BACKGROUND:Bronchial stump fistula (BSF), which is located on the bronchial stump following pulmonary resection, represents a distinct subtype of bronchopleural fistula (BPF). Although the endobronchial valve (EBV) has been used to treat BPF, few clinical studies involve BSF occluded by EBV because the abnormal bronchial stump makes EBV implantation challenging. The present research reports novel methods of using a circular loop ligation technique for securing EBV to achieve BSF occlusion and a new classification of BSF that is compatible with these novel methods. METHODS:Based on the length of the bronchial stump, small visible BSF (SVBSF, less than 8 mm) is classified into the following types: SVBSF1 (< 3 mm), SVBSF2 (≥ 3 mm but shorter than a normal bronchus), and SVBSF3 (preserves a complete bronchial structure). SVBSF2 is further classified into SVBSF2a (the stump base remains partially intact) and SVBSF2b (complete destruction of the stump base). This retrospective research involved SVBSF2 patients who underwent EBV fixation with circular loop ligation. Detailed medical records were collected and analyzed to evaluate the efficacy of the novel procedure. RESULTS:A total of 15 patients underwent EBV implantation and fixation. All patients achieved a resolution of air leakage. Postoperative assessment revealed no instances of EBV displacement among VBSF2a patients, with all cases exhibiting significant improvement. CONCLUSIONS:The circular loop ligation methods for securing the EBV enable effective BSF closure in SVBSF2, especially SVBSF2a cases. This technique enables some BSF patients with abnormal structures at bronchial stumps to successfully perform the EBV occlusion.

Bronchial stump fistula occurs at the site of a lobectomy or segmentectomy and is a specific type of bronchopleural fistula. In addition to complications such as empyema and pneumothorax, a large bronchial stump fistula can result in decreased lung ventilation due to significant air leakage, particularly during general anaesthesia with endotracheal intubation, making closure of the large bronchial stump fistula challenging. The present paper reports on a case of a patient with a large right bronchial stump fistula who had difficulty maintaining normal oxygenation when using conventional tracheal intubation for mechanical ventilation. We utilised left-lung single-lung ventilation during the procedure to ensure adequate oxygenation and inserted a customised Y-shaped silicone stent via the transthoracic approach into the right-side fistula to occlude the bronchial stump fistula. A satisfactory outcome was achieved in this case.

Empyema is one of the most dangerous complications in thoracic surgery. It can easily progress to severe empyema with life-threatening conditions that are extremely challenging to treat. We successfully treated a patient with critically severe empyema via extracorporeal membrane oxygenation (ECMO), and the patient eventually recovered and was discharged. A 64-year-old male developed empyema 5 years ago. The thoracic infection led to a breakdown of the left chest wall. During hospitalisation, the patient's condition gradually deteriorated. We promptly initiated ECMO support and performed multiple debridement surgeries, fistula closure, targeted anti-infection treatment, and nutritional support. Ultimately, the patient's condition improved, as he eventually recovered and was discharged.

AbstractBronchopleural fistula (BPF), a common complication of lobectomy, is a pathological communication between the bronchus and the pleural space. The bronchial stump fistula (BSF), which is located on the bronchial stump, is a specific type of BPF. BSF can be directly diagnosed via bronchoscopy. However, identification becomes difficult when the BSF is very small (less than 1 mm), referred to as micro BSF in this study because it cannot be found during bronchoscopic exploration. This clinical dilemma easily leads to misdiagnosis of BSF. In this paper, a new procedure for locating micro BSFs using guidewire exploration was reported. This innovative approach involves the use of a guidewire to detect suspected micro BSFs. If the guidewire successfully penetrates the bronchial stump, it indicates the presence of a micro BSF; otherwise, there is none. After precise localization of three micro BSFs, submucosal injection of lauromacrogol around them was performed followed by thoracic fenestration.

