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[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai最新文献

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[Two resected cases of cavitary lung cancer with pulmonary aspergillosis]. [腔型肺癌合并肺曲霉病切除2例]。
I Kamiya

Two cases of cavitary lung cancer with pulmonary aspergillosis were experienced. Case 1 was a 45-year-old male. Chest X-ray and Chest CT revealed a round shadow in the thin-wall cavity of the upper lobe of the right lung. Upper lobectomy of the right lung was performed. Histologically large cell carcinoma was found to invade the entire cavity wall, and aspergillus was not detected in the intracavitary space. Case 2 was a 75-year-old male. Chest X-ray and Chest CT revealed a round shadow in the thin-wall cavity of the upper lobe S1 + 2 of the left lung. As a result of upper lobectomy of the left lung and S6 partial resection, large cell carcinoma was found to invade the entire cavity wall, and aspergillus was not detected in the intracavitary space. Only 19 cases including ours are reported about cases of lung cancer complicated by pulmonary aspergillosis at the same site in Japan. The mechanism of aspergillus infection had not been clarified in the discussions of the reported literature and nothing characteristic could be pointed out in our cases except for the assumption that the presence of cancer was a factor triggering Aspergillus implantation.

本文报告2例腔型肺癌合并肺曲霉病。病例1为一名45岁男性。胸部x线及CT示右肺上叶薄壁腔内圆形影。行右肺上肺叶切除术。组织学上发现大细胞癌侵袭整个腔壁,腔内腔内未检出曲霉。病例2为一名75岁男性。胸部x线及CT示左肺S1 + 2上叶薄壁腔内圆形影。经左肺上叶切除及S6部分切除,发现大细胞癌侵袭整个腔壁,腔内腔内未检出曲霉。包括本院在内,日本仅有19例肺癌合并肺曲霉病的病例报道。在文献报道的讨论中,曲霉感染的机制尚未明确,在我们的病例中,除了假设癌症的存在是引发曲霉植入的一个因素外,没有任何特征可以指出。
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引用次数: 0
[An experience of the modified Norwood's operation for hypoplastic left heart syndrome with aberrant origin of right subclavian artery and persistent left superior vena cava--the procedure without total circulatory arrest and cardiac arrest]. 改良诺伍德手术治疗左心发育不全综合征伴右锁骨下动脉起源异常和持续性左上腔静脉的经验——无全循环骤停和心脏骤停。
S Yokoyama, K Matsuo, T Fujiwara, T Jibiki, Y Okajima, H Aotsuka

We reported a successful case of the modified Norwood operation for a 21-day-old neonate with hypoplastic left heart syndrome (MS and AS) associated with an aberrant right subclavian artery and a persistent left superior vena cava. The modified Norwood operation was performed without total circulatory arrest and Cardiac arrest. A 4 mm Gore-Tex graft, which was anastomosed between the right carotid artery and the right pulmonary artery for systemic-pulmonary shunt, was used for cerebral perfusion during aortic arch reconstruction. Coronary perfusion was performed with a small cannula placed on the relatively large ascending aorta during anastomosis between the main pulmonary artery and the ascending aorta. Equine pericardial patch was used for aortic arch reconstruction and the ascending aorta was directly anastomosed to a part of the main PA. Postoperative course was uneventful and postoperative MRI revealed no stenosis of the aortic arch and the pulmonary artery.

我们报告一例改良的诺伍德手术成功治疗了一例21天大的左心发育不全综合征(MS和AS)新生儿,该患者伴有右侧锁骨下动脉异常和持续性左上腔静脉。改良的Norwood手术无全循环骤停和心脏骤停。在主动脉弓重建过程中,采用4mm Gore-Tex移植物吻合于右颈动脉和右肺动脉之间进行全身-肺分流,用于脑灌注。肺动脉主动脉与升主动脉吻合时,在相对较大的升主动脉上放置小套管进行冠状动脉灌注。采用马心包补片重建主动脉弓,将升主动脉与部分主动脉弓直接吻合。术后过程顺利,术后MRI显示无主动脉弓和肺动脉狭窄。
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引用次数: 0
[A case of recurrent bronchogenic cyst 15 years after initial operation]. [术后15年支气管源性囊肿复发1例]。
T Konobu, Y Saitoh, M Umemoto, Y Nakao, H Imamura, A Okamura

