Ebstein心脏畸形外科矫治39例

目的　总结Ebstein心脏畸形外科治疗经验。方法　回顾近 18年收治Ebstein畸形 39例 ,其中重型 8例 ,中间型 2 7例 ,轻型 4例。采用改良Danielson法矫正畸形 30例 ,其中 19例同时行瓣环成形 ,3例行瓣叶修补 ,6例行瓣交界成形 ;单纯三尖瓣成形 3例 ;Minale法修复 1例 ;双向上腔静脉—肺动脉连接和三尖瓣成形 1例 ;4例行三尖瓣置换。结果　 2例 (成形和换瓣各 1例 )术后早期死于右心衰竭(5 1% )。成形术后三尖瓣功能正常 2 7例 (77 1% ) ,轻至中度关闭不全 5例 (14 3 % ) ,中至重度关闭不全 3例 (8 6 % )。生存者随访 0 5～ 18年 ,平均 8 6年。 33例心功能I级 ,3例心功能II级 (成形 2例、瓣膜替换 1例 ) ,1例行人工瓣置换者术后顽固性右心衰竭 ,于 1年后失访。结论　Ebstein畸形应尽早外科治疗。修复成形多能矫正畸形 ,重症者可同时行双向腔—肺动脉连接术     

以手术切除为主的综合疗法治疗原发性肝癌:附108例报告

目的 探讨和总结以手术切除为主的综合疗法治疗原发性肝癌的方法和疗效。方法 回顾分析1999年1月～2002年9月实施的以手术切除为主的综合疗法治疗108例原发性肝癌的临床资料。综合疗法包括手术切除肝癌，配合射频、经肝动脉化疗栓塞、经皮酒精注射、皮下药物输注系统化疗栓塞、冷冻、生物治疗等方法。结果 手术死亡率0．9％，术后并发症发生率18．7％，1年内肝内复发转移率56．1％，远处转移者为17．9％，1，2，3年生存率分别为79．46％，61．83％，36．61％。结论 以手术切除为主的综合疗法治疗原发性肝癌疗效满意，其治疗后肝内复发及远处转移率低，能提高原发性肝癌的无瘤生存率和长期存活率。     

Surgical treatment of lung metastasis: experience with 108 cases

In this study the Author's analyze their experience (between September 1973 and December 2002) with 108 pulmonary resections for metastatic tumors to the lungs to evaluate prognostic factors and the impact on survival of extended metastasectomy. Overall mortality and major morbidity were 1.85% and 2.78%. The actuarial survivals at 5 and 10 years were respectively 46.6% and 39.9%. The best mean survivals are observed in patients with metastases from breast, colorectal, thyroid and urinary tract carcinomas, in cases with disease free interval > 12 months and in the patients who underwent sequentially surgery and chemotherapy. Patients with pulmonary metastases also potentially benefit from iterative pulmonary resection.     

Ebstein's malformation

2 patients suffering from Ebstein's malformation underwent a total correction 3 years or 9 months respectively ago. In the first case we used a Bj?rk-Shiley valve, plication according to Hardy was omitted. In the second case an Angell-Shiley-bioprosthesis combined with Hardy's plication was performed. Both children are in a good condition now.     

Surgical treatment of Taussig-Bing malformation in an adult--a case report

With the development of pediatric cardiac surgery, the surgical treatment of Taussig-Bing malformation has been common in frequency and a majority of these cases are reported. However, because the patient's condition is so critical in the early stage of life, the importance of adequate initial operation is emphasized, and this area is restricted to the operative cases of child patient. In this clinical study, the operation for 41-year-old adult patient with Taussing-Bing malformation was successfully performed using the Kawashima's procedure, and we would like to report the detailed operative procedure as well as its clinical courses. This patient was female of 41 years of age and at surgery, this case was found to be the Taussig-Bing malformation associated with pulmonic stenosis, and the operation for intracardiac repair was carried out using intracardiac conduit (5 x 4 cm) and also extracardiac conduit (5 x 3 cm). It is reported that there are many operative procedure available in child patients but we believe that Kawashima's procedure is probably the best choice of operation for adult patients because of its simplicity.     

