國立成功大學醫學院附設醫院 外科部 心臟血管外科

Presentation on theme: "國立成功大學醫學院附設醫院 外科部 心臟血管外科"— Presentation transcript:

1 國立成功大學醫學院附設醫院 外科部 心臟血管外科
我在成大外科六年 賴昭翰 國立成功大學醫學院附設醫院 外科部 心臟血管外科

2 一生最美麗的決定，7/7請大家出席

3 我就是來走心臟外科的！ 帶著兩把刀出生的小孩 “行心臟外科咁好?”

4 住院醫師前期 R1-R2 葉明霈 周進風 R3-R4 總醫師、急診一起來 Legal problem AVF, LIMA harvest

5 成大第一例心臟移植

6 去年立下的目標

7 Result of ECMO Time Successful weaning/ support (%) 2004 to 2006/6
4/13 (30.8) 2006/6 to present 7/11 (63.6) Total 11/24 (45.8)

8 一篇影響我很深的文章

9 Endovascular Surgery 到林口長庚醫院短暫學習endovascular surgery 史丹佛大學一遊，學習EVAR
在OR內, 利用NS的C-arm做percutaneous transluminal angioplasty (PTA) Endovascular aortic repair (EVAR)的基礎 史丹佛大學一遊，學習EVAR

10 Surgical mortality (%)
謝謝你們給我們面子 Surgery Number Surgical mortality (%) Remarks CABG 48 2 (4.17) LVEF<30% × 4, AMI × 1 Beating heart 9 Valve surgery 20 LVEF<30% × 3, AMI × 1 Valve + CABG 6 Aortic surgery 12 Thoracic aorta 5 AAo × 3, DAo × 2 Abdominal aorta 7 Ruptured AAA × 1 Others 11 Total 91 2 (2.20) Age>80y/o × 7

11 印象最深的兩台手術 (1) Patient 1 Age/ gender 78, M Op date 2006/11/17 Diagnosis
AR + AAo aneurysm + MR + CAD1 Op time 8hrs and 30mins Operation Bentall's op + MVP + PCABG1 Extubation POD1 Discharge POD10 楊P評語 可以畢業了

12 印象最深的兩台手術 (2) Patient 2 Age/ gender 65, M Op date 2007/02/19 Diagnosis
Type A IMH (A variant of aortic dissection) Op time 6hrs Operation AAo replacement Extubation POD1 Discharge POD11 楊P評語 95分 病人感謝 二十年前，我協助成立成大醫院，幫助了很多病人；二十年後，也救了我自己

13 Publications Original article Case report
Lai CH, Shan YS, Sy ED, Hsieh YH, Tsai HW, Lee JC, Lin PW. The significance of CD44 expression in gastrointestinal neuroendocrine tumors. Hepato-gastroenterology Jul-Aug;52(64): (SCI) Case report Lai CH, Chen JY, Wu HY, Wen JS, Yang YJ. Successful conservative management with positive end-expiratory pressure for massive haemothorax complicating pacemaker implantation. Resuscitation. In press. (SCI) Lai CH, Wu JM, Yang YJ. Ebstein's anomaly of the tricuspid valve in combination of tetralogy of Fallot: total correction in infancy. Ann Thorac Surg Jan;83(1): (SCI) Roan JN, Lai CH, Wen JS, Lin PY, Luo CY, Wu JM, Yang YJ. Correction of tetralogy of fallot with absent pulmonary valve syndrome in a young infant using a bicuspid equine pericardial tube. J Formos Med Assoc Apr;105(4): (SCI) Wu HY, Yang YJ, Lai CH, Roan JN, Luo CY, Kan CD. Bilateral complete persistent sciatic artery. J Formos Med Assoc. Accepted. (SCI)

14 In Writing Original article Case report
Lai CH, Ko WC, Chen PL, Wu HY, Roan JN, Kan CD, Yang YJ, Luo CY. Infected aneurysms in adults with non-typhoid Salmonella bacteremia: Incidence, risk factors and prognosis. Lai CH, Wu HY, Kan CD, Wen JS. Small incision on preformed venocutaneous tunnel: a simple technique for permanent hemodialysis catheter exchange. Case report Lai CH, Wen JS, Lin PW, Luo CY. Secondary iliac arterio-rectal fistula and infected aortic stump pseudoaneurysm complicating appendicitis-related infected iliac aneurysm.

15 Conference Papers 國際外科醫學會 外科醫學會年會 胸腔心臟血管外科醫學會年會
Lai CH, Shen YS, Lee JC. Nested Polymerase Chain Reaction in the diagnosis of Negative Ziehl-Neelsen Stained Mycobacterium Tuberculosis in Ano: Report of Four Cases. 2002 外科醫學會年會 賴昭翰, 羅傳堯. Surgery for Proximal Aortic Dissection: Late Results. 2007 賴昭翰, 羅傳堯. Surgical Results for Acute Aortic Syndrome. 2007 賴昭翰, 羅傳堯. Application of "Bi- or Tri-furcated Vascular Graft" in Aortic Arch Reconstruction. 2006 賴昭翰, 羅傳堯. Equivalent Mid-term Outcomes after Off-pump and Conventional Coronary Artery Bypass Grafting. 2006 賴昭翰, 羅傳堯. Analysis of Conversion in Off-pump Coronary Artery Bypass. 2005 賴昭翰, 楊友任. Anomalous Origin of the Right Coronary Artery from the Main Pulmonary Artery: A Case Report. 2004 賴昭翰, 沈延盛. The Significance of CD44 Expression in Gastrointestinal Neuroendocrine Tumors. 2003 賴昭翰, 李政昌. Nested Polymerase Chain Reaction in the diagnosis of Negative Ziehl-Neelsen Stained Mycobacterium Tuberculosis in Ano: Report of Four Cases. 2002 胸腔心臟血管外科醫學會年會 賴昭翰, 羅傳堯. Technical Problems from Right Axillary Artery Cannulation in Proximal Aortic Surgery. 2006 賴昭翰, 楊友任. Ebstein’s Anomaly of the Tricuspid Valve in Combination of Tetralogy of Fallot: Total Correction in Infancy. 2005 賴昭翰, 羅傳堯. Aortic Stump Mycotic Aneurysm- A Case Report. 2005 賴昭翰, 羅傳堯. Alternative Method for Proximal Anastomosis on Porcelain Aorta in Coronary Artery Bypass Grafting. 2003

16 六年行醫心得 Surgeon沒有做錯事，病人就有機會存活 快樂是短暫的，痛苦卻是長久的 嘴巴上再怎麼樂觀，心裡還是得戰戰兢兢

17 值得推薦的好習慣 做心臟外科醫師之前，充實自己的內科知識 紀錄所有開過的、跟過的刀 每週 紀錄老師所敎的 反省自己的過錯 至少慢跑一次5Km
至少清一次病歷

18 感謝六年來的照顧， 我一定不會讓大家失望 Lai CH, 2007