Thoracoscopic pericardiotomy for management of purulent pneumococcal pericarditis in a child

Purulent pericarditis is an extremely rare complication of pneumococcal pneumonia in children that may result in to cardiac tamponade. While image-guided pericardiocentesis is the treatment of choice for such a condition, it may fail in the presence of thick pus; loculations and thoracoscopic pericardiotomy are useful procedures for such situations. Herein, we report such a case involving a 6-year-old boy who presented with purulent pneumococcal pericarditis that was managed with thoracoscopic pericardiotomy and who recovered well. Thoracoscopic pericardiotomy is a safe procedure that allows effective drainage under vision, pericardial biopsy for diagnosis, and a simultaneous opportunity to perform thoracoscopic pleural drainage.     

"一孔法"胸腔镜胸2交感神经节切除术治疗手汗症

目的评价"一孔法"胸腔镜胸2交感神经节切除术治疗手汗症的安全性和有效性.方法自2004年5月～2004年9月,17例手汗症患者在全麻双腔插管下行双侧胸腔镜胸2交感神经节切除术.术毕排出胸腔残余气体,不置胸腔引流管.结果术后手掌多汗症状消失.全组无手术死亡.平均双侧手术时间39min,平均随访时间2.1个月.无病例复发.结论"一孔法"腔镜胸2交感神经节切除是一种安全有效治疗手汗症的微创方法.     

胸腔镜检术在胸腔积液中的应用价值

对146例原因不明胸腔积液患者作胸腔镜检查,其中127例确诊为恶性病109例和良性特异性疾病18例。将全部病例组织学诊断与随访结果比较,发现本检查敏感性为92.7％、特异性100％,准确率93.2％。72例经胸腔镜喷入滑石粉治疗,63例获得完全的胸膜固定,持久的成功率在67例恶性胸水中为88.1％,在5例良性胸水中为 80％。术后仅有短暂发热和局限性皮下气肿及2例胸腔引流部位肿瘤种植。本法对胸腔积液病因诊断有较高临床实用价值,滑石粉胸膜固定术是控制顽固性胸腔积液的一种有效方法。     

完整刮治术及开窗引流术治疗颌骨囊肿的疗效及预后对比

目的比较完整刮治术及开窗引流术治疗颌骨囊肿的疗效及预后。方法回顾性分析本院收治的126例大型牙源性颌骨囊肿患者的临床资料,将行完整刮治术的85例患者纳入刮治组,将行开窗引流术的41例患者纳入开窗组。比较2组患者手术时间及术中出血量,术后3 d内发生局部疼痛或上下唇麻木的例数,术后创腔感染、恢复及复发情况。结果开窗组手术时间、术中出血量、术后疼痛或麻木的比例均显著小于刮治组;开窗组未发现术后创腔感染及术后36个月内复发者,且预后良好,未发现神经损伤患者;而刮治组术后创腔感染13例,36个月内复发16例,2组差异显著。结论对于适用于开窗引流术的大型牙源性颌骨囊肿患者,该手术方式可简化手术程序,减少创伤,降低术后并发症发生率,术后恢复良好,复发率低,安全有效。     

超声引导下经皮穿刺置管多次灭能术治疗囊肿的价值

目的 探讨安全高效的囊肿治疗方法.方法 对65例(肝、肾、卵巢)囊肿患者, 采用超声引导下穿刺置入COOK公司产7F引流管行囊肿穿刺、引流、灭能术治疗,并留置引流管2～3 d,用无水乙醇对囊肿壁灭能2～3次.结果 随访1.5年,65例患者中囊肿消失痊愈61例,痊愈率93.8%;囊肿明显缩小(直径＜1/3)但仍残有囊腔3例,总有效率98.5%;复发1例.无腹腔出血及化学性腹膜炎发生.结论 应用超声引导下经皮穿刺置管多次灭能术治疗囊肿方法安全有效.     

Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts

Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71‐year‐old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5‐cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso‐biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst.     

