2016年 · 第32卷第02期

Female, 5 days after birth, weight 3.95 kg, no asphyxia. He was admitted to hospital because of "3 days of breast refusal and 1 day of bruise". At admission, the child had extreme breathing difficulties, with obvious nasal fan and three concave signs, cyanotic skin with marbling, heart rate of 180 beats/min, and systolic murmur of grade 3~4/VI could be heard in the precordial area. The blood glucose was 0.9 mmol/L. After blood gas analysis, the child was given tracheal intubation ventilator assisted ventilation and hypoglycemia was corrected. The skin color of the child turned red. Echocardiography, cardiac catheterization and CT enhanced contrast were performed. Diagnosis: Left heart dysplasia; Atrial septal defect; Patent ductus arteriosus. Ventilator oxygen concentration was downregulated to 0.21. Leukocyte 26.41×10⁹/L, neutrophil ratio 0.296, C-reactive protein<2.50 mg/L. Preoperatively, ceftriaxone was given for anti-infection, dobutamine for cardiotonic treatment, intermittent intravenous bolus injection of furosemide for diuresis, and alprostadil for maintenance of arterial catheter therapy. Control the inlet and outlet volume and ion balance to keep the respiratory tract open.

Prosthetic valve endocarditis (PVE) is a serious complication after valve replacement, with an incidence of 1% ~6%^[1]Despite the continuous progress of medical technology, the mortality rate is still high, which seriously threatens the lives of patients. Brucella endocarditis (BE) is a rare complication of brucellosis, accounting for only 0.3% ~0.7%, but accounting for 80% of the mortality rate of brucellosis^[2]。 Prosthetic valve brucella endocarditis (PVBE) is rare, but it is highly destructive and has a high mortality rate. Now summarize the diagnosis and treatment experience of 6 cases of PVBE admitted to our hospital from January 2010 to December 2013.

anticoagulation bridging period refers to the period of time after heart valve surgery when warfarin starts to reach anticoagulation intensity levels. During this period, the International Normalized Ratio (INR) has not reached the standard, and patients are at higher risk of thromboembolism. Whether heparin drugs need to be added to enhance anticoagulation during the anticoagulation bridging period has been controversial. The purpose of this study was to investigate the effect of heparin intervention during anticoagulant bridging period after heart valve surgery on the incidence of early postoperative thromboembolic and hemorrhagic events.

Sleeve lobectomy is the primary procedure in bronchoplasty and was initially used primarily in lung cancer patients with limited lung function who could not tolerate pneumonectomy. Since then, it has been reported that the thoroughness of lymph node dissection and the radical effect of sleeve lobectomy are comparable to those of traditional lobectomy, and the long-term survival rate is no less than that of total pneumonectomy at the same stage. The biggest advantage of sleeve resection is that it can maximize the preservation of lung function, improve the postoperative quality of life, and reduce the incidence of respiratory and circulatory failure related to the whole lung after operation.

Since 2003, uniportal video-assisted thoracic surgery has been used in the diagnosis and treatment of benign and malignant pulmonary nodules, pleural effusion and empyema^[1,2,3]。 In 2010, Gonzalez completed the large-scale development of single-port thoracoscopic lobectomy^[4,5,6]It has attracted widespread international attention and has been rapidly promoted all over the world. In Asia, Taiwan was the first to report the technique, followed by Hong Kong and South Korea^[7,8]。 At present, there are also many hospitals in China. From September 2014 to April 2015, we performed 113 cases of lobectomy using a 3 cm incision single-port thoracoscopy, which are now reported below.

We screened patients with esophageal cancer who underwent modern second-field or third-field lymph node dissection at Sun Yat-sen University Cancer Prevention and Treatment Center from October 2009 to September 2012 to explore the metastatic pattern of upper mediastinal lymph nodes in thoracic esophageal squamous cell carcinoma.

Most heart, pericardium and part of the mediastinum surgery are performed by the median approach of the chest. After the sternum is split longitudinally, the left and right sternum are tied with metal wires such as steel wire or titanium wire for closure and refixation. However, these fixation methods have many disadvantages. We tried a lighter and more robust sternal fixation system^[1,2]The postoperative sternum refixation was carried out and good clinical results were achieved, which are summarized and reported below.

Male, 28 years old. When he accidentally fell into a machine tool at work, he caused a large-scale compound trauma throughout his body. After being rescued by an outside hospital, his vital signs gradually stabilized. Echocardiographic examination revealed a massive shunt near the apex of the ventricular septum. The patient was sent to the outpatient department of our hospital and was diagnosed with closed heart injury, apical ventricular septal perforation (22 m), and cardiac function grade IV. Anti-heart failure treatment was given, and multiple case discussions decided to choose interventional occlusion or open heart repair with cardiopulmonary bypass. However, both treatment options have great difficulties and risks: it is difficult for the patient to lie down for a long time, and the perforation of the ventricular septum is located at the apical septum. This traumatic perforation is different from the muscular ventricular defect, and it has no complete edge and is not a vertical channel. The evaluation guide wire catheter is difficult to operate, and there is no suitable model of domestic VSD occlusion umbrella. In addition, it is necessary to choose a large incision near the apex of the left ventricle for open heart repair of defects by cardiopulmonary bypass. It is difficult to stop bleeding by suturing the incision after operation, and it may cause myocardial stiffness at the suture edge and affect cardiac function.

