Objective:To compare the clinical application of aspirin and low molecular weight heparin in pulmonary lobectomy after percutaneous coronary intervention(PCI), and to explore the effect of aspirin monotherapy in anti-platelet therapy.Methods:From January 2018 to December 2019, the clinical data of 48 patients with coronary atherosclerotic heart disease(coronary heart disease) who underwent lobectomy in the Thoracic Surgery Department of Beijing Anzhen Hospital within 12 months after PCI were retrospectively analyzed. There were 37 males and 11 females. The age ranged from 41 to 76(67.6±10.4) years. There were 22 cases with hypertension, 18 cases with diabetes and 2 cases with cerebrovascular disease. Iliac artery stents were inserted in 2 cases and vertebral artery stents in 1 case. Preoperative atrial fibrillation in 2 cases. There were 46 patients with gradeⅠand 2 patients with gradeⅡcardiac function(NYHA). According to the preoperative antiplatelet treatment, the patients were divided into aspirin group(25 cases) and low molecular weight heparin group(LMWH group, 23 cases). In the aspirin group, clopidogrel or ticagrelor was stopped 5 days before lobectomy, and aspirin single drug antiplatelet therapy was used, orally 100 mg every day until the morning of operation. In the LMWH group, aspirin, clopidogrel or ticagrelor were stopped 7 days before surgery, and 0.6 ml LMWH calcium was injected subcutaneously, once every 12 hours, and stopped 12 hours before surgery. Perioperative clinical data of the two groups were recorded and analyzed, and major adverse cardiac event(MACE) and bleeding events were observed.Results:There was no death in all groups. MACE and bleeding occurred in 1 case respectively in LMWH group. There were no significant differences between the two groups in length of hospital stay, duration of operation, diameter of lesion, total postoperative thoracic drainage and retention time of thoracic drainage tube( P>0.05). The intraoperative blood loss and chest drainage in the aspirin group were significantly lower than those in the LMWH group in the first 3 days after surgery, with statistical significance( P<0.05). Conclusion:The incidence of MACE increases after lobectomy for coronary heart disease within 12 months after PCI, and aspirin monotherapy is safe and effective in antiplatelet therapy.

Objective:To explore the cognition, needs and source of knowledge of subcutaneous injection with insulin pens in patients with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) , to analysis the influencing factors of their knowledge level.Methods:Totally 132 T2DM and MCI patients hospitalized in Beijing Friendship Hospital, Capital Medical University from July 2016 to July 2018 were selected using convenient sampling. The questionnaire survey was used to collect the general information of the research subjects and their cognition, needs and source of knowledge of subcutaneous injection with insulin pens. Univariate and multiple linear analysis was used to analyze the factors affecting the knowledge of subcutaneous injection with insulin pens in T2DM and MCI patients.Results:The most desired knowledge of insulin pen injection for T2DM and MCI patients was the correct injection method (81.82%) and the choice of injection site (75.00%) . The main source of insulin pen injection knowledge for T2DM and MCI patients was community health promotion (72.73%) and patient experience sharing (64.39%) . The total score of diabetes knowledge of the patients was (22.20±5.40) . The univariate analysis showed that the knowledge of insulin pen injection was statistically significantly different between T2DM and MCI patients with different educational backgrounds, course of diabetes, monthly household income per capita, duration of insulin pen use, and whether they received training ( P<0.05) . The multiple linear regression analysis revealed that educational background, course of diabetes, duration of insulin pen use and whether they have received training were the influencing factors of the knowledge of insulin pen injection knowledge in T2DM and MCI patients ( P<0.05) . Conclusions:The knowledge of subcutaneous injection with insulin pens in T2DM and MCI patients is relatively lacking, especially in patients with low educational background, short course of diabetes, short duration of insulin pen use and no training. Nursing educators should strengthen the education of relevant knowledge such as insulin injection methods and injection sites, and pay attention to the role of community hospitals and peer support to meet the needs of patients for relevant knowledge.

