Objective:Discuss the advantages and opportunity of interventional treatment of empyema by using catheter,and comparing with the traditional treatment.Method:14 patients by putting the pig-tail catheter into the limited empyema with local anesthesia and to wash the cavity with antibiotics solution ,and pull out the cather from the empysema step by step with the reduction of the purulent fluid. Result:12 of 14 patients recovered entirely ,2 patients got well obviously, the average date in the hospital is 22.3 days without other clinical complications.Conclusion:It is very effective and safe methods for treating the limited empyema by using pig-tail catheter.

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.

食管腐蚀性狭窄是胸外科最常见的食管良性狭窄,治疗难度较大,尚无统一规范的治疗方案.2000年1月～2004年5月我们共收治了78例食管腐蚀性狭窄病人,其中放置支架术后再狭窄8例(10.25%),77例分别进行了手术治疗,术式以旷置狭窄段以下食管并经胸骨后结肠代食管术为主.疗效满意,现报道如下.

2003年8月,我们为1例肺淋巴管平滑肌瘤病病人行右单肺移植术.术后病人发生严重的支气管吻合口和肺内毛霉菌感染,经治疗已痊愈;移植肺支气管软化造成狭窄,反复扩张治疗,目前病情稳定.现报道如下.

The aim was to assess complement dependent cytotoxicity and change of IL-1 in hyperacute rejection of pig-to-human xenotransplantation. Cultural porcine vascular endothelial cells (PVECs) and human sera were used to set up an vitro model of hyperacute rejection of pig-to-human xenotransplantation. Various serums were divided into four groups: HS, HI HS, C1q-D, PS. Every serum was incubated with cultural primary porcine endothelial cells from 0.5 to 4 h, then supernatant fraction was removed to test LDH content, finally percent cytotoxicity was calculated. Morever, IL-1β in supernatant fraction was determined by ELISA. Result: 1) In the same time point, percent cytolysis of HS was higher significantly than that of control (P0.01) and HI HS, C1q-D’s percent cytolysis was similar to control’s (P0.05). As time prolonged, percent cytolysis of HS continued to increase ( P 0.01). However, percent cytolysis of every group didn’t increase after 3～4 h. 2) In the group of HS, the contents of IL-1β were higher than those of control ( P 0.01). Other groups’ contents were similar to those of control ( P 0.05). When reaction time prolonged, content in group HS went up and remained stable when reaction time arrived at 3～4 h. The results suggest that endothelial cells have an important role in the thrombosis in hyperacute rejection of pig-to-human xenotransplantation by influencing IL-1.

1998年4月至2002年1月,我们共手术治疗胸内气管原发性肿瘤5例,部分手术难度较大,麻醉困难.现报道如下.

病人男,20岁,自幼反复咳嗽,咯黄脓痰,常有头痛伴鼻腔脓性分泌物.查体见鼻腔有脓涕,副鼻窦压痛;轻度漏斗胸;心尖搏动位于右侧.听诊右侧心音无病理杂音,双肺有细湿罗音.X线胸片显示镜面右位心,双肺纹理粗重.支气管碘油造影示左肺中叶及左下叶外基底段、右肺舌段支气管柱状扩张.腹部B超显示肝、脾转位.精液检查示精子不运动.临床诊断为Kartagener综合征.

Objective To study the treatment of stenosis of both anastomosis of bronchus after bilateral lung transplantation.Methods One patient with mucosal necrosis and stenosis in both anastomosis of bronchus underwent a bilateral lung transplantation in Jan.1998.Multiple processes of dilation and Nd:YAG laser treatment through both fiberoptic and rigid bronchoscope within 13 months were performed. Results we succeeded in remaining the diameter of left anastomosis 10 mm but failed in the right. Then we had to do right pneumonectomy because of repeated pneumonia. Tuberculosis infection was found in the wall of stenosed area.Conclusion Ischemia of bronchus, large dose of corticosteroid and tuberculosis may contribute to the stenosis of this patient. Early treatment of dilation using conscious sedation was critical and the effect of metal hollowed bar like dilator may be better than the balloon ones.

