2016年 · 第32卷第05期

Myasthenia gravis (MG) can be cured or relieved by surgical removal of the thymus^[1]。 Early clinical commonly used enlarged thymectomy mainly includes median sternum, right and/or left thoracoscopy, sternal transection, posterolateral thoracotomy, etc. Different surgical methods have different curative effects^[2]。 In recent years, new surgical methods (such as robot surgery) have made great progress, but all of them have problems such as chronic postoperative pain^[3]。 At present, the internationally recognized procedure and recognized in the MG treatment guidelines is still longitudinal sternum splitting^[4]However, this procedure has great trauma, hemorrhage and complications. We adopted a new "three-hole" operation of enlarged thymectomy through the costal margin of the xiphoid process for the treatment of MG, which can take into account the advantages of longitudinal sternum splitting, thoracoscopic and robotic procedures.

At present, various guidelines recommend that patients with sinus rhythm after mitral valve replacement should be treated with warfarin anticoagulation for 3 months, followed by long-term aspirin. For patients with atrial fibrillation, which is considered as valvular atrial fibrillation, long-term warfarin anticoagulation is recommended^[1]。 The activity of liver metabolic enzymes of warfarin in Asians is quite different from that of Westerners, so the dose should be reduced. Japanese guidelines for anticoagulant treatment of non-valvular atrial fibrillation suggest that the international standardized ratio (INR) is 1.6~2.6. Most literatures in China also suggest that warfarin anticoagulation INR between 1.6~2.5 can achieve effective anticoagulation without increasing bleeding complications^[2]。 Antithrombotic therapy is also based on European and American guidelines for this part of atrial fibrillation patients with mitral valve inserted into biological valves in China^[3]There are no clinical studies based on the Chinese population, and in reality, a large proportion of patients fail to continue taking warfarin for various reasons, or switch to aspirin for safety considerations.

The incidence of congenital heart disease (CHD) in live births is approximately 0.8%, with severe cases requiring surgical treatment. With the continuous progress of surgical technology, the prognosis of children with congenital heart disease has been greatly improved. However, incision infection is one of the common postoperative complications of congenital heart disease, which seriously affects the postoperative quality of life of children and their families, and also increases the hospitalization days of children and affects the bed turnover. Therefore, it is very important to prevent the occurrence of incision infection. From January 2013 to December 2014, 28 cases of incision infection occurred in our department. The risk factors of incision infection are summarized and reported as follows.

Deep sternal incision infection (DSWI) is a serious fatal complication after cardiac surgery. It is reported that the incidence of DSWI is 1% ~5%, and the mortality rate can reach 10% ~47%^[1,2]。 However, there are few studies on the clinical classification of DSWI and its clinical characteristics based on clinical classification. We describe and compare the clinical characteristics of DSWI patients after cardiac surgery based on clinical classification, which are summarized and reported below.

Pulmonary atresia combined with ventricular septal defect (PA/VSD) is common, and there are many clinical classifications according to pulmonary blood source and pulmonary artery development^[1,2,3]。 From April 2012 to December 2014, we diagnosed and treated 5 children with PA/VSD, which did not meet the classification reported in the literature.

For esophageal cancer complicated with gastric cardia cancer in the same period, the stomach, colon or jejunum can be selected to replace the esophagus to complete the upper gastrointestinal tract reconstruction. The selection of replacement esophageal organs should be determined according to the location and size of esophageal tumor and gastric tumor. We reviewed the clinical data of 25 patients with dual-source carcinoma of esophagus, stomach and cardia who underwent surgical treatment in our department from March 2011 to March 2015, and explored the surgical treatment methods and feasibility.

Of patients with congenital atrial septal defect (ASD) undergoing surgical treatment, approximately 10% are superior caval ASD, 90% of whom have partial anomalous pulmonary vein drainage to the superior vena cava (PAPVC)^[1]。 In order to correct the above two intracardiac malformations simultaneously, Warden et al^[2]The superior vena cava was dissected in the distal segment where the right superior pulmonary vein merged into the superior vena cava, and the broken end of the superior vena cava was anastomosed with the right atrium, and the residual superior vena cava and the right superior pulmonary vein were separated into the left atrium, that is, Warden's operation. The traditional Warden surgery is performed by median thoracotomy, which has more complications. We used thoracoscopic Warden surgery, which avoided some complications of traditional thoracotomy while ensuring the success rate of the surgery. The summary report is as follows.

Surgical treatment of left atrial myxoma usually adopts right atrial-atrial septal approach for tumor resection. However, when the tumor is huge and located in some atypical positions such as the left atrial roof or the left atrial posterior wall, it is often necessary to enlarge the incision and prolong the time of cardiopulmonary bypass^{[1,2,3,4,5,6]}。 We performed left atrial myxoma resection using the right superior pulmonary vein-atrial septum-right atrial approach. The experience is summarized and reported below.

Female, 47 years old. Dysphagia for more than 5 years, aggravated for 1 year. Chest CT showed irregular soft tissue density shadow of about 9 cm ×7 cm ×4 cm in the lower esophagus, with unclear boundary, uniform internal density, and compressive changes in adjacent tissues (Figure 1)； Upper gastrointestinal tract angiography showed filling defects in the lower esophagus with unclear boundaries and obstruction of barium passage (Figure 2)； Gastroscopy showed that a huge bulging lesion was visible 25~35 cm away from the incisors, and the surface mucosa was smooth (Figure 3)； Ultrasound gastroscopy revealed: esophageal submucosal bulging lesion, originating from the muscularis propria (Figure 4)。 Admission diagnosis: esophageal space-occupying nature to be diagnosed, esophageal giant leiomyoma suspected.