2016年 · 第32卷第10期

Coronary artery bypass grafting (CABG) is one of the most important methods for the treatment of coronary atherosclerotic heart disease. In the United States, nearly 400,000 patients undergo CABG surgery each year. Also in China, with the increasing incidence of coronary heart disease, the number of CABG operations is also increasing year by year. In 2014, the number of CABG operations nationwide reached 42,000.

Chronic empyema is one of the refractory diseases in thoracic surgery caused by untimely or improper prolongation of acute pleural cavity infection. Pleural fibroplatectomy is an ideal radical operation for the treatment of chronic empyema^[1,2]。 Clinically, visceral fibers often invade the lower lung tissue, and the two lack separation levels and are difficult to peel off. The traditional fiberboard stripping will forcibly peel off the visceral fiberboard completely, which will lead to multiple or large-area lacerations of the deep lung tissue, and adverse consequences such as persistent postoperative air leakage, infection, poor lung recruitment, and reformation of residual cavity. Moreover, the incidence of bronchopleural fistula is extremely high, so it is necessary to reoperate and perform more invasive operations such as thoracoplasty or muscle flap tamponade to eliminate the residual cavity. In view of this, we treated chronic empyema with preservation of visceral pleural fibroplate in patients who have difficulty in removing visceral fibroplate during operation, which is now reported as follows.

The incidence of patent foramen ovale (PFO) in normal adults is about 25%. In recent years, some studies have found that PFO is closely related to migraine, paradoxical embolism, unexplained stroke and neurodecompression disease^[1,2]The treatment of PFO has attracted attention. Our experience of percutaneous femoral vein occlusion in the treatment of PFO guided by esophageal ultrasound without X-ray assistance is reviewed and reported below.

PatientMale, 40. There were no abnormalities in past history, personal history and family history. Physical examination was normal. Enhanced CT of the pulmonary artery showed arteriovenous fistula in the upper lobe of the right lung and the boundary area of the upper and lower lobes of the right lung.

At present, the treatment of esophageal cancer is mainly based on surgery, and the number of elderly patients among patients undergoing surgery has increased significantly. Patients with esophageal cancer often lead to insufficient nutritional intake and varying degrees of malnutrition due to difficulty in eating, decreased gastric volume and loss of appetite after digestive tract reconstruction. However, malnutrition is an independent risk factor for the prognosis of cancer patients^[1]。 From May to October 2015, our department performed laparoscopic jejunostomy on 28 patients, and made an attempt to improve postoperative nutritional support for patients with esophageal cancer. The report is as follows.

PatientMale, 52 years old. Esophagoscopy was performed due to dysphagia, and esophageal cancer was diagnosed and admitted to hospital. The preoperative examination was improved, and no contraindications for surgery were found. Ivor-Lewis surgery was performed on 31 Dec 2014 under general anesthesia. The tubular stomach was routinely made during the operation. Fever occurred on the 4th postoperative day, followed by dyspnea, cough, coughing up gastric juice-like fluid. Bronchoscopy and esophagoscopy were performed, and the fistula of the gastric wall was seen, and the fistula of the posterior wall of the right middle bronchus communicated with the gastric cavity. The size of the fistula is approximately 2 cm ×4 cm (estimated by the laparoscopist based on the ratio of fistula to bronchoscope diameter).