目的探讨食管癌术后乳糜胸的有效治疗方法。方法回顾分析食管癌术后并发乳糜胸的手术与非手术治疗结果。结果434例食管癌术后发生乳糜胸17例,非手术治疗5例,死亡1例,手术治疗12例,均治愈。结论积极再手术是食管癌术后乳糜胸的有效治疗方法。

目的探讨心脏不停跳下心脏黏液瘤摘除术的方法和意义.方法总结36例心脏黏液瘤在心脏不停跳进行手术的病例.术中不阻断升主动脉,不使用心脏停搏液,鼻咽温维持在(33±1)℃,在心脏空跳下完成肿瘤切除.结果心脏手术完毕即可停机,术后发生低心排血量综合征1例,1例右心房巨大黏液瘤术后未醒,全组无死亡病例.结论心脏不停跳下黏液瘤摘除术能最大限度地减少心肌缺血缺氧损伤,避免再灌注损伤,是一种理想的心肌保护方法.

Objective:To summerize the surgical treatment experience of adult patients with PDA underwent surgical treatment at our department.Methods:Deep hypothermia low rate(DHLF)CPB were used in all patients.Results:No surgical death and late death.Postoperative complications included low cardiac output in 3 cases,pericardial effusion in 2 cases.Conclusion:Adopting DHLF CPB to adult PDA surgical treatment is a safe and effective method.

病人 女,22岁.妊娠28周产下双胞胎男婴后自觉气憋,间断腹痛、腹胀2个月.胸部CT示心包内可见气液平面(图1).行钡剂灌肠造影示结肠疝入心包腔内,疝囊颈部肠管互相靠拢,呈"紧腰样"征(图2).诊断为"心包膈疝".

Objective:To summerize the experience of total correction for adult patients with tetralogy of fallot(TOF).Methods:From October 1998 to October 2005,13 adult patients with tetralogy of fallot underwent total correction.Each patient had stenosis of the right ventricular outflow tract(ROVT).Among them,8 patients with pulmonary valvular stenosis,1 patient with mutiple stenosis of pulmonary valve,ring and trunk.The ventricular septal defects were closed with dacron patch in all cases.The complex patch with dacron and autogeneic pericardium was used to enlarge ROVT.8 cases required tuansannular patch,1 case enlarged main pulmonary artery trunk and ROVT,4 cases enlarged ROVT only.Results:No perioperative death.8 cases with severe low cardiac output syndrome,1 case with acute renal failure.No late death was encountered during the follow-up period(range 4～80 months).Conclusion:The adult TOF patients were susceptible to severe post-operative complications after total correction treatment.The perioperative management should be enhanced.The result is satisfactory.

目的 评价国产二尖瓣成形环在心瓣膜成形外科中的疗效.方法 回顾1986年12月～1995年9月在全身麻醉中度低温体外循环下用国产二尖瓣成形环行成形术36例,其中二尖瓣成形28例次,三尖瓣成形9例次.结果 住院死亡4例.术后发生低心排血量综合征5例,呼吸功能不全2例,行气管切开1例,突发心室颤动3例,多器官功能衰竭2例,脑栓塞1例.随访31例无死亡.经超声心动图检查32个成形瓣膜,未见反流5例,轻度反流23例,中度以上反流2例,轻度狭窄2例.跨瓣压差＜1.07kPa(8mmHg)24例,1.07～1.73kPa(8～13mmHg)8例.结论 国产二尖瓣成形环在心瓣膜成形外科中具有重要地位.

心脏瓣膜病以风湿性心脏病最为多见,另外还有部分先天性心脏病及老年性瓣膜退行性病变 ,由于患者术前心功能较差,故围手术期处理至关重要.我院自1993年5月至1999年8月,共进行心脏瓣膜替换术37例,取得了满意效果,现总结如下.