Objective To compare the efficacy and indications between the biliary bypass laparotomy surgery.and the two different kinds of biliary stent insertion surgery in the palliative alleviating jaundice of cholangiocarcinoma.Methods From March 2008 to March 2013,69 patients treated with palliative alleviating jaundice therapy of cholangiocarcinoma were included,who were all came from the Third Affiliated Hospital of Guangzhou Medical University.Including 17 patients who treated with the open biliary bypass surgery and 52 patients who treated with interventional therapy.We analysed the differences between these cases of biliary drainage operations in the recent jaundice reduction rate,average stay,mortality rate,the incidence of related complications,et al.Results All these different drainage ways had good effect in alleviating jaundice,incidence of alleviating jaundice have no obvious difference (P ＞ 0.05).Compared to the open biliary bypass surgery,interventional therapy had obvious advantages in the average stay and postoperative survival (P ＜ 0.05).The pancreatitis rate was lower in Percutaneous Group than that in Endoscopic Group (P ＜ 0.05).incidence of biliary tract infection and biliary tract bleeding have no obvious difference (P ＞ 0.05).There were no significant differences between the success rates of in biliary stent insertion operation in patients with each model cholangiocarcinoma (P ＞ 0.05).Conclusions Among the therapies of the palliative alleviating jaundice of cholangiocarcinoma,the internal biliary drainage of biliary stent insertion operation was superior to the treatment of the biliary bypass laparotomy.As to biliary stent insertion operations,endoscopic biliary stenting surgery should be the preferred choice.

Objective To investigate the early curative effect of Blalock-Taussig(B-T) shunt and summarize the key point in its post-operative intensive care,analyze the related risk factor of its mortality.Methods We collected 71 patients who received B-T shunt in Shanghai Children's Medical Center from June 2015 to June 2017. All of 71 cases were divided into neonates group (25 cases) and non-neonate group (46 cases). All patients were operated through median sternotomy,19 were emergency cases,in which 15 cases were neonates. Eight cases used cardio-pulmonary bypass in our study,in which 4 cases were neonates. Twenty-nine cases received ductus ligation in total 34 patients with patent ductus arterious. Percutaneous heparin was immediately administered after operation as an anticoagulation therapy. Relative large dosage inotropic agents was used after sufficient volume infusion in order to guarantee diastolic pressure higher than 35 mmHg(in neo-nates >30 mmHg,1 mmHg =0. 133 kPa). Ventilator parameter was adjusted to obtain appropriate flow distribu-tion between pulmonary and systemic circulation. In order to avoid excessive pulmonary flow,the target PO2 was set between 40 ～ 45 mmHg. Results Oxygen saturation elevated by 15％ after operation in all 71 cases. Average mechanical ventilation time was 92 hours,mean inotropic agents score was 17. There were 6 dead cases,mortality was 8. 5％ . In neonates,4 cases dead,mortality was 16. 0％ . There was no significant difference in ventilation time,ICU retention day and mortality between neonates group and non-neonates group. The logis-tic regression analysis showed that the body weight and ratio between the shunt conduit diameter and body weight (mm/ kg) were the risk factors for early post-operative mortality[body weight:2500 ～ 3500 g:OR =6. 729,95％ CI =1. 373 ～17. 131;≤2500 g:OR = 7. 832,95％ CI = 2. 563 ～ 28. 325. the ratio between the shunt conduit diameter and body weight (mm/ kg):1. 10 ～1. 15:OR = 4. 204,95％ CI = 1. 195 ～ 23. 926;≥1. 15:OR= 3. 981,95％ CI =1. 195 ～12. 926]. Conclusion B-T shunt is still a high risk operation although it is a palli-ative method. Low body weight and bigger diameter conduit are the significant factors related to its mortality. Strict control of the systemic and pulmonary flow ratio is the key point in the post-operation intensive care.

Objective:To summarized the experience of 149 cases of critical pediatric cardiac surgery in a single-center during the epidemic period, for providing a safe and feasible management strategy.Methods:Based on the epidemiological characteristics of COVID-19, a strategy consisting of 14 days of isolation was established for the arrangement of cardiac surgery in children during the epidemic period. Retrospective analysis of clinical data of 149 cases of critical cardiac surgery performed from January 23, 2020 to March 20, 2020 under the guidance of this strategy. The primary composite endpoint was death and suspected or confirmed COVID-19.Results:The median age of the children undergoing surgery was 136 days; 73(49.0%) cases were male. Twenty-one cases (14.1%) came from Shanghai, one case (0.7%) came from Hubei Province, and 127 cases (85.2%) came from areas other than Hubei and Shanghai. One patient (0.7%) outside Shanghai who had been isolated for less than 14 days carried emergency surgery under special protection; other 148 patients (99.3%) underwent elective early repair procedure. One patient (0.7%) died, and no COVID-19 was confirmed or suspected.Conclusion:During the COVID-19 epidemic, pediatric cardiac surgery can be safely performed using a specific management strategy, which can be used as a reference when major public health events occur.

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.