ObjectiveTo investigate the clinical effect of biliary stent implantation through T-tube lumen and nasobiliary drainage through intrahepatic bile duct in the treatment of biliary leakage after biliary tract exploration.MethodsRetrospective analysis was performed on the clinical data of one case of bile leakage after common bile duct exploration admitted to the Department of Hepatobiliary Surgery of Nanchong Central Hospital in December 2016.ResultsIn this case, the biliary stent was placed in the T-tube lumen and the nasal bile duct was placed in the intrahepatic bile duct for biliary drainage. The guidewire was inserted into the hilum of liver through the tunnel in the T-tube cavity, and nasobiliary drainage was placed to the hilum of liver. In addition, a guide wire was inserted through the T-tube into the duodenum, and a 8.5F plastic stent was placed into the duodenum. One end of the stent was placed in the common bile duct, and the other end was placed in the intestinal cavity for biliary drainage. After drainage, the patient’s bile leakage stopped and the abdominal infection was controlled. Ten days after the biliary stent implantation, the patient was discharged successfully, the T-tube and nasobiliary duct were clamped 20 days after the surgery, and T-tube angiography and abdominal B-ultrasound were performed 2 months later, and it found that the scaffold of the lower common bile duct had fallen off, so removed the T-tube. The patient recovered completely after 2 years of follow-up.ConclusionThe means of T-tube tunnel biliary stent and the nasobiliary duct drainage through the intrahepatic bile duct are effective methods to treat biliary leakage, the operations are simple and easy to operate.
Mitral valve regurgitation is one of the most common heart valve diseases, of which secondary mitral valve regurgitation (sMR) has large proportion and poor prognosis. For patients who still have symptoms after the guideline-directed management and therapy, the effects of surgery are controversial, and transcatheter therapy provides a new option. Transcatheter edge-to-edge repair has become one of the recommended therapies by the guidelines, meanwhile transcatheter mitral valve annuloplasty and transcatheter mitral valve replacement are developing. However, the etiological mechanism of sMR is complex and diverse. There is an interaction between cardiac function and structure and sMR in dynamic change. It brings challenges to the selection of indicators and evaluation timing. The complex anatomical structure also makes it more difficult to design instruments and select surgical methods. This paper reviews the challenges and progress of transcatheter therapy for sMR.
Mitral regurgitation is the most prevalent valvular heart disease, with a poor prognosis that brings a heavy burden to population health and socio-economics. Transcatheter repair is a relatively mature technique for mitral regurgitation, but is strict in anatomical screening and the reduction of regurgitation is limited. With the advance in techniques and technology, transcatheter replacement has become an attractive treatment modality for mitral regurgitation in succession to transcatheter repair. At present, several replacement devices have initiated clinical trials to establish feasibility. Early data has shown that transcatheter replacement for mitral regurgitation is safe and effective, which needs to be confirmed with larger population and longer follow-up. Besides, some technical challenges remain to be addressed, in order to increase accessibility of this innovative technology.
Nowadays, percutaneous pulmonary valve treatment is a hot topic in valvular heart disease, consisting of percutaneous balloon pulmonary valvuloplasty and percutaneous pulmonary valve implantation (PPVI). The percutaneous balloon pulmonary valvuloplasty is the prime intervention of pulmonary valve stenosis. The main indication of PPVI is pulmonary valve regurgitation and/or obstruction. PPVI is still the research focus, with the improvement of surgical indications and the development of surgical devices. However, compared with surgical pulmonary valve replacement, it still has limitations. This article reviews the treatment progress of percutaneous pulmonary valve treatment, especially PPVI.
Transcatheter aortic valve replacement (TAVR) for aortic stenosis has been confirmed to be safe and efficient, and its status has gradually increased with the continuous updating of guidelines. But for severe pure aortic valve regurgitation, it has long been considered a relative contraindication to TAVR. However, many elderly, high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance. But because of the complexity and challenging anatomic features, high technical requirements, limited device success rate, high rate of complications, and lack of randomized controlled studies to confirm its safety and efficacy, TAVR treatment of pure aortic regurgitation has been evolving in a debate. In recent years, with the application of new-generation valves and an increasing number of studies, some new insights have been gained regarding TAVR for severe aortic regurgitation, and this article will review the progress of research on TAVR for severe pure aortic regurgitation.
Objective To assess the effect of continuous positive airway pressure treatment (CPAP) on subjective and objective sleepiness in patients with obstructive sleep apnea-hypopnea syndrom (OSAHS). Methods We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSAHS. We use computer to search Pubmed (1990-2008.5), CNKI (1994-2008.5), google (1995-2008.5), Springer Link (1997-2008)、 and many meeting articals. We chose the literatures that divided patients randomly into two groups as CPAP group and subtheraputic CPAP or drug group. Meta-analysis were performed to access the effect and bias. Results A total of 15 trials involving 1 052 patients were included. A Meta-analysis showed that (1) The total effect was that compared with the control group, CPAP treatment group significantly depressed the degree of sleepiness in ESS [WMD= – 2.61, 95%CI (– 3.92, – 1.29)] and in MWT/ MSLT [WMD= 1.42, 95%CI (– 0.01, 2.85)]. (2) Results of subgroups on ESS were that: 1. CPAP vs CT: there was a significant effect on CPAP therapy [WMD= – 3.15, 95%CI (– 4.84, – 1.47)]. 2. CPAP vs sham CPAP: there was no significant difference between the two groups. 3. CPAP vs drugs: CPAP was more efficient than drugs. CPAP may be more efficient in improving patients’ life quality. Conclusion CPAP is a valuable treatment for OSAHS no matter in subjective or objective sleepiness .But more attention should be paid to the lone-time treatment of CPAP.
