2018年 · 第34卷第06期

Perioperative hemorrhage is one of the common complications of thoracic surgery. The proportion of secondary thoracotomy caused by postoperative hemorrhage is about 1.25% to 1.94%. Bleeding can also lead to various complications, such as shock, disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS), etc.^[1,2,3]。 The incidence of bleeding after thoracotomy was 0.1% ~3%^[2,4]Moreover, postoperative hemorrhage is more dangerous than intraoperative hemorrhage and has a higher mortality rate^[5]。 There are many causes of bleeding, on the one hand, it is related to the condition of the patient before operation, such as taking anticoagulants, liver disease, diabetes, etc., on the other hand, it is also related to the condition of the disease itself (for example, malignant tumor invades the surrounding blood vessels, the disease site is adjacent to large blood vessels, etc.), and it is also related to the proficiency of different doctors in surgical operation^[6,7]。 In recent years, minimally invasive techniques have been widely used in surgery, but the limitation of the angle of the cutting closure or stapler in laparoscopic surgery, damage to the posterior wall of blood vessels caused by right-angle forceps or scissors, laceration caused by blunt separation, laxity or misplacement of vascular clips, excessive pulling of fragile blood vessels, improper use or accidental injury of energy devices are all important factors leading to postoperative bleeding^[8]。

Although the surgical technique of esophageal cancer is maturing at home and abroad, the postoperative complications and perioperative mortality rate are still very high^[1]。 With the development of laparoscopic techniques, minimally invasive esophagectomy (MIE) is believed to reduce postoperative complications, reduce mean hospital stay, reduce intraoperative bleeding, and relatively improve postoperative quality of life^[2,3]。 However, some scholars believe that the incidence of diaphragmatic hernia after MIE is higher than that of conventional Ivor-Lewis surgery^[4]。 The clinical data of patients with diaphragmatic hernia after laparoscopic esophageal cancer surgery in our hospital from September 2013 to March 2015 were retrospectively analyzed and reported as follows.

video-assisted thoraeoseopie surgery (VATS) esophageal surgery has the advantages of less trauma, faster recovery of postoperative ventilation function, fewer pulmonary complications and short hospital stay. It has been popularized and applied in esophageal cancer surgery, but CO₂Artificial pneumothorax is bound to have increased intrathoracic pressure, obstruction of superior vena cava return, mediastinal displacement, cardiac compression, hypercapnia, etc., which may lead to increased risk of perioperative cardiovascular events^[1]However, the elderly patients have relatively poor cardiopulmonary compensatory function and more concurrent diseases, and artificial pneumothorax may have a greater impact on them. The present study aims to adopt a multifactoriallogisticRegression analysis was used to screen the risk factors of major cardiovascular events during perioperative period of VATS esophageal cancer surgery in elderly patients, in order to provide certain reference indicators for early clinical warning and timely intervention.

Male, born 30 min, weight 1.76 kg. B-ultrasound at 25 weeks of gestation showed that the fetus had congenital left diaphragmatic hernia, and the intrathoracic hepatic echo range was about 32mm ×24mm, LHR: 0.73, O/E LHR: 31% (Figure 1)； The reexamination at 28 weeks of pregnancy was assessed as mild diaphragmatic hernia (B-ultrasound at 28 weeks of pregnancy showed that the intrathoracic liver echo range was about 23 mm ×23 mm. LHR: 1.69, O/E LHR =60%) (Figure 2)。 The infant with moderate diaphragmatic hernia was assessed by our hospital as dyspnea after birth, and was transferred to our department with tracheal intubation resuscitation sac and pressurized oxygen. After admission, it was difficult to insert the gastric tube, and the bedside chest X-ray showed congenital left diaphragmatic hernia, heart shadow and mediastinum deviation to the right (Figure 3)。 Diagnosis: Left congenital septal hernia.

Male, 42 years old. The upper part of the sternum is slightly raised, the pain is mild, and the breath is short for half a year. Now the sternum mass is obviously enlarged and the pain is aggravated. Physical examination showed a raised mass at the upper sternal stem, about 10 cm ×5 cm, with hard texture, poor mobility and positive tenderness. Chest enhanced CT examination revealed expansive bone destruction of the upper sternum (Figure 1)。 Bone scan revealed abnormal radioactive concentration in the sternal stem (Figure 2)。