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  杨传瑞 医学博士、主任医师
  早年从师于我国著名心脏瓣膜外科专家蔡用之教授,获心脏外科硕士学位。后期师从我国心胸外科学会主席、著名心脏血管外科专家孙衍庆教授,获心脏外科博士学位。
点击浏览杨传瑞详细信息
杨传瑞博士曾在德国梅芝医学院 Kaiserslautern 心脏外科中心工作一年,主攻冠心病搭桥手术,具有600余例搭桥手术经验。并先后以访问学者的身份前往德国柏林心脏中心、法国巴黎心脏外科中心及意大利米兰心脏外科中心参观访问。
近年来在北京安贞医院率先开展经腋下小切口行房间隔缺损、室间隔缺损手术及瓣膜替换手术,手术成功率百分之百。
专业特长:
  从事心脏外科的教学、科研及临床工作22年。在儿童先心病、室间隔缺损、房间隔缺损、法鲁氏四联症等手术;心脏瓣膜替换手术以及冠心病搭桥手术等具有丰富的临床经验。
        
杨传瑞博士在第15届亚洲心脏外科学会(年会)上作微创专题报告
[日期  共阅 2772 次]

          2007年5月17- 20日接受亚洲心脏外科学会主席吴清玉教授邀请,杨传瑞博士主持第15届亚洲心脏外科学会年会微创专题会议,并在会议上报告了采用系列微创器械经腋下小切口成功治疗先心病741例,风心病(瓣膜成形及换瓣)91例,为目前世界上采用该技术临床应用的最大一组病例(832例)报告。该组病人到目前为止,尚无一例病人出现严重手术并发症。手术效果极佳。

以下为该报告的英文摘要

Experience   in   Correction  of   Congenital Heart   Disease  and   Valve  Replacement of  Rheumatic   Heart   Disease   by    Minimally Invasive  Surgery
                        ( 832  cases report )
                                                                                  
 (abstract)
 
Chuan-rui  Yang  MD. zhang jianqun MD, Bo ping MD, Chao xiangrong MD, Xu yi MD  Bai tao MD ,Hang xinsheng MD, Huang guohui MD, Song wei MD, Mu junhsneg MD

Department  of   Cardiac     Surgery   ,  Anzhen   Hospital , Capital  Medical  University,   Beijing , China
 
From July  2000  to  September 2006,  741patients with  congenital  heart disease ( ranging from  2 to 42 years old ) were repaired , and 91 patients with Rheumatic   Heart   Disease  ( ranging  from 16 to  57 years )   had mitral valve  operation  using  Right   Oblique    Infra-Axillary  Thoracotomy
 
                               Material and method
Medtronic Aortic Cannular
 
A stab knife  for ascending aortic cannulation

Stabilizers   for Aortic Cannulation

Stabilizers   for Superior Vena Cave cannulation

Retractor for Pericardium Suspension
 
Minimally Invasive Right Oblique Infra-Axillary  Thoracotomy for Congenital Heart Disease741 Cases
 
VSD        ——            391 cases
VSD   +  DCRV______________       7  cases
ASD            ——                 327  cases           
Teralogy of Fallot ­ —                    4  cases
PAVCD         ——                   5  cases
PAPVC         ——                   7  cases
 
 
Minimally   Invasive   Right  Oblique  Infra  --  Axillary Thoracotomy for Mitral Valve disease,  Total:  91  Cases
MVR + TVP   ——             51   cases
 MVR         ——             25   cases
MVP         ——             9   cases
Thrombi of left atrium_ _________  6   cases
 
SURGICAL TECHNIQUE (1)
Right Oblique  Infra-Axillary  Thoracotomy
--------------------------------------------------------------------------
1.Patient position : Left  lateral decubitus 45 degrees            
2.The skin incision :From third to fifth intercostal  space  (5—12 CM)
3.Entering the chest cavity through the fourth or third intercostal
4.Opening the pericardium longitudinally 2 to 3 cm anterior to the phrenic nerve
 
SURGICAL TECHNIQUE(2)
A series of  new operative instruments:
--------------------------------------------------------
1. A stab knife  for ascending aortic cannulation
2. Medtronic aortic cannular
3. retractor for pericardium suspension
4. A new instrument tool for bicaval snares
5. Stabilizers for all kinds of cannulation
 
                               Result (1)
     ( In Congenital  Heart Group )
      Skin incision: 5—8cm in children8 – 12cm over 12-year
      Aortic clamping time 18 – 72minutes
      285 of  327 ASD were beating heart surgery ,
      CPB time : 16- 82minutes;
      Operation time 58 – 153 minutes
 
                                result (2)
     ( In Congenital  Heart Group )
       no early or late deaths in  this  group
       Aortic rupture one case
       hemorrhage necessitating reexploration  6 cases
       paresis of the right hemidiaphragm – one case
       rib fractures in 12 patients.
      Follow-up ranged from 4 to 72 months (mean 48.8 months) and included 426 of the 741patients. They were all in normal sinus rhythm and free of symptoms, in New York Heart Association functional class I except for one patient who had mild dyspnea with exertion, attributed to right phrenic nerve paralysis in congenital  heart group
 
 
                                Result (3)
                    ( In Rheumatic   Heart   Disease Group )
Skin incision in adult patients:9.6±1.81cm
Aortic clamping time:40.8±23.29minutes
CPB time 67.4±32.52 minutes
Operation time 130±26.85 minutes
                               Result (4)
                    ( In Rheumatic   Heart   Disease Group )
 
no early  deaths in  this  group
Aortic bleeding  one case
hemorrhage necessitating reexploration  one case
paresis of the right hemidiaphragm – one case
rib fractures in four patients.
Follow-up ranged from 5 to 68 months (mean 42.3 nonths) and included 64 of the 91 patients. They were all  in New York Heart Association functional class I or II except for one patient who had died 2 months after operation in Rheumatic  Heart  Disease group
 
                               Discussion
       Complete median sternotomy  is  the conventional  approach  for  cardiac  operations , but  it  has  the invasive  and  cosmetic  problems,   especially   in young    female   patients.     Minimally    invasive  approaches  for cardiac  operations have recently gained widespread interest. --------- Laks H, Hammond GL. A  and  Dietl CA, Torres  AR.
Traditional    surgical   dictums,   such   as “wounds   heal   from  side  to  side  and not  end  to  end”  and   “always  make an incision   big  enough  to  assure  complete exposure”  are  gradually  yielding  to  less invasive  operations.----  Doty  DB.   (from  LDS  Hospital, Salt  Lake City, Utah USA  in 1998)
  According  our  experience, using A series of  new operative instruments for treating Congenital Heart  Disease  and  Valve  Replacement of  Rheumatic   Heart   Disease   by  Minimally Invasive Right Oblique Infra-Axillary  Thoracotomy  has follouing advantages:
1.Short Incision
2.Operating Time is shortened  for Some Patiets
3.Less Pain Postoperation
4.A Few Days for Staying in Hospital
5.Less Incidence for Temponade
 
Disadvantages: Not Suitable for Some Patients including  Congenital Heart  Disease combined with left side disease and some Rheumatic  Heart  Disease. 
 

 

 
 
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