Objective:To explore the influence of expressive writing on self-perceived burden and personal significance index of patients with newly diagnosed primary liver cancer.Methods:Convenience sampling method was used to select 129 patients with newly diagnosed primary liver cancer admitted to Beijing Friendship Hospital Affiliated to Capital Medical University between December 2017 and December 2018. Research subjects were divided into routine nursing group ( n=65) and expressive writing group ( n=64) according to the method of random number table. Patients of routine nursing group received routine postoperative care for liver cancer and postoperative chemotherapy care. Patients of expressive writing group carried out expressive writing intervention on the basis of routine nursing group. The intervention started from the second chemotherapy of patients, and a total of four themes were set including emotional expression, cognitive evaluation, active exploration and future outlook. The writing time for each theme was one week, four consecutive weeks, and 20 minutes each time. Before and four weeks after intervention, self-perceived burden and personal significance index of patients between two groups were compared with the Self-Perceived Burden Scale of Cancer Patients (SPBS-CP) and the Chinese version of Personal Meaning Index (PMI) . Results:There was no statistically significant difference in the SPBS-CP score of routine nursing group before and after intervention ( P>0.05) . After intervention, the total score and scores of four dimensions, including the care burden, economic/family burden, psychological/emotional burden and treatment burden of SPBS-CP in expressive writing group were lower than those before intervention; and the scores of above indicators in expressive writing group were all lower than those in routine nursing group; the differences were all statistical ( P<0.05) . There was no statistically significant difference in the score of PMI of routine nursing group before and after intervention ( P>0.05) . After intervention, the score of PMI of expressive writing group was higher than that before intervention, and higher than that of routine nursing group with statistical differences ( P<0.05) . Conclusions:Compared with routine nursing, expressive writing can improve the self-perceived burden of patients with newly diagnosed primary liver cancer and the personal significance index, which has certain clinical significance.

Objective:To evaluate the safety and efficacy of Nuss procedure as surgical correction for adult patients with severe pectus excavatum.Methods:The clinical data of minimally invasive repair for pectus excavatum in patients older than 20 years from 2006 to 2016 were reviewed.The surgical procedure,clinical result and post-operative follow-up were recorded.Results:Fifty-eight patients (42 men,16 women) with a mean age of (21.8 ±5.4) years and a mean Haller index of (6.2 ±3.7) were included.Eleven patients were repaired due to previous failed Ravitch and Nuss procedures.Modified Nuss procedures were performed in all 58 patients.Cardiac operations were performed for co-existed disorders before pectus bars were implanted in 8 cases.Two bars were required in 16 patients.The mean duration of the procedure was (65.3 ± 21.7) min.The mean blood loss was(27.5 ± 12.1)mL.Hemothorax occurred in one patient who underwent concurrent Bentall procesure and needed reoperation.All patients recovered and the mean length of hospital stay was (6.2 ± 1.7)days.During follow-up,pectus bar dislocated in one patient and required an operative repair.The cosmetic result were excellent and patient satisfaction was high one year post-operatively.Bars were removed in 37 patients.No recurrence of deformity happened during follow-up.Conclusion:Nuss procedure can be performed safely in adults with satisfactory effectiveness and excellent cosmetic result.Nuss procedure may serve as the first preference in adult population with severe pectus excavatum.

目的:总结合并冠心病的食管癌患者围手术期临床经验;方法:分析15例伴有冠心病的食管癌患者围手术期临床资料,对比同期普通食管癌患者病例29例,对术中及术后相关临床资料进行比较分析;结果:与同期普通食管癌患者相比,合并冠心病的食管癌患者在手术时间、术中失血、术后胸腔引流量及带管时间、胃液引流量、胃肠减压时间、术后住院时间等方面差异均无统计学意义;但围手术期出现心率失常3例及轻微心肌梗死事件1例,两组均无死亡病例出现;结论:当心功能正常时,伴有冠心病的食管癌患者开展手术治疗是安全可行的,围手术期停用阿司匹林时出现心血管事件是可以接受的风险.

Objective To summarize the clinical experience of anti-platelet therapy in the treatment of pa-tients undergoing lung resection. Methods The clinical data of 35 cases that received anti-platelet therapy and un-derwent lung resections because of pulmonary ailment were analyzed. The operative procedures, perioperative and long-term results were compared to the control group. Results All patients recovered and no serious cardiovascular events occurred. The operative time, blood loss, drainage time, the rate of complication, hospital stay and long-term results were similar in the two groups. Conclusion Major lung resection can be performed safely in patients on anti-platelet therapy. Perioperative cessation of anti-platelet drug does not increase the risk of cardiovascular events.