RATIONALE:Fungal empyema is a chronic refractory disease. It is difficult to control thoracic infection, and it is faced with the problem of recurrence. How to control the infection and reduce the probability of recurrence is a difficult problem. Surgical operation combined with endobronchial therapy was used to control infection, seal the fistula and eliminate residual cavity and achieved good results.PATIENT CONCERNS:A total of 5 patients with fungal empyema were treated from 2019 to 2021, aged 27 to 72 years, with an average age of 54.8 ± 7.6 years. Two cases were on the left side and 3 cases on the right side.DIAGNOSIS:While meeting the diagnostic criteria of empyema, the diagnosis of fungus in pus culture or the discovery of fungus in deep tissue pathology confirmed the diagnosis of fungal empyema in the 5 cases.INTERVENTIONS:Through surgical operations combined with bronchoscopy and individualized treatment, the infection was controlled, the fistulas were blocked, and the pus cavity was filled.OUTCOMES:After 11 to 30 months of follow-up, the muscle flap in the abscess cavity was mildly atrophied, and there was no recurrence of empyema. Three patients who completed the second-stage operation had their chest tubes removed and returned to normal life. The 2 patients who did not complete the second-stage operation had no recurrence of thoracic infection and no recurrence of cough or fever, and their quality of life was greatly improved.LESSONS:Surgical operation combined with bronchoscopy is a reliable method for the treatment of fungal empyema, which can find and plug the fistula more efficiently and eliminate the residual cavity by surgery to avoid recurrence. Therefore, it is a recommended treatment method.

RATIONALE:Pulmonary sequestration, which can be divided into 2 main types: intralobar pulmonary sequestration (IPS) and extralobar pulmonary sequestration, is an uncommon congenital condition for which surgical resection is usually indicated. Video-assisted thoracoscopic surgery, as compared with open thoracotomy, has increasingly become the preferred operative procedure in the treatment of PS, owing to less postoperative pain and faster recovery. This report describes a rare and challenging case with a giant IPS undergoing video-assisted thoracic lobectomy.PATIENT CONCERNS:A 39-year old woman suffered from recurrent pneumonia for nearly 3 years. An enhanced computed tomography scan performed in our hospital revealed a 12.0 cm × 10.0 cm-sized IPS in the left lower lobe, supplied by an 8-mm aberrant artery originating from the descending thoracic aorta.DIAGNOSIS:Histology of the resected lobe confirmed the diagnosis of giant intralobar pulmonary sequestration associated with infection.INTERVENTIONS:Thoracoscopic left lower lobectomy was performed.OUTCOMES:The patient has been discharged from the hospital on the ninth day after surgery with an uneventful recovery, she was in good health after a 1-year follow-up.LESSONS:Although full of challenges, thoracoscopic lobectomy for giant IPS is a safe and feasible surgical procedure associated with reduced surgical trauma and postoperative pain as well as improved cosmetic results compared with traditional thoracotomy.

BACKGROUND Postoperative chronic empyema (PPE) remains a complex challenge for thoracic surgeons. We retrospectively investigated patients with PPE who were treated with free vastus lateralis muscle flap transplantation, and report our results. METHODS Eight patients with PPE and persistent bronchopleural fistula (BPF) treated in our hospital from January 2015 to June 2019 were retrospectively analyzed, the time since onset of empyema ranged from 5 to 72 months. The operation was performed in two stages, stage I surgery included empyema debridement, rib resection drainage or open-window thoracostomy (OWT), meanwhile, BPF was treated under bronchoscope. Stage II surgery included obliteration of the pleural space by free muscle flap transplantation. The keys to the operation are thorough debridement, closure of the BPF, and complete obliteration of the residual pleural space. The challenge lies in the anastomosis of the lateral femoral circumflex artery and vein that supply the vastus lateralis muscle flap to the thoracodorsal vessels. RESULTS The free muscle flaps survived in all eight patients. The abscess cavity was completely obliterated with the muscle flap. Good efficacy was achieved with primary wound healing. No serious perioperative complications were reported. No empyema recurrence, atrophy, infection, or necrosis of the muscle flap was seen during the 18- to 72-month follow-up. CONCLUSIONS The vastus lateralis muscle flap has a large volume with good blood supply and strong antibacterial ability. It can be used for effective obliteration of a large residual cavity caused by empyema and maintains a good thoracic shape. It is an ideal choice for the treatment of postoperative chronic refractory empyema.

Objective:To evaluate the safety and clinical efficacy of transplanting a muscle flap to treat the postoperative refractory empyema with a bronchopleural fistula.Methods:From July 2015 to December 2019, the clinical data of 15 patients who suffered from postoperative refractory empyema with bronchopleural fistula was retrospectively summarized. There were 13 males and two females with a mean age of 61.7 years. Ten cases had previous posterolateral thoracotomy and four cases underwent minimally invasive surgery. After conservative and endoscopic therapy, a pedicled latissimus dorsi muscle flap, a pectoralis major muscle flap, or a free vastus lateralis myocutaneous flap was harvested from the ipsilateral local thorax or thigh and was transferred to cover the intrathoracic cavity.Results:There was no perioperative death. During a mean follow-up of 14.8 months, one patient was dead, one suffered from a recurrence of refractory empyema, and l3 patients had an uneventful course with no recurrence of refractory empyema and bronchopleural fistula. Postoperative chest computed tomography or magnetic resonance imaging showed the empyema cavity was satisfactorily covered with a pedicle or free muscle flap.Conclusions:Muscle flap transplantation is an effective alternative for treating the postoperative refractory empyema with bronchopleural fistula, which can achieve promising short-medium-term results.

