2018年 · 第34卷第10期

With the popularization of high resolution CT, the detection rate of pulmonary nodules is increasingly high, and most of them are malignant tumors, which require early surgical intervention. The incidence of heart disease (such as rheumatic valvular disease) decreased, but the incidence of degenerative valvular disease and coronary heart disease increased^[1]。 The experience of cardiothoracic surgery in our hospital in treating patients with heart diseases complicated with lung tumors is summarized, and the report is as follows.

Esophageal foreign body perforation with mediastinal infection is a kind of critical disease with complicated treatment, which can lead to septic shock, or serious complications such as esophageal aortic fistula and lead to death^[1]。 Early surgical intervention and adequate drainage are the key to diagnosis and treatment of mediastinal infection^[2]。 Video-assisted mediastinoscopy is widely used in the diagnosis and treatment of thoracic surgical diseases^[1,3,4]。 From July 2013 to February 2018, we applied mediastinoscope-assisted transthoracic mediastinal drainage to treat 7 cases of mediastinal infection caused by small foreign body perforation in the esophagus, which are reported below.

In recent years, the incidence of esophageal cancer is increasing worldwide^[1]For most patients with esophageal cancer, surgical resection is the most important treatment option. Three-incision esophagectomy has a higher incidence of complications (nearly 50%) and a higher mortality rate (0-22%) at 30 days after operation. The main complications were pulmonary infection (16% ~33%), anastomotic leakage (9% ~16%), atrial arrhythmia (6% ~20%)^[2]。 These complications significantly increase patient mortality and prolong hospital stay, requiring further treatment^[3]。 The results of studies on the microbiota at different sites show that the microbiota may accelerate the progression of certain diseases, including periodontal disease, gastrointestinal autoimmune diseases, and even gastrointestinal tumors^[4]。

PatientFemale, 51 years old. The left upper lung occupied space for 2 days. No cough and sputum, slight chest tightness, no shortness of breath, dyspnea, no general bone and joint pain, no eyelid drooping, blurred vision, diplopia, strabismus, inflexible eyeball rotation, no indifferent expression, wry smile, dysarthria, no weakness in chewing, choking and coughing after drinking water, dysphagia, etc. Physical examination: the trachea was centered, the thorax was not deformed, the thoracic dilation was bilaterally symmetrical, the breathing sounds of both lungs were clear, no dry and wet rales were heard, the heart rhythm was uniform, no pathological murmur was heard, the abdomen was flat and soft, and there was no tenderness. Chest enhanced CT examination showed: irregular soft tissue mass shadow in the upper lobe of the left lung, with clear boundary, 7.7 cm ×5.2 cm in size, lobulation was visible, and the bronchus in the anterior segment of the upper lobe of the left lung was compressed and narrowed, which showed mild enhancement after enhancement, and necrosis was not obvious; No obvious enlarged lymph nodes were found in the hilar and mediastinum of both sides; There was no obvious abnormal change in the morphological density of heart shadow (Figure 1)。 No serum acetylcholine receptor antibodies were detected.

PatientMale, 25 years old. Sudden right chest tightness for 3 days, aggravated for 1 day. The right thorax was full, the intercostal space was widened, the respiratory movement was weakened, the speech tremor and speech resonance disappeared, the percussion drum sounded, the right breathing sound was absent, no skin erythema was seen, the lymph nodes on the body surface were not touched and obviously swollen, and the limbs moved normally. Chest CT examination showed right pneumothorax with compression of about 80% and multiple cystic changes in both lungs (Figure 1)。 Blood routine, pulmonary function, head CT, abdominal B-ultrasound and other examinations showed no obvious abnormalities. Spontaneous pneumothorax on the left side 5 years ago, improved after surgical treatment. Smoked 10 cigarettes/day for 10 years without quitting.

PatientMale, 15 years old. After accidentally swallowing duck bones, he developed chest pain, swallowing discomfort, belching, and low fever. On March 30, 2018, he went to two hospitals in other places. Chest CT examination showed high-density shadow in the mediastinum, all considered esophageal foreign body and perforation, and the foreign body broke into the mediastinum. Further visit to our hospital, chest enhanced CT examination showed: at the level of the fifth thoracic vertebra, a strip of high-density shadow could be seen in the mediastinum, located at the level below the aortic arch, closely related to the descending aorta, possible foreign body, and multiple gas density shadows in the mediastinum (Figure 1)。 After consultation with the gastroenterologist, the esophageal foreign body complicated with perforation was considered, but the foreign body was closely related to the descending aorta. Endoscopic examination may aggravate the risk of mediastinal emphysema and foreign body displacement, resulting in large blood vessel injury and life-threatening, so it was transferred to our department.

PatientMale, 43 years old. Feeding obstruction for half a year. X-ray chest radiograph showed: right posterior mediastinal mass shadow, uneven density, size 6.4 cm ×2.4 cm, clear border (Figure 1)。 Esophagography showed that an external arc impression of about 9 cm in the middle and lower segments of the esophagus was seen, and a high-density mass was seen in the posterior mediastinum area of the corresponding plane, and the local barium passed smoothly (Figure 2)。 Chest CT showed a 4.8 cm ×7.6 cm ×10.0 cm mass in the posterior mediastinum, with smooth edges and uneven density, and a large number of calcifications. CT value was 88~424 HU, and esophagus was compressed and shifted to the right (Figure 3)。 MRI examination showed that the posterior inferior circular abnormal signal of the posterior mediastinal tracheal carina was 4.7 cm ×7.6 cm ×10.0 cm in size, and the T1WI and T2WI showed isolow confounding signals with regular margins (Figure 4)。 Improve preoperative examination and exclude surgical contraindications.