例1 男，47岁。终末期结节病肺纤维化。1995年2月行左侧单肺移植〔1〕。术后环孢素、硫唑嘌呤、强的松三联免疫治疗，4次临床急性排斥，甲基强的松龙冲击治疗有效。术后13个月时低热伴胸闷、咳嗽、少量白痰；左前胸季肋部疼痛，局部轻度压痛，外观正常。数天后局部隆起，CT显示左前胸壁低密度区；穿刺抽出黄色脓液，涂片见大量抗酸杆菌、结核菌培养结果阳性。临床诊断胸壁结核脓肿伴混合感染。给予链霉素、异烟肼、利福平治疗；脓肿切开引流换药，3个月后伤口愈合。随访至今已5年，结核未再复发。 例2 男，30岁。原发肺动脉高压。1998年1月体外循环下行双侧肺移植〔2〕。术后2周支气管吻合口远端粘膜广泛坏死、结痂，结痂脱落后深面出现肉芽组织。术后11个月右上叶及中间干支气管开口几乎闭塞，无法进一步扩张。至术后14个月，右下肺野开始出现斑点状阴影，逐渐增多，致膈面消失。体温升高，痰涂片及培养均无阳性发现。因右肺实变逐渐加重，被迫于术后16个月时切除右肺。术后肺标本见各叶、段开口均已经完全闭塞，肺组织内有多处脓肿。病理报告：干酪样增殖性肺结核、支气管内膜结核。服用利福平、异烟肼、乙胺丁醇治疗。全肺切除术后3周出现支气管残端瘘，积极抗结核及免疫抑制治疗，现已经痊愈，无病生存超过2年。 讨论 Kesten等〔3〕指出，所有的肺移植术后感染都出现在肺移植术后前3个月内，有证据说明是供体带给受体的感染。肺移植术后肺结核与大剂量使用激素有关。本组2例供体X线胸片均未见异常，但不能排除结核感染尚未发病的可能，亦可能为移植术后感染结核。且因担心排斥反应对病人生命的威胁，使用激素量较大，可能也是病人结核发病的原因之一。病人发病时间在术后13～14个月。我们认为，结合我国具体国情，给肺移植病人预防性服用异烟肼，利大于弊，但尚待进一步总结。 一般情况下结核病的诊断并不困难，但移植术后在免疫抑制治疗情况下，病人的临床表现，如乏力、盗汗可以很轻微，发热也很难与其他感染引起的发热鉴别。X线表现也很不典型。本组2例病人即如此 ，其中双肺移植病人由于术后早期有吻合口狭窄，更忽视了结核感染；尤其是支气管内膜结核的存在，始终认为是炎性肉芽肿，致支气管阻塞造成远端细菌感染，而被迫切掉了一侧肺。 肺移植术后结核感染一旦确诊，常规抗结核药物异烟肼、利福平、乙胺丁醇、链霉素等治疗效果都很好，即使是在免疫抑制治疗之下，也能治愈，很少复发。

Objective To investigate the diagnosis and treatment of tuberculosis(TB)after lung transplantation.Method One case of abscess in the left chest wall caused by TB infection after left single lung transplantation was diagnosed.The patient was cured by anti-TB drugs along with incision of the abscess.Results Mter anti-tuberculotic treatment,the patient's disease conditions were rapidly controlled,body temperature retumed to normal and the would healed within 3 months.Conclusions The symptoms of TB after lung transplantation are atypical and so are the corresponding laboratory tests.Sometimes it is difficult to distinguish it from acute rejection and infection.Most TB patients can be cured with anti-tuberculotic as soon as the right diagnosis is obtained.

很久以前器官移植就已经成为人类渴望实现的美好愿望,并为此进行了不懈努力.

异种移植最大障碍是由体液免疫造成的超急性排斥反应(Hyperacute rejection,HAR).本实验用猪胸主动脉血管内皮细胞和人血清建立HAR体外模型,LDH释放法检测补体依赖的细胞毒作用,探讨HAR中补体激活途径.