There are few reports on the postoperative recurrence of bronchogenic cysts. We conducted a re-operation on a 57-year-old man with a bronchogenic cyst 15 years after an initial operation. His history showed an earlier operation for a bronchogenic cyst at the age of 42 at another hospital. 15 years after this initial operation, he suffered from common cold like symptoms, and was referred to our hospital, because of an abnormal shadow on his chest X-ray. A chest CT and MRI revealed an oval tumor just under the right intermediate bronchus. We suspected it was a recurrence of the bronchogenic cyst, and an operation was performed. The cyst was firmly adhered to the lung, and at the upper site of the cyst, a region adjacent to the intermediate bronchus was adhered to the bronchial wall. The histological findings were similar to those of 15 years previously. The cyst wall lined with pseudostratified columnar ciliary epithelium with muscular layer, which led to a diagnosis of a bronchogenic cyst. Congenital cysts, including bronchogenic cysts, are considered to originate in abnormal primordia. If there are remaining abnormal primordia, a recurrence of the disease can occur.

关于支气管源性囊肿术后复发的报道很少。我们对一名57岁的男性患者在初次手术15年后进行了支气管源性囊肿再次手术。病史显示42岁时曾因支气管囊肿在另一家医院接受手术。在初次手术15年后,他出现了类似普通感冒的症状,并因胸部x光片上的异常阴影而被转介到我们医院。胸部CT及MRI显示右侧中间支气管下方有一卵圆形肿瘤。我们怀疑这是支气管源性囊肿的复发,并进行了手术。囊肿与肺黏附牢固,囊肿上部靠近中间支气管的区域与支气管壁黏附。组织学结果与15年前相似。囊肿壁衬有假层状柱状纤毛上皮及肌层,诊断为支气管源性囊肿。先天性囊肿,包括支气管囊肿,被认为起源于异常的原基。如果仍然存在异常的原基,则可能发生疾病复发。
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引用次数: 0
[DDD pacemaker implantation--cardiac pacemaker tips in the left atrium and ventricle by the left thoracotomy]. [DDD起搏器植入-心脏起搏器尖端在左心房和左心室通过左开胸]。
N Ozaki, M Yamaguchi, H Ohashi, M Imai, Y Oshima, T Kumamoto

Recently DDD pacemaker implantation for the children has undergone trials world wide; though regarding the approach, ways and positions of the epicardial lead, a few problems are still remained to be discussed. Now we report 9 cases (5 males, 4 females) of DDD pacemaker implantations by the left anterolateral thoracotomy approach. The 9 patients weighing 6.5 to 33 kg, were aged 11 months to 12 years (mean 6 years) of whom male 5, female 4 with degree of Block; 2 and 7. To all patients the stab-in type epicardial tips were implanted in the left atrium, the screw-in type ventricular epicardial tips were in the left ventricle by the 4th intercostal thoracotomy, and the pacemaker generators were beneath the fascia of the abdominal rectus muscle. We have no sensing and pacing failure, all pacemakers are working in the DDD mode well.

最近,儿童DDD起搏器植入在世界范围内进行了试验;虽然关于心外膜导联的入路、方式和位置,仍有一些问题有待探讨。本文报告经左前外侧开胸入路行DDD起搏器植入术9例(男5例,女4例)。9例患者体重6.5 ~ 33kg,年龄11个月~ 12岁(平均6岁),男5例,女4例,均有阻滞程度;2和7。针刺型心外膜尖植入左心房,旋入型室性心外膜尖经第4次肋间开胸置入左心室,起搏器发生器位于腹直肌筋膜下方。我们没有感应和起搏器故障,所有起搏器在DDD模式下工作良好。
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引用次数: 0
[A case of traumatic cardiac contusion accompanied by the rupture of pericardium]. 外伤性心挫伤伴心包破裂1例。
K Imasaka, J Yoshida, T Iwai, M Sakamoto, M Yoshitoshi, M Akao

We experienced a case of traumatic cardiac contusion accompanied by the rupture of the pericardium after multiple blunt trauma sustained in a traffic accident. A 26-year-old woman who had suffered from blunt chest and abdominal trauma was admitted to our hospital, being unconscious with multiple severe injuries including pelvic fracture, bilateral hemothorax, and multiple fractures in the extremities. The patient was in a shock status. We performed the transcatheter arterial embolization of the internal iliac arteries to control the bleeding, when aortography showed that the contrast media extravasated toward the left thoracic cavity. Immediately, an operation for blunt chest trauma was performed. Blood was flooding out of the ruptured pericardium because of the contusion of myocardium. The postoperative course was uneventful. Blunt chest trauma is usually accompanied by multisystem injury. Therefore, it is imperative to determine the priority of treatment based on preoperative examination in patients having multiple injuries.

