ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.
ObjectiveTo summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.MethodsWe retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.ResultsThe mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.ConclusionCTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.
摘要:目的： 分析肺动脉血栓栓塞症（PTE）的临床特征、诊断方法及治疗。提高诊断率和治愈率,改善预后。 方法 ：回顾分析我院过去七年间收治的25例PTE患者的危险因素、临床表现、辅助检查、治疗情况等临床资料。 结果 ：PTE的危险因素有深静脉血栓、高龄、心肺疾病、长期卧床等慢性基础疾病以及近期手术、外伤史等。其临床表现各异,D-二聚体、CT肺动脉造影（CTPA）敏感性高。 结论 ：PTE临床表现多样,D-二聚体可作为筛选检查首选;CTPA可作为无创检查之首选。确诊后正确及时治疗可使预后显著改善。Abstract: Objective: to analyze the clinical character\ methods of diagnosis and therapies of pulmonary thrombus embolism, to improve the precisions of diagnosis and therapy, to make prognosis better. Method : 25 patients of pulmonary thrombus embolism admitted in our hospital in the past seven years, were analyzed by risk factors, clinical manifestation accessory examination and therapies. Result : risk factors of pulmonary thrombus embolism included thrombus in venue profound, senility the diseases of heart and lung, keeping in the bed for a long time, above clinic diseases, operation and trauma in the near future their clinical manifestations were different, the sensitivity of dipolymer and CT pulmonary arteriography were high. Conclusion : clinical manifestations of pulmonary thrombus embolism were various, dipolymer may be regarded as the firster to diagnbose pulmonary thrombus embolism, CT pulmonary arteriography may be regarded as the first non-traumatogenic examination to diagnose pulmonary thrombus emboklism. After the diagnosis, correct therapies in time can greatly improver prognosis.
Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.
Abstract: Objective To investigate the clinical features, differential diagnosis, surgical treatment and outcome of primary pulmonary artery sarcoma. Methods Between January 1994 and December 2004, 5 patients with primary pulmonary artery sarcoma were identified at operation and treated by surgical resection. Pulmonary valve stenosis were initially diagnosed in 3 patients, and chronic pulmonary embolism were initially diagnosed in 2 patients. Tumor resection from the vascular bed was performed in 1 patient and tumor resection and homograft reconstruction of pulmonary arteries were performed in 4 patients. Results One patient died of postoperative refractory pulmonary hypertension, 2 patients died 4 months after operation because of brain metastases, 1 patient was alive for 9 months after operation with recurrent pulmonary tumor, and 1 patient was alive for 2 years after operation without clinical or radiological signs of tumor recurrence or metastasis. Histological examinations showed 4 malignant mesenchymomas and 1 fibrosarcoma. Conclusions Primary pulmonary artery sarcomas are rare and usually fatal tumors of the cardiovascular system. The diagnosis is difficult and this disease is frequently misdiagnosed as chronic pulmonary hromboembolism and pulmonary valve stenosis. Early diagnosis can be improved by computerized tomography scanning and magnetic resonance imaging. Radical surgical resection was the most effective modality for shortterm palliation. The prognosis of pulmonary artery sarcoma is poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis.
ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism. MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
Venous thromboembolism (VTE) is a high-risk complication in hospitalized patients, especially in patients with orthopedic surgery, neurosurgery, thoracic surgery, cardiac surgery and tumor surgery. It is also a significant cause of patients’ unexpected death and perioperative death. Through establishment of norms of VTE management system and organizational structure, formulation of perfect VTE risk assessment system and prevention and treatment scheme for hospitalized patients, training of all the medical staff for related knowledge, and test operation of the system in key departments, we established a hospital standardized system of venous thromboembolism prevention and management. Our VTE prevention and treatment work achieved good results through multidisciplinary collaboration.
摘要:目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)后发生严重并发症的原因、治疗措施和经验教训。方法:分析 2007 年 8 月至2009 年 4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果:2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开(endoscopic sphincterotomy, EST)取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论:术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
ObjectiveTo evaluate clinical outcomes of de-airing technique in minimally invasive cardiac surgery (MICS). MethodsFifty-six patients undergoing MICS in Zhongshan Hospital of Fudan University between June 2011 and June 2013 were recruited as a MICS group, including 31 male and 25 female patients with their age of 33-71 (57.3±7.2)years. Fifty-six patients who underwent mitral valvuloplasty via routine median sternotomy during the same period were recruited as the control group, including 27 male and 29 female patients with their age of 51-69 (53.7±6.8)years. Postoperative residual air in the heart, abnormal ECG findings, time to recovery of consciousness, cognitive function and neurological complications were compared between the 2 groups. ResultsThere were 69.6% patients with mild residual air and 30.4% patients with moderate residual air in the heart of MICS group, and 73.2% patients with mild residual air and 26.8% patients with moderate residual air in the heart of the control group (P > 0.05). There was no statistical difference in the incidence of abnormal ECG findings between the 2 groups (32.1% vs. 26.8%, P > 0.05). Patients with better, good and bad postoperative cognitive function accounted for 85.7%, 12.5% and 1.8% in MICS group respectively, and 78.6%, 19.6% and 1.8% in the control group respectively (P > 0.05). There was no statistical difference in the incidence of neurological complications between the 2 groups (1.8% vs. 1.8%, P > 0.05). ConclusionWith appropriate de-airing techniques, postoperative incidence of air embolism of MICS is comparable with that of conventional cardiac surgery via median sternotomy, and the risk of air embolism of MICS is not higher.
ObjectiveTo systematic review the diagnostic value of magnetic resonance (MR) for pulmonary embolism (PE).MethodsWe electronically searched databases including EMbase, PubMed, The Cochrane Library, WanFang Data and CNKI from inception to November 2016, to collect the diagnostic studies about MR in the diagnosis of PE. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies, and then meta-analysis was conducted using Stata 12.0 software.ResultsA total of 14 studies involving 1 042 patients were included. The pooled Sen, Spe, +LR, –LR and DOR were 0.90 (95%CI 0.83 to 0.94), 0.95 (95%CI 0.90 to 0.98), 19.8 (95%CI 8.5 to 46.1), 0.10 (95%CI 0.06 to 0.18), 189 (95%CI 69 to 521), respectively. The AUC of SROC were 0.97 (95%CI 0.95 to 0.98).ConclusionMR has a good diagnosis value for PE which can be regarded as an effective and feasible method for suspected PE patients, especially for those who has contraindication of computed tomographic pulmonary angiography.