23例髋臼骨折手术治疗体会

髋臼骨折属于关节内骨折,其位置深在,周围有较多的软组织包绕,手术较为困难。2000年2月-2007年2月,笔者手术治疗髋臼骨折23例,疗效较好。     

手术治疗42例踝关节骨折

2004年8月～2008年10月,我院手术治疗踝关节骨折42例,疗效满意。1材料与方法1.1病例资料本组42例,男33例,女9例,年龄18～63岁。按Lauge-Han-sen分型方法：旋后内收型3例,旋后外旋型30例,旋前外展型1例,旋前外旋     

手术治疗64例股骨转子周围骨折疗效分析

2003年1月～2008年6月,我科分别采用DHS、股骨近端解剖钢板及股骨近端重建钉对64例股骨转子周围骨折患者实施内固定手术治疗,结合术后功能锻炼,取得较好的治疗效果.     

手术治疗三踝骨折17例体会

2007年1月～2010年12月,我们采用切开复位内固定治疗17例三踝骨折患者,疗效满意. 1材料与方法 1.1病例资料本组17例,男10例,女7例,年龄22 ～ 67岁.左侧11例,右侧6例,均为闭合骨折.根据LangeHansen分型:Ⅲ度旋前外展型1例;Ⅳ度旋后外旋型10例,Ⅳ度旋前外旋型6例.后踝骨折均超过关节面的1/4,均合并内、外踝骨折;其中合并胫腓下联合分离2例.患者术前均摄X线平片和螺旋CT扫描三维重建.     

Surgical treatment of Ebstein's anomaly: valve replacement and reconstruction

Because of the relative infrequency of Ebstein's anomaly the type of effective surgical treatment remains controversial. Various authors have reported different results depending upon the type of surgical treatment involved. In TYIH between 1974-1987, 30 cases with Ebstein's anomaly have been operated upon; 12 cases underwent surgical repair and in the remaining 18 cases a tricuspid valve replacement was performed. Four out of the 12 reconstruction cases remained on cardiopulmonary by-pass (CPB) because of the failure of the right ventricle and artificial valves were implanted in these cases. One of these patients died. In all, 3 patients died as a result of annuloplasty and the postoperative courses of these patients were eventful. Among the remaining 18 patients with artificial valve replacement only one patient died and the remainder of the tricuspid valve replacement group had an uneventful postoperative period.     

17例巴洛综合征的外科治疗

目的 总结17例巴洛综合征的手术治疗,并对其诊断、病因、手术方法进行初步探讨.方法 2005年8月至2007年12月,17例经临床、心脏超声及术后病理确诊有巴洛综合征病人,行二尖瓣成形术或置换术,随访其术后心功能与预后情况,总结巴洛综合征二尖瓣成形术的特点.并对10例上海地区病人进行基因学测序研究,探讨该巴洛综合征病人是否存在FLNA基因的位点发生改变.结果 术后病人心功能均提高至Ⅰ级.12例二尖瓣成形者术后食管超声显示,6例轻微反流,1例轻度反流,5例未测及反流.5例二尖瓣置换术者术后心脏超声均未见反流.所有接受手术治疗者,左心房内径、左心室舒张末内径及左室收缩末内径均较术前明显缩小(P<0.05).基因学测序结果显示,10例病人中有2例在FLNA的EXON1的5'UTR区域G10A位点发生改变.结论 二尖瓣手术(成形术或置换术)是治疗巴洛综合征的有效手段.巴洛综合征的二尖瓣成形术修复较难,有其特殊性,要警惕SAM现象,不能勉强修复;二尖瓣置换术也是一种很好的选择.部分巴洛综合征病人在FLNA的EXON 1的5'URT区域G10A有基因位点改变.     

