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96例重症肌无力患者的外科治疗

目的 总结重症肌无力（MG）患者的外科治疗和围术期处理经验，以提高手术疗效。 方法 2002年1月至2007年6月，对96例MG患者行胸腺切除加前纵隔脂肪组织清扫术，根据临床相对记分、服药量改变及生活能力于术后3个月评估临床疗效。 结果 无围术期死亡。术后发生MG危象8例（8.3% ），其中术前未服用糖皮质激素6例（18.75%），服用糖皮质激素2例（3.13%），经相应的治疗治愈。术后发生其他并发症9例（9.4%），其中肺部感染7例，切口感染2例，均经相应的治疗治愈。随访96例，随访时间3~18个月，其中32例临床痊愈，30例基本痊愈，15例显效，12例好转，7例无效。 结论 MG患者经内科治疗效果不佳或无效时，均应考虑手术治疗，无论是否有胸腺增生，特别是对合并有胸腺瘤者，应限期手术。若决定行手术治疗，术前除继续服用抗胆碱酯酶药物外，口服糖皮质激素15d左右可增加手术安全性，提高手术疗效。

Treatment for Patients with Primary Tracheal Tumors

Abstract: ObjectiveTo explore the surgical characteristics of primary tracheal tumors treatment and its prognosis. Methods [WTBZ]We retrospectively investigated the clinical records of 38 patients with primary tracheal tumors in both Xiangya Hospital of Central South University and Hunan Provincial Tumor Hospital from Febuary 1982 to August 2009. There were 24 males and 14 females aged from 7 to 65 years. There were 2 benign lesions, 13 adenoid cystic carcinomas, 11 squamous cell carcinomas, 5 mucoepidermoid carcinomas, 4 adenocarcinomas and 3 other cell types. One patient with adenocarcinoma underwent exploratory thoracotomy only; 33 patients underwent tracheal resection and airway reconstruction, and according to the tumor growth characteristics, the surgeon applied circumferential tracheal resection with endtoend anostomosis or wedge resection; One patient had papilloma resected under fiber bronchoscopy; and three patients with locally advanced lesions underwent radiotherapy without surgery. The overall survival rate was calculated by the KaplanMeier method. The logrank method was used for comparing survival rates among different groups, characterized by cell types or surgical procedures. Results [WTBZ]The patient with exploratory thoracotomy died 3 days after surgery from respiratory failure. The perioperative mortality was 2.94% (1/34), and all the remaining 33 patients recovered and were discharged from hospital. Minor complications happened to 12 patients (35.29%), including 6 patients with pulmonary infection, 4 with atelectasis, and 2 with hoarseness. The followup time ranged from 6 months to 15 years. The followup rate was 97.29% (36/37). The threeunresected patients died within 6 months after hospital discharge. The 1, 5, and 10year survival rate for resected patients was88% （95%CI 0.77 to 0.99), 47%(95%CI 0.29 to 0.66), and 41% (95%CI 0.21 to 0.61), respectively. The survival rate of adenoid cystic carcinoma or mucoepidermoid carcinoma was significantly higher than that of squamous cell carcinoma or other tissue types (χ2=17.581, P=0.001). There was no statistical difference (χ2=0.021, P=0.886) in 5 year survival rate between wedge resection group at 63%(95%CI 0.34 to 0.91) and the segmental resection group at 77%(95%CI 0.44 to 0.99). Conclusions [WTBZ]Surgical treatment is safe and beneficial for primary tracheal tumors, and the pathological type is a significant prognostic factor after complete resection.

非粘液瘤性心脏良性肿瘤的诊断与手术治疗

目的 总结非粘液瘤性心脏良性肿瘤的诊断和外科治疗经验。 方法 1982年9月～2005年10月手术治疗5例非粘液瘤性心脏良性肿瘤，其中男2例，女3例；年龄2～46岁（33.4±17.8岁）。所有肿瘤均被完整切除，同时将其附着的心内膜和心肌组织一并切除，用心包或补片修补缺损，术毕反复冲洗心腔并吸净。 结果 5例患者均治愈出院。术后均获得随访，随访时间3个月至11年，未发现严重心律失常，并恢复正常工作、学习；其中1例5年后复发，再次手术无法切除。 结论 非粘液瘤性心脏良性肿瘤的临床表现、病理类型多样，手术治疗效果好，术后应重视复查。

主动脉窦瘤破裂的外科治疗

目的 总结主动脉窦瘤破裂的外科治疗经验。 方法 83例主动脉窦瘤破裂患者均在气管内插管静脉复合麻醉中度低温体外循环下行主动脉窦瘤修复术，同时矫治合并的心内畸形,包括行主动脉瓣置换术20例，主动脉瓣成形术9例，三尖瓣成形术4例，肺动脉瓣重建术2例，室间隔缺损修补术37例，房间隔缺损修补术5例，右心室流出道疏通2例，右室双腔心矫治术1例。 结果 本组无手术死亡。术后并发心力衰竭2例，再次开胸止血4例，均经治疗后痊愈。所有患者均得到随访,随访时间1个月～6年, 平均随访25.6个月。心功能Ⅰ~Ⅱ级。心脏彩色超声心动图复查:未发现主动脉窦瘤复发或残余分流，主动脉瓣轻度反流2例，轻至中度反流2例；术后6年主动脉瓣重度反流1例，再次行主动脉瓣置换术。 结论 主动脉窦瘤破裂预后不良，尽早手术是治疗主动脉窦瘤破裂惟一有效的治疗方法。治疗的关键是恰当切除瘤体，可靠闭合窦瘤口，彻底矫治心脏畸形。

改良Carpentier法治疗埃布斯坦综合征25例

目的探讨改良Carpentier方法矫治埃布斯坦综合征(Ebsteinsyndrome)的疗效。方法采用自体心包片加宽前瓣,以加大面积;后瓣叶边缘对合缝在隔瓣叶或前瓣;自制心包片包裹涤纶环加固瓣环;可调式DeVega三尖瓣成形。结果采用改良Carpentier方法矫治的25例Ebstein综合征患者除1例死于低心排血量综合征外,余24例治愈出院,手术死亡率4%(1/25)。术后随访3～94个月,心功能级3例,级18例,级3例,未发生新的心律失常。结论改良Carpentier方法矫治Ebstein综合征,方法新颖实用,疗效满意。

大咯血急诊手术36例