2018年 · 第34卷第12期

transcatheter aortic valve implantation (TAVI) refers to the surgical technique of releasing and anchoring a transcatheter heart valve (THV) to an autologous or artificial aortic valve through different approaches using interventional techniques and tools under non-direct vision conditions, guided by imaging techniques such as X-ray and ultrasound. TAVI has the characteristics of no sternotomy, no cardiopulmonary bypass and no cardiac arrest. Compared with traditional surgical aortic valve replacement, the trauma is significantly reduced.

video-assisted thoracoscopic surgery (VATS) has been widely used by domestic and foreign thoracic surgeons with the maturity of surgical techniques, including sublobectomy, lobectomy and total pneumonectomy, because of its advantages of less trauma and quick recovery^[1,2]。 In recent years, one-way total thoracoscopic lobectomy has better solved the conversion to thoracotomy caused by lung fissure hypoplasia, which has gradually enriched the technique of complete thoracoscopic surgery^[3]。

Cervicothoracic junction tumors refer to tumors in which the thoracic mediastinum tumors expand upward or the neck root tumors grow downward, exceeding the cervicothoracic anatomical boundaries such as the 1st and 7th cervical vertebrae, clavicle and suprasternal notches. There are trachea, esophagus and blood vessels at the junction of the neck and thorax. Once the tumor invades or the lymph nodes metastasize to this point, it is difficult to obtain a satisfactory surgical field by simple chest or neck incision^[1]。 We applied anterior cervicothoracic approach combined with microsurgery to completely resect 2 cases of cervicothoracic junction tumors with satisfactory results, which are reported below.

Female, 35 years old. Progressive dyspnea for 1 year, aggravated for 1 month. Chest CT showed right pneumothorax. Symptoms were relieved after treatment such as oxygen inhalation, asthma relief and pain relief. Closed thoracic drainage was performed 1 year ago for spontaneous pneumothorax on the right side. Physical examination: Old scar was seen in the second intercostal area of the midline of the right clavicle, weakened breathing sound in the right lung, percussion drum sound, and nodules the size of mung beans were seen in both toes (Figure 1)。 No abnormalities were found in the biochemical and immune antibody tests at admission. Preoperative chest CT showed right pneumothorax, compressed lung tissue and multiple thin-walled cysts in both lungs (Figure 2)； Cranial MRI (Figure 3) shows multiple subependymal nodules; Abdominal CT showed multiple hamartomas of the liver and kidneys (Figure 4)。 Combined with medical history and imaging data, the initial diagnosis was tuberous sclerosis with pulmonary lymphangioleiomyomatosis.

From October 19th to 21st, 2018, the "2018 Henan Medical Association Cardiac and Macrovascular Surgery Branch Reelection and Academic Annual Meeting and Central China Cardiovascular Conference" sponsored by Henan Medical Association and hosted by Fuwai Huazhong Cardiovascular Hospital, Central China Branch of National Cardiovascular Center, Henan People's Hospital and Henan Cardiovascular Center was held in Zhengzhou. More than 500 experts and scholars in the field of cardiac and macrovascular surgery from home and abroad attended the conference.