Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for c...Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.展开更多
Objective：To obtain early results of off-pump coronarE~ artery bypass grafting（OPCAB） in patients with significant left main coronary artery（LMCA） and triple vessels stenosis by comparing with those of a similar ...Objective：To obtain early results of off-pump coronarE~ artery bypass grafting（OPCAB） in patients with significant left main coronary artery（LMCA） and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery（CCAB）. Methods：Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results： The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups （OPCAB group：3.76 ± 0.98, CCAB group：3.81 ± 1.02）. Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance （P 〉 0.05）. The frequency of atrial fibrillation （AF）, IABP usage, mediastinitis, re-operation for bleeding （or tamponade） were similar in the two groups （P 〉 0.05）. Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group（P 〈 0.05）.Conclusion： Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.展开更多
严重的冠脉病变包括冠脉左主干(left main coronary artery,LMCA)急性完全闭塞、次全闭塞以及3支血管病变(3-vessel disease,3-vd)。尽管LMCA急性完全闭塞患者能生存到达医院者很少,但aVR导联ST段抬高对其诊断的特异性和准确率均超过80...严重的冠脉病变包括冠脉左主干(left main coronary artery,LMCA)急性完全闭塞、次全闭塞以及3支血管病变(3-vessel disease,3-vd)。尽管LMCA急性完全闭塞患者能生存到达医院者很少,但aVR导联ST段抬高对其诊断的特异性和准确率均超过80%。对LMCA急性次全闭塞及3-vd患者,aVR导联ST段抬高的诊断价值高于心电图的任何其他单一或多个导联。aVR导联ST段抬高幅度越大、持续时间越长,患者的病情就越重。本文对aVR导联ST段抬高的诊断标准、电生理机制及国外研究进展进行综述。展开更多
文摘Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.
基金This work was supported by the Fund of Social Development in Jiangsu province(NO:BS2006013)
文摘Objective：To obtain early results of off-pump coronarE~ artery bypass grafting（OPCAB） in patients with significant left main coronary artery（LMCA） and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery（CCAB）. Methods：Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results： The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups （OPCAB group：3.76 ± 0.98, CCAB group：3.81 ± 1.02）. Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance （P 〉 0.05）. The frequency of atrial fibrillation （AF）, IABP usage, mediastinitis, re-operation for bleeding （or tamponade） were similar in the two groups （P 〉 0.05）. Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group（P 〈 0.05）.Conclusion： Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.
文摘严重的冠脉病变包括冠脉左主干(left main coronary artery,LMCA)急性完全闭塞、次全闭塞以及3支血管病变(3-vessel disease,3-vd)。尽管LMCA急性完全闭塞患者能生存到达医院者很少,但aVR导联ST段抬高对其诊断的特异性和准确率均超过80%。对LMCA急性次全闭塞及3-vd患者,aVR导联ST段抬高的诊断价值高于心电图的任何其他单一或多个导联。aVR导联ST段抬高幅度越大、持续时间越长,患者的病情就越重。本文对aVR导联ST段抬高的诊断标准、电生理机制及国外研究进展进行综述。