我们经历了一例外伤性心脏挫伤并心包破裂后多发钝性创伤持续的交通事故。一名26岁女性因胸部和腹部钝性创伤入院,昏迷,多处严重损伤,包括骨盆骨折,双侧血胸,四肢多处骨折。病人处于休克状态。当主动脉造影显示造影剂向左胸腔外渗时,我们对髂内动脉进行了经导管动脉栓塞以控制出血。立即进行了钝性胸部创伤手术。由于心肌的挫伤,血液从破裂的心包中涌出。术后过程平淡无奇。钝性胸外伤通常伴有多系统损伤。因此,对于多发伤患者,在术前检查的基础上确定治疗的优先顺序是非常必要的。
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引用次数: 0
[Clinical results of single-stage mobilization of pectoral muscle flaps and omental transposition for infected mediastinitis after open heart surgery]. [单期胸肌瓣动员及大网膜转位治疗心内直视术后感染性纵隔炎的临床结果]。
T Asakura, K Aoki, M Tadokoro, T Nakagawa, S Furuta

The purpose of this study was to retrospectively evaluate the outcome of refractory infected mediastinitis managed primarily with mobilization of pectoral muscle flaps and omental transposition. From January 1992 to December 1995, infected mediastinitis occurred in 11 (2.5%) of 447 consecutive patients. All patients required sternal debridement. The wound was thoroughly irrigated with a solution of 0.5% povidone-iodine in physiological saline after debridement and then the defect was repaired. Reconstruction of the chest wall was attained using pectoral muscle flaps in seven patients and pectoral muscle flaps and omental transposition in four. Antibiotic therapy was provided for 6 weeks or more according to the regimen in North America. No hospital deaths occurred after surgery. Significant early complications occurred in four patients. The reasons for the prolonged hospitalization were a recurrent wound infection, prosthetic valve endocarditis and saphenous vein graft pseudoaneurysm formation caused by Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant Staphylococcus epidermidis (MRSE). Length of stay in ICU after surgical treatment was range 1 to 140 days (an average of 11 +/- 3 days in 9 patients without complications in ICU). Duration between surgical treatment and discharge was range 47 to 300 days (an average of 58 +/- 8 days in 7 patients without significant early complications). At the time of this report, the patients are doing well with no signs of recurrence of infection. The mean follow-up was 28.8 months (range 8 to 48 months). We conclude that single-stage mobilization of pectoral muscle flaps together with omental transposition is very usefull for managing refractory infected mediastinitis. But careful follow-up is needed after this procedure in case of MRSA-caused mediastinitis because of its tendency to recur.

本研究的目的是回顾性评估顽固性感染性纵隔炎主要通过胸肌瓣的动员和网膜转位治疗的结果。1992年1月至1995年12月,447例患者中有11例(2.5%)发生感染性纵隔炎。所有患者均需胸骨清创。创面清创后用生理盐水中0.5%聚维酮碘溶液彻底冲洗创面,修复创面缺损。其中7例采用胸肌瓣重建胸壁,4例采用胸肌瓣和大网膜转位重建胸壁。根据北美的方案,抗生素治疗提供6周或更长时间。手术后无院内死亡病例。4例患者出现明显的早期并发症。住院时间延长的原因为耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)所致伤口反复感染、人工瓣膜心内膜炎和隐静脉移植物假性动脉瘤形成。术后ICU住院时间1 ~ 140天(9例患者无并发症,平均11 +/- 3天)。手术治疗至出院的时间为47 ~ 300天(7例患者无明显早期并发症,平均58±8天)。在本报告发表时,患者情况良好,没有感染复发的迹象。平均随访28.8个月(8 ~ 48个月)。我们的结论是,胸肌瓣的单阶段动员和大网膜转位对治疗难治性感染性纵隔炎非常有用。但由于mrsa引起的纵隔炎有复发的倾向,因此在此手术后需要仔细随访。
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引用次数: 0
[50th annual meeting of the Japanese Association for Thoracic Surgery. October 1-3, 1997. Tokyo, Japan. Abstracts]. [第50届日本胸外科协会年会]。1997年10月1日至3日。东京,日本。摘要]。
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引用次数: 0
[One stage operation for sternal turnover with preserved rectus muscle pedicles and aortic root replacement associated with Marfan's syndrome]. [马凡氏综合征合并保留直肌蒂胸骨翻转和主动脉根置换术一期手术]。
J Hirota, K Akiyama, M Takiguchi, S Osawa, S Sasaki, T Nagumo

