2016年 · 第32卷第03期

During the development of thoracoscopic surgery, many anatomical and technical problems have become the bottleneck restricting the development and promotion of minimally invasive thoracic surgery. Such as localization of small lesions in the lung, confirmation of pulmonary segment boundary, and treatment of variant pulmonary blood vessels and bronchus. It is very important to determine the adjacent relationship between the lesion and pulmonary artery, pulmonary vein, bronchus, lung fissure and lymph node before operation to fully evaluate the resectability and estimate the postoperative pulmonary function. computer tomography (CT) three-dimensional reconstruction integrates the planar images into a three-dimensional form, which can observe the target organs or tissues in different directions, comprehensively and intuitively display the precise spatial position of small pulmonary nodules, understand the running, branching and variation of pulmonary blood vessels, draw up the extent of surgical resection, design the incision and surgical approach. It can effectively predict postoperative lung function, improve surgical precision, reduce injury and improve surgical treatment effect.

Mediastinal tumors are common chest tumors in children, including abnormal cysts formed by some embryonic tissue remnants and primary or secondary tumors. video-assisted thoracscopic surgery (VATS) has mature experience in mediastinal tumor surgery. However, because the disease composition of mediastinal tumor in infants and young children is quite different from that of adults, VATS surgery for mediastinal tumor in infants and young children is rarely reported. Since the cardiac surgery department of our hospital carried out VATS mediastinal tumor resection in 2013, a total of 18 cases have been completed, and the report is as follows.

Heart surgery has a large amount of blood loss and blood transfusion. 10% ~20% of blood in western countries such as Britain and America is used for heart surgery^[1]。 How to reduce perioperative blood transfusion in cardiac surgery has become one of the current clinical research hotspots. Between May 2010 and June 2015, we retrospectively analyzed blood transfusions in 52 patients undergoing cardiac surgery with emergency cardiopulmonary bypass using two different ultrafiltration techniques as follows.

Esophageal and cardiac resection and esophagogastric anastomosis are a standard procedure for the treatment of esophageal and cardiac cancer. For a long time, most patients have gastroesophageal reflux symptoms after surgery. The surgical technique of tubular stomach has reduced the problem of gastroesophageal reflux in some patients, but the problem of reflux is still more prominent in some patients, especially in patients undergoing low-end anastomosis, such as subarch anastomosis in cardia and esophageal cancer^[1]。 In recent years, we have adopted "residual stomach closure angle" folding, which has obvious anti-reflux effect. The summary report is as follows.

With the development and widespread application of imaging methods, more and more small pulmonary nodules have been found. It has been reported at home and abroad that thoracoscopic (VATS) segmentectomy will be the main treatment for stage Ia non-small cell lung cancer (NSCLC) with a diameter of ≤2 cm, and its survival rate is comparable to lobectomy^{[1,2,3,4,5,6]}。 Thoracoscopic segmentectomy has the advantage of preserving more healthy lung tissue and less trauma^[7]。 The difficulty of thoracoscopic anatomical pulmonary segment resection is to determine the boundary between the target segment and the adjacent pulmonary segment. Many methods have been reported at home and abroad^[5,8,9,10]However, the positioning is not accurate, or the method is complicated, and special equipment is required, so it is difficult to promote it. We used the method of methylene blue staining under total thoracoscopy to determine the intersegmental boundary. The positioning was accurate, safe and feasible.

Male, 39 years old. Due to repeated cough and expectoration with hemoptysis for 14 years, it was aggravated for 1 month. Has coughed up hair-like objects. CT examination showed: the left upper lobe lingual segment bronchial cystic dilatation, with multiple nodular foci and partial fusion, fat density (CT value-65 HU), punctate calcification foci and parenchymal density (plain CT value 44 HU), and enhancement of the parenchymal part after enhancement (CT value 54 HU), considering benign lesion bronchiectasis and Aspergillus infection; Bronchiectasis and infection of the dorsal segment of the left lower lobe (Figure 1)。 Bronchoscopy showed a prominent mass in the anterior bronchial lumen of the left upper lobe, with a large amount of straw-like and stone-like substances (Figure 2)。 Clinical consideration of teratoma is highly likely.

Female, 26 years old. Repeated dry cough for 1 year, aggravated by lying down. Enhanced CT of the chest showed a massive mixed density shadow of the right middle mediastinum, adjacent to the trachea, with a size of 12.6 cm ×8.6 cm ×4.7 cm, and a clear boundary between the upper part and the thyroid gland. No obvious enhancement was observed after enhancement (Figure 1)。 Physical examination: brown patches were widely distributed all over the body, with a diameter of 0.1~2.0 cm, some of which were sac-like and soft above the skin. There were no positive signs in the thorax and abdomen. Other preoperative examinations showed no obvious abnormalities.

Female, 66 years old. Hepatic hydatidectomy was performed in 1976, 1982, 1988, 1992 and 1998 in an external hospital due to recurrent episodes of hydatideosis in the right lobe of liver. In 1996, he underwent pulmonary hydatid external capsulectomy through the right thoracic 7th intercostal approach in the external hospital due to hydatid in the lower lobe of the right lung, and recovered smoothly after operation; Visited in 1999 and 2003 to receive oral treatment with albendazole emulsion. In June 2009, the patient experienced hemorrhagia once, about 50 ml, and no other discomfort, which was relieved after hemostasis and symptomatic treatment in the local hospital. Thereafter, hemoptysis symptoms appeared repeatedly and repeatedly, all of which were relieved by conservative treatment.