Abstract: ObjectiveTo explore the surgical characteristics of primary tracheal tumors treatment and its prognosis. Methods [WTBZ]We retrospectively investigated the clinical records of 38 patients with primary tracheal tumors in both Xiangya Hospital of Central South University and Hunan Provincial Tumor Hospital from Febuary 1982 to August 2009. There were 24 males and 14 females aged from 7 to 65 years. There were 2 benign lesions, 13 adenoid cystic carcinomas, 11 squamous cell carcinomas, 5 mucoepidermoid carcinomas, 4 adenocarcinomas and 3 other cell types. One patient with adenocarcinoma underwent exploratory thoracotomy only; 33 patients underwent tracheal resection and airway reconstruction, and according to the tumor growth characteristics, the surgeon applied circumferential tracheal resection with endtoend anostomosis or wedge resection; One patient had papilloma resected under fiber bronchoscopy; and three patients with locally advanced lesions underwent radiotherapy without surgery. The overall survival rate was calculated by the KaplanMeier method. The logrank method was used for comparing survival rates among different groups, characterized by cell types or surgical procedures. Results [WTBZ]The patient with exploratory thoracotomy died 3 days after surgery from respiratory failure. The perioperative mortality was 2.94% (1/34), and all the remaining 33 patients recovered and were discharged from hospital. Minor complications happened to 12 patients (35.29%), including 6 patients with pulmonary infection, 4 with atelectasis, and 2 with hoarseness. The followup time ranged from 6 months to 15 years. The followup rate was 97.29% (36/37). The threeunresected patients died within 6 months after hospital discharge. The 1, 5, and 10year survival rate for resected patients was88% （95%CI 0.77 to 0.99), 47%(95%CI 0.29 to 0.66), and 41% (95%CI 0.21 to 0.61), respectively. The survival rate of adenoid cystic carcinoma or mucoepidermoid carcinoma was significantly higher than that of squamous cell carcinoma or other tissue types (χ2=17.581, P=0.001). There was no statistical difference (χ2=0.021, P=0.886) in 5 year survival rate between wedge resection group at 63%(95%CI 0.34 to 0.91) and the segmental resection group at 77%(95%CI 0.44 to 0.99). Conclusions [WTBZ]Surgical treatment is safe and beneficial for primary tracheal tumors, and the pathological type is a significant prognostic factor after complete resection.
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
Objective To investigate the diagnosis and treatment of congenital choledochal cysts(CCC) in children. MethodsThe manifestation, auxiliary examination, mode of operation and effect of 42 patients with CCC in children from Jan., 1980 to June, 1999 were analyzed retrospectively.Results The patients with the triad of jaundice, an abdominal mass, and pain was 38.1% among the 42 patients. B-ultrasonic diagnosis was made with a correct diagnostic rate of 95.2%. The effective rate of internal drainage was significantly lower than that of resection of the cyst(χ2=19.36, P＜0.001) while the reoperation rate and incidence of carcinoma of internal drainage were higher than those of resection of the cyst(χ2=11.59, P＜0.001 and χ2=4.97, P＜0.05). Conclusion B-ultrasonic diagnosis is recommended as the first examination method. Internal drainage should be abandoned. Resection of the cyst with Roux-Y hepaticojejunostomy is recommended as the treatment of choice on extrahepatic cholangiectasis. Liver transplantation is a reasonable choice to treat the diffuse intrahepatic cholangiectasis.
Abstract： Objective To explore the optimal timing and treatment of acquired Lutembacher’s syndrome. Methods Sixteen acquired Lutembacher’s syndrome patients were studied retrospectively based on records collected between January 2000 and December 2009 in Beijing Anzhen Hospital. There were 9 males and 7 females at age of （39.45±10.23）years. All of them underwent endotracheal intubation, intravenous general anesthesia, and cardiopulmonary bypass. All patients were operated on through a median sternotomy incision into the chest, the right atrium, atrial septal defect to expand with mitral valve replacement and atrial septal defect repair. Postoperative mortality and perioperative complications were observed. During follow-up, periprosthetic leakage was observed using echocardiography, along with the level of residual atrial septal shunt, ventricular size, pulmonary artery pressure changes, and improvement in cardiac function. Results Two of the 16 patients（12.5%）died, one of renal failure, and one of respiratory failure. One patient required extracorporeal membrane oxygenation for 3 days, one required continuous renal replacement therapy for 11 days because of acute renal failure, and one experienced respiratory failure and used a respiratory machine for 23 days. All three of those patients recovered. Fourteen patients were followed up for between six months and five years, and the follow-up rate was 100%. The left ventricular end-diastolic diameter was （42.1±5.7） mm, as measured by echocardiography six months post-operation. There was no detectable periprosthetic leakage or residual shunt. The ejection fraction was （67.4%±6.7%）, and estimation of pulmonary artery pressure was （23.4±5.4） mm Hg. Twelve patients were class Ⅱ（ New York Heart Association） and two patients were class Ⅲ. Conclusion Acquired Lutembacher’s syndrome should be treated promptly if patients’ left ventricular end stage diastolic volume index is good enough to ensure they can tolerate surgery. Extracorporeal membrane oxygenation （ECMO）should be used early in patients who are anticipated to be difficult to withdraw from extracorporeal circulation perioperatively.
