目的：：探讨经右胸食管癌切除术配合管状胃成形在食管癌治疗中的应用价值。方法：32例行食管癌切除术患者中,24例胸中上段食管癌患者经右胸颈部吻合,8例胸下段食管癌患者经右胸胸内吻合,所有患者均行管状胃成形。结果：32例患者手术切除率100%,无围手术期死亡,其中颈部吻合口瘘1例,声音嘶哑3例,肺部感染4例,均经保守治疗后治愈。所有患者均无胃排空障碍、乳糜胸及反流性食管炎等并发症的发生。32例患者术后随访3~19个月,2例肺转移,1例肝转移,其余患者均健康存活。结论：经右胸行食管癌手术更有利于肿瘤彻底切除和淋巴结清扫,管状胃重建可减少术后并发症的发生,改善患者生活质量。

Objective:To summarize the experience in repairing the atrioventricular dissociation defects by microtraumatic surgery with non-stop cardiac impulse.Methods:Twenty-four cases of congenital atrioventricular dissociation defects were repaired through the right subaxillay incision with extracorporeal circulation and the heart beating.The atria defects in 2 cases complicated with partial anomalous pulmonary venous connection(PAPVC) were enlarged and the right pulmonary vein which had been drained to the right atrium was isolated to the left atrium with a displaced septum;the valve junction incision was performed in 2 cases complicated with pulmonary valve stenosis,3 cases complicated with tricuspid valve incompetence received tricuspid valve plastic operation.Results:No deaths or complications such as residual shunt,gaseous emboli or low cardiac output were observed.The right atrium posterior wall and the right lower pulmonary veins in 2 of the cases were damaged separately;1 had transient hemoglobinuria and 1 arrhythmia.Conclusions:The procedure of right subaxillay incision with extracorporeal circulation and non-stop cardiac impulse causes little trauma,but it must be operated safely and accurately.

目的:观察中西医结合治疗真菌性角膜炎的临床疗效。方法:43例患者随机分为2组,对照组20例给予西药常规治疗,治疗组23例在对照组西药治疗的基础上给予中药外洗、内服。3个月后观察比较2组疗效。结果:治疗组有效率为95.7%,治愈率为78.3%,对照组分别70.0%、45.0%,2组比较均有显著性差异(P均<0.05)。结论:中药内服、外洗法能更好地缩短病程、提高视力,降低眼内炎、前房积脓、眼球丧失等严重并发症的发生率。

Objective To study methods,path and pass to develop Phacoemulsification and intraocular lens inplantation in primary hospital. Methods 117 cases(134 eyes) received Phacoemulsification and intraocular lens inplantation. Postoperative vision acutity were recorded in one day and one month after cataractsurgery. Intraoperative and postoperative complication were observed. Results Among 134 eyes,there are 96 eyes visual acutity ≥0.5 one day postoperation,making up 71.6%.there are 123 eyes visual acutity ≥0.5 one mother postoperation,making up 91.7%. The subcapsula lentis break in nine eyes. No nucleus lentis sink into corpus vitreum,No sevre complication occurred in the guoup. Conclusion Phacoemulsification and intraocular lens inplantation is the best choice for cataract patients. If operater learns step by step and operate carefully,they will completely grasp the technology. Phacoemulsification is a safe and reliable method. It is valuable to introduce in primary hospital.

目的 总结80例心脏瓣膜疾病的外科治疗经验.方法 80例患者中行二尖瓣置换术43例,二尖瓣成形术5例,主动脉瓣置换术12例,双瓣置换术12例,单瓣膜置换+冠状动脉搭桥术4例,二尖瓣成形+主动脉瓣置换术1例,带瓣人工血管置换术(Bentall术)2例,三尖瓣置换术1例,同期三尖瓣成形18例,血栓取出术13例,左房缩缝+左心耳结扎3例.结果 死亡3例,死亡率为3.7%.死亡原因为左室破裂、低心排并肾衰、心律紊乱各1例,低心排3例,心律紊乱10例,心包积液1例,术中二次转机2例,二次剖胸止血1例.结论 提高手术疗效,降低死亡率,应重视围术期处理及心脏功能的支持、保护,提高手术质量,减少手术并发症.

患者女,24岁.因"间断性咯血10 d,加重2 h"入我院呼吸内科.查体:双肺呼吸音粗,左下肺闻及细湿罗音,心率84次/min,律齐,各瓣膜区未闻及病理性杂音,血压120/90 mm Hg(1 mm Hg=0.133 kPa).入院后予以抗炎、止血等治疗.效果差,36 h咯血约1 500 ml.行支气管动脉造影示:左支气管动脉开口于左锁骨下动脉,见造影剂外溢,支气管壁显影.欲行左支气管动脉栓塞术,因其异位开口,导管无法进入.转入心胸外科.

1 病历报告 患者，男，45岁。活动后胸闷、气促3个月余。以登楼时心悸明显，于1999年5月6日入院。查体：体格健壮，胸骨左缘第2、3肋间闻及Ⅱ/Ⅳ级收缩期杂音；肝肋缘下2指，质较硬。双下肢轻度凹陷性水肿。X线胸片示右心房不大，心胸比0.50。实验室检查HBsAg(+)，抗-HBe(+)、抗-HBc(+)。超声心动图示右心房内可见53mm×33mm实质性团块充填，附着于房间隔近右房顶部，随心脏缩舒活动而出入于三尖瓣口，三尖瓣口血流无明显受阻。术前诊断右心房粘液瘤。1999年5月在气管插管全麻中低温体外循环下手术。