2018年 · 第34卷第05期

China's medical and health undertakings are developing rapidly, and at the same time, they are facing huge challenges. With the aging of the population, the change of lifestyle and the improvement of medical and health standards, the disease spectrum in China is changing rapidly^[1]The incidence and mortality of chronic non-communicable diseases remain high^[2]。 Among them, cardiovascular disease has become the leading cause of death in China, accounting for 42.61% of the total causes of death in urban residents^[3]The incidence and disease complexity are increasing year by year^[4]In the future, the situation of cardiovascular disease prevention and treatment in China is very severe.

Transnasal-fistula drainage is a new drainage method for the treatment of anastomotic fistula after esophageal cancer surgery reported in our department in 2009, which effectively solves the problem of drainage path^[1,2]。 However, there is no more research on what is the reasonable value of drainage negative pressure. Negative pressure wound treatment technique (negative pressure wound therapy, NPWT)^[3]It refers to applying a negative pressure of 125 mmHg (1 mmHg =0.133 kPa) to the wound surface to promote wound healing. Anastomotic fistula is a special kind of wound. We introduced NPWT technique into the treatment of fistula, and gave a specific treatment negative pressure. The negative pressure drains pus out of the body cavity at the same time, and acts on the fistula cavity wound to produce a therapeutic effect, effectively shortening the treatment time. The report is as follows.

paravalvular leak (PVL) is one of the most common complications after valve surgery in heart surgery. More severe PVL can cause complications such as heart failure, hemolysis and infectious endocarditis due to hemodynamic changes. Advanced age, multiple valve replacement surgery, infectious endocarditis, connective tissue disease increase the risk of developing PVL^[1]。 These factors not only increase the proportion of reoperations, but also prevent the optimal placement and suture of the newly replaced valve in the autologous annulus. At present, conventional surgical treatment requires secondary thoracotomy, which is risky, bleeding, complications, and easy to relapse PVL^[2]。

Primary cardiac tumors are relatively rare, accounting for only 0.001% to 0.5% of routine necropsies^[1]。 Primary heart valve tumors are less common, not more than 3% to 10% of heart tumors^[2]。 At present, there is no standardized diagnosis and treatment plan, and most heart centers at home and abroad report it on a case-by-case basis.

Female, 66 years old. He was admitted to the hospital for "8 years of finding a progressive mass in the left chest". There were no obvious symptoms of discomfort. Physical examination: A mass of about 14 cm ×12 cm in size was seen below the subscapular corner of the left back. There was no tenderness, toughness, unclear boundary, poor mobility, and no redness or swelling.

Case 1 female, 70 years old. Admitted for 6 years with intermittent dry cough. No nausea and vomiting, no abdominal pain, and dry cough worsened in the past 1 year. X-ray chest radiograph showed a circular density shadow at the right diaphragm position (Figure 1)。 CT showed a rounded shadow of pure fat density next to the cardiopaphragmatic angle on the right side of the anterior mediastinum, with clear boundaries (Figure 2)。 Enhanced CT showed interruption of the continuity of the right diaphragmatic angle diaphragm, and a round-like pure fat density shadow was seen next to the diaphragmatic angle behind the sternum, about 9.8 cm ×6.2 cm in size, with a clear boundary, and the walking vascular shadow was seen in it, which originated from the abdominal vessels. Morgagni hernia was considered (Figure 3)。