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无名动脉插管简化支架“象鼻”手术治疗DeBakey Ⅰ型主动脉夹层

心脏恶液质瓣膜病患者的外科治疗

原发性心脏肿瘤的外科治疗

目的 总结原发性心脏肿瘤的外科治疗经验，以提高手术疗效。 方法 回顾性分析1980年6月至2008年12月中国医科大学附属第一医院收治的263例原发性心脏肿瘤患者的临床资料，其中男90例，女173例；年龄10～79岁（41±13岁）。良性肿瘤241例，其中良性粘液瘤240例，纤维瘤1例；恶性肿瘤22例，其中恶性粘液瘤7例，恶性间皮瘤4例，血管肉瘤5例，横纹肌肉瘤1例，肺动脉内膜肉瘤1例，平滑肌肉瘤1例，炎症性恶性纤维组织细胞瘤1例，恶性淋巴瘤1例，滑膜肉瘤1例。手术完整摘除肿瘤252例（恶性肿瘤11例），局部切除肿瘤5例（均为恶性肿瘤），开胸探查取病理活组织检查6例（均为恶性肿瘤）。同期行冠状动脉旁路移植术（CABG）5例，二尖瓣置换术5例，二尖瓣成形术4例，三尖瓣成形术9例，三尖瓣生物瓣置换术1例，主动脉根部及肺动脉成形术1例，肺动脉瓣置换术1例，肺动脉主干及左右肺动脉人工血管加肺动脉瓣置换术1例，肺动脉切开取栓术1例，经股动脉取瘤栓术5例。 结果 围术期死亡7例（良性粘液瘤6例、恶性粘液瘤1例），其中术中不能停体外循环2例，术后发生低心排血量、心室颤动3例，呼吸、循环衰竭1例，大面积脑出血1例；其余患者无并发症发生。随访247例（良性肿瘤229例，恶性肿瘤18例），随访时间3个月～28年，失访9例（良性肿瘤6例、恶性肿瘤3例）。随访期间良性粘液瘤复发4例，均再次手术治疗；良性肿瘤患者死亡13例（心源性猝死6例、脑卒中2例、肺癌1例、不明原因4例），其余216例均生存。随访期间恶性肿瘤患者死亡15例，术后生存时间为1～4年，死于肿瘤复发或转移11例，心力衰竭和恶病质各2例。 结论 原发性心脏肿瘤一经确诊应尽早手术治疗，良性肿瘤手术效果好，恶性肿瘤术中应尽量切除肿瘤。

Comparative Study between Offpump and Onpump Coronary Artery Bypass Grafting in the Patients of Multivessel Coronary Disease Below 70 Years Old

Abstract: Objective To compare the therapeutic effects between offpump coronary artery bypass grafting (off-pump CABG) and onpump coronary artery bypass grafting (on-pump CABG) in the patients of multivessel coronary disease below 70 years old, in order to decide on the best surgery method. Methods From June 2007 to June 2009, 196 patients below the age of 70 underwent coronary artery bypass grafting (CABG), including 152 male patients and 44 female patients. The average age was 55.00 years old, ranging from 46 to 69 years. The patients were divided into two groups according to the methods of operation. There were 94 patients in the off-pump CABG group including 2 patients who were converted to the onpump CABG surgery because of the unstable hemodynamics. The other 102 patients were in the onpump CABG group. The type and number of the vessel grafts, the quantity of blood transfusion, intubation duration, length of stay in hospital, complications during perioperative period and mortality were compared between the two groups. Results In the offpump CABG group, 2 patients were converted to onpump CABG surgery because of the unstable hemodynamics, and 1 of them died from multiple organ failure. In the onpump CABG group, 2 patients died from severe low output syndrome and sudden heart arrest respectively. No significant difference was found in the vessel grafting materials, perioperative complications and mortality between the two groups (Pgt;0.05), while the number of anastomosis (3.22±0.65 vs. 4.52±1.11, t=9.807, P=0.000), the [CM(159mm]quantity of blood transfusion (312.57±305.26 ml vs. 744.86±279.37 ml, t=10.317, P=0.000),the intubation duration (10.71±5.32 h vs.17.12±4.67 h, t=8.683, P=0.000) and the length of stay in hospital (17.75±3.04 d vs. 21.24±6.46 d, t=4.782,P=0.000) in the off-pump CABG group were significantly lower or shorter than those in the on-pump CABG group. A total of 93 patients in the off-pump CABG group and 100 patients in the on-pump CABG group were followed up with the time periods ranging from 2 to 26 months. All patients survived without angina. Conclusion There is no significant difference in the early clinical therapeutic effects between off-pump CABG and onpump CABG in the patients of multivessel coronary disease below 70 years old, but revascularization in the on-pump CABG patients is better. So far, offpump CABG cannot replace on-pump CABG and more clinical trails are needed for evaluation of the longterm prognosis.

