1 病例资料 1. 1 病例1 患者32岁,孕1产0.因孕34周,突然胸痛、憋喘1h于2011年12月20日来诊.既往有自发性气胸的类似发病史.1h前用力排便时突然出现右侧胸痛、憋喘.入院检查:T 36. 3℃,P 91 次/min,R 22 次/min,BP 106/60mmHg (1mmHg=0. 133kPa).口唇轻度紫绀,气管轻度右移,左胸呼吸动度减弱,叩呈鼓音,呼吸音消失,右肺及心脏无异常.腹部膨隆,宫底高度30cm,胎位为左枕前位,胎心144/min,无产兆.心电图示:正常心电图;未行X线胸片示检查.诊断为:妊娠并发自发性气胸.来院后立即于胸腔闭式引流(10F),患者呼吸困难明显减轻.同月25日上午患者自觉引流管处疼痛难忍且呼吸困难,请产科医生会诊.会诊认为患者胸腔引流管置管处疼痛明显,妊娠已足35周,为防止出现胎儿缺氧意外,建议行剖宫产术.遂于12月25日下午剖宫产,产1健康男婴(阿氏评分10分) ,同期行胸腔镜肺大疱破裂修补手术.治疗后胸部 CT检查,右肺已完全复张,痊愈出院.

目的 探讨单侧自发性气胸合并双侧肺大疱的理想处理方式.方法 总结16例单侧自发性气胸患者接受胸腔镜手术处理两侧肺大疱的经验.结果 患者于术后3～7d均顺利出院,手术时间为(119.44±6.77)min,术中出血量为(58.85±9.63)mL,术后胸腔引流量为(163.82±97.65) mL,引流时间为(1.96 ±0.48)d,住院时间为(6.06±1.78)d,住院费用为(3.83±1.50)万元.术后出现进行性出血1例.随访1～ 84个月,出现气胸复发1例.结论 在胸腔镜下同期处理两侧肺大疱可以降低患者对侧气胸的发生率,从而避免患者再次手术的痛苦,减少住院费用.

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.

AIM The study aimed to unveil the effect of TK1 expression on the clinicopathological significance and prognosis in patients with lung cancer. Results & methodology: Studies for meta-analysis were selected according to a thorough literature search in databases (PubMed, EMBASE and Chinese databases). Ten studies containing 1393 lung cancer patients were investigated in our analysis. The TK1 overexpression was associated with poorer overall survival(OS) in lung cancer patients (hazard ratio = 1.881; 95% CI:1.318-2.684, Z = 3.48; p = 0.001). Furthermore, The TK1 expression is associated with the clinicopathological features of lung cancer patients (tumor type, age, lymph node metastasis, distant metastasis and tumor, node, metastasis [TNM] stages).  Discussion & conclusion: The TK1 expression might have a supportive implication in assessing biological behavior and prognosis of lung cancer patients.

目的 研究长时程心脏不停跳保存方法和技术.方法 选用成年广西巴马小型猪6头,麻醉成功后,取胸部正中切口,全身肝素化,不切开心包.先在头臂干插灌注管,后切断上腔静脉和左下肺静脉,用手协助排空左心室,用停跳液灌注心脏.摘取心脏后与灌注装置连接并用去白细胞和去血小板的稀释血液灌注心脏,使心脏恢复跳动(非工作心脏模型).结果 不停跳保存6例离体心脏8h全部成功,保存期间灌注压没有上升.结论 心脏空跳保存是可行的,保存的关键技术是减轻红细胞破坏、维持适宜的灌注压、左心室有效的减压和防止心脏水分丧失.

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:To explore the value of video-assisted thoracoscopic operation for diagnosis and treatment of chest difficult diseases.Methods:The data of 33 patients with clarify diagnosis by video-assisted thoracoscopic operation were retrospectively analyzed.Results:32 cases had pathological diagnosis in 33 cases,and they had no operation complication.Conclusion:For chest difficult diseases with diagnosis difficult,video-assisted thoracoscopic operation is safe and effective method of diagnosis and treatment.

Objective To observe the effect of different temperature on hemorrheological parameters in beating heart model of pig during cardiopulmonary bypass. Methods A total of fourteen pigs,aged 3~4 months,weight 20~25kg,were randomly divided into two groups (A and B,n=7). Established the model of beating heart during cardiopulmonary bypass. Group A: when the temperature of nasopharynx decreased at 37℃ to stop cooling down the temperature of the blood,maintained the temperature of nasopharynx at 36℃~37℃ about 30 minutes,and then warmed to normal degree and suture the heart. Group B: when the temperature of nasopharynx decreased at 32℃ to stop cooling down the temperature of the blood, maintained the temperature of nasopharynx at 31℃~32℃ about 30 minutes,and then warmed to normal degree and suture the heart. Blood samples were taken at before cardiopulmonary bypass(T1), failed to a certain temperature(T2), the maintain of temperature(T3), the achievement of the warm up(T4) and 20 minutes after stopping bypass (T5) from the femoral artery about 5ml. Observed the hemorrheological parameters. Results The blood viscosity and Hct of T2 ,T3 ,T4 and T5 were decreased compared to T1 in different shear rate (low,medium and high),P<0.05; the blood viscosity of T2 ,T3 ,T4 and T5 were decreased compared to T1 at high shear rate (P<0.05); the IR of T2 and T3 were decreased compared to T1 in group A (P<0.05); the blood viscosity of low and medial shear rate,the erythrocyte electrophoresis index, Arbc,TK were not significantly different between groups and within group. Conclusion Different temperatures have no significant adverse effects on hemorrheological parameters in beating heart model of pig during cardiopulmonary bypass.

