脊柱后侧弯胸廓畸形所致肺心病8例临床分析

脊柱后侧弯胸廓畸形所致肺心病８例临床分析侯丽萍，王秀春包钢职工医院内科（０１４０１０）关键词脊柱后弯，脊柱侧弯，胸廓畸形，肺心病胸廓畸形引起肺心病较少见，临床上容易漏、误诊，治疗困难，预后不良。我院近年来收治脊柱后、侧弯胸廓畸形引起的肺心病８例，男４...     

Diagnosis of asymptomatic atrial septal aneurysms using two-dimensional color

Objective To evaluate the dimensions of atrial septal aneurysm (ASA), the presence and characteristics of interatrial shunt, the movement of the wall of the aneurysm, and correlation between these findings and sign and/or symptoms suggesting embolism in Manisa, a district of a western Anatolian city of Turkey.Methods Two thousand five hundred cases were examined by routine transthoracic echocardiography (TTE) in both pediatric and adult cardiology outpatient clinics. ASA was detected in 20 cases and evaluated by two-dimensional color Doppler echocardiography (CDE). The length of the base, the maximum radius and the maximum displacement of ASA were measured. The shunt between the atria was examined by CDE. In cases where a shunt could not be found, galactose and palmitic acid was injected. Standard 12-lead electrocardiogram (ECG) and exercise stress test were also performed.Results No clinical signs or symptoms were found, suggesting a systemic or cerebral embolism.The maximum displacement of ASA was between 2 and 5 mm. All of the aneurysms were localized in the right atrium, and the walls of the aneurysrn did not move beyond the base of the left atrium during the maximum displacement. Interatrial shunt was detected in 14 of 20 patients (70%) by CDE and in the remaining six cases by contrast TTE. Frequent ventricular ectopic beats were observed in one patient.Conclusions During routine TTE we observed 0. 8% asymptomatic ASA in our population. The use of a contrast agent was found to be a valuable additional method in patients with ASA when the shunt could not be detected by CDE. The risk for embolism is not high when the maximum displacement of the wall of ASA was 5 mm or less and no bulge into the left atrium was observed. Based on our experience with this method, TTE is easy to perform, well-tolerated and acceptable.     

微创漏斗胸矫治术围手术期护理

漏斗胸是小儿常见的胸廓发育畸形之一,主要表现为小儿前胸正中部位的胸骨带动周围连接的肋骨向内塌陷成漏斗状,使胸腔内的脏器受到压迫甚至移位,并导致小儿心肺发育功能受到严重影响.     

胸壁肿瘤术中胸廓重建的临床分析

胸壁肿瘤除少数（如尤文肉瘤）对放疗敏感外，均应采用手术治疗，彻底切除肿瘤．肿瘤切除术后胸壁骨架组织和软组织较大面积缺损，需要重建胸廓，以恢复其坚度，防止因胸壁软化产生反常呼吸运动，影响呼吸循环功能．我科自2002年3月至2005年12月共手术治疗胸壁巨大肿瘤6例，分别采用自体组织、钢丝网及钛合金网修补胸壁缺损，现报告如下．[第一段]     

胸廓内甲状腺病变的CT诊断

①目的探讨ＣＴ对胸廓内甲状腺病变的诊断价值。②方法回顾性分析１４例胸廓内甲状腺病变的ＣＴ检查资料,经手术和病理证实为甲状腺肿６例,甲状腺腺瘤４例,甲状腺癌４例。③结果ＣＴ能较好显示病变的范围,病变内部的钙化、囊变,及其与周围组织器官的邻界关系,并是款出血征象。④结论ＣＴ对于胸廓内甲状腺病变的诊断有一定价值,但对于甲状腺肿、甲状腺腺瘤及甲状腺癌之间的鉴别缺乏特征性。     

硬膜外阻滞加静滴普鲁卡因-芬太尼维持机械通气用于开胸手术12例

目的探讨硬膜外阻滞加浅全麻的联合麻醉中精简全身用药种类的可行性及优点。方法选择各类开胸手术各１２例,硬膜外阻滞相同。对照组实行常规全麻用药组合（静吸加肌松）;实验组不用吸入剂和肌松剂,只用１％普鲁卡因—０．００１％芬太尼（ＰＦ液）静滴维持通气。分别观察两组麻醉平稳度、机械通气情况和术中循环参数变化及术后呼吸神经功能恢复情况。结果两组麻醉的稳定性和机械通气的适应性无明显差异;而术中循环参数的变化和术后呼吸功能的恢复情况有较明显的差异（Ｐ＜０．０５）;神经功能恢复的程度及稳定性差异更明显（Ｐ＜０．０１）。结论硬膜外阻滞加静滴ＰＦ液维持机械通气是硬膜外阻滞加浅全麻联合麻醉中较好的组合形式。     

鸡胸的治疗进展

鸡胸是小儿前胸壁生长发育过程中的一种骨性畸形，发病率约1：1000，男女比例约4：1，其病因尚不十分明确。鸡胸的畸形随年龄增长呈进行性加重趋势，并逐步由对称性鸡胸演变为不对称性鸡胸，严重者可导致限制性呼吸障碍，出现反复呼吸道感染，对儿童的生长发育及心理健康产生不良影响。治疗方法包括保守治疗及手术治疗，保守治疗包括运动疗法及矫形器械治疗，手术治疗包括胸廓成形术及改良NUSS矫形钢板技术。下面就国内外对这一疾病的治疗进展综述如下。     

以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果

目的探讨通过彩色多普勒超声行术前血管评估, 选取合适的胸廓内动脉穿支并以其为蒂, 行预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果。方法采用回顾性观察性研究方法。2017年9月—2021年3月, 西安交通大学第一附属医院收治11例符合入选标准的面部瘢痕患者, 其中男6例、女5例, 年龄16～58(31±12)岁, 瘢痕面积7 cm×5 cm～14 cm×9 cm, 均采用以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复。手术分2期或3期进行, 术前用彩色多普勒超声对胸廓内动脉血管穿支进行评估。Ⅰ期行皮肤软组织扩张器(以下简称扩张器)置入术, 于胸壁置入1个额定容量为400～600 mL的圆柱形扩张器, 扩张3～4个月, 注水量为扩张器额定容量的1.2～1.5倍。Ⅱ期行瘢痕切除+预扩张胸三角皮瓣游离移植术, 皮瓣切取面积为9 cm×7 cm～16 cm×10 cm。将皮瓣血管蒂(胸廓内动脉肋间穿支血管)与面动静脉或者颞浅动静脉进行端端吻合, 供区创面直接缝合。5例患者因皮瓣蒂部臃肿在Ⅱ期术后3～6个月行Ⅲ期皮瓣修薄术。在末次手术后6个月统计皮瓣存活、并发症发生情况, 并采用塞姆斯温斯坦...     

先天性漏斗胸的治疗进展

目的对近年先天性漏斗胸的治疗进展作一综述。方法广泛查阅近年国内外治疗先天性漏斗胸的相关文献,总结治疗现状及进展。结果先天性漏斗胸矫正方法主要有胸廓成形术(Ravitch胸骨抬高术和Nuss微创手术)和假体植入术,磁力推进和无创负压吸引治疗尚处于研究阶段。结论先天性漏斗胸的矫正除改善功能外,对外观要求也在提高,微创和无创治疗是下一步研究重点。     

Nuss手术纠治小儿漏斗胸

小儿漏斗胸是常见的胸廓畸形，患病率0．1％-0．3％。本科2005年8月至2006年8月采用电视胸腔镜下钢板植入胸骨抬举术（Nuss手术）治疗12例，效果满意，报道如下。