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Advance of Basic Research and Clinical Diagnosis and Treatment of Pleuropulmonary Blastoma

Pleuropulmonary blastoma (PPB) is a kind of rare malignancy which often occurs in children and is related to dysplasia. It always involves in pleura and lung. PPB is misdiagnosed easily because of its special pathophysiological characters and complex biological behavior. Early detection and correct treatment are very important for thoracic surgeon to cure PPB. This paper reviews the advance of pathophysiological characters, molecular genetic characters, clinical manifestation, clinical diagnosis and differential diagnosis, and treatment and prognosis of PPB.

Advances on Bone Marrow Derived Stem Cell Engraftment for Lung Regeneration

Because lung tissues have no the capacity of regeneration, it is difficult to cure for lung diseases. At present, it is known that bone marrow derived stem cells are able to differentiate into lung tissue cells directionally, bone marrow derived stem cells are engrafted into the injured lung tissues,and induced to differentiate into alveolar epithelial cells, and further develop alveolar tissue. This is a promised therapeutic tool, but it still is the basal research stage.Now we will review engraftment of bone marrow derived stem cell in various kinds of lung disease model.

Correlation Between Lymphangiogenesis and Lung Cancer Metastasis

Lymphangiogenesis plays an active role in lung cancer metastasis. Currently, it attracts more and more attention because of its role in tumor metastasis and become a hotspot in the field. Lymph node metastasis of lung cancer is the key factor for the unfavourable prognosis of the patient suffered lung cancer. But the correlation of lymphangiogenesis and lung cancer metastasis is yet unknown. Some development about it is reviewed.

电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折

目的探讨应用电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折的方法和疗效。方法自 2009年 1～ 12月上海交通大学医学院附属新华医院（崇明）胸心外科收治 38例多发性肋骨骨折患者（内固定组），均行电视胸腔镜探查、止血、胸腔内血凝块清除、肺裂伤修补，应用电视胸腔镜定位肋骨骨折部位，切开复位，并采用形状记忆环抱接骨板行肋骨内固定。选择 2008年 1 ～ 12月我科收治的 44例胸部创伤经保守治疗的患者作为对照（非内固定组）。术后观察两组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生情况。结果内固定组患者均临床愈合，治愈率为 100%。平均手术时间 48.2 min，术后胸痛明显缓解，平均 2.5 d可坐起， 6.8 d可站立行走，平均住院时间为 10.2 d，原有的胸壁畸形均矫正、平均骨折愈合时间为 4周，无明显并发症发生。内固定组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生率均短于或少于非内固定组（ P＜ 0.05）。内固定组随访 38例，随访时间 2～ 14周，均复查胸部 X线片，未见明显并发症发生，无再次骨折，接骨板无松动、断裂。结论应用电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折具有创伤小、操作简便、固定可靠、组织相容性好及并发症少等优点，有利于促进骨折愈合和呼吸功能改善，是治疗多发性肋骨骨折较理想的方法。

儿童胸腔内巨大间叶性软骨肉瘤一例

微创Nuss手术治疗漏斗胸复发患者12例

摘要： 目的 总结微创Nuss手术对漏斗胸修复失败的治疗效果，以提高治疗水平。 方法 运用微创Nuss手术对12例初次接受Ravitch手术复发性漏斗胸患者进行再次修复，患者均为男性，年龄8~17岁，平均年龄15.6岁；Haller指数均大于3.25；主要症状包括呼吸急促、胸痛、哮喘或哮喘样症状和反复上呼吸道感染。体格检查和CT扫描提示：心脏受压、心脏移位及其他心脏异常，术前肺功能检查多数患者低于正常值的80%。常规使用矫形板及固定片进行矫形；并对术前症状、术中资料、术后结果进行分析。 结果 平均手术时间100 min，较初次手术时间稍长。发生并发症为血胸2例、大量胸腔积液3例、切口疼痛超过1周1例，均经保守治疗治愈，无死亡和心脏穿孔患者。术后随访12例，随访时间6～20个月；随访结果12例患者术前症状均消失，7例患者运动耐力增加；体格检查示：心脏受压和心脏移位缓解，患者均对手术结果表示满意或非常满意。有8例术后用力呼气量(FEF)25%~75%较术前得到改善（Plt;0.05）。 结论 对初次漏斗胸修复失败或复发患者应用Nuss手术矫正后可取得理想的效果。

