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学龄儿童注意力缺陷多动障碍及抽动秽语综合征与智商及学习困难的关系

摘要:目的：探讨注意缺陷多动障碍(ADHD)和抽动秽语综合征(TD)患儿的智商及学习困难关系。方法：采用韦氏儿童智力量表(C WISC)对ADHD和TD病组及正常学龄儿童(对照组)各100例进行智力测验, 分别计算各分测验的量表分、 言语智商(VIQ)、操作智商(PIQ)和总智商(FIQ), 进行对比分析。结果：ADHD组言语量表中的知识、词汇、理解分测验及操作量表中的填图、积木分测验及PIQ、FIQ均显著低于正常对照组(Plt;0.01)。TD组中言语量表中的算 术、词汇、理解分测验以及PIQ、FIQ均低于正常对照组(Plt;0.05)。结论：ADHD和TD病组儿童智商均在正常范围或处于边缘水平, 但均存在智力发展不平衡的现象。

Follow-up System of Multi-Disciplinary Team in Colorectal Cancer

Objective　To build a systematic, comprehensive, high efficient and maneuverable follow-up system in multi-disciplinary team (MDT). Methods　Comparing with abroad follow-up practical management, the advantages and disadvantages were analyzed by using multiple follow-up forms and the construct of staffs to guide and evaluate the postoperative patients in colorectal carcinoma at the beginning of follow up system. Results　Follow-up system was made rationalized, and an effective follow-up model was built up to extend in MDT. Conclusion　Following up the present situation with patients of colorectal cancer in this country, the correct direction which is based on current follow-up system would be put out. That would be the important study to improve the medical treatment in next stage.

胃切除术后残胃癌内镜诊断9例报告

Long-term Echocardiography Characteristics and Their Clinical Significance of Patients after Mitral Valve Replacement

Objective To investigate long-term echocardiography characteristics and their clinical significance of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 204 patients who underwent prosthetic MVR and finished echocardiography examination at least 5 years after surgery in West China Hospital of Sichuan University. There were 44 male patients and 160 female patients with their age of 23 to 73 （50.9±10.6）years. Postoperatively， all the patients were followed up for 5-15 （7.9±2.3）years and regularly received echocardiography examination at the outpatient department. Analysis variables included left atrium （LA） dimension， left ventricle （LV） dimension，right atrium （RA） dimension， right ventricle （RV） dimension， left ventricular ejection fraction （LVEF） and effective orificearea （EOA） of the mitral valve. Results Long-term echocardiography showed that LA and LV dimensions were signifi-cantly smaller than preoperative dimensions （P＜0.05）， while RA and RV dimensions were not statistically different from preoperative dimensions （P＞0.05）. Long-term LVEF was significantly higher than preoperative value （P＜0.05）. Long-term EOA was 1.1-4.8 （2.3±0.5）cm2， including EOA of 1.1-1.4 cm2 in 7 patients （3.4%，7/204），and 1.6-1.9 cm2in 42 patients （20.6%，42/204）. During long-term follow-up， 7 patients underwent their second heart surgery， including2 patients with prosthetic valve dysfunction， 1 patient with prosthetic perivalvular leak and severe hemolytic anemia，3 patients with severe tricuspid regurgitation which were not improved after medication treatment， and 1 patient with moderateaortic valve stenosis and regurgitation. Two patients had left atrial thrombosis during follow-up， including 1 patient who died of endocarditis 7 years after surgery， and another patient who was still receiving conservative therapy and further follow-up. Conclusion Concomitant tricuspid or aortic valve disease should be actively treated during MVR， and postoperative patients need better follow-up. Many patients after MVR need long-term cardiovascular medication treatment during follow-up in order to improve their heart function and long-term survival rate.

Early and Midterm Results of Endovascular Repair of Pseudoaneurysms of Descending Aorta

Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.

