右心肿瘤的外科治疗

目的　总结 2 7例右心肿瘤外科治疗经验。方法　右房原发肿瘤 18例 ,转移性肿瘤 3例 ,右室原发肿瘤 6例 ;恶性肿瘤 10例 ,占 3 7%。结果　手术死亡 1例。 1例因术中出血 ,肿瘤未能完全切除。 3例转移性肿瘤仅做解除梗阻手术。 2例肿瘤切除同时进行三尖瓣置换术。结论　 ( 1)术中应注意插管方法 ,防止瘤体脱落 ,必要时采用深低温停循环方法 ;( 2 )切除瘤体时应注意心脏功能和结构的完整性。     

后纵隔哑铃型神经源性肿瘤的诊断和外科治疗

目的探讨后纵隔哑铃型神经源性肿瘤的临床病理特征、诊断、鉴别诊断及外科治疗方法,提高临床诊治水平。方法回顾性分析16例后纵隔哑铃型神经源性肿瘤的相关临床资料,并结合文献进行复习。结果16例中男9例,女7例,12例有胸闷、胸痛、咳嗽和肢体麻木等临床症状,1例双下肢瘫痪,3例无症状。全部病例经胸部CT和磁共振检查提示诊断,均行一期完整切除肿瘤,治愈出院。结论手术方案应根据肿瘤大小、部位和生长形态等因素选择手术方案。采用后正中切口联合胸腔镜辅助手术是治疗后纵隔哑铃型神经源性肿瘤较佳手术方式。     

原发性纵隔肿瘤的诊疗分析

目的探讨原发性纵隔肿瘤的诊断及外科治疗方法。方法对我院50例原发性纵隔肿瘤患者的临床资料进行分析。结果 50例患者均经手术治疗,术后病理证实为原发性纵隔肿瘤。其中：胸腺肿瘤及囊肿26例,占52%;神经源性肿瘤12例,占24%;畸胎样瘤4例,占8%。全组均完整切除或大部切除,无手术相关严重并发症及死亡病例。结论在原发性纵隔肿瘤中,病率最高为胸腺肿瘤及囊肿,其次为神经源性肿瘤及畸胎样瘤。无论肿瘤良恶性,外科手术均是确诊及治疗的第一选择。     

大左室心脏瓣膜病的外科治疗

目的:以回顾性研究总结大左室心脏瓣膜病的外科治疗经验。方法:84例大左室心脏瓣膜病患者行外科手术治疗,二尖瓣置换术55例,主动脉瓣置换术7例,二尖瓣置换+主动脉瓣置换术22例。术前充分准备,术中采用低温冷血停搏液灌注,加强心肌保护,注意保留二尖瓣后瓣及瓣下结构,术后积极防治并发症。结果:本组术后早期发生并发症(低心排,肺部感染,肝肾功能不全等)22例,治愈出院62例。结论:大左室心脏瓣膜病患者行外科手术治疗风险大,术后并发症多;全面综合的外科治疗是大左室心脏瓣膜病患者顺利康复的关键。     

Echocardiographic manifestations of mediastinal masses compressing or encroaching on the heart

Because of its central position within the thorax, the heart can be encroached upon by masses originating in either anterior, posterior, or superior mediastinum. A distinction may be made between (A) Encroachment: distortion or partial displacement of one or more cardiac chambers by a contiguous mediastinal mass, without adverse hemodynamic effects, and (B) Compression: resulting in clinical manifestations similar to tamponade. Transthoracic and, recently, transesophageal echocardiography have been found useful in detecting mediastinal masses, the information obtained being complementary or preliminary to more complete imaging by CT or MRI. Anterior masses tend to compress the right heart chambers; posterior masses impinge on or compress the left atrium or ventricle, particularly the former. The wide variety of echographic appearances are briefly reviewed. Recently TEE has made it possible to diagnose masses obstructing the superior vena cava or pulmonary veins. A common, though little known, type of posterior mediastinal encroachment that echocardiographers need to be aware of is that of abnormal esophageal/gastric masses including hiatus hernia and esophageal carcinoma, which have typical two-dimensional echo features and may sometimes simulate left atrial masses.     

