多心腔多发粘液瘤的临床特征与手术方法

目的　探讨多心腔多发粘液瘤的临床特征,改进其手术方法,避免术中瘤体遗漏,心肌损伤,提高手术生存率。　方法　收治多心腔多发粘液瘤１２ 例。在体外循环下切除瘤体３３ 个。术后长期观察随访。　结果　术中发现超声诊断对该症往往漏诊,原手术方法对心肌损伤大,易出现并发症。术后５ 例复发,其中３ 例因拒绝和等待手术者死于脑栓塞;另２ 例再手术者死亡１ 例,８ 例健在。　结论　本病手术难度大,术中要仔细探查,避免遗漏。术后复发率高,要长期随访。该症瘤体更易脱落,一旦确诊应及早手术。     

体外循环下行心粘液瘤摘除术的护理

对１８例心房粘液瘤患者施行粘液瘤摘除手术，治愈率１００％。护理要点：术前积极作好心理护理，避免剧烈活动，保持最佳睡眠体位，预防栓塞和猝的发生，术后严密监测心电图、平均动脉压、中心静脉压及尿量的变化，应用呼吸机辅呼吸，加强呼吸道管理，维持心包及纵隔引流的效能，有效控制体温反跳 。     

多心腔多发粘液瘤的外科治疗

１９８０年至１９９４年作者共收治多心腔多发粘液瘤１１例。其中二心腔者８例，三心腔者３例。全组病例均手术治疗，切除瘤体３１个。术后远期效果满意，远期有５例复发或再发。其中３例死于脑栓塞，另２例复发者再手术死亡１例，其余６例健在。多心腔多发粘液瘤相似，但症状重于单发瘤。超声心动图对其诊断安全准确的，但在确定一个心腔中有几个瘤体存在往往漏诊。作者着重对多心腔发粘液瘤的临床特点、手术切口的选择以及如何避免     

右心粘液瘤的诊治

目的　探讨右心粘液瘤的诊治及疗效。方法　自 1984年 8月至 1999年 6月 ,16例右心粘液瘤病人接受外科治疗 ,术前超声心动图明确右房粘液瘤 11例 ,右室粘液瘤 5例 ,4例右房粘液瘤同时合并左房粘液瘤。均在体外循环下行粘液瘤摘除术 ,1例同时行三尖瓣置换术。结果　无围术期死亡 ,1例术后出现左心功能衰竭 ,运用左心辅助装置治疗后好转。随访 1个月到 15年 ,平均 4 8年。 1例术后13年粘液瘤原位复发再次手术治疗 ,复发率 6 .2 5 %。结论　右心粘液瘤一经确诊应立即手术 ,且效果好、安全。超声心动图对右心粘液瘤的诊断具有极其重要的作用。     

左房粘液瘤手术中的ACT监测

在体外循环（ＣＰＢ）下，行左房粘液瘤摘除术１２例。术中常规划行全血激活凝固时间（ＡＣＴ）监测。肝素化前其ＡＣＴ生理值正常，但这类患者对肝素不够敏感，即在同一时期的病例，用同样批号的肝素，左房粘液瘤患者的肝索首次用量和中途追加量比其他病种明显增多，两组比较有显著差异（Ｐ〈０．０１）。作者认为对心房粘液瘤病例的ＣＰＢ手术，要特别加强ＡＣＴ监测，否则有可能因肝素用量不足而发生凝血，以致造成严重意外。     

腹膜假粘液瘤

腹膜假粘液瘤经近期的免疫组化技术研究业已被证实为阑尾恶性肿瘤的的转移病灶,虽经大块切除,但仍有复发可能,5年生存率为53％,现复习1986～1997年文献有关治疗的方法及其结果。     

