身痛逐瘀汤辅助尺骨鹰嘴截骨入路术治疗气滞血瘀型肱骨髁上髁间骨折的效果观察

目的:观察身痛逐瘀汤对尺骨鹰嘴截骨入路术治疗气滞血瘀型肱骨髁上髁间骨折的效果分析。方法:回顾性分析我院诊断为气滞血瘀型肱骨髁上髁间骨折的患者总计45例,均实施以尺骨鹰嘴截骨入路术治疗,其中23例接受术后身痛逐瘀汤治疗的患者为研究组,而另22例未接受的患者则为对照组。比较术后1d与术后7d时的疼痛、肿胀评分及中医证候积分,术后7d与随访6个月时患肢握力、捏力及日常生活、上肢运动评分,并记录患者在住院期间并发症的发生情况,肿胀消退、疼痛消失、住院总时长、随访骨性愈合时间及关节活动度。结果:在术后的7d时较术后1d疼痛、肿胀评分及中医证候积分均明显下降,研究组低于对照组,P<0.05。在随访6个月时较术后7d患肢握力、捏力及日常生活、上肢运动评分均明显提升,且研究组高于对照组(P<0.05)。研究组术后住院期间并发症率更低(P<0.05)。研究组患者肿胀消退、疼痛消失、住院总时长、随访骨性愈合时间均短于对照组,关节活动度大于对照组(P<0.05)。结论:在气滞血瘀型肱骨髁上髁间骨折的治疗中,运用尺骨鹰嘴截骨入路术治疗,可以帮助患者骨折有效复位,而术后以身痛逐瘀汤辅助治疗,可以明显的减轻术后的疼痛与肿胀程度,减轻中医证候症状,减少住院期间并发症的发生,改善患肢握力、捏力及日常生活能力、上肢运动功能,缩短了患者的住院、骨性愈合时间,并提升关节活动度。

无气腹腔镜下治疗宫角妊娠18例临床观察

目的探讨无气腹腔镜宫角妊娠手术治疗可行性及优点。方法对18例宫角妊娠患者临床资料进行回顾性分析。结果 18例患者均在无气腹腔镜下进行手术,无中转开腹及并发症发生。结论无气腹腔镜手术治疗宫角妊娠是安全、可行的,只要掌握手术技巧,可取得临床满意疗效。

Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

Objective： To review our experience of the treatment of bilateral primary spontaneous pneumothorax （PSP） by video-assisted thoracoscopic surgery （VATS）. Materials and methods： Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results： Twelve males and one female, with age ranging from 15 to 36 years （mean 23.1 years）, were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously （n=4） or sequentially （n=9）. The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients （84.6%） had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was （45.6±18.3） min （range 25-96 min） and （120.6±28.7） min （range 84-166 min） respectively for the non-simultaneous （second VATS for the recurrence of contralateral side after first VATS） and simultaneous （bilateral VATS in one operation） procedures. There was no postoperative mortality. However, prolonged air leakage （〉7 d） occurred in one patient （7.7%） who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions： VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with double-phase contrast material-enhanced computed tomography

Objective： To evaluate the efficacy of double-phase contrast material-enhanced computed tomography （CT） in assessing no-surgical treatment response in bronchogenic carcinoma preliminarily. Methods： 52 patients with bronchogenic carcinoma after no-surgical treatment underwent double-phase contrast material-enhanced computed tomography. Two spiral CT scans were obtained at 25 and 90 seconds respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 mUs by using an autoinjector. Precontrast and postcontrast attenuation on every scan was recorded and peak height was calculated. Enhancement pattern was evaluated on the images obtained at 25 and 90 seconds after injection of contrast medium. Results： Precontrast attenuation, postcontrast attenuation at 25 and 90 seconds were 42.20 ± 7.43 Hu, 57.35 ± 10.09 Hu and 71.85 ±12.45 Hu, respectively. No statistically significant difference in precontrast attenuation was found between our results in the study and the results in our old study （mean precontrast attenuation 40.70 Hu） which was obtained in cases before therapy （t = 1.455, P = 0.152 〉 0.05）. Peak height of bronchogenic carcinoma after no-surgical treatment （29.46 ±10.85 Hu） were significantly lower than that of bronchogenic carcinoma before therapy obtained in our old study （mean peak height 35.79 Hu; t = 4.206, P = 0.001 〈 0.05）. 32 of 52 cases showed homogeneous enhancement at 90 seconds. Of the 32 cases, there were 21 with inhomogeneous enhancement, 7 with inhomogeneous enhancement, 2 with central enhancement and 2 with peripheral enhancement at 25 seconds. Conclusion： Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the peak height after administration of contrast material. Peak heights can reflect the blood supply of bronchogenic carcinoma and might be index for evaluation of no-surgical treatment response in bronchogenic carcinoma.