肺癌冻融治疗对临近大血管及心脏的影响

目的观察肺癌氩氦冻融治疗过程中对临近大血管及心脏的影响。方法96例侵犯心脏及大血管的肺癌患者,在CT引导下经皮肺穿刺行氩氦刀治疗,术后用CT监测冰球大小和肿瘤的消融范围。冻融前先行血管增强扫描或PET-CT检查,明确肿瘤与临近器官的关系,但应避免误穿。结果所有患者均在局麻下完成了经皮肺穿刺行氩氦刀治疗。在上腔静脉、主动脉等大血管附近的肺癌,经氩氦刀冷冻形成的冰球不对称,临近心血管部位的冰球较小,融化较快,但冻融过程中无严重不良反应发生。结论氩氦刀对大血管及心脏无明显影响,对包绕于大血管和侵犯心脏的肿瘤可直接冷冻。     

纵隔胸腺囊肿的外科治疗

目的探讨纵隔胸腺囊肿的临床表现、诊断及鉴别诊断、病理特征和外科治疗,以提高临床诊治水平。方法回顾分析我院1980～2008年经病理证实的27例外科治疗的纵隔胸腺囊肿的相关临床资料,并复习文献,总结临床经验。结果27例中男16例,女11例;年龄11～69岁,平均43岁。约66．7％的纵隔胸腺囊肿患者就诊时有症状,术前确诊2例,所有病例均完整切除,8例采用胸腔镜,术中和术后无并发症及死亡,22例随诊4个月～28年无复发。结论纵隔胸腺囊肿首选外科手术切除,可去除病灶,消除症状,明确诊断。诊断依据术后病理检查。     

Upper posterior mediastinal tumor supplied by an atrial branch of the left circumflex artery

We report a case of a 39-year-old woman with an upper posterior mediastinal tumor. The tumor was demonstrated by echocardiography and further defined by computerized tomography and magnetic resonance imaging. The tumor was fed by a large atrial branch of the left circumflex artery. Because of its location (adjacent to large vessels), it could not be resected by surgery. Cathet. Cardiovasc. Intervent. 47:467–468, 1999. © 1999 Wiley-Liss, Inc.     

面肌痉挛显微血管减压术中责任血管的解剖分析对手术疗效的影响

目的分析面肌痉挛（hemifacial spasm，HFS）患者颅内责任血管与面神经之间的解剖关系，为HFS显微血管减压术（microsurgical neumvascular decompression，MVD）提供解剖学依据。方法回顾性分析106例经显微血管减压术治疗的面肌痉挛患者的临床资料。术前均行三维时间飞越法磁共振血管造影（3D-TOF-MRA）检查，了解面神经受压迫是否存在责任血管及其来源与走向。采用枕下乙状窦后小脑下外侧入路显露面神经脑干段，仔细观察责任血管及其来源后将其推移，在责任血管与脑干之间放置Teflon减压垫棉。结果3D-TOF-MRA检查显示面神经被微小血管压迫的阳性率达92％。术中发现全部病例均有明确的责任血管，其中小脑前下动脉占66％（70／106）。34例患者中发现面神经根区（root exit zone，REZ）存在明显的压迫切迹。术后104例抽搐症状立即完全消失；2例抽搐症状明显好转，3个月内延迟治愈，总有效率为100％。结论血管压迫可能是面肌痉挛的主要病因。术中REZ的显露、准确判断责任血管、面神经REZ的充分减压，以及垫棉的大小和放置的位置等，是影响手术疗效的重要因素。     

复杂纵隔肿瘤的外科治疗

目的探讨各类复杂纵隔肿瘤的外科治疗方法及特点。方法对13例复杂纵隔肿瘤患者的外科治疗方法进行回顾性分析。结果取颈部低位领状(和胸骨半劈开)切口切除巨大胸骨后甲状腺肿6例;3例合并上腔静脉综合征患者分别行纵隔肿瘤切除、人工血管置换或自体心包修补术;再次手术完整切除纵隔肿瘤2例;手术治疗因肿瘤反复破溃引起纵隔感染、冻结2例。结论一些复杂纵隔肿瘤的手术难度及危险性较大,应根据不同情况,采取适当术式,以达到理想的治疗效果。     

原发性腹膜后肿瘤累及下腔静脉13例外科治疗

目的探讨原发性腹膜后肿瘤累及下腔静脉（IVC）时的手术处理方法。方法回顾性分析和总结2000年9月至2005年4月的13例原发性腹膜后肿瘤累及IVC的患者均采用经腹切口径路肿瘤切除及IVC受累部分血管处理的经验。结果本组肿瘤患者中恶性11例，良性2例。11例恶性肿瘤完整切除，其中2例是复发再次手术。2例良性肿瘤完整切除，合并脏器切除12例。全组无手术死亡。IVC受累部分血管处理采用以下几种方法，2例单纯缝合术，4例端端吻合术，1例单纯结扎术，6例血管重建术。生存期〉1年者11例（84．6％），生存期〉2年7例（53．8％），随访过程中2例（15．4％）肿瘤复发再次切除。结论累及IVC的原发性腹膜后肿瘤的外科治疗要有充分的术前准备、仔细的手术操作和妥善的术后处理才能提高切除率、降低复发率，延长存活时间。     

