Objective Implementation of radical surgery,thoracoscopic observation for its To observe the clinical effect and safety of thoracoscopic lung cancer patients with radical surgery.Methods Our hospital treated patients as research subjects,according to the surgical approach divided into observation group(35 cases) and control group(32 cases),the indicators of two groups of patients with intraoperative,postoperative complications and follow-up six months after the recurrence rate of surgery were compared.Results The two groups of patients with blood loss,average length of stay and postoperative pull the drainage tube time,the observation group lower than the control group(P0.05);In observation group,the incidence of complications(5.71%)was significantly lower than that of the control group(28.12%);Follow-up six months after the recurrence rate were 8.57% in the control group to 21.88%(P0.05).Conclusions Thoracoscopic lung cancer patients in the case of circumstances permit radical surgery with less trauma,clinical efficacy,postoperative complications and recurrence rate characteristics.

目的对比三种手术方式治疗上段食管癌的近期疗效以及并发症比较。方法回顾性分析2006年8月至2012年8月来我院诊断及治疗的上段食管癌患者,并选取了120例采用三种不同的手术方式进行治疗,经左胸食管癌切除术组(A组)、经颈胸腹三切口食管癌切除术组(B组)、颈食管抽拨胃代食管颈部吻合组(C组),每组30人,术后将三组患者不同手术方式的治疗效果和并发症情况进行对比分析。结果 A组吻合口漏的发生率、恢复过程中的出现呼吸和吞咽困难频率明显高于B组与C组,B组在各方面比较中最低,C组中肺部并发症的发生率较小,患者愈合速度快。结论综合分析,采用颈胸腹三切口食管癌切除术治疗上段食管癌的效果明显,出现并发症较少,但针对不同患者实际情况采取不同手术方式。

目的探讨保守疗法与手术治疗创伤性连枷胸的方法及疗效。方法对笔者所在医院收治的65例创伤性连枷胸患者的临床资料进行回顾性分析,其中对照组30例行保守疗法即非手术外固定治疗,实验组35例行手术内固定治疗。随访10～15d,对比两组患者治疗前后的血气指标和APACHEⅡ评分变化。结果组内比较,治疗后两组患者的血气指标和APACHEⅡ评分均优于治疗前,差异有统计学意义(P<0.05);两组组间相比,实验组患者上述指标优于对照组,差异有统计学意义(P<0.05)。结论应用手术治疗创伤性连枷胸,可明显改善患者的血气指标,提高患者的生活质量。

Objective Through investigating the clinical effect of closed thoracic drainage in treating pleural effusion to judge whether the method is safe,effective and of clinical promotion and application.Methods Retrospectively analysis 35 cases of the patients'data with closed thoracic drainage as treatment group from October 2009 to October 2011 in the hospital.Meanwhile,choosing 35 cases of the patients'data with traditional repeated thoracentesis as control group.Compared fever,exudation,breath shortness,time of pleural fluid absorption condition and complication of the two groups.Results As a result,there is low fever,less exudation and complication,obviously improvement of breath shortness in the treatment group than that of the control group.In 65 cases of the treatment group,the markedly ones were 59(90.7%),the effective ones were 4(6.2%)and the invalid ones were 2(3.1%);In the other group,the markedly were 34(52.3%),the effective ones were 33(33.9%) and the invalid were 9(13.8%).The differences are statistically significant(P < 0.05).Conclusion Closed thoracic drainage is easy to operate.It's safe,effective,less complication and could reduce pain with multiple puncture,which is worthy of promotion and application.

