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Objective To observe and compare the operation ,short-term therapeutic effect and long-term therapeutic effect be-tween painless gastrostomy under endoscopy and nasal-jejunal catheterization as well as to explore their clinical feasibility and clini-cal application .Methods 81 cases of patients with severe acute pancreatitis in the hospital ICU from May 2012 to September 2013 , were divided into gastrostomy jejunostomy group(43 cases)and nasojejunal feeding group(38 cases) .The operation time ,gastroin-testinal nutrition tube inner curvature ,removal rateetc were observed to calculate the success rate .Contrast ratio ,plugging rate and catheter related infection rate and several indexes were observed to evaluate the therapeutic effect of two groups of short-term infec-tion ofincision .long-term calculation of two groups with tube ,comfort score and nutritional indexes to evaluate the therapeutic effect index .Results The operation time ,the digestive tract inside area rate ,nutrition tube removal ,catheter related pulmonary infection rate ,average indwelling catheter time ,comfort ,nutrition index of the two groups had statistically significant (P0 .05) .Conclusion With fewer complications and longer tube time , painless gastrostomy under endoscopy is safe ,simple and feasible ,which is easily accepted by patients .
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Objective To explore the radical surgery for tetralogy of Fallot combined with right pulmonary artery stenosis.Methods Thirteen cases with tetralogy of Fallot combined with right pulmonary artery stenosis accepted radical surgery,among them 7 cases who-had a long right pulmonary artery stenosis accepted aortic transaction for radical surgery of tetralogy of Fallot;5 cases who had the entrance stenosis of the right pulmonary artery accepted right pulmonary artery patch expansion for radical surgery of tetralogy of Fallot;One case who had the distortion and stenosis after pulmonary shunt accepted the radical surgery for tetralogy of Fallot after seperation and expansion.Results There were no operation-related deaths,post-operative low cardic output and perfusion lung occurred for all the cases.Ten cases had grade 1 cardiac function and 3 cases had grade 2,respectively.Conclusion Right pulmonary artery stenosis increased the risks during the radical surgery for tetralogy of Fallot,but it is still the primary operation choice.
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Objective:To evaluate the role of percutaneous endoscopic gastrostomy/jejunostomy(PEG/PEJ) in critical patients. Methods:Percutaneous endoscopic gastrostomy/jejunostomy procedures were performed in 25 critical patients. Indication, procedure-related complication,technical success and clinical outcome were reviewed. Results:The technical success was 100% and there were no serious complications. In 4 patients(16%),local cleansing, drainage were used for the infection of PEG site. PEJ tube dysfunction occurred in 3 patients(12%). Conclusion:PEG /PEJ is a safe,minimal invasive,and effective procedure for enteral nutrition in critical patients.
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Objective To evaluate the value of thoracotomy through small right subaxillary oblique incision for pediatric ventricular septal defect(VSD). Methods From November 2001 to December 2008,1539 children with VSD underwent thoracotomy through small right subaxillary oblique incision in our hospital.At the fourth intercostal space between the anterior and middle axillary lines,a straight or oblique incision was made,then along the inferior edge of the fourth rib the chest was opened,and the right edge of the pericardium was fixed at the thoracic retractor.Afterwards,off-pump circulation was established and minimally invasive cardiac surgery was carried out.Results The procedure was completed successfully in all the 1539 patients.The cross-clamp time was(22.8?11.4) min(11 to 48 min),and CPB time was(33.0?14.9) min(27 to 64 min).Two patients(0.13%,2/1539) died in 24 hours after the operation.One of them died of severe allergic reaction to protamine.And the other died of severe low cardiac output in 4 hours after the surgery,because of an injury to the left coronary artery.In this series,the postoperative complications included incisional infection in 3 cases,atelectasis in 9,perfusion lung in 5,low cardiac output in 5,infectious endocarditis in 3 and acute renal failure in 4.These 29 cases were discharged after the complications being cured.Follow-up was available in 1446 cases for(47.0?11.2) months(range,6~91 months).During the period,small residual shunts in the VSD were detected in 5 cases,and other cases showed no abnormalities.Conclusions Thoracotomy through small right subaxillary oblique incision is minimally invasive,safe and effective for pediatric VSD.
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Objective:To evaluate the effect and the significance of combined treatment for severe acute pancreatitis in ICU.Methods:96 cases of severe acute pancreatitis treated in ICU of the hospital where the authors worked from Jan.1996 to Jun.2004 were analyzed retrospectively.Results:GroupⅠwere treated with routine methods.14 patients died and the mortality was 31.8%(14/44).Group Ⅱwere treated with routine methods combined with continuous renal replacement therapy(CRRT).5 patients were treated with CRRT twice.26 patients were treated with emergent endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and endoscopic naso-bile drainage(ENBD).32 patients were treated with the mechanical ventilation.46 patients were cured and 6 patients died. The mortality was 11.5%(6/52).Conclusion:The combined treatment in ICU can increase the curative effect of the severe acute pancreatitis.
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Objective: To evaluate the effect and the significance of combined treatment for acute severe pancreatitis complicated with acute respiratory distress syndrome(ARDS) in ICU.Methods: 71 cases of severe acute pancreatitis with ARDS treated in ICU of the hospital where the authors worked from Jan.1996 to Apr.2005 were analyzed retrospectively.Results: GroupⅠwere treated with routine methods and the mechanical ventilation.14 patients died,and the mortality was 48.3%(14/29).Group Ⅱwere treated with routine methods and the mechanical ventilation.All patients were treated with continuous renal replacement therapy(CRRT),of whom 7 patients were treated with CRRT twice.22 patients were treated with emergent endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and endoscopic naso-bile drainage(ENBD).33 patients were cured and 9 patients died.The mortality was 21.4%(9/42).Conclusion: The combined treatment in ICU can increase the curative effect of the severe acute pancreatitis complicated with ARDS.