心房粘液瘤36例临床分析

目的总结心房粘液瘤的临床特点、手术效果和治疗难点。方法回顾性分析2001年5月至2011年11月昆明医科大学第二附属医院收治的36例心房粘液瘤患者的临床资料。其中男9例、女27例,年龄26~57（43.0±7.6）岁,病程1~18个月。左心房粘液瘤33例,右心房粘液瘤2例,双心房粘液瘤1例。结果术前巨大左心房粘液瘤死亡1例,体外循环下手术治疗35例,无手术死亡病例,无术后相关并发症,随访4个月至7年,无术后复发病例。结论心房粘液瘤病情进展迅速,诊断明确后应积极手术治疗。对瘤体大、位置特殊的病例,操作尤须仔细、规范,以减少术后并发症的发生和复发。     

腹膜假粘液瘤：综合报道

膜腹假粘液瘤经近期的免疫组化技术研究业已被证实为阑尾恶性肿瘤的转移病灶，虽经大块切除，但仍有复发可能，５年生存率为５３％，现复习１９８６－１９９７年文献有关治疗的方法及其结果。     

家族性心脏粘液瘤

家族性心脏粘液瘤何忠良，陈如坤，张昌铭，朱家光例１女，４７岁。活动后胸闷、气促４个月伴昏厥。超声心动图示左房粘液瘤。在体外循环下手术，经右房及房间隔径路切除肿瘤及少量蒂周组织，房隔直接缝合。痊愈出院。２年后复查超声心动图时发现左房粘液瘤复发，后因肿瘤...     

主动脉缩窄合并心内畸形的一期手术治疗

１９９３年６月至１９９４年８月为５例主动脉缩窄合并先天性心内畸形病儿施行了一期手术治疗。男４例，女１例，年龄１．５～１３岁，体重７．５～４５ｋｇ。除主动脉缩窄外，合并的心内畸形有室间隔缺损、主动脉瓣及瓣下狭窄、主动脉瓣关闭不全等。手术采用左后外侧第４肋间切口，矫治主动脉缩窄后，同期行胸骨正中切口体外循环下心内畸形矫治。本组无手术死亡和并发症，取得了满意的治疗效果。作者认为，对主动脉缩窄合并心内畸形施行一期手术矫治是完全可行的。     

The Variations in the Immunologic Features and Interleukin-6 Levels for the Surgical Treatment of Cardiac Myxomas

Purpose In this study, we propose the existence of a relationship between cardiac myxomas and the immunologic features or interleukin-6 (IL-6), while also considering the optimal treatment of cardiac myxoma, especially “familial myxoma.” Methods In a 19-year period at our hospital, 20 patients underwent 21 operations for cardiac myxomas. The immunologic features and the IL-6 levels were measured pre-operatively in 13 cases and post-operatively in 10 cases. A case of “familial myxoma” was diagnosed based on molecular genetic analyses. Results No patients died in the hospital. The tumor size correlated with the preoperative IL-6 and/or α1-globulin values (P < 0.05). In addition, all of the immunologic features and IL-6 levels normalized by 4 weeks after surgery. “Familial myxoma” demonstrated recurrence without showing increases in either the immunologic features, inflammatory signs, or serum IL-6 levels. Conclusions Patients with cardiac myxoma should therefore be operated on immediately because the possibility that the tumor size might be large when IL-6 and/or α1-globulin values are high. In addition, cases of “familial myxoma” require careful observation and periodic echocardiography after surgery to identify any possible recurrence. Recently, molecular genetic analyses are therefore considered to be an important diagnostic tool for cardiac myxoma, especially “familial myxoma.” Our “familial myxoma” case demonstrated a C769T PRKAR1a mutation, which has also been observed in other cases of “familial myxoma.”     

