Valvotomy in calcific mitral stenosis

The results of transventricular mitral valvotomy in 50 cases of heavily calcified mitral stenosis are presented.The mortality and quality of results in patients undergoing a first valvotomy were more satisfactory than in patients undergoing a second operation. Associated mitral incompetence has an adverse effect on the results, particularly after a second operation.As a result, it is suggested that closed valvotomy, in these circumstances, is only acceptable for patients who are undergoing a first operation and who have minimal or no regurgitation. Valve replacement is advised for all other cases.     

Partial gastrectomy for haemorrhage

An analysis was made of the results of 566 partial gastrectomies for haemorrhage from gastroduodenal ulceration between 1953 and 1962 with regard to mortality, morbidity, and long-term follow up.With rigid criteria for selection of patients for surgery, the overall mortality rate for ulcerative gastroduodenal haemorrhage was 8.6%. The actual operative mortality rate more than doubles if an emergency operation is performed later than four days after the patient's admission with haemorrhage.Postoperative and later bleeding complications occurred in 5% of patients.Regardless of the length of ulcerative history, over 92% of patients have clinically satisfactory long-term results. Six per cent required further operation, after which, they too had clinically satisfactory results.     

齿线上环直肠一周的绒毛状腺瘤的外科诊治附五例分析

目的探讨齿线上环直肠一周的绒毛状腺瘤的手术策略。 方法回顾分析上海市长海医院治疗的5例齿线上环直肠一周的绒毛状腺瘤的病例,其中,3例患者采用经肛局部切除,2例患者采用直肠拖出式经腹前切除＋末端回肠造口术方式治疗。 结果5例患者术后均恢复顺利,术后肛门功能良好,无围手术期死亡。 结论对齿线上环直肠一周的直肠绒毛状腺瘤患者,是肛肠外科医生面临的棘手问题,应根据患者不同情况,采用经肛局部切除或采用直肠拖出式经腹前切除＋末端回肠造口术,可达到理想的治疗效果。     

The surgical treatment of discrete subaortic stenosis (author's transl)

The AA. examine their experience concerning 23 patients operated on for a discrete subaortic stenosis since 1969. Immediate results are satisfactory, even if there have been postoperative complications in 26% of the patients. Late results are less satisfactory, above all because of the progression of aortic insufficiency far from the operation. Date of literature are nor allowing valuable indications about the natural history of the patient after surgical treatment, because of the scarcity of postoperative hemodynamic controls and, especially, of serial examinations. The AA. believe, on the ground of considered data and personal experience, that it is prudent, awaiting for further critical evaluation of late results, to limit surgical indications, in asymptomatic patients, to cases with left ventricular-aortic gradient superior to 70 mmHg.     

应用自体肺动脉瓣置换病变主动脉瓣（附4例报告）

应用自体肺动脉瓣置换病变主动脉瓣、同种肺动脉瓣原拉重建右室流出道（Ross手术）治疗4例主动脉瓣病变患者,成功3例。1例主动脉瓣二瓣化畸形术后存在轻度主动脉瓣返流。超声心动图均提示主动脉根部及同种瓣良好。1例术中误伤自体肺动脉瓣,改机械瓣置换。认为用自体肺动脉瓣置换病变主动脉瓣效果满意,术中预防自体肺动脉瓣损伤和主动脉瓣返流是手术成功的关键,同种肺动脉瓣原位重建右室流出道可为常规选择的管道。     

先天性巨结肠类缘病的治疗探讨

目的探讨先天性巨结肠类缘病(HAD)的治疗方法。方法分析7例HAD患儿的治疗方案。术前或术中明确诊断的4例HAD患儿中,1例行根治性手术,1例行延期根治性手术,1例根治性手术后继续保守治疗,1例行肠造瘘术后等待根治术时机;3例按先天性巨结肠(HD)行根治术,术后复习病理切片才明确诊断,及时随诊,2例分别在首次术后3个月和8个月再行根治术,1例继续扩肛治疗。结果7例HAD患儿排便情况满意。结论根治手术对HAD治疗至关重要,保守治疗是HAD治疗的必要补充。     

