目的 探讨术前抗凝治疗对高龄下肢骨折合并深静脉血栓(DVT)患者手术安全性的影响.方法 回顾性分析86例高龄下肢骨折合并DVT患者的临床资料.术前使用低分子量肝素钙抗凝5～7 d,复查下肢静脉彩超,提示血栓消失(n=29)或血栓部分机化(n=57),再进行手术治疗.观察患者围术期出血并发症及急性肺栓塞的发生情况.结果 所有患者均顺利完成手术,在围术期均未出现严重出血并发症(如脑出血、消化道出血、术后切口大渗血等),也没有出现急性肺栓塞.结论 对于高龄下肢骨折合并DVT患者,术前进行抗凝治疗5～7天后,复查彩超提示血栓消失或部分机化时,行骨科手术治疗安全性较高.

非小细胞肺癌(NSCLC)是肺癌最常见的组织学类型.对于晚期NSCLC患者,传统治疗方法是以铂类为基础的化疗,但化疗副作用大且效果有限.近年来,随着肺癌靶点及分子靶向药物的不断研发,分子靶向治疗已成为晚期NSCLC患者一种重要的治疗手段.本文对目前晚期NSCLC患者的分子靶向药物治疗进行综述,以期为临床提供参考.

目的 探讨参附注射液(SFI)联合无创肢体缺血预处理(NLIPC)对二尖瓣置换术病人心肌的保护作用.方法 选取择期二尖瓣置换术病人32例,随机分为对照组、SFI组、NLIPC组、SFI联合NLIPC(SFI+ NLIPC)组,各8例.SFI组在术前30 min经中心静脉和开放主动脉后经体外循环(CPB)泵入SFI 1.5 mL/kg;NLIPC组对病人左下肢实施5 min缺血/5 min再灌注处理,连续重复该过程3次;SFI+ NLIPC组联合使用SFI和NLIPC,对照组为常规CPB.检测4组心肌损伤生化指标,观察心脏复跳情况和术后多巴胺使用情况.结果 SFI+ NLIPC组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、丙二醛(MDA)升高程度明显低于其他3组(P＜0.01);术后心脏复跳率高于对照组(P＜0.05);多巴胺用量低于其他3组(P＜0.05).结论 联合使用SFI和NLIPC对缺血再灌注心肌具有较好的保护作用.

INTRODUCTION: Pericardiectomy for patients with constrictive pericarditis and multivessel coronary artery disease is rare. Therefore, there is limited experience of pericardiectomy in these patients. PRESENTATION OF CASE: We performed only pericardiectomy under the support of intra-aortic balloon pumping (IABP) for a patient with tuberculous constrictive pericarditis and multivessel coronary artery disease who refused to accept revascularization. The postoperative course was uneventful. DISCUSSION: There is limited experience of pericardiectomy in patients with constrictive pericarditis and coronary artery disease, especially in those who want to perform only pericardiectomy and refuse to accept revascularization. There has only been one case report of a patient who had constrictive pericarditis and coronary artery disease, and hemodynamic instability postoperatively who did not have revascularization performed. Cardiopulmonary bypass facilitates dissecting grossly thickened pericardium off the heart and coronary artery exposure, but is associated with higher mortality and reoperation rates, renal failure, and atrial fibrillation. In our patient, cutting grossly thickened pericardium to expose the coronary artery under cardiopulmonary bypass was unnecessary because he refused to accept revascularization. Therefore, we performed only pericardiectomy under the support of IABP to avoid hemodynamic instability. CONCLUSION: Performing only pericardiectomy under the support of IABP for a patient with constrictive pericarditis and multivessel coronary artery disease is safe and effective as long as the left ventricular ejection fraction is normal. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

