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Objective To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH).Methods Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group,and the data,including birth weight,pregnant weeks,ages at operation,hospital stay postoperatively and the number of recurrence cases were compared,between the 2 groups.The size of defect was coded into A,B,C and D grades.Status of patients was grouped into Ⅰ,Ⅱ,Ⅲ,Ⅳ,and Ⅴ stages according to the defect size and complicated congenital heart disease.Results There were 7 cases in TRHP group,including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect,respectively.The contents of the hernia included small intestine,colon,kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively,whose symptom disappeared after treatment.The follow-up time was (12.17 ± 3.41) months,and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them,29 cases belonged to class-A defect,18 cases class-B defect,and 4 cases class-C defect,respectively.Cases classified into A and B defects were in stage Ⅰ or Ⅱ,and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect,40 cases presented left CDH and 5 case presented right CDH.Among them,5 neonates had hernia sac.The contents of the hernia included small intestine,colon,kidney and spleen.There were significant differences in the operative time [(83.47 ± 10.28) min vs.(54.29 ± 17.09) min,P ＜0.05] and length of stay postoperatively [(12.76 ±5.89) d vs.(7.86 ± 2.03) d,P ＜ 0.05] in both groups.TRHP was carried out by the same surgeon,and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups,significant difference was found [(83.47 ± 10.28) min vs.(54.29 ± 17.09) min,P ＜ 0.05].The cases were followed up for (46.17 ± 6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months,respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases.Conclusions It is safe to repair CDH by THRP in neonates with CDH A or B defect,for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect.
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Objective@#To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH).@*Methods@#Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group, and the data, including birth weight, pregnant weeks, ages at operation, hospital stay postoperatively and the number of recurrence cases were compared, between the 2 groups.The size of defect was coded into A, B, C and D grades.Status of patients was grouped into Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴstages according to the defect size and complicated congenital heart disease.@*Results@#There were 7 cases in TRHP group, including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect, respectively.The contents of the hernia included small intestine, colon, kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively, whose symptom disappeared after treatment.The follow-up time was (12.17±3.41) months, and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them, 29 cases belonged to class-A defect, 18 cases class-B defect, and 4 cases class-C defect, respectively.Cases classified into A and B defects were in stageⅠorⅡ, and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect, 40 cases presented left CDH and 5 case presented right CDH.Among them, 5 neonates had hernia sac.The contents of the hernia included small intestine, colon, kidney and spleen.There were significant differences in the operative time [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05] and length of stay postoperatively [(12.76±5.89) d vs.(7.86±2.03) d, P<0.05] in both groups.TRHP was carried out by the same surgeon, and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups, significant diffe-rence was found [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05]. The cases were followed up for (46.17±6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months, respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases.@*Conclusions@#It is safe to repair CDH by THRP in neonates with CDH A or B defect, for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect.
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Objective To summarize the experiences of surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants.Methods The clinical data of 51 cases with aortic coarctation and/or aortic hypoplasty hospitalized in Wuhan Children's Hospital between Jan.2010 and Jun.2013 were analyzed retrospectively.Thirty-two patients had received a expanded end-to-end anastomosis and 19 patients had got a end-to-side anastomosis.Autologous pericardial patch,bovine pericardial patch or autologous pulmonary patch was taken according to the circumstances during surgery.Results There were 2 intraoperative deaths because of serious low cardiac output syndrome,and 2 postoperative deaths,which could not take off long-term respiratory assistance after surgery in aortic one child and low cardiac output syndrome in the other.Three patients appeared trachyphonia but recovered basically after 3 months follow-up.Forty-seven patients were followed up for 2 months-3 years,among them,3 patients had significant upper to lower extremity systolic blood pressure gradient[＞20 mmHg(1 mmHg =0.133 kPa)],and a second operation was proposed recently for 1 of them,while the other 2 children were in follow-up.The other 44 patients did not appear obvious restenosis.The 47 cases of children had no neurologic symptoms.Conclusions There have to be positive diagnoses and strictly surgery indications for aortic coarctation and/or hypoplasty associated with intracardiac anomalies in infants.Selective antegrade cerebral perfusion or deep hypothemic circulatory arrest depends on the surgon's discretion.Both expanded end-to-end anastomosis and end-to-side anastomosis can achieve good operation effects.
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Objective To compare the effect of applying low molecular weight heparin calcium in different periods of reteplase for acute myocardial infarction(AMI).Methods Ninety-one cases of AMI were divided into group A(30 cases),group B(30 cases)and group C(31 cases)by random digits table.The patients in three groups were given reteplase intravenous thrombolysis,and 5000 U low molecular weight heparin calcium was abdominal wall subcutaneous injections once 12 h at intravenous thrombolysis immediately(group A),after intravenous thrombolysis 6 h(group B)and 12 h(group C).They all were treated for 7-10 d.The rate of coronary artery recanalization,acute phase complication and adverse reaction were compared among three groups.Results The rate of coronary artery recanalization in group A,B and C was 76.7％(23/30),96.7％(29/30),74.2％(23/31)respectively.The rate of coronary artery recanalization in group B was significantly higher than that in group A and C(P ＜ 0.05).The rate of acute phase complication and adverse reaction in group B[33.3％(10/30)]was significantly lower than that in group A and C[70.0％ (21/30)and 61.3％(19/31)](P ＜ 0.05).Conclusions After reteplase intravenous thrombolysis in 6 h,applying low molecular weight heparin calcium can significantly improve the rate of coronary artery recanalization and reduce the rate of acute phase complication and adverse reaction.
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0.4?g was defined as the cutoff,then these patients were divided into two groups,the elevated group and the normal group,and were followed up for a month to compared with the rate of cardiac events.Results Among the 62 cases,there were 8 cardiac events in the evelated group of 24 patients.2 cardiac events in the normal group of 38 patients.There was a significant difference between the two groups(P