Search

巨大纵隔肿瘤的外科治疗

目的 回顾性总结15例巨大纵隔肿瘤的临床经验,探讨其外科治疗及预后. 方法 15例巨大纵隔肿瘤患者中经右胸切口7例,胸骨正中切口5例,左胸切口3例;其中2例术中运用体外循环,2例行血管成形术.结果 患者全部治愈出院,辅以放疗、化疗,预后良好. 结论 巨大纵隔肿瘤的外科治疗困难,手术切口、术中操作技术、肿瘤有无外侵对肿瘤切除起主要作用,体外循环的运用有助于肿瘤的完整切除.

老年性巨大纵隔肿瘤的手术治疗

目的总结老年性巨大纵隔肿瘤的手术治疗效果。 方法回顾性分析2008年1月至2013年5月扬州大学临床医学院苏北人民医院12例年龄大于60岁行巨大纵隔肿瘤手术治疗的老年患者，男7例、女5例，年龄60～71（64.2±3.4）岁。手术全部切除11例，姑息性切除1例，其中肺叶切除2例，部分心包切除2例。 结果全组无手术死亡病例。术后病理诊断：脂肪瘤1例，胸骨后甲状腺瘤2例，纵隔囊肿3例，胸腺瘤2例，神经鞘瘤1例，腺鳞癌1例，鳞癌1例，孤立性纤维性肿瘤1例。术中并发大出血1例，术后并发复张性肺水肿2例，予以对症治疗后痊愈。随访3个月至5年，1例失访。1例因肿瘤转移死亡，1例死于其它疾病；余9例随访均健康，生活质量良好。 结论手术治疗老年性巨大纵隔肿瘤效果好。术前应充分做好准备，术中防止低血压、心脏压迫，控制致命性出血，术后积极防治复张性肺水肿。

胸腔镜联合椎管后路手术切除后纵隔椎管内哑铃形神经源性肿瘤

纵隔Castleman病一例报告及文献复习

Castleman 病为一种较少见、原因不明的不典型淋巴组织增殖性疾病, 又称血管滤泡性淋巴组织增生、巨大淋巴结病或血管瘤性淋巴错构瘤[ 1 ] 。由于缺乏特征, 临床表现多样, 加之临床少见, 故本病误诊和漏诊率均较高[ 2 ] 。我们总结了我科近期收治的1 例以纵隔淋巴结肿大为临床表现的Castleman 病例并复习了有关文献, 旨在加强对Castleman 病的认识, 提高对该病的诊治水平。

全胸腔镜下纵隔良性肿瘤切除术22例

创伤性纵隔血肿的特点及处理

目的 探讨创伤性纵隔血肿的临床特征、诊断方法和治疗.方法 对12例纵隔血肿病例进行了总结,对其临床表现、治疗方法、疗效和预后进行了分析.结果 486例胸部创伤患者中发生纵隔血肿12例,占胸部创伤的2.5%.根据病情进行开胸手术及B型超声波定位引导下血肿穿刺治疗,治愈11例,死亡1例.结论 严重胸部创伤时,即使无明显临床症状,亦应考虑纵隔血肿的存在,并给予必要的检查,积极治疗,效果满意.

Safety of the removal of pericardial and mediastinal drain within a different drainage volume after cardiac valvular replacement surgery: A case control study

ObjectiveTo assess the safety of the removal of pericardial and mediastinal drain within different drainage volume after cardiac valvular replacement surgery.MethodsBetween July 2013 and July 2017, 201 patients with rheumatic heart disease (CHD) were treated with valve replacement in our hospital, including 57 males and 144 females, aged 15 to 72 years. They were divided into two groups according to the amount of 24-h drainage before the drain removal: a group one with 24-h drainage volume≤50 ml (n=127) and a group two with 24-h drainage volume>50 ml (n=74). The postoperative hospital stay and the incidence of severe complications between the two groups were compared.ResultsThere was no difference between the two groups in the baseline information or the incidence of severe pericardial effusion and tamponade, while the group two tended to have a shorter length of hospital stay after surgery (8.0 d vs. 7.5 d, P=0.013).ConclusionIn CHD patients undergoing valvular surgery, compared with a relatively low amount of drainage before the drain removal, drawing the tube at a greater amount of drainage (24-h drainage volume>50 ml) will shorten the length of hospital stay after cardiac surgery while incidence of severe complications remains the same.

Clinical analysis of the mediastinal tumor in patients with spontaneous breathing intravenous anesthesia

ObjectiveTo evaluate the safety and the clinical curative effect of mediastinal tumor resection by video-assisted thoracoscopic surgery(VATS） with spontaneous breathing under intravenous anesthesia, comparing with endotracheal tube anesthesia.MethodsThe data of 43 patients, aged 28–58 years, with mediastinal benign tumors which had been cofirmed by chest CT in our hospital were retrospectively analyzed. Among them, 18 patients underwent mediastinal tumor resection by VATS with spontaneous breathing under intravenous anesthesia, 25 patients by endotracheal tube anesthesia.The differences, including the time of anesthesia intubation and extubation, operation time and intraoperative blood loss, muscle strength at 4 hours and at 24 hours after operation, pain score at 24 hours after operation, hospitalization time, were be compared between the two groups.ResultsThe duration of intubation (17.8±4.8 min) in spontaneous breathing under intravenous anesthesia group was shorter than another group (28.6±8.17 min), the difference was statistically significant (P<0.05). Muscle strength at 4 hours after operation in spontaneous breathing under intravenous anesthesia group was significantly higher than another group (38.5±6.5 kg vs. 28.3±5.2 kg, P<0.05) as well. However, there was no significant difference between the two groups in extubation time, operation time and intraoperative blood loss, muscle strength and pain score at 24 hours after operation, hospitalization time.

原发性纵隔肿瘤的外科治疗

目的总结原发性纵隔肿瘤的外科治疗经验。方法回顾性分析我院1986年6月～2004年12月122例原发性纵隔肿瘤患者的临床资料，肿瘤全部切除107例，肿瘤大部分切除6例，单纯探查活检9例，手术切除率为92．6％（113／122）。结果手术死亡2例，术后94例患者获得随访，随访3个月～18年。除1例良性胸腺瘤切除术后7个月肿瘤复发外，其余良性纵隔肿瘤患者术后均预后良好。2例年轻的胸腺癌患者分别在术后3个月和5个月死于癌肿复发及其引起的各种并发症。结论原发性纵隔肿瘤不论良性还是恶性，只要无明确的远处转移和呼吸循环系统功能不全，允许胸部探查者均应及早手术，争取摘除肿瘤。

Toumai® endoscopic robot-assisted thoracic surgery in three patients

ObjectiveTo explore the application of Toumai® minimally invasive endoscopic robot in thoracic surgery, and to observe its safety and short-term surgical efficacy. MethodsThree patients were enrolled from October to December 2021, including 1 male (69 years) and 2 females (47 years and 22 years). All 3 patients received surgery with Toumai® endoscopic surgical robot, including radical lung cancer surgery in 2 patients and mediastinal tumor resection in 1 patient. ResultsAll 3 patients were successfully operated without conversion to thoracotomy, complication or death. For the male lobectomy patient, the total operation time was 120 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female lobectomy patient, the total operation time was 103 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female mediastinal tumor patient, the total operation time was 81 min, the intraoperative blood loss was 50 mL, the catheter drainage time was 3 days and the hospital stay time was 3 days. ConclusionThe Toumai® minimally invasive endoscopic surgical robot is safe and effective in thoracic surgery. Compared with Da Vinci surgical robot, Toumai® has the same 3D visual field experience and smooth operation.