CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略

目的:探讨CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略。方法:回顾分析颌下腺后段导管结石初治的患者共77例的CBCT和临床资料,以CBCT矢状位三维成像,磨牙后纵线为解剖标志线,并根据结石横径和位置将患者分为4组,Ⅰ组:线后结石(n=22);Ⅱ组:线前直径>4 mm结石(n=33);Ⅲ组:线前直径<3 mm结石(n=17);Ⅳ组:线前直径3~4 mm结石(n=5)。对Ⅰ组患者手术从口外入路摘除腺体同时去除结石,对Ⅱ组30例在内镜辅助下口内旁路切口取出结石保留腺体(预定方案),3例切除腺体(改行方案)。Ⅲ组16例均通过涎腺内镜从导管内直接取出(预定方案),1例通过口内旁路取出(改行方案)。Ⅳ组3例通过涎腺内镜从导管内直接取出(预定方案),2例改为口内旁路方案。结果:预定方案手术成功率Ⅰ组100%,Ⅱ组90.9%,Ⅲ组94.1%,Ⅳ组60%。并发面神经损Ⅰ组2例(9.0%),舌神经损伤Ⅰ组4例(18.1%),Ⅱ组12例(40.0%)。术后结石复发Ⅱ组2例(6.7%),Ⅲ组1例(6.7%)。结论:CBCT定位结合涎腺镜指导颌下腺后段导管结石清除术能够在尽量保留腺体功能,减少手术创伤和并发症。

RADIOFREQUENCY CURRENT CATHETER ABLATION OF THE LEFT ATRIOVENTRICULAR ACCESSORY PATHWAYS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia(PSVT) underwent radiofrequency catheter ablation(RFCA). The success rate was 94. 3%. Among these patients,26 had manifest preexcitation syndrome, and 44 had concealed preexcitation. Eighteen patients with concealed preexcitation underwent coronary sinus (CS) pacing, and delta wave appeared in 15. The keys to successful RFCA were correct positioning of the radiofrequency(RF) catheter tip, A/V amplitude ratio, AV interval (in sinus rhythm) and VA interval(during SVT or ventricular pacing). After 1～14 months of follow-up. two patients had supraventricular tachycardia(SVT) recurrence.

CLINICAL ADVANTAGES OF TOTAL CAVOPULMONARY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS

Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (EC-TCPA) without cardiopulmonary bypass (CPB). Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (no-CPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period. Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appe-ared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P = 0.04) and hospital stay (P = 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P = 0.004) in no-CPB group compared with CPB group. Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.

出血性休克复苏时应用心肺支持可改善心肌功能(英)

严重出血性休克即使控制失血仍因供氧需氧矛盾、心内膜下明显受损，而致心肌功能失常。近年便携式体外循环机的改进又不需肝素化，临床试用于抢救心梗或肺梗塞已有成功的报道。严重创伤病人用心肺支持（CPS）是否有盖尚无定沦。为此作者将羊制成出血休克模型，复苏时使用CPS观察对左室功能、心肌血流量以及代谢的影响。作者选择24只羊在右房和右股动脉置旁路导管。左室心尖处置放高度传真性测微压力计。