单孔法胸腔镜下双侧胸交感神经链切断术治疗手汗症疗效观察

目的观察单孔法胸交感神经链切断术治疗原发性手汗症的手术可行性和疗效。方法在全麻单腔气管插管下,通过单孔（直径5 mm）途径于针状胸腔镜下行双侧胸交感神经链切断术治疗原发性手汗症105例。结果手术均顺利。术后全部患者手部多汗症状全部消失,平均手术时间（双侧）24 min,手温平均升高2.6℃。术后24 h胸壁切口处疼痛评分（3.0±0.6）分。术后住院时间平均1.5 d。术后3个月切口疤痕几乎消失。结论单孔法胸腔镜下双侧胸交感神经链切断术治疗原发性手汗症方法可行,疗效满意。     

Heart transplantation and the Batista operation for children with refractory heart failure

Medically refractory heart failure may be present in children with cardiomyopathy (CMP) or complex congenital heart disease (CHD). In adults, the surgical management of this condition is either heart transplantation or the Batista operation. From March 1995 to January 2000, a total of 6 children, aged from 1 to 16 years, with medically refractory heart failure associated with CMP or complex CHD underwent cardiac transplantation and one of them also had the Batista operation as a bridge to transplantation. One of the 6 patients died of intractable sepsis 17 days after the operation, but the other 5 were discharged with satisfactory hemodynamics. Immunosuppressive agents, including azathioprine, cyclosporin or FK-506, were given. One patient experienced moderate acute rejection, but it was controlled by FK-506, OKT-3 and solumedrol. However, another suffered from lymphoproliferative disease 8 months after transplant, but it was controlled by intravenous immunoglubulin, alpha-interferon and acyclovir. Cardiac function during serial follow-up (range, 1 month to 5 years) revealed normal systolic and diastolic function and none received any anticongestive medications. Almost all patients received an oversized donor heart. The left ventricle (LV) mass was remodeled, initially as an decrease and later as an increase. The patient who underwent the Batista operation was discharged 1 month after the operation with an increased LV ejection fraction (from 10% to 22%). She was successfully bridged to heart transplantation 7 months after the Batista operation. The results of cardiac transplantation in growing children are satisfactory and remain the mainstay of surgical treatment for medically refractory heart failure in these patients. However, with a shortage of donor hearts, the Batista operation may be adopted as a bridge to heart transplant with a fair response.     

Surgical management of coarctation of aorta

Between 1961 and 1988, 68 patients underwent operation for coarctation of the aorta. The average age of presentation of these subjects was higher than in other series. 7.1 percent were asymptomatic, a finding which is not seen in reports from the west. Operative procedures included resection and end to end anastomosis, resection and graft interposition, bypass grafting, patch aortoplasty and subclavian flap aortoplasty. However, the technique of patch aortoplasty, routinely performed in the last 24 years of this series seemed by far the most satisfactory procedure. Subclavian flap aortoplasty was carried out in a selected group of younger children. Associated cardiac anomalies influenced the results adversely. The overall operative mortality was 5.8 percent. Hypertension did not regress in 11.7 per cent of patients inspite of a successful operation as judged by the return of peripheral pulses in the lower limbs. Re-coarctation was not seen in this series. The overall results of operation for coarctation of the aorta have been very satisfactory and comparable with those in other published series.     

罕见心腔外心脏肿瘤的外科治疗

本文报道了手术切除罕见心腔外心脏肿瘤4例。1例为巨大心外膜脂肪瘤,体积33×20×6～9cm,将心脏游离面完全包绕,引起严重发作性心律紊乱,误诊10余年。经两次手术切除治愈,切除肿瘤重共达1450g。心包异位胸腺瘤和心包血管内皮肉瘤各1例,术前皆因大量心包积液而产生心包填塞征,术后症状、体征消失。1例心包异位胸腺囊肿,术前咳嗽、胸闷,心前区隐痛,经X线发现此囊肿。本文就4例的诊断、治疗、误诊原因进行分析讨论。     

An operation for anomalous origin of left coronary artery.