Ultrafast CT and the cardiovascular system

Ultrafast computed tomography (CT) is a new imaging technique that relies on electron beam technology. Its rapid image acquisition speeds make it ideal for evaluating the cardiovascular system. The high-resolution, flow, and cine-modes are unique and provide complimentary information about cardiovascular anatomy, function, and flow dynamics. Ultrafast CT can provide quantitative measurements of cardiac output, ejection fraction, ventricular volumes, and ventricular mass as well as evaluation of segmental cardiac function. This technique can be used to assess coronary artery bypass graft patency as well as to screen for coronary artery calcium. Intracardiac thrombus or tumor, valvular disease, and disorders of the pericardium can be evaluated and characterized using ultrafast CT. The diagnosis of congenital lesions of the heart and great vessels is facilitated by this imaging modality, which can help determine complex anatomic abnormalities and quantitate shunt lesions. Acquired lesions of the great vessels, such as aortic dissection and aneurysm, can be diagnosed by ultrafast CT, which can also be used for serial examination and conservative management.     

胸腺肿瘤的诊断和外科治疗

目的总结胸腺肿瘤的诊断和外科治疗经验。方法回顾性分析1995年至2006年人住我科手术治疗的73例胸腺肿瘤患者临床资料。结果胸部X线和CT等影像学检查是诊断木病的主要手段,重症肌无力是常见的伴随症状,单纯性胸腺瘤的治疗效果优于恶性胸腺瘤和胸腺癌。结论胸腺肿瘤是低度恶性肿瘤,手术足治疗胸腺肿瘸的主要手段。术前分期与术后放化疗是影响生存的预计因素。     

儿童纵隔肿瘤误诊漏诊临床分析

目的探讨误诊漏诊儿童纵隔肿瘤的原因。方法分析我院25例误诊漏诊纵隔肿瘤的患儿临床资料。结果25例误诊漏诊的纵隔肿瘤患儿中,畸胎瘤10例,淋巴瘤7例,神经母细胞瘤4例,胸腺瘤3例,神经纤维瘤1例,大部分患儿因反复咳嗽,喘息,发热就诊而被误诊为肺炎。结论儿童纵隔肿瘤易于误诊的主要原因为其临床表现不典型或被肺炎掩盖以及临床医生对其认识不足或对摄胸部X线片、CT不够重视而被误诊漏诊,因此临床医生要对儿童纵隔肿瘤高度警惕,以便尽早做相应检查以确诊。     

Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally

We sought to determine the impact of prenatal diagnosis on the perioperative outcome of newborns with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA). All neonates with HLHS or TGA encountered at Children’s Hospital, Boston, Massachusetts, from January 1988 to May 1996 were identified and outcomes documented. Birth characteristics, preoperative, operative, and postoperative variables of term newborns with a prenatal diagnosis of HLHS or TGA who underwent a Norwood operation (n = 27) or arterial switch operation (n = 14), respectively, were compared with newborns with a postnatal diagnosis of HLHS (n = 47) or TGA (n = 28) who had undergone surgery. Of 217 neonates with HLHS and 422 with TGA, 39 and 16, respectively, had a prenatal diagnosis. The preoperative mortality among neonates aggressively managed did not differ between the prenatal and postnatal diagnosis groups for either HLHS or TGA (p >0.05). Neonates with a prenatal diagnosis who underwent surgery had objective indicators of lower severity of illness preoperatively, including a higher lowest recorded pH (p = 0.03), lower maximum blood urea nitrogen (p = 0.002), and creatinine (p = 0.03) among newborns with HLHS, and a tendency toward higher minimum of partial pressure of arterial oxygen in the TGA group (p = 0.06). Prenatal diagnosis was not associated with an improved postoperative course or operative mortality (p <0.05) within a diagnostic group. Thus, a prenatal diagnosis improves the preoperative condition of neonates with HLHS and TGA, but may not significantly improve preoperative mortality or early postoperative outcome among neonates managed at a tertiary care center.     