目的 观察和评价采用偏心型封堵器导管介入治疗干下型室间隔缺损的近期疗效和安全性。 方法 2011年8月－12月，6例经无主动脉瓣脱垂的干下型室间隔缺损（直径≤7 mm）患者（年龄＞3岁）在杂交手术室接受介入治疗。造影评估后，建立动静脉轨道，在保留导丝的情况下置入合适型号的国产偏心型室间隔缺损封堵器，并于术后定期随访复查。 结果 6例患者缺损直径4～7 mm（平均5.3 mm），其中5例成功地接受了导管介入封堵治疗，置入封堵器直径5～9 mm（平均6.4 mm）。仅1例因封堵器置入后出现主动脉瓣受压影响关闭，即改由外科微创经胸封堵成功。所有患者在随访期内，无栓塞、残余分流、瓣膜功能障碍、房室传导阻滞、死亡等并发症。 结论 无主动脉瓣脱垂的干下型室间隔缺损患者接受导管介入封堵治疗是安全、可行的，且短期随访结果良好。
Quadricuspid aortic valve (QAV) is a rare congenital heart disease, and its long-term lesion type is mainly reflux. The application of transcatheter aortic valve replacement (TAVR) in such patients is extremely rare. This article reports a case of an elderly patient with QAV complicated with severe regurgitation and small subvalvular membrane. Through preoperative evaluation and guidance from the cardiac team discussion, a relatively high oversize rate retrievable valve was selected and the TAVR surgery was successfully completed. At the same time, the valve implantation depth was adjusted to cover the subvalvular membrane. After surgery, the patient’s symptoms such as palpitations were significantly improved. No obvious perivalvular leakage or regurgitation was observed. It provides a reference for TAVR surgical plans for such patients.
ObjectiveTo compare the efficacy and safety of Venus A-Valve and other overseas devices in transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis (AS).MethodsWe retrospectively analyzed the baseline characteristics, procedural details, and postprocedural outcomes of severe AS patients who underwent TAVR with Venus A-Valve or overseas devices between April 2012 and January 2019 in West China Hospital of Sichuan University.ResultsA total of 342 AS patients undergoing TAVR were finally included, 238 with Venus A-Valve and the other 104 with overseas devices (43 with CoreValve, 33 with Lotus, 21 with SAPIEN XT, and 7 with SAPIEN 3). Baseline characteristics were comparable between the two groups, and the proportion of patients with bicuspid aortic valve was around 50% in both groups. After successful valve implantation, all patients’ hemodynamics were significantly improved, with the median of maximum velocity decreased to 2.30 m/s (inter-quartile range: 0.60 m/s) and 2.50 m/s (inter-quartile range: 0.62 m/s), respectively (P=0.003). Postprocedural 30-day and 1-year all cause mortalities were similar (30-day: 5.9% vs. 1.9%, P=0.086; 1-year: 8.4% vs. 5.8%, P=0.307), while low incidence of procedure-related complications and improved life quality were achieved in both groups.ConclusionTAVR with the domestic Venus A-Valve is feasible, safe, and can produce favorable outcomes for AS patients, and especially for Chinese TAVR population with a high prevalence of bicuspid aortic valve.
Objective To investigate whether an internet-based neck-specific training program can alleviate pain and disability in participants with cervical spondylotic radiculopathy (CSR). Methods Patients diagnosed with CSR at West China Hospital of Sichuan University between March 2022 and September 2022 were randomly allocated to either an telehabilitation group or a traditional treatment group. The primary outcome measures included Visual Analogue Scale, Neck Disability Index, and patient satisfaction. Secondary outcome measures included the Euroqol group’s 5-Domain questionnaire, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Tanaka Jingjiu cervical spondylosis symptom scale (20 points) and satisfaction. Quantitative outcome measures were collected at baseline, 12th and 24th weeks after the first intervention, while qualitative outcome measures were collected at 24th weeks after the first intervention. Results A total of 90 patients were included, with 45 in each group. There was no statistically significant difference between the two groups in terms of age, gender and other demography characteristics and general data (P>0.05). There is no interaction effect (group × time) for the Tanaka Jingjiu cervical spondylosis symptom scale (20 points) (P>0.05), the interaction effects (group × time) for other quantitative outcome measures were statistically significant (P<0.05). The time effect showed significant statistical differences across all quantitative outcome measures (P<0.001), while the group effect did not exhibit any significant statistical differences (P>0.05). The comparison results within the group showed that at different time points, the differences between the two groups were statistically significant (P<0.001). There were no significant statistical differences between the two groups in terms of qualitative outcome measures (P>0.05) . Conclusions An internet-based neck-specific training program or traditional treatment for 12 weeks can effectively reduce pain and disability among CSR patients, with significant long-term effects. There was no significant difference in treatment effectiveness between the two groups.