目的 比较术前运用Hook-wire和医用胶两种定位方式行胸腔镜手术(VATS)切除孤立性肺小结节(SPN)的临床疗效.方法 选取2016年3月至2019年9月在浙江省立同德医院心胸外科同一医疗组行VATS的SPN患者共70例.所有患者均为单个结节定位,其中采用CT引导下Hook-wire定位者42例,医用胶定位者28例,观察和比较两组患者定位时间、定位成功率,气胸、出血、刺激性咳嗽等定位相关并发症发生率,同时记录比较两组患者VATS时间,统计两组术中冷冻切片病理检查结果.结果 所有患者均顺利完成术前CT引导下肺结节穿刺定位.两组患者定位时间比较差异无统计学意义(P>0.05);Hook-wire组定位成功率明显低于医用胶组,差异有统计学意义(P<0.05).Hook-wire组气胸和渗血的发生率均明显高于医用胶组,差异均有统计学意义(均P<0.05);医用胶定位组咳嗽的发生率明显高于Hook-wire组,差异有统计学意义(P<0.05).所有患者均顺利完成VATS,Hook-wire组VATS时间明显长于医用胶组,差异有统计学意义(P<0.05);而两组患者术中冷冻切片病理检查结果比较差异无统计学意义(P>0.05).结论 CT引导下Hook-wire或医用胶定位均可用于VATS切除SPN,安全性高,可简化VATS操作难度,缩短时间,医用胶相比Hook-wire定位成功率高、手术用时更短,相关并发症少,予以优先推荐.

目的 总结1例闭合性颈段气管断裂伤的诊治经验,进一步提高对该病的认识和诊疗水平.方法 患者,男性,41岁.颈部被钢板撞击伤后出现高度皮下气肿、呼吸困难,皮下排气后症状改善不明显,紧急行颈胸部CT检查发现高度皮下和纵隔气肿、颈部气管不连续,考虑气管断裂伤,在急诊手术中发现气管1～2环间全断离,伴软骨骨折、周围软组织损伤,行气管断端吻合、低位气管切开术.结果 术后恢复顺利,2周后拔除气管套管,病人呼吸、进食正常,但出现声音嘶哑,喉镜检查发现声带固定,半年后复查胸部CT气管断端吻合口无狭窄,因声音嘶哑未改善行双侧声带切除和气管切开术,带气管套管至今2年余.结论 闭合性颈段气管断裂伤可能引起气道梗阻而窒息死亡,救治成功的关键是确保气道通畅、早期做出正确诊断和及时重建断裂气管,气管吻合术能取得满意的疗效.

脓胸相关性弥漫性大B细胞淋巴瘤(PAL)通常发生于慢性脓胸患者.临床表现各异,常有胸痛、背痛或肩痛,伴或不伴其他症状.由于其在基因方面与普通的弥漫性大B细胞淋巴瘤存在着明显差异,故WHO将其单独分类.

目的 总结和分析支气管胸膜瘘合并难治性脓胸个体化综合治疗的方法和疗效.方法2015年7月—2019年11月共收治支气管胸膜瘘合并难治性脓胸患者12例,其中男性10例,女性2例;年龄23～78岁,平均(60.75±15.05)岁.初始手术为非小细胞肺癌4例,肺部良性疾病4例,包裹性胸腔积液3例,恶性胸腺瘤肺转移1例.胸膜瘘发生后,采取经脓胸引流控制感染和介入封堵瘘口治疗;病情基本稳定后,行肌瓣移植术填塞脓腔等综合措施,并根据病情进行个体化治疗.结果全组无围手术期死亡病例;在平均17.45个月的随访中,1例患者因肿瘤转移死亡;1例复发小脓腔;其余10例无支气管胸膜瘘和脓胸复发,肌瓣存活,复查胸部CT/MRI显示脓腔被彻底填塞.结论对支气管胸膜瘘合并难治性脓胸患者采取个体化综合治疗措施,能达到彻底根治的目的,成功率高,疗效显著,值得推广.

