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Stanford A型主动脉夹层合并短肠综合征一例

右胸前外侧切口行二尖瓣置换术

目的总结经右胸前外侧切口径路行二尖瓣置换术的临床经验。方法125例二尖瓣病变患者经右胸前外侧切口径路在体外循环下行二尖瓣置换术,首次行二尖瓣置换术45例,再次行二尖瓣置换术80例。手术切口位于右乳房下方,长约15～18cm,切口内侧缘在胸骨右缘。结果术中升主动脉阻断时间37.95±15.06min,体外循环时间72.36±17.40min。术后早期死亡4例,死亡率3.2%。术后并发室性心律失常5例,右肺不张2例。结论采用右胸前外侧切口径路行二尖瓣置换术具有显露好、操作方便、损伤小、术后输血少和美观等优点,尤其适合再次心脏手术患者和女性患者。

The degree of the angle between left principal bronchus and trachea influences on pulmonary function in the patients with rheumatic mitral valve disease

Objective To estimate the degree of the angle between left principal bronchus and trachea, and it is correlative with the pulmonary function in the patients with rheumatic mitral valve disease. Methods According to various degree of angles between left principal bronchus and trachea,53 patients were divided into three groups, group 1: angle between left principal bronchus and trachea less than 50 degree, group 2: between 50 and 64 degree, group 3: between 65 and 79 degree. The pulmonary function tests,ultrasonic cardiography and left principal bronchus X-ray tomographic film were carried out in three groups before operation. Compare pulmonary function data with different angle between left principal bronchus and trachea in three groups. Results Exception of vital capacity ,residual volume and total lung capacity,the rest markers of lung function showed significant differences (Plt;0.05) in three groups. The correlation of the angle between left principal bronchus and trachea and the ratio of residual volume and total lung capacity among three groups were positively correlative, and the other parameters of lung function were negatively correlative (Plt;0.01). Conclusion The degree of the angle between left principal bronchus and trachea is positively correlative with the extent of pulmonary function impairing.

二尖瓣再狭窄人工瓣膜置换术

目的 总结 57例左径二尖瓣闭式扩张术后再狭窄的患者经右前外侧切口行二尖瓣置换术的经验。方法 经右前外侧切口第 4肋间进胸，在膈神经前方1.5 cm处纵行切开心包，主动脉阻断期间用顺行性灌注或逆行性灌注氧合血，同时向心腔内注入冰水降低心肌温度的方法保护心肌，行二尖瓣人工瓣膜置换术。结果 本组发生低心排血量综合征4例，手术死亡3例。全组术后呼吸机辅助时间及胸腔引流量与同期经胸正中切口行首次二尖瓣置换术患者比较差别无显著性意义（P＞0.05）。结论 左径二尖瓣闭式扩张术后再狭窄的患者经右前外侧切口行二尖瓣置换术能减少心脏与大血管撕裂出血，手术显露好，结合术中良好的心肌保护，可获得较满意的手术疗效。

Robot-assisted Thoracoscopic Esophagectomy for Esophageal Carcinoma

ObjectiveTo evaluate the efficacy and safety of robot-assisted thoracoscopic esophagectomy in the treatment of esophageal carcinoma. MethodsWe retrospectively analyzed the clinical data of 79 patients with robotassisted thoracoscopic esophagectomy in our hospital from August 2010 to June 2015. There were 43 males and 36 females at average age of 62 years. The clinical effect was analyzed. ResultsThe mean operation time was 245 min (range 170 min to 330 min). The mean blood loss was 75 ml (range 20 ml to 310 ml). The mean hospital stay was 10.2 days (range 7 days to 26 days). Two perioperative deaths occurred. A total of 14 (17.7%) patients with complication were reported. Mean lymph node harvest was 20.7 nodes with 10.9 in chest, 9.6 in abdomen. ConclusionRobot-assisted thoracoscopic esophagectomy is technically feasible and safe. It is expected to reduce surgical trauma and reduce the incidence of pulmonary complications.