心房颤动导管消融术前食管造影对消融策略及预防食管损伤的价值研究

目的 采取术前心脏CT检查评估食管与左心房、肺静脉的解剖关系，优化心房颤动(房颤)导管消融安全策略，最大限度减少食管损伤。方法 选择2019年1月至2021年10月苏北人民医院心血管内科首次行射频导管消融和冷冻球囊消融术的老年房颤患者118例，所有患者成功行术前食管造影和心脏增强CT检查，左侧型102例，非左侧型16例。按照消融方式不同分为射频消融组86例和冷冻消融组32例。随访观察食管损伤相关症状的发生情况。结果 食管前壁距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉分别为(12.20±6.55)mm、(7.13±3.32)mm、(24.10±9.72)mm、(18.10±8.35)mm,其与左下肺静脉距离最近，有统计学差异(P<0.05)。下肺静脉水平食管与左心房后壁接触宽度为(18.12±4.54)mm。左侧型与非左侧型患者食管距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉比较，有统计学差异(P<0.01)。射频消融组左侧型与非左侧型患者食管距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉比较，有统计学差异(P<0.05,P<0.01);冷冻消融...     

选择性上肺静脉造影显示下肺静脉开口位置的研究

目的探讨心房颤动(简称房颤)射频消融治疗中通过选择性上肺静脉造影显示下肺静脉开口位置的可行性与效果。方法97例房颤患者,取左前斜位(LAO)50°和右前斜位(RAO)50°两个体位进行左上肺静脉造影。取LAO50°及RAO30°两个体位进行右上肺静脉造影。结果97例(100%)均可通过选择性左上肺静脉造影清晰显示左下肺静脉开口的下缘,其中78例(80.4%)可以清晰显示左下肺静脉的开口前缘。79例(81.4%)患者可以清晰显示左下肺静脉开口的后缘。选择性右上肺静脉造影时,86例(88.7%)能够清晰识别右下肺静脉开口下缘,76例(78.4%)能清晰显示右下肺静脉开口前缘,81例(83.5%)能清晰显示右下肺静脉开口后缘。结论选择性上肺静脉造影不仅能够显示上肺静脉的开口位置,而且在大部分患者中亦能较清晰显示下肺静脉的开口解剖。     

心房颤动射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

目的利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离(CPVA)术前术后肺静脉的形态学变化。方法房颤患者共28例,行环肺静脉电隔离术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。研究随访射频消融术后肺静脉的形态结果学特点和术前做对比分析。应用64排螺旋CT测量环肺静脉电隔离术前、后肺静脉口的径线,截面积,左房容积。结果 CPVA成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.05);而左上肺静脉口最小径、左下肺静脉口最大径、左下肺静脉口最小径无明显统计学差别(P>0.05)。复发组术后仅见右下肺静脉口最大径,左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05),余肺静脉指标及左心房容积未见显著差异(P>0.05)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%分别为61.6%及56.3%;狭窄50%～70%分别为3.6%和5.4%。结论 (1)CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。(2)CPVA术后可引起部分患者无症状性肺静脉狭窄。     

心房颤动射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

目的利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离(CPVA)术前术后肺静脉的形态学变化。方法房颤患者共28例,行环肺静脉电隔离术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。研究随访射频消融术后肺静脉的形态结果学特点和术前做对比分析。应用64排螺旋CT测量环肺静脉电隔离术前、后肺静脉口的径线,截面积,左房容积。结果 CPVA成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.05);而左上肺静脉口最小径、左下肺静脉口最大径、左下肺静脉口最小径无明显统计学差别(P>0.05)。复发组术后仅见右下肺静脉口最大径,左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05),余肺静脉指标及左心房容积未见显著差异(P>0.05)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%分别为61.6%及56.3%;狭窄50%～70%分别为3.6%和5.4%。结论 (1)CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。(2)CPVA术后可引起部分患者无症状性肺静脉狭窄。     

首次用一个穿过球囊的周边超声消融系统分离肺静脉治疗复发性房颤

标准的标测和消融房颤的局部来源 ,操作时间长 ,效率低。用解剖学方法作肺静脉分离可能克服这些局限性。方法和结果　 15例药物治疗无效的房颤病人 ,用一种新导管周边分离肺静脉 ,此导管尖在一充满生理盐水的球囊中有一超声探头 (8-ＭＨｚ)。 9例病人确认出 12个心房灶和 /或房颤触发点 (肺静脉位置 :左上 3,右上 6 ,左中 1,右下 1,左后 1)。 5例病人病变处未见分区图触发灶。不论病人触发点位置部位 ,均试行肺静脉左、右上方周旁分离。当窦率活化作用见到静脉有一囊心房肌时消融较下肺静脉。病人的肺静脉均予消融 ,每例病人平均接受 14 7±…     

