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右心房膨出瘤二例

食管靜脈性血管瘤一例

左心房粘液瘤的外科治療

目的 探討左心房粘液瘤的診斷和治療經驗,以提高手術療效. 方法 回顧性分析自1995年10月至2001年10月收治57例左心房粘液瘤病例,術前均經彩色超聲心動圖確診,均在體外循環下行粘液瘤摘除術,同期行二尖瓣成形術5例,二尖瓣機械瓣置換術2例,三尖瓣成形術37例,房間隔缺損修補術2例,隔膜型主動脈瓣下狹窄環切開術1例. 結果 無圍術期及手術死亡,隨訪1個月～6年,2例復發再次手術,捶⒙?.5%. 結論 左心房粘液瘤一經確診應盡快手術,手術效果滿意,復發率低;彩色超聲心動圖對診斷及術后隨訪有重要作用,應注意術后隨訪.

動脈導管未閉封堵術后殘余漏二例

肺部隱球菌病伴隱球菌性腦膜炎一例

先天性主動脈瓣二葉化畸形的外科治療

目的 探討先天性主動脈瓣二葉化畸形的診斷、適宜手術時機、圍術期處理以及手術療效. 方法 60例患者被施行心瓣膜置換術,行主動脈瓣機械瓣置換術56例,行自體心包瓣置換術4例;同時行主動脈竇瘤破裂修補術2例,胸主動脈瘤修補術2例,動脈導管未閉縫扎術3例,室間隔缺損修補術5例,冠狀動脈旁路移植術3例.其中伴感染性心內膜炎25例. 結果 術后早期死亡5例,死亡率為8.3%.隨訪49例,平均隨訪時間5.4年,5年生存率為84.3%. 結論 先天性主動脈瓣二葉化畸形以男性居多,左、右二葉型較前、后型常見,可致主動脈瓣關閉不全和/或狹窄,以關閉不全多見(75%).出現充血性心力衰竭、心絞痛、暈厥、感染性心內膜炎時應盡早行手術治療,癥狀不明顯的患者應定期復查超聲心動圖,主動脈瓣置換術是常用的手術方法.

Transhiatal Esophagectomy without Thoracotomy in 105 Patients with Esophageal Cancer

Abstract： Objective To investigate the indications， surgical techniques and postoperative complication management of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospectively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy without thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010， including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 （48-81） years. There were 51 patients with upper thoracic esophageal cancer， 18 patients with middle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 （140-210） minutes， mean intraoperative blood loss was 150 （100 to 250） ml， and mean hospital stay was 15 （10-35） days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications， including 3 patients with anastomotic leakage at neck， 4 patients with recurrent laryngeal nerve injury， 5 patients with pleural effusion， 2 patients with pneumothorax， 3 patients with pneumonia， 3 patients with arrhythmia， 1 patient with chylothorax， 2 patients with incision infection， 2 patients with delayed gastric emptying， and 2 patients with anastomotic stenosis， who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years， and 8 patients were lost during follow-up. During follow-up， there were 94 patients who had lived for 1 year， 67 patients who had lived for 3 years， and 34 patients who had lived for 5 years postoperatively， and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thoracotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for patients with stageⅡor earlier esophageal cancer who can’t tolerate or aren’t suitable for transthoracic esophagectomy.