目的 探讨完全单孔胸腔镜肺叶切除在高龄肺癌患者中的临床应用价值.方法 2018年2月至2019年4月,采用单孔全胸腔镜肺叶切除治疗高龄(73.1±5.9)岁肺癌患者45例,进镜和操作均位于同一个孔,取第5肋间,切口长3～5 cm,术后常规放置2根胸腔闭式引流管.结果 全组无手术死亡,无中转开胸,无严重并发症发生.手术时间(121.5±33.2)min,术中出血量(61.4土12.4)mL.术后胸腔引流(3.6±1.3)d,术后住院时间(6.6±2.3)d.清扫淋巴结(15.4±4.7)枚.结论 单孔全胸腔镜肺癌根治术在高龄患者中应用安全、可靠,值得临床推广应用.

目的 探讨恶性肿瘤合并感染性心内膜炎患者心肺转流(CPB)管理方法.方法 回顾性分析本院2010年3月至2019年3月,15例恶性肿瘤合并感染性心内膜炎患者行瓣膜置换术的CPB管理要点.结果 CPB时间35～133(71.62±14.33)min,主动脉阻断时间29～75(52.12±13.12)min,15例患者均痊愈出院,无院内死亡.结论 CPB中重视肾保护,术中加强超滤,维持适当高的血压,大剂量使用乌司他丁,可减少术后并发症,改善患者预后.

BACKGROUND:We have previously reported that hemofiltration (HF) may be an effective additional means of treating heat stroke when rapid cooling is not effective.METHODS:Dogs were assigned to a heat stroke (control) or heat stroke + hemofiltration (HF) group (n = 8 each group). After heat stroke induction, dogs in the HF group received HF for 3 h. Serum concentrations of interleukin (IL)-10, tumor necrosis factor (TNF)-α, IL-6, blood urea nitrogen (BUN) and creatinine were measured at baseline and 1, 2, and 3 h after heat stroke. Clearance rates of solutes were determined 1, 2, and 3 h after the start of HF.RESULTS:Serum concentrations of all solutes tended to increase with time after heat stroke in the control group, but decreased (BUN, creatinine) or remained relatively unchanged (TNF-α, IL-6, IL-10) with time in the HF group. Concentrations of all solutes were significantly lower in the HF group compared with the control group at 2 and 3 h (P < 0.05). Clearance rates for small molecular weight solutes were high, while those for larger molecular weight solutes were low.CONCLUSION:HF prevents heat stroke-induced increases in serum cytokine concentrations and is effective for clearing small molecular weight solutes from serum, but less effective for clearing larger molecular weight solutes, including TNF-α, IL-6, and IL-10.

Objective To explore the effects of hemofiltration on endothelin and nitric oxide in severe heat stroke dogs with shock.Methods Sixteen healthy male hybrid dogs were randomly divided into 2 groups,8 for each:as heat stroke group( HS group)and hemofiltration group( HF group).Severe heat stroke model was induced with high temperature.The dogs were taken out of the heating cabin as soon as it reached heat stroke level,then observed under normal temperature with no treatment.The HF group accepted hemofiltration treatment immediately.The changes of ET,NO,NO/ET of two groups of dogs were observed and compared.Results The value of the ET,NO,NO/ET were compared,there were no significant differences (P ＞ 0.05 ) between two groups before heatstroke.The value of ET,NO,NO/ET of the dogs were all higher when got heat stroke and the two groups of dogs showed no significant difference(P ＞ 0.05 ).One hour after heat stroke,the ET of HS group rose continually while HF group declined,but there were no difference comparing with the time of got heat stroke.The value of ET in HF group was lower than HS group(P ＜0.05).The NO of HS group rose but showed no significant difference(P ＞0.05),while in HF group the NO declined and showed significant difference(P ＜ 0.01 ).The value of NO in HF group was lower than HS group(P ＜ 0.01 ).The ratio of NO/ET in HS group and HF group all declined and showed no significant difference ( P ＞0.05).There was no significant difference in NO/ET between two groups at this time(P ＞ 0.05).After two and three hours,comparing with the time of got heat stroke,the value of ET in HS group rose apparently and showed significant difference(P ＜0.01 ),the value of ET in HF group slowly declined and showed significant difference( P ＜ 0.01 ).The value of ET in HF group was obviously lower than HS group(P ＜0.01 ).The value of NO in HS group still rose but showed no difference ( P ＞ 0.05 ),the value of NO in HF group continuously declined and showed significant difference(P ＜0.01 ).The value of NO in HF group was lower than HS group(P ＜0.01 ).The ratio of NO/ET in HS group was little lower comparing with the time of got heat stroke,but showed no significant difference(P ＞ 0.05).The ratio of NO/ET in HF group declined and showed significant difference( P ＜ 0.01 ) and apparently lower than HS group( P ＜0.01 ).Conclusions The value of plasma ET and serum NO will rise and the balance of NO/ET will be disturbed in dogs with severe heat stroke caused shock,hemofiltration can remove the ET and NO from blood,and renew the ratio of NO/ET,so the clearance of ET and NO from blood by HF may be one of the important mechanism in stabilizing the blood pressure and improving circumfusion in dogs with severe heat stroke.