Surgical treatment of osteoblastoma : a report of 20 cases

Osteoblastoma is a locally aggressive osteoblastic lesion of bone with rare malignant transformation. We retrospectively evaluated 20 patients who were diagnosed and surgically treated for osteoblastoma in our institution. Their mean age was 22.5 years (range: 10 to 34). The most frequent location was in the posterior elements of the spine, followed by the long bones of the extremities and the talus. Intralesional curettage was the most common modality of treatment; it was used in 11 patients, with a 13% recurrence rate. This series demonstrates that osteoblastoma may be locally aggressive and may recur after removal. Although it is usually treated successfully with curettage, wide excision should be considered along with careful follow-up over the long term owing to the possibility of recurrence or malignant transformation.     

克罗恩病46例的外科治疗

目的探讨克罗恩病的特点及其有效的外科治疗方法。方法回顾性分析了近20年来收治的46例克罗恩病患者的临床资料。结果本组患者术前确诊16例,误诊率65.2%。病变呈节段性分布24例,弥漫性分布4例,单一分布18例,2例合并有癌变。手术治疗共62例次,手术原因以肠梗阻最多(44/62,71.0%)。手术方法以肠部分切除吻合术最多(38例次,61.3%),1990年前肠组织切除范围掌握在距离病变两端各10cm处;1990年后在保证吻合口通畅和足够血运的前提下,尽可能减少肠组织切除范围。随访发现,1990年前手术后的复发率为20.1%(3/13);1990年以后为25.0%(4/16);差异无显著性意义(P>0.05)。结论克罗恩病手术原因以肠梗阻最多见,切除肠管范围、切缘有无病变残留并不影响复发率。外科手术仅适用于治疗克罗恩病的并发症,不能改变其基本病变进程。     

17例巴洛综合征的外科治疗

目的 总结17例巴洛综合征的手术治疗,并对其诊断、病因、手术方法进行初步探讨.方法 2005年8月至2007年12月,17例经临床、心脏超声及术后病理确诊有巴洛综合征病人,行二尖瓣成形术或置换术,随访其术后心功能与预后情况,总结巴洛综合征二尖瓣成形术的特点.并对10例上海地区病人进行基因学测序研究,探讨该巴洛综合征病人是否存在FLNA基因的位点发生改变.结果 术后病人心功能均提高至Ⅰ级.12例二尖瓣成形者术后食管超声显示,6例轻微反流,1例轻度反流,5例未测及反流.5例二尖瓣置换术者术后心脏超声均未见反流.所有接受手术治疗者,左心房内径、左心室舒张末内径及左室收缩末内径均较术前明显缩小(P<0.05).基因学测序结果显示,10例病人中有2例在FLNA的EXON1的5'UTR区域G10A位点发生改变.结论 二尖瓣手术(成形术或置换术)是治疗巴洛综合征的有效手段.巴洛综合征的二尖瓣成形术修复较难,有其特殊性,要警惕SAM现象,不能勉强修复;二尖瓣置换术也是一种很好的选择.部分巴洛综合征病人在FLNA的EXON 1的5'URT区域G10A有基因位点改变.     

Surgical treatment of cor triatriatum: report of four cases

Four cases of cor triatriatum are reported. Cases 1 and 2 had IIA, case 3 had IA, and case 4 had IIIB 1 type of cor triatriatum according to Lucas-Schmidt classification. Cases 1 and 2 were diagnosed by echocardiography preoperatively. They were not performed cineangiocardiography because of pulmonary congestion. Case 3 had type IA so called classical type, which is hemodynamically identical to mitral stenosis and supravalvular stenosing ring. The clinical features are depend on the size of the communication between accessory chamber and true left atrium. As case 4, he had been diagnosed of simple atrial septal defect preoperatively, careful echocardiographic examination was essential for accurate diagnosis. In case 2 with hypoplastic left heart, secondary surgical repair is considered to be desirable followed by balloon dilatation of two atrial septal defects communicated to accessory chamber and to true left atrium. Thus, we expect development of hypoplastic left ventricle.