Follow-up results of 3,500 arthroscopic operations on the knee joint

Summary In a clinical study the postoperative results of 3,500 arthroscopic operations on the knee joint were analyzed with a follow-up period of 1 year. At the time of examination 55.3% of patients were symptom-free, 33.8% had definite relief of symptoms and in 10.9% the symptoms were unchanged or progressive. The results of the different procedures performed varied widely, with the best results being obtained after meniscectomy. The average postoperative hospitalization was 3.5 days. Arthroscopy is a procedure with a low morbidity. Rehabilitation in the immediate postoperative period is accelerated due to reduced pain and functional impairment.Presented at the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988     

左心房粘液瘤的外科治疗

目的　探讨左心房粘液瘤的诊断和治疗经验 ,以提高手术疗效。　方法　回顾性分析自 1995年 10月至2 0 0 1年 10月收治 5 7例左心房粘液瘤病例 ,术前均经彩色超声心动图确诊 ,均在体外循环下行粘液瘤摘除术 ,同期行二尖瓣成形术 5例 ,二尖瓣机械瓣置换术 2例 ,三尖瓣成形术 37例 ,房间隔缺损修补术 2例 ,隔膜型主动脉瓣下狭窄环切开术 1例。　结果　无围术期及手术死亡 ,随访 1个月～ 6年 ,2例复发再次手术 ,复发率 3.5 %。　结论　左心房粘液瘤一经确诊应尽快手术 ,手术效果满意 ,复发率低 ;彩色超声心动图对诊断及术后随访有重要作用 ,应注意术后随访。     

10 Years’ controlled results of suture repair

Summary Background: Over a period of 10 years, we prospectively evaluated the Shouldice technique for primary inguinal hernia repair with regard to recurrence rates and hernia type-related risk profiles. Methods: 196 unselected patients with 237 primary inguinal hernias were prospectively examined 1, 5 and 10 years after hernia repair was performed by 36 different surgeons (71% senior surgeons) using the standardized Shouldice technique. Follow-up included primarily physical examination and comprised 91.1%, 85.6% and 73% of the patients after 1, 5 and 10 years. Results: Early and late complications of inguinal hernia repair occurred in 11.4%. Eighty-eight per cent were not limited in their daily life activities 10 years after the operation. Recurrent hernia was found in 1.3% after 5 years and 2.95% (7 out of 237) after 10 years. The rate of recurrence tended to be higher after direct (4.8%) and combined hernias (4.2%) than after indirect hernia (1.6%). Almost all recurrences were found in stage III hernias. Conclusions: Ten years after Shouldice repair, 97% of the patients are free of recurrence. These results indicate that there is no need to abandon the Shouldice technique with local anaesthesia as the standard procedure for primary inguinal hernia repair.      

Calculating Follow-up Rates

Follow-up rates are presented as a percentage but the method of calculation is seldom discussed. Determining a follow-up rate begins with identifying the numerator and denominator used in the calculation. Four methods of calculating follow-up rate after surgical treatment for weight reduction were studied. Method 1 follow-up rate, 91.2%, was calculated using patients with at least one follow-up contact as the numerator (6169) and the number of primary operations performed as the denominator (6764). Method 2 calculated patient contact on or beyond a specific time point: 65.9% for ≥ 6 months (4232/6424), ≥ 1 year (y) = 52.1% (3111/5977), ≥2 y = 29.8% (1455/4890), ≥3 y = 18.8% (710/3784), ≥4 y = 12.5% (331/2643). Follow-up calculated using method 3 determined patient contact within specific time points: 0-1 y = 89.7% (6064/6764), 1-2 y = 45.8% (2739/5977), 2-3 y = 23.0% (1124/4890), 3-4 y = 13.9% (526/3784), 4-5 y = 11.3% (298/2643). Method 4 studied patient contact within time points according to ASBS guidelines. Rates for method 4 were: 0-6 months = 58.8% (11,938/20,292), 6-12 months = 36.7% (4717/12,848), 1-2 y = 45.8% (2739/5977), 2-3 y = 23.0% (1124/4890), 3-4 y = 13.9% (526/3784). Results using these four methods of calculation emphasize the need to standardize follow-up rate before operative comparisons can be made.     