A CLINICAL ANALYSIS OF 38 PATIENTS WITH PRIMARY TRACHEO BRONCHIAL TUMORS

During a 17-year period, 38 patients with primary tracheobronchial tumors received surgical treatment in PUMC Hospital. Arnong the 38. 12 had low-malignancy tracheal tumors, 11 had benign tracheal tumors, 14 had low malignancy bronchial tumors and 1 had a benign bronchial tumor. Fifteen operations were perforrned on 12 patients with low-malignancy tracheal tumors, including local resection of the tumor and tracheal wall in 4 and curettage of the tumor plus electrical cauterization in 10. Postoperative radiotherapy was used as an adjuvant treatment in 8 patients with adenocystic carcinoma. Eight patients have survived for more than 5 years and 3 patients have survived for longer than 10 years postoperatively. All 11 patients with benign tumors received curettage of the tumor and were followed up for an average of 6. 5 years. Among them, 9 are still alive. Of the 14 patients with low malignancy bronchial tumors, 5 underwent curettage of the tumor plus electrical cauterization through incision of the main bronchus or intermedial bronchus, and 7 underwent lobectomy or pneumonectomy. The authors conclude that the correct diagnosis rate can be increased by enhancing recognition of this disease and applying tracheal tomography and bronchoscopy.

Congenital bronchoesophageal fistula in adults

AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively.The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with changes in enhancement pattern

Objective： The aim of this study was to evaluate the efficacy of changes in enhancement pattern in assessing no-surgical treatment response in bronchogenic carcinoma preliminarily. Methods Thirty-three patients with bronchogenic carcinoma underwent two-phase contrast material-enhanced computed tomography prior to and after stopping no-surgical treatment more than one-month respectively. Two spiral CT scans were obtained at 25 and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 3 mL/s by using an autoinjector. The sum of the tumor longest diameters （LD） prior to treatment, after treatment and the sum of the post-treatment tumor enhancement area LD on the images obtained at 90 s after injection of contrast medium were recorded, Precontrast and postcontrast attenuation on every scan was recorded and peak height was calculated. The significance of the difference among groups was analyzed by means of ANOVA, student t test and chi-square test. Results： The sum of the tumor LD prior to treatment, that of after treatment and the sum of the post-treatment tumor enhancement area LD on the images obtained at 90 s after injection of contrast medium were （4.49 ± 1.32）, （4.05 ± 1.63）, （3.36 ± 1.22） cm respectively and there were statistically significant dif- ferences among them （f= 5.467, P = 0.006）. The sum of the tumor LD prior to treatment was significantly higher than that of the post-treatment tumor enhancement area （P = 0.001）. No statistically significant difference in the sum of the tumor LD was found between the pre- treatment and the post-treatment （P = 0.207）. There was no statistically significant difference between the sum of the tumors LD and that of tumor enhancement area after treatment （P = 0.086）. The response rate （RR） （21.21%） according to changes in sum of the tumor LD was significantly lower than that （30.30%） according to changes in the sum of the post-treatment tumor enhancement area LD （x2 = 15.12, P 〈 0.05）, and the progressive diseases （PD） rate （21.21%） was significantly higher than that （12.12%; X2 = 14.12, P 〈 0.05）. No statistically significant difference was found between precontrast attenuation prior to treatment [（41.77±7.03） HU] and that after treatment [（41.89 ± 7.63） HU; t = 0.335, P = 0.740 〉 0.05]. Peak height of bronchogenic carcinoma prior to treatment [（36.50 ± 11.21） HU] were significantly higher than that after treatment [（29.91 ± 10.35） HU; t = 10.081, P = 0.001]. Conclusion： Therapeutic effect may be underestimated with use of changes in sum of the tumor LD. The changes in sum of tumor enhancement area LD in addition to peak height is suggested to be used in assessing no-surgical.treatment response in bronchogenic carcinoma.

Palliative cardia resection with gastroesophageal reconstruction for perforated carcinoma of the gastroesophageal junction

Iatrogenic perforation of esophageal cancer or cancer of the gastroesophageal(GE)junction is a serious complication that,in addition to short term morbidity and mortality,significantly compromises the success of any subsequent oncological therapy.Here,we present an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE junction.Immediate surgical intervention included palliative resection and GE reconstruction.In the case of iatrogenic tumor perforation, the primary goal should be adequate palliative(and not oncological)therapy.The different approaches for iatrogenic perforation,i.e.surgical versus endoscopic therapy are discussed.

