndrome; and percutaneous double hemi-section was done according to the deformity range of varus and valgus foot. The traditional open Achilles tendon lengthening was used in 23 cases (24 feet, control group). There was no significant difference in age, gender, disease duration, motion of ankle dorsiflexion, and Hannover Achilles tendon score (P gt; 0.05). Results The operation time, postoperative hospitalization days, and intraoperative blood loss in the trial group were less than those in the control group, showing significant differences (P lt; 0.05). After operation, incision healing by first intention was obtained in the other cases except 1 case which had infection in the control group. The patients were followed up 6-35 months in the trial group and 8-34 months in the control group. Correction of varus deformity foot was not obvious in 1 case of the trial group, correction of varus and valgus deformity feet were satisfactory in the other cases. There was no significant difference in motion of ankle dorsiflexion and Hannover Achilles tendon score between 2 groups at last follow-up (P gt; 0.05), but significant differences were found between preoperation and last follow-up in 2 groups (P lt; 0.05). There were significant differences in motion of ankle dorsiflexion and Hannover Achilles tendon score between normal and affected sides in 2 groups at last follow-up (P lt; 0.05). Conclusion Modified percutaneous mini-incision Achilles tendon lengthening has similar effectiveness to the traditional open Achilles tendon lengthening for Achilles tendon contracture syndrome. And it can effectively correct varus and valgus deformities of the foot with less trauma and fast recovery.

Application Experience of Laparoscopic Cholecystectomy and Small Incision Cholecystectomy for Gerontal Patients

目的 比較腹腔鏡膽囊切除術（LC）與小切口膽囊切除術（MC）在老年患者中的臨床效果，以指導臨床選擇應用。 方法 回顧性分析筆者所在醫院2010年7月至2013年7月期間行LC（LC組，n=109）及MC（MC組，n=111）的老年患者的臨床資料，比較2組術中和術后相關指標的差異。 結果 LC組和MC組患者的手術時間〔（45.72±6.14）min比（40.67±6.02）min〕、術中出血量〔（10.18±3.31）mL比（11.13±2.93）mL〕、住院時間〔（9±5）d比（10±5）d〕及總并發癥發生率〔28.4%（31/109）比31.5%（35/111）〕比較差異均無統計學意義（P＞0.05）；但LC組患者的術后疼痛程度輕、胃腸道功能恢復時間短〔（46.3±10.5）h比（71.4±9.8）h〕、住院費用較高〔（8 010±450）元比（4 800±680）元〕、切口感染發生率較低〔0（0）比15.3%（17/111）〕、肺部感染發生率較高〔17.4%（19/109）比9.9%（11/111）〕，P＜0.05。 結論 LC對老年膽囊結石或膽囊炎患者具有更好的臨床效果；但對心肺功能異常者，尤其是不能耐受全麻和氣腹的患者選擇MC更為合適，所以臨床上應視患者具體情況加以選擇。

Application of Ultracision Harmonic Scalpel in Open Colorectal Cancer Operation

Objective　To discuss the differences of the effects on open colorectal cancer operation between using ultracision harmonic scalpel (UHS) and monopolar electrosurgery. Methods　Fifty-nine patients from April to December in 2007, suffering colorectal cancer in the same treatment group, underwent open radical operation, 29 by GEN300 UHS (UHS group) and 30 by monopolar electrosurgery as control group. There was no significant difference between two groups among the factors of age, gender, tumor location, Dukes staging, gross morphology and degree of histological differentiation (Pgt;0.05). Results　Shorter incision was applied in UHS group than in the control group. The mean operation time of UHS group and control group were 126 and 119 min, respectively (Pgt;0.05). The mean operative blood loss was 50 (20-140) ml in UHS group and 90 (40-200) ml in control group (Pgt;0.05). There were no significant differences among factors of bowel function recovery, mean hospitalization and incidence of complications between two groups (Pgt;0.05). The mean time for postoperative drainage fluid changing from bloody to serous was 8 (2-20) h in UHS group, however, 48 (16-80) h in control group (Plt;0.05). Conclusion　In open colorectal cancer operation, benefits of using UHS are shorter incision and minimally invasiveness.

Bentall procedure through the right anterior mini-incision: A clinical analysis in a single center

Objective To summarize the effectiveness of Bentall procedure through the right anterior mini-incision. MethodsThe clinical data of patients who underwent Bentall via right anterior mini-incision from September 2020 to September 2021 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed. ResultsA total of 14 males with an average age of 55.1±9.3 years and body mass index of 24.7±2.8 kg/m2 were enrolled. The cardiopulmonary bypass (CPB) time was 185.6±32.9 min, the aortic cross-clamping (ACC) time was 144.8±30.3 min, the ventilation time was 18.1±13.5 h, the time in the intensive care unit was 3.7±1.8 d, and the hospital stay time was 13.4±1.6 d. Postoperative complications occurred in 5 patients: 3 patients of pleural effusion, 1 patient of pericardial effusion and 1 patient of postoperative bleeding with secondary thoracotomy hemostasis. The median follow-up time was 4 (2, 6) months. There was no mortality in the hospital or during the follow-up. As for the learning curve, the ACC time, CPB time and operation time were significantly shortened after four cases (P<0.05). ConclusionThe right anterior mini-incision for Bentall operation is safe and effective, and has clinical value.

On-pump coronary artery bypass grafting for the treatment of multivessel diseases via left anterolateral minithoracotomy

ObjectiveTo analyze the safety and follow-up results of on-pump coronary artery bypass grafting (CABG) for the treatment of multivessel diseases via left anterolateral minithoracotomy.MethodsFrom January 2018 to March 2020, a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy. Among them, 14 patients had three-vessel diseases and 16 patients had two-vessel diseases.ResultsThere were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts. The average number of bypass vessels was 2.3±0.5. There was no perioperative death in the whole group, one patient underwent rethoracotomy due to hemorrhage, and one patient suffered acute renal insufficiency. The average time of postoperative tracheal intubation was 16.0±5.8 hours, and the postoperative ICU stay was 30.1±11.5 hours. Twenty five patients were followed up, including coronary CT angiography examinations at 6 months and 1 year after operation. Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred.ConclusionOn-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.