Aim: To examine the effectiveness of continuous haemofiltration as a treatment for severe heat stroke in dogs.Methods: Dogs were randomly allocated to a control or continuous haemofiltration group (both n=8). Heat stroke was induced by placing anaesthetised dogs in a high temperature cabin simulator. Upon confirmation of heat stroke (rectal temperature > 42 degrees C, mean arterial pressure (MAP) decrease > 25 mmHg), dogs were removed from the chamber and continuous haemofiltration was initiated and continued for 3 h for dogs in the continuous haemofiltration group. Dogs in the control group were observed at room temperature.Results: Rectal temperature, haemodynamics, pH, blood gases and electrolyte concentrations rapidly returned to baseline in the continuous haemofiltration group, but not the control group. After 3 h, rectal temperature was 36.68 +/- 0.51 degrees C in the continuous haemofiltration group and 39.83 +/- 1.10 degrees C in the control group (P<0.05). Continuous haemofiltration prevented endotoxin and all serum enzyme concentrations from increasing and caused malondialdehyde concentrations to decrease. After 3 h, endotoxin concentrations were 0.14 +/- 0.02 EU ml(-1) in the continuous haemofiltration group and 0.23 +/- 0.05 EU ml(-1) in the control group (P=0.003), while malondialdehyde concentrations were 4.86 +/- 0.61 mmol l(-1) in the continuous haemofiltration group and 8.63 +/- 0.66 mmol l(-1) in the control group (P<0.001). Five dogs died in the control group within 3 h, whereas no dogs died in the continuous haemofiltration group.Conclusions: Continuous haemofiltration rapidly reduced body temperature, normalised haemodynamics and electrolytes, improved serum enzyme concentrations and increased survival in dogs with heat stroke. Continuous haemofiltration may be an effective treatment for heat stroke. (c) 2011 Elsevier Ireland Ltd. All rights reserved.

Objective To explore the effects of hemofiltration on serum enzyme (SE),endotoxin (ET) and malonaldehyde (MDA) of dogs with heat stroke caused shock.Methods Sixteen healthy male hybrid dogs were randomly divided into 2 groups,8 for each:as heat stroke group (HS group ) and hemofiltration group (HF group).Severe heat stroke model was induced with high temperature.The dogs were taken out of the heating cabin when it reached heat stroke level,and then observed under normal temperature without treatment.The dogs in HF group was immediately treated with hemofiltration.The changes of SE,ET,MDA of two groups of dogs were observed and the survival time between two groups was compared,Results The time from heat exposure to shock was ( 107.00 ± 28.52 ) and ( 111.38 ± 22.24 )minutes in HS group and HF group respectively ( t =- 0.354,P =0.729 ).The SE ( CK,LDH,ALT,AST) of the dogs were all higher after heat stroke,and the dogs of two groups showed no siginificant difference (P ＞ 0.05).At three hours after heat stroke,the SE increased apparently in HS group and HF group,but the level was significantly lower in HF group. Before heat stroke,the serum ET showed no siginificant difference between two groups ( P ＞ 0.05 ).After heat stroke,the serm ET was much higher than before ( P ＜0.01 ),but there was still no siginificant difference between two groups ( P ＞0.05 ).At three hours after heat stroke,the ET increased both in HF group and HS group,but the level was lower in HF group.Before heat stroke,the serm MDA had no siginificant difference between two groups ( P ＞ 0.05 ).After heat stroke,the serm MDA was much higher than before ( P ＜ 0.0l ),but there was still no siginificant difference between two groups (P ＞ 0.05 ).After heat stroke in three hours,the MDA of HS group rose apparently while HF group slowly declined.The median survival time of HF group was 180 min while HS group was 75 min,the survival rate showed siginificant difference (P ＜ 0.01 ).Conc4usions HF can improve the prognosis of dogs with heat stroke caused shock,prolong its survival time,reduce mortality.The mechanism is probably that HF clear serum MDA,partially clear serum ET and then eventually reduce cell and tissue injury and reduce SE.

