2016年 · 第32卷第08期

Aortic root aneurysms are not uncommon diseases in cardiovascular surgery, and the principle of surgical management is relatively simple and fixed. Solitary unruptured right coronary sinus tumor is relatively rare, difficult to diagnose, and surgical management decisions are relatively complicated. The data and experience of surgical treatment of 3 patients with unruptured valley sinus tumor involving the right coronary sinus alone treated by surgery in our center are summarized as follows.

From May 2010 to December 2014, 42 children with congenital pectus excavatum underwent right single incision, non-thoracoscopic assisted modified Nuss surgery, and the results were satisfactory. The summary report is as follows.

In recent years, video-assisted thoracic surgery (VATS) has become the mainstream of radical lung cancer surgery. Single-port video-assisted thoracoscopic surgery^[1]Compared with traditional porous VATS, single-port VATS can reduce the injury of chest wall muscles, intercostal nerves and blood vessels to a greater extent, and reduce postoperative chest wall paresthesia and postoperative incision pain^[2]Improve the aesthetics of the incision^[3]。 We analyzed the clinical data of 50 patients who underwent radical resection of lung cancer by single-port thoracoscopic step-by-step dissection, and explored the superiority and clinical application value of single-port thoracoscopic step-by-step dissection technique in early radical resection of non-small cell lung cancer (NSCLC).

Infection of thoracotomy is a common complication of thoracic surgery. Traditional treatment methods require frequent dressing changes, a large workload, a long course of treatment, and a lot of expense. vacuum-assisted closure (VAC) is used to fill the wound with foam dressing of special materials, and then seal it with biological semipermeable membrane. The drainage tube in the dressing is connected with negative pressure and irrigation, which can completely remove the wound exudate and promote wound healing. It is used maturely in burn department, orthopedics and other fields, but it is rarely used in chest incision infection^[1,2,3,4]。 The Department of Cardiothoracic Surgery of Anqing Municipal Hospital has treated 12 patients with thoracotomy incision infection with VAC since December 2012, and the results are satisfactory, as reported below.

Esophageal cancer is one of the most common malignant tumors in China, and surgery is the first choice of treatment^[1]。 Thoracoabdominal total laparoscopic radical esophagectomy is highly praised for its low trauma, quick recovery and low complications. Common surgical procedures include total laparoscopic McKeown surgery (three incisions through THE neck-right thorax-upper abdomen), total laparoscopic Ivor-Lewis surgery (two incisions through THE right thorax-abdomen), and transhiatal esophagectomy (THE), among which McKeown surgery is THE mainstream^[2]。 However, laparoscopic Ivor-Lewis surgery is called a truly more minimally invasive procedure because it is less invasive and has fewer complications (especially for anastomotic leakage and recurrent laryngeal nerve injury^[3]。 We compared the two surgical procedures to explore the feasibility, safety and short-term clinical efficacy of laparoscopic Ivor-Lewis surgery in the treatment of middle and lower thoracic cancer of the esophagus.

Total thoracoscopic lobectomy in the treatment of early non-small cell lung cancer (NSCLC) is comparable to thoracotomy, and has the advantages of less trauma, less pain and fast recovery^[1,2]。 Because various existing imaging methods have some false negatives in the qualitative diagnosis of mediastinal lymph nodes, 10% ~20% of NSCLC have no lymph node metastasis before surgery (N₀), while mediastinal lymph node metastasis was confirmed either intraoperatively or postoperatively (N₂), clinically referred to as accidental N₂Period^[3,4]Some of them underwent thoracoscopic lobectomy, but it is unclear whether the surgical outcome is equivalent to or better than thoracotomy. We collected and retrospectively analyzed the data of 105 such patients, including 47 in the laparoscopic group and 58 in the thoracotomy group. We compared the clinicopathological characteristics, intraoperative conditions and near-and medium-term prognosis of the two groups, which are reported below.

PatientFemale, 40 years old. Intermittent cough, chest tightness for 5 months, aggravated for 1 month. Physical examination: The left upper lung breathing sound was thickened, the heart rate was 112 beats/min, the rhythm was uniform, and the apex of the heart could be heard with diastolic grade II murmur. Moderate anemia. Echocardiogram showed that an isoechoic mass with a size of about 56 mm ×39 mm was seen in the left atrium, with a clear boundary, slightly oscillating with the heart beat, reaching the mitral valve opening in the diastolic phase, with a pedicle about 7~8 mm long, located at the left superior pulmonary vein opening (Figure 1)。 Enhanced chest CT showed that a fusion mass shadow was seen in the left upper lung, 65 mm ×52 mm in size, irregular in shape, clear in boundary, involving the left chest wall (Figure 2), a mass shadow can be seen in the left atrium (Figure 3), the border was clear, and the left superior pulmonary vein was filled with mass shadow (Figure 4)。

PatientFemale, 60 years old. Repeated cough for 2 months, chest pain, fatigue and weakness for 10 days. No previous special medical history. Physical examination of chest and nervous system showed no significant positive signs. Mediastinal enhanced CT showed right upper mediastinal mass occupation (Figure 1)。

Thoracic and gastric perforation after esophageal cancer surgery is easily confused with intrathoracic esophagogastric anastomotic fistula. From May 2001 to April 2015, a total of 315 cases of esophageal cancer surgery were performed in our department, including 4 cases of postoperative thoracic and gastric perforation, which are summarized as follows.

PatientFemale, 41 years old. Upper abdominal fullness, hiccup and discomfort for more than 3 years, swallowing obstruction, occasional melena for half a year, and low fever for 7 days. Physical examination: No obvious abnormalities were found except anemia. Ultrasound gastroscopy showed that a strip-shaped bulge of the posterior wall of the esophagus was visible about 19 cm ~38 cm away from the incisors (Figure 1), the surface is smooth, hyperechoic mass can be seen at the lesion, the boundary is not clear, the internal echo is not uniform, originating from the submucosa, and the layer of the tube wall at the lesion site is not clear (Figure 2)。 Chest enhanced CT showed that the wall of the esophagus and cardia area was slightly thicker, and a massive filling shadow of slightly lower mixed density was seen in the esophageal lumen, mainly fat density, with smooth edges, and the maximum cross-sectional diameter was about 6.3 cm ×3.2 cm (Figure 3)。 Esophageal barium meal showed a huge strip-shaped filling defect from the flat thoracic entrance to the lower end of the upper esophagus, with an extent of about 18 cm. The esophageal lumen in this segment was dilated, there was no obvious sign of destruction of the esophageal mucosa, no obvious stenosis of the cardia, and the contrast medium passed smoothly (Figure 4)。