Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetu...Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.展开更多
目的:探讨采用预置牛心包包裹-右心分流法对伴凝血功能异常的A型主动脉夹层(AAD)手术的止血效果及早期疗效。方法:回顾性分析2018年1月—2022年9月于南部战区总医院心脏外科中心行全弓置换手术的患者399例,术前伴凝血功能异常AAD患者78...目的:探讨采用预置牛心包包裹-右心分流法对伴凝血功能异常的A型主动脉夹层(AAD)手术的止血效果及早期疗效。方法:回顾性分析2018年1月—2022年9月于南部战区总医院心脏外科中心行全弓置换手术的患者399例,术前伴凝血功能异常AAD患者78例,根据术前是否采用预置牛心包包裹法止血进行分组,其中预置包裹组23例,对照组55例。全组内科凝血异常治疗策略参考美国2017 EACTS/EACTA(成人心脏手术患者血液管理指南)对症治疗,预置组均采用预置牛心包包裹-右心分流法止血,对照组止血先尝试主动脉人工血管“裸奔”,必要时加牛心包或自体心包补片包裹分流止血。比较分析两组患者术前一般资料及凝血异常指标情况、手术情况、输血量及凝血药物使用情况及术后早期恢复情况。结果:全组AAD伴凝血功能异常患者均完成外科手术操作。①术前情况:两组患者年龄、发病时间、高血压例数、肝功能异常情况及凝血相关异常指标无明显差异;②术中情况:两组行Bentall术(带主动脉瓣人工血管升主动脉替换术)、心脏停搏时间无明显统计学差异,与对照组相比,预置组体外循环时间[(291.5±56.8) min vs (223.7±45.3) min,P<0.001]、手术时间较短[(495.5±81.3) min vs (380.6±65.8) min,P<0.001];③输血量及凝血药物使用情况:与对照组相比,预置组输注血液制品(浓缩红细胞、新鲜冰冻血浆和血小板)及使用凝血相关药物(凝血酶原复合物、纤维蛋白原和重组人凝血七因子较少)(P<0.05);④术后恢复情况:与对照组比较,预置组患者术后24 h纵隔引流量较少、ICU留滞时间较短(P<0.05),院内死亡例数、机械通气时间、再次开胸止血、纵隔感染例数、床旁血滤治疗例数减少,但无统计学差异(P>0.05)。结论:预置牛心包包裹止血法应用于伴凝血功能异常的AAD手术基本不增加主动脉阻壁时间,可减少体外循环辅助时间�展开更多
基金supported by the National Key R&D Program of China (grant no.2019YFC1005105).
文摘Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.
文摘目的:探讨采用预置牛心包包裹-右心分流法对伴凝血功能异常的A型主动脉夹层(AAD)手术的止血效果及早期疗效。方法:回顾性分析2018年1月—2022年9月于南部战区总医院心脏外科中心行全弓置换手术的患者399例,术前伴凝血功能异常AAD患者78例,根据术前是否采用预置牛心包包裹法止血进行分组,其中预置包裹组23例,对照组55例。全组内科凝血异常治疗策略参考美国2017 EACTS/EACTA(成人心脏手术患者血液管理指南)对症治疗,预置组均采用预置牛心包包裹-右心分流法止血,对照组止血先尝试主动脉人工血管“裸奔”,必要时加牛心包或自体心包补片包裹分流止血。比较分析两组患者术前一般资料及凝血异常指标情况、手术情况、输血量及凝血药物使用情况及术后早期恢复情况。结果:全组AAD伴凝血功能异常患者均完成外科手术操作。①术前情况:两组患者年龄、发病时间、高血压例数、肝功能异常情况及凝血相关异常指标无明显差异;②术中情况:两组行Bentall术(带主动脉瓣人工血管升主动脉替换术)、心脏停搏时间无明显统计学差异,与对照组相比,预置组体外循环时间[(291.5±56.8) min vs (223.7±45.3) min,P<0.001]、手术时间较短[(495.5±81.3) min vs (380.6±65.8) min,P<0.001];③输血量及凝血药物使用情况:与对照组相比,预置组输注血液制品(浓缩红细胞、新鲜冰冻血浆和血小板)及使用凝血相关药物(凝血酶原复合物、纤维蛋白原和重组人凝血七因子较少)(P<0.05);④术后恢复情况:与对照组比较,预置组患者术后24 h纵隔引流量较少、ICU留滞时间较短(P<0.05),院内死亡例数、机械通气时间、再次开胸止血、纵隔感染例数、床旁血滤治疗例数减少,但无统计学差异(P>0.05)。结论:预置牛心包包裹止血法应用于伴凝血功能异常的AAD手术基本不增加主动脉阻壁时间,可减少体外循环辅助时间�
