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Article in Chinese | WPRIM | ID: wpr-747758


OBJECTIVE@#To explore the application of double pedicle blood supply pectoralis major myocutaneous flap in reconstruction of laryngeal and hypo pharyngeal defect after carcinoma resection.@*METHOD@#All the patients received initial treatment. Pectoralis major myocutaneous flap was Applied in one-stage reconstruction in 22 cases of laryngocarcinoma and hypopharyngeal carcinoma with post-operation defect. During operation, pectoral branches of thoracoacromial vessels and branch of lateral thoracic vessels were reserved and prepared to be double pedicle vessel fascia bundle without muscle at the beginning part, rearched to defect area through subclavian tunnel. After operation, it is necessary to closely observe the subcutaneous swelling, quantity and color of the drain and others of neck surgery area to exclude the occurrence of surgical hematoma. When there is suspicion, do timely exploration.@*RESULT@#Pectoralis major myocutaneous flaps of 22 patients were all survived. Pharyngeal fistula occurred in 2 cases and was cured by change of dressing. Twenty-one cases received radiotherapy after operation without secondary flap necrosis. After follow-up of 6 months to 24 months, one case of roll repairment of circumferential defect in cervical esophagus,found to have anastomotic stenosis 8 months after radiotherapy and then underwent gastrostomy treatment,the other 21 cases showed good recovery of swallowing function. Among 13 cases with laryngeal function reserved, only 1 case wearing tube and the extubation rate was 92.3% without communication barriers, no patient died in the short follow-up period.@*CONCLUSION@#For double pedicle blood supply pectoralis major nyocutaneous flap, blood supply are fully guaranteed and does not require complicated equipment to observe and monitor the flap blood supply after operation, it is important to exclude factors that may lead to muscular flap necrosis to ensure the survival of pectoralis major myocutaneous flap.

Esophagus , General Surgery , Fistula , Pathology , Humans , Hypopharyngeal Neoplasms , General Surgery , Laryngeal Neoplasms , General Surgery , Larynx , General Surgery , Myocutaneous Flap , Pharynx , Pathology , General Surgery , Reconstructive Surgical Procedures
Article in Chinese | WPRIM | ID: wpr-452292


Objective To evaluate the feasibility, safety and effectiveness of interventional occlusion with thin waist occluder for perimembranous ventricular septal defect with pseudoaneurysm. Methods During the period from March 2008 to March 2013 at Shanghai Yodak Cardiothoracic Hospital , interventional occlusion with thin waist occluder was carried out in a total of 96 patients with perimembranous ventricular septal defect (VSD) complicated by pseudoaneurysm. The patient’s age varied from 2 years to 36 years. Before the procedure, routine left ventricular angiography and ascending aortic angiography were carried out. Left ventricular angiography and ascending aortic angiography as well as the transthoracic ultrasonography were performed immediately after the procedure to observe the therapeutic results. Follow-up checkups with transthoracic ultrasonography, EKG and chest X-ray film were conducted at one week as well as at one, 3, 6 and 9 months after the surgery were conducted. Results Successful occlusion of VSD was obtained in 93 patients, with a success rate of 96.8% (93/96). After the surgery, small amount of shunt flow was detected in 8 patients, which disappeared within 48 hours in 7 patients, and in the other one the shunt flow disappeared one month later which was confirmed by follow-up examination. After the treatment, complete right bundle branch block occurred in 4 patients, complete left bundle branch block in 5 patients, and transientⅢdegree atrioventricular block in one patient. The conduction block disappeared at the time of discharge in all patients. The left ventricular end-diastolic diameter (LVEDD) decreased from preoperative (47.5 ± 5.2) mm to postoperative (45.2 ± 5.1) mm, the difference was statistically significant (t = 18.33, P < 0.01). During the follow-up period lasting for 9 months, no delayed cardiac arrhythmia, valve damage or sudden death occurred. Conclusion For the treatment of perimembranous ventricular septal defect with pseudoaneurysm, interventional occlusion with thin waist occluder is safe and effective with excellent mid-term effect. Based on the imaging findings, including the location, shape, ruptured orifice, number of the perimembranous pseudoaneurysm as well as the distance between the pseudoaneurysm and the aortic valve, to select suitable occluder and proper occlusion site is the key to ensure a successful surgery.

Article in Chinese | WPRIM | ID: wpr-584552


Objective To investigate the effect of selective intracoronary stenting to the improvement of myocardial viability and left ventricular function aftcr Q-ware acute myocardial infarction. Methods 32 patients with initial Q-wave myocardial infarction underwent isoket-infusion 99Tc mMIBI SPECT imaging and blood pool radionuclide ventriculography before and after selective intracoronary Stenting. Results (1) The abnormal radioactive segments were 212 vs 108 before and after intracoronary stenting. The mean scores of abnormal segments were 16.1?3.9 vs 8.3?1.4 (P

Article in Chinese | WPRIM | ID: wpr-586434


Objective To evaluate and compare the therapetic effectiveness among intravenous rt-PA thrombolysis, thrombolysis plus delayed intracoronary stenting and delayed intracoronary stenting for acute myocardial infarction (AMI) using 99 [KG*2/3]Tcm-MIBI myocardial SPECT imaging. Methods Ninty-five cases of AMI were divided into three groups which were the thrombolysis group (n=31), thrombolysis plus delayed stenting group (n=30) and the delayed stenting group (n=34). 99 [KG*2/3]Tcm-MIBI myocardial SPECT imaging was performed 3 weeks after thrombolysis therapy or 1 week after intracoronary stenting.The left ventricular myocardium was divided into 16 segments for evaluation. The score of myocardial 99 [KG*2/3]Tcm-MIBI uptake were analyzed semiquantitatively and the total score of myocardial 99 [KG*2/3]Tcm-MIBI uptake was calculated. Results The scores of the 3 groups were 28.4?7.5, 19.4?6.2 and 27.3?7.2 respectively. Significant difference was shown in the thrombolysis plus delayed stenting group compared with the thrombolysis and the delayed stenting group (t=7.2, t=6.9, P0.05). Conclusion 99 Tcm-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the various treatments of AMI. Thrombolysis plus delayed stenting seems to be more effective than thrombolysis and delayed stenting. On the other hand, thrombolysis and delayed stenting show similar effect in the treatment of AMI in the study.