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腋下小切口經胸膜外結扎動脈導管治療動脈導管未閉20例

動脈導管未閉合并重度肺動脈高壓患者的介入與外科治療

目的 探討動脈導管未閉(PDA)合并重度肺動脈高壓(PH)患者外科手術治療與介入封堵治療的適應證和治療效果。 方法 回顧分析1998年5月至2008年5月我科收治的30例PDA患者的臨床資料，其中男14例，女16例；年齡14～41歲，平均年齡25.8歲。18例行外科手術治療，12例行介入封堵治療。 結果 經外科手術和介入封堵治療患者術后即刻的肺動脈收縮壓(608±120 mm Hg vs. 100.2±14.2 mm Hg; 60.3±11.6 mm Hg vs. 108.4±17.6 mm Hg)和平均肺動脈壓(401±98 mm Hg vs. 76.1±11.3 mm Hg; 40.2±10.5 mm Hg vs. 79.5±13.6 mm Hg)均較術前明顯降低（Plt;0.05）。術后4例手術患者中有2例出現聲音嘶啞，2例殘余分流；介入封堵治療患者術后未出現明顯并發癥。隨訪29例，隨訪時間3個月~2年；1例失訪。隨訪期間患者無明顯胸悶、氣促等，超聲心動圖檢查大動脈水平未探及殘余分流，1例術前伴有心房顫動的患者在封堵術后2個月時猝死，死亡原因不明。28例患者術后90 d復查超聲心動圖提示：肺動脈收縮壓均較術前明顯降低（Plt;0.05），兩種治療方法的療效差異無統計學意義（Pgt;0.05）。 結論 介入封堵治療PDA合并重度PH的患者與外科手術治療相比較具有創傷小、風險小、并發癥少和恢復快等優點，尤其是介入封堵治療可行試驗性封堵，對鑒別動力性和阻力性PH具有不可替代的優越性。但一些特殊類型的PDA患者仍需外科手術治療。

術中胃鏡輔助治療食管癌術后上消化道出血

目的 總結術中胃鏡輔助治療食管癌術后上消化道出血的臨床經驗。 方法 回顧性分析2001年3月至2009年3月成都軍區總醫院6例食管癌手術后上消化道出血患者經胃鏡輔助手術治療的臨床資料，其中男5例，女1例；年齡55~78歲,平均年齡64歲。6例食管癌手術后患者均于術后24 h內發生上消化道出血，需再次手術止血，在胃鏡輔助下查找出血點，通過直接縫扎、局部藥物注射、微波凝固和金屬夾進行止血處理,再次手術后觀察止血效果。 結果 再次手術后6例患者上消化道出血立即停止,血壓回升,均未發生吻合口瘺和胸胃穿孔等并發癥，痊愈出院。隨訪6例，隨訪時間3個月~1年，隨訪期間1例死于放、化療并發癥，其余患者均未發生上消化道出血。 結論 胃鏡輔助手術治療食管癌手術后上消化道出血，能準確查找出血部位，通過縫扎、局部藥物注射,微波凝固治療、金屬夾止血的應用,控制出血迅速可靠,方法簡單、安全。

Clinical Analysis of 60 Patients Undergoing Complete Video-assisted Thoracoscopic Lobectomy

Objective To investigate clinical outcomes of complete video-assisted thoracoscopic lobectomy and summarize our preliminary experience. Methods Clinical data of 60 consecutive patients who underwent complete　video-assisted thoracoscopic lobectomy in General Hospital of Chengdu Military Command from March 2010 to August 2011 were retrospectively reviewed. There were 37 male patients and 23 female patients with their median age of 52.1 （17-77）　years. There were 7 patients undergoing left upper lobectomy， 19 patients undergoing left lower lobectomy， 12 patients　undergoing right upper lobectomy， 3 patients undergoing right middle lobectomy， 17 patients undergoing right lower lobectomy， and 2 patients undergoing combined right middle and lower lobectomy. Results The average operation time was 161 （50-270） minutes， average intra-operative blood loss was 310 （50-800） ml， average number of lymph node dissection　was 13.4 （6-29）， average postoperative thoracic drainage was 950 （250-2 800） ml， average duration of thoracic drainage was 4.6 （3-11） days， average intensive care unit stay was 1.2 （1-3） days， and average postoperative hospital stay was 7.7（4-14） days. None of the patients had any severe postoperative complication. Fifty-two patients were followed up for 7 to 24 months， and 8 patients were lost during follow-up. During follow-up， 5 patients had lung cancer metastases， including　2 patients with mediastinal lymph node metastases and 3 patients with distant metastases. After chemoradiotherapy，3 patients lived well but 2 patients died. None of the other patients had any severe complication during follow-up. Conclusion　Complete video-assisted thoracoscopic lobectomy is a safe and effective surgical strategy for patients with benign or malignantpulmonary disease.