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支气管扩张症138例

目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985～ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

带蒂肋间肌瓣防治支气管胸膜瘘17例临床分析

目的 探讨采用带蒂肋间肌瓣包埋支气管残端预防和治疗支气管胸膜瘘的临床意义，总结治疗经验。 方法  回顾性分析2001年10月至2009年6月重庆市江津中心医院对17例肺癌、肺结核伴支气管扩张、支气管扩张患者行肺切除术后采用带蒂肋间肌瓣包埋支气管残端的临床资料。14例为预防性治疗，男8例，女6例；年龄21～69岁；其中6例行全肺切除术，8例行肺叶切除术。3例行肺癌肺叶切除术后支气管胸膜瘘二期修补术，男2例，女1例；年龄58～68岁。 结果 预防性治疗14例患者，手术时间135～275 min，均治愈，无并发症；随访12例，随访时间6～60个月，随访期间无1例发生支气管胸膜瘘。3例肺癌术后支气管胸膜瘘接受带蒂肋间肌瓣治疗患者手术时间75～165 min，2例痊愈，1例同时行局部胸膜内胸廓成形术痊愈；3例均随访6～24个月，无1例再发支气管胸膜瘘。 结论  带蒂肋间肌瓣包埋支气管残端防治支气管胸膜瘘安全有效，尤其适用于肺切除术后支气管残端或吻合口的加固预防支气管胸膜瘘的发生。

Clinical analysis of the feasibility and safety of single utility port robot-assisted lung resection

ObjectiveTo investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach.MethodsThe clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed.ResultsAll patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points.ConclusionSingle utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

全肺切除治疗肺毛霉菌病合并肺脓肿一例并文献复习

目的 探讨侵袭性支气管肺毛霉菌病合并毛霉菌肺脓肿内科治疗无效时外科手术的可行性。方法 报告1例2022年在解放军总医院第八医学中心住院的支气管肺毛霉菌病合并毛霉菌肺脓肿患者内科治疗及外科手术过程，并对外科手术在肺毛霉菌病治疗中的有关文献进行复习。结果 患者男性，29岁，某药厂排污厂房工人，既往患有糖尿病。因咳嗽，咳痰，咯血40余天，高热5天入院。经支气管镜活检诊断为左主支气管毛霉菌病，积极内科治疗无效时，行左全肺切除术，术后治愈出院。术后病理示支气管肺毛霉菌病并左下肺毛霉菌肺脓肿。文献复习显示外科手术是支气管肺毛霉菌病治疗手段之一，但目前肺毛霉菌病手术治疗多限于单纯孤立病灶和肺叶切除术，全肺切除术罕见。未检索到类似本例全肺切除治愈支气管肺毛霉菌病，毛霉菌肺脓肿的报告。结论 侵袭性支气管肺毛霉菌病，合并毛霉菌肺脓肿在内科治疗无效时，外科手术治疗亦应值得考虑。

Influence of Perioperative Nursing Intervention on Pulmonary Tuberculosis Patients Undergoing Lung Resection

ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection. MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups. ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05). ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.

"Z"字形断肋保留肋骨的开胸术

目的 为行肺、食管等开胸术时保留肋骨,以保持胸廓的完整性.方法 采用"Z"字形断肋的方法行肺手术10例,食管手术4例.结果 全组病例术后恢复良好,切口疼痛明显减轻.胸部X线片示:各肋骨排列完整,断肋对合好.均痊愈出院.结论 该术式开胸时可快捷进胸、损伤小、出血少、切口暴露好;关胸时断肋对合严密,不易松脱;操作简单、方便、易掌握.

Bronchus Pulmonary Arterioplasty for Central Type Bronchiogenic Cancer

目的:探讨支气管肺动脉成形术治疗中心型肺癌的效果。方法:1998年12月至2008年12月对16例中央型肺癌施行支气管肺动脉联合成形肺叶切除,包括双袖式左肺上叶切除7例;双袖式右肺上叶切除2例;双袖式右肺中上叶切除2例;双袖式右肺中上叶切除同时隆突重建2例;袖式左上肺叶切除、肺动脉楔形切除2例;袖式右肺中上叶切除、肺动脉楔形切除1例。结果:本组无死亡及吻合口瘘发生,术后2例出现肺不张,2例并发肺感染,全组术后1年生存率为93.8%,3年生存率为62.5%。结论:肺动脉成形或肺动脉支气管同时成形肺叶切除减少了全肺切除和单纯剖胸探查的比例,扩大了手术适应征,符合最大限度地切除肿瘤及最大限度保留肺功能的肺癌手术基本原则,是一种安全、有效、可行的术式。

Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.

肺切除术后心脏疝一例

肺切除术联合化疗治疗耐多药肺结核51例

摘要： 目的 探讨肺切除联合化疗治疗耐多药肺结核的临床应用价值，总结治疗经验。 方法 1999年1月至2007年1月，我科共收治51例主病灶局限于肺叶或单侧全肺的耐多药肺结核患者，男38例，女13例；年龄18～56岁，平均年龄36.5岁。施行肺叶切除术30例，肺叶加同侧肺段切除术或同侧双肺叶切除术11例，全肺切除术10例；分析术后继续抗结核化疗18~24个月的疗效。 结果 51例患者均手术成功，46例完成化疗（18~24个月）后治愈；治疗失败5例，其中3例在疗程最后6个月痰菌仍为阳性，2例于围手术期内死于术后并发症。术后发生并发症12例，其中术后1个月内发生9例：呼吸功能衰竭3例，均经呼吸机辅助呼吸治愈；脓胸3例，2例经胸腔闭式引流治愈，1例术后3周死于多器官功能衰竭；支气管胸膜瘘1例，经留置胸腔引流管3个月后瘘口逐渐闭合治愈；暂时性视力障碍1例，未作特殊处理，1个月后视力恢复正常，急性肺水肿1例，治疗无效死亡。1个月后发生并发症3例：切口感染2例，经开放引流每日换药，行二期缝合伤口Ⅲ/丙愈合；支气管胸膜瘘1例，行胸部肌瓣填塞+胸廓成形术后支气管胸膜瘘再度复发，给予胸壁开放式引流，长期未愈，72个月后因大咯血窒息死亡。 结论 对主病灶局限的耐多药肺结核患者施行肺切除联合抗结核化疗，治愈率高，并发症发生率及病死率均在可接受范围内。