Search

Clinical Outcomes of Preservation of Posterior Leaflet and Subvalvular Structures in Mitral Valve Replacement

Abstract： Objective To summarize our experience and clinical outcomes of preservation of posterior leaflet and subvalvular structures in mitral valve replacement（MVR）. Methods We retrospectively analyzed the clinical data of 1 035 patients who underwent MVR in Beijing An Zhen Hospital from January 2006 to March 2011. There were 562 male patients and 473 female patients with their age of 37-78（53.84±13.13）years old. There were 712 patients with rheumatic valvular heart disease and 323 patients with degenerative valve disease, 389 patients with mitral stenosis and 646 patients with mitral regurgitation. No patient had coronary artery disease in this group. For 457 patients in non-preservation group, bothleaflets and corresponding chordal excision was performed, while for 578 patients in preservation group, posterior leafletand subvalvular structures were preserved. There was no statistical difference in demographic and preoperative clinical characteristics between the two groups. Postoperative mortality and morbidity, and left ventricular size and function were compared between the two groups. Results There was no statistical difference in postoperative mortality（2.63% vs. 1.21%, P =0.091）and morbidity （8.53% vs. 7.44%, P=0.519）between the non-preservation group and preservation group, except that the rate of left ventricular rupture of non-preservation group was significantly higher than that of preservation group（1.09% vs. 0.00%, P=0.012）. The average left ventricular end-diastolic dimension （LVEDD）measured by echocardiography 6 months after surgery decreased in both groups, but there was no statistical difference between the two groups. The average left ventricular ejection fraction (LVEF) 6 months after surgery was significantly improved compared with preoperative average LVEF in both groups. The average LVEF 6 months after surgery in patients with mitral regurgitation in the preservation group was significantly higher than that in non-preservation group （56.00%±3.47% vs. 53.00%±3.13%，P =0.000）, and there was no statistical difference in the average LVEF 6 months after surgery in patients with mitral stenosis between the two groups（57.00%±5.58% vs. 56.00%±4.79%，P =0.066）. Conclusion Preservation of posterior leaflet and subvalvular structures in MVR is a safe and effective surgical technique to reduce the risk of left ventricle rupture and improve postoperative left ventricular function．

外傷性肝破裂手術治療121例體會

One case report and literature review of arachnoid cyst rupture associated with epilepsy

ObjectiveTo review the diagnosis, clinical characteristics and treatment of Arachnoid cyst rupture associated with epilepsy. MethodsThe clinical data of one patient with arachnoid cyst rupture associated with epilepsy was reported and diagnosis, clinical characteristics, the treatment options were discussed with literature reviewed. ResultsWe arranged the operation:arachnoid cyst resection and the left anterior temporal lobe resection and colostomy, the patient recovered well postoperatively, without special discomfort, epilepsy did not attack again. ConclusionsArachnoid cyst rupture associated with epilepsy is extremely rare, postoperative effect is good through strict preoperative assessment.

Diagnosis and Surgical Management of Ruptured Abdominal Aortic Aneurysm

隨著外科技術和圍手術期治療水平日益提高，腹主動脈瘤擇期手術治療死亡率已控制在5%以內［1，2］，但破裂腹主動脈瘤（ruptured abdominal aortic aneurysm,RAAA）的死亡率一直在40%～70%，如果包括尚未到達醫院的RAAA患者，死亡率可達80%～90%，RAAA被美國列為第13位死亡原因［2~4］。目前，及時準確的診斷和快速有效的外科治療仍是降低RAAA死亡率的關鍵。......

