Chinese Journal of Thoracic and Cardiovaescular Surgery最新文献

{"title":"Clinicopathology observation of primary pulmonary sarcomatold carcinoma: 15 cases","authors":"Yangyang Sun, Xiaoli Zhou, W. Gu, Gengfang Wang, Wei Gao","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.003","url":null,"abstract":"Objective \u0000To investigate the clinical pathological feature of primary pulmonary sarcomatold carcinoma and to make a further understandine of the disease. \u0000 \u0000 \u0000Methods \u0000Data including clinical manifesation, pathological findings, molecular detection and immunophenotyping with pathologically confirmed primary pulmonary sarcomatold carcinoma was retrospectively analyzed. \u0000 \u0000 \u0000Results \u000015 patients with PPSC were identified(13 men and 2 women, age ranged 56-76 years, median age 66 years). The tumor were located in the left lobus superior(8 cases), lobus inferior(6 cases), and the right lobus medius(1 case). The main clinical symptoms was cough, sputum, bloody sputum, chest pain. Among the 13 males, 10 had smoking history of more than 30 years, and 2 females had no smoking history. All cases presented with a spheroid solid lung mass. All tumor showed mild enhancement similar to that of the surrounding musculature after contrast enhancement, and inhomogeneous central low-attenuation areas were seen in 15 patients. Pathological pattern: 6 cases spindle cell carcinoma, 4 cases pleomorphic carcinoma, 2 cases giant cells carcinoma, 2 cases carcinosarcoma, 1 case pulmonary blastoma. The tumors were composed of both carcinomatous and sarcomatous elements. Immunohistochemistry showed that CK was all positive, EMA was positive in 7, VIM was positive in 10 of 15 cases.10 patients were tested for common related genes of lung cancer, 4 patients had MET14 jump mutation, EGFR L858R gene mutation occurred in 3 cases, KARS G13D gene mutation in 2 cases, and BRAF V600E mutation in 1 case. All 15 patients underwent lobectomy, 13 underwent adjuvant chemotherapy, and 6 underwent local radiotherapy. Postoperative follow-up was 8 to 50 months, 3 cases were lost, and 4 cases were survival 3 years after the surgery. \u0000 \u0000 \u0000Conclusion \u0000Pulmonary sarcomatold carcinoma is a rare histologic subtype of non-small cell lung cancer. Compared with other NSCLC, there is no special clinical and imageing characteristics. Its definite diagnosis relies on postoperative pathological analysis and immunohistochemical staining, and PSC needs to be diatinguished from a variely of disease. PPSC is more aggressive and poor prognosis. \u0000 \u0000 \u0000Key words: \u0000Sarcomatold carcinoma; Lung neoplasma; Spindle cell carcinoma; Pathological characteristics","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87409978","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}

{"title":"Hepatoid adenocarcinoma of the lung: one case report","authors":"Qianjiang Ding, Q. Deng, K. Li, Yu-hong Pan","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.014","url":null,"abstract":"肺肝样腺癌是指癌细胞具有肝细胞样分化、有类似肝细胞癌的形态特征、免疫组化AFP呈阳性表达的肺腺癌，临床罕见。本例52岁男性患者，体检发现右肺上叶肿块、AFP升高。2018年11月行胸腔镜辅助小切口右肺上叶癌根治＋胸膜粘连松解术，清扫纵隔淋巴结。术后病理检查示肺原发肝样腺癌，结节大小约7.0 cm×6.0 cm×4.5 cm，紧贴肺膜，未见明确脉管癌栓及神经侵犯，支气管切缘(－)，周围肺组织(－)。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73376096","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}

{"title":"Initial results of the second order chordal-cutting procedure for chronic ischemic mitral regurgitation","authors":"Han Qingqi, Xu Zhiyun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.008","url":null,"abstract":"Objective \u0000To discuss and evaluate the safty and outcome of the second order chordal-cutting. \u0000 \u0000 \u0000Methods \u0000From Aug 2015 to Mar 2017, 9 chronic IMR patients underwent chordal-cutting procedure, in addition to myocardial revascularization and undersized mitral annuloplasty. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA)<145° and the coaptation depth (CD) less than 10 mm. Pre- and post-procedure clinical data including left ventricular ejection fraction(LVEF), mitral regurgitation grade, New York Heart Association (NYHA) class and dimension of the left ventricle were compared. \u0000 \u0000 \u0000Results \u0000There was no perioperative death. No patient was lost to follow-up. MR grade decreased from 2.89 ± 0.60 preoperatively to 0.56 ± 0.70 postoperatively. The New York Heart Association class decreased from 2.78 ± 0.70 preoperatively to 1.33 ± 0.50 postoperatively. The BA increased from (136.22 ± 4.55)°preoperatively to (174.22 ± 3.15)°postoperatively. The coaptation depth decreased from (8.59 ± 0.46) mm preoperatively to (1.54 ± 0.68) mm postoperatively. LVEF increased from 0.49±0.07 preoperatively to 0.57±0.05 postoperatively. The diastolic and systolic diameters of left ventricle decreased from (62.78 ± 5.24 )mm to (53.67 ± 2.99)mm and( 44.11 ± 4.62)mm to( 37.22 ± 3.27)mm, respectively. \u0000 \u0000 \u0000Conclusion \u0000In selected chronic IMR patients with a BA<145° and coaptation depth less than 10 mm, second order chordal-cutting can be a good surgical option, and is related to less MR return or persistence, improved LVEF, and lower New York Heart Association class. \u0000 \u0000 \u0000Key words: \u0000Chronic ischemic mitral regurgitation; Second order chordal-cutting procedure; Surgery","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80135957","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}