肺粘液表皮样癌的外科治疗与预后分析

目的分析肺粘液表皮样癌的诊断、临床特点、外科治疗及预后情况。方法回顾总结34例手术切除的原发性肺粘液表皮样癌,行肺叶切除术23例,全肺切除7例,肺楔形切除1例,纵隔镜淋巴结活检1例,转移肋骨活检1例,开胸探查1例,分析其临床特点、外科治疗方法及预后情况。结果术前确诊21例,术后1、3、5年生存率分别为84.4%、73.9%和62.5%。其中23例低度恶性肺粘液表皮样癌,1例有肺门淋巴结转移,1、3、5年生存率分别为100%、100%和90.9%;11例呈高度恶性,淋巴结转移率63.64%,术后1、3、5年生存率分别为50.0%、14.3%和0。结论原发性支气管粘液表皮样癌以低恶性为主,低恶性粘液表皮样癌经彻底手术切除可获治愈,高恶性病人术后易早期发生远处转移,预后差。     

The clinical features and prognostic outcomes of primary mediastinal yolk sac tumors: A retrospective analysis of 15 rare cases from multiple centers

Primary mediastinal yolk sac tumors (PMYSTs) are a rare occurrence. As such, the clinicopathological features, treatment, and prognosis, of this disease still remain unclear. In this study, we aimed to provide further information relating to this rare malignancy in order to facilitate the creation of more specific clinical guidelines for the diagnosis and treatment of patients with PMYSTs.In this retrospective study, we recruited 15 patients who had been diagnosed with PMYST from four medical institutions to create a population-based cohort. We then used Kaplan-Meier analysis and the log-rank test to investigate and compare overall survival (OS) and progression-free survival (PFS).A total of 15 cases were identified. The mean age was 27.3 years (range: 19–34 years). The estimated 1- and 2-year PFS rates were 66.7% and 60.0%, respectively. The 1- and 2-year OS rates were both 73.3%. Computer tomography scans revealed tumors were located in the anterior middle mediastinum (5 cases), the anterior superior mediastinum (1 case), the left anterior mediastinum (3 cases), and the right anterior mediastinum (6 cases). Of the 15 patients receiving extended resections, the majority (40.0%) underwent tumor resection, partial pericardiotomy, pulmonary wedge resection, and mediastinal lymphadenectomy. R0 resections were achieved in eleven patients. Four patients underwent R2 resection and experienced postoperative complications, including pneumonia (2 cases), atelectasis (1 case), and bronchopleural fistula (1 case). Four patients developed postoperative lung metastasis. Three patients died due to progressive diseases. Disease recurred in all patients at a median of 8.0 months (range: 6.0–11.0 months).PMYST is a rare but highly malignant tumor with a poor prognosis. Tumor resection, with optimal extended surgical management, may provide patients with the best chance of a cure although postoperative complications relating to the pulmonary systems should be treated with caution.     

Gallium scanning in the management of mediastinal Hodgkin's disease

Gallium-67 scanning was performed pre- and post-therapy in 25 patients with Hodgkin's disease and a mediastinal mass. At restaging after therapy, radiographs (or CT scans) did not predict the presence of active disease whereas gallium scans did with a high degree of accuracy. Gallium-67 determined disease activity in those patients who had a residual mediastinal mass predicting outcome in 11 out of 12 patients; one had a late relapse at 7 years. In patients without a residual mass gallium scanning was again accurate, predicting outcome in 11 of 13 patients. Two patients with negative gallium scans but subsequent active disease were scanned too soon after chemotherapy. The results suggest that gallium scanning has an important role in the management of mediastinal Hodgkin's disease and is superior to all current methods of assessing disease activity irrespective of the presence of a residual mediastinal mass.     

Villous tumor of the duodenum: report of a case and review of the literature

Villous tumors of the duodenum are rare tumors which have been infrequently reported in the literature. Surgical treatment options include wide local excision and radical pancreaticoduodenectomy. A case of duodenal villous adenoma presenting with bilious vomiting is presented here.     

心血管疾病的梯度回波电影磁共振成像观察

目的 :了解梯度回波电影磁共振 （cine- MRI）诊断心血管疾病的价值。方法 :分析 38例心血管疾病的 cine-MRI解剖结构和血流动力学改变 ,其中升主动脉瘤 （AAA） 10例 ,夹层动脉瘤 （AD） 2 1例 ,心包血肿 （PCH） 1例 ,肥厚型心肌病 （HCM） 3例 ,房间隔缺损 （ASD） 2例 ,ASD并发室间隔缺损 （VSD） 1例。结果 :cine- MRI上心血管壁呈中低信号。AAA和 AD主动脉增宽 ,AAA和 4例 AD左心室扩大 ,左室流出道有舒张期低信号区。 18例 AD内膜破裂口区有局部低信号区 ,6例假腔内血栓 ,后者信号强度与心动周期无关。PCH右侧房室受压变形。HCM心肌增厚。 ASD和 ASD并发 VSD有左向右单向分流。结论 :cine- MRI可较好地显示心血管疾病的解剖结构和血流动力学改变 ,与自旋回波序列结合可满足诊断需要