马凡综合征合并胸腹主动脉瘤的手术治疗及早中期结果

目的 探讨手术治疗马凡综合征(MFS)合并胸腹主动脉瘤的早中期结果。方法 回顾性分析2009年1月至2017年12月在阜外医院接受胸腹主动脉替换术的156例患者的临床资料,分为MFS组(n=58)和非MFS组(n=98),比较两组患者的一般情况、术后早期结果和中期随访结果。结果 MFS组患者较非MFS组更年轻(32比45岁,t=9.603,P=0.000),有家族史者更多(19%比0,χ ²=19.996,P=0.000),男性和吸烟者比例更低(55.2% 比 80.6%,χ ²=11.489,P=0.001;13.8% 比 46.9%,χ ²=17.686,P=0.001)。两组在急诊手术比例、预防性脑脊液引流、手术时间、术中循环管理方式、术中用血量方面差异均无统计学意义(P均>0.05)。MFS组的术后30 d死亡率明显低于非MFS组(0比9.2%, {\chi }_{\log ?\mathrm{rank}}^2 =5.616,P=0.018)。两组在脊髓损伤、肾功能衰竭、呼吸并发症方面差异均无统计学意义(P均>0.05)。MFS组平均随访时间43个月(3~114 个月),5年生存率(89.2±4.6)%,非MFS组平均随访时间50个月(0~111个月),5年生存率(83.8±4.1)%,两组5年生存率差异无统计学意义( {{\chi }_{\log ?\mathrm{rank}}^2}_{} =2.719,P=0.099)。MFS组5年免于再干预率为(72.7±8.4)%,非MFS组为(95.2±2.3)%,MFS组再干预率明显高于非MFS组( {\chi }_{\log ?\mathrm{rank}}^2 =5.034,P=0.025)。 结论 MFS患者术后早期死亡率低于非MFS患者,中期生存情况与非MFS患者相似,但再干预率明显高于非MFS患者,术后密切随访非常重要。     

Surgical management of Libman-Sacks mitral valve endocarditis

Introduction and importanceLibman-Sacks endocarditis is a non-bacterial form of thrombotic endocarditis that is associated with Systemic Lupus erythematous (SLE) syndrome.Case presentationA 32 years old male with SLE and Antiphospholipid syndrome, presented with shortness of breath, intermittent chest pain and pyrexia. He had an embolic cerebral infarct a year previously with recurrent seizures. Echocardiogram showed severe Mitral regurgitation with a fixed posterior leaflet and Mobile structures on the leaflet tips. He underwent mechanical Mitral valve replacement. Vegetation was found on valve leaflets. Blood and valve tissue Cultures were sterile. Valve histology showed scarring and active inflammatory changes but no bacterial or fungal colonies.Clinical discussionIn such case a durable valve repair cannot be gauranteed and bioprosthetic valve replacement is prone to early structural degeneration requiring re intervention especially in young patients. Mechanical valve has capacity to withstand the destructive inflammatory milieu of SLE and chronic renal failure.ConclusionA mechanical valve replacement is a reasonable choice in a young patient with SLE in the setting of antiphospholipid syndrome to reduce valvular re-intervention rate.     

Operative Re-intervention Following Pancreatic Head Resection: Indications and Outcome

Background  This study analyzed indication and outcome regarding operative re-intervention following pancreatoduodenectomy (PD) and pancreatogastrostomy (PG) with special emphasis on complications related to redo surgery. Patients and Methods  Two hundred eighty-five patients who underwent PD with PG between 1989 and 2008 were identified from a pancreatic resection database and indications for repeat surgery were registered. Patients with and without reoperation were analyzed with regard to gender, age, underlying disease, length of hospital stay, mortality rate, and postoperative complications. Results  Thirty-one patients (11%) underwent operative reintervention. Early intra-abdominal extraluminal postoperative bleeding was the main cause for redo surgery followed by abdominal abscesses. Thirteen percent of patients with and 1.9% without secondary surgery died during the postoperative course. Forty-five percent of reoperated patients had to undergo at least one more operation resulting in doubling of the length of hospital stay. There was no correlation between patients’ gender, age, and underlying disease and the need for operative reintervention. However, redo surgery was associated with higher incidence of delayed gastric emptying, pancreatic fistula and bleeding, and non-surgery related complication. Intra-abdominal bleeding and abscesses, insufficiencies of bilio-digestive and gut anastomosis, wound infections, and pancreatitis were observed significantly more often in patients with secondary surgery. Conclusions  Complications after pancreatic resection that require operative re-intervention are associated with a notably increased mortality, ranging between 13% and 60%. Apart from the surgeon’s experience in selecting patients and his/her personal technical skills in performing a pancreaticoduodenectomy, timely anticipation and determined management of postoperative complications is essential for improving the outcome of this operation.     

主动脉弓中断的外科治疗进展

主动脉弓中断足一种少见的先天性心脏病,在前列腺素E1未能普遍应用于临床之前,其病死率很高.早期的手术治疗主要采用分期纠治,包括一期重建主动脉弓,二期纠治其他心内畸形,其病死率高且社会经济负担较重.从20世纪90年代起,随着外科技术及围术期监护、体外及麻醉技术的不断提高,主动脉弓中断合并其他相关心内畸形多采用一期纠治.主动脉弓中断的手术死亡率已明显降低,但针对其存在较高的远期再狭窄及左室流出道梗阻,外科治疗仍存在较大的挑战,文章就此对其外科治疗及相关进展以及有关远期并发症的发牛进行综述.     

Type and time of first re-intervention of posterior restorations – 13-year scenario at the public dental service

Abstract

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.

Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25–30?years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n?=?2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.

Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7?years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.

Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.