2016年 · 第32卷第07期

From July 2010 to December 2015, 169 cases of thoracic and laparoscopic combined esophageal cancer surgery were completed in our department, including 55 cases of thoracic and laparoscopic combined gastroesophageal supraarchal anastomosis. The data of lymph node dissection and intrathoracic anastomosis are reported below.

Empyema complicated after thoracic surgery is treated by costal bed drainage, open drainage or thoracic fenestration to clean the abscess cavity and control the infection. However, most of them cannot eliminate the abscess cavity to achieve radical cure, and the course of the disease is often prolonged, resulting in chronic empyema^[1]。 We applied free lateral femoral myocutaneous flap tamponade to treat chronic empyema after thoracic surgery. The experience is summarized below.

Pulmonary artery abnormalities originating in the ascending aorta are rare congenital heart diseases, first described by Fraentzel in 1868^[1]。 The abnormal origin of the right pulmonary artery is more common than that of the left pulmonary artery. It often originates from the posterior wall of the ascending aorta within a few centimeters above the aortic valve, and sometimes it can be connected to the aorta through the arterial duct. Because of increased bilateral pulmonary blood flow, the vast majority of patients have heart failure at the early stage.

At present, the elderly lung cancer patients in China are on the rise, and the best treatment is still surgery, but the incidence of postoperative complications has increased significantly. Arrhythmia is one of the common complications after lung cancer surgery in elderly patients^[1,2]It mostly occurred 48 h after surgery, which prolonged the hospital stay and increased the hospitalization cost, and seriously affected the safety and rehabilitation of elderly lung cancer patients during the perioperative period. We reviewed the clinical data of 280 elderly patients with stage Ia lung adenocarcinoma from July 2009 to July 2014 in Nanyang Central Hospital of Henan Province, and analyzed the factors that may affect or lead to postoperative arrhythmia in elderly patients with lung adenocarcinoma, so as to provide scientific evidence for the prevention and control of postoperative arrhythmia.

A 52-year-old male patient. Physical examination revealed a mass in the right lung. Chest CT showed slightly more vascular texture in both lungs, and a massive shadow with increased density was seen in the right lung lobe, with uneven density and clear boundary, seeming to see multiple fusions, with the largest lateral surface 10.3 cm ×8.0 cm, and multiple irregular calcifications were seen in it (Figure 1), traction is visible adjacent to the pleura, and right atrium is compressed. The trachea and left and right main bronchial openings are unobstructed. The mediastinum was centered, and no enlarged lymph nodes were seen. There was no abnormality in the shape and size of the heart shadow. There was no thickening in the left pleura and no effusion in the bilateral pleural cavities. Preoperative diagnosis of right lung hamartoma.

PatientMale, 52 years old. Intermittent cough and expectoration for more than 3 years, hemoptysis for 6 months, and aggravation for 1 month. Chest enhanced CT showed a thick-walled cavity in the right upper lung, about 31 mm ×28 mm ×22 mm in size, and the thickness of the cavity wall was uneven. Wall nodules were visible in the cavity, and the enhancement showed moderate enhancement. The surrounding lung texture was collected, and the pleura was pulled (Figure 1)。 Fiber bronchoscopy showed no obvious abnormalities. PET-CT showed a thick-walled cavity in the posterior segment of the upper lobe of the right lung, with local wall nodules, and uneven metabolism increased, which was considered as the primary malignant lesion. L2 and T1, T8, T9 vertebral bodies have multiple punctate high-density shadows, mild metabolism, multiple osteogenic metastases are considered, and no obvious signs of metastasis are found on whole body bone imaging. Please consult an orthopedic expert, and the opinion is that metastasis is not considered in combination with medical history and various examinations of bones.

PatientMale, 47 years old. Stenting of the left iliac artery due to arterial embolism of the left lower extremity in 2010. On February 18, 2015, there was sudden persistent pain in the chest and back without obvious trigger. On February 22, an aortic CTA examination in a local hospital revealed intramural hematoma from the aortic arch, descending aorta, abdominal aorta to the right common iliac artery, with ulcer formation. The chest pain was not relieved after more than 20 days of hospitalization, and he was transferred to our hospital for treatment on March 26th. Blood pressure at admission: 125/77 mmHg (1 mmHg =0.133 kPa) in left upper limb, 124/82 mmHg in right upper limb, 96/52 mmHg in left lower limb and 103/58 mmHg in right lower limb. Another chest pain on March 30. Re-examination of aortic CTA showed huge penetrating ulcer of descending aorta, intramural hematoma of aortic arch, thoracic aorta, abdominal aorta to right common iliac artery, and left pleural effusion. The penetrating ulcer of the descending aorta was approximately 5 cm long (Figure 1、Figure 1◎)。