目的探索耳穴压豆结合穴位贴敷治疗方案在心脏外科术后患者中的临床效果。方法选取2014年9月至2015年4月于我院接受治疗的50例接受心脏外科手术的患者为研究对象,按照随机数表平均分成两组,其中25例接受常规治疗方案患者为对照组,其余25例接受耳穴压豆结合穴位贴敷治疗方案的患者为观察组。治疗前后采用焦虑自评量表(SAS)对患者自身焦虑程度进行评分,采用胃肠道症状体征评分量表对患者胃肠功能情况进行评分。结果研究发现,两组患者治疗前焦虑自评量表(SAS)评分分数以及中重度焦虑例数无较大差异(P>0.05),而观察组患者治疗SAS评分分数较对照组患者低,其中治疗后观察组患者SAS评分为(51.28±19.66)分,对照组SAS评分为(72.54±21.64)分,中重度焦虑患者例数较对照组少(P<0.05)。两组患者治疗前胃肠功能评分无较大差异,治疗观察组患者胃肠功能评分大幅下降,而对照组患者胃肠功能评分下降幅度较小,观察组患者胃肠功能恢复速度较快,差异具有统计学意义(P<0.05)。结论耳穴压豆结合穴位贴敷治疗方案在心脏外科术后患者中的效果显著,能够有效缓解患者伤口疼痛、促进患者胃肠功能的恢复以及改善患者睡眠质量。

目的 观察小剂量低分子肝素钙(low-molecular-weight heparin calcium,LMWH)、利伐沙班(rivaroxaban)结合常规预防方法预防高龄髋部骨折(包括股骨颈骨折及股骨粗隆间骨折)患者下肢深静脉血栓形成的疗效.方法 选2014-01～ 2015-02高龄(均≥75岁)髋部骨折患者106例,用随机数字表法随机分为小剂量LMWH组56例和利伐沙班组50例,观察两组预防下肢深静脉血栓形成的有效率及并发症的发生率.结果 预防下肢深静脉血栓形成有效率小剂量LMWH组为89.3％,利伐沙班组为90.0％ (P ＞0.05);出现切口大渗血的发生率小剂量LMWH组为0.0％,利伐沙班组为10.0％(P＜0.05);引起凝血酶原时间延长的发生率小剂量LMWH组为1.8％,利伐沙班组为6.0％(P＞0.05).结论 两组结合常规预防方法预防高龄髋部骨折患者下肢深静脉血栓形成均有良好疗效,而小剂量LMWH组切口大渗血并发症发生率比利伐沙班组低.

目的研究压耳穴对心脏术后患者机体功能恢复的影响。方法选取2014年9月~2015年4月50例住院并择期手术患者,将其随机分为对照组和观察组,各25例。对照组给予常规护理,观察组给予耳穴贴压护理组。分别观察两组应用措施后的心率、血压变化及胃肠功能的恢复情况,并通过应用焦虑自评表评定术后患者机体功能恢复情况。结果观察组在按压后第1、2、3、6天与对照组比较,心率降低,差异有统计学意义(P<0.05);观察组降压总有效率明显高于对照组,差异有统计学意义(P<0.05);对照组首次肛门排气(便)时间长于观察组,差异有统计学意义(P<0.05);观察组在持续间断性按压6天后焦虑自评量表(SAS)评分与对照组比较,差异有统计学意义(P<0.05)。结论压耳穴对心脏外科术后心率、血压降低有明显效果,有利于胃肠功能的恢复和焦虑的缓解。压耳穴对心脏外科术后护理具有重要临床意义。

目的 总结预防高龄(≥75岁)髋部骨折(包括股骨颈骨折及股骨粗隆间骨折)患者下肢深静脉血栓形成的经验.方法 206例高龄髋部骨折患者,根据是否合并慢性心功能不全分为有慢性心功能不全组(42例)和无慢性心功能不全组(164例).术后使用小剂量低分子肝素钙(LMWH)联合本院自制药正骨1号片结合常规预防方法进行预防下肢深静脉血栓形成,观察该方法预防下肢深静脉血栓形成的有效率及并发症的发生率.结果 预防下肢深静脉血栓形成有效率为94.17%,血栓形成发生率为5.83%;有慢性心功能不全组患者发生血栓10例(23.81%),无慢性心功能不全组患者发生血栓2例(1.22%),两组比较差异有统计学意义(P<0.05).术后切口大渗血发生率为1.46%,术后切口感染发生率为1.94%,引起凝血酶原时间延长发生率为0.49%,急性大面积肺栓塞发生率为0.结论 小剂量低分子肝素钙联合本院自制药正骨1号片并结合常规预防方法(如踝关节锻炼、伤肢间歇序贯加压充气泵等)预防高龄髋部骨折患者下肢深静脉血栓形成有良好的疗效及较低的并发症.合并慢性心功能不全患者更容易出现下肢深静脉血栓,应注意加强预防.

Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement.

目的：探讨中西医结合治疗急性主动脉综合征的临床效果。方法回顾性分析24例中西医结合治疗的急性主动脉综合征病人临床资料。结果24例病人住院期间无死亡，无并发症，全部顺利出院。结论中西医结合治疗可提高急性主动脉综合征的治疗效果。

Objective Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Here, we introduced a method of video-assisted thoracic surgery with no disposable consumables. Methods Between Oct. 2011 and Feb. 2016, a series of 84 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. Results Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage ( P > 0. 05 ), postoperative stay, and recurrence between the two groups [( 16 747. 30 ±2 586.41) yuan vs (21 088.54±6 005.68)yuan,P<0.05] . Conclusions Biportal thoracoscopic bleb ligation for primary spontaneous pneumothorax is a safe, low-cost, simple and reliable procedure.

A 6-year-old girl presented with paroxysmal binocular blindness, lasting 4–5 min each time, with foaming at the mouth and complexion pastiness. After half a year, her seizure frequency increased to 30 times a day. Since the onset of her illness, she suffered from an obvious hyperthyroidic appetite, weight gain and occasional urinary incontinence. She was neurologically normal without any significant focal or global deficits. Cranial MRI revealed a cystic mass located in the suprasellar region and extending to the anterior horn of the right lateral ventricle through the foramen of Monro. The mass was above the chiasm opticum and involved the rectal gyrus. It was hypointense on Tl-weighted images (Fig. 1A,D,E), hyperintense on T2-weighted images (Fig. 1B), and hypo/isointense on fluid-attenuated inversion recovery images (Fig. 1C). The mass showed slight peritumoral edema (Fig. 1C) and was not enhanced by contrast agent administration (Fig. 1F). No aqueduct obstruction was detected. Intraoperatively, the tumor was gelatinous, located in the suprasellar region, extending to the third ventricle and the corpus callosum body, and locally adhering to the anterior lower part of the hypothalamus, without adhesion to the optic nerve or chiasm opticum. The patient’s symptoms improved after operation.After 2 months, she stopped taking antiepileptic drugs on her physician’s advice. No adjuvant chemotherapy or radiotherapy was administered. The patient was followed up for 16 months until July 2014 with no tumor recurrence.

Background: Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.Methods: Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.Results: Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.Conclusions: The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

Objective To explore the MRI features of various neuronal tumors of the central nervous system (CNS) . Methods Twenty‐four patients with pathology proved neuronal tumors of CNS were collected .MRI examinations were performed including T1WI ,T2WI ,FLAIR and T1WI enhancement .MRI features including lesion location ,shape ,signal intensity ,mass effect and contrast enhancement were reviewed retrospectively .Results Of the 24 patients with CNS neu‐ronal tumors ,there were dysembryoplastic neuroepithelial tumor (DNET ,15 patients) ,ganglioglioma (7 patients) and central neurocytoma (2 patients) .In 15 DNET cases ,the lesion was located in different lobes (12 temporal lobe ,3 frontal lobe and 1 parietal‐occipital lobe) ,mainly involved cortical area .The lesion presented solitary or multiple cystic appear‐ances .Hyperintensity on T2 WI/FLAIR and hypointensity on T 1 WI was revealed .No Contrast enhancement was noted on twelve cases .The other 3 case showed patchy ,nodular and circular enhancement .No edema was found around the le‐sions .Seven cases with ganglioglioma included 5 temporal lobe ,1 frontal lobe ,and 1 parietal lobe .MRI features were cystic‐solid tumors ,Hyper‐isointensity on T2 WI/FLAIR and hypo‐isointensity on T1 WI was revealed .Two cases showed calcification .No edema was found around the tumors .The solid nodular portion of the tumors showed obvious enhance‐ment after contrast administration .Two patients with central neurocytoma were located in lateral ventricles .Cystic‐solid irregular abnormal signal was found on MRI ,which showed hypo‐isointensity on T1WI and hyper‐isointensity on T2WI/FLAIR .The solid and septum portion of the tumor presented obvious enhancement .Conclusion Neuronal tumors in CNS are characteristics on MRI ,which are helpful to differentiate these diseases from other brain tumors .By mastering the im‐aging and clinical features ,we can make the correct diagnosis of the tumors .