Esophageal atresia with right aortic arch: An experience of thoracoscopic repair through left thorax

Right aortic arch (RAA) is one of congenital cardiovascular anomalies associated with esophageal atresia (EA). The surgical treatment for EA with RAA is still challenging. Although most pediatric surgeons are familiar with the right-sided approach, the division of the tracheoesophageal fistula and the anastomosis of the esophagus through right thorax are often difficult in cases of RAA. There are a few reports on thoracoscopic repair for EA with RAA. We report a case of EA with RAA treated by left-sided thoracoscopic approach. With left-sided thoracoscopic approach, identification and anastomosis of the esophagus could be safely performed without obstruction by the right-sided descending aorta. There was no leakage or stricture. Thoracoscopic repair of EA with RAA through the left thorax is feasible and safe without obstruction by the right-sided descending aorta.     

多囊肝与单纯性多发肝囊肿的诊断与治疗

目的 探讨多囊肝与单纯性多发肝囊肿外科处理的方法 和预后.方法 多囊肝患者35例,行肝部分切除加开窗术12例,行开腹囊肿开窗术18例,行腹腔镜囊肿开窗术5例;单纯性多发肝囊肿患者54例,行B超引导囊肿穿刺抽液加无水酒精囊内注射6例,行腹腔镜囊肿开窗术36例,行开腹肝囊肿开窗术13例.按治疗方法 不同,对疗效进行分析.结果在35例多囊肝患者中,2例(16.7%)肝部分切除加囊肿开窗术、8例(44.4%)开腹囊肿开窗术、5例(100.0%)腹腔镜囊肿开窗术患者在术后0.5～8.5年(平均3.0年)内症状复发.54例单纯性多发肝囊肿患者随访8.5年,无一例症状复发.结论 肝部分切除加开窗术是治疗多囊肝的有效方法 ;肝脏移植能治愈多囊肝,是治愈严重多囊肝的惟一有效手段;B超引导下穿刺治疗仅适用于手术前暂时缓解症状的辅助治疗;腹腔镜肝囊肿开窗术应谨慎应用.腹腔镜肝囊肿开窗术是目前治疗有临床症状的单纯性多发肝囊肿的首选治疗措施.     

胸腔镜下滑石粉胸膜固定术治疗恶性胸腔积液疗效分析

目的观察胸腔镜辅助下医用滑石粉胸膜固定术治疗大量恶性胸腔积液的疗效,探讨其应用价值。方法将2006年1月至2008年12月本科收治的74例恶性胸腔积液患者分成两组,采用胸腔镜下医用滑石粉胸膜固定术35例,采用胸腔闭式引流（ARROW管）并注入50％高渗葡萄糖治疗39例。结果胸腔镜辅助下医用滑石粉胸膜固定术组总有效率88．6％,其中82．9％的恶性胸腔积液患者获完全持久胸膜固定;高渗葡萄糖胸膜粘连术治疗恶性胸腔积液组总有效率51．2％,其中完全缓解38．5％。结论胸腔镜辅助下医用滑石粉胸膜固定治疗恶性胸腔积液是一种有效措施。     

儿童扁桃体挤切术和剥离术的对比分析

目的 :探讨扁桃体切除的术式选择。方法 :对 12 36例使用挤切法或剥离法行扁桃体切除术的儿童进行回顾性研究。剥离术在全麻下进行 ,挤切术用局麻或表麻。结果 :两种术式发生出血的最高比例是在术后 4 .5h内 ,行剥离术组中约 1.6 %的病人出现严重出血体而需外科处理 ,但挤切术组未发现现象。结论 :经正确选择的儿童在局麻下行扁桃体挤切术安全、省时、有效     

胸腔镜下交感神经链切除术治疗双手多汗症(12例报告)

目的评价内镜下胸交感神经链切除术治疗多汗症的临床效果。方法回顾性分析内镜下胸交感神经链切除术治疗12例多汗症的结果。结果12例术后多汗症均治愈，2例术后2d发生背部、双股部不同程度代偿性出汗，3～6个月后缓解，术后获得随访的10例未见复发。结论胸腔镜下交感神经链切除手术安全、疗效确切、创伤小，缩短住院时间。     

胸腔镜手术治疗肋骨骨纤维异常增殖症的可行性研究(附15例报告)

目的 探讨胸腔镜微创手术治疗肋骨骨纤维异常增殖症的安全性、疗效及优势.方法 回顾性分析2013年2月-2020年8月中南大学湘雅二医院胸外科收治的15例肋骨骨纤维异常增殖症患者的临床资料,患者均采用胸腔镜微创手术方法治疗.其中,男7例,女8例,年龄16～52岁,平均(36.7±12.6)岁.病变位于左侧6例,右侧9例;...     

