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电视纵隔镜手术诊治胸部疾病36例

目的 探讨电视纵隔镜检查术( videomediastinoscopy, VM)在肺癌术前分期、纵隔疾病诊断中的价值。方法 自2006年2月至2007年4月，我们采用电视纵隔镜对36例拟诊为肺癌、纵隔肿物患者进行检查，33例经颈部行纵隔镜术，采用全身麻醉单腔气管内插管；3例经肋间行纵隔镜术，采用全身麻醉双腔气管内插管。 结果 除术前纤维支气管镜检查确诊4例外，余30例均经电视纵隔镜术检查后确诊；2例诊断不明或可能误诊，其中1例转院失访，另1例经开胸活检证实为肺大B细胞淋巴瘤。平均手术时间55min，平均出血量40ml，术后无死亡患者，无切口感染；发生并发症2例，1例出血，经止血纱布填压止血；1例喉返神经麻痹，经中医针灸治疗后好转。 结论 电视纵隔镜术是肺癌术前病理分期、纵隔疾病的重要检查方法，具有诊断准确率高、安全可靠等优点。

全胸腔镜与胸腔镜辅助小切口手术治疗自发性气胸78 例

胸壁去分化脂肪肉瘤外科治疗一例

胸部外伤手术107例临床分析

电视纵隔镜在胸部疾病诊断与治疗中的应用

摘要: 　目的　探讨电视纵隔镜在胸部疾病诊断和治疗中的应用价值, 总结其临床经验。　方法　对2006 年3 月至2007 年5 月开展的47 例电视纵隔镜手术资料进行回顾性分析, 其中经颈部纵隔镜手术38 例, 左胸纵隔镜手术8 例,右胸纵隔镜手术1 例。　结果　本组手术时间10～ 100m in, 平均44. 2min; 术中出血5～ 200ml, 平均33. 5ml 。肺癌术前分期12 例, 纵隔淋巴结病理检查阴性4 例, 阳性8 例, 均与开胸手术后检查结果相符, 其敏感性、特异性、准确性均为100%。纵隔疑难疾病诊断31 例, 经过纵隔镜手术后30 例(96. 8%) 明确诊断, 其中恶性肿瘤16 例, 分别为纵隔转移性肿瘤8 例、纵隔淋巴瘤3 例, 恶性纤维组织细胞瘤、食管鳞状细胞癌、促纤维组织增生性小圆细胞肿瘤、胸腺类癌、淋巴上皮癌各1 例; 良性疾病14 例, 分别为结节病8 例、慢性淋巴结炎4 例、纵隔淋巴结结核2 例。纵隔镜辅助纵隔或肺部病变切除4 例, 均顺利完成手术。本组手术无死亡及严重并发症发生, 均治愈出院。　结论　电视纵隔镜手术安全、可靠,可作为纵隔疑难疾病诊断和鉴别诊断的有效方法以及肺癌术前分期的金标准。

Fast Track Surgery in Rib Fracture Fixation

ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.