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开放升主动脉后顽固性心室颤动三例

5例胸内巨大囊肿及良性肿瘤的外科治疗

Changes of the perioperative brain natriuretic peptide concentrations in patients undergoing cardiac valve replacement

Objective To investigate the perioperative changes of serum brain natriuretic peptide (BNP) concentrations in patients undergoing cardiac valve replacement. Methods There were 20 patients admitted to the study, the serum BNP concentrations were measured before cardiac surgery, 24 hours, 7days, 14 days, and 30 days after operation. The preoperative NYHA cardiac function and the left ventricular ejection fraction(LVEF) were measured by echocardiogram. Results The preoperative BNP level was the baseline, it elevated markedly and acutely to a peak value 24 hours after operation ( P =0.003), then the BNP decreased 7 days later, but was still higher than the concentration before operation ( P =0.015), 14 days later it reached to the concentration before operation, 30 days later it was mild lower than preoperative BNP level, but there was no significant difference. There was a positive correlation between NYHA and BNP ( r =0.69, P lt;0.05), but no correlation between LVEF and BNP( r =0.29, P gt;0 05). Conclusion The preoperative serum BNP concentration can reflect the preoperative cardiac function in patients undergoing cardiac valve replacement, the high BNP level indicates the poor cardiac function. The BNP sharply elevated in the early time after operation, then gradually decreased in the late phase postoperation.

氟尿嘧啶缓释颗粒植入食管癌瘤床对食管癌根治术后局部复发的影响

目的 观察氟尿嘧啶缓释颗粒瘤床植入对食管癌根治术后局部复发的疗效和预后影响。 方法 纳入2009年1～12月期间重庆三峡中心医院60例行食管癌根治术患者，按其治疗方法分为试验组和对照组两组，每组30例。试验组男24例、女6例，年龄（62.00±7.70）岁；对照组男23例、女7例，年龄（60.20±8.20）岁。试验组患者术中在瘤床植入氟尿嘧啶缓释颗粒300 mg，对照组不植入任何物质。比较两组患者临床结果差异。 结果 两组患者术后主要并发症发生率差异无统计学意义（P＞0.05），试验组术后复发时间较对照组显著延长（P＜0.05）、试验组术后复发病灶大小及复发病灶的个数较对照组显著减少（P＜0.05）；两组患者1年生存率差异无统计学意义，但试验组患者2年及3年生存率显著高于对照组（P＜0.05），试验组中位生存时间较对照组显著延长［（29.2±1.9）月 vs. （23.4±1.4）月，P＜0.05］ 。 结论 食管癌术中瘤床植入氟尿嘧啶缓释颗粒能延缓肿瘤复发时间、提高食管癌患者2年及3年生存率，延长患者中位生存时间，而不增加术后并发症的发生，是一种安全、有效的局部化疗方法。