Objective To explore the diagnostic methods, therapy and the prognostic factors for the ruptured abdominal aortic aneurysm (RAAA). Methods The clinical data of 23 patients (males 15, females 8, age range 35-78, mean age 65) with RAAA below the level of renal arteries, who were treated with surgery, were collected from April 1999 to December 2005 and were analyzed retrospectively. Seven cases had a history of RAAA, 6 cases had pulsating abdominal masses; 15 cases were diagnosed by emergency Doppler ultrasonic examination or CT. All of the patients underwent emergency surgical operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or using transluminal ballon according to conditions of each patient. The aritficial vascular graft was then taken after the control of hemorrhage. Results There were 9 (39%) patients died within 30 d after the emergency operation. The causes of death included acute renal failure because of hemorrhagic shock (4 cases), multiple organ failure (3 cases), and respiratory-circulatory failure (2 cases).Conclusion Surgery may be an effective treatment for RAAA. The critical step of the operation was to control hemorrhage by obstructing the proximal end of the aortic rupture according to the conditions of each patient. The main postoperative complications and causes of death include acute cardiovascular and cerebrovascular diseases, renal failure and pneumonia.
ObjectiveTo investigate the clinicopathologic and epidemiological characteristics of patients with gastric cancer at our hospital in the past six years． Methods A total of 958 patients with gastric cancer were selected from January 2004 to December 2009 and clinicopathologic characteristics such as basic data, pathological type, tumor location, and TNM stage were retrospectively analyzed. ResultsOf the 958 patients，697 cases (72.8%) were male and 261 cases (27.2%) were female, and the age ranged from 26 to 91 years old (mean 62.6 years old). The occurrence rate of gastric cancer was higher in the patients of 46-65 years old (49.4%, 473/958) than that in the patients of ≥66 years old (42.3%, 405/958) and ≤45 years old (8.3%, 80/958). Regarding pathologic type, the majority of advanced gastric cancers (70.1%) were Borrmann Ⅱ, the adenocarcinoma and signetring cell carcinoma accounted for 82.3% and 7.8%, respectively. The cancer of gastric cardia accounted for 53.0%. Stagestratified analysis revealed that the majority of gastric cancers (47.4%) were stage Ⅲ. Conclusion①A prevalence of gastric cancer is found in middle, elderly male patients. Poorly differentiated adenocarcinoma in cardia is prominent. ②Patients with high malignant ganstrie cancer are younger. ③The majority of patients who underwent the surgical treatments have advanced or metastatic tumor, therefore it is necessary to improve the early diagnosis of gastric cancer.
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 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.
ObjectiveTo analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. MethodsWe retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22), aortic valve replacement+ascending aortoplasty(n=10), Bentall procedure(n=13), aortic valve replacement+ascending aortic replacement+right hemi aortic arch replacement(n=13), Bentall procedure+ascending aortic replacement+right hemi aortic arch replacement(n=8), Bentall procedure+ascending aortic replacement+total arch replacement+stented elephant trunk(n=2) were carried out according to the type. ResultsAll 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3), pneumonia(n=2), and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. ConclusionBicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.
ObjectiveTo summarize experience of surgical treatment for hilar cholangiocarcinoma. MethodsFrom January 2009 to July 2011, 87 patients with hilar cholangiocarcinoma were enrolled into the department of Biliary and Pancreatic Surgery of the Second Affiliated Hospital of Harbin Medical University. The intra-and post-operative results were analyzed. ResultsOut of 87 cases, the resection rate was 67.8% (59/87). The radical (R0) resection rate was 48.3% (42/87), R1 resection rate was 11.5% (10/87), palliative (R2) resection rate was 8.0% (7/87). The patients were successfully got through the perioperative period, threre was no operative mortality. 1-year, 3-year, 5-year survival rates of the R0 resection group were 92.9% (39/42), 31.0% (13/42), 19.0% (8/42), respectively. No patient was alive more than 3 years in the groups of R2 resection and internal or external drainage. 1-year and 2-year survival rates of the R1 resection group were 70.0% (7/10) and 20.0% (2/10), respectively. 1-year survival rate of the R2 resection group was 57.1% (4/7). 1-year survival rate of the internal or external drainage group was 35.7% (10/28). 1-year, 3-year, and 5-year survival rates of the R1 resection group and R2 resection group were significantly lower than those of the R0 resection group (P<0.05). ConclusionFor hilar cholangiocarcinoma, radical resection is the only method to cure. Preoperative evaluation, percutaneous transhepatic cholangial drainage so as to relieve obstruction of biliary tract, proper liver resection and intraoperative pathology for resection margin are imperative guarantees lead to radical resection. Palliative resection might prolong survival time and improve quality of life.
