Feasibility analysis of simultaneous combined operation for congenital heart disease with other malformations / 中华胸心血管外科杂志

Objective:To explore the feasibility of simultaneous combined operation for congenital heart disease with other malformations and to summarize the experience of operation and the ways to avoid risks.Methods:From May 2015 to December 2019, the clinical data of 44 children undergoing simultaneous combined operation in our hospital were collected, and the data of 44 children who were matched with the children undergoing combined operation in the same period were collected as the research objects, which were divided into high-risk group(17 cases)and low-risk group(27 cases). To compare and analyze the early hemodynamic indexes and other hospitalization indexes of different groups of children undergoing simultaneous operation and staged operation, so as to evaluate whether the scheme of simultaneous combined operation is more optimized.Results:All the children in the same period successfully underwent combined operation, among which 4 cases had postoperative complications and 1 case died out of hospital, all of them were children in high-risk group, and the other children were cured and discharged. Compared with the staging group, there was no significant difference in general data and early postoperative hemodynamic indexes of children in the same period group, but the cost of operation and anesthesia was lower, and the average hospitalization time was shortened by about 5 days for each person, with statistical significance. Compared with the low-risk group, the children in the high-risk group were significantly lower in age and weight, complicated in deformity, longer in operation time, lower in early postoperative cardiac output, stable in hemodynamics after operation, but higher in inotropicscore score(IS). Postoperative endotracheal intubation time, ICU time and overall hospitalization time were prolonged, and the overall cost was more( P<0.05) The incidence of postoperative adverse events was higher. Conclusion:Simultaneous combined operation for children with congenital heart disease with other malformations is generally safe and feasible., Staging is safe for children in high-risk group, and if simultaneous combined surgery is unavoidable, the condition must be assessed individually and a detailed treatment plan must be developed to avoid surgical risks.

Clinical analysis of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract / 中国基层医药

Objective@#To investigate the clinical value of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract.@*Methods@#From May 2012 to August 2017, 350 patients with chronic angle closure glaucoma complicated with cataract in the Second Hospital of Shaoxing were studied.According to the difference of treatment methods, they were divided into two groups, with 175 cases in each group.The control group was treated with trabeculectomy, the observation group was treated with modified glaucoma combined with cataract surgery.The intraocular pressure (IOP), visual acuity were observed.@*Results@#The IOP values of the observation group were (22.50±1.48)mmHg, (18.77±2.38)mmHg, (14.21±0.93)mmHg at 3 d, one month and three months after operation, which were significantly lower than those of the control group [(28.91±2.05)mmHg, (23.28±2.49)mmHg, (17.75±1.16)mmHg], the differences were statistically significant(t=33.54, 17.32, 31.50, all P<0.05). Three months after operation, the depth of central anterior chamber in the observation group was (3.21±0.51)mm, which was obviously higher than that in the control group [(2.90±0.77)mm], the difference was statistically significant (t=4.44, P<0.05). The visual acuity index of the observation group was better than that of the control group (P<0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (1.14% vs.4.00%, χ2=2.85, P>0.05).@*Conclusion@#The modified glaucoma combined with cataract surgery is effective in the treatment of chronic angle closure glaucoma with cataract, and can significantly improve the IOP and visual acuity.And the safety is high.

Application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer / 中华消化外科杂志

Objective To explore the application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 27 patients who underwent single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer in the General Hospital of Ningxia Medical University between September 2016 and April 2018 were collected.The surgical operators were divided into neck operation group and abdomen operation group.A "Y" tube was used to inflate the abdomen and mediastinum simultaneously with CO2,and the gas pressure was 12-16 mmHg (1 mmHg =0.133 kPa).Bilateral exchange free and join forces with the esophagus and xiphoid process operating small incision,the severed esophagus cardia;residual stomach was made into a 3-5 cm tubular stomach and was sutured at the top point;at the same time,esophagus was brought up from the neck,with a pouch suture between upper esophageal and stapling head;the tubular stomach through mediastinum-esophagus bed was pulled to the left neck and then gastroesophageal anastomosis manually or instrument was performed.Observation indicators:(1) surgical and postoperative recovery;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to May 2018.The measurement data with normal distribution were represented as x-±s.The measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery:all the 27 patients underwent successful single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer,with complete tumor resection and without conversion to open surgery.There was no arrhythmia or myocardial ischemia through intraoperative electrocardiography.Among 27 patients,5 had intraoperative rupture of the pleura and 3 stopped intermittently inflation with CO2 due to obvious hemodynamic changes.The operation time and volume of intraoperative blood loss were (121±21)minutes and (100± 30)mL.Twenty-seven patients had no thoracic incision,obviously decreased postoperative pain and out-of-bed activity at day 1 postoperatively.The volume of postoperative mediastinal drainage was (40± 10)mL.The mediastinal drainage-tube was removed at 1 week after regular food intake.Of 27 patients,5 with pleural effusion were cured by puncture drainage;2 were complicated with anastomotic leakage,1 of them with a small amount of subcutaneous gas under neck incision at 12 days postoperatively was cured spontaneously through oral food intake,without special treatment,and the other had a small amount of subcutaneous gas under neck incision after solid food intake at 1 month postoperatively and then was cured after 1-week fluid food intake;1 with anastomotic stenosis was improved after dilation treatment.The squamous cell carcinoma was confirmed by postoperative pathological examination,without cancer cell infiltration in the upper and lower margins.The numbers of mediastinal lymph node dissected,abdominal lymph nodes dissected and positive lymph node,postoperative pathological staging and duration of hospital stay were respectively 9.5±2.2,8.2±2.5,1 (range,0-12),T1-3N0-1M0 and 13 days (range,11-21 days).(2) Follow-up and survival situations:27 patients were followed up for 1-20 months,with a median time of 10 months.During the follow-up,there was no recurrence or metastasis and death.Conclusion The single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer is safe and effective,and it is especially suitable for patients with partial respiratory failure and closed thoracic cavity.

Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury: A Case Report / 대한신경손상학회지

It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.

Clinical efficacy and safety of combined grindding and cutting bone method of mandibular angle plasty / 中华医学美学美容杂志

Objective To study a safe means of mandibular angle plasty of bone cutting and its clinical efficay.Methods Through grinding bone oblique trapezoidal incisure,mandibular angle wide deformity was then corrected according to the cutting trace on bone cutting method.Results Of 260 cases of torture beauty,185 cases were followed-up,in which 181 (97.84％) cases were satisfied with the results,and 1 case got satisfaction after facial liposuction; other 1 case did not accepted further treatment advice of bone cutting processing because her mandibular angle was too wide.Two cases of bone wax reaction occured and got satisfaction after treatment.Conclusions Mandibular angle plasty by combined grinding with cutting makes it easy for positioning and bone cutting; bone cutting arc becomes more fluent with good exposure of its posterior horn.It can prevent mandibular fracture induced by bone cutting that does not reach the designated position.Therefore,this procedure is relatively simple and safe.

Combined Operation of Laparoscopic Cholecystectomy during Laparoscopic Appendectomy in Patient with Chronic Gallbladder Disease

PURPOSE: Laparoscopic cholecystectomy (LC) for asymptomatic gallbladder disease has been increasing since 1990 due to the development of LC technique. Moreover, it might be considered when someone with asymptomatic gallbladder disease needs emergency operation due to acute abdomen such as acute appendicitis. The aim of this study is to identify the efficacy of concurrent laparoscopic appendectomy with cholecystectomy. METHODS: From January 1997 to June 2009, 40 patients underwent laparoscopic appendectomy with cholecystectomy at Ewha Womans University Mokdong Hospital. 40 patients were enrolled in this study. We analyzed, retrospectively, clinical and diagnostic information, time and open conversion rate in operation, length of postoperation hospital stay, and complication rate. RESULTS: The mean age was 44.53+/-15.34 and male to female ratio was 1 to 1.86. 5% of all patients underwent abdominal surgery and 20% of all patients had associated diseases. Most common associated symptoms and final diagnosis were right lower abdominal pain (72.5%) and simple gallbladder stone (62.5%). Mean operation time was 98.75+/-33.14 min. and there was no open conversion. Mean length of postoperation hospital stay was 5+/-2 days. There was one (2.5%) postoperative complication. CONCLUSION: Combined operation of laparoscopic cholecystectomy during laparoscopic appendectomy can be a good modality for patients with chronic gallbladder disease.

Risk Factors of Fever in Portal Hypertensive Patients after Combined Operation / 中华医院感染学杂志

OBJECTIVE To investigate the causes of fever and risk factors in portal hypertensive patients after combined operation(devascularization+shunt).METHODS Forty five cases of portal hypertension(PHT) after combined operation were retrospectively and prospectively analyzed.RESULTS Complications caused 88% post operational fever.The most common cause was hydrothorax,hematocele or hydrops and infection in splenic recess.Long-term fever was related to liver function(P

Clinical Analysis of Combined Laparoscopic Surgery: A Report of 728 cases / 中国微创外科杂志

Objective To explore advantages of combined laparoscopic surgery(CLS).Methods The clinical data of 728 cases of CLS from July 1992 to March 2006 were analyzed retrospectively,including 586 cases of laparoscopic cholecystectomy(LC) combined with fenestration drainage of hepatic cysts,80 cases of LC combined with appendectomy,46 cases of LC combined with oophorocystectomy,16 cases of LC combined with unroofing and drainage of renal cysts.Results 726 cases of CLS were successfully performed,and 2 cases were converted to open surgery for abdominal adherence,with no complications such as bile duct injury,hemorrhea,infection and death occurred.During a mean follow-up period of 16 months(range,2-60 months) in 512 cases,no biliary calculi,recurrence of liver,kidney and ovarian cysts occurred.Conclusions CLS for two kinds or more abdominal diseases in one operation is safe and effective,with advantages of minimal invasion,less pain,and quicker recovery and so on.