外科治疗原发性纵隔巨大内胚窦瘤1例

病案摘要:患者男,23岁,主因"咳嗽、胸闷、朐痛半月余"入院,外院胸片提示:右侧胸腔积液.轻微活动即感呼吸困难,日常生活无法自理.入院后查体:神志清楚,气管略右偏,双肺呼吸动度不对称;触觉右肺语颤明显减弱,左肺正常;叩诊右肺呈浊实音,左肺清音;听诊右上肺闻及明显湿性啰音,右下肺呼吸音消失,左肺呼吸音粗,未闻及明显干湿啰音及胸膜摩擦音.查血清AFP＞ 1000 ng/mL.CT提示:右前纵隔巨大占位,右侧胸腔积液.为明确诊断,在GT引导下经皮行纵隔肿块穿刺活检术;病理提示(病理号:057718):内胚窦瘤,免疫组化:AFP(+)、PIAP(-)、CEA(-)、EMA(-).(胸部CT见图1、图2所示.穿刺物病理见图3).     

单心动周期实时三维超声心动图与电子计算机断层扫描评价心房颤动患者肺静脉结构及内径的对比研究

目的评估单心动周期实时三维超声技术的经食管心脏超声(TEE)在评估心房颤动(简称房颤)患者肺静脉解剖结构及内径的临床价值。方法 74例因房颤拟初次行射频消融手术患者,术前常规行采用单心动周期实时三维TEE检查、电子计算机断层扫描(CT)肺静脉血管造影及三维重建对比检查。结果与CT对比,TEE肺静脉检出率:右上肺静脉71/72(99%),右下肺静脉70/72(97%),74/74左上肺静脉(100%),70/74左下肺静(95%)。对于变异肺静脉,利用单心动周期实时三维TEE分别检出:7/10(70%)右中肺静脉,2/3(67%)左中肺静脉,1/2(50%)右肺静脉共干。CT与TEE对比测量静脉开口内径分别为右上肺静脉(20.59±4.75)mm vs(19.10±4.13)mm,右下肺静脉(17.48±2.97)mm vs(13.35±3.02)mm,左上肺静脉(21.78±3.77)mm vs(18.63±3.41)mm,左下肺静脉(18.13±3.31)mm vs(12.47±3.25)mm(P均0.001)。结论利用单心动周期技术的TEE可协助检出肺静脉及变异肺静脉,但与CT对比肺静脉开口的内径测值低。     

血管迷走性晕厥射频消融一例

患者女性,16岁,诊断为"心脏抑制型血管迷走性晕厥"。遂行迷走神经节消融,刺激方案:20 Hz(频率50 ms),10~15 m A,脉宽:5 ms,连续刺激60次(3 s)。最后在左上肺静脉底部、左下肺静脉底部、右上肺静脉前部、右下肺静脉底部等部位消融后不再出现心脏迷走反应。术后规则服用美托洛尔,未再出现晕厥。     

肺癌脑转移的手术治疗(22例临床分析)

<正> 肺癌是引起脑部转移最多见的肿瘤。Magilligan报导,尸检肺癌脑转移的发生率为30～50%,其中小细胞型肺癌的转移率更高。我科自1980年以来,共收治肺癌160例,其中有脑转移者22例,占全部肺癌的13.8%,现将本组病例分析讨论如下。临床资料一、性别与年龄:本组22例中男性16例,女性6例。发病年龄32～71岁,平均56岁。其中45岁以上者18例,占81%。二、原发肿瘤部位:22例肺癌发生部位分别为:左上肺3例,左下肺2例,右上肺8例,右下肺9例。     

持续性心房颤动对肺静脉结构重构的影响及CT的评估价值研究

目的探究持续性心房颤动对肺静脉结构重构的影响及CT的评估价值。方法选取2007年9月—2011年6月深圳市龙岗中心医院收治的24例持续性心房颤动患者为观察组,其中男12例、女12例;选取同期12例体检健康者为对照组。采用CT扫描肺静脉,比较两组受试者肺静脉直径及截面积,并观察不同性别持续性心房颤动患者肺静脉直径、截面积、圆度及静脉口指数。结果观察组患者左上、左下、右上、右下肺静脉最大直径、最小直径及截面积均大于对照组(P0.05)。不同性别持续性心房颤动患者左上、左下、右上、右下肺静脉最大直径、最小直径、截面积、圆度及静脉口指数比较,差异无统计学意义(P0.05)。结论持续性心房颤动会导致患者肺静脉发生结构重构,包括肺静脉直径增大及截面积增大,但无性别差异;CT对肺静脉结构重构具有良好的评估价值。     