PatientMale, 60 years old, weight 65 kg. In January 2014, I suddenly experienced chest tightness and palpitations after activity, which were relieved after rest. Since then, the symptoms have recurred and gradually worsened. Before admission, I felt chest tightness, shortness of breath and fatigue after walking 20 meters. I couldn't lie down at night and was accompanied by edema of both lower limbs. After admission, chest X-ray examination showed that the cardiothoracic ratio was 0.70, which was generally large, with increased striations in both lungs, tortuous aorta, and widened superior mediastinal shadow (Figure 1)。 Echocardiography showed aortic diameter 69 mm, ventricular septal thickness 11 mm, left ventricular posterior wall thickness 11 mm, left ventricular end-diastolic diameter 77 mm, left ventricular systolic diameter 69 mm, left ventricular ejection fraction (EF) 0.22, short-axis shortening fraction (FS) 0.11, enhanced aortic valve echo with moderate regurgitation, moderate and mild mitral and tricuspid valve regurgitation, a small amount of fluid effusion in pericardial cavity, whole aortic widening, fluttering intimal echoes were detected in aortic root, ascending aorta and aortic arch, and the lumen was divided into true and false cavities. CTA showed dissection of the ascending aorta involving the aortic arch, artery nominal and left subclavian artery, and occlusion of the left common carotid artery (Figure 2)。 Pulmonary vascular resistance was monitored by right cardiac catheter for 5.5 wood. The liver and kidney function were moderately or mildly impaired, and basically recovered after treatment. Preoperative diagnosis: dilated cardiomyopathy, Stanford type A aortic dissection, cardiac function grade IV. Whole heart, ascending aorta and aortic arch transplantation and descending aorta stenting were proposed.

PatientMale, 43 years old. Body weight 61 kg. Pain in the back and precordial area for more than half a month, and previous hypertension, gout and duodenal ulcer. Kidney transplantation was performed in 2006, and Xiaoxi (750 mg in the morning and 500 mg in the evening), tacrolimus capsules (1.5 mg in the morning and 1.5 mg in the evening) and prednisone (7.5 mg/day) were administered orally for a long time after operation. The electrocardiogram showed ST segment elevation of 0.1~0.4 mV in V1~ V4 leads, and abnormal Q waves were seen in Ⅱ, Ⅲ and avF leads. Coronary angiography showed complete occlusion of the left anterior descending artery from the opening; Diffuse lesion of left circumflex artery, 70% ~95% stenosis; The right coronary artery is small, diffuse lesion, 80% to 90% lumen stenosis. Echocardiography showed segmental wall motion abnormalities, left ventricular insufficiency, moderate-severe mitral and tricuspid regurgitation, small-moderate pericardial effusion, mild pulmonary hypertension, left ventricular end-diastolic diameter 7.5 cm, left ventricular end-systolic diameter 6.55 cm, left atrial diameter 4.9 cm, left ventricular ejection fraction 0.26. Blood urea nitrogen was 13.6 mmol/L, serum creatinine was 208 μ mol/L, and serum type B natriuretic peptide was 3 030 pg/ml. After admission, they were treated with anticoagulation, reducing myocardial oxygen consumption, stabilizing plaque, dilating crown, antihypertensive and diuretic. Immunosuppressants were used until 1 day before surgery and stopped on the day of surgery.

PatientFemale, 42 years old. Chest tightness and shortness of breath for more than 20 days, aggravated for more than 10 days after activity. No other special discomfort. Physical examination: blood pressure 128/86 mmHg (1 mmHg =0.133 kPa), pulse 80 beats/min. The heart rhythm was regular, and a grade 4/IV systolic murmur could be heard in the tricuspid auscultation area. Echocardiography showed a 20 mm ×14 mm parenchymal hyperechoic light mass in the right ventricle, the pedicle seemed to be attached to the lateral wall, and oscillated with the systolic movement of the heart (Figure 1)。 Negative coronary angiography, no previous hypertension, diabetes. Hysterectomy was performed in a local hospital 3 years ago; Laparoscopic total hysterectomy + intestinal adhesiolysis + right adnexectomy + appendectomy + ureteral stenting was performed in our hospital 1 year ago. Right kidney and right ureterectomy were performed in our hospital 8 months ago.