west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "开窗" 28 results
  • Technical points of external fenestration in the treatment of aortic dissection involved visceral branch arteries after EVAR

    Objective To summarize the advantages and key points of external fenestration in the treatment of aortic dissection involved visceral branch arteries after endovascular aortic repair (EVAR), and to explore the application effect of external fenestration in aortic dissection involved visceral branch arteries. Methods A patient with abdominal aortic aneurysm resulting in abdominal aortic dissection and involving multiple visceral arteries after EVAR was treated in Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu. The surgical procedure of this patient was summarized, and the current status of total lumen technique in the treatment of such diseases was discussed and analyzed. Results The operation was successful, and it took only five hours, the intraoperative blood loss was about 100 mL, the patient was kept in ICU for one day and discharged one week after surgery and no serious postoperative complications occurred (such as spinal cord ischemia, liver and kidney insufficiency, infection, lower limb ischemia, puncture pseudoaneurysm, etc.). Aortic CT angiography was reexamined in three months after surgery, and the three-dimensional reconstruction showed that the aortic stent was stable, the blood flow of visceral branch arteries was smooth, and the aortic dissection was well isolated. Conclusion Endovascular repair of aortic dissection involving branch arteries of important organs can be achieved by external fenestration technique, it is a new treatment for aortic lesions involved visceral branch arteries.

    Release date:2022-12-22 09:56 Export PDF Favorites Scan
  • 心包开窗术在冠状动脉旁路移植术中的应用

    目的分析心包开窗术在冠状动脉旁路移植术(CABG)中的应用效果。 方法回顾性分析2011年1月至2013年4月邢台市第三医院332例冠心病患者行CABG术的临床资料。按是否行心包开窗术分为两组。开窗组:166例(男119例、女47例),年龄36~72(62.7±10.3)岁,关胸前放置心包纵隔引流管同时行心包开窗术;对照组:166例(男122例、女44例),年龄38~79(62.2±11.4)岁,关胸前放置心包纵隔引流管,未行心包开窗术。拔除引流管后1~30 d出现中等量以上积液为迟发性胸腔积液或心包积液。 结果全组手术均成功,无死亡病例;开窗组术后发生2例膈肌上抬,反复呃逆,经药物治疗后好转。两组手术时间、体外循环时间,主动脉阻断时间、死亡率差异无统计学意义(P>0.05)。开窗组迟发性胸腔/心包积液发生率较对照组低(7.2% vs.23.5%,P<0.05)。开窗组住ICU时间、住院时间、住院费用低于对照组,差异有统计学意义(P<0.05)。 结论心包开窗术用于预防冠状动脉旁路移植术后胸腔积液与心包积液安全、有效。

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • 开窗手术法治疗耳廓假性囊肿

    目的:探索治疗耳廓假性囊肿的手术新方法。方法:手术切除囊肿外侧壁,于切口下缘皮肤全层开窗,加压包扎。结果:所有病例均一期愈合,无继发感染及复发。 结论:开窗手术法治疗耳廓假性囊肿疗效好,不易复发。

    Release date:2016-09-08 09:54 Export PDF Favorites Scan
  • A CONTRASTIVE STUDY OF TREATING SINGLE LEVEL RECURRENT LUMBAR DISC HERNIATION

    To assess long-term outcomes of reoperation for recurrent lumbar disc herniation, and to compare results of different methods. Methods There were 95 patients who had reoperation for recurrent lumbar discherniation between February 1998 to February 2003, among whom a total of 89 (93.7%) were followed up and their primary data were reviewed. There were 76 patients, with the mean age of 42 years (range from 23 to 61), who met the inclusion criteria and were included. Among them, there were 55 males and 21 females. All patients had the history of more than one sciatic nervepain. The mean recurrent time was 69 months(range from 8 to 130 months). There were 48 patients in L4,5 and 28 patients in L5, S1, of whom we chose 30 to undergo larger vertebral plate discectomy (or two-side fenestration) and nucleus pulpose discectomy (group A), 24 to undergo the whole vertebral discectomy (group B) and 22 to undergo the whole vertebral discectomy and 360degrees intervertebral fusion(group C). The patients’ cl inical results in the three groups were compared, and the cl inical curative effects were evaluated by using cl inical functional assessment standard. Results Cl inical outcomes were excellent or good in 80.3% of the patients, including 80.0% of group A, 79.2% of group B and 81.8% of group C. There was no significant difference in each group (P gt; 0.05). These three groups were not different in age, pain-free interval and follow-up duration (P gt; 0.05). The mean intraoperative blood losses in the three groups were (110.7 ± 98.8), (278.7 ± 256.3), (350.7 ± 206.1) mL, respectively. The mean surgery time were (65.9 ± 22.8), (111.6 ± 24.3), (127.3 ± 26.7) minutes, respectively, and the mean hospital ization time were (6.7 ± 1.4), (10.2 ± 1.8), (12.2 ± 2.3) days, respectively. Group A was significantly less than group B or C (P lt; 0.05) and there was no significant difference between group B and C. All the patients were followed up for 36 to 96 months with an average of 86 months, and with (87.6 ± 27.0), (84.5 ± 19.8), (83.6 ± 13.5) months of group A, B and C, respectively. At the endof the follow-up, there were more cases of spinal instabil ity at the same level in group B (19 patients) than in group A (1 patient) or group C (no patient) in X-ray, and the difference was significant (P lt; 0.05). Conclusion Reoperation for recurrent lumbar disc herniation is effective. Larger vertebral plate discectomy or tow-side fenestration is recommended for managing recurrent lumbar disc herniation.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • Application of fenestration rammer in thoracolumbar burst fracture