目的比较电视胸腔镜(VATS)与开胸手术(TH)治疗自发性气胸的临床疗效。方法随机选择2008年1月至2011年6月我院心胸外科住院治疗的120例自发性气胸患者,VATS,TH各60例,比较VATS与TH在手术时间、胸管引流时间、术中出血量、术后住院时间、术后复发及并发症等情况。结果与对照组比较,VATS组60例患者手术时间、胸管引流时间、术中出血量、术后住院时间及并发症具有显著性差异,具有统计学意义(P<0.05)。结论 VATS在治疗自发性气胸是微创、安全、有效的治疗手段。

目的观察吉西他滨联合顺铂治疗晚期NSCLC的近期疗效及毒性反应。方法吉西他滨1000mg/m2,第1、8天,顺铂总量75mg/m2,分3天(第2～4天),21天为1个周期,2周期评价疗效。结果可评价疗效119例,其中完全缓解0例,部分缓解50例,稳定66例,疾病进展3例,总有效率42.0%,临床获益率93.3%。主要毒性反应为骨髓抑制、恶心、呕吐。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌疗效高,毒性反应可耐受,可以作为治疗晚期非小细胞肺癌的一线首选方案。

目的 总结三分支主动脉弓覆膜支架治疗Stanford A型主动脉夹层的临床经验.方法 正中开胸,股动脉、右房插管转流,不游离主动脉弓及头臂血管,鼻温18℃,停循环,于无名动脉近端2 cm部分切开升主动脉,直视下置入三分支主动脉弓覆膜支架于主动脉弓和近端降主动脉及三支头臂血管内,行左颈总动脉、右无名动脉气囊导管选择性脑灌注,吻合支架血管近端与升主动脉人工血管,恢复全身灌注.观察并发症及疗效.出院时和3个月复查CT血管造影(CTA).结果 本组无死亡,手术过程顺利,脑及右上肢停循环6～7 min,左上肢及降主动脉停循环25～27 min,心肌血运阻断时间81～96 min,体外循环时间145～190 min.术后64排CTA示1例左锁骨下动脉支架外左侧少量血流流向降主动脉,3个月时消失;术后短暂、轻度精神症状1例;二次开胸止血1例,与血管吻合无关.术后1周及3个月CTA示支架血管位置满意,各头臂血管血流通畅.结论 三分支主动脉弓覆膜支架术中置入治疗A型主动脉夹层具有操作简单、并发症少、临床效果好等优点,值得临床推广应用.

随着影像学的发展,主动脉夹层的病例越来越多,应用覆膜支架腔内隔绝术已成为治疗StanfordB型主动脉夹层的首选方法.我院于2006年1月至2009年10月应用腔内隔绝术治疗Stanford B型主动脉夹层26例,效果良好,现报道如下.

目的总结西地那非联合NO在先天性心脏病合并重度肺动脉高压围手术期治疗经验。方法回顾分析15例重度肺动脉高压双向分流先心病围手术期相关治疗和预后。结果本组无死亡,无PI危象发生,无气管切开及二次插管;术后并发心律失常3例,低心排综合症1例。随访6～36个月,无远期死亡。心功能Ⅱ级,均可参加中度体力劳动。结论西地那非联合NO能提高先心病重度肺动脉高压围术期安全,降低并发症及死亡率的发生。

目的:总结房间隔缺损术后脑梗死的防治经验。方法:回顾性分析5例房间隔缺损心内修补术后脑梗死患者的临床资料。结果:3例临床治愈,2例遗留左侧肢体肌力3+级,1例术后心房颤动;随访1年,均为窦性心律,2例左侧肢体肌力3+级者恢复为4级,无再发脑梗死、出血等并发症发生。结论:房间隔缺损修补术应重视围术期处理,消除心房纤颤,维持窦性心律,重视抗凝。

目的 介绍胃、食管粘膜活瓣式三层错层吻合治疗食管中上段癌的手术方法,评价治疗效果. 方法 共对136例中上段食管癌行颈部胃、食管粘膜活瓣式三层错层吻合术. 结果 术后全组无死亡病例,出现吻合口瘘1例(0.74%),吻合口狭窄2例(1.47%),轻度胃食管返流5例(3.7%).结论 粘膜活瓣式三层错层吻合术具有优异抗返流功能,可有效防止食管癌术后胃食管返流的发生,并能减少吻合口瘘、吻合口狭窄并发症.