2016年 · 第32卷第11期

lymphoepithelioma-like carcinoma (LELC) occurs in the nasopharynx and is associated with EBV infection. Primary lung LELC is a rare non-small cell lung cancer, which occurs in Southeast Asia, and is infected with Epstein-Barr virus. Its biological characteristics are similar to nasopharyngeal carcinoma. At present, there are few reports on cases of pulmonary LELC. Surgical treatment is the main treatment mode, and radiotherapy and chemotherapy as adjuvant treatment are still controversial.

The traditional treatment methods for common congenital heart diseases such as atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) are mainly open-vision surgery under cardiopulmonary bypass and medical interventional occlusion, which have their own advantages and disadvantages^{[1,2,3,4,5,6,7]}。 Minimally invasive transthoracic occlusion is a new technique developed in recent ten years^[8,9]It combines the advantages of internal and surgical treatment methods. The incision of conventional transthoracic minimally invasive occlusion is the lower sternum, right or left margin of sternum, and the surgical incision is not concealed enough, and there are risks such as sternal deformity. We have been developing hollow guide probes since June 2013 to carry out minimally invasive occlusion of common congenital heart diseases by axillary approach under off-pump bypass^[10,11,12]Good results have been achieved. The recent and mid-term follow-up results are summarized and reported as follows.

Female, 63 years old. Recurrent chest tightness for 1 month without obvious trigger, no palpitations, shortness of breath, chest pain, radiating pain, syncope, and spontaneous relief after a few minutes of rest. He was admitted to hospital in November 2014. Past history and family history are not special. Physical examination: blood pressure 130/75 mmHg (1 mmHg =0.133 kPa), heart rate 56 beats/min, rhythm is uniform, heart sounds are acceptable, no obvious pathological murmur is heard in each valve area, myocardial enzyme and blood lipid levels are normal, and dynamic electrocardiogram shows frequent ventricular premature beats. It is clinically suspected that this symptom is caused by coronary artery disease. For a definite diagnosis, coronary arteriongraphy (CAG) is recommended.

Male, 22 years old. Chest tightness was admitted for 2 months. Physical examination: The respiratory sounds of both lungs were clear, no dry and wet rales were heard, and two-phase continuous murmur was heard on the left margin of the sternum. There was no hepatomegaly or ascites, and the peripheral vascular signs were positive. Echocardiography showed a rupture of the right coronary sinus of the aorta (into the right atrium) with a rupture of 6 mm. Aortic CTA showed rupture of the right coronary sinus of the aorta into the right atrium (Figure 1)。

Female, 51 years old. Sudden unconsciousness 1 h. Previous history of hypertension for 10 years, long-term oral medication. CT examination of the brain showed cerebral hemorrhage in the left basal ganglia area, with a volume of about 40 ml. Dehydration and intracranial pressure were treated symptomatically, intracranial hematoma puncture and drainage were performed, and brain protective drugs were used for treatment. The condition was stable and the mind improved. On the 7th day after drainage, dyspnea occurred after turning over, accompanied by a decrease in blood pressure and pulse oximetry to 0.50. Emergency orotracheal intubation, ventilator-assisted breathing; Deep venous access was established and blood pressure was maintained with vasopressor drugs. Bedside echocardiography showed a right ventricular diameter of 27 mm, pulmonary arterial pressure of 75 mmHg (1 mmHg =0.133 kPa), and a thrombus floating in the right atrium (Figure 1)。 D-dimer 7.51 mg/L. Ventilator-assisted enhanced CT of the chest showed bilateral pulmonary artery thrombosis (Figure 2)。 Vascular ultrasonography of the lower extremities revealed thrombosis of the right popliteal vein. Norepinephrine (20-30 μ g·kg^－1• min^－1) Maintain blood pressure around 110/60 mmHg.

Male, 44 years. Feeling of choking after eating, retrosternal pain with acid reflux and vomiting for 20 years. Chest enhanced CT showed cystic dilatation of the right thoracic esophagus, uneven thickening of the tube wall and uneven enhancement, which was closely related to the trachea and aorta (Figure 1、Figure 2)。 Gastroscopy showed surface ulcer formation from 28 to 35 cm away from incisors, and biopsy pathology showed: (esophageal) squamous cell carcinoma. Upper gastrointestinal tract angiography shows typical "bird's beak sign" (Figure 3)。 Combined with cranial MRI and whole body bone imaging, distant metastasis was excluded. Preliminary diagnosis: achalasia with esophageal squamous cell carcinoma.