摘要:目的:探討晚期食管癌切除、縱隔淋巴結(jié)清掃及術(shù)中縱隔熱灌注化療對殘留于氣管、支氣管、胸主動(dòng)脈、奇靜脈等器官的癌性肉眼微小病灶治療效果。方法:選擇食管癌病變浸潤超過外膜層外侵至氣管、支氣管、胸主動(dòng)脈、奇靜脈等器官患者112例，隨機(jī)分為兩組:治療組56例,術(shù)中42～43℃無菌蒸餾水2000～2500 mL加入順鉑(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在體外循環(huán)下行縱隔熱灌注化療40 min;對照組56例,術(shù)中未進(jìn)行縱隔熱灌注化療。結(jié)果:治療組術(shù)后第一年有6例出現(xiàn)縱隔區(qū)域腫瘤復(fù)發(fā)及淋巴結(jié)轉(zhuǎn)移,術(shù)后第二年有11例縱隔區(qū)域腫瘤復(fù)發(fā)及淋巴結(jié)轉(zhuǎn)移;對照組術(shù)后第一年有14例出現(xiàn)縱隔區(qū)域腫瘤復(fù)發(fā)及淋巴結(jié)轉(zhuǎn)移,術(shù)后第二年23例出現(xiàn)縱隔區(qū)域腫瘤復(fù)發(fā)及淋巴結(jié)轉(zhuǎn)移。結(jié)論:晚期食管癌術(shù)中縱隔熱灌注化療可明顯減少或延遲縱隔區(qū)域腫瘤復(fù)發(fā)及淋巴轉(zhuǎn)移,提高術(shù)后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
目的總結(jié)外傷性心臟破裂的急救流程及手術(shù)治療方法。 方法回顧性分析廣元市第一人民醫(yī)院2001年6月至2013年6月收治13例心臟破裂患者的臨床資料，其中男11例、女2例，年齡20～45（32.0±10.5）歲；病程30 min至2 h，平均（45.0±9.6）min。立即行床旁B超檢查，其中12例急診在全身麻醉、氣管內(nèi)插管下行心臟修補(bǔ)術(shù)，同期處理合并臟器損傷。 結(jié)果1例術(shù)前死于腹腔大出血，1例死于術(shù)后彌漫性血管內(nèi)凝血（DIC），術(shù)中發(fā)生惡性心律失常2例，術(shù)后發(fā)生慢性胸骨骨髓炎2例，痊愈出院11例。出院后1個(gè)月復(fù)查心臟彩色超聲，發(fā)現(xiàn)4例少量心包積液，余未見異常。 結(jié)論對于高度懷疑心臟破裂患者，建立快速的救治通道，早期準(zhǔn)確診斷、及時(shí)手術(shù)治療，是挽救患者生命的關(guān)鍵。