26例胸腺瘤的外科治疗

首都医院自1961～1977年手术治疗胸腺肿物病人26例,其中24例为实质性胸腺瘤,1例胸腺囊肿,1例胸腺增生,26例中11例属临床病理恶性(42%)。1/3病人伴有重症肌无力,约1/6病人伴有白血病、结节性红斑、米尼尔氏综合症和妊娠。11例恶性瘤中5例未能切除,2例系姑息性切除,4例完全切除。病理检查发现肿瘤大小与性质良恶间,细胞形态与重症肌无力问均无何特殊联系。切除后5年生存率75%,10年生存率60%。肿瘤性质良恶与重症肌无力的严重程度对预后有重要影响。     

经皮肺穿刺活检在临床上的应用(文献综述)

经皮肺穿刺活检是肺部病变的一种检查方法,它操作简单,迅速,有较高的诊断价值,但并非每个病例都适用,有发生合并症的可能,故须严格掌握适应证和禁忌证。本文结合我们的工作并综合国内外有关文献,扼要介绍于下。近年来,对于用常规检查方法不能确诊的肺内病     

DIAGNOSIS AND TREATMENT OF STAGE-Ⅲ PERIPHERAL SQUAMOUS CELL CARCINOMA OF RIGHT UPPER LUNG

During a 12-year period, 44 patients were surgically treated for stage- Ⅲ penpberal squamous cell carcinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe to the confirmation of the diagnosis was 2 months. All patients underwent the resection of the right upper lobe with the dissection of the right mediastinal lymph nodes, among them, 4 patients had sleeve lohectomy of the tight upper lobe. P-TNM staging: 23 cases were in stage-Ⅲ a, 21 cases in stage-Ⅲ b. The frequency of the postoperative complications was 20. 4%(9/44 cases). The 1-year survival rate of all patients was 61% (27/44 cases). None of stage -Ⅲb patients lived longer than 3 years. The postoperative 3-and 5-year survival rates of stage-Ⅲa cases were 65. 2% (15/23cases) and 21.7%(5/23 cases) respectively. In this article, the patients‘ clinical features, the causes of delayed-diagnosis, the operative and postoperative management were discussed. We suggest that the stage-Ⅲa patients should be given surgical treatment,whereas, for the patients of stage-Ⅲ b, palliative operation was given lust for the purpose of reliving the symptoms.     

SURGICAL TREATMENT AND PROGNOSIS OF BRONCHIAL CARCINOID TUMOR

In order to understand the effect of surgery in the treatment of the bronchial carcinoid tumor and thefactors affecting prognosis, 18 cases of bronchial carcinoid tumor are presented, including 5 cases withCushing‘s syndiome. There were Iobectoray in 10, lung wedge resection in 3, excision of intraluminal tumor of bronchus in 3, exploratory thoracotomy in 2 cases.No operation death.Pathological examinstion revealed 14 cases were typical carcinoid tumor and 4 cases were atypical carcinoid tumor.By 2-13 years fol-low-up,3,5 and 10 years survival rate were 82%,78% and 70% respectively.Bronchial carcinoid tumor is often confused microscopic and immunohistochemistry studies.Those patients accompanied with ectopicACTH secretion always have Cushing‘‘s syndrome,resection of tumor can produce good result.Proper operation method depnds on the location of the tumor and patient‘‘s extent of cardiac and pulmonary peserve.Atypical carcinoid tumor had high malignancy and poor prognosis.The size of tumor,lymph node involve ment and adjuvant therapy seem no definite effect on the patients‘‘ survival rate.     

心内直视手术后颅内出血4例报告

1978年以来,首都医院70例心内直视手术中,4例术后并发颅内出血,均经开颅手术,康复及死亡各半。本病文献报道较少,多见于病儿术后近期,临床表现为一侧颅脑大片占位病变,呈瞳孔增大、意识障碍、偏瘫、一侧或全身性抽搐等症。本文介绍临床资料并作简要讨论。 临床资料 本组4例中男女各半,年龄2～10岁,均为先天性心脏病,其中3例为空间隔缺损,1例为法乐氏四联症。术前凝血功能正常。手术于低温体外循环下进行,采用上海Ⅱ型、Ⅲ型人工心肺机,机内预充液包     

自发性肠胃反流性胃炎和食管炎

最近20年来通过大量研究,揭示胆汁和十二指肠内容物可反流至胃,造成胃粘膜的损害。其发病机制主要为:①胆汁在酸性介质中,特别在缺血条件下,对胃粘膜有损害作用;②胆汁加胰液和含有溶血卵磷脂的十二指肠分泌液混合后,对胃粘膜的破坏     

食管及胃贲门癌未切除病例的转流吻合术

食管及胃贲门癌外科治疗,近年已取得较大进步,切除率逐渐提高,死亡率及并发症明显降低,远期生存率亦有所增加。尽管如此,尚有相当部分病人由于病期较晚,不能行切除治疗。对于这些病例采用适当的减状治疗,以便合理减轻痛苦,维持一定营     

良性非特异性支气管食管瘘(6例报告及文献复习)

自1961至1979年我们曾对6例良性、成人、非特异性支气管食管瘘病人进行手术治疗,均作肺切除及食管修补而治愈。病理检查均无肿瘤、结核或霉菌等病变。本文结合文献讨论此病的名称、病因、诊断和治疗。临床资料1.性别和年龄男女各3例,22～48岁,平均38岁。2.临床表现术前、术中及术后确诊各2例,分别为例1～2、3～4及5～6。例1女,22岁,脓血痰3年,有咳出食物渣及土霉素片历史。食管碘油造影发现两处支气管食管瘘,分别引向右上、下肺,肺内有脓腔形成。胃造瘘控制肺内感染后,行右肺上叶及右肺下叶尖段切除,并修补食管瘘。一年后病人咳血,造影证实为右残余肺支气管扩张,切除右侧余肺,术后出现脓胸,行小型胸廓