目的 探討非小細胞肺癌合并孤立性腦轉移灶的手術治療效果，分析影響患者生存期的因素。 方法 回顧性分析2005年1月－2011年5月46例接受手術治療的非小細胞肺癌合并孤立性腦轉移灶患者的臨床資料，其中男35例，女11例；年齡35～67歲，平均53.2歲；所有患者均行肺部原發腫瘤及腦部轉移腫瘤切除術，其中肺葉切除術42例，全肺切除術4例，術后全部患者行全腦放射治療，部分患者行系統化學療法3～6周期。對隨訪患者的生存時間采用對數秩檢驗，分析影響生存率的因素。 結果 術后病理檢查提示腺癌27例，鱗癌15例，大細胞癌2例，其他類型2例。患者1年生存率80%，2年生存率41%，3年生存率14%，中位生存期23個月，平均生存期（27.8 ± 4.5）個月（乘積極限法）。對數秩檢驗結果提示N0與N1患者比N2患者生存率高（P=0.024），腺癌患者生存期比非腺癌患者生存期長（P=0.002）。 結論 外科手術治療非小細胞肺癌合并孤立性腦轉移灶的患者可以取得良好的治療效果，腺癌患者及無縱隔淋巴結轉移的患者生存期長。
【摘要】 目的 探討主動脈竇瘤破裂（RSVA）的臨床特點、診斷及外科治療方法。 方法 2004年1月-2009年12月對28例RSVA患者在體外循環下行RSVA修補術，同期行室間隔缺損修補術18例，房間隔缺損修補術4例，主動脈瓣成形術2例，主動脈瓣置換術4例。術后隨訪3個月～6年，平均32.4個月。 結果 28例患者均無手術死亡和殘余分流。失訪4例。心功能Ⅰ級20例，Ⅱ級4例；復查心臟彩色超聲心動圖無主動脈竇瘤復發或殘余分流，主動脈瓣輕-中度反流2例。 結論 外科手術是RSVA的最有效治療方法，竇瘤破口直徑gt;0.5 cm者宜用補片修補。伴有中或重度主動脈瓣關閉不全時需根據主動脈瓣病變程度以及手術者經驗決定，必要時需放寬換瓣指征。【Abstract】 Objective To evaluate the clinical characteristics, diagnosis, and surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA). Methods Twenty-eight patients with RSVA were treated surgically in extracorporeal circulation. Repair of RSVA with patch were taken in all patients while closure of ventricular septal defect (VSD) in 18 patients, closure of atrial septal defect (ASD) in four patients, aortic angioplasty (AA) in two patiens and replacement of aortic valve in four patients. Results There was no death and no residue leak after operation. The patients were followed-up for 24 patients, ranged from three months to six years, with the average 32.4 months. The cardiac function of 20 patients was found to be of NYHA classⅠand four patients of classⅡ. Review the heart colour echocardiography, there was no residual tumor or sinus and aortic regurgitation light-moderate in two patients. Conclusions Surgery is the most effective treatment for RSVA, the breaches of sinus tumor in diametergt;0.5 cm is used to repair. When the patients with moderate or severe aortic regurgitation, whether it is necessary to relax in disc indications depends on the degree of aortic disease and performer’s experience.
目的 總結68例二尖瓣成形術的臨床經驗，評估其術后臨床效果。 方法 回顧分析2001年12月－2011年12月進行二尖瓣成形術治療的68例二尖瓣關閉不全患者的臨床資料。成形術的方法為：人工瓣環植入、雙孔成形、后瓣矩形切除、贅生物切除及心包補片修復、腱索轉移等。術中采用注水實驗和經食管超聲心動圖檢查評估成形效果。 結果 68例患者中手術死亡2例，二次開胸止血1例，肺部感染3例。全部患者術中注水實驗和食管超聲心動圖檢查顯示成形效果滿意。存活66例患者隨訪6個月，術后10 d、6個月彩色多普勒超聲心動圖檢查：左心房內徑、左心室舒張末內徑縮小。術后6個月彩色多普勒超聲心動圖檢查：無或微量反流33例，輕度反流27例，輕～中度反流5例，中度反流1例。 結論 根據二尖瓣關閉不全的特征，選擇相應的二尖瓣成形技術，可以取的較好的臨床效果。
ObjectiveTo evaluate the safety and efficacy of total arterial off-pump coronary artery bypass grafting (OPCABG) using a left internal thoracic artery (LITA) combined with bilateral radial arteries (RAs). MethodsWe retrospectively analyzed the clinical data of patients with severe multi-vessel coronary artery disease who underwent total arterial OPCABG with a LITA and bilateral RAs at Sichuan Provincial People’s Hospital from November 2020 to April 2023. Results A total of 24 patients were included, comprising 23 males and 1 female, with a mean age of (53.63±4.33) years. The New York Heart Association (NYHA) functional class was Ⅱ to Ⅲ. The mean number of distal anastomoses was 3.17±0.38. A Y-graft was constructed in 12 patients and sequential grafting was performed in 4 patients. Concomitant procedures included coronary endarterectomy in 1 patient, intra-aortic balloon pump (IABP) implantation in 10 patients, and thymoma resection in 1 patient. The mean operative time was (308.13±30.39) min, mechanical ventilation time was (15.42±7.42) h, ICU stay was (46.08±27.32) h, and postoperative hospital stay was (11.71±1.90) d. There were no in-hospital deaths. Postoperative complications included one patient of acute renal failure and one patient of cerebral infarction. Pre-discharge color Doppler echocardiography revealed that the left ventricular end-diastolic diameter was significantly smaller than before surgery (P<0.05), while the left ventricular ejection fraction and fractional shortening were significantly higher (P<0.05). Coronary computed tomography angiography (CTA) showed that all arterial grafts were patent. During a mean follow-up of (14.58±8.75) months, no patients experienced angina recurrence or mortality. Repeat coronary CTA or angiography in 16 patients one year postoperatively confirmed that all arterial grafts remained patent. Conclusion Total arterial OPCABG using a LITA and bilateral RAs is a safe and effective treatment for patients with severe multi-vessel coronary artery disease. For high-risk patients, intraoperative IABP support is recommended.