内科胸腔镜肺活检对弥漫性间质性肺疾病诊断价值及安全性分析

目的探讨内科胸腔镜肺活检对弥漫性间质性肺疾病患者的诊断价值及安全性。方法回顾性分析35例内科胸腔镜肺活检的弥漫性间质性肺疾病患者临床及病理诊断资料。结果 31例患者获病理确诊,确诊率88.6%(31/35),其中普通型间质性肺炎(UIP)10例,肺结核6例,肺泡细胞癌4例,非特异性间质性肺炎(NSIP)、隐源性机化性肺炎(COP)各3例,肺泡蛋白沉着症(PAP)2例,韦格纳肉芽肿病(WG)、急性间质性肺炎(AIP)和淋巴管肌瘤病(LAM)各1例。术后并发症3例(8.6%),其中肺部感染合并呼吸衰竭2例,特发性肺间质纤维化急性加重1例,导致死亡2例(5.7%)。结论内科胸腔镜肺活检是诊断弥漫性间质性肺疾病安全有效的方法。     

胸腔镜下胸交感神经链切断术治疗手汗症的护理

目的探讨电视胸腔镜下治疗手汗症的治疗效果及护理体会。方法对37例手汗症患者行电视胸腔镜下切断胸2～4交感神经节,并进行精心护理。结果37例手汗症患者术后症状立即消除,平均3～4d康复出院。结论电视胸腔镜下胸交感神经切除术治疗效果满意,加强手术后护理,可减少并发症的发生。     

胸腔镜手术治疗食管良性疾病的疗效分析

【 目的】探讨食管良性疾病的胸腔镜治疗技术的实用性和安全性。【方法】在4个胸腔镜套管切口下分别为26例食管良性疾病病人施行手术治疗,其中食管平滑肌瘤摘除术16例、贲门失弛缓症肌层切开术6例、食管憩室切除术1例、食管囊肿1例、取异物术2例。【结果】本组无手术死亡及严重手术并发症。有3例病人因食管黏膜撕裂中转开胸手术。平均手术时间为95min,术后平均住院日为6d。【结论】食管良性疾病的胸腔镜手术创伤小、恢复快、手术瘢痕小,是一种安全、效果可靠的新术式。     

胸腔镜辅助小切口食管下段贲门癌手术

目的：总结21例胸腔镜辅助下小切口完成食管下段及贲门癌手术的治疗经验和体会。方法：全组病例均采用全麻双腔气管插管，电视胸腔镜辅助下左胸6cm小切口完成食管下段及肿块的游离，上腹旁正中约10cm的切口完成胃大小弯及贲门肿块的游离和切除，残胃与食管在胸内完成吻合。结果：1例死于术后并发症。余顺利出院。结论：电视胸腔镜下小切口完成食管下段及贲门癌的切除的术式，具有创伤小、恢复快、操作易等优点。     

电视胸腔镜下小切口食管下段、贲门癌手术

目的 总结15例电视胸腔镜下小切口完成食管下段及贲门癌手术的治疗经验和体会。方法 全组病例均采用全麻双腔气管插管,电视胸腔镜下左胸6cm 小切口完成食管下段及肿块的游离,上腹旁正中约10cm 的切口完成胃大小弯及贲门肿块的游离和切除,残胃与食管在胸内完成吻合。结果 好转14例,1例死于术后并发症。结论 电视胸腔镜下小切口完成食管下段及贲门癌切除的术式,具有创伤小,恢复快,易操作等优点。     

Local anaesthesia versus general anaesthesia for cardioverter-defibrillator implantation.

