目的 探讨腹主动脉瘤破裂的诊断和治疗方法。方法 我院从1999年10月至2004年1月期间经手术治疗腹主动脉瘤破裂6例。结果 1例患者因术后失血性休克而死亡； 5例患者随访4年，1例术后2年死于心肌梗死，余4例存活。结论 腹主动脉瘤应早期诊断、早期治疗，一旦破裂应迅速诊断、急诊手术，手术时应注意阻断腹主动脉的方法以及防止术后下肢缺血。
Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.
ObjectiveTo investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. Methods The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. ResultsThe average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B (P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups (P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups (P>0.05). At last follow-up, the breast satisfaction score in the patients’ Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group (P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups (P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Conclusion Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.
Progress in the treatment of acute myocardial infarction (AMI)， chronic coronary artery disease and their immediate complications has led to an increasing number of surviving patients with residual left ventricular dysfunction. It has been shown that viable myocardium in post-AMI patients and chronic heart failure patients plays an important role in predicting their prognosis and making clinical decisions. Viable myocardium refers to myocardium with reversible contractile dysfunction that occurs in coronary ischemia or after ischemia-reperfusion, but still has contractile reserve. Myocardial microvascular integrity is in correspondence with myocardial viability. Myocardial contrast echocardiography can evaluate the microvascular integrity of myocardial dysfunctional areas in patients with AMI or chronic coronary artery disease, detect viable myocardium， predict the potential for functional recovery in dysfunctional areas following reperfusion， and provide clinicians with valuable information for individualized treatment.
ObjectiveTo investigate the clinical characteristics of thoracic esophageal-gastric cancer (TEGC) and the safety and effectiveness of secondary reconstruction of thoracic and gastrointestinal tract after esophageal and preventriculus cancer (esophagogastric junction) surgery.MethodsThe clinical data of 353 patients with esophageal and preventriculus cancer who underwent endoscopic review from July 2007 to December 2019 were retrospectively analyzed. A total of 31 (8.78%) patients with relapsed or recurrent TEGC were found, including 24 males and 7 females with a mean age of 58.5 years (range: 42 to 68 years). There were 18 (58.06%) patients of adenocarcinoma and 13 (41.94%) squamous cell carcinoma. All patients underwent TEGC resection and secondary reconstruction of thoracic gastrointestinal tract. Thoracoabdominal computed tomography (CT) and upper gastrointestinal imaging (GI) were performed during follow-up, and gastroscopy was performed for suspected patients. All the patients were followed-up till death or December 30, 2019. The survival rate was calculated by Kaplan-Meier method, and the survival was analyzed using the log-rank test. ResultsThirty-one patients underwent thoracic esophagectomy and gastric cancer resection, and then reconstruction of the thoracic and gastrointestinal tract. Eight patients underwent residual gastroesophageal thoracic anastomosis, 13 patients colon esophagectomy, 6 patients jejunal esophagectomy (1 patient esophago-jejunal Roux-en-Y anastomosis), and 4 patients cervical esophagogastric anastomosis. The mean operation time and intraoperative blood loss were 404.8 (340-475) min and 378.4 (180-620) mL. The postoperative complications ocurred in 4 patients, including 3 patients of pulmonary infection and 1 patient of cervical incision infection. The mean hospital stay was 17.1 (14-21) d. All patients were followed up, the median survival time of 11 patients in stage Ⅰ-ⅡA was 25 (19.8-35.0) months and 20 patients in stage ⅡB-ⅢA was 16 (12.5-19.5) months. There was a significant difference between the two groups (χ2=7.840 8, P<0.01).ConclusionPostoperative relapsed and recurrent TEGC occurs after the surgery for esophageal and preventriculus cancers, most of which are caused by metachronous gastric cancer or residual esophageal carcinoma recurrence which leads to invasion of the thoracic and gastric wall. Regular endoscopic review is the main method after operation. It is technically safe and feasible to reconstruct the thoracic and esophageal digestive tract in patients with TEGC after reoperation, which can benefit the survival of patients.
目的 探讨Prolift系统全盆底重建术在治疗盆腔脏器脱垂疾病中的应用价值及疗效。 方法 回顾性分析四川大学华西第二医院妇科2010年1月－2011年5月收治的119例盆腔脏器脱垂患者的临床资料，其中47例应用Prolift系统进行全盆底重建术（A组），51例应用曼氏手术治疗（B组），21例应用经阴道全子宫切除术+阴道前后壁修补术治疗（C组）。分析比较各组的临床近期疗效。术后随访1年。 结果 A、B、C组在手术时间、术中出血量、术后安置尿管天数、术后住院天数间差异均无统计学意义（P＞0.05）。A组1例、B组11例、C组4例复发，A组与B、C组复发率比较差异有统计学意义（P＜0.05）。 结论 Prolift系统全盆底重建术安全性高，不增加脏器损伤的几率，且明显降低了患者的术后复发率，近期疗效肯定，是治疗盆腔脏器脱垂的一种理想术式。
目的:探讨关节镜下自体腓骨长肌腱重建膝关节交叉韧带的手术方法及临床疗效。方法:2005年11月至2008年2月我院采用关节镜下自体腓骨长肌腱重建膝关节交叉韧带17例,其中前交叉韧带7例,后交叉韧带10例。据敖英芳临床判断标准及Lysholm评分评价膝关节疗效;Takakura踝关节评分系统评价踝关节术后功能。结果:全部病例得到随访3~26个月,平均13-7个月,抽屉试验和Lachman试验阳性者1例,可疑阳性者2例,余患者均为阴性;踝关节术后功能评分均在96分以上。根据敖英芳临床判断标准,本组优14例,良2例,中1例。Lysholm评分术后86-54,与术前41-26比较,差异有统计学意义(Plt;0.01)。结论:关节镜下自体腓骨长肌腱重建膝关节交叉韧带简单,损伤小,效果满意。