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Objective: To evaluate short-term effect and risk factors for the timing of intra-aortic balloon pump (IABP) implantation with coronary artery bypass grafting (CABG) in high risk coronary artery disease (CAD) patients. Methods: A total of 197 high risk CAD patients received IABP with CABG in our hospital from 2010-01 to 2015-12 were retrospectively analyzed. There were 91 (46.2%) male and the mean arterial pressure (MAP) was (70.3±8.2) mmHg. Based on IABP implantation time, the patients were divided into 2groups: Pre-operative IABP group,n=89 and Intra- , post-operative IABP group,n=108. Peri-operative condition, durations of mechanical ventilation and ICU stay were compared between 2 groups; survival condition was studied by Kaplan-Meier analysis; risk factors causing 30-day mortality was assessed by Logistic regression analysis and its sensitivity and specialty was measured by ROC curve. Results: The mean durations for aortic clamping and cardiopulmonary bypass were (86.7±37.3) min and (147.3±18.4) min in all 197 patients. The age, gender, blood levels of CK-MB c-TnI, creatinine, MAP and European cardiac surgery system scoring were similar between 2 groups, allP>0.05. Compared with Intra- , post-operative IABP group, Pre-operative IABP group had decreased CK-MB (130.6±25.4) mmol/L vs (149.7±18.2) mmol/L at 48h post-operation and mechanical ventilation time (81.5±10.3) h vs (107.9±11.5) h, less in-hospital stay (21.3±4.1) d vs (27.7±9.4) d, reduced acute kidney injury (3.4% vs 23.1%), brain complication (5.6% vs 19.4%) and 30-day mortality (4.5% vs 36.1%), allP<0.05. Kaplan-Meier analysis indicated that the median survival time was longer in Pre-operative IABP group, (27.9±1.2 vs 16.5±2.2) dP<0.05; Logistic regression analysis and ROC curve demonstrated that IABP re-implantation (OR=2.37, 95% CI 1.42-5.72,P=0.01) was an important risk factor for 30-day mortality with the sensitivity of 75.3% and specialty of 67.4%. Conclusion: Pre-operative IABP implantation was helpful for decreasing post-operative level of CK-MB, reducing mechanical ventilation, in-hospital time and short-term mortality in high risk CAD patients; IABP re-implantation was the risk factor for short-term mortality.
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Objective For benign or tumor of borderline malignancy in the distal pancreas,a spleen-preserving distal pancreatectomy can be carried out.This study aimed to assess the safety and feasibility of this operation.Methods Between June 2009 and March 2012,7 patients underwent laparoscopic distal pancreatectomy assisted by the da Vinci Robotic System (RDP) for benign or pancreatic tumor with borderline malignancy.The clinical data were analyzed.Results Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was successfully carried out in 6 patients,with robotic assisted splenectomy and distal pancreatectomy on the remaining patient.Among them,to the 6 patients with distal pancreatectomy,one patient received right adrenal tumor resection and another patient received cholecystectomy.The average operation time was 368 minutes,and the blood loss was 200 ml.One patient developed postoperative bleeding,and was treated conservatively with hemostatic drugs (grade Ⅱ).There was no conversion to laparotomy.According to the international pancreatic fistula research team's classification of postoperative pancreatic fistula,1 patients were diagnosed to have pancreatic fistula (grade A).The mean postoperative hospital stay was 8.7 days.There were no other complications.Conclusions Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was safe and feasible.The Kimura operation was used in spleen-preserving operations because its 3D visual field and stability in control helped to preserve splenic blood supply and reduced the chance of postoperative regional portal hypertension.
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Objective To investigate the influence of double-effect activation of cholinergic antiinflammatory pathway on the liver injury and inflammatory response in obstructive jaundice rats by applying cholinesterase inhibitor and cholinergic M receptor blocker to activate alpha 7 nicotinic acetylcholine receptor.Methods 22 adult male Wistar rats were randomly assigned into three groups:sham operation (SO) group (n=6),bile duct ligation (BDL) induced obstructive jaundice with (BDL treatment group) or without treatment (BDL control group) (n=8 each).The medicine treatment group was given anisodamine (25 mg/kg) and neostigmine (25 μg/kg) daily via intraperitoneal injection after surgery,the control group was given equal amount of normal saline.The body weights of rats in each group were measured every other day.After 12 days,the rats were killed,and the pathological changes of liver injury,liver function and the expression levels of proinflammatory cytokines in the serum and liver tissue were observed.Results The body weight of BDL rats was significantly lower than the SO group rats,and the growth rate of BDL treatment group rats was the same as the rats in BDL control group 3 days after the starting of treatment.The AST,ALT,bilirubin and gamma-GT levels of BDL control and treatment groups were significantly higher than the SO group (P＜0.05),but there was no significant difference between BDL control and treatment groups.The serum albumin level of BDL treatment group was obviously higher than that of BDL control group,but the pathological liver injury was significantly slighter.The gene expression levels of TNF-alpha,IL-1 beta and IL-6 in the liver tissue were significantly higher in BDL groups than SO group (P＜0.05),but BDL treatment group was significantly lower than BDL control group (P＜0.05).In addition the serum TNF-alpha and IL-1 beta concentrations of BDL treatment group and control group were significantly higher than the SO group (P＜0.05),but the BDL treatment group was obviously lower than that BDL control group (P＜0.05).Conclusion The combine application of cholinesterase inhibitor and cholinergic M receptor blocker to activate the cholinergic anti-inflammatory pathway can significantly inhibit the obstructive jaundice induced proinflammatory gene expression and liver injury.
