2016年 · 第32卷第09期

In recent years, the development of minimally invasive endovascular treatment technology for aortic valve stenosis, namely transcatheter aortic valve replacement, has enriched the treatment methods of aortic valve diseases, making patients with degenerative aortic valve stenosis who are contraindicated for surgery expected to get minimally invasive and safe treatment. Based on the domestic experience of minimally invasive endovascular treatment of aortic stenosis and combined with international experience, we initially put forward the basic principles and application points of minimally invasive endovascular treatment of aortic stenosis, in order to improve the standardization of minimally invasive endovascular treatment of aortic stenosis in China.

Tracheal scar stenosis can be caused by tracheal intubation, incision or trauma, and the incidence rate is 10% ~22%. However, severe stenosis with respiratory obstruction symptoms such as stridor and dyspnea is very rare, only 1% ~2%^[1]。 Once severe tracheal stenosis occurs, the patient's life may be in danger due to local inflammation, edema and secretion retention at any time, and urgent treatment is required. From January 2008 to November 2014, 9 cases of severe tracheal scar stenosis were surgically treated in our department, and all patients recovered smoothly. The report is as follows.

Male, 18. Physical examination found that the right 10th rib occupied space for more than 10 days. There are no symptoms such as fear of cold and fever, cough and expectoration, chest tightness and chest pain. Past health, no history of exposure to infectious diseases such as tuberculosis, schistosomiasis and typhoid fever. There was no history of surgical trauma. Physical examination: There was no deformity in the bilateral thorax, a bulging lesion was seen in the posterior segment of the right 10th rib, hard in texture, no redness, swelling and tenderness in the skin, the bilateral respiratory motility was consistent, the speech and trembling were equivalent, the buckling of both lungs was clear, the auscultation respiratory sound was clear, and no dry and wet rales were heard. X-ray chest radiography showed that the local bone of the right 10th rib was cystic expansion, about 3.5 cm ×2.0 cm in size, and the surrounding cortex bone was destroyed and thinned. Chest CT showed a space-occupying lesion of the right 10th rib. In the mediastinal window, there was a soft tissue expansion shadow in the right 10th rib, the density was still uniform, the CT value was 45Hu, and there were scattered loofah-like shadows with slightly higher density. There was no obvious soft tissue mass shadow in the surrounding chest wall, and no abnormal changes in the adjacent pleura were seen (Figure 1)。

Male, 47 years old. Repeated chest tightness and shortness of breath for 8 months, aggravated with chest pain for half a month. Physical examination showed no obvious positive signs. All indexes of laboratory tests were roughly normal. Chest CT showed a mass of soft tissue shadow below the tracheal carina, some of which were still clear, the largest layer was about 8.1 cm ×5.0 cm, with uneven internal density, patchy high-density shadow on the edge, and uneven enhancement on enhanced scan (Figure 1)。

Female, 48 years old. In February 2015, I suddenly suffered from severe pain in my lower back, accompanied by weakness in my right lower limb. After symptomatic treatment in the local hospital, my symptoms improved. Thoracic CT in April showed aortic dissection (Stanford type B). Deny hypertension, diabetes, family genetic history. Physical examination at admission: blood pressure 165/58 mmHg (1 mmHg =0.133 kPa) in left upper limb, 157/58 mmHg in right upper limb, 169/60 mmHg in left lower limb, and 98/59 mmHg in right lower limb. No cardiopathological murmur was heard at auscultation. Ultrasound of arteries of both lower limbs: the right femoral artery was 0.46 cm in diameter and the left femoral artery was 0.42 cm in diameter.

Female, 42 years old. Chest tightness for half a month. Previous thrombosis in both lower limbs, no history of hypertension, diabetes, heart disease and cerebrovascular disease, and no history of food or drug allergy. Hysterectomy 1 year ago, right kidney, right ureterectomy 7 months ago. Physical examination: blood pressure 116/78 mmHg (1 mmHg =0.133 kPa), heart rate 78 beats/min, harmonic heart rhythm, no murmur in auscultation area of heart valves. Electrocardiogram showed sinus rhythm. Echocardiography showed slightly hyperechoic right ventricle, moderate tricuspid insufficiency, pulmonary hypertension (mild) (Figure 1)。 Blood biochemical examination showed: forebrain natriuretic peptide 217 pg/ml (0-150), lactate dehydrogenase 318 U/L (114-240), D-dimer 0.466 μ g/ml (0-0.3), and other tests were normal.

Carcinoma of stomach remnant refers to the carcinoma of stomach remnant after partial gastrectomy. The pattern of occurrence, development and metastasis is different than that of gastric cancer^[1]Some patients go to gastrointestinal surgery and undergo total gastrectomy in the abdominal cavity. There is no unified standard for digestive tract reconstruction. There are different evaluations of various digestive tract reconstruction procedures at home and abroad, and there are many controversies^[2]。 Many gastrointestinal surgery methods such as 3S type jejunum substituting stomach or P loop type jejunum substituting stomach are observed^[3]。 Some of the patients were treated in thoracic surgery for total gastrectomy after jejunal stomach replacement or colon stomach replacement and esophageal anastomosis. In this case, the patient had left thoracotomy after cardia cancer surgery (the anastomosis was 30 cm away from the incisors). The anastomosis was located in the chest, and the tumor appeared in the residual stomach. The surgical procedure could be colon replacement stomach and esophageal anastomosis, or jejunum replacement stomach and esophageal anastomosis, which was complicated, difficult and risky.