2015年5月至2019年9月应用游离股外侧肌皮瓣移植术治疗7例顽固性慢性脓胸，其中男5例，女2例；年龄23～70岁，平均(66.38±11.24)岁。脓胸均为胸部外科手术后并发症，右侧6例，左侧1例。术中取游离股外侧肌皮瓣填塞脓腔，显微镜下行旋股外侧动脉降支动脉、静脉与胸背动、静脉间断缝合，以提供该组织瓣的血供。术后游离肌皮瓣成活6例，失活1例。术后随访(26.5±18.2)个月，1例恶性胸腺瘤转移复发，术后半年死亡；其他6例均肌瓣成活，脓腔填塞良好，无脓胸复发，无胸闷等不适。肌瓣供区愈合良好，下肢功能无明显影响。游离股外侧肌皮瓣移植术能有效填塞脓胸残腔，不改变胸廓外形，不影响下肢功能，适用于含有巨大脓腔、无法使用带蒂和其他游离肌皮瓣的术后慢性脓胸，近、中期疗效满意，是一种可供选择的理想方法，值得临床推广。

慢性脓胸通过开窗引流、胸膜剥脱术、胸廓成形术、介入封堵等治疗可以取得比较理想的效果,但临床上仍有一些患者因存在不易被彻底清除的巨大脓腔,也可能合并胸膜支气管瘘、胸壁窦道、残留骨和软骨等坏死组织,从而导致局部感染不易控制而难以彻底根治.笔者应用联合带蒂肌瓣移植术治疗慢性难治性脓胸15例.现报道如下.

目的 观察血管内皮生长因子(VEGF)对大鼠离体心脏骨髓间充质干细胞(BMSCs)滞留率的影响.方法 取20只雄性SD大鼠,腹腔注射麻醉无菌条件下取股骨和胫骨,用DMEM培养基缓慢冲洗骨髓腔,离心收集细胞,接种到DMEM培养基原代培养,取传代3代后的BMSCs.另取100只雌性SD大鼠随机分成正常灌注BMSCs组、正常灌注BMSCs+VEGF组、缺血再灌注BMSCs组、缺血再灌注BMSCs+VEGF组,每组25只.正常灌注BMSCs组大鼠建立心脏离体灌注模型,灌注1 ×106/mL BMSCs细胞1mL,停2min后重新灌注,于5、10、30、60、120min时间点收集从心脏流出的灌注液,每个时间点5只.正常灌注BMSCs+VEGF组大鼠灌注BMSCs前预先向心脏注入浓度1000μmol/L的VEGF 1mL,其他实验步骤与正常灌注BMSCs组相同.缺血再灌注BMSCs组大鼠建立心脏离体灌注模型,待心脏稳定搏动15min后,关闭灌注系统使心肌缺血30min,建立缺血再灌注模型,其他实验步骤与正常灌注BMSCs组相同.应用荧光定量聚合酶链反应(RT-PCR)检测各组大鼠高体心脏不同时间点骨髓间充质干细胞滞留率.结果 正常灌注BMSCs组大鼠5、15、30、60、120min时间点之间平均BMSCs滞留率差异无统计学意义(P＞0.05);缺血再灌注BMSCs组大鼠5、15、30、60、120min时间点平均BMSCs滞留率均高于正常灌注BMSCs组[(36.96±4.79)％比(16.32±3.84)％、(35.88±4.76)％比(14.02±5.23)％、(28.05±3.46)％比(12.48±3.46)％、(27.04±6.35)％比(12.42±3.61)％、(27.06±5.84)％比(12.42±3.49)％,P均＜0.05];与正常灌注BMSCs+VEGF组比较,缺血再灌注BMSCs+VEGF组平均BMSCs滞留率明显增加[(41.46±5.88)％比(19.38±4.66)％、(37.82±5.74)比(19.54±5.11)％、(32.82±3.53)比(16.68±2.64)％、(33.24±6.19)比(16.06±2.12)％、(31.60±3.24)比(15.60±2.00)％,P均＜0.05);正常灌注BMSCs+VEGF组与正常灌注BMSCs组同时间点平均BMSCs滞留率比较,差异无统计学意义(P＞0.05);缺血再灌注BMSCs+VEGF组与缺血再灌注BM-SCs组同时间点平均BMSCs滞留率比较,差异无统计学意义(P＞0.05).结论 缺血再灌注可显著增加大鼠离体心脏骨髓间充质干细胞滞留率;而血管内皮生长因子对其无明显干预作用.