Objective:To summarize the clinical efficiency of bronchial sleeve lobectomy for 34 cases of central type lung cancer.Methods: 34 cases of bronchial sleeve lobectomy which were made from Jan,2003 to Dec,2010 were studied retrospectively,including 14 cases right upper lobe,4 cases right middle and lower lobes,10 cases left upper lobe and 6 cases left lower lobe.Results: there was no death in these cases.The complication included that pulmonary infection was 14.7% and arrhythmia was 11.8%.Conclusion: bronchial sleeve lobectomy could increase the rate of operative resection,reserve more the healthy pulmonary parenchyma,while improving the cured rate and the long term survival rate of lung cancer without severe perioperative complications.

Objective To study the different effects of bronchial embolization between the fibrin glue and the chemical rubber and the additional role of the trypsin in bronchial embolization.Methods All 30 animals were randomly divided into five groups,including chemical rubber group,fibrin group,trypsin + chemical rubber group,trypsin + fibrin group and trypsin group (n =6 in each group).Embolizing bronchia with chemical rubber and fibrin glue was conducted respectively in chemical rubber group and fibrin group.Pretreating bronchiole with trypsin was done at first,and then the bronchiole was embolized in trypsin + chemical rubber group and trypsin + fibrin group.The embolism was done under the X-ray,then CT scan was used to detected the development of the pulmonary atelectasis.Two weeks after the embolism the animals were killed for lung pathology.Results All of the animals with the chemical rubber had the atelectasis.Only 4 cases of the animals with the fibrin glue appeared short-term atelectasis and all of them recovered in 10 days.The fibrous tissue proliferation could be seen in animals with the trypsin.Conclusions The effect of embolizing bronchia with the fibrin glue is not good enough.The chemical rubber of α- cyanoacrylate alkyl is more preferable.At same time pretreating bronchiole with tryPsin can enhance the embolism and get stable atelectasis.

Objective To explore the classification,diagnosis,clinical features and surgical treatment of pulmonary sequestration.Methods The clinical data of 23 patients with pulmonary sequestration from 1985 to 2011 were retrospectively reviewed.Results From 1985 to 2011,23 patients with pulmonary sequestration were operated and were pathologically confirmed.There were 15 males and 8 females aged 9-48 years.Their disease course ranged from 1 month to 30 years.The pulmonary sequestration was in left lower lobe in 17 cases and right lower lobe in 6 cases.All cases were in base segment.21 cases suffered from intralobar sequestration and 2 cases suffered from extralobar sequestration.Twelve of 23 cases got confirmed preoperative diagnosis.All cases were cured.Follow-up was performed in 7 patients,and no long-term complication was noted.Conclusion Pulmonary sequestration is rare pulmonary congenitaldeformity.CTA is the most helpful for diagnosis.Surgery can achieve good outcomes.

目的:探讨微创矫正术式Nuss手术治疗成年漏斗胸的临床价值。方法:回顾性分析29例漏斗胸患者临床资料。结果:29例均顺利完成手术,同期行心脏手术3例,8例采用双支撑钢板,手术时间(50~95)min,术中出血量5~100 mL;术后发生轻微气胸2例;术后住院时间5~10 d,均康复出院。随访6~41个月,1例术后17个月因外伤致钢板移位,再次手术治愈。术后1 a矫形效果评价均优,5例已拔出支撑钢板,无复发。结论:Nuss手术应用于成年患者安全、有效,畸形矫正满意,可作为成年漏斗胸患者首选手术方式。

Objective To evaluate the safety and efficiency of muscle-sparing(MS)thoracotomy in the operation of lung resection.Methods The data of 64 cases of pulmonary ailment that underwent lung resections were analyzed.The operative procedures and clinical results between two groups of muscle-sparing and posterolateral thoracotomy were compared.Results All patients recovered.The operative time,blood loss,drainage time,the rate of complication and hospital stay were similar in both groups.The cases underwent muscle-sparing thoracotomy had less postoperative pain compared with those underwent posterolateral thoracotomy.The vital capacity and forced expiratory volume in 1 second of the MS group surpassed that of posterolateral thoracotomy group,2 weeks after the operation.Conclusion MS thoracotomy is safe and effective in lung resection.It has the superiority of pain-relieving and is beneficial to postoperative pulmonary function.