在南京军区福州总医院手术室里,22岁的陈某被实施全麻后,主刀医生开始给他做胸部手术。切口处血液汩汩外流,麻醉科医生用吸引器将这些血送入一个大透明罐子——自体血储存罐。旋即又被送入一个如传真机般大小的自体血回输机,内置的无菌海绵对血液进行初步过滤,去掉杂质和有害菌体的鲜血在回输机内快速离心、过滤、清洗……层层处理后的健康血液通过静脉重新输入陈某体内。在

Objective To explore the effect of continuous hemofiltration(CHF) on internal environment and survival rate of severe heatstroke dogs with shock.Methods Sixteen healthy male dogs were randomly divided into heatshock group(HS group,n=8) and continuous hemofiltration group(CHF group,n=8).Severe heatstroke model was established by applying high temperature to whole body,and then the animals were removed from the heating cabin as soon as they presented manifestations of shock.Dogs of HS group were put into an ordinary environment,while dogs of CHF group received CHF treatment.The core temperature(Tc),mean arterial pressure(MAP),blood gas analysis,serum electrolytes and survival rate of dogs in two groups were observed.Results The time from heat exposure to shock was 107.0±28.5min and 111.4±22.2min in HS group and CHF group respectively(t=-0.354,P=0.729).The Tc in CHF group declined to normal level 15 to 30 minitues after CHF treatment,while the Tc in HS group remained at a level higher than that before heat exposure at 90min after shock.The Tc of two groups showed significant difference at each time point after shock(P < 0.01).The MAP of both groups was obviously lowered than that before heatstroke.The MAP of CHF group raised gradually 30 min after treatment,while the MAP of HS group rose very slowly,and it was significantly lower than that of CHF group at each time point after 45min(P < 0.05,P < 0.01).All the dogs in both groups manifested hyperventilation and respiratory alkalosis when shock appeared.After shock,respiratory alkalosis in HS group gradually became metabolic acidosis,with some animals manifested combined metabolic and respiratory acidosis because of respiratory decompensation,while the blood gas levels in CHF group recovered to normal gradually.The blood gas levels of two groups showed significant difference at each time point after shock(P < 0.05,P < 0.01).Hypernatremia,hyperchloraemia and hyperpotassaemia were found in all animals of both groups.In CHF group the electrolyte disturbance recovered gradually and reached normal level at 180min after shock,while it did not recover in HS group.The levels of serum sodium,chlorine and potassium in HS group were significantly higher than those in CHF group at each time point after shock(P < 0.05,P < 0.01).The median survival time of CHF group(180 minutes) was significantly longer than that of HS group(75 minutes,χ2=6.929,P=0.008).Conclusion CHF could improve the prognosis of severe heatstroke dogs with shock,prolong the survival time and reduce the fatality rate.The mechanism may be associated with fast cooling at early stage,maintenance of hemodynamic stability,and correction the acid-base imbalance and electrolyte disturbance.

目的 探讨体外培养人食管癌细胞及建立细胞系的方法,为食管癌的研究奠定实验基础. 方法 对46份食管癌新鲜标本分别采用组织块培养法和胶原酶消化悬液培养法进行体外培养并观察食管癌细胞生长情况.结果 3份标本两种方法均培养出食管癌细胞,后者培养的细胞生长速度快. 结论应用组织块和胶原酶消化法培养食管癌细胞,方法可行,适合推广应用.

OBJECTIVE:To study the expression of Aurora-B in non-small cell lung cancer (NSCLC) tissues and NSCLC cell lines.METHOD:Aurora-B expression was examined using immunohistochemical SP method in 91 stage I and 69 stage II-III NSCLC tissues and 40 adjacent tissues. The mRNA and protein expressions of Aurora-B in NSCLC cell lines (A549, H460 and H1299) were examined by RT-PCR and Western blotting, respectively.RESULTS:The protein expression of Aurora-B was detected in 77.7% (94/121) of the tumor tissues and 9.8% (4/41) of the adjacent tissues, showing a significant difference between them (P<0.01). The positivity rate of Aurora-B protein was not related with the gender and age of NSCLC patients, but with lymph node metastasis, differentiation and histological type of NSCLC (P<0.05). Aurora-B was expressed in all the NSCLC cell lines (A549, H460 and H1299) at both mRNA and protein levels. A549 cells showed the highest expression of Aurora-B.CONCLUSION:Aurora-B protein is highly expressed in NSCLC tissues and cell lines, and may play a crucial role in the invasion, metastasis and development of NSCLC. The mRNA and protein expression levels of Aurora-B differ significantly between different NSCLC cell lines.