<正>食管癌是我国常见病之一,手术治疗是主要的治疗手段,目前术后代食管材料仍然选用是胃、结肠等,使得一些患者的手术受到限制,如果有人造食管进行良好替代,就能解决许多问题。然而现在人造食管研究仍然处在实验阶段,较长一段时间来进展不大,近5年来国内外鲜有相关报道。现本文就这方面问题作一综述。1食管癌治疗现状我国为食管癌的高发区,国内食管癌患者占全世界患者

<正>孤立性肺结节(SPN)随着CT检查越来越普遍,它的发现明显增多,且结节中肺癌所占比例较高,所以要高度重视。我科2005年10月至2012年10月收治65例SPN,现就其诊治作一回顾性分析,总结如下。1临床资料1.1一般资料2005年10月至2012年10月收治SPN65例,男性45例,女

<正>我院心胸外科最近收治1例胸部穿通等多处刀刃伤致严重失血性休克的患者,术前、术中心跳骤停各一次,术后广泛渗血,经过多科室的协作,抢救成功,现报道如下。1临床资料及救治经过患者,男,30岁,于2009年6月23日凌晨因"左胸、头部等处刀刺伤半小时"来急诊科就诊。查体:全身多处血迹,血压82/40 mmHg,脉搏154次/分,呼吸32次/分,神志欠清,面色苍白,左前胸第6肋间有一伤口长约2 cm,有血气溢出,头

目的总结单操作孔胸腔镜手术的经验和体会。方法 6例接受单操作孔胸腔镜手术患者,其中自发性气胸5例、右胸膜多发肿物并大量胸腔积液1例。患者均采用双腔气管插管全麻后侧卧位单肺通气,取腋中线第4肋间为胸腔镜观察孔,在腋前线第4肋间作一长约2～3 cm的切口作为操作孔。结果 5例自发性气胸患者行肺大疱切除及胸膜摩擦固定术,其中有1例同期行两侧肺手术;右胸膜多发肿物并大量胸腔积液1例,取胸膜结节行病理检查后,做胸膜固定术。手术时间45～160 min,平均65 min;出血10～60 mL,平均30 mL;术后患者均顺利恢复出院,无术后血胸、肺部感染等并发症。随访1个月无复发病例。结论单操作孔电视胸腔镜能够完成肺大疱切除手术、胸膜固定术以及胸腔肿物活检手术,且与常规三孔电视胸腔镜技术的治疗效果相同,但对胸腔前外侧的部位操作相对艰难,需要把带长电刀头的电刀弯曲到合适的程度进行操作以及适时地互换操作孔与观察孔。

目的探讨非开胸食管内翻拔脱术在食管癌治疗中的临床效果及其应用价值。方法对19例食管癌患者Ⅰ期4例,Ⅱa期10例,Ⅱb期5例均采用非开胸食管内翻拔脱术,行颈部胃食管端侧吻合。结果全组无手术死亡,均获随访,术后生存时间5年及以上4例,3～5年8例,0.5～3年3例,4例在术后出现死亡,其中2例因癌转移死亡,2例因其他疾病死亡。结论非开胸食管内翻剥脱术具有术后康复快、微创等优点,尤其适用于早中期食管癌及心肺功能差的患者。

<正>肺癌是全球病死率最高的肿瘤之一,大部分患者为非小细胞肺癌(NSCLC),严重威胁人类的健康。近年来,肺癌发病率呈上升趋势,在城市位于恶性肿瘤第1位。尽管在过去30多年里,手术、放疗、化疗取得了较大的进步,但是肺癌总的疗效仍然不理想。近几年来,以多学科综合治疗为导向的理念,为提高肺癌疗效提供了新的思路。2007年2月至2011年2月本院对收治的53例NSCLC患者在行肺癌根治术的同时术中