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心包異位胸腺瘤一例

采用可吸收肋骨釘手術治療連枷胸九例

成人先天性膈肌膨出癥七例的臨床分析

巨大右肺囊腫合并肝右葉囊腫的同期手術治療

目的　探索巨大右肺囊腫合并肝右葉囊腫的同期手術治療效果。　方法　回顧性分析解放軍第一醫院1995年6月至2011年5月經右胸行巨大右肺囊腫合并肝右葉囊腫同期手術治療3例男性患者的臨床資料，平均年齡56 （48～62）歲，經胸部X線、CT檢查等術前臨床診斷為巨大右肺囊腫合并肝右葉囊腫。雙腔氣管內插管，復合全身麻醉，經右胸后外側切口第6、第7肋間進胸，先切除右肺囊腫，再經膈肌切口切除肝右葉囊腫。　結果　平均手術時間85 （75～96） min，術后24 h平均胸腔引流量164 （150～180） ml，48 h拔除胸腔引流管。1例放置膈下引流管，術后24 h引流量20 ml，48 h拔除胸腔引流管。切口Ⅰ期甲級愈合。無胸腹腔出血、感染，無支氣管胸膜瘺、膽瘺等并發癥。術后組織病理學診斷：肺囊腫、肝囊腫。住院時間8 d，隨訪0.5～16.0年，癥狀消失，無復發。　結論　經右胸部切口同期手術治療右肺囊腫合并肝右葉囊腫可減少腹部手術切口、減輕患者痛苦、縮短手術和治療時間、減少醫療費用，手術療效確切，遠期效果滿意。

INTERNAL FIXATION TREATMENT OF MULTIPLE RIB FRACTURES WITH ABSORBABLE RIB-CONNECTINGPINS/

Objective To study the indications, methods, and therapeutic effect of absorbable rib-connecting-pins fixation in the treatment of multi ple rib fractures. Methods Between March 2007 and September 2009, 40 patients with multiple rib fractures received internal fixation with absorbable rib-connecting-pins, including 8 one-side flail chest and 1 twoside flail chest. There were 32 males and 8 females with an average age of 39.8 years (range, 25-72 years). The injury was caused by traffic accident in 32 cases, fall ing from height in 6 cases, and blunt hitting in 2 cases. Preoperatively, imaging data of the chest X-ray or spiral CT three-dimensional (3D) examination showed that all patients had multiple ribs fractures and displacement. The number of fractured ribs was 4-10 (median, 6), and the fracture location ranged from the 2nd to the10th ribs. Of them, 28 cases were accompanied by hemathorax, pneumathorax or hemopneumothorax; 5 cases by thoracic organ injury; and 10 cases byother part trauma. The time from injury to hospital ization was less than 1 day in 26 cases, 1-3 days in 12 cases, and 3-6 days in 2 cases, and the time from hospital ization to operation was 3 hours to 3 days (mean, 1.2 days). Results The median fixation rib number was 5 (range, 3-8). The mean operative time, the time in bed, and hospital ization days were 32 minutes (range, 15-50 minutes), 4.5 days (range, 2-7 days), and 11.2 days (range, 5-18 days), respectively. All incisions healed by first intention. No pulmonary infection, pulmonary atelectasis, intrathoracic infection or other compl ications occurred. All cases were followedup 6-12 months (mean, 8 months). PaO2 [(86.6 ± 2.2) mmHg (1 mm Hg=0.133 kPa)] and SpO2 (97.2% ± 0.6%) at 2 hours after operation were obviously improved when compared with preoperative ones [PaO2 (53.6 ± 4.7) mm Hg and SpO2 (86.2% ± 1.8%)], showing significant differences (t=2.971, P=0.005; t=2.426, P=0.020). The chest X-ray films or spiral CT 3D indicated that fracture of rib healed within 3-6 months (mean, 4.5 months) after operation. Conclusion Severe collapsed chest wall orflail chest caused by fracture of multiple ribs should be treated by absorbable rib-connecting-pins, which is a simple, firm, and effective method.

手術內固定治療創傷性連枷胸對患者呼吸功能的影響

目的觀察連枷胸患者胸壁加壓包扎、肋骨牽引和手術內固定的治療效果。 方法納入2001年1月至2010年6月解放軍第一醫院心胸外科收治的56例連枷胸患者，分為3組：牽引治療組，14例，其中男10例、女4例，年齡（39.7±11.6）歲；包扎治療組，12例，其中男11例、女1例，年齡（40.2±13.2）歲；手術內固定組，30例，其中男26例、女4例，年齡（42.6±12.5）歲。比較3組的治療效果。 結果手術內固定組與牽引治療組和包扎治療組比較，除需呼吸機支持率與牽引治療組差異無統計學意義（P>0.05）外，呼吸機通氣時間、住ICU時間、胸腔引流管拔除時間均縮短（P<0.05），胸部并發癥發生率及死亡率降低（P<0.05），動脈血氧分壓（PaO2）、動脈血氧飽和度（SaO2）顯著升高（P<0.01），肺挫傷評分下降明顯；而牽引治療組PaO2、SaO2及肺挫傷評分較入院時改善緩慢，胸壁加壓包扎治療組甚至有加重趨勢。 結論大面積浮動胸壁的病理改變以胸腔容積減少為基礎，胸壁加壓包扎無治療效果，甚至加重低氧；肋骨巾鉗懸吊牽引固定對連枷胸缺氧內環境的改善效果不佳；手術切開復位內固定是改善大面積浮動胸壁呼吸功能障礙的有效方法。