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电视胸腔镜肺叶切除术在肺良性疾病中的应用

目的　探讨电视胸腔镜（VATS） 肺叶切除术治疗肺良性疾病的价值，总结治疗经验。 方法　2009年1月至2012年9月苏州大学附属第一医院收治85例肺良性病变患者，其中男 46例，女39例；平均年龄51.3岁。病种包括支气管扩张症、结核球或结核性空洞、炎性假瘤、巨型肺大泡（＞10 cm）、肺囊肿、肺隔离症等。85例患者均接受电视胸腔镜肺叶切除术，行左肺上叶切除术20例，左肺下叶切除术20例，右肺上叶切除术21例，右肺中叶切除术5例，右肺下叶切除术19例。 结果　85例电视胸腔镜肺叶切除术中2例因出血中转开胸。手术时间（156.6±53.2） min，术中出血量（165.7±92.3） ml，术后胸腔引流时间（5.2±1.7） d，术后引流液量（138.5±14.6） ml，术后住院时间（3.9±0.9） d，术后疼痛时间（2.8±1.1） d。随访6个月，均无围手术期死亡及严重并发症发生。 结论　电视胸腔镜肺叶切除术治疗肺良性疾病创伤小，患者恢复快，是一种安全有效的手术方式。

支气管内型错构瘤伴骨化一例

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty

Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups (P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups (P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group (t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups (P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation (P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion Cementless THA is a safe and effective method for ANFH in patients with HIV infection.