Early lung disease in asbestos-product workers

We attempted to detect early signs of asbestos-induced lung disease in groups of workers in a factory which manufactured heat-resistant and friction composites. Chest auscultation results, scored on the frequency, persistence, and distribution of rales, were 2+ in 25/79 asbestos-exposed workers (32%) vs. 1/22 non-exposed workers (5%). Vital capacity was slightly but significantly reduced in two of three subgroups of asbestos workers compared to non-exposed workers. Although none of the workers had asbestosis according to clinical criteria, and only 2 had more than slight parenchymal lesions on a 70 mm chest x-ray film, the asbestos-exposed men as a group had signs of early parenchymal lung disease which were absent or minimal in the control subjects. If medical examinations of asbestos workers are to be useful in detecting early lung disease in individuals or are to serve as a "biological monitor" of the work environment, they should at least include chest auscultation, as well as lung function tests which are adequately standardized to allow definition of slight degrees of lung function loss.     

Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia

Objective

To explore the feasibility and safety of complete video-assisted thoracoscopic surgery (C-VATS) under non-intubated anesthesia for the resection of anatomic pulmonary segments in the treatment of early lung cancer (T1N0M0), benign lung diseases and lung metastases.

Methods

The clinical data of patients undergoing resection of anatomic pulmonary segments using C-VATS under non-intubated anesthesia in the First Affiliated Hospital of Guangzhou Medical University from July 2011 to November 2013 were retrospectively analyzed to evaluate the feasibility and safety of this technique.

Results

The procedures were successfully completed in 15 patients, including four men and eleven women. The average age was 47 [21-74] years. There were ten patients with adenocarcinoma, one with pulmonary metastases, and four with benign lung lesions. The resected sites included: right upper apical segment, two; right lower dorsal segment, one; right lower basal segment, two; left upper lingular segment, three; left upper apical segment, one; left upper anterior apical segment, two; left upper posterior segment, one; left lower basal segment, one; left upper posterior and apical segments, one; and left upper anterior and apical segments plus wedge resection of the posterior segment, one. One case had intraoperative bleeding, which was controlled with thoracoscopic operation and no blood transfusion was required. No thoracotomy or perioperative death was noted. Two patients had postoperative bleeding without the need for blood transfusions, and were cured and discharged. The pathologic stage for all patients with primary lung cancer was IA. After 4-19 months of follow-up, no tumor recurrence and metastasis was found. The overall mean operative length was 166 minutes (range 65-285 minutes), mean blood loss 75 mL (range 5-1,450 mL), mean postoperative chest drainage 294 mL (range 0-1,165 mL), mean chest drainage time 2 days (range 0-5 days), and mean postoperative hospital stay 5 days (range 3-8 days).

Conclusions

Complete video-assisted throacoscopic segmentectomy under anesthesia without endotracheal intubation is a safe and feasible technique that can be used to treat a selected group of IA patients with primary lung cancer, lung metastases and benign diseases.     

A dynamic analysis of chest wall motions with MRI in healthy young subjects

OBJECTIVE: The objective of this study was to analyse respiratory-related motion of the chest wall with non-invasive method. METHODOLOGY: Using magnetic resonance image (MRI), 30 sequential images (scanning time, 0.4 s per image) on sagittal, axial and coronal planes were obtained in nine healthy young subjects during quiet breathing (QB) and maximal deep breathing (MDB). The coronal planes were obtained in five of nine subjects during MDB. Ventilation was simultaneously measured with pneumotachometer. RESULTS: There was a linear correlation between instantaneous lung volume and lung cross-sectional area. Motion of the diaphragm and rib cage was also linearly related to instantaneous lung volume. The exception was lower anteroposterior (AP) diameter of the rib cage. The contribution of individual part of the chest wall motion to a unit lung volume change was assessed by slope (S) of the linear regression line. The S at the anterior diaphragm was significantly smaller than those at middle and posterior parts during MDB. The S of middle and posterior diaphragmatic motion was approximately five times that of AP motion of upper rib cage. The S of AP motion of upper rib cage was twice that of transverse motion during either QB or MDB. CONCLUSION: We concluded that dynamic MRI study with concurrent ventilation measurement is a simple and reliable method for evaluation of local chest wall motion, and that neither diaphragm nor rib cage works as a single functional unit during active ventilation.     