目的 探讨胸腔镜探查联合小切口辅助对多发肋骨骨折内固定治疗的临床疗效.方法 回顾分析2015年8月至2018年2月间我科收治的严重胸部钝性伤行手术内固定病人共32例,所有患者均于伤后一周内在胸腔镜下探查,并辅助予8 cm左右的小切口,选用镍钛记忆合金肋骨环抱器固定肋骨,重塑胸壁的结构及稳定性,同时记录与手术相关数据指标.结果 32例患者均顺利完成胸腔探查+肋骨内固定手术,平均肋骨固定数5.6根(4～11根),平均手术时间为126 min(86～180 min),术中平均出血量:130 mL(100～250 mL),术后平均拔管时间3 d(2～5 d),术后平均住院时间:8.5 d(6～15 d),术后平均随访6月,2例患者出现胸壁慢性疼痛,无死亡及其他严重并发症患者.结论 胸腔镜辅助小切口治疗严重多发肋骨骨折安全、有效,它能使内固定手术更加微创化,促进患者快速康复.

Objective] To set neonatal TCM constitution identification table,and test the reliability and efficiency,providing a powerful basis for promoting neonatal TCM constitution identification table widely. [Methods] Determine neonatal TCM constitution identification table according to related literature,parents' feelings and reactions for inquiry and expert consultation, and examine the reliability and efficiency of result. [Results] ①Reliability-testing shows: total cronbach coefficient is 0.782,remove any entries in the 15 entries,compared with the total coefficient table,the coefficients are decreased,and reproducibility correlation coefficients are greater than 0.7. ②Validity-testing shows: the Pearson correlation coefficients between each table factor score and total score are over than 0.6. [Conclusions]The structure of table is clear ,good content and structure validity provides a tool and method for neonatal TCM constitution identification.

目的 探讨健康新生儿的体质分型,确定各类型体质的典型临床表现,为新生儿体质分型提供辨识依据.方法 通过对在我院出生的93名健康新生儿的体质进行辨识,观察新生儿面色、唇色、舌质、肌肤弹性、肢端温度等条目,考察健康新生儿的体质分型.采用SPSS 19.0软件进行统计学分析,对三种体质类型的各个条目进行比较,对差异有统计学意义的条目再进行体质的两两组间比较.最终,确定各体质分型的典型表现,以期通过五脏的外在表现,推知五脏的偏盛与不足.结果 通过辨识发现新生儿体质以阴阳平和质居多(76.34％),其次为阳盛质(20.43％),阴盛质最少(3.22％).经统计分析发现阳盛质以面色潮红、唇色多深红或红润、头发浓密等为典型表现;阴盛质以唇色淡红略白、舌质淡白及头发较稀疏为典型表现;平和质以面色红润或淡红,唇色红润或略淡红,头发多且较密等为特点.结论 不同体质的新生儿在脏腑的虚实和气血阴阳方面是有差别的.阳盛质新生儿心肝阳气相对较旺,脾阴相对不足,肾中精气充实;阴盛质新生儿的脾中气亏血少,心血不足,肾中先天之精欠充盛;阴阳平和质新生儿五脏发育相对完善,气血生化有源,肾中精气较为充实.

[目的]建立新生SD大鼠缺氧缺血性脑损伤(HIBD)模型,观察低氧诱导因子-1(HIF-1)的表达及加味补阳还五汤对新生大鼠缺氧缺血性脑损伤的保护作用,为新生儿缺氧缺血性脑损伤提供新的治疗思路.[方法]新生7d龄SD大鼠140只,随机分为空白组(28只)、HIBD模型组(28只)及加味补阳还五汤纽(84只),加味补阳还五汤组按给药剂量分为高、中、低剂量组.每组分别在规定时间点处死,光镜下观察各组大鼠左侧脑组织HE染色的病理改变、组织中HIF-1α蛋白表达,并通过RT-PCR检测HIF-1基因表达.[结果]缺氧缺血后新生大鼠出现不同程度的行为异常,1h后逐渐由兴奋转为抑制,少数发生抽搐;HE染色结果显示,加味补阳还五汤高剂量组各时间点损伤程度比中、低剂量组均有明显减轻;免疫组化结果显示,加味补阳还五汤各剂量组各时间点HIF-1α阳性细胞数均较空白组多,高剂量组各时间点HIF-1α阳性细胞数均较HIBD纽明显增多;荧光定量PCR检测结果表明加味补阳还五汤高剂量组HIF-1的表达量高于其他组,差异均有统计学意义(P＜0.05).[结论]加味补阳还五汤能通过上调HIF-1的表达来减轻缺氧缺血所致的脑损伤,此研究为临床治疗新生儿缺氧缺血性脑损伤提供了新的治疗思路.