ObjectiveTo understand the current progress of diagnosis and treatment of accidental gallbladder cancer.MethodThe relevant literatures about diagnosis and treatment of accidental gallbladder cancer and gallbladder cancer were analyzed and summarized.ResultsDue to the lack of specific symptoms and signs in most patients with accidental gallbladder cancer at the early stage, appropriate imaging examinations and tumor marker examinations could improve the preoperative diagnosis rate. The radical resection was the most effective method for accidental gallbladder cancer, but there were still some controversies about the scope of resection according to different tumor stages, the choice of laparoscopic cholecystectomy or open cholecystectomy, and the timing of reoperation. The postoperative adjuvant therapy could improve the prognosis of patients, but most patients didn’t receive adjuvant therapy after surgery.ConclusionsMost patients with accidental gallbladder cancer are in the early stage, and most of them could obtain radical resection. If the first operation fails to achieve radical resection or postoperative pathological examination to confirm the diagnosis, comprehensive evaluation of the tumor stage and the patient’s general condition should be performed, and remedial treatment should be taken as soon as possible.
Objective
To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics.
Method
The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed.
Results
A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period.
Conclusion
A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
ObjectiveTo summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy.MethodsFrom 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed.ResultsThe interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients.ConclusionStandardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.
ObjectiveTo investigate the reason, prevention, and treatment measures of gastrointestinal unplanned reoperation.
MethodsClinical data of 21 patients who carried out gastrointestinal unplanned reoperation for various reasons from Jun. 2012 to Jun. 2013 in our hospital were retrospectively analyzed.
ResultsTwenty-one of 2 492 patients with gastrointestinal tract surgery carried out gastrointestinal unplanned reoperation, and the incidence of reoperation was 0.8%. The causes of reoperation were intra-abdominal hemorrhage in 10 cases, gastrointestinal fistula in 7 cases, inflammatory intestinal obstruction with peritonitis in 1 case, and incision dehiscence in 3 cases. After undergoing suture hemostasis, colostomy, anastomotic fistula repair, debridement, and suture,20 cases were cured or improved, and 1 case died. The median of hospitalization expense was 76 000 yuan(46 000-116 000 yuan), and the median of hospital stay was 25-day(16-49 days).
ConclusionsGastrointestinal unplanned reoperation can cause more serious economic and emotional burden to patients, standardizing surgical procedure and enhancing perioperative monitoring can reduce the incidence of unplanned reoperation. In addition, grasp legitimately the indications of reoperation, implement timely, and effective reoperation can avoid further deterioration of the disease.
Objective To investigate and evaluate the safety and efficacy of the aortic-mitral annular enlargement technique (double annular enlargement) in patients with small-size valve prostheses after prior valve surgery. MethodsThe clinical data of patients who underwent double valve annular enlargement in Wuhan Asia Heart Hospital from April 2020 to April 2022 were retrospectively analyzed. Results A total of 30 patients were collected, including 2 males and 28 females aged 9-78 (52.71±3.53) years. All patients had previous heart valve surgery, including 1 patient receiving the third heart surgery. All patients were operated on successfully and there were no postoperative in-hospital deaths. There was no postoperative bleeding which needed a secondary open-chest hemostasis, and one patient underwent permanent pacemaker implantation due to postoperative sick sinus syndrome. The mean diameter of the implanted prosthetic aortic valve was 24.23±1.60 mm, which was significantly larger than that of the preoperative aortic valve (21.03±1.90 mm, P＜0.001). The mean diameter of the implanted prosthetic mitral valve was 28.33±1.21 mm, which was significantly larger than that of the preoperative mitral valve (25.43±0.84 mm, P＜0.001). The mean peak gradient difference across the prosthetic aortic valve on postoperative echocardiography was 18.17±6.44 mm Hg, which was significantly lower than that of the preoperative aortic valve (82.57±24.48 mm Hg, P＜0.001). The mean peak gradient difference of the postoperative prosthetic mitral valve was 12.73±5.45 mm Hg, which was significantly lower than that of the preoperative mitral valve (19.43±8.97 mm Hg, P=0.003). Conclusion The double annular enlargement technique is safe and effective for reoperation in patients with a history of valve surgery with a small aortic root to obtain both a larger size prosthetic valve for a larger orifice area and stability of the mitral-aortic valve union, resulting in good postoperative hemodynamic characteristics and clinical outcomes.