Minimally Invasive Mitral Valve Replacement Combined with Atrial Fibrillation Radiofrequency Ablation via Right Minithoracotomy

ObjectiveTo summarize clinical advantages and outcomes of minimally invasive mitral valve replacement (MVR) combined with atrial fibrillation (AF) radiofrequency ablation via right minithoracotomy. MethodsEight patients with mitral valve disease and AF who received surgical therapy in the First Hospital of China Medical University between October 2009 and October 2012 were included in the study. There were 4 males and 4 females with their age of 34-67 (52.4±17.5) years. All the patients underwent minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy. Clinical outcomes were summarized. ResultsThere was no in-hospital death or conversion to conventional sternotomy in this group. Two patients received biological valve replacement and 6 patients received mechanical prosthesis. Operation time was 207.9±18.1 minutes, cardiopulmonary bypass time was 81.7±23.9 minutes, and chest drainage amount was 126.7±34.5 ml. AF recurred in 1 patient on the 3rd postoperative day. All the patients were in sinus rhythm at discharge. These patients were followed up for 18.3±7.4 months. During follow-up, 1 patient had AF recurrence. Seven patients were in NYHA class Ⅰ, and 1 patients was in NYHA class Ⅱ. ConclusionMinimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy can achieve satisfactory clinical results and esthetic appearance, and is a good choice for patients with mitral valve disease and AF.

冠状动脉旁路移植术治疗左主干分叉病变

目的 探讨冠状动脉左主干分叉病变的外科治疗方法，总结其临床经验。 方法 1999年3月至2008年4月我院共收治29例冠状动脉左主干分叉病变患者，在体外循环心脏不停跳下行冠状动脉旁路移植术(CABG)，观察体外循环时间、术后呼吸机辅助时间、 ICU时间、住院时间、围术期以及随访情况。 结果 体外循环时间为482±15.5 min，术后呼吸机辅助时间14.2±4.6 h，住ICU时间3.3±0.8 d，住院时间18.0±2.7 d，无围术期心肌梗死发生。本组患者随访7～98个月 (29.0±19.2个月)，25例心绞痛症状完全消失，2例心绞痛症状缓解，3例于术后3年、4年和8年分别死于脑血管病变、心脏骤停及肺癌。超声心动图检查提示:左心室收缩功能获得不同程度的改善。 结论 冠状动脉左主干分叉病变应用体外循环心脏不停跳CABG可以取得良好的治疗效果。

Extracorporeal Membrane Oxygenation after Cardiac Surgery: A Clinical Analysis of 27 Adult Patients

ObjectiveTo summarize the experience of applying extracorporeal membrane oxygenation (ECMO) after cardiac surgery in adult patient. MethodsWe retrospectively analyzed the clinical data of 27 patients underwent ECMO from December 2011 to October 2013. There were 15 males and 12 females at the mean age of 51±11 years ranging from 41 to 73 years. Vein-artery perfusion was performed in all 27 patients. ResultsAll 27 patients underwent ECMO. The mean time of using ECMO was 81.2±36.4 hours ranging from 48.0-192.0 hours. The mean time of hospital stay was 307.8±97.0 hours ranging from 168.0-480.0 hours. The rate of weaning from ECMO was 77.8% (21/27). The rate of discharge was 51.9% (14/27). The rate of perioperative mortality was 44.4% (12/27). ConclusionEffective monitoring with other supportive equipments is helpful to promote the result of ECMO.

80岁以上老年患者行非体外循环冠状动脉旁路移植术16例

Hypothermia Continuous Renal Replacement Therapy for Severe Heart Failure after Cardiac Surgery

目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果 方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。 结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m2）vs.（1.8± 0.2）L/（min· m2）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。 结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。

主动脉缩窄合并冠心病一例