Objective To investigate the clinical effects and the brain protection effect of different cardiopulmonary bypass in treating descending aortic aneurysms. Methods From January 2001 to December 2008, 65 patients were diagnosed to have descending aortic aneurysm with magnetic resonance imaging (MRI) in our hospital. Among them, there were 56 males and 9 females whose age was between 15 and 71 years old with an average of 48.1 years. The disease process ranged from 6 days to 4 months (19.0±6.5 d ). Preoperative diagnosis showed that there were 41 cases of DeBakey type Ⅲinterlayer, 9 cases of Marfan syndrome with postoperative complications of type Ⅲ interlayer, 7 cases of pseudoaneurysm and 8 cases of true aneurysm. We adopted artificial blood vessel repair patch to repair the damaged point of the descending aorta in 2 cases, performed vascular aneurysm resection and artificial vessel replacement on 63 patients, and carried out descending aorta replacement and intercostal artery grafting in 18 cases. Results Among the 65 cases of cardiopulmonary bypass patients, there were 13 cases of left heart bypass, 12 cases of heart bypass, 30 cases of deep hypothermic circulatory arrest (DHCA) with total body retrograde perfusion (TBRP) and 10 cases of modified separate perfusion of upper and low body. Cardiopulmonary bypass time, DHCA time, retrograde perfusion time, upper body circulatory arrest time and low body circulatory arrest time were respectively 51-212 min, 18-75min, 18-73 min, 21-31 min, and 39-67 min. No death occurred during the operation, and there were no brain complications or complications of paralysis among all the patients. Two patients died after operation because of renal failure. Conclusion Good results can be achieved by selecting different method of cardiopulmonary bypass based on the anatomical location and range of the thoracic descending aortic aneurysms. The selection criteria should be favorable to the surgical operation and organ protection.
Esophageal cancer is the seventh most common cancer worldwide. On August 29, 2023, National Comprehensive Cancer Network (NCCN) released the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2023). This article aims to highlight the key updates in treatment and follow-up recommendations between the version 3 and the version 2 in 2023, providing the latest guidance for the management of esophageal cancer in our country.
Objective To explore a scientific disease cost accounting. Method Disease cost accounting = disease cost accounting of clinic pathway + disease basis cost accounting. Conclusions It is the tendency with the medical reform for the social security department to pay by disease for the hospitals, as a result, both social security department and hospitals have to resort to the scientific way in terms of cost accounting of disease. And it is practical and effective by means of cost accounting for clinic pathway.
OBJECTIVE: To modify the design of the Achilles tendon-scar composite flap into the Z-shape and to apply it into clinic situations to correct the tendon-scar contracture after burn and other injures. METHODS: According to degree of contracture and strephenopedia, the central limb of Z-shaped design lay in contracture line of posterior ankle area just over the Achilles tendon and extended 8 to 12 cm in length. Lateral limbs extended 5 to 8 cm and usual angles of the Z-shape was 60 degrees. The two tendon-scar composite flaps were made and slipped along the central limb between them. From March 1994 to August 1999, seven patients with Achilles tendon scar contracture were operated with this method. RESULTS: Excellent relieving of the Achilles tendon-scar contractue was achieved. No such complications happened as ischemia and necrosis of the flaps. CONCLUSION: The Z-shaped tendon-scar composite flap is practical in clinics. It is characterized by abundant blood supply, easily procedure and reliable result.