{"title":"Whole process echocardiogram navigated congenital heart disease minimally invasive treatment in 1 164 children patients","authors":"Minglei Gao, Yuhang Liu, Ye Zhao, P. Wen","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.013","url":null,"abstract":"回顾性分析2011年1月至2017年12月大连市儿童医院心脏中心应用全程超声导航进行先天性心脏病食管超声心动图导航经胸微创手术，以及经食管超声心动图及经胸超声心动图导航经皮介入治疗的疗效、安全性及经验。全组1 164例，封堵、扩张及支架置入成功1 161例，合并主动脉瓣脱垂高位室间隔缺损转为体外循环下心内直视手术3例。全组无手术即刻及近期并发症。随访6～83个月，未见迟发房室传导阻滞、心脏磨蚀等远期并发症，患儿心肺功能及生长发育均恢复正常。全程超声导航先天性心脏病微创治疗效果良好，安全性高，可获得满意疗效，值得临床推广。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86733591","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}

{"title":"Surgical treatment of Stanford A intramural hematoma","authors":"Ning-ning Liu, Jin-dong Li, Long-fei Wang, Zi-hua Zhou, Jun Wang, Yong-min Liu, Junming Zhu, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.010","url":null,"abstract":"Objective \u0000To summarize experience and result in surgical treatment of Stanford type A intramural hematoma. \u0000 \u0000 \u0000Methods \u000060 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement. \u0000 \u0000 \u0000Results \u0000In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%. \u0000 \u0000 \u0000Conclusion \u0000Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success. \u0000 \u0000 \u0000Key words: \u0000Aortic intramural hematoma; Surgical procedures; Cardiopulmonary bypass; Sun's procedure","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87615202","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}

{"title":"Retrospective study of right axillary and femoral artery cannulation in Sun’s operation","authors":"Kaiyue Jin, H. Qiao, Xiaonan Li, Yingen Feng, Lin Li, Yong-min Liu, Junming Zhu, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.009","url":null,"abstract":"Objective Summarize the anatomical features of the aortic dissection of right axillary and femoral artery cannulation in Sun's surgery. Exploring whether right axillary and femoral artery cannulation can reduce the incidence of organ malperfusion and improve patient prognosis. Methods From January 2015 to December 2017, 181 cases with aortic dissection were treated in Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing Great Blood Vessel Research and Treatment Center, 122 patients were enrolled in the right axillary and femoral artery cannulation group, and 59 patients in control group were enrolled. Retrospective analysis the data of two groups, intraoperative, and postoperative univariate were compared between the two groups. Results A total of 17 patients died in the postoperative group, with 9 (7.38%) in the combined perfusion group and 8 (13.56%) in the control group, P=0.181. Among the complications of the two groups, 18 patients(14.75%) in combined perfusion group had renal insufficiency and 17 patients (28.81%) in the control group, P= 0.025. 0 case had stransient spinal cord injury in combined perfusion group , 3 cases(5.08%) in control group , P=0.033. Conclusion Right axillary and femoral artery cannulation can reduce the incidence of complications of postoperative organ dysfunction and improve patient prognosis. Key words: Stanford A aortic dissection; Right axillary and femoral artery cannulation; Organ malperfusion","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73041355","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}