Successful surgical correction for anomalous origin of the left coronary artery from the pulmonary artery in a 4-year-old child is reported. An aortopulmonary fistula was created and a pericardial baffle was inserted within the pulmonary artery to connect the fistula to the ostium of the left coronary artery. The clinical, haemodynamic, and angiographic features of the anomaly are presented. The child's progress is satisfactory 17 months after the operation.     

高频电波刀电环切除术结合爱宝疗治疗宫颈上皮内瘤样病变的护理

目的研究高频电波刀电环切除术（LEEP）结合爱宝疗治疗宫颈上皮内瘤样病变的方法、效果及临床观察和护理。方法采用LEEP联合爱宝疗对129例宫颈病变患者进行治疗,包括：宫颈上皮内瘤样病变（CIN）I29例;Ⅱ79例和Ⅲ17例;观察手术时间,出血量及术后修复情况,对其疗效进行回顾性分析。结果LEEP术无需麻醉,手术时间短,标本无碳化结果准确,出血量少,并发症少,一次性治愈率高。结论LEEP结合爱宝疗治疗宫颈病变安全有效,注意术后护理及随防,可取得满意疗效。     

An operation for anomalous origin of left coronary artery.

Successful surgical correction for anomalous origin of the left coronary artery from the pulmonary artery in a 4-year-old child is reported. An aortopulmonary fistula was created and a pericardial baffle was inserted within the pulmonary artery to connect the fistula to the ostium of the left coronary artery. The clinical, haemodynamic, and angiographic features of the anomaly are presented. The child's progress is satisfactory 17 months after the operation.     

Modified Nikaidoh procedure for transposition of great arteries, ventricular septal defect and left ventricular outflow tract obstruction

The surgical management of transposition of the great arteries with ventricular septal defect and left ventricle outflow tract obstruction is a real challenge in congenital heart surgery. The Rastelli operation has been used for many years with satisfactory early and late results. A newer operation described by Nikaidoh seems to take anatomy more into account and has been performed with promising outcomes. In this report, we present a patient with transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction who was successfully treated with a modification of the Nikaidoh procedure.     

Direct reconstructive venous surgery

Unilateral occlusions of the pelvic veins may be corrected by a Palma operation. In the classic Palma operation the contralateral long saphenous vein is suprapubicly led to the opposite side and is anastomosed end-to-end or end-to-side with the common femoral vein of the occluded side. Just lately, spirally wall reinforced PTFE grafts showed more favourable results than Palma grafts. Circumscribed occlusions of the superficial femoral vein can be interposed by the May-Husni operation. Thereby the ipsilateral long saphenous vein is implanted end-to-side into the popliteal vein. We perform the Palma operation as well as the May-Husni operation under the protection of a temporary av-fistula. The ascending venography only permits to make a statement on the morphological operability, whereas the functional operability is indicated by means of phlebodynamometry. Phlebodynamometry and plethysmography are the best means to judge the functional result of the operation which is of importance for the patient. The results of the Palma operation can be regarded as very satisfactory, provided that the morphological and functional indication for the operation was correct. The use of the endothelium protective operative technique by Robert Mays as well as the application of a temporary av-fistula yield a success that is above 80 p.c. As against that, the May-Husni operation achieves less than 50 p.c. success, even if a temporary av-fistula is established in the area of the ancle. Less favourable are the results obtained by direct restorative interventions on the subclavian vein, so that these operations should only be indicated in exceptional cases.     

Colectomy with ileoproctostomy for ulcerative colitis: Report of five cases

Summary and Conclusions Twenty-five patients with ulcerative colitis were treated by abdominal colectomy with ileorectal anastomosis. Five additional case reports available since and initial publication in 1964 are presented. Proctocolectomy with permanent ileostomy remains the operation of choice for most patients requiring resectional surgery for ulcerative colitis. For selected patients abdominal colectomy with ileorectal anastomosis is a satisfactory alternative. Such patients should possess an otherwise healthy anorectum with only mild to moderate proctitis. Anal ulcer (chronic fissure-in-ano), fistula-in-ano, and symptomatic hemorrhoidal disease are considered contraindications to this operative procedure.     

