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胸食管异物损伤的临床诊断与治疗

目的　探讨提高胸食管异物损伤诊断及治疗效果的方法。　方法　回顾性分析九江学院附属医院2004年5月至2011年10月26例胸食管异物损伤患者的临床资料，其中男18例，女8例；年龄41.2 （18～70）岁。通过多层螺旋CT （MSCT）成像结合临床特征判断其病理类型，采用胃镜异物取出11例，全身麻醉下胃镜异物取出5例，行开胸手术8例，主动脉覆膜支架腔内隔绝2例。　结果　Ⅰ类损伤10例，Ⅱ类损伤5例，Ⅲ类损伤6例，Ⅳ类损伤5例。20例有异物，6例无异物；24例治愈，2例死亡， 分别因血管置换术中出血及血管修补术后再出血死亡。　结论　依据MSCT成像结合临床特征及病史，明确胸食管异物损伤的诊断及病理类型，采取多学科合作的合理治疗方法，能明显提高胸食管异物损伤的诊疗效果。

原发性纵隔内胚窦瘤一例

食管癌术后下消化道出血的诊治分析

Clinical Analysis of 17 Patients with Chest Injuries in Lushan Earthquake

Objective To summarize our treatment experience for patients with chest injuries in “4•20” Lushan earthquake. Methods Medical records of 17 patients with chest injuries after 2013 Lushan earthquake who were admittedto the Department of Thoracic Surgery，West China Hospital were analyzed retrospectively. The diagnosis of chest injuries was mainly confirmed by medical history，physical examination，X-ray and CT scan of the chest. Clinical characteristics and treatment outcomes were analyzed. Among the 17 patients，there were 14 men and 3 women with their age of 57.3±16.1 years. Results There were 12 patients （70.6%）with crash injury of heavy objects，4 patients （23.5%） with fall injury and 1 patient with road traffic injury. Chest injuries were skin and soft tissue contusion in 17 patients （100%），rib fracturein 15 patients （88.2%） including 1 patient with abnormal respiratory movements，pulmonary contusion in 15 patients （88.2%），hemopneumothorax in 11 patients （64.7%），sternal fracture in 1 patient （5.9%） and bilateral pneumothorax with widespread subcutaneous emphysema in 1 patient （5.9%）. Thirteen patients （76.5%） had concomitant brain，abdominal，orthopedic or nerve injuries. One patient underwent left thoracotomy，clot removal and internal fixation of rib fractures for left coagulated hemothorax and left lower lobe atelectasis. All the 17 patients received timely and effective treatment and there was noin-hospital mortality. Conclusions Mechanisms of earthquake injuries are often complex，and patients often have multipleinjuries. The main types of chest injury are rib fractures and pulmonary contusion. Tube thoracostomy is a simple andeffective treatment strategy for them. Satisfactory pain management and bronchoscopy procedure can effectively help patientswith removal of respiratory secretions and maintenance of airway patency.

胸外科患者术后肺栓塞的诊断与治疗

目的　总结肺栓塞（pulmonary embolism，PE）患者的特点，提高胸外科患者术后并发症的诊断与治疗水平。　方法　回顾性分析上海交通大学附属胸科医院2007年6月至2008年10月收治术后肺栓塞患者22例的临床资料，其中中高危肺栓塞8例，男5例、女3例，平均年龄63.5 （55～76）岁，肺癌5例，食管癌1例，纵隔肿瘤1例，慢性炎性肉芽肿1例，均行溶栓治疗；低危肺栓塞14例，男 11例、女 3例，平均年龄61.7 （55～75）岁，肺癌9例，食管癌5例，均行抗凝治疗。　结果　中高危患者中7例症状在24 h内明显改善，均痊愈出院，随访3个月无复发；1例24 h内好转，48 h后出现严重的肺部感染，并于5 d后死亡。14例低危患者均于治疗3～5 d后氧合改善，随访3个月无复发。　结论　胸外科患者术后肺栓塞的诊断仍较为困难；溶栓治疗是中高危肺栓塞患者的首选治疗方案；深静脉血栓（deep vein thrombosis，DVT）形成是术后肺栓塞的高危因素，应高度重视。

下行性坏死性纵隔炎的诊断与治疗

目的　探讨下行性坏死性纵隔炎（DNM）的诊断和治疗方法。　方法　回顾性分析1988年1月至2009年12月青岛大学医学院附属医院收治11例DNM患者的临床资料，其中男8例，女3例；年龄25～71 （55±3）岁。早期收治的患者外科治疗采用颈部清创、引流，或经颈部纵隔引流；后期收治的患者采用颈、胸部同期清创、引流及术后冲洗。　结果　行单纯颈部清创、引流及经颈部纵隔引流的7例患者中死亡4例，均死于严重纵隔感染导致多器官功能衰竭，3例生存患者均为感染尚未侵犯下纵隔和胸腔；行颈、胸部清创、引流和冲洗的4例患者全部治愈。随访7例，随访时间3个月，患者恢复良好。　结论　DNM病情凶险，一旦发病迅速进展为脓毒血症，甚至死亡。重视口咽部和颈部感染患者的胸部症状、体征变化，及时行胸部CT检查是尽早诊断DNM的关键。尽早进行颈、胸部彻底清创、充分引流及有效冲洗是治疗DNM成功的关键。