【Abstract】 Objective To explore the biomechanical properties of a new intramedullary controlled dynamicnail ing (ICDN). Methods Ten pairs of specimens of adult femurs, with the age of 18 to 55 years, were divided into twogroups (groups A1 and B2, n=10). The length of the specimens was (438 ± 10) mm , and the external diameter was (26.4 ± 1.5) mm. The specimens of the two groups were osteotomized transversely after the biomechanical test. ICDNs and GK nails were randomly implanted into the femurs, respectively (groups A2 and B2). Torsional, bending and axial compressive tests were made in each group, and the effect of dynamic compression between the fracture fragments was tested. Results The resistance to compression of groups A1, B1, A2 and B2 were (0.19 ± 0.18) × 106, (0.22 ± 0.12) × 106, (1.67 ± 0.68) × 106 and (0.86 ± 0.32) × 106 N/mm, respectively. There was statistically significant difference between groups A2 and B2 (P lt; 0.01). The bending stiffnesses of coronal section of groups A1, B1, A2 and B2 were (0.94 ± 0.25) × 103, (1.10 ± 0.21) × 103, (0.70 ± 0.22) × 103, (0.64 ± 0.21) × 103 N/mm, respectively. The bending stiffness of sagittal plane of groups A1, B1, A2 and B2 were (1.06 ± 0.26) × 103, (0.96 ± 0.25) × 103, (0.67 ± 0.25) × 103, (0.61 ± 0.18) × 103 N/mm, respectively. There were no statistically significant differences between groups A1 and B1 or between groups A2 and B2 (P gt; 0.05). When the torque was 5 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.00 ± 2.54), (4.76 ± 1.93), (0.50 ± 0.63), (0.35 ± 0.31) Nm/°, respectively. When the torque was8 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.30 ± 3.27), (3.94 ± 2.01), (0.42 ± 0.52), (0.36 ± 0.18) Nm/°, respectively. There were statistically significant differences between groups A1 and A2 or between groups B1 and B2 (P lt; 0.05), and no statistically significant difference between between groups A2 and B2 (P gt; 0.05). The average maximal pressure generated between the fracture fragments which were fixed with ICDN was 21.6 N, and the pressure between the fracture fragments which were fixed with GK nail ing could not be tested. Conclusion The design of ICDN conforms to the special anatomical structure of the femur. ICDN could provide a completely different structure, a different fixation principal and a more balancedfixation than GK nail. ICDN incorporates the flexible and rigid fixation, which is l ikely to be the trend of the fracture fixation.
【摘要】 目的 探讨深吸气量（inspiratory capacity，IC）与慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者临床特征的相关性。 方法 2009年12月-2010年6月纳入84例稳定期COPD患者，测定6分钟步行试验（6-minute walk test，6MWT）、圣乔治生活问卷评分（St George′s respiratory questionnaire，SGRQ）及肺功能检查:第1秒用力呼气容积（forced expirotovy volume in one second，FEV1）、IC、IC与肺总量（total lung capacity，TLC）比值（IC/TLC）等相关指标，并进行相关性分析。 结果 6MWT值与FEV1无明显直线相关（r=0.14，Pgt;0.1）；6MWT值与FEV1≥60%无明显直线相关（r=0.16，Pgt;0.1）；6MWT值与IC值呈正的直线相关（r=0.317，Plt;0.01）；6MWT值与IC/TLC值呈正的直线相关（r=0.274，Plt;0.01）；SGRQ值与FEV1呈负的直线相关（r=-0.307，Plt;0.01）；SGRQ值与IC值无直线相关（r=-0.001，Pgt;0.25）；SGRQ值与IC/TLC值无直线相关（r=-0.003，Pgt;0.25）。 结论 对COPD患者，IC比FEV1更准确地反映患者的运动耐量的程度，FEV1比IC更准确地反映患者呼吸困难的严重程度。【Abstract】 Objective To explore the relationship between the inspiratory capacity (IC) and clinical characters of stable chronic obstructive pulmonary disease (COPD). Methods Between December 2009 and June 2010, 84 patients with stable COPD were enrolled. Lung function (FEV1, IC, IC/TLC) ,6 minute walk-test (6MWT) and St George′s respiratory questionnaire (SGRQ) were examined. The relationship among FEV1, IC, IC/TLC, and the results of 6MWT and SGRQ by Pearson correlation analysis. Results There was no linear correlation between 6MWT and FEV1 （r=0.14，Pgt;0.1）, and 6MWT and FEV1≥60% （r=0.16，Pgt;0.1）. There was positive correlation between 6MWT and IC （r=0.317，Plt;0.01）, and 6MWT and IC/TLC （r=0.274，Plt;0.01）. There was negative correlation between SGRQ and FEV1 （r=-0.307，Plt;0.01）; and no linear correlation between SGRQ and IC （r=-0.001，Pgt;0.25）, and SGRQ and IC/TLC （r=-0.003，Pgt;0.25）. Conclusion In stable COPD patients, IC may be more accurate than FEV1 in refection of exercise tolerance while FEV1 may be more sensitive than IC in evaluation of dyspnea.
