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Objective: To summarize the clinical experience and short-term outcome of minimally invasive occlusion in patients with peri-membranous ventricular septal defect (PmVSD) via right subaxillary route under trans-esophageal echocardiography (TEE) guidance. Methods: A total of 122 PmVSD patients treated in our hospital from 2014-01 to 2015-07 were summarized. There were 54 male and 68 female with the mean age of (2.7±2.2, 0.5-9.7) years, mean body weight of (13.9±6.0, 6.1-38.0) kg and mean PmVSD diameter of (3.8±0.8, 2.5-7.0) mm. The patients were taken left lateral position, a (2-3) cm incision was performed along right mid-axillary line between the 3rd rib and 4th rib, the thoracic entrance was at 4th inter-costal space. A purse-string suture was conducted on right atrial surface, a special hollow probe was inserted into right atrium and crossed tricuspid into right ventricle under TEE guidance; the probe was adjusted to the point or crossed VSD into left ventricle followed by guide wire insertion to establish a deliver pathway, and ifnally, occlusion device was regularly deployed to close the defect. Post-operative ECG, TEE and chest X-ray were conducted for followed-up study. Results: There were 119/122 (98.4%) patients occluded successfully and 3 failed patients were converted to cardiopulmonary bypass surgery at the original incision. The average size of occluder was (4.9±1.1, 4-10) mm and all devices were concentric. The patients were followed up at the mean of (8.3±5.0, 1.0-19.8) months, during that period, 12/119 (10.1%) had new mild tricuspid regurgitation, 16 (13.4%) suffered from incomplete right bundle branch block, 4 (3.4%) had small residual shunt and 2 of them were self-closed at 1 and 3 months after operation respectively. There were no complete atrio-ventricular block, no new aortic valve regurgitation and no device dislocation. Conclusion: Minimally invasive occlusion of PmVSD via right subaxillary route under TEE guidance was a safe, effective, feasible and better cosmetic method for treating relevant patients; while its long-term outcome should be further observed.
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Objective: To summarize the short-term clinical experience of minimally invasive direct cardiac surgery (MIDCS) with right anterolateral thoracotomy incision by closed cardiopulmonary bypass. Methods: A total of 42 patients received MIDCS in our hospital from 2013-09 to 2015-05 were summarized. There were 18 male and 24 female patients including 16 with atrial septal defect (ASD) repair, 4 with ventricular septal defect (VSD) repair, 16 with mitral valve replacement (MVR), 1 with mitral valve plasty (MVP) and 5 with aortic valve replacement (AVR). Direct cardiac surgery was performed by cardiopulmonary bypass through femoral artery-vein and right jugular vein annulations. A right anterolateral thoracotomy incision (length 3-5 cm) was made to enter the chest and complete the operation. Results: All 42 patients received successful operation, no peri-operative or early post-operative death, no incision infection occurred. Cardiopulmonary bypass time was [98-142 (122.4 ± 23.7) min], aortic cross-clamp time [0-118 (48.3 ± 26.2) min]. Post-operative mechanical ventilation time was [8-76 (17.4±13.1) h], intensive care unit stay time [45-124, (54.6 ± 32.6) h], hospital stay time [6-12, (8.2 ± 1.3) d]. Incision length was [3-7, (4.8 ± 1.5) cm], the draining volume at the 1st post-operative day was (356.9 ± 283.8) ml and there were 27 (64.3%) patients without transfusion. Conclusion: The short-term outcomes for MIDCS were good, it with superior safety, broad application range with minimal invasion and less complication.
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Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femoral neck fractures (26 males and 44 females; at age range of 67-95 years,mean 78.3 years) treated from October 2008 to June 2010.There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures (2-4 months post-injury),all of whom were type Ⅲ or Ⅳ fractures according to the Garden' s classification.All surgeries were completed by the same operation group.The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females.The two groups were compared in aspects of incision size,operative time,perioperative complications,prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks (range,12-18 weeks).The differences between the two groups were significant regarding the incision length,perioperative blood loss,and blood product transfusio amount (P ＜0.01 ),but insignificant in operative time ( P ＞ 0.05 ).All patients were able to take weight-bearing walk six weeks postoperatively.The two groups showed significant difference in the hip joint function by Chamley's criteria six weeks postoperatively ( P ＜ 0.05 ),but insignificant difference in the hip joint function by Harris' s criteria at the last follow-up ( P ＜ 0.05). Conclusion The modified posterolateral minimally invasive approach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients,for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time.
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Objective To evaluate effects of minimally invasive dynamic hip screw(DHS)in treatment of intertrochanteric femoral fractures.Methods The study involved 98 patients with intertrochanteric femoral fractures treated by closed reduction and C-arm fluoroscopy guided minimally invasive DHS from January 2004 to January 2010.According to AO classification,there were 38 patients with type A1 fractures and 60 with type A2 fractures.According to Evans classification,there were nine patients with typeⅠ?fractures,29 with type Ⅱ,36 with typeⅢ?and 24 with type V.Intraoperative blood loss,operation time and incision length were recorded.Results The intraoperative hemorrhage,operation time and incision length were average 250 ml(range,150-450 ml),54.3 minutes(range,45-70 minutes),and 5.2 cm(range,4-7 cm),respectively.All the patients were followed up for 12-38 months(mean 16.8 months).Fracture healing time was 10-14 weeks(average 11.5 weeks).According to Zuekerman functional scoring for hip joint,the results were excellent in 61 patients,good in 30,fair in four and poor in three,with excellence rate of 92.9％.Varus deformity of hip occurred in four patients.No patient presented surgical site infection,implant failure or displacement of fractures.Conclusion Minimally invasive DHS is an effective means in treating intertrochanteric femoral fractures,but the key point of successful treatment is to strictly grasp the correct operative procedures.