肺结核患者涂阳率及其影响因素的研究

目的分析某医院收治新发初治肺结核的涂阳率及其影响因素。方法对某医院2011年收治新发初治的肺结核患者液基夹层集菌法痰涂片阳性率及其影响因素进行相关性分析。结果 2011年共收治新发初治肺结核患者1111例,其中男性728例,涂阳率41.1%;女性383例,涂阳率21.9%。左肺结核217例,涂阳率19.4%;右肺结核339例,涂阳率26.5%;双肺结核555例,涂阳率29.5%。上肺结核240例,涂阳率16.7;中肺结核178例,涂阳率21,3%;下肺结核65例,涂阳率30.8%;上中下肺结核628例,涂阳率31.5%。结论年龄、职业、发病季节与涂阳率无关;性别、病灶部位与涂阳率有关,其中男性涂阳率大于女性;双肺涂阳率高,右肺大于左肺;下肺及上中下肺涂阳率大于上、中肺。     

儿童继发性肺结核的CT表现分析

回顾性分析2012年8月至2017年9月沈阳市第十人民医院(沈阳市胸科医院)临床确诊的75例儿童继发性肺结核患者的临床资料及CT表现。75例患儿病灶好发于上叶尖后段[右肺上叶后段为64.0%(48/75)、左肺上叶尖后段为62.7%(47/75)、右肺上叶尖段为56.0%(42/75)]、下叶背段[右肺下叶背段为61.3%(46/75)、左肺下叶背段为42.7%(32/75)]。病变以多种形态并存于肺内,其中以纤维条索状影[92.0%(69/75)]、小叶中心腺泡样结节及结节状融合影[91.7%(68/75)]、斑片状影[86.7%(65/75)]、淡片状影[80.0%(60/75)]为最常见的病灶形态,而结核球的发生率很低[5.3%(4/75)]。病灶密度改变中,钙化[58.7%(44/75)]的发生率稍高,空洞多表现为厚壁[22.7%(17/75)]及无壁空洞[10.7%(8/75)]。结核性胸膜炎[77.3%(58/75)]、支气管结核[36.0%(27/75)]的并发率高。     

Contour maps of auscultatory percussion in healthy subjects and patients with large intrapulmonary lesions

Auscultatory percussion of the chest is a clinical examination method that has been purported to detect intrapulmonary masses by their effect on transmission of the percussion note to the posterior chest. Recent findings from this laboratory suggested that the sound of sternal percussion may actually travel through the chest cage and not the lung parenchyma. To investigate this possibility further, we recorded the sound produced by sternal percussion at 63 evenly spaced points over the posterior chest wall of 3 healthy subjects and 4 patients with large, discrete intrathoracic lesions in the right upper lobe (2 patients), left lower lobe, and left upper lobe (1 patient each). We constructed 3-dimensional contour maps of the indices of sound amplitude and frequency to view graphically the pattern of distribution of the sound. Examination of the maps revealed areas of increased amplitude in the zones of projection of some osseous structures, especially the scapulae, both in the healthy subjects and patients. No disturbances in the pattern reflecting the presence of mediastinal structures or intrathoracic lesions were found despite the existence of deeply situated lung masses as large as 10 cm in diameter. These findings support the argument that the sound of sternal percussion travels to the posterior chest predominantly through chest wall structures.     

Evaluation of lung lobar ventilation dynamics with magnetic resonance imaging: a comparison of interstitial pneumonia patients with normal subjects]

Magnetic resonance imaging (MRI) was utilized to study lung lobar dynamic ventilation in 11 patients with interstitial pneumonia (IP) and 10 non-smoking men. The IP patients included 7 with interstitial lung disease associated with collagen vascular disease, 3 with idiopathic interstitial pneumonia, and 1 with lung cancer who was excluded from statistical analysis. We calculated lung lobar volumes in each phase from each dynamic image and constructed time-volume curves(TVCs). Lung lobar volume rates(%), fluctuation rates(%), lobar fluctuation rate/total lung fluctuation rate (%), and time lag (sec.) for the IP patients and normal subjects were calculated and compared. In the former, the mean volume rate for the right upper lobe was larger (p < 0.01) than that in normal subjects. The mean volume rate for the left lower lobe in the IP patients was smaller(p < 0.01) than that in the normal subjects. In IP patients, peak TVC for the right middle lobe appeared later (p < 0.01) than that in normal subjects. Although the fluctuation rates and fluctuation rate/total lung fluctuation rate for the lower lobes tended to be higher than those for the upper and middle lobes in normal subjects, this tendency was not distinct in IP patients. The quantitative evaluation of pulmonary ventilation dynamics with MRI may be a useful noninvasive technique for the assessment of lung lobar ventilation in patients with IP.     