经皮左心耳封堵联合冠脉介入“一站式”治疗对房颤合并冠心病患者的安全性及疗效初探

目的 探讨对非瓣膜性房颤合并冠心病的患者，同期进行经皮左心耳封堵术联合冠脉介入一站式治疗的可行性、安全性及疗效。方法 回顾性分析珠海市人民医院2017年4月-2018年6月收治的5例房颤合并冠心病的患者的临床资料。所有患者术后采用阿司匹林100mg Qd+氯吡格雷75mg Qd双抗1年，阿司匹林/波立维单抗长期使用的方案。术后即刻评价左心耳封堵及冠脉介入疗效，并于术后45天，90天随访观察左心耳封堵器的位置、血栓形成以及残余分流情况及患者临床表现。结果 5例患者均成功植入WATCHMAN左心耳封堵器及冠脉支架。术后即刻封堵效果满意，WATCHMAN封堵器符合PASS原则，冠脉介入治疗效果满意。术中无器械表面血栓，无心包填塞及血管并发症。随访结果显示，5例患者无出现脑卒中、心功能恶化者、封堵器移位、封堵器残余分流加重及器械表面血栓、心绞痛或心梗事件，且亦未发现皮肤瘀斑、消化道出血、脑出血等出血事件。结论 对非瓣膜性房颤合并冠心病患者，同期实施左心耳封堵术联合冠脉介入一站式治疗的安全性可，有一定的可行性，近、中期的随访效果良好。     

老年女性乳腺癌166例临床分析

目的 探讨老年女性乳腺癌的手术效果.方法对1989年8月至2004年8月收治的166例老年女性乳腺癌患者的临床资料进行回顾性分析.结果166例中,改良根治术98例（59.0%）,根治术21例（12.7%）,全乳房切除术29例（17.5%）,肿瘤局部切除术18例（10.8%）.术后化疗126例,放疗12例,内分泌治疗73例.术后并发症发生率为10.8%,无手术死亡.术后3年和5年生存率分别为82.2%和65.2%.结论老年人乳腺癌采用手术及综合治疗可以取得满意的临床疗效,不同病情的患者应用不同的术式,老年并非是手术禁忌证;同时要内外科配合,重视并处理好并存症和术后并发症.     

Laparoscopy-assisted total gastrectomy for a case of MALT lymphoma: a case report

A case of laparoscopy-assisted total gastrectomy with regional lymph node dissection for MALT (mucosa-associated lymphoid tissue) lymphoma is reported. The patient was a 45-year-old male with MALT lymphoma. Eradication of Helicobacter pylori as the initial therapy had failed to halt progression of the tumor. Considering certainty of the second therapy, he was transferred to surgical treatment. Total gastrectomy was required and this was performed by the laparoscopy-assisted approach. The postoperative course was satisfactory and the patient has been disease-free for 5 years after the operation. Laparoscopic operation could be a useful option in the second-line treatment for MALT lymphoma after failure to eradicate H. pylori.     

彩色多普勒超声在颈动脉内膜剥脱手术治疗前后的应用价值

目的:研究彩色多普勒超声在颈动脉内膜剥脱手术治疗前后的应用价值。方法:回顾性分析115例因颈动脉狭窄而行颈动脉内膜剥脱术患者的资料和彩色多普勒超声结果。结果:颈动脉内膜剥脱术后,狭窄处颈动脉的内径、血流速度较术前明显改善(P0.001);术后随访疗效满意。结论:颈动脉内膜剥脱术是颈动脉狭窄有效的治疗方法。彩色多普勒超声能够为手术提供可靠的客观依据,并可作为评价手术效果、随访的有效方式。