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
Objective
To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone.
Methods
Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection.
Results
Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients.
Conclusion
For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
Objective To improve the diagnosis and treatment of concealed penis in children. Methods From August 1998 to January 2004, 43 cases of concealed penis in children were treated with Huang Lugang’s procedure aging aged 2-14 years (7 years on average). Eight children are obesity. The albuginea tissue were fixed to the lateral Buck’s fascia at the base of the penis. Removal of the excessive suprapublic fat was given in 2 cases of obesity type. Results All patients were followed up from 3to 24 months. The results were satisfactory in 35 (81.4%).The penile contour were dissatisfactory in 8 patients with obesity including 2 patients given removal of the excessive suprapublic fat. Conclusion The Huang Lugang’s procedure was simple and can achieved satisfactory results, but it should be used carefully in case of obesity type.
Objective To evaluate the cl inical effectiveness of open reduction and internal fixation in the treatment of occult Lisfranc injury. Methods Between July 2002 and July 2009, 47 patients with occult Lisfranc injuries underwent open reduction and internal fixation. There were 31 males and 16 females with an average age of 35.6 years (range, 19-66 years). Injuries were casused by traffic accident in 27 cases, fall ing from height in 11 cases, sport in 16 cases, and crush in 3 cases. Thelocations were left foot in 18 cases and right foot in 29 cases. Simple medial column was involved in 6 cases, medial and middle columns in 24 cases, middle and lateral columns in 13 cases, and three columns in 4 cases. Base fractures of metatarsal bone were identified in all cases. The time from injury to operation was 4-21 days (mean, 8.6 days). The unstable Lisfranc joints were reduced and fixed by plates, screws, staples, and Kirschner wire through 1 or 2 longitudinal dorsal incisions. Results One case had infection and wound was repaired with flap at 2 weeks after operation; the other wounds healed primarily. Thirty-two patients were followed up 28.3 months on average (range, 12-75 months). The mean time of fracture heal ing was 12.3 weeks (range, 9-15 weeks). Osteoarthritis at midfoot was found in 15 cases at last follow-up and arthrodesis was not needed. The results were excellent in 9 cases, good in 16 cases, fair in 4 case, and poor in 3 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score system; the excellent and good rate was 78.1%. No re-dislocation occurred during the followup. Conclusion More attention should be paid to base fractures of metatarsal bone, operative exploration is conducive to diagnosis of occult Lisfranc injury. Suitable internal fixation should be selected according to injury type and concomitant injury. Anatomical reduction and stable fixation are the keys to reconstruct the joint stabil ity in the initial treatment of occult Lisfranc injury
Abstract: Objective To investigate the clinical features of solitary fibrous tumor (SFT) in the thorax and its optimal surgical approaches. Methods We retrospectively reviewed the clinical records of 16 patients with SFT in the thorax in our hospital between January 2004 and June 2010. There were 8 males and 8 females, with a median age of 49 years (1973 years). Laboratory examination showed normal results. Chest Xray and computed tomographic scan revealed lung tumor in 8 cases, mediastinal mass in 3 cases, fibrous tumor in 2 cases, pleural mass in 2 cases, and retroperitoneal mass in 1 case. Five patients underwent CT guided biopsy or thoracoscopy, and 3 of them were diagnosed to have SFT. There was no clear diagnosis for the remaining 13 cases before operation. None of them had been exposed to asbestos. Symptoms were present in 5 patients. All patients underwent surgical treatment with resection performed through routine thoracotomy in 10 cases and by means of videoassisted thoracoscopy in 6 cases. The tumors originated from the visceral pleura in 12 patients, from parietal pleura in 3 patients (from diaphragmatic pleura in 1, and costal pleura in 2), and from the lung in 1 patient. Results All tumors were totally excised. Immunohistochemical staining showed CD34 was positive in all tumors. There was no postoperative mortality and no major complications. All patients were regularly rechecked and followed up. The followup was ranged from 1 to 72 months, with a median time of 21 months. During the followup, all patients survived and no recurrence was observed by means of chest X radiography or CT. Conclusion SFT tumors in the thorax are rare neoplasms and can have giant diameters. Wide local excision is recommended as the best therapeutic option. The SFT has the possibility of recurrence, and careful longterm clinical followup is required.
Objective
To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion.
Methods
From December 2012 to December 2016, 39 patients were diagnosed as acute type-A aortic dissection complicated with lower limb malperfusion and underwent operation.There were 27 males and 12 females with an average age of 51.4±12.4 years.
Results
Early mortality rate was 17.9%(7/39). 32 patients of postoperative survival. The follow-up rate was 93.8%(30/32), 3 months to 3 years after the operation, the results is satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7%(29/30).
Conclusion
Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe, feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient’s status is strongly recommended for optimal surgical decision making.