Therapy Progress for Vascular Pathology of Marfan Syndrome

Abstract：　Marfan syndrome （MFS） is a congenital and heritable autosomal dominant disorder of the connective tissue　which is often passed down through families. Its clinical presentation typically involves the skeletal， cardiovascular and ocular systems with a high natural mortality. Aortic root aneurysm and consecutive acute aortic dissection represent the main cardiovascular manifestations and main causes of morbidity and mortality in MFS. At present， the predominant therapeutic method is surgery， but surgical outcomes are quite unsatisfactory. Recent studies demonstrate that losartan， a common　antihypertensive agent， is useful to treat MFS， the mechanism of which may results from inhibiting overactivation of transforming growth factor β （TGF-β） signaling. This discovery will definitely promote the transition of traditional surgical treatment of MFS into pharmacotherapy. In this review， we focus on the molecular biological pathogenesis， traditional and new therapeutic strategies for MFS patients.　

Diagnosis and Treatment of 34 Patients with Spontaneous Esophageal Rupture

Objective?To investigate clinical characteristics， diagnosis， and treatment for patients with spontaneous　esophageal rupture， and improve clinical diagnostic and treatment level.?Methods?We retrospectively analyzed the　clinical data of 34 patients with spontaneous esophageal rupture who were treated in Subei People’s Hospital from January 1996 to June 2010. There were 28 male patients and 6 female patients with their age ranging from 32 to 80 years old (mean 57.6 years old). Main clinical manifestations included severe chest and abdominal pain after vomiting， fever， dyspnea and shock. The duration between disease onset and establishing diagnosis ranged from 4 hours to 7 days. Thirteen patients received conservative treatment including chest drainage， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy. Twenty one patients received surgical treatment including layered anastomosis of the ruptured esophagus， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.?Results?All the patients were cured without in-hospital death. The mean hospital stay of the 13 patients who received conservative treatment was 46 days， while that of the 21 patients who received surgical treatment was 17 days. All the ruptured esophagus were one-stage healed. All the 34 patients were followed up from l to 8 years， including 11 patients in the conservative treatment group and 19 patients in the surgical treatment group， but 4 patients was lost during follow-up. All the patients had a normal diet without symptoms of esophageal stricture， reflux esophagitis or chronic thoracic empyema.?Conclusion　Spontaneous esophageal rupture is a thoracic emergency with a high misdiagnosis rate and mortality．Early diagnosis， early surgical repair of ruptured esophagus and satisfactory chest drainage play a vital role in the treatment for patients with spontaneous rupture of esophagus.

Clinical Analysis of Diagnosis and Treatment of Acute Pancreatitis in Pregnancy

目的 探讨妊娠期并发急性胰腺炎(APIP)的病因、发病机理、临床特点及防治措施. 方法 对四川省宜宾市第二人民医院和四川大学华西医院1995年1月至2006年12月期间收治的72例APIP患者的临床资料进行回顾性分析. 结果 本组72例中,属轻型急性胰腺炎(MAP)者49例(68.06%),重症急性胰腺炎(SAP)者23例(31.94%); 有胆囊炎合并胆囊结石病史者43例(59.72%),伴高脂血症者21例(29.17%).采用非手术治疗56例,手术治疗16例,孕妇治愈66例(91.67%),死亡6例(8.33%),死因为多器官功能障碍综合征、急性呼吸窘迫综合征及严重复腔感染; 终止妊娠16例(均为32～38周妊娠),56例继续妊娠; 72例中双胎2例,胎儿死亡共15例(20.27%); 漏诊、误诊6例.结论 APIP的发生与胆结石和高脂血症有关,并于妊娠中晚期发病率高; 其临床表现复杂,易误诊,对孕妇及胎儿威胁极大; 把握该疾病的特点,提高对APIP的认识和警惕性,及时准确的诊断与"个体化"的治疗原则,适时终止妊娠,可以提高其治愈率,降低母婴死亡率.

Experience in Diagnosis and Treatment of Upper Gastrointestinal Rebleeding after Pericardial Devascularization in Portal Hypertension Patients

目的　 探讨门静脉高压症断流术后上消化道再出血的原因及防治措施。方法　对近8年解放军第302医院肝胆外科收治的因门静脉高压症行脾切除、贲门周围血管离断术后发生上消化道再出血的15例患者的临床资料进行回顾性分析。结果　15例术后消化道再次出血患者中，因急性胃黏膜病变出血9例，残留食管胃底曲张静脉再次破裂大出血5例，围手术期门静脉、脾静脉及肠系膜上静脉血栓形成并呕血1例。围手术期再出血并死亡2例，通过保守或手术治疗治愈13例。结论　断流术是治疗门静脉高压症引起上消化道大出血的良好术式，术后再出血是断流术后常见并发症之一，完善的手术操作、适时祛聚抗凝减少门静脉系统血栓形成可减少断流术后再出血的发生或减轻其症状