主动脉弓游离翻转术在弓后食管癌术中的应用

自1988年4月至1989年4月,我们对16例主动脉弓后食管癌行主动脉弓游离翻转术,切除13例,切除率81％,根治性切除8例,姑息性5例。我们认为:本方法具有术野暴露清楚、能在直视状态下分离肿瘤与周围组织的较重粘连、处理术中意外、扩大肿瘤切除范围、提高切除率等优点。本文详细介绍了其操作方法,注意事项,优点及适应症。     

主动脉弓右侧食管癌经左胸后外切口手术的体会

主动脉弓右侧食管癌多采用右胸切口.暴露较好。但因切口多.术后并发症高.有一定缺点。作者采用左侧剖胸7例.计弓上吻合术4例.颈部吻合术3例。术中遇到粘连严重者4例.分离困难时奇静脉损伤3例,采用主动脉弓游离牵开的方法进行处理,取得了满意效果。手术要点:结扎肋间动静脉不宜超过3支;牵拉主动脉弓时用力要缓慢轻柔.不可过急。     

Interrupted Aortic Arch with Tricuspid Atresia

A rare instance of an interrupted aortic arch and tricuspid atresia with long survival is described. Only one other case of this rare association is described in the literature and survival to the age of 17 years with these complex malformations is unusual.     

Direct thrombin injection into aneurysmal sac in a patient with a type II endoleak

Endovascular grafting of abdominal aortic aneurysms provides a good alternative to open surgery, especially in high‐risk patients. Endoleaks are a well‐recognized complication and are typically diagnosed on CT. We descibe a case in which a patient's endoleak was evaluated by MRI and successfully treated by direct thrombin injection into the site of the leak.     

乌拉地尔配合腔内修复术治疗Stanford B型胸主动脉夹层动脉瘤的临床疗效分析

目的 探讨乌拉地尔配合腔内修复术治疗Stanford B型胸主动脉夹层动脉瘤的临床效果.方法 选取Stanford B型胸主动脉夹层动脉瘤患者37例,经主动脉CT血管造影(CTA)确诊后,对患者行胸主动脉夹层腔内修复术,手术前、中以及后期均采用乌拉地尔配合控制术中血压.结果 37例手术均成功完成,手术成功率100％.术后随访1年,其中术后2个月因再发胸主动脉夹层动脉瘤死亡1例,术后6个月因腹主动脉夹层而接受外科手术1例,其余患者预后状态良好,随访1年患者的存活率为97.3％.结论 稳定的血压结合精准的腔内修复是治疗Stanford B型胸主动脉夹层动脉瘤成功的关健.采用乌拉地尔配合腔内修复术治疗Stanford B型胸主动脉夹层动脉瘤安全、有效,值得临床进一步推广.     

Abdominal Aortic Aneurysm with Perianeurysmal Fibrosis: Demonstration of Ureteric Obstruction by Computerized Tomography

When perianeurysmal fibrosis occurs in association with an abdominal aortic aneurysm it may produce ureteric obstruction and renal function impairment. Such a case is described and the pre-operative radiological evaluation of this condition is discussed. The role of computerized tomography is emphasized in its ability to provide accurate anatomical detail regarding the aneurysm, the extent of surrounding fibrosis and ureteric involvement within it.     

Perirenal Cobwebs: A Sign of Aortic Aneurysm Rupture

Since venous collaterals were described in 1981 as causing linear densities in the perirenal fat, the list of causes of perirenal cobwebs has continued to grow. Inflammatory and neoplastic processes, particularly those originating in the kidney, may produce similar appearances. If no cause for the cobwebs is found in the kidney, extrarenal pathology should be considered, in particular acute pancreatitis and aortic aneurysm rupture. Four patients are described who all demonstrated unilateral perirenal cobwebs in association with ruptured abdominal aortic aneurysms. It is postulated that blood enters the perinephric fat through weak points in the renal fascia caused by the entrance of vessels.     

