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电视胸腔镜辅助肺叶切除及系统性淋巴结清扫术治疗肺癌的临床分析

目的 探讨肺癌患者采用电视胸腔镜辅助肺叶切除及系统性淋巴结清扫术的临床操作方法、技术要点和适应证等。 方法 2007年2月至2008年2月我科收治了60例周围型原发性支气管肺癌患者，男36例，女24例；年龄34～79岁，平均年龄55岁。根据采用的手术术式不同，将60例患者分为两组，电视胸腔镜辅助（VAMT）组（n=30）：行电视胸腔镜辅助肺叶切除及系统性肺门、纵隔淋巴结清扫术；传统开胸组（n=30）：采用传统手术方法行肺叶切除及系统性肺门、纵隔淋巴结清扫术。 结果 两组患者均无死亡。 VAMT组患者切口长度（6.8±1.1 cm vs. 21.5±3.4 cm）、术后杜冷丁用量（52.5±10.2 mg vs. 228.3±32.6 mg）、术后胸腔引流时间（3.2±0.8 d vs. 5.7±1.5 d）和术后住院时间（6.3±1.4 d vs. 8.5±1.8 d）短于或少于传统开胸组（Plt;0.05）; 而清扫淋巴结数、术中出血量和术后胸腔引流量两组差异无统计学意义（Pgt;0.05）。 结论 对可手术的原发性肺癌患者行电视胸腔镜辅助下系统性淋巴结清扫术是可行的，在淋巴结清扫的彻底性方面能达到常规开胸手术的效果，并且创伤小、术后并发症少。

原发性乳糜性心包积液一例

心脏不停跳手术患者心肌线粒体变化的观察

目的　观察心脏不停跳手术患者心肌线粒体形态及量化计分情况 ,探讨其对心肌的保护效果。　方法　16例二尖瓣置换术患者按不同的术式分为心脏不停跳组和心脏停搏组。分别于上、下腔静脉 (心脏不停跳组 )或主动脉 (心脏停搏组 )阻断前 ,阻断 6 0 min和开放后 2 0 min取心肌标本 ,在透射电子显微镜下观察线粒体形态并进行量化计分。　结果　上、下腔静脉或主动脉阻断前两组心肌线粒体计分差别无统计学意义 (Pgt;0 .0 5 ) ;阻断 6 0 min和开放后 2 0 min心脏停搏组心肌线粒体计分均高于心脏不停跳组 (Plt;0 .0 1) ,心脏不停跳组心肌超微结构优于心脏停搏组。结论　浅低温心脏不停跳手术可减轻心肌缺血 -再灌注损伤 ,有较好的心肌保护作用。

心内直视手术中体静脉异位引流的外科处理

心脏不停跳心瓣膜置换术45例

目的 探讨心脏不停跳心瓣膜置换术的手术方法、气栓的预防和心肌保护作用. 方法在心脏不停跳、浅低温、体外循环下行心瓣膜置换术45例,其中二尖瓣置换术(包括再次二尖瓣置换术4例)39例,主动脉瓣置换术2例,双瓣膜置换术4例. 结果无手术死亡,无术后脑部并发症及严重低心排血量. 结论心脏不停跳下行心内直视术有良好的心肌保护作用.

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.