259例应用国产C—L短柱侧倾碟瓣行二尖瓣置换术后15年随访

目的评价应用国产C—L短柱侧倾碟瓣行二尖瓣置换术的近期与远期疗效，分析影响手术疗效的因素，以提高手术疗效。方法回顾性分析自1991年10月至2006年11月，259例用国产C—L短柱侧倾碟瓣行二尖瓣置换术患者的临床资料和长期随访结果。结果本组早期死亡12例，死亡率为4．63％（12／259）。术后早期未出现与心瓣膜相关的并发症。1996年以后病死率降至2．59％。随访235例患者，12例失访，随访率95．1％（235／247），随访时间9．77±3．09年。晚期死亡患者26例，随访期间无由于心瓣膜结构损坏导致的患者死亡。5年，10年和15年的生存率分别为86．80％±2．30％，78．20％±3．33％和55．23％±4、34％；无血栓栓塞率5年，10年和15年分别为95．95％±0．74％，92．52％±4．11％和80．52％±4．11％；无出血率5年，10年和15年分别为94．64％±1．75％，89．55％±3．28％和79，39％±4．43％。心功能分级（NYHA）Ⅰ级141例（67．46％），Ⅱ级56例（26．79％），Ⅲ级10例（4．78％），Ⅳ级2例（0．95％）。结论通过15年的长期随访显示，行二尖瓣置换术选择国产C—L短柱侧倾碟瓣是安全可靠的。     

Satisfactory Outcomes of All-Poly Fixed Bearing Unicompartmental Knee Arthroplasty for Avascular Osteonecrosis Versus Osteoarthritis: A Comparative Study With 10 to 22 Years of Follow-up

BackgroundWhile good mid-term results for treating spontaneous knee osteonecrosis (SPONK) with unicompartmental knee arthroplasty (UKA) have been reported, concerns remain about implant survival at long-term. This study aimed to compare outcomes and survivorship of UKA for SPONK vs osteoarthritis at a minimum of 10 years.MethodsThis case-control study included medial UKA for femoral SPONK operated between 1996 and 2010 with a minimum 10-year follow-up (n = 47). Each case was matched with a medial UKA for osteoarthritis based on body mass index (BMI), gender, and age. Knee Society Score (KSS), complications and radiological (loosening) data were collected at the last follow-up. Kaplan-Meier survivorship analysis was performed using revision implant removal as endpoint.ResultsThe mean follow-up was 13.2 years (range 10 to 21 years). Mean age and BMI were 72.9 ± 8.4 years and 25.5 ± 3.6 Kg/m² in SPONK group. At last follow-up, knee and function KSS were 89.5 ± 12 and 79 ± 18 in SPONK group vs 90 ± 15 (P = .85) and 81.7 ± 17 (P = .47) in control group. Complications and radiological results showed no significant differences. The survival rate free from any revision was 85.1% at last follow-up in SPONK group and 93.6% in control group (P = .23). The leading cause for revision was aseptic tibial loosening (57.1%) in SPONK group. The 15-year survival estimate was 83% in SPONK group.ConclusionSatisfactory clinical outcomes at long-term after UKA for femoral SPONK were observed, similar to those after UKA for osteoarthritis, despite a higher risk of tibial loosening in the SPONK group. No symptomatic femoral loosening leading to a revision was observed.Level of EvidenceIV.     

Excision After Chemoradiotherapy of Invasive Thymoma Extending into the Right Atrium: Report of a Case

We report a case of invasive thymoma with intracardiac extension, resulting from the progression of intracaval growth, in a 56-year-old woman. Initially, the patient received two courses of chemotherapy, but the tumor showed only a modest response; however, subsequent radiotherapy reduced the tumor size further and the intracardiac lesion disappeared, making it possible to excise the tumor without cardiopulmonary bypass. Thus, when a thymoma does not respond well, we recommend radiotherapy as another treatment option, because its effects may allow for less invasive and more complete tumor excision.