目的 探讨纵隔镜辅助手术治疗早期食管鳞状细胞癌的远期结局.方法 回顾性分析2005年12月～2014年12月180例早期食管鳞状细胞癌接受纵隔镜辅助食管癌切除术的临床资料,通过无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)分析患者远期生存情况.结果 均无术后30、90 d内死亡发生.术后并发症发生率30.6％(55/180),按发生率由高到低分别为吻合口漏15.6％(28/180),肺不张7.8％(14/180),肺部感染5.0％(9/180),声带麻痹2.8％(5/180),切口裂开2.2％(4/180),肠梗阻1.1％(2/180),乳糜胸1.1％(2/180),膈疝0.6％(1/180).术后吻合口/残胃复发率10.6％(19/180),术后转移部位前2位分别为淋巴结转移率16.7％(30/180)、肺转移率5.6％(10/180).3年PFS为74.4％,OS为81.1％;5年PFS为70.6％,OS为71.7％.结论 纵隔镜辅助食管癌切除术是治疗早期食管癌的有效手段.

Objective To compare the cost-effectiveness of non-intubated general anesthesia with conventional general anesthesia for thoracoscopic bulla resection. Methods Sixty patients scheduled for elective thoracoscopic bulla resection, were divided into two groups (30 each) using a random number table: the conventional general anesthesia group (T group) and the non-intubated general anesthesia group (NT group). Patients in group T were induced with conventional general anesthetic, single-lung ventilated after intubation with double-lumen bronchial catheters. Patients in group NT were induced with general anesthesia combined nerve block, and spontaneous breathings were retained. The results of blood gas analysis, anesthesia time, operation time, intraoperative blood loss, time for orientation recovery and modified Aldrete score ≥ 9 minutes were recorded. The intraoperative and postoperative complications, postoperative hospital stay time, VAS and PC A scores 48 h after operation were recorded. Calculate the cost of anesthesia and the total cost of hospitalization. Results Compared with T group, NT group had lower pH value and higher PCO2 at 30 min before and after the thoracic closure, oxygenation index in the NT group increased at 30 min after the thoracic closure (P < 0.05). Compared with T group, anesthesia time, time for orientation recovery and modified Aldrete score ≥ 9 minutes, incidence of postoperative sore throat, postoperative hospital stay time, VAS scores at 6, 12 h and PC A at 48 h after the operation, anesthesia costs, and total hospitalization costs in the NT group were all reduced (P < 0.05). Conclusions Fully considering the safety, compared with the traditional tracheal intubation general anesthesia, non-intubation general anesthesia can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing thoracoscopic bulla resection.

目的 对比免气管插管和传统双腔气管插管胸腔镜肺大疱切除术的安全性和可行性.方法 2016年6月～2018年5月,行免气管插管胸腔镜肺大疱切除术50例(免管组),同期行全麻双腔气管插管胸腔镜肺大疱切除术50例(插管组),2组术前临床资料差异无统计学意义,比较2组麻醉和手术指标.结果 2组均顺利完成手术,与插管组比较,免管组术前麻醉准备时间短[(17.6±3.0)min vs.(41.5±5.4)min,t=27.130,P=0.000],术后苏醒时间短[(22.0±4.0)min vs.(40.6±6.0)min,t=18.330,P=0.000],胸管引流时间短[(22.3±5.5)h vs.(24.6±4.3)h,t=2.328,P=0.022],术后住院时间短[(2.2±0.7)d vs.(2.8±0.4)d,t=4.681,P=0.000],麻醉费用少[(1896.0±310.5)元vs.(3734.0±359.3)元,t=27.370,P=0.000].结论 免气管插管的胸腔镜肺大疱切除术具有安全、便捷的优点,可以减少麻醉副作用,缩短住院时间,降低医疗费用,符合快速康复理念.

Objective To compare the safety and early clinical efficacy of thoracoscopic lobectomy by nonintubated versus traditional intubated anesthesia.Methods We retrospectively analyzed clinical data of 30 patients treated with non-intubated thoracoscopic lobectomy in the Third Affiliated Hospital of Soochow University from June to December,2016.Meanwhile we selected 30 patients treated with thoracoscopic lobectomy by traditional intubated anesthesia as a control group.Clinical results of two groups were compared.Results There was no statistical difference in preoperative clinical data between the two groups.All patients were successfully operated.Patients in non-intubation group had shorter durations of anesthesia induction time and back to awake time,shorter duration of chest drainage and hospital stay,less C-reactive protein levels after surgery,compared with the control group(all P＜0.05).Conclusion Non-intubated thoracoscopic lobectomy is technically feasible and safe with reduced complications of traditional anesthesia,less postoperation pain,shorter hospital stay and less hospitalization costs which fit the idea of fast recovery.

我们采用电视纵隔镜技术为47例早期食管癌患者进行了经纵隔径路食管切除手术.现将本组病例治疗经验总结报道如下. 资料和方法 2004年2月至2007年2月,在常州市第一人民医院接受治疗的早期食管癌患者中随机选择83例,入选标准:(1)通过胃镜确诊为食管鳞癌.(2)术前检查胸部增强CT及上腹部B超检查无明显转移.(3)术前经食管超声内镜(EUS)检查纵隔无明显肿大淋巴结,且食管癌浸润不超过T2.排除标准:(1)既往有颈椎疾病史,头颈不能后仰者.(2)有明确心肌梗死、脑梗死、肺梗塞病史.(3)胸部CT或超声内镜示纵隔淋巴结肿大超过1 cm.

目的分析纵隔镜辅助食管癌切除手术的术后并发症。方法回顾性分析128例纵隔镜辅助食管癌切除手术资料,探讨术中、术后并发症的原因、处理方法和结果。结果术中因出血中转开胸2例;气管损伤1例。术后发现喉返神经损伤4例;乳糜纵隔2例;纵隔血肿3例;血胸4例;吻合口瘘7例;呼吸衰竭2例;心律失常12例。结论纵隔镜辅助食管癌切除手术创伤小,术中、术后并发症较常规手术少。

<正>上世纪80年代至90年代初,二尖瓣闭式分离技术在我国得到广泛开展,在此期间曾行二尖瓣闭式分离术的病人中,大部分再次出现二尖瓣狭窄,我院自2003年3月—2009年5月共收治此类病人19例,行瓣膜置换手术,其中

2002年1月-2005年1月共抢救外伤性胸主动脉破裂(TRA)患者7例,现就围术期处理方面的体会报告如下.

肺大疱和(或)自发性气胸的手术治疗既往常规采用剖胸手术,但其切口长,术后伤口疼痛剧烈,恢复期长;对双侧肺大疱的治疗则需行胸骨正中劈开同期手术或2次剖胸手术,患者手术创伤大,且分次手术费用昂贵,难以接受.我科自2003年9月-2007年6月,应用电视胸腔镜(VATS)同期手术治疗双侧肺大疱28例,取得了良好的近期效果,现报道如下.