Objective: To investigate the effects of porcine hemorrheological indices during cardiopulmonary bypass (CPB) on beating heart. Method: 10 Guangxi local health cross-bred pigs that the age was 3～4 months and the weight was 20～25Kg were choosed to establish the experiment model of CPB on beating heart after general anesthesia. Blood samples were taken before CPB(T1),low temperature maintain 30min(T2),finish rewarming before the end of CPB(T3)and 20min after the end of CPB(T4),first draw 5ml blood from femoral artery as artery blood group(group A),after 1 min draw 5ml blood from central venous catheter as vein blood group(group V). The specimen’s hemorheology indices included blood viscosity(ηb) and blood viscosity reduction(ηre) in 10s-1,50s-1,150s-1 ,erythrocyte aggregation (RAI),RBC rigid index (IR) and erythrocyte deformation index(TK) and hematocrit (Hct),et al were detected. Results: The levels of two groups’ indices such as ηb,ηre,Hct and RAI were all lower in T2, T3, and T4 time points than in T1 time point(P<0.05), but there was no significant difference between the two groups; The changes of IR and TK both in the group and in between groups had no significant difference(P>0.05). Conclusion: In the model of Guangxi local health cross-bred pigs established on beating heart under cardiopulmonary bypass, changes of hemorrheological parameters during cardiopulmonary bypass present good advantage for microcirculation perfusion.

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。

目的探讨单操作孔电视胸腔镜肺大疱胸腔外缝扎技术治疗自发性气胸的临床疗效。方法对14例自发性气胸患者行单操作孔胸腔镜肺大疱胸腔外缝扎手术,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7肋间为胸腔镜观察孔,在腋前线第4肋间作一长约2 cm的切口为操作孔。结果 14例自发性气胸患者行肺大疱胸腔外缝扎及胸膜摩擦固定术,手术时间45~60 min,出血量10~60 mL,平均30 mL;术后3~5 d全部顺利恢复出院,无术后血胸、肺部感染等并发症。随访1个月至1年无复发病例。结论单操作孔电视胸腔镜肺大疱胸腔外缝扎技术是一种简单、微创、经济的自发性气胸胸腔镜治疗方法。

目的探讨经胸非体外循环房间隔缺损微创封堵术治疗房间隔缺损(atrial septal defect,ASD)的疗效。方法全组17例患者,年龄7～56岁。ASD直径14～36 mm。均在全麻下经右胸第4肋间隙胸骨旁2～3 cm小切口进胸,在经食管心脏彩超引导下经输送器置入封堵器,闭合ASD。结果 17例手术均成功,手术时间(64.3±16.3)min,术中失血量(33.6±9.5)mL,全组无死亡。术后3～6 d恢复后出院。随诊3～16个月,B超示封堵伞没有残余漏,没有移位,心功能较术前改善显著,肺动脉压下降明显。结论经胸壁微创非体外循环下行房间隔缺损封堵手术简单、难度小、创伤小、患者恢复快,值得临床推广。

目的探讨紧急开胸手术对心脏介入治疗并发急性心包填塞的价值。方法回顾性分析10例心脏介入治疗并发急性心包填塞而紧急手术患者的临床资料。结果 10例患者中行二尖瓣球囊扩张术4例,心导管射频消融术3例,肺动脉球囊扩张术1例,冠心病介入治疗2例。穿孔部位:冠状动脉2例、右心房2例、左心耳1例、左心房2例、左房顶1例、冠状静脉窦1例、肺动脉1例;4例二尖瓣球囊扩张患者在心脏修补后随即在体外循环下行二尖瓣置换术1,例冠状动脉狭窄患者止血后行冠状动脉旁路移植术,其余患者行心脏破裂修补术。术后死亡2例,治愈出院8例。结论心脏介入治疗并发急性心包填塞,及时恰当的紧急手术对于挽救患者生命具有重要价值。

目的:介绍右腋下小切口心脏不停跳房间隔缺损修补术的方法和临床体会。方法:总结我院2009年6月至2010年12月右腋下小切口心脏不停跳房间隔缺损修补术21例。结果:21例病人手术过程顺利,转机时间平均30.6min,手术时间平均158.8min,术后胸液引流总量平均89.4mL,术后住院时间平均6.3d,全组病人痊愈出院。结论:右腋下小切口心脏不停跳房间隔缺损修补术创伤小,并发症少,恢复快,伤口美观且隐蔽。

