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Objective To analyze the clinical effect through 20 adult atrial septal defect repair cases with totally thoracoscopic and summarize the experience of totally thoracoscopic cardiac surgeries.Methods From March 2014 to August 2016, 20 adult atrial septal defect cases repaired by totally thoracoscopic were enrolled in the study. Extracorporeal circulation was established by inserting artery pump tubes into the right femoral artery and vein tubes in to the right femoral vein, cold blood cardioplegia was perfused ante gradely through the aortic root in order to protect the myocardium, then atrial septal defect repair cardiac surgeries were implemented by perforating 3 holes through the right chest wall. Analyze the operation time, aortic cross clamping time, CPB time, amount of drainage, hospital stay, postoperative complications and so on.Results The operation time was 3.5~5.0 h, and the average level was (3.8 ± 0.5) h. The blocking duration of the ascending aorta ranged from 28 to 46 min, and the average level was (29.8 ± 8.2) min. The duration of extracorporeal circulation ranged from 86 to 108 min, and the average level was (80.6 ± 11.5) min. Ventilation time ranged from 5 to 8h, and the average level was (6.0 ± 0.8) h. The amount of thoracic drainage ranged from 100 to 260 ml, and the average level was (150.0 ± 35.0) ml. Hospital stay ranged from 6 to 9 days, and the average level was (6.5 ± 1.2) days. All the operations were completed successfully. There were no in-hospital death or serious post-operative complications. UCG performed 3~5 days after the operation revealed surgical results were satisfactory. Follow up to 1~28 months were available in all cases. During the period, the heart function was conifrmed asⅠ level.Conclusion Adult atrial septal defect repair surgeries with totally thoracoscope is safe and reliable and have advantages of less injury, rapid discovery, light pain, and less postoperative drainage.
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Objective To evaluate the security and effectiveness of emerging sternal rigid plate by comparing with wires closure. Methods 60 patients who undergoing median sternotomy from two centers were enrolled in this study, 30 received wire cerclage( control group) and the other 30 received rigid plate fixation( experimental group) . Patients' sternal were closed with wires or rigid plates, and the painness, sternal union and status of wires or rigid plates were followed up and assessed one week, three months and six months after procedures. Results All patients survived and were followed up. 117 rigid plates were implanted. There was no significant difference in pre-operative data, post-operative painness, sternal union and status of wires and plates between control and experimental group. No patient reached the standard of clinical sternal union one week post-operation, but all patients reached the standard of clinical sternal six months post-operation. One patient in control group suffered sternal nonunion, movement and wound infection after sternotomy. Conclusion Compared to wire closure, sternal closure with rigid plates is the same safe and effective.
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BACKGROUND: Appropriate anastomosis materials can improve success rate of trachea and bronchus reconstruction.Common domestic suture materials include silk suture, dacron and synthesized absorbable suture. However, the suture with best effects in preventing and lightening scar granulation hyperplasia and luminal stenosis remains Uncertain.OBJECTIVE: To compare the influence of three kinds of suture materials on histopathological changes of anastomotic stoma and transforming growth factor-β_1 (TGF-β_1) expression in rabbits following tracheotomy.DESIGN, TIME AND SETTING: A randomized, controlled animal experiment and histopathological observation were performed at the Animal Experimental Department, Nanhua University from September 2005 to October 2006.MATERIALS: Artificial absorbable suture was purchased from Brazil Johnson & Johnson Professional Products; silk suture and dacron were purchased from Hangzhou Fuyang Medical Suture Factory and Hangzhou Huawei Medical Products Co., Ltd.METHODS: A total of 36 New Zealand healthy adult rabbits, regardless of gender, weighing 1.6-2.0 kg, were randomly divided into silk, dacron and artificial absorbable suture groups with 12 animals in each group. The end-to-end anastomosis following tracheotomy was performed using silk, dacron and artificial absorbable suture, respectively.MAIN OUTCOME MEASURES: The pathological changes and TGF-β_1 level around the sutures 1, 2, 4 weeks post operation were observed.RESULTS: A total of 36 rats were included in final analysis. There were no difference in anastomotic healing between three groups 1 and 2 weeks postoperatively, with a great amount of inflammatory cell infiltration, mainly neutrophil, around the sutures.Moreover, bleeding in the focus and foreign body grannuloma were found. At 4 weeks postoperatively, foreign body grannuloma formed accompanied with obvious firboplasia in silk and dacron groups, and the sutures in the artificial absorbable suture group were absorbed. Compared with 1 and 2 weeks postoperatively, the expression of TGF-β_1 was slightly decreased in silk and dacron groups at 4 weeks (P > 0.05), but the absorbable suture group significantly decreased (P < 0.05).CONCLUSION: Of three kinds of suture materials, artificial absorbable suture exhibited good histocompatibility, effectively reducing inflammatory reaction and benefiting the prevention and lightening of formation of pathological scar after tracheal surgery.