非小细胞肺癌(NSCLC)是肺癌最常见的组织学类型.对于晚期NSCLC患者,传统治疗方法是以铂类为基础的化疗,但化疗副作用大且效果有限.近年来,随着肺癌靶点及分子靶向药物的不断研发,分子靶向治疗已成为晚期NSCLC患者一种重要的治疗手段.本文对目前晚期NSCLC患者的分子靶向药物治疗进行综述,以期为临床提供参考.

目的 研究广西巴马小型猪心脏解剖特点及其供体心脏的获取方法.方法 选用广西巴马小型猪26头,在全麻体外循环下获取供心,用于供心离体灌注实验.结果 供体心脏获取耗时25～30 min.在26例供心离体灌注实验中,20只(76.9％)自动复跳,6只在人工心脏按压后复跳,均为窦性心律.同时发现广西巴马小型猪的前后腔静脉心包内段比较短,升主动脉也较短,主动脉弓分两支,右肺动脉与左心房常常融合,不容易分离.结论 广西巴马小型猪的心脏有其自身的特点,应根据其特点采用相应的方法获取供体心脏.

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.

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.

Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement.

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 Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Here, we introduced a method of video-assisted thoracic surgery with no disposable consumables. Methods Between Oct. 2011 and Feb. 2016, a series of 84 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. Results Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage ( P > 0. 05 ), postoperative stay, and recurrence between the two groups [( 16 747. 30 ±2 586.41) yuan vs (21 088.54±6 005.68)yuan,P<0.05] . Conclusions Biportal thoracoscopic bleb ligation for primary spontaneous pneumothorax is a safe, low-cost, simple and reliable procedure.

Background: Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.Methods: Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.Results: Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.Conclusions: The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

<正>孤立性肺结节(SPN)随着CT检查越来越普遍,它的发现明显增多,且结节中肺癌所占比例较高,所以要高度重视。我科2005年10月至2012年10月收治65例SPN,现就其诊治作一回顾性分析,总结如下。1临床资料1.1一般资料2005年10月至2012年10月收治SPN65例,男性45例,女

<正>我院心胸外科最近收治1例胸部穿通等多处刀刃伤致严重失血性休克的患者,术前、术中心跳骤停各一次,术后广泛渗血,经过多科室的协作,抢救成功,现报道如下。1临床资料及救治经过患者,男,30岁,于2009年6月23日凌晨因"左胸、头部等处刀刺伤半小时"来急诊科就诊。查体:全身多处血迹,血压82/40 mmHg,脉搏154次/分,呼吸32次/分,神志欠清,面色苍白,左前胸第6肋间有一伤口长约2 cm,有血气溢出,头

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。

目的探讨非开胸食管内翻拔脱术在食管癌治疗中的临床效果及其应用价值。方法对19例食管癌患者Ⅰ期4例,Ⅱa期10例,Ⅱb期5例均采用非开胸食管内翻拔脱术,行颈部胃食管端侧吻合。结果全组无手术死亡,均获随访,术后生存时间5年及以上4例,3～5年8例,0.5～3年3例,4例在术后出现死亡,其中2例因癌转移死亡,2例因其他疾病死亡。结论非开胸食管内翻剥脱术具有术后康复快、微创等优点,尤其适用于早中期食管癌及心肺功能差的患者。

<正>肺癌是全球病死率最高的肿瘤之一,大部分患者为非小细胞肺癌(NSCLC),严重威胁人类的健康。近年来,肺癌发病率呈上升趋势,在城市位于恶性肿瘤第1位。尽管在过去30多年里,手术、放疗、化疗取得了较大的进步,但是肺癌总的疗效仍然不理想。近几年来,以多学科综合治疗为导向的理念,为提高肺癌疗效提供了新的思路。2007年2月至2011年2月本院对收治的53例NSCLC患者在行肺癌根治术的同时术中

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。

<正>肺癌是全球病死率最高的肿瘤之一,大部分患者为非小细胞肺癌(NSCLC),严重威胁人类的健康。近年来,肺癌发病率呈上升趋势,在城市位于恶性肿瘤第1位。尽管在过去30多年里,手术、放疗、化疗取得了较大的进步,但是肺癌总的疗效仍然不理想。近几年来,以多学科综合治疗为导向的理念,为提高肺癌疗效提供了新的思路。2007年2月至2011年2月本院对收治的53例NSCLC患者在行肺癌根治术的同时术中

[目的]分析严重胸外伤及合并伤的有效救治方法,以降低死亡率,提高救治效果。[方法]对160例严重胸外伤患者的救治措施进行回顾性分析总结。[结果]治愈147例,死亡13例。[结论]积极抗休克、尽早手术、保护各脏器功能是抢救严重胸外伤及合并伤成功的关键。

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。

Objective:To evaluate the feasibility of video-assisted minimal access surgery for lobectomy and pneumonectomy in the benign pulmonary diseases and non-small cell lung cancer treatment.Methods:Under general anesthesia,via a video-assisted minimal access approach,anatomical lobectomy or pneumonectomy was partially performed through a 6 to 8 cm incision.A total of 41 patients,including 31 pati-ents with lung cancer and 10 with benign tumor,received lobectomy(38 cases) or pneumonectomy(3 cases),which were performed under a video vision and a direct vision through the small incision.Results:The group without serious complications due to operation.The average operation time was 2.5 h(1.5-4h),and average blood loss was 200m l(100-500ml).41 cases were followed up for 6 - 46 months,average 17 months.Among the 31 patients with lung cancer,who were followed up for 8-46 months,3 died of liver and bilateral lungs metastasis 8,12,or 16 months after the operation.Conclusion: Video-assisted minimal access surgery is feasible for lobectomy and pneumonectomy.

目的探讨电视胸腔镜辅助小切口术(VAMT)治疗老年自发性气胸的疗效。方法双腔气管插管,静脉复合麻醉,腋中线第7肋间插入胸腔镜后,于腋中线胸大肌及背阔肌间做4～6 cm切口,经第4或第5肋间进胸,镜下及直视下缝扎或切除肺大泡,干纱布摩擦壁层胸膜。结果 25例患者无手术死亡。手术时间(70.1±19.3)min,术后平均住院时间17 d。术后并发症5例,包括肺持续性漏气、复张性肺水肿、心律失常,经治愈后出院。结论 VAMT治疗老年自发性气胸创伤小、恢复快、并发症少,疗效满意。

<正>125Ⅰ粒子是一种人工同位素,进行组织间植入治疗恶性肿瘤,首先应用于前列腺癌,后来也逐步应用于肺癌、食管癌、肝癌、胰腺癌、鼻咽癌、颅内肿瘤等,并且取得较好的疗效。随着现代医学影像设备、内镜技术、计算机技术与现代分子生物学的发展,近10多年来125Ⅰ粒子组织间植入治疗肺癌发展较快,植入技术已较为成熟,125Ⅰ粒子具有植入方式灵活、并发