AIMS: Cardioverter-defibrillators are conventionally implanted under general anaesthesia. However, implantation under conscious sedation is being increasingly used. It has been shown that cardioverter-defibrillators can be implanted in a more pacemaker-like approach: under local anaesthesia for the surgical procedure, and with mild sedation for defibrillation threshold testing only. The aim of the present study was to compare local and general anaesthesia in defibrillation threshold testing and implantation of cardioverter-defibrillators. METHODS AND RESULTS: Forty patients were assigned to two groups: in the first 20 consecutive patients the cardioverter-defibrillator was implanted under general anaesthesia (GA), and in the subsequent 20 patients under local anaesthesia (LA). There was no significant difference between the two groups in regard of age, body weight, underlying disease, left ventricular ejection fraction, and NYHA classification. The defibrillation threshold was 13.7 +/- 5.5 J under local anaesthesia versus 10.7 +/- 4.7 J under general anaesthesia (n.s.). For defibrillation threshold testing 7.9 +/- 3.6 shocks had to be applied in patients under general anaesthesia versus 6.2 +/- 1.3 shocks under local anaesthesia (n.s.). Mean heart rate, arterial oxygen saturation and mean arterial blood pressure remained stable throughout defibrillation threshold testing, irrespective of the type of anaesthesia used. The duration of the surgical procedure was 62 +/- 16 min under GA and 60 +/- 14 min under LA (n.s.), however, the entire implantation procedure was significantly longer in patients under general anaesthesia than in those under local anaesthesia (124 +/- 24 min and 97 +/- 22 min, respectively, p < 0.005). There were no complications in either group and the procedure was well tolerated. With the use of local anaesthesia the cost of anaesthesia were reduced by 72%. CONCLUSION: Local anaesthesia in combination with mild sedation is as safe and well tolerated as general anaesthesia in cardioverter-defibrillator implantation. Lidocaine used for local anaesthesia does not adversely affect the defibrillation threshold. Device implantation in a pacemaker-like approach results in a significant reduction in total procedure time and costs, and facilitates scheduling of the procedure.     

内科胸腔镜对恶性胸腔积液的诊断和治疗

目的探讨内科胸腔镜技术在恶性胸腔积液中诊断和治疗的临床应用。方法通过内科胸腔镜病理活检诊断为恶性胸腔积液,镜下进行滑石粉喷洒胸膜固定术,观察其疗效和并发症。结果 69例恶性胸腔积液病人被确诊,其中肺癌58例（腺癌41例、鳞癌8例、小细胞癌5例、腺鳞癌4例）,胸膜间皮瘤3例,直（结）肠腺癌胸膜转移3例,乳腺癌2例,胸腺瘤1例,平滑肌肉瘤1例,淋巴细胞性淋巴瘤1例。诊断阳性率88.5%（69/78）。36例恶性胸腔积液患者行滑石粉喷洒胸膜固定术,有效率为91.7%（33/36）,平均拔管时间为5.6 d（2~13 d）。主要并发症：胸痛29例（80.6%）,发热16例（44.4%）。结论内科胸腔镜对恶性胸腔积液的诊断有重要价值,对恶性胸腔积液进行滑石粉喷洒胸膜固定术是一种安全、有效的治疗方法 。     

Video-Assisted Thoracoscopy is Feasible Under Local Anesthesia

Video-assisted thoracoscopy (VAT) is usually performed under general anesthesia (GA). We performed an analysis to determine whether multithoracoport VAT under local anesthesia (LA) is feasible.Methods: Forty-five VAT under LA were performed in 34 men and 11 women (mean age 46.8 years) in the endoscopy room.Results: The waiting time for VAT under LA was 0.5-6h on working days. There were no major complications during or after the VAT. In 9 patients, pleural malignancy was diagnosed, and in 7 patients suspected malignancy was excluded. In 5 patients we found bacterial empyema, of whom 4 had diathermic adhesiolysis during VAT. In 4 patients, the clinical diagnosis was tuberculosis by exclusion, and in 2 patients no conclusive diagnosis could be drawn. VAT influenced treatment policy 15 times, and in 17 pneumothorax patients talc poudrage was performed during the procedure.Conclusion: VAT under LA is safe, effective, logistically simple, and requires no long waiting times. No conversion to GA was necessary.