二尖瓣置換同期射頻消融術后延遲左心室破裂一例

主動脈竇瘤破裂的外科治療

目的 總結主動脈竇瘤破裂的外科治療經驗。 方法 83例主動脈竇瘤破裂患者均在氣管內插管靜脈復合麻醉中度低溫體外循環下行主動脈竇瘤修復術，同時矯治合并的心內畸形,包括行主動脈瓣置換術20例，主動脈瓣成形術9例，三尖瓣成形術4例，肺動脈瓣重建術2例，室間隔缺損修補術37例，房間隔缺損修補術5例，右心室流出道疏通2例，右室雙腔心矯治術1例。 結果 本組無手術死亡。術后并發心力衰竭2例，再次開胸止血4例，均經治療后痊愈。所有患者均得到隨訪,隨訪時間1個月～6年, 平均隨訪25.6個月。心功能Ⅰ~Ⅱ級。心臟彩色超聲心動圖復查:未發現主動脈竇瘤復發或殘余分流，主動脈瓣輕度反流2例，輕至中度反流2例；術后6年主動脈瓣重度反流1例，再次行主動脈瓣置換術。 結論 主動脈竇瘤破裂預后不良，盡早手術是治療主動脈竇瘤破裂惟一有效的治療方法。治療的關鍵是恰當切除瘤體，可靠閉合竇瘤口，徹底矯治心臟畸形。

Diagnosis and Treatment for Spontaneous Rhexis Hemorrhage of Liver Cancer

Objective　To explore the diagnosis and treatment for spontaneous rhexis hemorrhage of liver cancer. Methods　Clinical data of thirty patients who suffered from spontaneous rhexis hemorrhage of liver cancer from January 1995 to March 2009 were collected and analyzed retrospectively. Results　Twenty-six cases were stanched by surgical therapy, in which 14 cases underwent liver cancer resection, 10 cases underwent bleeding transfixion and hepatic artery ligation (or intubation), and 2 cases underwent omentum stuff transfixion. Four cases died one week after surgery, one died after 15 d, 9 cases died 1 to 3 months after operation, 5 cases survived after 4 to 6 months, 3 cases survived after 7 to 12 months, and in 4 cases survival time was longer than 12 months (in which one patient’s survival time was 16 months, one was 5 years and two patients were still alive with survival time of 3 and 13 years respectively). Four patiens went through the non-surgical therapy and survival time was 3 to 14 d. Conclusion　The spontaneous rhexis hemorrhage of the liver cancer is not the telephase of the liver cancer. Early diagnosis and operation can stanch bleeding effectively. The surgical therapy is better than the non-surgical therapy. Resection of liver neoplasms in time can raise long-term survival time.

Hepatectomy for Spontaneous Ｒupture of Ｈepatocellular Ｃarcinoma (Report of 19 Cases)

【摘要】目的探討肝切除術治療原發性肝細胞癌自發性破裂（SRHCC）的效果。方法回顧性分析19例肝切除術治療SRHCC患者的效果。結果肝切除19例，1個月存活率為94.7%，1年、3年及5年存活率分別為63.2%、16.7%及8.3%,平均存活時間為30.8個月(4 d～25年零9個月)，最長1例存活超過25年零9個月，目前仍健在。１８例肝功能屬ChildPugh A級患者安全度過圍手術期；　1例肝功能ChildPugh B級者術后4 d死于肝功能衰竭。結論SRHCC并非均為晚期病變，對早期肝癌破裂肝功能良好者應采取急診手術切肝；　如患者情況或醫療條件不允許，可行延期或二期手術治療。

Diagnosis and Treatment of Traumatic Rapture of Diaphragm (Report of 32 Cases)

目的報告32例膈肌破裂與創傷性膈疝的診治體會。方法對該院收治的32例創傷性膈肌破裂進行回顧性分析。結果該32例中，開放性損傷12例，閉合性損傷20例，26例并發創傷性膈疝。經X線檢查，18例有陽性發現； 16例行CT檢查，結果均為陽性； 術前確診24例（75%），治愈28例，死亡4例（12.5%）。結論CT和X線檢查是診斷膈肌破裂和創傷性膈疝的主要依據。早期診斷、及時手術治療是提高治愈率、降低死亡率的關鍵。

外傷性脾破裂104例診治體會