Female, 42 years old. In September 2014, I had intermittent cough without obvious trigger, cough white foamy sputum, no discomfort such as coughing up blood, chest pain, chest tightness, shortness of breath, etc., and went to Yili Friendship Hospital in Xinjiang. Lung CT showed a spherical high-density shadow in the outer basal segment of the lower lobe of the left lung, which was close to the pleura, with a size of 3.5 cm ×2.8 cm, and a relatively concentrated multiple spotty high-density shadow in the upper lobe of the right lung, but no abnormalities were observed.Figure 1)。 Later, the left lower lobe mass puncture pathological examination showed lung alveolar soft tissue tumor, excluding metastatic lesions, immunohistochemistry Vimentin (+), Ki67 (+)<1% and the rest were negative. PET-CT showed that the scattered FDG metabolism was slightly increased in the pleura of the outer basal segment of the left lower lobe, with SUVmax: 1.7, and CT value of 37~57 Hu, with clear boundary. It was considered as low-grade malignant lesion, but benign lesion was not excluded. No obvious abnormal concentration was observed in both kidneys and ureters. Focal increased FDG metabolism can be seen in the uterus. CT shows that the uterus is not large in shape, the morphological outline is basically regular, and there is no obvious abnormal density shadow. Physiological uptake is considered. There were no obvious signs of malignant tumor in the remaining scan range.

A 76-year-old female with intermittent progressive dysphagia for 2 years. Physical examination: The right breast was absent, a surgical scar about 8 cm long was seen on the right anterior chest wall, and no swollen lymph nodes were palpable in the bilateral axillary, supraclavicular and neck. In April 1982, the patient underwent radical mastectomy for breast cancer in another hospital, but did not undergo radiotherapy or chemotherapy. Two years ago, due to dysphagia, gastroscopy showed rough mucosa and narrow cavity at 28 cm from incisors, and biopsy pathology showed chronic inflammation of esophageal mucosa. Upper gastrointestinal tract angiography showed that the middle esophageal lumen stenosis was about 90 mm long, the wall was slightly stiff, the mucosa was still continuous, and there was no obvious filling or deficiency (Figure 1)。 Chest CT showed slightly centripetal uniform thickening of the middle and upper segments of the esophageal wall, lumen stenosis, and postoperative changes of right breast cancer, which were considered as benign esophageal stenosis (Figure 2)。 During the period, repeated gastroscopy, upper gastrointestinal angiography and chest CT all showed benign esophageal stenosis, which was aggravated than before. A retrievable esophageal stent was placed in August 2013, and the stent was removed 2 months later, and dysphagia was relieved. Five days ago, dysphagia was aggravated, and reexamination of gastroscopy and chest CT showed that esophageal stenosis was aggravated compared with the anterior. PET-CT showed postoperative changes of right breast cancer, and centripetal esophageal thickening still considered benign esophageal stenosis. No tumor cells were found in 4 biopsies of the patient, all of which were chronic inflammation, and the possibility of esophageal malignant tumor could not be ruled out clinically.

Female, 73 years old. Acid reflux and heartburn for more than 20 years, chest pain with shortness of breath for 1 day after activity. Physical examination: intestinal sounds can be heard in the chest. X-ray chest radiograph showed that the lower mediastinum was widened, and the air-liquid plane was visible in the heart shadow (Figure 1)。 CT of the chest showed: a cystic mixed density shadow was seen in the left posterior mediastinum, with a clear boundary, and fat and intestine were seen in it; Mass-like mixed density can be seen in the right diaphragmatic angle area, in which fat density is the main one, and the heart shadow is compressed (Figure 2)。 24-h esophageal sphincter pressure measurement: lower esophageal sphincter pressure is low, upper esophageal sphincter pressure is normal. The results of esophageal pH monitoring were consistent with gastroesophageal reflux disease (mild). Preoperative diagnosis: parasternal hiatal hernia (right side); hiatal hernia (type III); Gastroesophageal reflux disease.

Male, 35 years old. He was admitted to the hospital because "4 years after drainage of empyema was found, pus and exudate from the drainage port aggravated for 2 months". The patient drank and vomited 4 years ago, and then developed chest tightness and chest pain. He was diagnosed as "empyema". He was given closed chest drainage, but the effect was not good. He was discharged from the hospital because of economic reasons. After discharge, he found that the drainage fluid was mixed with food residues, but he did not pay attention to it. After half a year, he removed the drainage tube by himself. The drainage port intermittently drained pus mixed with light blood fluid and food residues, accompanied by chest tightness, dyspnea after activity, cough and expectoration, and no special treatment was given. In the past 2 months, the drainage port has been aggravated by pus and exudate, and the body weight has been reduced by 10 kg. History of prior knife stab wounds to the left waist 5 years ago.