Laparoscopy combined with esophagogastroscopy for achalasia of the cardia:Report of 25 cases / 中国微创外科杂志

Objective To investigate the value of laparoscopy combined with esophagogastroscopy in the treatment of achalasia of the cardia. Methods Twenty-five patients with achalasia of the cardia between October 2003 and April 2006 in this department underwent the HellerDor operation under laparoscopy combined with esophagogastroscopy.Results A1l the operations were successfully accomplished.The operating time was 60~240 min(mean,107 min) and the intraoperative blood loss,5~60 ml(mean,22 ml).Intraoperative mucosal perforation was encountered in 4 patients.All the patients got out of bed for activities at 8 hours after operation,with first passage of flatus,removal of the gastric tube,and liquid diet intake at 1~3 days after operation(mean,1.5 days).The esophageal manometry showed the lower esophageal sphincter(LES) pressure had decreased to normal levels at 7 days after operation.The 24-hour ambulatory pH studies showed a high reflex index in 3 patients,but without symptoms.Upper gastrointestinal barium swallow showed the dilated esophagus had a 8~26 mm(mean,18 mm) decrease in diameter at 8 days after operation.The length of postoperative hospitalization was 8~11 days(mean,8.5 days).Follow-up for 1~30 months(mean,5.4 months) in all the patients showed 23 patients were asymptomatic and 2 had intermittent dysphagia.Conclusions Heller-Dor operation under laparoscopy combined with esophagogastroscopy has advantages of precise positioning,little invasion,less pain,and good effects,increasing the quality of operation as well as decreasing the incidence of complications.

Combined Carotid Endarterectomy and Coronary Artery Bypass Graft: Two cases report

Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.

Combined laparoscopic surgery:A change of incision site instead of an increase of incision number / 中国微创外科杂志

Objective To study the clinical application of changing the incision site rather than increasing the incision number in combined laparoscopic surgery (CLS). Methods Thirty-six patients had undergone CLS, that is, the laparoscopic cholecystectomy (LC) combined with choledocholithotomy, or appendectomy, or oophorocystectomy, or enterodialysis. The operations were completed after changing the incision site. Results All the 36 operations were accomplished smoothly requiring no additional incisions. No complications were found. Conclusions The minimally invasive advantages in CLS are embodied in changing the incision site rather than increasing the incision number.

Combined laparoscopic surgery.(A peport of 21 Cases) / 中国微创外科杂志

Objective To investigate the advantages and indications of combined laparoscopic surgery(CLS). Method 488 casesof laparoscopic procedures were given from May 1992 to February 2002.Among them 21 were CLS.Laparoscopic common bile duct exploration (LCBDE)+Laparoscopic cholecystectomy(LC)(7);Laparoscopic fenestration of liver syst+LC(4),LC+Laparoscopic appendectomy(4);LC+hand-assisted laparoscopic splenectomy(2);laparoscopic cystectomy for pancreatic pseudocyst+LC (1);LCBD+LC+Laparoscopic fenestration of right renal cyst(1)and LC+laparoscopic partial hepatectomy for small liver cancer(1). Results The combined procedures were succesful in all the 21 cases with no complications. Conclusions CLS has expanded the field of laparoscopy and advantages of minimally invasive nature and indications should be strictly choosen for the procedure.

Sucessful Treatment of A Giant Craniopharyngioma:Combined Preoperative Stereotactic Cyst Drainage and Microsurgical Radical Excision: A Technical Note

Even though the craniopharyngioma was benign neoplasm pathologically, actually it is a clinical malignancy because its troublesome, harzardous and difficult surgical excision with high surgical mortality, morbidity and also high recurrency, especially in cases of giant sized tumor which diameter was over the 3 cm. The authors present a technical note of a giant craniopharyngioma which was mixed tumor of huge sized cystic portion and calcified solid portion in 10 years old female patient, and its diameter was 9 cm. The surgical technique of complete radical excision of tumor was staged combined method as initial percutaneous gradual drainage of cystic fluid by EVD system which was placed by stereotactic method and followed by successful radical extirpation of remaining cyst wall and solid mass by pterional-trans-sylvian microsurgical approach. There was no complication during and post-operatively.