Surgical treatment of primary tracheobronchial malignant tumors

Objective： The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors. Methods： The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively. The surgical management included sleeve tracheal resection in 8 cases, lower trachea and carina resection with carina reconstruction in 4 cases, local enucleation of the tumor in 4 cases, left or right carino-pneumon-ection in 2 cases, and resection of the tracheal or bronchial tumor and reconstruction of the airway under cardiopulmonary bypass （CPB）in 6 cases. Results： Among the 18 cases, there were 7 adenoid cystic carcinomas, 9 squamous cell carcinomas, 1 lymphoepithelial-like carcinoma and 1 follicular non-Hodgkin tymphoma. All the cases recovered well except one who died of endotracheal bleeding and asphyxia at the 10th postoperative day. Conclusion： Surgical resection is the most effective treatment for primary tracheobronchial malignant tumors. The selection of operation modes should be individualized according to patients＇ condition. Both complete resection and safety should be taken into consideration simultaneously.

Role of PMN in the lung injury following cardiopulmonary bypass

Objective： To explore the role of polymorphonuclear neutrophils （PMN） activation in lung injury following cardiopulmonary bypass （CPB）. Methods： Twenty four cases of patients with rheumatic heart disease were enrolled in this study to detect the situation of PMN activation and the degree of lung injury. Bronchoalveolar lavage fluid （BALF） and blood samples were collected just after anaesthesia and 4 h postoperatively. Related clinic data were recorded. Results： This cohort included 4 male and 20 female with age ranging from 29 to 69 years old, and body mass from 37 to 73 kg. Mean cardiopulmonary bypass time was （106.46±33.58） rain, mean cross clamp time was （77.58_＋28.02） rain, and mean mechanical ventilation time was （24.17±30.90） h. Postoperative PaO2/FiO2 decreased significantly than that during preoperation （P=0.000）. The postoperative WBC counts in peripheral blood and in BALF were both increased significantly than those during preoperation. And the postoperative rates of PMN in BALF were also increased significantly. Postoperative neutriphil elastase （NE） and myeloperoxidase （MPO） released from inflammatory ceils were increased significantly （P=0.000） both in plasma and BALF. The postoperative yon Willebrand factor （vWF） concentration in plasma was also increased significantly （P=0.000）. The postoperative concentration of sLPI in plasma was decreased, whereas it was increased significantly in BALF. Furthermore, there was a negative correlation between NE and PaO2/FiO2 both in BALF and in plasma. A negative correlation was present between vWF in plasma and PaO2/FiO2. A positive correlation was found between sLPI in plasma and PaO2/FiO2. Conclusion： PMN is recruited and activated after CPB and released large quantity of proteases, and lead to lung injury, sLPI is an important protective factor against inflammatory injury.

Surgical treatment of tracheal extramedullary plasmocytoma and pertinent literature review

Objective: To study the diagnostic method, surgical management and complications of the tracheal malignant tumor, as well as the characteristics of plasmocytoma. Methods: One patient with tracheal plasmocytoma and pertinent literature were analyzed retrospectively. Results: Resection of the tracheal tumor and reconstruction of the trachea were performed successfully in this case, and the pathological diagnosis is plasmocytoma. Conclusion: The nature, location and extent of tracheal tumor are precisely determined from radiologic studies before resection, as well as tracheal intubation and tracheal anastomosis without tension in operative procedures, are very important for triumphal operation. Even extramedullary plasmocytoma may occur in a lot of organs, but the incidence of it is rare. Both surgery and radiotherapy are cardinal methods for extramedullary plasmocytoma.

Experience with the surgical treatment of patients with both esophageal carcinoma and bullous emphysema

Objective： We aimed to investigate the security and feasibility of the simultaneous surgery for patients with both esophageal carcinoma and bullous emphysema. Methods： We described simultaneous surgery performed on 49 cases with both esophaoeal carcinoma and buUous emphysema, accounting for 2.5% of all esophagectomy patients from January 2000 to January 2003. Radical resection of upper and mid-thoracic esophageal cancer was performed in 31 cases, including three approaches from the right chest, left neck and midsection. Thirty-six patients were underwent cervical anastomosis and 13 cases were operated by intrathoracic anastomosis. Results： No perioperative period death occurred. And postoperative com- plications were as follows： cervical anastomotic leakage in 9 cases, lung infection in 11 cases, pulmonary air leak in 13 cases （2 cases lasted for 4 weeks）, recurrent laryngeal nerve damage in 4 cases, supraventricular tachycardia in 4 cases. Patients all recovered and left the hospital with average hospitalization time of 17.5 days. Conclusion： Patients with both esophageal carcinoma and bullous can perform the esophageal carcinoma resection and lung volume reduction surgery （LVRS） simulta- neously. It will not increase the mortality rate and show the feasibility and safety in patients.

Outcomes of surgical management of tracheobronchial injuries a case series from a developing country

Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma. Methods： A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries. Results： The average age was 3 l years with most of the patients being male （14：1）. Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma （blunt and penetrating trauma）. Eightpatients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% （1 patient）. Most patients survived with no sequelae （10 patients） while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management. Conclusions： Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.