改良Ravitch 手术治疗成人复发性漏斗胸

摘要： 目的 观察改良Ravitch手术治疗成人复发性漏斗胸的效果。 方法 回顾性分析2007年7月至2010年1月新华医院收治的8例成人复发性漏斗胸患者的临床资料，均为男性；年龄18～26岁，平均年龄21.5岁。 所有患者均采用改良Ravitch手术治疗。对术前症状、术中资料、术后结果进行分析。 结果 手术均顺利完成，术中无并发症发生，无死亡。患者胸廓畸形得到纠正，左右对称。术后发生左侧气胸2例，其中1例有胸腔积液，经胸腔闭式引流后治愈。无切口感染、浮动胸壁和反常呼吸等并发症发生。8例患者随访1~20个月，5例胸痛消失，1例胸痛明显缓解。呼吸急促等症状明显好转；无胸廓凹陷和浮动胸骨发生，无畸形复发。复查肺功能6例患者最大呼气中段流速（FEF）均gt;80%，但用力肺活量（FVC）、一秒率（FEV1%）略有改善。 结论 成人复发性漏斗胸患者采用改良Ravitch手术再次矫正后可获得较满意的效果。

The Experimental Studies of Recombinant Adenovirus Vectormediated βGalactosidase Gene Transfected to Endothelial Progenitor Cells

Objective To determine the transfection efficiency of recombinant adenovirus to endothelial progenitor cells(EPCs) and provide the base of lung cancer therapy by transfecting human herpes simplex virusthymidine kinase（HSV-TK） gene to EPCs. Methods Admove recombinant adenovirus 5F35(AD5F35) which transfected with βgalactosidase(AD5F35LacZ) to the 24 well plate cultivated with EPCs and transfect the EPCs. Stain the EPCs with LacZ kit and calculate the transfection efficiency. Results The blue stain cells were cells transfected successfully with AD5F35LacZ under the optical microscope. The transfection efficiencies of adenovirus to EPCs were different under the premise of the different multiplicity of infection(MOI). In a certain range, the transfection efficiencies rise with the MOI rise. When MOI was 400,the proportion of blue stain cell is the highest, which was 98.38%±1.25%. Conclusion Recombinant adenovirus can transfect EPCs successfully. The transfection efficiencies rise with the MOI rise. When the MOI is 400,the transfection efficiency is the highest.

Protect Effect of Basic Myocardial Construction in Remnant Myocardium by Umbilical Cord Blood Mesenchymal Stem Cells implanted into Infarcted Myocardium

Objective To investigate the influence of infarcted myocardial construction by umbilical cord blood mesenehymal stem cells（MSC） with induced to myo-derived stem cells and implanted into infarcted myocardium. Methods Thirty-six adult mongrel canines were randomly divided into MSC transplant group and control group （18 each group）. Transplant group： the umbilical cord blood MSC differented to myo-derived stem cells induced by 5-azacytidine（5-aza） were implanted into the acute myocardial infarct site via the ligated left anterior descending （LAD） artery. Control group： administer the same volume of IMDM culture medium containing 0. 02% 4,6- diamidino-2-phenylindone （DAPI）. At 2, 4, 8 weeks after implantation, the change of basic myocardial construction and the distribution of desmin were observed by using Nagar-Olsen staining and immunohistology respectively. Results With less fusing, the arrangement of gelatine fibers and elastic fibers were in order in transplant group,and they were partly fused in control group by Nagar-Olsen staining. The expression of desmin of infarcted myocardial cell in transplant group was much higher than those in control group （P〈0. 01）. No significant difference was detected in the expression of desmin in normal site of both groups （P〉0. 05）. Conclusion There is an protective effect on the basic myocardial construction in infarcted myocardium after the umbilical cord blood MSC was differented to myo-derived stem cell by induced with 5-aza in vitro and implanted into the acute myocardial infarction.

胸腔镜加小切口行Heller手术治疗贲门失弛缓症

目的 探讨胸腔镜加小切口行Heller手术治疗贲门失弛缓症的手术方法和效果,以提高手术疗效.方法 1996年1月～2000年12月,对37例经病史、食管镜和食管X线钡餐造影确诊为贲门失弛缓症患者,在胸腔镜加小切口下行Heller手术治疗,并进行随访观察. 结果 1例患者改行常规开胸手术.手术时间1～3.5小时,平均手术时间1.8±0.4小时.所有患者术后均未发生食管漏和手术死亡,住院期间于胃肠道功能恢复后可正常进食,吞咽困难症状消失.至最后1次随访,手术效果优29例(78%),良5例 (14%),差3例 (8%),后者术后3个月因吞咽困难复发行食管扩张,发生食管反流4例(11%),但不需手术或药物治疗. 结论 胸腔镜加小切口Heller手术治疗贲门失弛缓症具有良好的效果.