A 40-year-old man with Marfan's syndrome had annulo aortic ectasia with Sellers grade 4 aortic valve regurgitation and Wada grade 3 pectus excavatum. Simultaneous operation was successfully performed by aortic valve composite graft insertion and sternal turnover with the rectus muscle pedicles. Following a midline skin incision, the cost-sterno complex (plastron) was dissected together with the bilateral rectus muscle pedicles, and the sternum was divided transversely through the second intercostal space. The plastron with muscle pedicles was retracted away from the anterior chest toward the abdomen and was covered by the moistened sternal bag made of polyethylene to prevent dryness and contamination during the composite graft insertion. The aortic root was replaced with a composite graft consisting of a 25 mm SJM valve and a 26 mm Hemashield graft. A short interposed 10 mm Hemashield graft was inserted between the ostia of the left coronary artery and the composite graft. The right coronary artery was reimplanted in the aortic conduit using the button technique with a doughnut pledget. This one stage method offered excellent operative exposure and enabled us to prevent possible necrosis of the sternum, infection of the mediastinal sinus, and postoperative cardiac failure resulting from chest wall compression. In this procedure, active usage of the rapid autologous transfusion system effectively reduced the total amount of blood transfusion.

一名40岁的马凡氏综合征患者有主动脉环扩张伴Sellers 4级主动脉瓣反流和Wada 3级漏斗胸。采用主动脉瓣复合移植物置入胸骨直肌蒂翻转术同时手术成功。在皮肤中线切开后,将成本-胸骨复合体(板突)与双侧直肌蒂一起剥离,并通过第二肋间隙横向分割胸骨。将带肌肉蒂的椎板从前胸向腹部缩回,并用聚乙烯制成的胸骨湿袋覆盖,以防止复合移植物插入过程中的干燥和污染。主动脉根部由一个25毫米SJM瓣膜和一个26毫米hemasshield移植物组成的复合移植物代替。在左冠状动脉口与复合冠状动脉口之间置入短插10mm hemasshield移植物。右冠状动脉被重新植入主动脉导管使用按钮技术与甜甜圈承诺。这种一期方法提供了良好的手术暴露,使我们能够防止可能的胸骨坏死、纵隔窦感染和胸壁压迫引起的术后心力衰竭。在这个过程中,积极使用快速自体输血系统,有效地减少了输血总量。
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引用次数: 0
[Ruptured thymic cysts with mediastinal hemorrhage and hemothorax--a case report and reviews of the literature]. 【胸腺囊肿破裂合并纵隔出血和血胸——1例报告及文献复习】。
K Tsuda, I Yoshida, K Ohshima, Y Morishita

We report a rare case with rupture of thymic cyst including mediastinal hemorrhage and hemothorax. A 68-year-old man was referred to our hospital for the treatment of right hemothorax. A chest roentgenogram following thoracentesis demonstrated a widened mediastinum. Chest computed tomograms revealed a large anterior mediastinal mass extending to the right pleural cavity and bilateral pleural effusion. Digital subtraction angiography showed a normal aorta and great vessels. A median stenotomy revealed a large encysted hematoma along the thymic cyst extending from the right anterior mediastinum into the right pleural cavity and ending with rupture. Pathological examination demonstrated that the largest thymic cyst was continued to the hematoma resulting from partial destruction of its epithelial lining. To our knowledge, only five cases including our's with ruptured thymic tumors were reported, and this is the first report of ruptured thymic cyst resulting in mediastinal hemorrhage and hemothorax.