食管癌残胃食管弓上吻合术7例报告

对7例远端胃大部切除术后食管癌，采用左胸、上腹两切口行食管癌根治，残胃食管弓上吻合术。术后无吻合口瘘及狭窄发生，无输入、输出襻梗阻表现。对远端B-Ⅱ式胃大部切除术后的中下段食管癌，特别是年老体弱的患者宜采用本术式。     

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

Purpose

The axillary arch is an anomalous muscle that is not infrequently encountered during axillary sentinel lymph node biopsy (SLNB) of breast cancer patients. In this study, we aimed to investigate how often the axillary arch is found during SLNB and whether it affects the intraoperative sentinel lymph node (SLN) identification rate.

Methods

We retrospectively analyzed the correlation between the presence of the axillary arch and the SLN sampling failure rate during SLNB in 1,069 patients who underwent axillary SLNB for invasive breast cancer.

Results

Of 1,069 patients who underwent SLNB, 79 patients (7.4%) had the axillary arch present. The SLNB failure rate was high when the patient''s body mass index was ≥25 (p=0.026), when a single SLN mapping technique was used (p=0.012), and when the axillary arch was present (p<0.001). These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001). Additionally, if the axillary arch was present, the mean operative time of SLNB was 20.8 minutes, compared to 12.5 minutes when the axillary arch was not present (p<0.001). If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location.

Conclusion

The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate. It is necessary to keep in mind that carefully checking the high axillar region during SLNB in breast cancer patients with the axillary arch is important for reducing SLN sampling failure.     

食管胃弓上弓后吻合术治疗食管胸下段癌236例

文章总结了236例食管胸下段癌食管胃弓上弓后吻合术经验。认为该术式不易发生吻合口瘘，尤其适用于高龄或心肺功能较差者。     

Congenital Hemihypertrophy with Abnormalities of The Aortic Arch,and of the Skeletal,Cutaneous and Ocular Systems

The authors record a case of congenital hemihypertrophy in a woman of 24 years. Diagnosis is usually made earlier in infancy or childhood. The principal features of this curious malformation are described. Associated malformations are common. In the present case, a particular malformation is stressed, namely an abnormality of the aortic arch with a right-sided aorta and low implantation of the left subclavian artery which arose from an aortic diverticulum. Another interesting point is the presence of anomalies of the extremities, brachydactyly, and syndactyly. Cutaneous and ocular anomalies are more common and the condition appears to be related to phacomatosis. The different theories of the pathogenesis of the condition are discussed.     

子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义

目的 分析子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义.方法 选取子宫内膜癌患者71例为研究对象,行盆腔加腹主动脉旁淋巴结切除术,分析患者术后临床特征,以及影响患者盆腔及腹主动脉旁淋巴结转移的危险因素.结果 对盆腔及腹主动脉旁淋巴结患者行切除术后淋巴结转移率较低,分别为21.2%和23.9%,且患者术后并发症较少,仅为7例;线性回归分析提示,影响盆腔淋巴结转移的独立危险因素有肿瘤中低分化、深度肌层浸润、临床分期及脉管浸润,而影响腹主动脉旁淋巴结转移的独立危险有肿瘤低分化、非子宫内膜样癌、深度肌层浸润、盆腔淋巴结转移及淋巴管浸润;71例患者随访1年生存率为87.32%,且发生盆腔加腹主动脉旁淋巴结转移患者的生存率明显低于无淋巴结转移者.结论 盆腔加腹主动脉旁淋巴结切除,有利于提高子宫内膜癌患者的临床治疗效果,而且安全性较高,值得临床推广应用.     

Aortic occlusion in nonspecific aortoarteritis (Takayasu disease): incidence and spectrum of involvement

Nonspecific aortoarteritis (Takayasu disease) is a primary arteritis of unknown etiology which commonly involves the aorta, and results in stenosis, occlusion, dilatation or formation of aneurysm in the involved segment. Of these, occlusion is the most rare form of involvement, and is usually reported to occur in the abdominal aorta. Only one case of aortic arch occlusion has been reported. We retrospectively studied the frequency and sites of aortic occlusion in 110 consecutive patients who underwent digital subtraction angiography. Aortic occlusion was seen in three (2.7%) patients, and involved the abdominal aorta in two, and the aortic arch in one patient. The clinical presentation in all three patients was with systemic hypertension and lower limb claudication. The detection and localization of the aortic occlusion is important since this has practical implications in the management of these patients. Intravenous digital subtraction angiography is usually adequate for the diagnostic assessment.     