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 report the effect of Russe technique in treating old scaphoid fracture. METHODS: From January 1987 to February 1999, 11 cases of old scaphoid fractures were treated with Russe technique. The follow-up period averaged 5 years and 7 months. RESULTS: The fracture healing rate was 100%, and wrist pain was completely relieved in all cases. The ranges of motion averaged 41.2 degrees of flexion, 40.5 degrees of extension, 8.7 degrees of radial deviation, and 15.4 degrees of ulnar deviation. The grip strength reached 82.9% of the normal side. CONCLUSION: Russe technique is an effective and safe method of treatment for old scaphoid fracture.
Objective To investigate the diagnosis and treatment methods of primary cardiac malignant tumors，so as to improve its’ level of diagnosis and treatment. Methods From April 2004 to June 2008, 19 patients with primary cardiac malignant tumors were diagnosed and treated in the department of cardiac surgery in this hospital. Male 11, Female 8.Age of the patients was 40.7±12.1 years(17-64 years). Preoperative diagnosis were occupying lesion in cardiac, malignant tumors were possible. Complete resections of malignant tumors were achieved by cardiopulmonary bypass (CPB) in 3 cases, and partially resected in 1 case, heart transplantation was performed in 1 case, only biopsies were performed in 5 cases. 9 cases (47.4%) lost the chances of operative treatments. Results There were no operative and hospitalstay deaths. Hospital stay was 10±7 d（9-15 d）, all patients were safely discharged from hospital. Two cases suffered from postoperative pericardial effusions，and high temperature happened in 1 patient, these 3 cases recovered by puncture and symptomatic treatment. The pathological diagnosis: leiomyosarcoma in 1case, malignant mesothelioma in 1 case and hemangioendothelial sarcoma in 8 cases. 14 cases (73.7%) were followed up from 1 to 38 months, 14 cases died of tumor recurrence or metastasis, the mortality was 73.7%, 5 cases (26.3%) were failed to be followed up. Conclusion The prognosis of patient with primary cardiac malignant tumor is still poor. Earlier diagnosis and complete surgical removal of the tumor as soon as possible may improve the patients’qualities of lives.
Objective To investigate the effect of vitamin K1 in the function of blood coagulation state, intraopera- tive blood loss, and hemoglobin content of liquid in postoperative drainage in patients with cirrhosis combined with portal hypertension before and after splenectomy combined with the hydrodynamic vein cut-out surgery. Methods In total of 143 cases of cirrhosis combined with portal hypertension who treated in our hospital from January 2010 to October 2015 were prospectively collected, and randomly divided into 3 group, including 51 cases of vitamin K1 group, 45 cases of carbazochrome sodium sulfonate group, and 47 cases of control group. Drug was used form 1 week before surgery to 5 days after surgery (vitamin K1 group: vitamin K1, 0.03 g, intravenous drip; card collaterals sodium sulfonic group: card collaterals sulfonic sodium, 80 mg, intravenous drip; control group: normal saline, 250 mL, intravenous drip). Prothrombin time of patients in 3 groups was detected at 1 week before surgery, 3 days before surgery, 1 day before surgery, 1 day after surgery, 3 days after surgery, and 5 days after surgery; hemoglobin content of liquid in postoperative drainage was detected on 1, 3, and 5 days after surgery. Results In terms of prothrombin time, there was no significant difference at 1 week before surgery and 5 days after surgery (P>0.05); prothrombin time of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P>0.05); prothrombin time of vitamin K1 group and carbazochrome sodium sulfonate group was both lower than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and vitamin K1 group on 1 day and 3 days after surgery (P>0.05). In terms of intraoperative blood loss, intraoperative blood loss of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group (P>0.05). In terms of hemoglobin content of liquid in postoperative drainage, it was lower in vitamin K1 group and carbazochrome sodium sulfonate group than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference among 3 groups on 5 days after surgery (P>0.05). Conclusion Vitamin K1 is helpful to improve function state of blood coagulation before and after surgery in patients with cirrhosis combined with portal hypertension (from 1 week before surgery to 3 days after surgery), and reduce the intraoperative blood loss; carbazochrome sodium sulfonate can improve function status of postoperative blood coagulation to 3 days after surgery and postoperative blood loss, but has no obvious improvement in the function status of preoperative blood coagulation and introperative blood loss.