1993年以来,国内大陆进行了10例肺移植手术(单肺8例、双肺2例),大部分病人术后7～48d死亡.北京安贞医院首例单肺移植至今已生存5年,2年前双肺移植1例(即本例)至今也生存.现总结报告双肺移植术后2年的治疗随访经过和经验体会,希望能对我国肺移植工作有所帮助.

Objective To study the role of vascular endothelial cells in hyperacute rejection of pigto-human xenotransplantation.Methods The in vitro cultured porcine vascular endothelial cells(PVEC) and human sera were co-reacted to set up an in vitro model of hyperacute reiection of pig-to-human xenotransplantation,PGI2 and TXA2 contents in the supematant were determined by using RIA and PGI2/TXA2 calculated.PVECs were treated with nonml human sera in group HS.with heat-inactived human sera in group HI HS,with C1q-depleted human serum in group C1q-D,and with porcine sera in group PS. In control group,no sera was used.Results The ratio of PGF1α/TXB2 in group HS(1.16±0.31) was lower than in the control(2.03±0.22,P＜0.01) after the reaction of sara with PVEC for 0.5 h.However,the ratio in groups HI HS,C1q-D and PS(2.04±0.40,2.05±0.10,1.97±0.21,respectively) was similar to that in the control group(P＞0.05).With the reaction time prolonging from 0.5 to 4 h, the ratio in group HS was gradually decreased (P＜0.01),but the ratio in the remaining groups kept stable (P＞0.05).Conclusions After pig-to-human xenotrasnplantation,endothelial cells were activated to resuh in the changes in PGI2 and TXA2 and PGI2/TXA2, which could promote the thrombosis of hyperacute rejection.

良性转移性平滑肌瘤(benign metastasizing leiomyomas,BML)是一种罕见的、原因不明的疾病.世界上仅有40余例报告[1].

传统的死亡概念是心脏和肺丧失功能,由于心肺功能的停止是容易观察到的,所以判定是否死亡比较容易取得一致.不过,最近30年来,传统的死亡观念遇到了挑战,一方面是由于复苏抢救设备的出现,使人工维持心肺功能成为可能,心跳、呼吸停止才算是死亡的观念受到质疑;另一方面,大量的资料表明,当脑干受到广泛而不可恢复的损伤时,即使人工维持的心肺功能非常好,也不能真正挽救生命,而只是在延迟心肺的死亡过程.

肺移植适用于治疗双侧肺部均有严重病变、在目前治疗过程中肺功能正在进一步减退,内、外科都无法进一步治疗的终末期肺病患者;患者的预期寿命和生活质量已经极差,不过还没有危及移植后长期存活的疾病,如肝、肾病变,急性危重肺病患者很少考虑肺移植,单侧肺部病变再严重也不是适应证,因为把一侧肺全部切除,剩下的另一侧肺也可以很好地维持生命.

家族性自发性气胸是一种少见的遗传性疾病,本文报告3个家族共11例患者,5男6女,共21次气胸发作,有6人经手术治疗,气胸原因为胸膜下肺大疱破裂.复习文献,作者认为我国家族性自发性气胸符合常染色体显性遗传.

肺移植已经成为治疗许多终末期肺部疾病的有效方法,移植给患者的肺即"供肺",来自肺外原因死亡的病人.由于常温下肺不能长时间保存,供肺必须从仍有心跳,即有血液灌注的供体上采取,用低温保护液灌注保存,也就是要使供肺没有或只有很短的"热缺血"时间,然后在数小时内完成移植.

Objective To observe the therapeutic effect of single lung transplantation. Methods Left single lung transplantation was performed on a 47-year-oldmale patient with pulmonary sarcoidosis in Feb. 23,1995. Results After operation, complications, including hypertension, diabetes mellitus, recurrence of sarcoidosis and chest wall tuberculosis , were all cured. There were five episodes of acute rejection. The patient recovered well 6 months after operation and was able to undertake light physical labour. Conclusion Lung transplantation might be an only effective method for the treatment of endstage pulmonary dieases.