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先天性心脏病继发感染性心内膜炎的外科治疗

目的 总结先天性心脏病继发感染性心内膜炎41例外科治疗的经验。方法 手术均在体外循环下进行畸形矫正和赘生物清除。室间隔缺损(VSD)直接缝合16例，补片修补10例；动脉导管未闭(PDA)均采用直视缝合法。同期行肺动脉瓣成形术5例，三尖瓣置换术2例，主动脉瓣置换术12例，主动脉瓣和二尖瓣置换术2例。结果 1例急诊VSD修补同时行主动脉瓣置换术，术后并发脑栓塞死亡；其余患者均痊愈出院。随访35例，随访时间3～102个月，无1例死亡和心内膜炎复发。结论 正确把握手术时机和使用有效抗生素是提高治愈率的关键，应强调对先天性心脏畸形的早期治疗，以防止严重并发症。

升主动脉-腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎

目的 为了有效治疗累及胸腹主动脉的Ⅱ、Ⅲ型大动脉炎,探讨升主动脉-腹主动脉旁路移植术的手术疗效. 方法 自1976年至2001年采用升主动脉-腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎47例,同期行人工血管与肾动脉旁路移植术10例,冠状动脉旁路移植术和自体肾移植术各2例,三尖瓣成形术和髂动脉旁路移植术各1例. 结果 术后1例死于凝血障碍出血,死亡率为2.13%;术后因肠梗阻再手术1例;存活患者血压和血运均明显改善,上肢血压较术前明显下降,平均为118/77mmHg (1kPa=7.5mmHg) vs 177/83 mmHg;术后上、下肢血压差别无显著性意义.平均随访8.2年,远期死亡2例( 4.35%),再手术1例,远期效果优良率为81.82%. 结论 升主动脉-腹主动脉旁路移植术是治疗Ⅱ、Ⅲ型大动脉炎的简单、安全、远期疗效好的方法.

一期手术治疗主动脉缩窄合并升主动脉瘤一例

腹直肌韧带状瘤1例报道

成人主动脉缩窄的临床特点和外科矫正

目的探讨成人主动脉缩窄的临床特点和外科治疗方法。方法40例成人主动脉缩窄患者行手术矫治，其中心脏不停跳手术28例，常规体外循环下手术12例。行主动脉狭窄段切开、人工血管补片扩大术12例，人工血管置换术15例，锁骨下动脉降主动脉旁路移植术1例，采用人工血管行胸一腹主动脉旁路移植术9例，经心包后径路行升主动脉一降主动脉旁路移植术3例。结果全组无手术死亡，几种术式术后均无脑部和脊髓等神经系统并发症。术后36例得到随访，平均随访12个月。36例患者上、下肢血压差均小于10mmHg（1kPa－7．5mmHg）。超声心动图和超高速CT检查提示人工血管血流通畅，无假性动脉瘤形成。结论成人主动脉缩窄的外科术式有多种选择，掌握好手术适应证，根据患者的具体病理生理状况选择合适的手术方式可获得满意的治疗效果。

Surgical Treatment of Aneurysm in Behcet’s Disease

Objective To summarize the outcome in surgical management and medical therapy of aneurysm involved in Behcet’s disease. Methods From April 1977 to December 2004,7 patients (one female) were admitted. There were 4 false aneurysms in aortic isthmus, and 1 right subclavian artery pseudoaneurysm, and 1 right axillary artery false aneurysm, and 1 thoracicoabdominal multiple pseudoaneurysms. Surgical procedures included 4 aneurysmorrhaphys and patch angioplasties, 1 aneurysmorrhaphy and tube graft replacement, 1 covered stents and axillary to axillary artery bypasses, 1 aneurysmorrhaphy and right subclavian artery ligation. The other 3 cases survived. Results There were no hospital death, but there were 1 anastomotic aneurysm occurrence, 2 new aneurysms formation, 1 femoral artery occlusion at canal insertion site, and 1 bypass graft occlusion. Follow-up from 1 to 12 months, there were death in 4 cases. Conclusions Behcet’s disease could easily result in anastomotic aneurysm and/or new aneurysm or rupture occurrence. Based on location of lesion, selection of proper intervention, and combination with immunosuppression therapy, the satisfactory result could be obtained, therein, prosthetic graft replacement surpasses the patch angioplasty.

Prospective Randomised Neurocognitive Study of Unilateral and Bilateral Antegrade Selective Cerebral Perfusion for Total Aortic Arch Replacement

ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.

冷脑保护液对大脑皮层组织丙二醛、血栓素A2及前列环素的影响

目的 研究深低温停循环间断灌注充氧脑保护液对大脑皮层组织丙二醛(MDA)、血栓素A2(TXA2)及前列环素(PGI2)的影响.方法 杂种犬10条,随机均分为两组.A组:单纯深低温停循环120分钟;B组:深低温停循环后间断灌注充氧脑保护液.两组动物分别于不同时相测定大脑皮层组织MDA,TXA2的代谢产物血栓素B2(TXB2)及PGI2代谢产物6-Keto-PGF1a的含量. 结果 恢复循环45分钟后,A组MDA和TXB2含量明显高于心肺转流术前(P＜0.01),6-Keto-PGF1a含量明显低于B组(P＜0.01). 结论 深低温停循环间断灌注充氧脑保护液能明显减少恢复循环后大脑皮层组织MDA和TXA2的生成,增加PGI2的生成,发挥其对大脑皮层组织的保护作用.

经胸骨正中切口心脏手术后并发乳糜胸的治疗

摘要： 目的 探讨经胸骨正中切口心脏直视手术后发生乳糜胸的可能机制和治疗经验，以减少术后乳糜胸的发生。 方法 回顾分析1996年10月至2006年1月收治的18例经胸骨正中切口径路行心脏直视手术后发生乳糜胸患者的临床资料，其中男12例，女6例；年龄2个月~79岁，平均年龄144岁。所有患者均采用在禁食基础上的保守治疗，包括胸腔闭式引流、静脉高营养、强心、利尿等综合措施。 结果 住院时间7~130 d，胸腔引流时间4~35 d。全组死亡2例，其中死于心律失常、心搏骤停1例；因肺部感染、再次插管，死于多器官功能衰竭1例。随访14例，随访时间2~10年，失访2例。随访期间无乳糜胸复发或需二次手术者。 结论 经胸骨正中切口径路行心脏直视手术后发生乳糜胸可能与手术时损伤较小的淋巴侧枝有关，采用禁食、胸腔闭式引流、静脉高营养等保守治疗效果满意。

法洛四联症根治术后肺动脉瓣置换术

目的　讨论法洛四联症 (TOF)术后肺动脉瓣关闭不全的外科治疗时机和方法。　方法　 5例 TOF患者行根治术后发生严重肺动脉瓣关闭不全 ,选用液氮保存的同种带瓣肺动脉行肺动脉瓣置换术 (PVR) ,并同期分别行三尖瓣成形术 (TVP)、右心室流出道 (RVOT)成形术、VSD残余漏修补术或 RVOT疏通。　结果　 1例术后早期因进行性右心功能衰竭死亡 ;余 4例均恢复良好 ,无严重心律失常 ;分别随访 3个月～ 4年 ,心功能为I ～II 级。　结论　早期 PVR能明显改善右心功能 ;采用同种带瓣肺动脉手术简便 ,早期效果满意。