Contour maps of auscultatory percussion in healthy subjects and patients with large intrapulmonary lesions

Auscultatory percussion of the chest is a clinical examination method that has been purported to detect intrapulmonary masses by their effect on transmission of the percussion note to the posterior chest. Recent findings from this laboratory suggested that the sound of sternal percussion may actually travel through the chest cage and not the lung parenchyma. To investigate this possibility further, we recorded the sound produced by sternal percussion at 63 evenly spaced points over the posterior chest wall of 3 healthy subjects and 4 patients with large, discrete intrathoracic lesions in the right upper lobe (2 patients), left lower lobe, and left upper lobe (1 patient each). We constructed 3-dimensional contour maps of the indices of sound amplitude and frequency to view graphically the pattern of distribution of the sound. Examination of the maps revealed areas of increased amplitude in the zones of projection of some osseous structures, especially the scapulae, both in the healthy subjects and patients. No disturbances in the pattern reflecting the presence of mediastinal structures or intrathoracic lesions were found despite the existence of deeply situated lung masses as large as 10 cm in diameter. These findings support the argument that the sound of sternal percussion travels to the posterior chest predominantly through chest wall structures.     

Can High Resolution Computed Tomography Predict Lung Function in Patients with Chronic Obstructive Pulmonary Disease?

High-resolution computed tomography (HRCT) is a useful method for quantifying the extent of emphysema. Few reports have mentioned the relationships between HRCT scans and pulmonary function tests in chronic obstructive pulmonary disease (COPD). For diagnosis, COPD requires chronic airflow limitation and emphysema and/or chronic bronchitis. We examined 20 who were previous smokers with middle to moderate COPD. All were normocapnic with mean arterial oxygen pressure (PaO₂) 77,52 ± 16,789 mmHg. Forced spirometry, somatic plethysmography and cardiopulmonary exercise test were performed in each patient. HRCT was performed in both full inspiration and full expiration at three levels through the upper (at the aortic arch), lower (2 cm above the diaphragm), and middle lung (midpoint between upper and lower) levels. During expiration all pulmonary function parameters correlated with the HRCT grade in the middle right and left part of the lungs. The middle right part of the lung during expiration correlated statistically significant with MVV (r = –0.681, p =0.001), forced vital capacity (FVC) (r = –0.477, p = 0.027), forced expiratory volume in 1 sec (FEV1) (r = –0.632, p = 0.002), resistance (r = 0.674, p = 0.001), residual volume (RV) (r = 0.733, p = 0.001), total lung capacity (TLC) (r = 0.696, p = 0.001), functional residual capacity (FRC) (r = 0.752, p =0.001) and peak oxygen consumption during exercise (VO₂) (r = –0.493, p = 0.023). The middle left part of the lung during expiration correlated statistically significant with MVV (r = –0.673, p = 0.001), FVC (r = –0.493, p = 0.027), FEV1 (r = –0.629, p = 0.003), resistance (r = 0.593, p = 0.005), RV (r = 0.601, p = 0.005), TLC (r = 0.546, p = 0.012), FRC (r = 0.594, p = 0.006) and peak VO₂ (r = –0.525, p = 0.015). Forced expiratory volume in 1 sec (FEV1), which is a well-established measure of airflow obstruction, correlated with the HRCT grade (1) in the middle left part of the lung during inspiration (r = –0.468, p = 0.035) and during expiration (r = – 0.629, p = 0.003) (2) in the lower right lung during inspiration (r = –0.567, p = 0.007) and during expiration (r = –0.558, p = 0.008) (3) in the lower left lung during inspiration (r = –0.542, p = 0.011) and during expiration (r = –0.558, p = 0.008) (4) in the upper right lung during expiration (r = –0.469, p = 0.037) (5) in the upper left lung during expiration (r = –0.463, p = 0.035) and (6) in the middle right lung during expiration (r = –0.632, p = 0.002). According to our results HRCT was a valuable tool for evaluating the severity of COPD — especially the middle right and left part of the lungs, during expiration — and correlated well with pulmonary function tests.     

全胸腔镜下肺叶切除的临床应用

目的 探讨全胸腔镜肺叶切除术的临床价值.方法 全胸腔镜下行肺叶切除127例.其中右肺上叶19例,右肺中叶12例,右肺下叶17例,右肺中下叶7例,左肺上叶44例,左肺下叶28例;对94例原发性肺癌患者并同期施行纵隔淋巴结清扫.结果 全组手术均顺利完成.结论 全胸腔镜肺叶切除术疗效可靠、技术可行,安全、微创、恢复迅速,适用于早期周围型肺癌和需要施行肺叶切除的良性肺部疾病,但需要娴熟的内镜下处理血管和清扫淋巴结等关键技术.