应用床边透析机进行持续性静-静脉血液滤过(CVVH),防治犬海水型呼吸窘迫综合征.旨在为该方法的临床应用提供实验依据.

Objective To study the experimental canine models of respiratory distress syndrome(RDS) induced by immersion in seawater(SW)(SW-RDS) and treated with continuous blood purification(CBP). Methods Hybrid dog SW-RDS models were randomly assigned into trial group with continuous venous-to-venous hemofiltration(CVVH)(n=7) and control group(n=7).Fifteen minutes after immersion in SW,the dogs in the trial group were purely removed 50-100 ml fluid during four hours' CVVH treatment.The changes in blood gas analysis,endothelin(ET) and oxyradical were compared between the two groups,as well as the histological changes in the lung tissues.Results All the dogs in the trial group survived,however two dogs in the control group died after four hours' immersion in seawater.Fifteen minutes after immersion,blood gas analysis reported markedly metabolic acidosis,hypoxemia and decrease in the arterial pH,oxygen partial pressure(PaO2),saturation of blood oxygen(SO2),actual bicarbonate(AB) and base excess(BE). Afer four hours' immersion,nitrogen monoxide(NO) and superoxide dismutase(SOD) decreased,whereas ET and malondialdehyde(MDA) ascended.Compared with that of the control group,pH,AB and BE of the trial group were retrieved roughly to normal after four hours' CVVH,PaO2 and SO2 ascended(not retrieved to normal),ET and MDA significantly decreased,and SOD ascended notably.In the trial group,lung histological changes including the shape and the findings under light microscope and electron microscope were significantly lessened when compared with that in the control group.Conclusion The CBP treatment for SW-RDS dogs can retrieve acid-base balance,ameliorate hypoxemia,eliminate the fluid in lungs and palliate the injury of lungs.

目的:明确食管癌术后健侧胸腔积液的易患因素,探讨针对性的防治经验。方法:对448例食管癌手术患者的一般资料、术式、病理特征、预后进行回顾性研究。结果:全组18例(4.0%)患者发生健侧胸腔积液。采取颈部吻合者发生率显著低于胸腔内吻合者(P=0.032),淋巴结清扫范围增大则显著增加发生率(P=0.042)。发生健侧胸腔积液者ICU天数显著增加(P<0.001)。结论:保持健侧胸膜完整、减少胸腔内污染,可以降低术后健侧胸腔积液发生率。颈部吻合方式能有效避免该并发症。一旦发生,要尽早作出诊断,加强止痛,积极防治继发呼吸衰竭。

慢性心包填塞是心包积液的严重并发症,重则危及生命[1].我科自2000年1月至2003年12月,采用心包留置深静脉单腔或双腔管治疗慢性心包填塞70例,取得良好效果,现报告如下:

电视胸腔镜手术(video-assisted thoracoscopicsurgery,VATS)是胸外科领域的一项新技术,目前已广泛地应用于各类肺部疾病的治疗.2003年10月至2005年10月,我们采用VATS治疗肺部疾病42例,报告如下.

在过去的两年中我们完成了2例肺移植,获得了初步手术和临床成功,取得了一些经验和教训.报告如下.

曲霉菌感染是肺移植术后一种严重的并发症,文献报道其发病率为20%～40%,病死率超过70%[1],我院于2002年4月在全麻体外循环下行同种异体双肺移植1例,术后并发肺曲霉菌感染,患者存活41天,现报告如下:

1999年9月～2003年12月我科共收治自发性食管破裂病人9例.本文重点对病人的外科治疗进行了讨论,采用食管裂口修补、带蒂大网膜移植是较好的治疗方法.

Objective To summarize the expeience of application of HTK solution in heart transplantation for heart preservation.Methods 5 patients suffered from different kinds of end-stage heart disease who underwent heart transplantation during 2002 to 2004 in Fuzhou General hospital, HTK solution was applied for donor heart preservation in all cases. Results The donor hearts of 3 cases autoresuscitate during reperfusion of aortic cross-clamping when transplantation completed, while the other two required electric therapy with a dose of 20J. All cases survived by now, and the cardiac function kept normal during follow-up period of 1~30 months.Conclusions HTK solution can provide excellent protect effect to donor heart in heart transplantation.

急性心包填塞是心脏手术后的一种严重并发症.处理不及时,可导致患者死亡.本文就心脏手术后急性心包填塞的预防、诊断和治疗予以讨论.