Objective To introduce a method of the surgicalcorrectionof Poland’s syndrome in children. Methods From May 1990 to May 2002, 3 female children with Poland’s syndrome were treated. One child of 12 years old with defects of the right second and third costal cartilages, pectoralis major and pectoralis minor underwent repair of chest wall with graft of autologous costal cartilage from left sixth costal cartilage and transfer of the latissimus dorsi flap. The other 2 children, 3 and 16 years old, with defects of theleft second, third and fourth costal cartilages, pectoralis major and pectoralis minor underwent graft of autogenous costal cartilage from the right sixth costal cartilage and implant of Dexon mesh. Results Three patients were followed up 1, 7 and 10 years postoperatively, respectively.The contour of chest wall in 3 patients were improved. The functions of the chest, back and upper limbs in the deformitis side were good and the growth and development of thechildren were normal during follow-up postoperatively.Conclusion The congenital deformities of multiple systems and parts in the body are involved in Poland’s syndrome so that it is necessary to make a proper surgical plan according to the extent of lesions for a satisfactory result.
目的 总结法洛四联症矫治术的临床经验，进一步提高治愈率，降低其并发症和死亡率。 方法 回顾性分析2005年4月1日至2013年3月31日河南省胸科医院704例行法洛四联症矫治术患者的临床资料，其中男394例、女310例，年龄3个月至45岁，平均（3.6±6.6）岁。 结果 684 （97.20%） 例治愈，死亡20例，死亡率2.8%。死于低心排血量综合征和多器官功能衰竭16例，急性肾功能衰竭2例，术后灌注肺合并肺部感染1例，心搏骤停1例。因术后出血量多，再次开胸止血21例（2.98%）；脱离呼吸机后二次气管内插管21例（2.98%），腹膜透析治疗肾功能不全25例，发生感染性心内膜炎10例，Ⅲ°房室传导阻滞2例；10例术后出院前复查发现小的室间隔缺损残余漏，5例跨肺动脉瓣压差超过40 mm Hg。随访1～8年，随访到658例，随访率98%。随访期间因心衰死亡3例，因心内膜炎死亡1例。 结论 术前精确诊断，把握好手术适应证，术中矫治满意，术后及时恰当处理是手术成功的关键。
Objective To study the method of treating hemifacial atrophy withfree serratus muscle flap. Methods Three patients diagnosed as having serious hemifacial atroph was treated with free serratus muscle flap. The root of the flap was thoracodorsal artery and thoracodorsal vein, which was anastomosed with superficial temporal artery and vein, facial artery and vein, lingual artery and vein,and so on.During the operation, long thoracic nerve was dissected and anastomosed with facial nerve. The sizes of the flaps were 12 cm×8 cm16 cm×12 cm.Results All free-muscle flaps healed well after the transplant. The face and buccal area looked chubby and rounded. There were no obvious protuberance and discontentment on the buccal area. The shoulders of all patients moved well. The facial contourof the patients recovered well during the follow-up period (1.3 years). Conclusion The method has a good result, The long-term effect needs further study.
ObjectiveTo explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT).MethodsA total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg.ResultsIn all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period.ConclusionRVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.
Abstract: Objective To summarize the experience of surgical treatment of tetralogy of Fallot (TOF) with anomalous coronary artery. Methods From March 1993 to April 2006, 22 patients with TOF and anomalous coronary artery underwent repair. The resection of hypertrophied parietal, septal band and the ventricular septal defect (VSD) repairs were performed by trans-right ventricular outflow tract (RVOT) approach in 5 cases, and by transatrial approach in 17 cases, which consisted of 7 cases required a transannular patch to enlarge a pulmonary annulus, construction of a double barrel outlet in 6 cases, by autologous pericardium conduit (3 cases), homograft (1 case) and reflected anterior wall of the main pulmonary artery in combination with bovine pericardium (2 cases). Results There was one operative death because of the anomalous coronary artery impairment. The accessory left anterior descending artery was severed because it was mistaken for the conal arteryin 1 case, which caused failure to wean from bypass, after the left internal mammary artery was anastomosed to the accessory left anterior descending artery, the cardiopulmonary bypass (CPB) was stopped successfully. Mean early gradient(ΔP) was 23.4mmHg and ΔP＞20mmHg in 9 cases. Eighteen cases were followed up, mean time was 13.2 months. Late ΔP＞20mmHg in 7 cases, and ΔP were less than 20mmHg in 11 cases. Conclusion The repair of TOF with anomalous coronary artery is more safe by using the transatrial approach. The surgical reconstruction of RVOT depends on the anatomic characteristic of anomalous coronary artery.
OBJECTIVE: To study the effects of jaw advancement in treating micromandibular deformity associated with obstructive sleep apnea syndrome (OSAS) by ramus osteotomy and genioplasty. METHODS: From April 1998 to February 2002, 12 patients with micromandibular deformity associated with OSAS (aged 14-36 years, 7 females and 5 males) were treated. Invert "L" shape ramus osteotomy and inverted replantation of posterior segment of ramus were performed to reconstruct the TMJ with the jaw advancement and genioplasty at the same time in 7 cases; mandibular angle osteotomy, bone grafts and genioplasty in 3 cases; and the jaw advancement by ramus sagittal osteotomy and genioplasty in 2 cases of the first branchial arch syndrome. RESULTS: The follow-up period was 6 months to 4 years. All the patients gained good appearance and had the distance of opening movement over 3.0 cm. Micromandible and facial asymmetries were corrected satisfactorily. The ratio of SaO2 was ascended from 82%-92% (preoperation) to 97%-99% (postoperation). OSAS was relieved. CONCLUSION: The jaw advancement by ramus osteotomy and genioplasty for treating micromandibular deformity associated with OSAS can correct the maxillofacial deformities and enlarge the upper airway space to relieve OSAS. This method has achieved satisfactory result.
Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.
ObjectiveTo investigate the methods and significance of early orthodontic treatment for class Ⅱ malocclusion with molars scissors bite. MethodsTen patients with classⅡ malocclusion with molars scissors bite from 2011 and 2014 were selected. Study models and clinical data of them were retrospectively analyzed. Cephalometric radiographs taken before and after treatment were traced and measured. Student's t-test was used to analyze whether there was a significant difference before and after treatment. ResultsAfter treatment, the change of SNA, S-Go/N-Me, and soft tissue facial angle was not significant(P>0.05). SNB, N-ANS, ANS-Me, and S-Go increased significantly. ANB, Y axis, H angle, lower lip to H-line, and inferior sulcus to H-line decreased significantly(P<0.05). The treatment duration was 12 months on average. ConclusionEarly treatment of molars scissors bite and class Ⅱmalocclusion can keep the mandible and tempromandibular joint function well through occlusion guidance and muscle balance, which may prevent the exacerbation of facial deformity effectively.