    Objective To observe and evaluate the clinical effect of the new fenestration rammer in the treatment of thoracolumbar burst fracture by posterior internal fixation and reduction of lamina with finite fenestration decompression. Methods Patients with thoracolumbar burst fractures admitted to Zigong Fourth People’s Hospital between September 2017 and January 2020 were retrospectively selected. The patients were divided into observation group and control group according to different surgical methods. The observation group used a new tamping device with finite fenestration rammer of unilateral lamina to reduce the spinal occupying bone mass, and the control group used conventional instruments for reduction of intraspinal fracture masses. The operation time, intraoperative blood loss, CT measurement of sagittal diameter ratio of spinal canal and the number of cases of postoperative vertebral empty shell phenomenon were recorded in the two groups, and Frankel grading evaluation of spinal nerve function was conducted. Results A total of 67 patients were included. There were 33 cases in the observation group and 34 cases in the control group. The patients in both groups were followed up for 12 to 16 months, with an average of (14.45±2.25) months. The improvement rate of Frankel rating in each group was 100%. In the control group and the observation group, except for the sagittal diameter ratio of spinal canal before operation (P=0.616), the operation time [(150.44±26.47) vs. (120.91±20.86) min], the intraoperative blood loss [(244.41±42.97) vs. (183.33±34.56) mL], the sagittal diameter ratio of spinal canal one week after operation [(92.50±2.32)% vs. (93.72±2.40)%], the sagittal diameter ratio of spinal canal at the last follow-up [(91.50±2.96)% vs. (93.17±3.27)%] and the occurrence of empty shell phenomenon (13 vs. 5 cases) were statistically significant (P<0.05). The intragroup comparison showed that the sagittal diameter ratio of spinal canal was improved one week after operation and at the last follow-up compared with that before operation (P<0.05), there was no significant difference in the sagittal diameter ratio of spinal canal between one week after operation and the last follow-up (P>0.05). Conclusions The new fenestration rammer can effectively reduce the spinal occupying bone mass in thoracolumbar burst fracture, effectively restore the volume of the spinal canal, achieve the purpose of decompression, effectively prevent the formation of vertebral shell, maximize the retention of the stable structure of the posterior column, and avoid iatrogenic nerve injury. It is safe and effective.

    Release date:2022-10-19 05:32 Export PDF Favorites Scan
  • CUFF 预开窗技术治疗胸主动脉腔内修复术后近端内漏

    目的探讨胸主动脉腔内修复手术中即时造影提示覆膜支架近端出现Ⅰ型内漏,通过追加植入体外预开窗的支架延长段(CUFF)以延长锚定区,并消除Ⅰ型内漏的手术方式的安全性、有效性及其技术要点。方法2016~2017 年阜外医院血管外科中心实施胸主动脉腔内修复手术 623 例,其中 6 例患者在第 1 枚覆膜支架植入后,采取了追加植入 1 枚体外预开窗 CUFF 的方法处理了近端Ⅰ型内漏并保留了弓部分支动脉。6 例患者平均年龄 63.3(54~76)岁,男 4 例、女 2 例,其中 Stanford B 型主动脉夹层 2 例,胸主动脉假性动脉瘤 1 例,主动脉穿通性溃疡 3 例,全部接受经股动脉途径的胸主动脉腔内修复术治疗。结果本组手术成功率 100.0%,预开窗技术分支动脉保留成功率 100.0%,预开窗平均时间 10.3(6~17)min。5 例保留了左锁骨下动脉,1 例同时保留了左颈总动脉和左锁骨下动脉,后者经开窗向左颈总动脉植入覆膜支架 1 枚。本组锁骨下动脉均未植入支架。Ⅰ型内漏消除率 83.3%(5/6),1 例患者术后仍有微少量内漏,未予进一步处理。所有患者均获得门诊或电话随访,随访时间 10.3(3~25)个月,即时造影残留微少量内漏患者于术后 3 个月随访时内漏完全消失,所有患者生活质量改善,无死亡患者。结论对于腔内修复治疗术中出现近端Ⅰ型内漏的主动脉弓降部疾病患者,采取追加植入体外预开窗 CUFF 的方法,可在延长近端锚定区的同时成功保留弓上分支动脉。