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Objective To compare the results of surgical resection with radiofrequency ablation in the treatment of primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus.Methods The clinical data of 30 patients with primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus treated between January 2006 and December 2009 were analyzed retrospectively.Patients were divided into two groups according to the treatment.Result The treatments were successfully carried out in the surgical resection group (n=15) and the radiofrequency ablation group (n =15).There was no perioperative death.Both surgical resection and radiofrequency ablation improved the overall survival and recurrence-free survival.The survival outcome of radiofrequency ablation was similar to surgical resection.Conclusion Both surgical resection and radiofrequency ablation were safe and effective for patients with primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus and improved the overall survival and recurrence-free survival.
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Objective In order to improve the outcome of surgical treatment for atherosclerotic heart disease,we summarize our clinical experience of surgical treatment during the last four years and propose our therapeutic strategy.Methods A retrospective study was performed including consecutive 1052 patients receiving isolated or combined CABG surgery which was performed by a single surgical team from January 2006 through March 2010 at Fu Wai Hospital.Patients'characters were quantified by European score System for cardiac operative risk evaluation (EuroSCORE).Operative strategies were classified as candioplegic arrest,on-pump beating,isolated off-pump,and the hybrid procedures to treat the concomitnnt diseases,such as peripheral vascular disease,atrial fibrillation,congenital heart diseases,et al.Clinical data including the surgical indications,preoperative patient co-morbidity,postoperative clinical course,and perioperative outcomes were analyzed of.Results Patients showed a mean EuroSCORE of 3.4 ±2.6.There were 127 patients ( 12％ ) with a EuroSCORE ＞6.The mean age of the patients was(61.2 ± 9.5 ) years,ranging from 26 to 84 years.The overall in-hospital postoperative mortality rate was 0％,and all patients had an uneventful recovery course and discharged.The transfusion rate was 31.9％.950 patients (90.3％)were OPCAB and 102 (9.7％) were on-pump CABG.There were 87 patients underwent concomitant CABG and heart valvereplacement or repair.21 patients underwent hybrid procedure by simultaneous peripheral artery stenting and OPCAB,and 14patients underwent redo CABG.The Average number of distal anastomoses was 3.2 ±0.9,and the mean postoperative hospital stay was (7.7 ± 2.5 ) days.Fourteen patients had re-exploration for bleeding,8 with pneumonia,5 with acute renal insufficiency and 6 had intra-aortic balloon pump (IABP) for cardiac dysfunction.All these patients recovered after proper treatment.Conulusion Surgical treatment for the coronary heart disease could achieve satisfactory curative effects by the individualized treatment,technological innovation and strengthen perioperative management.Excellent results and low major complications in the perioperative coupe could be expected through this strategy.
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Objective Aprotinin has been suspended in cardiac surgery since risks factors associated with mortality and other adverse events in western Literatures.This study was to investigate the effect of aprotinin on short-term outcomes in cardiac surgery in Chinese patients.Methods Two groups of patients who underwent cardiac surgery during equal period just before and after aprotinin was suspended in China.Aprotinin groupp(n=1699) was defined as operations from june 19,2007 to Dec 18,2007,when aprotinin was used in all the patients.Control group(n=2225)was defined as operations from Dec19,2007 to June 18,2008,when aprotinin was not umed.Postoperative outcomes between the two groups,including blood loes and transfusion requirement,in-hospital mortality and major adveme outcome events were compared,using univariate analysis and mulfivariable logistic regression analysis.Results Aprotinin group had less postoperative blood loes,transfusion requirement and reoperation for bleeching as compared with the control group.Application of aprotinin did not increase the risk of in-hospital mortality (0.5%vs.10%,P=0.08)and other major ad-verse events,including renal dysfunction,renal failure requiring dialysis,low cardiac output syndrome (LCOS),neurological and pulmonary complications.Aprltinin group also had and shorter mechanical ventilation time(P=0.04),a lowwer rate of delayed mechan-ical ventilation time(P=0.04)and a higher PaO2/FiO2 in the bolld gas analysis(P<0.001).which presented a better respiratory function.Multivariable Logistic regression analysis got identical results with univariate analysis.Conclusion The use of aprotinin in cardiac surgery could reduce blood loss and transfusion requirement significantly,and showed a protective effect on the lungs.In the mean time it did not increase the risk of mortality or major complications.We suggest further studies should be performed to make a decision of continuing or stopping the use of aprotinin in cardisc surgery in Chinese or Asian population.