目的:研究子宫腺肌病局部病灶切除术的可行性,方法及手术疗效的评价。方法:对2002年3月至2006年3月97例子宫腺肌病保留子宫仅作局部病灶切除术的患者进行随访观察。结果:97例子宫腺肌病手术后痛经治愈率:轻度,100%,中度37.8%,重度36%,痛经缓解率,中度及重度分别为62.2%及64%。月经过多治愈率为100%。妊娠分娩率原发不孕57.6%,继发不孕52.9%。结论:子宫腺肌病局部病灶切除术既治愈和改善了患者的临床症状又保留生殖器官的完整性及生理生殖功能可且有助于妊娠率的提高,是值得使用的方法。
Objective To analyze the crucial factors which affect the hospitalization expenses of patients with uterine adenomyosis, in order to take corresponding measures. Methods A total of 583 patients diagnosed with uterine fibroids reported by hospitals in urban areas of Suining city through hospital quality monitoring system between December 2013 and December 2015 were included in this study. The main reasons for the expense structure was described by Pareto’s law. The importance of hospitalization expense influencing factors was analyzed by neural network model, and single factor analysis was used to analyze important influencing factors of hospitalization expenses. Results The main factors influencing hospitalization expenses included length of stay in hospital, operation techniques and illness conditions, and their importance value was respectively 0.581, 0.175 and 0.088. Conclusion Based on hospitalization expenses, length of stay in hospital and expense structure, high intensity focused ultrasound therapy is more reasonable in the treatment of uterine adenomyosis.
Objective To summary the clinical experiences of ventricular septal myotomymyectomy on hypertrophic obstructive cardiomyopathy(HOCM) and investigate the treatment strategies during perioperative period for better clinical results. Methods From October 1996 to June 2009, 62 patients with HOCM underwent surgical treatment. There were 41 male and 21 female, aged 668 years with mean 34.05 years. The ventricular septal myotomymyectomy operation (Morrow operation or modified Morrow operation) was performed through the aortic incision under general anesthesia and hypothermic cardiopulmonary bypass (CPB). The concomitant operations included coronary artery bypass grafting (5 cases), mitral valve replacement (12 cases), mitral valve plasty(9 cases), aortic valve replacement (4 cases), tricuspid valve plasty(2 cases) and ductus arteriosus closure (2 cases). During the perioperative period, the patients were examined by echocardiography or transesophageal echocardiograph(TEE), electrocardiogram or dynamic echocardiogram and chest radiography. Left atrial diameter，left ventricular enddiastolic [CM(159mm]diameter，left ventricular outflow tract (LVOT) pressuregradient，interventricular septal thickness, ejection fraction[CM)](EF), the changes of mitral valve construction and function were evaluated. Results The time of CPB and aortic occlusion were 104.23±47.14 min and 66.76±36.32 min, respectively. The endotracheal intubation time was 13.23±11.76 h and the postoperative intensive care unit(ICU) stay was 42.53±37.41 h. Four patients died and the mortality was 6.45％(4/62). The main causes of death included septic shock complicated with acute renal failure(1 case), refractory arrhythmia, ventricular fibrillation, atrial flutter complicated with severe low cardiac output syndrome (1 case), severe acute renal failure(1 case) and Ⅲ°atrioventricular(AV) block complicated with low cardiac output syndrome(1 case). Postoperative left atrial diameter (34.56±6.45 mm vs.43.46±7.21 mm，t=6.948,P=0.000), left ventricular enddiastolic diameter (37.14±6.31 mm vs.42.03±6.23 mm，t=3.145,P=0.020), LVOT pressure gradient (23.54±17.78 mm Hg vs. 103.84±44.04 mm Hg,t=13.618,P=0.000) and interventricular septal thickness (17.12±5.67 mm vs.26.93±5.23 mm, t=10.694,P=0.000) decreased significantly compared with those before operation. There was no mitral valve regurgitation, or only mild mitral valve regurgitation. No systolic anterior motion(SAM) was found. The main postoperative arrhythmias included complete left bundle branch block, intraventricular block, complete atrioventricular block and atrial fibrillation. All the 58 cases were cured and discharged. Fiftythree cases were followed up for 3 months12 years, and 5 cases were lost. No death, complication and reoperation were found. Symptoms relieved significantly. The cardiac function was in New York Heart Association grade Ⅰ-Ⅱ. The quality of life improved significantly. Conclusion Most patients with HOCM can achieve satisfactory relief of LVOT obstruction and SAM via ventricular septal myotomymyectomy. The main arrhythmias after operation are bundle branch block and atrial fibrillation. Satisfactory effects can be achieved by accurate surgical technique and effective drug treatments.
ObjectiveTo compare clinical outcomes between modified and traditional Morrow procedures for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). MethodsForty-two HOCM patients undergoing surgical correction in Beijing Anzhen Hospital between January 2005 and July 2011 were recruited in this study. According to different surgical techniques, all the patients were divided into 2 groups. In traditional Morrow procedure group, there were 16 patients including 13 males and 3 females with their age of 49±15 years. In modified Morrow procedure group, there were 26 patients including 14 males and 12 females with their age of 40±18 years. Preoperative and postoperative echocardiography were performed to compare ventricular septal thickness (VST), left ventricular outflow tract velocity (LVOTV)and left ventricular outflow gradient (LVOG)between the 2 groups. ResultsVST, LVOTV and LVOG of HOCM patients were significantly reduced after both traditional and modified Morrow procedure. There was statistical difference in preoperative and postoperative VST (23.10±3.64 mm vs. 17.38±4.39 mm), LVOTV (433.08±101.68 mm/s vs. 248.46±101.88 mm/s)and LVOG (78.57±40.16 mm Hg vs. 4.29±21.52 mm Hg)in traditional Morrow procedure group (P < 0.05). There was statistical difference in preoperative and postoperative VST (25.04±47.05 mm vs. 18.38±6.55 mm, P < 0.05), LVOTV (414.83±83.33 mm/s vs. 159.72±60.84 mm/s, P < 0.05)and LVOG (77.94±29.16 mm Hg vs. 17.56±9.39 mm Hg, P < 0.05)in modified Morrow procedure group (P < 0.05). Preoperative and postoperative difference in LVOG of modified Morrow procedure group was more significant than that of traditional Morrow procedure group (74.25±27.91 mm Hg vs. 34.63±30.66 mm Hg, P < 0.05). ConclusionModified Morrow procedure is superior to traditional Morrow procedure in reducing postoperative LVOG for HOCM patients.
Dilated cardiomyopathy (DCM) is a highly prevalent disease which has multiple clinical manifestations and pathological features. With the characteristics of multi-sequence and multi-parameter, cardiac magnetic resonance imaging (MRI) can accurately assess the morphology, function and tissue characterization of heart, and provide comprehensive information for diagnosis of DCM. This review focuses on the sequences and clinical applications of MRI evaluation in DCM in order to provide additional information for clinical diagnosis, treatment and prognosis.
ObjectiveTo explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure.MethodsA total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF.ResultsOverall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively.ConclusionIncreased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.