2018年 · 第34卷第03期

In recent years, thoracic trauma has become an important type of trauma^[1]。 Chest trauma is often accompanied by lung parenchymal injury, such as hemopneumothorax, intrapulmonary hemorrhage, lung contusion and laceration, etc. traumatic pulmonary pseudocyst (TPP) is one of the manifestations of intrapulmonary laceration, but it is rare in clinical practice. The clinical data of 11 patients with TPP admitted to our department were retrospectively analyzed, and the clinical features, imaging features, diagnosis and management strategies of this lesion were elucidated.

Open heart repair of atrial septal defect (ASD) under cardiopulmonary bypass is effective, but due to the anatomical position, inferior cavity ASD is generally large, adjacent to the opening of the inferior vena cava, located in the posterior lower part of the inferior branch of the atrial septum, and is mostly elliptical. Most defects have anterior, posterior and upper edges, but no lower edge, which continues with the inferior vena cava without clear boundary. It is quite different from general central ASD surgery^[2]。 The pulmonary vein openings are mostly adjacent, and most adult patients have heavy right heart load after long-term blood shunt, obvious enlargement and hypertrophy of right ventricle and right atrium, increased vena cava pressure, thinning of tube wall, difficult and easy to cause damage and bleeding of inferior vena cava. Although the effect of traditional patch repair by median thoracotomy is acceptable, there are problems such as cumbersome surgical operation and easy injury.

Functional tricuspid valve insufficiency is a common heart disease. Increased pulmonary artery pressure secondary to left heart system valve disease and tricuspid annulus dilatation caused by right ventricular dilatation are the main pathological basis of functional tricuspid valve insufficiency^[1]。 In left heart system surgery, if the tricuspid regurgitation is not effectively corrected, with the progressive aggravation of regurgitation, the postoperative mortality and morbidity of patients will increase, and finally offset the clinical value of other cardiac correction surgery^[2]。 Therefore, it is of great clinical value to perform adjustable autologous Tricuspid valvuloplasty (TVP) and select an effective TVP procedure. Current clinical TVP procedures can be roughly divided into two types^[1,3]: De Vega Technique and Annuloplasty. Due to the possible problems of suture rupture, leaflet avulsion or severe leaflet shrinkage, De Vega technique has poor effect in the medium and long term, and the incidence rate of tricuspid insufficiency over moderate volume is 10% ~40%^[4]Therefore, at present, domestic and foreign scholars tend to apply artificial valve annuloplasty in the shaping method^[3]。 However, even with plastic ring, 8% ~15% of patients still have more than moderate volume of tricuspid regurgitation in early postoperative period, and the more severe the preoperative regurgitation, the higher the risk of failure of plastic valve^[4]。 The implantation of prosthetic annulus limits the systolic and diastolic functions of the annulus itself and the ventricle, which is prone to problems such as annular dehiscence, thrombosis and infectious endocarditis^[5,6]。 In addition, the high price of forming ring affects its popularization in China^[6]。 Pericardial tissue is widely used in the field of cardiovascular surgery because of its convenience, compliance and durability^[7]。 At present, there are no clinical studies of autologous fresh pericardial soft ring for tricuspid valvuloplasty. We used autologous fresh pericardial strips as an adjustable soft ring for the treatment of tricuspid valve insufficiency to evaluate its short-term efficacy, which is reported below.

At present, modern radiographic technology provides great convenience for medical work, especially for thoracic surgery, so that doctors can conveniently observe the character and location of lung lesions, as well as the shape and relationship of surrounding blood vessels and trachea. OsiriX, as a professional reading and processing software for DICOM images under MacOS operating system, can easily reconstruct and tailor images in multiple dimensions through tools set by software. Highlight the structure you want to observe, and you can rotate, zoom, see through, and generate animated videos. For thoracic surgeons, pulmonary disease is one of the most important work contents. Because of the great variability of pulmonary blood vessels, the operation is difficult. In the past, it was very limited to judge the condition only by the cross-section of CT imaging. However, after processing the DICOM file of CT imaging by OsiriX software, the judgment of lesions is clearer and more accurate, which provides a very beneficial help for formulating a more accurate and targeted individualized thoracoscopic surgery treatment plan.

Diabetes mellitus is one of the high risk factors for the development of coronary atherosclerotic heart disease (CHD), which can increase the incidence of complications and mortality after coronary artery bypass grafting (CABG)^[1]。 With the advancement of surgical technology, off-pump coronary artery bypass grafting (OPCABG) cases are increasing year by year, but the influence of diabetes on OPCABG is still uncertain, and there are few related reports^[2]。

Female, 19 years old. Physical examination chest X-ray fluoroscopy found a round low-density shadow of the left posterior mediastinum next to the spine, and perfect X-ray chest radiograph after admission (Figure 1), chest CT (Figure 1◎、FIGURE 1) and chest MRI (Figure 1，Figure 1，FIGURE 1，Figure 1) Check. Because the tumor is huge, dumbbell-shaped convex towards the spinal canal and thoracic cavity, adjacent to the heart and large blood vessels, and accompanied by scoliosis, after excluding the contraindications for surgery, staged surgical treatment is planned: in the first stage, a neurosurgeon will perform spinal canal mass resection and spinal canal decompression, and an orthopedic surgeon will perform spinal deformity correction at the same time (FIGURE 1ˊ)。 During the operation, an irregular long strip of huge tumor in the spinal canal of T5~8 segments was seen, which was located outside the dura mater, and was gray-white and gray-red, adhering tightly to the surrounding tissues. The surface of the dura mater became thinner under pressure and was squeezed to the right side. The tumor in the spinal canal was carefully removed. Due to the compression and destruction of the tumor, the pedicle was obviously destroyed and thinned. Screws were placed in the left T6~8 and right T6~7 pedicles, and then titanium rods were placed for fixation. The second stage surgery was performed 1 month after the first stage surgery. Excluding the contraindications of surgery, video-assisted thoracoscopic mediastinal mass resection was performed by a thoracic surgeon under general anesthesia, and the mediastinum occupied space after complete resection.

Female, 60 years old. Chest tightness for more than 2 months, sudden syncope for more than 6 days. Previous history of hypertension and diabetes; There was no history of trauma, blood transfusion, food or drug allergy. Physical examination: blood pressure 136/84 mmHg (1 mmHg =0.133 kPa), heart rate 93 beats/min, harmonic heart rhythm, no murmur in auscultation area of heart valves. Mild limitation of right limb movement, right upper limb muscle strength grade 4, right lower limb muscle strength grade 4; The mobility of the left limb is acceptable, the muscle strength of the left upper limb is grade 5, and the muscle strength of the left lower limb is grade 5. Electrocardiogram showed sinus rhythm. Echocardiography showed: left atrium enlargement, solid echo in left atrium, small mitral regurgitation, and decreased left ventricular diastolic function (Figure 1)。 Magnetic resonance brain imaging showed a mixed irregular single lesion without evidence of hydrocephalus (Figure 2)。 Magnetic resonance angiography showed metastatic aneurysm deposition with tumor embolization. Blood biochemical examination showed: forebrain natriuretic peptide 326pg/ml and lactate dehydrogenase 385 U/L.