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Objective To study feasibility of combined haemostatic percutaneous injection therapy guided by contrast-enhanced ultrasonography (CEUS) in treatment of renal injuries. Methods Eighteen New Zealand rabbits were inflicted with kidney injury imitating grades Ⅲ-Ⅳ blunt injuries. The animals were randomly and equally divided into three groups, Group A ( treated with hemocoagulase),Group B ( treated with hemocoagulase and Alpha-cyanoacrylate) and Group C ( control group, given normal saline). The hemostatic time, hemostatic effect, and perirenal hematoma were observed. Results A perirenal hematoma was observed one hour after treatment. The perirenal fluid thickness was (0.200 ±0.012) cm in Group A, (0.050 ±0.002) cm in Group B and (0.400 ±0.009) cm in Group C, with statistical significance between two test groups and Group C (P ＜ 0.05 ). At days 7 and 14 following treatment, lesion length and cross section was ( 1. 107 ±0. 143) cm and (0.433 ±0. 163) cm in Group A, (0.567 ±0.082) cm and (0. 160 ±0. 078) cm in Group B, and (0.980 ±0. 203) cm and (0.686 ± 0. 157) cm in Group C. There was statistical significance between the test groups (Groups A and B) and Group C (P＜0. 01) at day 14. The lesion size in Group A was lager than that in Group B (P ＜ 0.01 ). One month after treatment, a slight nephrohydrosis occurred in Group B. Conclusions Either injection of simple hemocoagulase or combined use of hemocoagulase and Alpha-cyanoacrylate guided by CEUS can attain positive hemostatic effect, but the latter one is more rapid and reliable.
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Objective To determine the safety and efficacy of minimally invasive surgical treatment for post-traumatic thoracolumbar kyphosis. Methods A retrospective review was performed on seven patients with post-traumatic thoracolumbar kyphosis admitted from April 2009 to February 2010.There were four males and three females, at average age of 45.3 years. After general anesthesia, minimally invasive transarticular osteotomy and multi-level SextantTM percutaneous reduction and internal fixation were performed under QuadrantTM working tube system. The status of pain and ability was evaluated by using visual analogue scale (VAS) and Oswestry disability index (ODI). The kyphotic deformity was evaluated by using the Cobb's angle. Results The operation lasted for mean 135 minutes, with mean perioperative blood loss of 106 ml but with no any complications occurred. The mean follow -up period was 5.5 months ( range 4 -16 months ). The mean VAS score was improved from preoperative ( 7.6 ±3.5) points to postoperative (2.5 ± 1.3) points, with statistical difference (P ＜0.01 ). The mean ODI was improved from preoperative 53.6 ± 24.2 to postoperative 20.6 ± 6.3, with statistical difference ( P ＜0.01 ). The Cobb angle was also improved from preoperative ( 32. 1 ± 4.5 ) ° to postoperative ( 7.3 ±2.9 ) °, with statistical difference ( P ＜ 0. 01 ). Conclusion Minimally invasive transarticular osteotomy under QuadrantTM working tube system is a safe and effective alternative for dealing with post-traumatic thoracolumbar kyphosis.
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Objective To discuss the value of percutaneous compression plate (PCCP) in treating intertrochanteric fractures. Methods A retrospective study was done on 57 patients with intertrochanteric fractures treated by PCCP from January 2008 to January 2009 to evaluate the operative effect.Results All the fractures were healed in 11-15 weeks after the operation, with no incision infection, hematoma, internal fixation failure or fracture collapse. Two surgical incisions were for 2 cm, with no blood transfusion found in any patient. According to Harris score, the postoperative excellent rate reached 92.6%. Conclusion PCCP can attain similar effect wiht DHS and now is the choice of treatment in treating intertrochanteric fracture in the elderly patients.
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Objective To discuss the functional results of percutaneons compressive screw fixation for float injury to the pubic symphysis. Methods From March 2003 to March 2007, 48 cases of float injury to the pubic symphysis were treated with percutaneons compressive screws, including 27 males and 21 females with an average age of 29.4 years. Of them, 39 eases were complicated with injury to the pelvic posterior ring. Emergency surgery was done for 13 cases, 27 cases were operated on within 3 to 7 days after injury and 8 within 7 to 14 days. Guided pins and screws were used during dosed reduction and percutaneous pelvic fixation was done under the guidance of intraoperative fluoroscopic imaging. Float injury to the pubic symphysis was amended by percutaneous fixation after dosed manipulation. Results The average operation time for the48 patients was 55 (31 to 100) min. The intraoperative bleeding averaged 20 to 30 mL. Satisfactory reduetian and fixation was achieved in 41 cases, but 7 cases had poor reduction. All the fractures healed 3 to 6 months postoperatively without infection, nonunion or injury to vessels, nerves or organs. All the patients could turn the body freely in bed the day after operation. Those without injury to the pelvic posterior ring could walk with crutches 3 days after operation. By the Orlando evaluation system for pelvic fractures, 37 eases were rated as excellent, 7 as good, 3 as fair and I as poor. Conclusions The percutaneous compressive screw fixation may decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures may be avoided by using percutaneons techniques.