ObjectiveTo evaluate the clinical outcomes of pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF) after re-PVR surgery.MethodsPubMed, EMbase, the Cochrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and data abstraction were determined independently and in duplicate. Literature searches from database establishment to December 2018. The heterogeneity and data were analyzed by the software of Stata 11.0.ResultsOf 4 831 studies identified, 26 studies met eligibility criteria, and invovled with a total of 3 613 patients. The combined 30-day mortality for PVR was 2.2% (95% CI 1.5%-3.1%) and follow-up mortality was 3.4% (95% CI 2.4%-4.9%), re-PVR rate was 6.8% (95% CI 5.1%-9.2%), and the rate of intervention was 11.4% (95% CI 8.0%-16.4%). Subgroup analysis showed that the patient's age range may be a heterogeneous source of mortality during the follow-up period, and there was no statistical heterogeneity for adult patients (P=0.63, I2=0%), with a lower incidence than those including adolescents patients. The type of valve was likely to be a source of retrospective PVR. There was no statistical heterogeneity in bioprosthetic valves and allograft lobes (P=0.24, I2=25%). And the incidence of re-PVR was lower than that of the mechanical valve patients. Heart function classification (NYHA) of patients with TOF after PVR was statistically improved (P<0.05). Electrocardiogram QRS change was not statistically differently (P>0.05). Postoperative MRI findings showed a decrease in RVEDV, an increase in RVEF, a decrease in RV/LV ratio, and a decrease in pulmonary valve (all P<0.05). Funnel map monitoring, Begg test and Egger's test both indicated that there was no publication bias.ConclusionsAccording to the results of the analysis, PVR after TOF surgery is a more mature surgery, the clinical effect was significant, with lower early and long-term mortality. The long-term mortality rate of adolescent patients undergoing PVR is higher than that of adult patients. Long-term outocme of re-PVR or re-intervention is still the main problem affecting the effect of the operation. Indications for surgery and choice of valve need further investigation.
ObjectiveTo evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.MethodsWe searched PubMed and other databases, reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy, timing of reoperation for incidental gallbladder cancer.ResultsLaparoscopic radical resection and re-resection were theoretically and technically feasible, but its efficacy and timing of re-resection were controversial, and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.ConclusionsLaparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer. Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.
ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.
Objective To investigate the value of indocyanine green fluorescence imaging in common bile duct reexploration. Methods The clinical data of 32 patients who underwent open common bile duct reexploration in the Affiliated Hospital of Southwest Medical University from January 2018 to December 2020 were collected retrospectively. All patients divided into the control group (conventional exploration group, 20 patients) and the fluorescence imaging group (using indocyanine green fluorescence imaging, 12 patients) according to the operational manner. The intraoperative and postoperative results of two groups were analyzed. Results The operative time [(165.2±6.9) min vs. (130.8±5.5) min], the time to find extrahepatic bile duct [(43.9±3.8) min vs. (23.1±4.1) min] and the amount of bleeding [(207.7±7.7) mL vs. (127.5±15.3) mL] in the control group were longer or more than those in the fluorescence imaging group (P<0.05). The incidence of postoperative infection in the control group [7 cases (35.0%) vs. 0 cases (0.0%)] and the length of hospital stay [(10.8±2.8) d vs. (7.1±1.3) d] were higher or longer than those in the fluorescence imaging group (P<0.05). There were no significant difference between the two groups in the incidence of postoperative bile fistula [6 cases (30.0%) vs. 2 cases (16.7%)] and the incidence of residual stones [3 cases (15.0%) vs. 3 cases (25.0%), P＞0.05]. Conclusion Indocyanine green fluorescence imaging appears to be a feasible, expeditious, useful, and effective imaging method while performing reexploration.
Objective
To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones.
Methods
Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed.
Results
All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05).
Conclusion
With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.