{"title":"Immune indicators analysis in 282 patients of thymoma with autoimmune diseases","authors":"Yuan Chen, Peng Zhang, Jian Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.004","url":null,"abstract":"Objective \u0000To compare the difference of immune indices and T lymphocyte subsets in patients with simple thymoma, thymoma combined with myasthenia gravis or other autoimmune diseases, analyze the immune characteristics of patients with thymoma combined with or without autoimmune diseases. \u0000 \u0000 \u0000Methods \u0000Retrospective analyze thymoma surgical cases in cardiothoracic surgery of Tianjin Medical University General Hospital from January 2014 to December 2018. A total of 282 patients with thymoma were included in the analysis, including 66 patients with simple thymoma, 188 patients with myasthenia gravis, and 28 patients with other autoimmune diseases. Patients were grouped by combining with MG or autoimmune diseases. Age, sex, pathological type, immune indexes (including IgG, IgA, IgM, IgE, C3, C4, CRP, circulating immune complexes, anti-nuclear antibodies), T cell subsets (including CD4+ T cells, CD8+ T cells, Th1, Th2, Th17 and Treg) were analyzed. \u0000 \u0000 \u0000Results \u0000The results showed that thymoma with autoimmune diseases and antinuclear antibodies positive were more likely to occur in female patients. Types B1, B2 and B3 thymomas were more likely to be associated with MG. Immune index analysis showed that IgG increased (P=0.008) and C3 decreased (P=0.007) significantly in patients of thymoma with MG or autoimmune diseases, they were the most significant immune indicators. CRP content in thymoma with MG was significantly lower than that in simple thymoma (P=0.004). the content of circulating immune complexes was higher in patients of thymoma with autoimmune diseases (P=0.03). IgG, IgE and circulating immune complexes increased significantly (P<0.05) and C3 decreased significantly (P=0.03) in thymoma patients with anti-nuclear antibody positive. T lymphocyte subsets analysis showed that CD4+ T lymphocyte, CD8+ T lymphocyte, CD4+ /CD8+ , Th1 cell and Th2 cell had no statistical significance. Thymoma patients with MG and autoimmune disease had higher Th17 content and higher Th17/Treg ratio, while Treg cells content decreased. \u0000 \u0000 \u0000Conclusion \u0000Women with thymoma were more likely to have autoimmune diseases and type B thymoma was more likely to have MG. The most significant immune indices were IgG and C3. The increase of IgG and the decrease of complement C3 were related to the type of immune diseases. The increase of Th17 cells and the decrease of Treg cells were related to the thymoma with autoimmune diseases. \u0000 \u0000 \u0000Key words: \u0000Thymoma; Autoimmune diseases; Myasthenia gravis; T lymphocyte subsets","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91531492","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}

{"title":"Sternal suspension technique in treatment of pectus excavatum after open repair of congenital heart disease","authors":"Jie Yu, Q. Zeng, Na Zhang, Cheng-hao Chen, Changqi Xu, D. Yan, Dingyi Liu, Qian Zhang, Xu Zhang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.002","url":null,"abstract":"Objective \u0000To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution, 5 males and 3 females. The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20(range 3.60-5.19). All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions. \u0000 \u0000 \u0000Results \u0000All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml). There was one patient suffered pneumothorax after operation. The patients were followed up for 4 months to 13 years with an excellent and good outcome. \u0000 \u0000 \u0000Conclusion \u0000Sternal suspension technique is a safe and effective procedure for pectus excavatum. To improve the security and reduce the incidence of cardiac injury, sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease. \u0000 \u0000 \u0000Key words: \u0000Pectus excavatum; Sternal suspension; Nuss procedure; Congenital heart disease","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91340459","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}

{"title":"Neurodevelopmental outcomes at eighteen months of age in infants with congenital heart disease","authors":"G. Juan, He Shaoru, Sun Yunxia, Liang Suixin, Liu Yumei, Z. Jian, Chen Jimei, Zhong-hai Jin, Yu Yuhui","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.001","url":null,"abstract":"Objective \u0000To analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 18 months of age. \u0000 \u0000 \u0000Methods \u0000Eighteen-month-old infants with CHD at the follow-up clinic of our hospital were selected. The Bayley scales of infant development(BSID) were used to evaluate the levels of mental development(MDI) and psychomotor development(PDI). The clinical features during hospitalization were reviewed, and the risk factors of MDI and PDI were analyzed. \u0000 \u0000 \u0000Results \u0000A total of 116 children with CHD underwent BSID evaluation at 18 months of age. Both the MDI(95.38±22.98) and PDI(87.84±22.57) of the cohort were significantly lower than the average value of the normal population(P<0.05). In infants with cyanotic CHD, the MDI was higher(β=17.218). The longer the length was of the hospital stay, the lower the PDI(β=-0.577). In patients undergoing cardiopulmonary bypass surgery, the PDI was higher(β=11.956). Compared to infants with relatively normal behavior, the PDI of infants with mild behavioral problems was lower(β=-10.605). \u0000 \u0000 \u0000Conclusion \u0000Children with CHD who underwent cardiac surgery have delayed neurodevelopmental outcomes compared with those of healthy children. The outcomes of infants with cyanotic CHD or undergoing cardiopulmonary bypass surgery was better than others. Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes. \u0000 \u0000 \u0000Key words: \u0000Heart surgery; Congenital heart disease; Infants; Neurodevelopment; Outcomes","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80449062","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}

{"title":"Abdominal hemorrhage after aortic valve replacement in 1 case and literature analysis","authors":"Bing-xing Tian, Fayu Liang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.012","url":null,"abstract":"心脏外科手术后腹部并发症发生率低，而出现腹腔内出血则非常罕见。1例患者因行体外循环下主动脉瓣置换术，术后血压下降明显(32/21 mmHg)(1 mmHg＝0.133 kPa)，保守治疗效果差。考虑心脏压塞，开胸探查未见出血。随后行腹腔穿刺有不凝血，诊断腹腔出血，剖腹探查见腹腔大量深红色陈旧血，肝脏周围大量凝血块，但未见出血点。推测出血可能与术中下腔静脉插管操作不慎有关。经积极治疗，患者好转出院。提示体外循环心脏外科手术后发生不明原因出血，注意腹腔出血可能，当患者循环不稳定，保守治疗效果差时，应该积极手术干预。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85579123","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}