Results of the Ross operation in a pediatric population

Objective: To analyse the results of the mid-term clinical and echocardiographic follow-up of the pediatric Ross operation. Methods: Echo-Doppler follow-up of 53 consecutive pediatric Ross procedures performed between 1994 and 2003. Median age was 9.7 years at time of operation (2 weeks–17.7 years). Six patients were younger than 3 months. Median age at follow-up was 15.6 years. Aortic valve/left ventricular outflow tract (LVOT) anomalies were congenital in 49 (92%). Seventy percent had previous surgery or balloon valvuloplasty. Root replacement was used in all. Thirteen patients (25%) had LVOT enlargement. Mean cross-clamp time was 113 (69–189) minutes. Results: Early mortality occurred in 3 patients after emergency surgery following balloon failure (n=1) and extended Ross following interrupted arch/VSD repair (n=2). Late mortality was due to LV fibroelastosis in 2 patients and complicated pulmonary artery stenting in another. RVOT reoperations were required because of late homograft obstruction in 2 patients and because of pulmonary artery stenosis in another. Five patients (9.4%) were reoperated for pulmonary autograft dilatation (n=3) and for leaflet fibrosis or perforation (n=2). Autografts were repaired in two patients, while a mechanical valve was inserted in 3 cases. At 9 years the actuarial survival and event free survival were 89 and 74%, respectively. At last follow-up 90% of autograft diameters indexed to body surface area was above the 90th percentile of normal aortic root diameters. LVOT and RVOT gradients were low and autograft insufficiency was trivial to mild in 84% and mild to moderate in 16%. Autograft stenosis was not noticed. Conclusions: The pediatric Ross procedure remains an important tool but autograft dilatation also occurs in the pediatric population. The significance of this finding has yet to be determined.     

头面颈部毛细血管畸形的手术治疗

目的 探讨手术治疗头面部不同类型毛细血管畸形的适应证,手术方法及疗效.方法 对适合手术的23例头面颈部患者,根据病灶的面积和手术前的条件分别采用了植皮,扩张器局部皮瓣转移修复和游离皮瓣修复等方法,并进行术后评价和随访.结果 除一例特别原因造成皮片下积血,皮片部分成活不良二期再植,一例同位素治疗后扩张器病例远端发生血运障碍后改植皮以外,其余皮片,皮瓣均成活良好,但随访皮片有较明显的色差,而皮瓣色泽,质地良好.结论 皮瓣修复效果较好,其中扩张的局部皮瓣转移修复效果最佳.游离皮瓣较适合有皮下组织萎缩的大面积的病例,而其他大面积病灶可采用分期分区植皮.     

逆行岛状皮瓣修复手部软组织缺损

目的报道手部软组织缺损逆行岛状皮瓣修复方式的选择及临床效果。方法根据手部软组织缺损的不同部位，应用六种不同的手与前臂逆行岛状皮瓣进行修复。结果本组57块皮瓣中，除4块皮瓣远端部分坏死外，其余皮瓣成活良好，外观满意，弹性、质地良好，两点辨别觉6～12mm。结论手与前臂逆行岛状皮瓣切取简便，创伤小。根据手部软组织缺损不同部位，选择不同的逆行岛状皮瓣进行修复，可获得满意的临床效果。     

Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap

We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraop-erative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.     

ABL50血气分析仪电、液路故障维修

本文介绍ABL50型血气分析仪使用过程中遇到的电、液路故障处理方法。     

定向皮肤扩张器在面颈部瘢痕治疗中的应用

目的:探讨定向扩张器在治疗面颈部瘢痕中的临床应用。方法:回顾性分析我科2000年至2004年用定向扩张器治疗48例面颈部瘢痕患者。手术分两期:先于瘢痕附近正常皮下置入定向扩张器,皮肤充分扩张后行扩张器取出、瘢痕切除、局部皮瓣转移。结果:48例患者共治疗56处瘢痕,置入扩张器60个,一次修复最大面积为12cm×16cm,除5例遗留部分瘢痕经第二次皮肤扩张修复外,所有患者均得到有效治疗;扩张期并发症18处(30%),以扩张器外露最多见。结论:定向皮肤扩张器在面颈部瘢痕治疗中有很大的应用价值。但应重视预防并发症。     

Concomitant mitral valve repair and left ventricular reconstruction in a patient with chronic ischemic mitral regurgitation and inferior left ventricular aneurysm

The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair, left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation, inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in the literature.     

胸锁乳突肌肌皮瓣在舌癌根治术后舌缺损修复中的应用

目的:总结中晚期舌癌根治性切除即时进行舌再造的经验。方法:对1988年1月至2004年12月间舌癌根治术后即刻修复采用的胸锁乳突肌皮瓣的临床资料进行分析。结果:14例皮瓣全部成活。再造舌外形大部分良好,语言和吞咽功能基本恢复。结论:以胸锁乳突肌肌皮瓣修复中晚期舌癌根治性切除后的舌缺损,可较好恢复舌的形态和功能,提高生存质量。     

Voice prosthesis insertion after endoscopic balloon-catheter dilatation in case of a stenotic hypopharyngo-oesophageal junction

Stenosis of the hypopharyngo-oesophageal junction can be a rare complication of laryngectomy and/or partial pharyngectomy and makes the insertion of voice prosthesis extremely difficult. This study describes the authors’ experiences gained by endoscopic balloon-catheter dilatation of hypopharyngo-oesophageal stenoses prior to implantation of voice prostheses in four cases. In two patients a single balloon-catheter dilatation resulted in wide enough pharyngo-oesophageal lumen on the long run. The average prosthesis wearing-times were 6.8 months in case 1 and 4.6 months in case 2, corresponding to the published literature data. In case 3, repeated dilatation of the pharyngo-oesophageal transition had proved to be unsuccessful despite taking every effort with the endoscopic balloon-catheter method. Having excised the stenotic segment, reconstruction with pectoralis major myocutaneous flap (PMMF) was indicated. Eighteen months later, a repeated restenosis was observed and a free jejunal flap needed to be performed as a final solution. In case 4, the insertion was carried out into a previously dilated jejunal free flap, which became gradually ischemic and stenotic since the major head-and neck procedure was carried out that resulted in prosthesis rejection after just 1 week. The authors emphasize that correct indication of pedicled and free flaps in head and neck reconstruction is a prerequisite from the aspect of prevention of pharyngo-oesophageal strictures. Endoscopic balloon-catheter dilatation is a safe and established method for dilatating hypopharyngo-oesophageal stenoses of different origin. The procedure provides maximum patient benefit with minimal trauma and morbidity; moreover, facilitates insertion of voice prostheses. However, a single balloon-catheter dilatation cannot always result in wide enough oesophageal lumen on the long run (case 3). Insertion of a voice prosthesis into a previously dilated ischemic jejunal segment is challenging and avoidable due to risks of complications.     

处女膜修补手术及麻醉方法的改进

目的；增大处女膜粘膜瓣的接触面，减少因麻醉造成的处女膜粘膜水肿，提高修复手术的成功率。方法：手术全部采用1％的卡因行粘膜表面麻醉。53例采用瓦合粘膜瓣法，3例用瓦合粘膜瓣联合阴道粘膜瓣修复法。结果：56例术后一月随访，53例处女膜孔径为一指，成功率94．64％。结论：采用1％的卡因粘膜表面麻醉，瓦合粘膜瓣法及瓦合粘膜联合阴道粘膜瓣修复法对处女膜修复是行之有效的。