我们报告一例罕见的胸腺囊肿破裂,包括纵隔出血和血胸。一名68岁男子因右胸血而转诊至我院。胸腔穿刺后的胸片显示纵隔增宽。胸部电脑断层显示一个大的前纵隔肿块延伸到右胸膜腔和双侧胸膜积液。数字减影血管造影显示主动脉和大血管正常。胸腺囊肿沿胸腺囊肿呈大囊状血肿,从右侧前纵隔延伸至右侧胸膜腔,最终破裂。病理检查显示,最大的胸腺囊肿持续到血肿,造成部分上皮破坏。据我们所知,包括我们在内仅有5例胸腺肿瘤破裂的报道,这是第一例胸腺囊肿破裂导致纵隔出血和血胸的报道。
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引用次数: 0
[Thoracoscopic enucleation of esophageal leiomyoma]. 胸腔镜下食管平滑肌瘤切除术。
M Takemura, M Higashino, H Osugi, T Tokuhara, N Takada, H Kinoshita

We treated four cases of thoracoscopic enucleation of esophageal leiomyoma. All four cases were asymptomatic, but either barium swallow or esophagofiberscopic examination revealed esophageal submucosal tumor. The locations of the tumors were middle and lower in one case and middle in the other three cases. All patients were intubated with a double lumen endotracheal tube under general anesthesia. Two patients required thoracotomy due to the tumor surrounding the esophageal wall in one case and severe adhesion to the esophageal mucosa in the other. The mini-thoracotomy was used in three cases. In the other two cases, we used four and three trocars, respectively. The balloon catheter, which had been inserted into the esophageal lumen, was useful for removing the tumor. The tumor was pulled up using the traction suture and dissected from the mucosa and muscular layer. After enucleation of the leiomyoma, the split muscular layer was sutured. The postoperative course was uneventful. These two patients were discharged on the 12th and 15th postoperative days, respectively. We conclude that the thoracoscopic enucleation of the esophageal leiomyoma is useful for reduction of surgical stress and is a more feasible approach for the treatment of esophageal leiomyoma.

我们治疗了4例胸腔镜下食管平滑肌瘤切除术。4例患者均无症状,但钡餐或食管纤维镜检查均发现食管粘膜下肿瘤。肿瘤位于中下位1例,中下位3例。所有患者均在全麻下行双腔气管插管。2例患者因肿瘤包围食管壁,1例与食管黏膜粘连严重,需要开胸手术。3例采用小开胸术。在另外两个病例中,我们分别使用了四个和三个套管针。球囊导管已插入食管腔,可用于切除肿瘤。用牵引缝线将肿瘤拉起,从粘膜和肌肉层剥离。平滑肌瘤去核后,缝合裂开的肌层。术后过程平淡无奇。两例患者分别于术后第12、15天出院。我们认为胸腔镜下食管平滑肌瘤切除术可以减轻手术压力,是治疗食管平滑肌瘤的一种较为可行的方法。
{"title":"[Thoracoscopic enucleation of esophageal leiomyoma].","authors":"M Takemura,&nbsp;M Higashino,&nbsp;H Osugi,&nbsp;T Tokuhara,&nbsp;N Takada,&nbsp;H Kinoshita","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We treated four cases of thoracoscopic enucleation of esophageal leiomyoma. All four cases were asymptomatic, but either barium swallow or esophagofiberscopic examination revealed esophageal submucosal tumor. The locations of the tumors were middle and lower in one case and middle in the other three cases. All patients were intubated with a double lumen endotracheal tube under general anesthesia. Two patients required thoracotomy due to the tumor surrounding the esophageal wall in one case and severe adhesion to the esophageal mucosa in the other. The mini-thoracotomy was used in three cases. In the other two cases, we used four and three trocars, respectively. The balloon catheter, which had been inserted into the esophageal lumen, was useful for removing the tumor. The tumor was pulled up using the traction suture and dissected from the mucosa and muscular layer. After enucleation of the leiomyoma, the split muscular layer was sutured. The postoperative course was uneventful. These two patients were discharged on the 12th and 15th postoperative days, respectively. We conclude that the thoracoscopic enucleation of the esophageal leiomyoma is useful for reduction of surgical stress and is a more feasible approach for the treatment of esophageal leiomyoma.</p>","PeriodicalId":6434,"journal":{"name":"[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai","volume":"45 9","pages":"1606-11"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
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