    Release date:2020-01-17 05:18 Export PDF Favorites Scan
  • Effects of fenestration on long-term results of extracardiac total cavopulmonary connection patients in different risk levels

    ObjectiveTo evaluate the long-term effects of fenestration on patients at different risk levels, who performed external conduit total cavo-pulmonary connection operation.MethodsThis was a retrospective analysis which enrolled 383 patients undergoing external conduit total cavo-pulmonary connection in Fuwai Hospital from 2008 to 2015. Based on the preoperative data and whether fenestration in the operation, the whole cohorts were divided into four subgroups: a high risk group with fenestration(mean age: 10.53±7.06 years, 55 males), a high risk group with non-fenestration(mean age: 9.30±7.83 years, 43 males), a low risk group with fenestration(mean age: 8.91±7.13 years, 65 males) and a low risk group with non-fenestration(mean age: 8.23±5.34 years, 67 males). Then we collected and analyzed the perioperative data and long-term prognosis of this cohorts in different risk levels.ResultIn the high-risk group, the duration of chest drainage in fenestration group was significantly shorter than that of the non-fenestration group (12.39±12.03 d vs. 23.30±15.36 d, P=0.001). The incidence of delayed chest drainage in the fenestration group was lower than that in the non-fenestration group (25.0% vs. 47.1%, P=0.002). In addition, the length of hospital stay was shorter than that of the non-fenestration group (18.91±12.79 d vs. 29.68±37.77 d, P=0.004), with significant statistical difference. In the low risk group, there were 3 (2.7%) and 2 (1.6%) deaths at the follow-up in the non-fenestration and fenestration groups respectively (P=0.761). And 1 patient (1.3%), 1 patient (1.4%) died in the fenestration and non-fenestration group (P=0.593) in high risk group. However, there was no statistically significant difference among the fenestration and non-fenestration groups in terms of long-term intestinal protein loss syndrome and arrhythmia in different risk level groups.ConclusionFenestration can reduce the incidence of early complications and hospital stay, effectively, especially for the high-risk patient. Fenestration is recommended for high-risk patients with external conduit total cavo-pulmonary connection operation.

    Release date: Export PDF Favorites Scan
  • Endovascular treatment outcomes of chronic thoracoabdominal aortic dissection

    ObjectiveTo evaluate the feasibility, safety and efficacy of endovascular treatment for chronic thoracoabdominal aortic dissection. MethodsThe patients with chronic thoracoabdominal aortic dissection who underwent total endovascular treatment at Shanghai City First People’s Hospital between December 2021 and March 2024 were retrospectively analyzed. The patients were divided into single-trunk group and double-trunk group according to the treatment methods. Clinical data including demographic characteristics, preoperative risk factors, surgical details, postoperative complications and long-term follow-up data were collected. Outcome measures mainly included surgical success rate, in-hospital mortality, endoleak rate and incidence of branch restenosis. ResultsThirty-four patients with thoracoabdominal aortic dissection were treat with total endovascular treatment. That success rate of operation was 100%. The in-hospital mortality was 2.94%. the incidence of paraplegia was 0.00%. the incidence of cerebral infarction was 2.94%. The incidence of type Ⅲ endoleak was 5.88%. The incidence of branch artery stenosis was 8.82%. The incidence of dissection progression was 8.82%. The reintervention rate was 14.71%. In the aspect of reconstruction of splanchnic artery branches, fenestration stent was the main method in the single-trunk group, and branch stent was the main method in the double-trunk group, the difference was statistically significant (P<0.05). There was no significant difference in perioperative and mid-term follow-up results between the two groups (P>0.05). ConclusionTotal endovascular treatment is a safe and effective treatment option for patients with thoracoabdominal aortic dissection.

    Release date:2024-06-20 05:33 Export PDF Favorites Scan
  • Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area

    ObjectiveTo evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing.MethodsThe clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment.ResultsAll the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.

    Release date:2022-01-21 01:31 Export PDF Favorites Scan
  • Effectiveness and safety of fenestrated endograft versus chimney stent repair for juxtarenal abdominal aortic aneurysms: a meta-analysis

    ObjectiveTo systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).MethodsThe databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).ConclusionsBoth F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.

    Release date:2020-10-21 03:05 Export PDF Favorites Scan
3 pages Previous 1 2 3 Next

Format

Content