Objective To investigate the security and efficiency of endovascular repair for Stanford type B aortic dissection (AD) with severe complications. Methods Between January 2003 and December 2009, 60 patients having Stanford type B AD with severe compl ications were treated, including 39 males and 21 females with an average age of 43.7 years (range, 34-71 years). Severe compl ications included 27 cases of huge hemothorax, 1 case of paraplegia, 7 cases of acute renal failure,10 cases of cel iac trunk ischemia, 10 cases of superior mesenteric artery ischemia, and 5 cases of severe limb schemia. Emergency stent-graft deployment were appl ied in all patients, and 64 stent-grafts were successfully implanted. Results All patients survived and were followed up 3-86 months. Hemothorax disappeared after 28 days to 3 months of operation in all hemothorax patients; renal function returned normal after 1 to 9 days; l imb and visceral ischemia disappeared gradually after 1 to 14 days; and muscular strength of lower limb in the paraplegia patient began to recover after 4 hours of operation. The postoperative CT angiography showed enlarged true lumen and thrombosis in the false lumen. Conclusion Emergency endovascular repair is a safe and effective method to treat Stanford type B AD with severe complications.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer.
MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups.
ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer.
ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.
Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.
Objective To learn the predictive risk factors of acute conversion of off-pump coronary artery bypass grafting (off-pump CABG)to on-pump coronary artery bypass grafting (on-pump CABG), referring for making decision in operating. Methods During Jan. 2002 to May 2006, 546 patients underwent planned off-pump CABG were analyzed retrospectively, and cases of acute conversion of off-pump to on-pump CABG (converted group) were compared with unconverted to on-pump(off-pump group) by multivariate logistic regression. Results 24 patients of off-pump CABG were acutely converted to on-pump CABG because of ventricular fibrillation or unstable hemodynamics. The mortality in converted group was 16.7%(4/24), much higher than off-pump group ［27% (14/522) , P＜0.001］. By multivariable logistic regression, acute myocardial infarction (OR=3.142,P=0004), emergent CABG (OR=1.571,P=0.011) and right main coronary artery(RCA) stenosis less than 90% (OR=1922,P=0.024) were predictors of acute conversion of off-pump to on-pump. Conclusions The mortality in patients undergoing acute conversion of off-pump to on-pump coronary artery surgery is high. When applying off-pump CABG in patients with acute myocardial infarction, emergency CABG and right main RCA stenosis ≤90%, preventive set up of extracorporeal circulation is necessary.
Objective To analyse the factors of complications aftertreatment of intertrochanteric fractures with Gamma nail. Methods From January 1998 to May 2004, 50 patients were treated with Gamma nail, including 18 males and 32 females and ageing from 47 to 82 years. The locations were the left side in 16 cases andthe right in 34 cases. According to Evans classification, there were 4 cases oftype Ⅰ, 2 cases of type Ⅱ, 23 cases of type Ⅲ, 10 cases of type Ⅳ and 11 cases of type Ⅴ. Results Fifty patients were followed up 429 months. Accordingto the Harris criterion for evaluation, the results were excellent and good in 35 cases, showing sthenic weight loading walking and normal range of motion of the hip joint. The postoperative complications appeared in 15 cases: 5 cases of coxa vara or coxa valga, 3 cases of rotation deformity of lower limb, 2 cases oftension screwprotrusions and lower shorten, 1 case of failure of internal fixation, 1 case of femoral fracture, 2 cases of coxalgia and 1 case of pain in knee joint and stiff knee joint. Conclusion The reason of complications was various, mainly lies in insufficient comprehension and analysis of the types of fractures, unfamiliarity with the characteristics and usage of the instruments and neglected rehabi litation instruction, inappropriate functional training and too early weight loading after operation.
Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.
Acute renal failure(ARF) is a serious complication after cardiac surgery. It is an important influential factor of increasing mortality, extending mechanical ventilation time and intensive care unit time, resulting in cognition functional impairment and respiratory function failure et al, and increasing cost of hospitalization. Extracorporeal circulation, intra-aortic balloon pump, renal inadequacy before surgery, diabetes and peripheral vascular disease are all risk factors of ARF after operation. These factors can lead to ARF by constriction of capacitance vessel, filling defect of renal and ischemia-reperfusion injury et al. Appropriate drug treatment, haemodialysis and hemofiltration could protect renal function and improve prognosis of ARF.
Objective To investigate the surgical indications of pulmonary aspergilloma, and to reduce postoperative complications. MethodsA total of 160 surgically treated patients with pulmonary aspergilloma were analyzed retrospectively from September 1975 to March 2006. All patients were divided into two groups: simple pulmonary aspergilloma(SPA,n=34) and complex pulmonary aspergilloma(CPA, n=126), according to the nature and extent of the underlying disease of the lung. The operative procedures included 154 pulmonectomy, 3 thoracoplasties with pulmonectomy or filling with the muscle flap, and 3 cavernostomy filling with the muscle flap. Results 156 of 160 cases had been cured with cure rate of 97.5% and no postoperative deaths. There were postoperative complications in 44 patients(27.5%) including: pneumonia(15 cases), incomplete reexpansion(12 cases), prolonged air leak(10 cases), empyema (5 cases), pulmonary abscess(5 cases), bronchopleural fistula(3 cases) and wound infection(2 cases). Postoperative complications of SPA group were lower than those in CPA group (P＜0.05). One hundred and fifty-one patients were followed up for 4 months to 5 years, no recurrence were observed. Conclusion Surgical resection for pulmonary aspergilloma should be selected first whenever the diagnosis of aspergilloma is confirmed. Objective and reliable preoperative evaluation is the key to reducing postoperative complications and surgery success. Because of minimal invasiveness, short length of hospital stay and less postoperative complications, video-assisted minithoractomy surgery may be superior to open thoracotomy in patients with localized underlying pulmonary disease and less pleural adhesions.
ObjectiveTo Summarize and analyze the pheochromocytoma complications of surgery patients and its influential factors, in order to provide a basis for preoperative assessment and postoperative support treatment for the patients.
MethodsWe reviewed the clinical data of 88 patients with pheochromocytoma from West China Hospital between January 2010 and December 2012. Among them, 35 had complications (complication group), and the other 53 had no complications (non-complication group). We analyzed preoperative blood catecholamine levels, preoperative preparation, tumor size, tumor location and surgical approach in all these patients.
ResultsThere were 16 patients (45.7%) with bilateral adrenal tumors (χ2=19.976, P<0.001), and 9 patients (25.7%) with extra-adrenal tumors (χ2=7.380, P=0.007) in the complication group, significantly higher than 3 (5.7%) and 2 (3.8%) patients respectively in the non-complication group. The diameter of tumor in the complication group was (8.33±3.69) cm, which was significantly higher than that in the non-complication group[(4.32±3.12) cm] (t=5.484, P<0.001). The risk factors for complications in patients undergoing pheochromocytoma surgery included bilateral adrenal tumors (OR=10.316, P<0.001), extraadrenal tumors (OR=8.827, P=0.008), diameter of the tumor longer than 6 cm (OR=94.937, P<0.001), laparotomy (OR=40.727, P<0.001) and long time surgery for more than three hours (OR=312.000, P<0.001).
ConclusionPatients who develop complications after pheochromocytoma surgery usually have bigger, and bilateral adrenal or extraadrenal tumors. Patients whose surgery is laparotomy or longer than three hours may also have more complications.These influential factors should be considered in future comprehensive treatment in order to achieve a good prognosis.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.
