肺曲菌球手术治疗(附10例报告)

本文报告10例肺曲菌球外科手术治疗的经验。由于抗菌素，激素和免疫抑制剂的广泛应用，肺曲菌球的发病率有逐渐增加的趋势。本组病例的主要临床症状是咳血，有典型的肺曲菌球X线表现者4例，其余6例均被误诊并行抗结核治疗数年。内科治疗对肺曲菌球无明显疗效。当频繁大量咳血，不能除外恶性或手术有助于原有基础病变的治疗，则应行外科处理。一般多行肺叶切除，偶而局部肺切除或病灶摘除也可获满意疗效。

自发性气胸的处理(附127例报告)

为了深刻理解自发性气胸发病机理和临床处理原则，获得更佳疗效，本文分析了北京协和医院和唐山嘉盛医院1964年至1996年间，开胸手术治疗原发性自发性气胸68例，继发性自发性气胸3例，和单纯胸腔闭式引流处理继发性自发性气胸的56例，均获得满意治疗结果。文章对自发性气胸的病因、肺大疱与气胸的鉴别、血气胸、局限性气胸、双侧自发性气胸、以及电视胸腔镜外科治疗自发性气胸均做了较详细讨论。认为原发性自发性气胸于第2次发作后应进行开胸手术切除胸膜下肺大疱和胸膜磨擦，对继发性自发性气胸，应慎重考虑开胸手术，一般单纯胸腔闭式引流即可获得有效的治疗结果。

贲门胃底平滑肌瘤和平滑肌肉瘤的临床分析

为了研究和认识贲门胃底平滑肌肿瘤的临床特点、检查方法、治疗方式以及影响预后的因素，本文回顾性分析我院外科手术并病理证实的14例贲门胃底平滑肌肿瘤，其中肌瘤10例，肉瘤4例。主要症状是上腹部疼痛不适和反复黑便，无吞咽困难和梗阻。术前造影和胃镜检查基本可明确诊断。平滑肌肉瘤预后不佳。贲门胃底平滑肌瘤和肉瘤的区别主要在病理上核分裂数、瘤细胞坏死以及临床上肿瘤大小，而手术切除范围并不明显影响存活率。

DIAGNOSIS AND TREATMENT OF PULMONARY HAMARTOMA

From 1970 to 1997, 67 patients with pulmonary hamartoma were operated on in our hospital. There were 38 men and 29 women with a M/F ratio of 1. 3: 1. The mean age was 47 years (range 21 to 82 years). The peak incidence was 40 to 60 years. 39% Patients had pulmonary symptoms: hemoptysis, cough, phlegm and chest pain. All were solitary. 68. 7% tumors were located in right lung and 64. 2% in upper or middle lobe. 80. 6% hamartomas were less than 3 cm in transverse diameter. On chest films, the opacity was homogeneous in 79.1% cases, heterogeneous in 20.9% and calcifications in 9.0%. The vast majority of shadows were heterogeneous on CT films. Operation is the best treatment for hamartomas. Postoperative mortality was 1. 5%. There was none recurrences and canceration during the follow-up (mean 14 years).

肺动静脉瘘的诊断及治疗

1978～1996年．我院手术治疗肺动静脉瘘10例，其中男7例，女3例，平均年龄34（15～52）岁。单发6例，多发4例。主要临床表现为紫绀、红细胞增多症、低氧血症、胸部异常血管杂音及与肺门有粗大血管形相连的肺部阴影。手术适应症为：①所有单发病变；②肺动静脉瘘为体循环供血；③有一种或多种并发症；④肺内存在大量的右向左分流。多发患者手术的选择应首先切除病变最集中的肺叶，其它肺周的小病灶可局部切除。单发患者术后无复发，症状可完全消失；多发患者疗效较差，常需进一步治疗。