全反式视黄酸致小鼠腮弓畸形的机制研究

背景与目的：研究全反式视黄酸(All-trans Retinoic Acid , RA)对小鼠胚胎腮弓的致畸作用及其可能的致畸机制。材料与方法：采用植入后全胚胎培养观察RA 对孕8.5 d小鼠腮弓的致畸作用;采用5-溴脱氧尿嘧啶核苷(Bromodeoxyuridine,BrdU)标记及检测,切口末端标记法,切片和整体免疫组化观察RA对颅神经嵴细胞 (Cranial neural crest cells, NCC) 增殖、凋亡和迁移的影响。结果：RA诱导腮弓出现发育不良,发育不全,第一、二腮弓融合畸形;RA处理组腮弓BrdU掺入率减少,凋亡增加,NCC出现异常的迁移路径和方式。 结论：RA诱导腮弓畸形,NCC增殖减少,凋亡增加,迁移改变是其可能的致畸机制。     

腹主动脉旁淋巴结切除术在子宫内膜癌开腹手术治疗中的应用价值

目的 探讨腹主动脉旁淋巴结清扫在子宫内膜癌开腹手术治疗中的临床意义.方法 选择接受手术治疗并经病理确诊为子宫内膜癌的患者172例,根据术中是否进行腹主动脉旁淋巴结清扫将入选患者分为观察组109例和对照组63例.观察2组患者围手术期相关指标指标.随访3年,观察2组患者的生存、复发情况及并发症的情况.结果 观察组患者手术时间和住院时间长于对照组,差异有统计学意义(P<0.05).观察组和对照组患者的生存率和死亡率差异无统计学意义(P>0.05),观察组患者的复发率低于对照组(P<0.05),其中病理分级为G2和G3期的观察组患者术后复发率显著低于对照组(P<0.05).观察组患者术后发生淋巴囊肿、下肢淋巴水肿和肠梗阻的概率高于对照组,差异有统计学意义(P<0.05).结论 子宫内膜癌手术治疗中行腹主动脉旁淋巴结清扫能有效降低患者术后复发率,但是增加了术后淋巴囊肿和下肢淋巴水肿的发生率,临床推行过程中应充分评估患者的自身情况.     

经左胸全隆凸切除、右主支气管切除重建术1例报道

经左胸全隆凸切除重建术临床少见[1],同期行右主支气管切除、右上叶-中间段支气管重建右主支气管、再与气管下段吻合重建隆凸术则国内外未见报道。华中科技大学同济医学院附属同济医院普胸外科在2009年2月成     

左右半结直肠肿瘤转移风险模型构建及评价

目的 探讨左右半结直肠肿瘤患者肝、肺、骨和脑转移的影响因素并对比构建Nomogram图预测转移概率。方法 回顾性筛选和分析2010年至2018年SEER数据库中结直肠肿瘤有肝、肺、骨和脑转移的患者信息。根据肿瘤部位分成左半、右半和直肠肿瘤,利用多因素Logistic回归分析分别筛选转移相关影响因素,建立Nomogram预测图并使用ROC曲线下面积AUC和校准曲线进行检验。结果 筛选出49 335例符合条件的结直肠癌患者。其中,N分期和CEA与肝、肺、骨及脑转移均相关,且与原发肿瘤部位无关,而种族在左右半不同部位对肝转移的影响不同（P<0.05）。肝转移构建的Nomogram模型较好,根据左半,右半和直肠三个原发部位构建的预测肝转移Nomogram模型的AUC分别为0.821（95%CI: 0.813~0.830）、0.841（95%CI: 0.833~0.848）和0.796（95%CI: 0.782~0.811）。结论 影响不同原发肿瘤部位的结直肠癌患者远处转移的因素及其相应的预测模型存在差异。