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右心辅助循环在下腔静脉疾病外科治疗中的应用

Video-ass isted Thoracoscopic Surgery of Ben ign Pulmonary D iseases: 128 Cases

Abstract: 　Objective　To investigate the role of video-assisted thoracoscopic surgery (VATS) in treatment of benign pulmonary disease, in order to promo te the mini-invasive way of operation. 　Methods　From May 2001 to M ay 2006, 128 patients with benign pulmonary diseases were treated by VATS. The diseases included 17 kinds of different lesions, such as tuberculosis, bronchiectasis, inflammatory pseudotumor, giant bullae of lung, hamartoma,lymphangiomyomatosis, etc. 53 cases had definite diagnosis before operation, the others had final diagnosis by pathology. Limited resection were performed in 66 cases, single lobectomy in 56 cases, bilobectomy in 2 cases, and concomitant bilateral lobectomy in 4 cases. Limited resections were carried out by pure thoracoscopic procedure with three ports, lobectomies were carried out by video-assisted minithoracotomy with 7-10cm incision. 　Results　For lim ited resect ion, the average operat ive durat ion w as 110m in (30-180m in) , blood loss was 60m l (10-300m l) , none had intraoperative blood transfusion needed. Conversion to minithoracotomy occurred in 2 patients. Postoperative bleeding happened in one case, which was controlled by medicine. Average length of stay was 6. 5 days. For lobectomy, the average operation time was 145 min (80-260min) , blood loss was 190ml (50-500m l) , no intraoperative blood tansfusion needed. Conversion to tranditional thoracotomy occurred in 3 patients, pneumonia occurred in 2 patients, delayed healing of mini-incision occurred in 2 patients. One diaphragmat ic hernia and one active bleeding after operat ion underwent second thoracotomy. Average length of postoperative stay was 7. 4 days (4-13d). For bilateral lobectomies, the average operative duration was 330min (270-415m in) , postoperative length of hospital stay was 10.7days (8-16d). No perioperative death occurred. 　Conclusion　VATS for benign pulmonary disease is miniinvasive and safe, the pat ients recover quickly. It could be the choice of operation for selected patients in equipped center.

小儿主动脉缩窄或主动脉离断合并心内畸形的诊断与外科治疗

目的　探讨主动脉缩窄（CoA）或主动脉离断（IAA）合并心内畸形的诊断及手术方式选择。　方法　2003年1月至2010年3月济宁医学院附属医院手术治疗14例小儿CoA（9例）或IAA（5例）合并心内畸形 ［包括室间隔缺损（VSD）、房间隔缺损（ASD）、房室隔缺损（APSD）等畸形，但不包括单纯合并动脉导管未闭（PDA）］ 患者， 其中男10例，女4例；年龄0.7～12.0 （3.2±4.5）岁；体重5.5～25.5 （10.2±5.5） kg。分期手术3例，经胸骨正中切口径路一期手术矫治11例。　结果　手术死亡2例，其中1例为分期手术，二次手术行VSD修补术后死于急性左心衰竭；1例术前诊断为VSD＋PDA合并重度肺动脉高压，术前未发现IAA，术后死于急性肾功能衰竭。随访12例，随访时间6～84 （32±22）个月，患者恢复良好。复查心脏超声心动图提示：胸主动脉轻度狭窄2例，继续随访观察。　结论　多层螺旋CT和核磁共振成像是目前诊断CoA和IAA的首选检查方法。经胸骨正中切口径路一期手术治疗CoA或IAA合并心内畸形婴幼儿，可获较好的显露及疗效。

全胸腔镜下纵隔良性肿瘤切除术22例

肺炎性肌纤维母细胞瘤一例

血气胸手术后对侧迟发性肺水肿一例

二尖瓣置换术后左心室后壁破裂修补二例

动脉导管未闭合并其他心脏畸形的外科治疗

摘要: 　目的　总结动脉导管未闭合并其他心脏畸形的外科治疗经验, 以提高手术效果。　方法　2004 年11 月～2006 年12 月手术治疗动脉导管未闭合并其他心脏畸形44 例, 40 例采用正中切口, 上、下腔静脉插管, 转流前游离动脉导管, 双10 号线结扎; 对导管粗大者可在并行转流下分离导管并结扎, 4 例患者实行分期手术。　结果　本组无手术死亡。术后发生低心排血量综合征3 例, 经积极治疗治愈; 2 例发生血红蛋白尿, 均在2d 内恢复。44 例术后超声心动图复查均无再通, 无灌注肺发生。术后随访36 例, 均在3 个月～ 2 年顺利恢复, 活动正常。　结论　经胸部正中切口手术是一种简单、有效的方法, 可同时修补其他心内畸形。分离、结扎动脉导管时应熟练掌握导管及其邻近解剖关系, 根据生命体征及导管直径的大小决定是否应用并行心肺转流。

Surgical Treatment of Hilar Cholangiocarcinoma

目的 探讨肝门部胆管癌2种手术方法的疗效。方法 回顾性分析我院1998～2006年期间收治的37例肝门部胆管癌患者的临床资料。结果 37例患者中13例行根治性手术切除, 其1年与3年的生存率分别为100%（13/13）和76.92%（10/13），中位生存期为22.43个月； 另24例行姑息性手术（均为肝内胆管内引流术），其1年与3年生存率分别为54.55%（12/22）和9.09%（2/22），中位生存期为15.42个月。结论 根治性手术是治疗肝门部胆管癌的主要手段； 姑息性手术，如合理的肝内胆管内引流能改善患者的生存质量。

Surgical Treatment for Non-malignant Esophageal-tracheal/bronchial Fistula

ObjectiveTo investigate clinical characteristics and surgical treatment of patients with non-malignant esophageal-tracheal/bronchial fistula.?Methods?We retrospectively analyzed clinical data of 12 patients with non-malignant esophageal-tracheal/bronchial fistula who underwent surgical repair in Peking Union Medical College Hospital from January 2002 to October 2011. There were 6 males and 6 females with a mean age of 49.8 years (ranging from 32 to 72 years). There were 7 patients with esophagotracheal fistula，1 patient with esophagobronchial fistula，2 patients with gastro-bronchial fistula after esophagectomy for esophageal cancer，and 2 patients with esophageal diverticulum bronchial fistula. Nine patients underwent surgical repair via right thoracotomy approach，and 3 patients via left thoracotomy approach. Seven patients underwent esophageal fistula and tracheal fistula repair，1 patient underwent esophageal fistula and bronchial fistula repair，2 patients underwent gastric fistula and bronchial fistula repair，1 patient underwent esophagectomy, gastroesophageal anastomosis and left lower lobectomy, and 1 patient underwent esophageal diverticulum repair and left lower lobectomy.?Results?All the patients recovered well from surgery with no perioperative complication or in-hospital death，and resumed oral intake 7-10 days after surgery. Three months to 1 year postoperatively, regular examinations including upper gastroenterography and　fibrobronchoscopy found no sign of tracheal/bronchial stenosis or esophageal stenosis，and no patients needed stent implantation or dilatation treatment. All the patients were followed up from 3 months to 10 years and had a good quality of life during follow-up.?Conclusion?Excluding malignant etiology and determining the exact fistula location are key points of clinical diagnosis for esophageal-tracheal/bronchial fistula. Adequate preoperative nutritional support and 1-stage surgical repair can lead to satisfactory clinical outcomes.