食管瘢痕性狭窄常是误服酸碱等化学制剂或热力灼伤所致,经适当急性期处理,狭窄后行食管扩张治疗,大部分病人可以治愈.但部分病人瘢痕狭窄严重,扩张效果不佳或反复出现狭窄需手术治疗.

原始神经外胚叶瘤(primitive neumedodeimal tumor,PNET)是一种临床少见的疾病.因肿瘤恶性程度高,无有效的治疗方法,预后不良.我科收治1例,报告如下.

Objective To evaluate the clinical and medical economical effects of axillary thoracotomy and video-assisted thoracoscopic surgery (VATS) as the surgical treatment for spontaneous pneumothorax.Methods The data of 118 cases of spontaneous pneumothorax that underwent two kinds of surgical treatments were analyzed. The clinical results and medical cost composition between two groups were compared.Results All patients recovered and the rate of complication and recurrence was low in both groups. The cases underwent VATS had less postoperative pain compared with those underwent axillary thoracotomy. The medical cost of VATS was significantly more than that of axillary thoracotomy and most of additional expenses were from endostaplings(RMB 20,631±752 vs 11,385±350).Conclusion Both methods are safe and effective in the treatment of spontaneous pneumothorax. Patients after VATS are less painful and most of additional expenses of VATS are from endostaplings.

Except the traditional medical therapy and lung volume reduction surgery, a new interventional method with bronehoscope was developed, by which occluding airways causes pulmonary atelectasis to reduce lung volume. It can relieve patients" symptoms to some degree. This therapy has been applied clinically after animal experiment, and there are two methods,one is placement of endobronehial one-way valves,the other is embolism bronchi with biogel. Both are effective,but their long-standing effect needs further bservation.

BACKGROUND Surgical resection remains the treatment of choice for pulmonary arteriovenous malformation but removes some normal lung parenchyma. This study aimed to evaluate the effect and safety of the lung-saving procedure of fistulectomy as an alternative to lung resection. METHODS From July 2003 to July 2008, 6 selected patients with pulmonary arteriovenous malformations underwent fistulectomies. Among them, 1 patient underwent emergency operation and 2 underwent bilateral operations. One patient received postoperative embolotherapy. RESULTS No hospital deaths or postoperative morbidity occurred. PaO2 increased significantly after operation. All patients were free of symptoms and hypoxia during a follow-up for 9 months to 5 years. CONCLUSIONS Fistulectomy is a safe and effective procedure for patients with pulmonary arteriovenous malformation and may be an alternative to lung resection.

Objective:To study the value of 18F fluorodeoxyglucose(FDG)coincidence imaging for the diagnosis of pulmonary mass.Method:To compare the conclusions of 18F-FDG SPECT coincidence imaging and CT,with the pathological diagnosis as a gold standard.Totally 106 patients were included.Among them,22 cases were pathologically benign,and 84 cases were malignant.Result:With 18F-FDG SPECT coincidence imaging,90 cases were diagnosed as cancer and 16 cases as benign lesions.With comparison of the pathological results,the false-positive cases were 9,and the false-negative cases were 3.With CT,86 cases were diagnosed as cancer,and 20 cases as benign lesions.Among which,the false-positive cases were 13,and the false-negative cases were 3. 18F-FDG SPECT coincidence imaging is statistically superior to CT in aspects of the sensitivity,accuracy and negative predictive value.Tuberculosis is the main disease that brings false-positive conclusion.Specifically,tubercular hyperplasia is the predominant pathological type that leads to misdiagnosis among all the tuberculosis patients.Conclusion:The 18F-FDG SPECT coincidence imaging has a very high value for the diagnosis of pulmonary mass,and also for making treatment scheme.

肺移植目前是治疗终末期肺疾病的有效方法,1995年和1998年我们完成单肺和双肺移植各1例,病人分别生存5年11个月和4年7个月,后期均出现明显的肺功能下降,临床诊断为慢性排斥.