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電視胸腔鏡輔助肺葉切除及系統性淋巴結清掃術治療肺癌的臨床分析

目的 探討肺癌患者采用電視胸腔鏡輔助肺葉切除及系統性淋巴結清掃術的臨床操作方法、技術要點和適應證等。 方法 2007年2月至2008年2月我科收治了60例周圍型原發性支氣管肺癌患者，男36例，女24例；年齡34～79歲，平均年齡55歲。根據采用的手術術式不同，將60例患者分為兩組，電視胸腔鏡輔助（VAMT）組（n=30）：行電視胸腔鏡輔助肺葉切除及系統性肺門、縱隔淋巴結清掃術；傳統開胸組（n=30）：采用傳統手術方法行肺葉切除及系統性肺門、縱隔淋巴結清掃術。 結果 兩組患者均無死亡。 VAMT組患者切口長度（6.8±1.1 cm vs. 21.5±3.4 cm）、術后杜冷丁用量（52.5±10.2 mg vs. 228.3±32.6 mg）、術后胸腔引流時間（3.2±0.8 d vs. 5.7±1.5 d）和術后住院時間（6.3±1.4 d vs. 8.5±1.8 d）短于或少于傳統開胸組（Plt;0.05）; 而清掃淋巴結數、術中出血量和術后胸腔引流量兩組差異無統計學意義（Pgt;0.05）。 結論 對可手術的原發性肺癌患者行電視胸腔鏡輔助下系統性淋巴結清掃術是可行的，在淋巴結清掃的徹底性方面能達到常規開胸手術的效果，并且創傷小、術后并發癥少。

原發性乳糜性心包積液一例

心內直視手術中體靜脈異位引流的外科處理

心臟不停跳心瓣膜置換術45例

目的 探討心臟不停跳心瓣膜置換術的手術方法、氣栓的預防和心肌保護作用. 方法在心臟不停跳、淺低溫、體外循環下行心瓣膜置換術45例,其中二尖瓣置換術(包括再次二尖瓣置換術4例)39例,主動脈瓣置換術2例,雙瓣膜置換術4例. 結果無手術死亡,無術后腦部并發癥及嚴重低心排血量. 結論心臟不停跳下行心內直視術有良好的心肌保護作用.

心臟不停跳手術患者心肌線粒體變化的觀察

目的　觀察心臟不停跳手術患者心肌線粒體形態及量化計分情況 ,探討其對心肌的保護效果。　方法　16例二尖瓣置換術患者按不同的術式分為心臟不停跳組和心臟停搏組。分別于上、下腔靜脈 (心臟不停跳組 )或主動脈 (心臟停搏組 )阻斷前 ,阻斷 6 0 min和開放后 2 0 min取心肌標本 ,在透射電子顯微鏡下觀察線粒體形態并進行量化計分。　結果　上、下腔靜脈或主動脈阻斷前兩組心肌線粒體計分差別無統計學意義 (Pgt;0 .0 5 ) ;阻斷 6 0 min和開放后 2 0 min心臟停搏組心肌線粒體計分均高于心臟不停跳組 (Plt;0 .0 1) ,心臟不停跳組心肌超微結構優于心臟停搏組。結論　淺低溫心臟不停跳手術可減輕心肌缺血 -再灌注損傷 ,有較好的心肌保護作用。

Clinical analysis of the short-term prognosis after resection surgery in patients with non-small cell lung cancer combined with type 2 diabetes

ObjectiveTo analyze the effect of type 2 diabetes (T2DM) on the short-term prognosis of patients with non-small cell lung cancer (NSCLC) after resection surgery.MethodsClinical data of 207 NSCLC patients who underwent resection surgery in our hospital from January 2016 to January 2019 were retrospectively analyzed. The 100 NSCLC patients with T2DM were allocated to a T2DM group (58 males and 42 females, with an average age of 65.26±7.26 years), and 107 patients without T2DM were allocated to a non-T2DM group (66 males and 41 females, with an average age of 64.21±7.51 years). The short-term prognosis of the patients was compared between the two groups.ResultsCompared with the non-T2DM group, the postoperative atelectasis (P=0.012) and pulmonary infection (P=0.040) were statistically different in the T2DM group. The postoperative complication rate in the T2DM group was significantly higher than that in the non-T2DM group (66.0% vs. 33.6%, P<0.001). The postoperative hospitalization time in the T2DM group was longer than that in the non-T2DM group (9.83±6.35 d vs. 8.09±4.40 d, P=0.007).ConclusionT2DM will increase the incidence of postoperative complications, prolong the length of hospital stay and increase the economic burden of the NSCLC patients, which is not conducive to the postoperative prognosis of patients.