目的:探讨电视胸腔镜(VATS)手术在孤立性肺结节(SPN)诊治上的临床应用价值。方法:分析我院心胸外科2005年1月至2009年12月诊治的105例SPN患者的临床资料,患者分为VATS组51例,开胸(TH)组54例。对两组的手术结果及两组中行肺楔形切除病例的手术时间、术中失血量、术后胸腔引流管留置时间、术后住院时间进行比较。结果:两组所有病例均通过手术明确诊断。两组均无手术中死亡,VATS组无术中、术后严重并发症发生,TH组术后1例因呼吸功能衰竭死亡。两组SPN性质比较差异无统计学意义(P>0.05)。在行肺楔形切除的病例中,VATS组的手术时间、术后留置胸腔引流管时间和术后住院时间比TH组明显缩短,术中失血量明显减少。结论:VATS在SPN的诊治上与TH效果相当,VATS具有手术时间短、出血少、恢复快等优点,为SPN的临床诊治提供了一种创伤小、安全可靠的手段。

目的:探讨电视胸腔镜手术(VATS)同期治疗双侧自发性气胸的可行性、安全性。方法:回顾性分析和总结我科2008年3月至2009年12月应用电视胸腔镜手术同期治疗双侧原发性自发性气胸10例患者的临床资料。结果:10例患者均经胸腔镜完成手术,无术中、术后死亡病例,无术后复发病例,无术后并发症发生。结论:电视胸腔镜手术同期治疗双侧自发性气胸是安全、有效的术式。

目的:探讨电视辅助胸腔镜手术在纵隔肿瘤治疗上的临床应用价值。方法:回顾性分析我院心胸外科2006年3月至2010年4月运用电视辅助胸腔镜手术治疗的38例纵隔肿瘤患者的临床资料。结果:36例经胸腔镜完成肿物切除,2例中转开胸手术,全组病人术后恢复好,无围手术期死亡发生。病理结果:胸腺瘤8例,胸腺囊肿4例,胸腺增生3例,胸腺癌1例,神经源性肿瘤13例,气管支气管囊肿5例,心包囊肿2例,淋巴结增生1例,成熟性畸胎瘤1例。结论:电视辅助胸腔镜手术对纵隔肿瘤的临床诊治提供了一种创伤小、恢复快、安全可靠的新手段。

Objective To investigate clinical features and imaging presentations of inflammatory pseudotumor of the lung(IPL) to reduce the rate of misdiagnosis and enhance the rate of diagnosis before surgery. Methods Clinical data of 53 patients with IPL who were identified by pathological examination from Jan. 2003 to Jul. 2008 was retrospectively reviewed. 21 cases were misdiagnosed as lung cancer. 19 cases were suspected having tuberculoma(8 cases) or other benign lung tumors. 10 cases were undefined as occupied lesion in the lung. 2 cases were dignosed as mediastinal tumor. 1 case was dignosed as pulmonary metastasis of esophageal carcinoma. All patients received surgery,including wedge resection in 21 patients,lobectomy in 32 patients(pulmonary two-lobectomy in 6 patients) and lymph node dissection in 11 patients. Results The rate of misdiagnosis before surgery was 86.9%. 2 cases of postoperative complications occurred,including 1 case of pleural effusions and 1 case of chylothorax. Both patients were fully recovered and left hospital. 2 death occurred with a follow-up rate of 92.5%(49/53) from 2 to 68 months. 1 case died of hypertensive cerebral hemorrhage after 40 months and 1 case died of lower limb deep venous thrombosis and pulmonary embolism after 6 months. Both died of other diseases but IPL. Conclusion IPL lacks the characteristic of clinical presentations and imaging examination. The rate of misdiagnosis is high before operation. The main patterns of surgical management are wedge resection and lobectomy. The diagnosis and surgical pattern depend on the intraoperative frozen pathological section.

目的总结胸段食管异物的手术治疗经验。方法胸段食管异物患者11例,其中2例单纯食管异物行食管壁切开取出异物;合并食管穿孔、纵隔感染者9例,其中一期修补食管穿孔8例,食管无法修补者行食管内T管引流1例。结果术后死亡1例;术后食管胸膜瘘2例,经保守治疗后痊愈,8例恢复顺利。结论食管异物应尽早取出,对于需要外科手术的患者,应根据情况选择手术入路及手术方式。

Objective To summarize the experience in diagnosis and surgical treatment of pulmonary arteriovenous fistula.Methods Clinical data of 13 patients with pulmonary arteriovenous fistula were retrospectively analyzed. Results Eleven patients were diagnosed by chest spiral CT scan and vascular three-dimensional reconstruction , two patients were diagnosed by pulmonary angiography.Twelve patients received surgical operation successfully, lobectomy in 10 patients, pulmonary wedge resections in 2 patients.Symptoms disappeared or improved after operation, and clinical results were satisfactory.One patient with diffuse lesion gave up treatment.Conclusion Spiral CT scanning and vascular three-dimensional reconstruction are the most common diagnostic tools for pulmonary arteriovenous fistula.Surgery for limited pulmonary arteriovenous fistula has a good effect, and surgical procedure should be flexibly used on the basis of disease conditions.