Objective To summarize our experience of using rigid bronchoscopy in the managent of patients with tracheobronchial disease. Methods From Sep.2002 to Nov.2007, 44 patients of tracheobronchial disease（31 men，13 women, median age 51.9 years) underwent rigid bronchoscopic operations. All procedures were carried out under general anesthesia with high frequency jet ventilation. After the rigid bronchoscope was placed in the main trachea through the mouth , the airway was checked out firstly, and then the lesion was removed by repeated freezing, argon plasma coagulation, cauterization or mechanical ablation, and a stent maybe implanted while needed. Results All 54 procedures were accomplished endoscopically without mortality or major morbidity (16 clearence,19 core out,8 scar clearance,3 foreign body removal, 8 stent insert or removal).The lesion located at trachea in 19 cases, at carina in 4 cases,at left main bronchus in 11 cases and at right main bronchus in 10 cases. There were 17 benign diseases and 27 malignant diseases. There were 3 slight complications. 16 patients compliating with benign disease were followed-up and 1 patient was missed,there was no tumor recurrence except 3 patients complicating with tracheal scar who received reoperations during 4-44 (mean 23.0) months follow-up period. Of the 27 malignant cases,23 patients were followed-up and 4 patients were missed, the follow-up period were 5-58(mean 27.1)months.3 patients died in one months after operation of other disease; the other patients all survived more than one month,especially 7 patients who received radical resection of the tumor survived more than one year. Conclusions These data show that rigid bronchoscope can be applied safely and effectively in the management of tracheobronchial disease.
目的:比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法:筛选1997年6月至2008年6月间收治的60例高龄新鲜不稳定性股骨转子间骨折患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组30例,平均年龄83.6岁;B组30例,平均年龄81.7岁。随访时间8个月～9年(平均2.3年)。结果:两种术式在住院时间和术后引流量的差异无统计学意义(Pgt;0.05);而在手术时间、术中出血量、下地开始行走时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面,两组比较差异均有统计学意义(Plt;0.05)。结论:人工股骨头置换术可以作为治疗高龄股骨转子间骨折的一种选择,术后能早期离床负重活动、较快恢复伤前活动能力、降低术后短期并发症和内科合并症的发生率、减低术后一年内死亡率。
Abstract: Objective To summarize the clinical experiences of videoassisted thoracoscopic surgery (VATS) lobectomy performed on a series of 300 consecutive patients, and report the results of a 3year followup. Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery, People’s Hospital of Peking University. Of the 300 patients, there were 159 males and 141 females with the age ranged from 18 to 86 years (58.30±13.90 years). Preoperative diagnosis showed that there were 266 patients of mass in the lung, 22 of bronchiectasis, 5 of cyst/abscess in the lung, 3 of pulmonary sequestration, 2 of fungus infection, and 2 of pneumothorax. We assessed the perioperative variables by standard descriptive statistics and estimated the 3year survival rate by KaplanMeier analyses. Results Sixtysix patients were diagnosed to have benign diseases and 234 patients were with malignancies. A percentage of 81.82% (54/66) of the benign patients had infectious diseases, and the majority of the malignancies was nonsmall cell lung cancer (213 patients), especially adenocarcinomas which comprised 73.08% (171/234) of all the malignancies. A total of 273 patients accomplished VATS lobectomy, of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300). In the VATS lobectomy accomplished group, the mean operation time was 317±088 h, and the blood loss was 225.70±195.20 ml. Benign surgery took significantly less time (t=2.280, P=0.0032) and had shorter drainage time(t=1.392, P=0.0304) than those of malignancies. Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27). Bleeding was the second reason for conversion in 5 patients at a percentage of 1852%. The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the nonupper lobe surgery group (χ2=6.131, P=0.013), while gender (χ2=1.182, P=0.277), pathology (χ2=0.210, P=0.647) and the tumor located in left or right side(χ2=2.933, P=0.087) didn’t influence the risk of conversion. The result of the 3year followup showed that there was no reoccurrence of symptoms in patients with benign diseases; Nonsmall cell lung cancer patients had a 3year survival rate of 0.87 with the 95% confidence interval (CI) from 0.77 to 0.96, and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98. Conclusion VATS lobectomy is safe and effective. This research shows that domestic technologies of VATS lobectomy and its midterm results have reached the international standard.
目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。