2017年 · 第33卷第01期

Pulmonary artery branch stenosis is one of the more common malformations in congenital heart disease, which can occur simply or may be a postoperative complication of some complex congenital heart diseases, such as Fallot tetralogy, ventricular septal defect pulmonary atresia (PA/VSD), single ventricle, persistent truncus arteriosus, etc. At present, the main solutions include surgical patch enlargement of stenotic pulmonary artery, medical catheter balloon dilatation and stent placement, etc. But both methods have varying degrees of flaws; Surgical operation is subject to the anatomical structure of the left and right pulmonary artery branches, which is easily compressed by the aortic arch to varying degrees. Stenosis often appears again after operation, and the reoperation rate reaches 30% ~40%^[1,2]Medical catheters cannot be widely used in younger children due to reasons such as age and path of catheters. Therefore, it is necessary to find a more effective method to solve the pulmonary artery branch obstruction in clinic.

ventricular septal defect (VSD) is the most common congenital heart disease in clinic, accounting for about 3‰ of live births after birth^[1]。 Multi-pore perimembranous VSD is a common type among them. Traditional treatment methods include repair under cardiopulmonary bypass and percutaneous interventional occlusion. The former is traumatic, bleeding and unattractive; The latter occludes multiple perimembranous VSD, which is prone to residual leakage, and it is difficult to place double occluders. We retrospectively analyzed the surgical data and mid-term follow-up data of 15 patients with multi-pore perimembranous VSD treated with transthoracic double occluder, and explored the indications, efficacy and complications of occlusion, which are reported below.

Descending necrotizing mediastinitis (DNM) is a severe invasive infection secondary to the oropharynx, with a mortality rate of 40% ~60%^[1,2]。 From June 2007 to January 2015, we treated 43 patients with type ⅡB DNM assisted by video-assisted thoracoscopy (VATS). The experience is summarized as follows.

Minimally invasive esophageal cancer surgery has developed rapidly in recent years, but the choice of specific minimally invasive surgery methods is controversial. At present, McKeown procedure is commonly used at home and abroad, but cervical anastomosis significantly increases complications such as recurrent laryngeal nerve injury, anastomotic leakage and esophageal reflux^[1]。 Ivor-Lewis esophagectomy is a classic procedure for middle and lower esophageal cancer, which effectively avoids the defect of cervical anastomosis. However, minimally invasive Ivor-Lewis esophagectomy (MIILE) is difficult to perform, especially the anvil placement under thoracoscopy. From January 2013 to December 2015, we completed 184 cases of MIILE using a circular stapler using thoracoscopic manual purse suture, which is summarized below.

Female, 44 years old. There was no obvious trigger to find a mass on the right back, the size of an egg, with needle-like pain, no fear of cold and fever, and no history of tumor or tuberculosis. One day ago, the pain was unbearable, and the B-ultrasound in the local hospital showed substantial occupation of the right back. Visiting our hospital, the physical examination showed that a lump was palpable on the right back, 7 cm ×9 cm in size, hard, fixed, tender, no redness or heat on the skin surface, and no superficial lymph node swelling in the whole body. Blood routine, liver function and tumor markers were normal in laboratory tests.

Male, 52 years old. Physical examination found that the right posterior mediastinum occupied space for more than 1 month, and there was no obvious discomfort in the complaint. Chest CT examination showed a 4.4 cm ×3.4 cm soft tissue density shadow behind the superior vena cava in the right superior mediastinum, with a CT value of about 50HU, followed by high density collateral circulation (Figure 1)。