目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验，提高抢救成功率。 方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料，男23例、女3例，年龄16～71（22.0±8.4）岁。其中刀刺伤25例，钢锥刺伤1例；心脏穿透伤23例，升主动脉刀刺伤2例，主肺动脉刀刺伤1例；心脏压塞型7例，失血休克型8例，心脏压塞+失血休克型2例，亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗，侧开胸手术20例，前正中开胸手术6例，其中2例在体外循环下手术。 结果全组死亡2例，均为失血休克型，1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征，1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭，其余患者痊愈出院，救治成功率达92.3%。18例随访1个月至7年，无后遗症发生。 结论迅速明确伤情，及时诊断，急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。
目的 探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果，分析影响患者生存期的因素。 方法 回顾性分析2005年1月－2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料，其中男35例，女11例；年龄35～67岁，平均53.2岁；所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术，其中肺叶切除术42例，全肺切除术4例，术后全部患者行全脑放射治疗，部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验，分析影响生存率的因素。 结果 术后病理检查提示腺癌27例，鳞癌15例，大细胞癌2例，其他类型2例。患者1年生存率80%，2年生存率41%，3年生存率14%，中位生存期23个月，平均生存期（27.8 ± 4.5）个月（乘积极限法）。对数秩检验结果提示N0与N1患者比N2患者生存率高（P=0.024），腺癌患者生存期比非腺癌患者生存期长（P=0.002）。 结论 外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果，腺癌患者及无纵隔淋巴结转移的患者生存期长。
目的 总结68例二尖瓣成形术的临床经验，评估其术后临床效果。 方法 回顾分析2001年12月－2011年12月进行二尖瓣成形术治疗的68例二尖瓣关闭不全患者的临床资料。成形术的方法为：人工瓣环植入、双孔成形、后瓣矩形切除、赘生物切除及心包补片修复、腱索转移等。术中采用注水实验和经食管超声心动图检查评估成形效果。 结果 68例患者中手术死亡2例，二次开胸止血1例，肺部感染3例。全部患者术中注水实验和食管超声心动图检查显示成形效果满意。存活66例患者随访6个月，术后10 d、6个月彩色多普勒超声心动图检查：左心房内径、左心室舒张末内径缩小。术后6个月彩色多普勒超声心动图检查：无或微量反流33例，轻度反流27例，轻～中度反流5例，中度反流1例。 结论 根据二尖瓣关闭不全的特征，选择相应的二尖瓣成形技术，可以取的较好的临床效果。
ObjectiveTo summarize the application experience of off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries, and evaluate its safety and efficacy. MethodsThe clinical data of the patients with severe multiple coronary arteries stenosis undergoing off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries in the Affiliated Hospital of University of Electronic Science and Technology ＆ Sichuan Provincial People’s Hospital from November 2020 to April 2023 were retrospectively analyzed. Results Finally 24 patients were enrolled. There were 23 males and 1 female. The mean age was 53.63±4.33 years. The cardiac function class was from grade Ⅱ to Ⅲ according to New York Heart Association. There were 3.17±0.38 distal anastomoses. Y graft in 12 patients and sequential graft in 4 patients were performed. Coronary endarterectomy in 1 patient, intraaortic balloon pump (IABP) catheter implantation in 10 patients, and thymoma resection in 1 patient were also performed simultaneously. The operation time was 308.13±30.39 mi. The ventilator support time was 15.42±7.42 h, and the intensive care unit stay time was 46.08±27.32 h. The postoperative hospital stay time was 11.71±1.90 d. There were no death, but acute renal failure in 1 patient and cerebral infarction in 1 patient were found after operation. The postoperative left ventricular end diastolic diameter by echocardiogram before discharge was significantly reduced, the postoperative left ventricular ejection fraction and short axis shortening rate were significantly increased, compared to preoperative ones (P≤0.05). All arterial grafts were patent suggested through coronary artery computed tomography angiography (CTA) examination before discharge. All patients were followed up for 14.58±8.75 months. No angina recurrence and death were found. All arterial grafts were still patent in 16 patients suggested through coronary artery CTA or angiography examination at 1 year after operation. Conclusion Off-pump total artery coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries for patient with severe multiple coronary arteries stenosis is safe and effective. For high-risk patient, IABP assistance during operation is recommended.