Mid-term Outcomes after Correction of Type Ⅰ and Type Ⅱ Persistent Truncus Arteriosus

Abstract： Objective To analyze the mid-term outcomes after correction of type Ⅰ and type Ⅱ persistent truncus arteriosus in all patients operated in our institution over the past 5 years. Methods Between May 2006 and October 2010, 17 patients, mean age 4.7（ 0.7-19.0）years, underwent repair of truncus arteriosus（ type Ⅰ in 13 and type Ⅱ in 4） in Fu Wai Cardiovascular Hospital. Some other concomitant cardiovascular malformations included truncal valve regurgitation, partial anomalous pulmonary venous connection, mitral regurgitation and atrial septal defect. Their average pulmonary vascular resistance was （4.4±2.2） Wood units detected by cardiac catheterization before operation. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in all 17 patients （aortic homografts in 3, pulmonary homografts in 2, and bovine jugular vein in 12 patients）. Survivors were followed up for assessment of residual heart lesions. Results The early mortality was 5.8% （1/17）. The mean cardiopulmonary bypass time was （165±52） min, mean aortic cross-clamping time was （114±29） min, and mean postoperative ventilation time was （106±148） h. Two patients had pleural effusion after surgery, 2 patients underwent tracheostomy, and other patients recovered uneventfully. The surviving 16 patients were followed up for 0.6-5.0 years. All patients were alive with their original conduit during follow-up. No patient required re-operation for conduit dysfunction after correction. Conclusion Truncus arteriosus remains a challenging congenital heart disease. For patients with type Ⅰ and type Ⅱ persistent truncus arteriosus who have missed their best age for correction, cardiac catheterization should be routinely examined, and the operation should be performed if the pulmonary vascular resistance is under 8 Wood units before operation. Although the short- and mid-term results of surgery are good, more observations are needed to assess its long-term effect.

Surgical Treatment for Acute Aortic Dissection with Involvement of Aortic Root

Abstract:　Objective　To evaluate surgical strategies for the treatment of acute Stanford type A aortic dissection with involvement of the aortic root.　Methods　From January 2005 to December 2010, 62 consecutive patients underwent emergency surgical intervention for acute Stanford type A aortic dissection with involvement of the aortic root in Renji Hospital Affiliated to Medical School of Shanghai Jiaotong University. According to different methods for the management of proximal aortic dissection, these patients were divided into 3 groups: group A, aortic valve commissural suspension＋supracommissural replacement of the ascending aorta （SCR）,including 28 patients （20 males and 8 females，mean age 45.2±15.6 years）; group B, partial sinus remodeling+ascending aortic replacement, including 10 patients （7 males and 3 females，mean age 44.6±14.9 years）；group C, Bentall procedure,including 24 patients （17 males and 7 females，mean age 46.2±15.6 years）. Clinical outcomes were compared among the three groups.　Results　Six patients died peri-operatively and in-hospital mortality was 9.67% （6/62）. Fifty-four patients were followed up, and the mean follow-up time was 27.3±15.7 months. During follow up, 2 patients died, one for lung cancer and the other for unknown reason. One patient in group A underwent CT scan 6 months after surgery which showed aortic root pseudo-aneurysm. Cardiopulmonary bypass time and aortic cross-clamping time of group C were significantly longer than those of group A and group B （274±97 min vs. 194±65 min, 210±77 min, t=22.482, 30.419, P=0.002， 0.122；150±56 min vs. 97±33 min, 105±46 min, t=12.630, 17.089, P=0.000，0.034）. There was no statistical difference in mortality （t=1.352，P=0.516）, incidence of postoperative reexploration for bleeding, acute renal failure and neurological complication （t=0.855, 0.342, 2.281; P=0.652, 0.863, 0.320） among the three groups.　Conclusion　For patients with acute aortic dissection involving the aortic root, aortic valve commissural suspension+SCR，partial sinus remodeling＋ascending aortic replacement and Bentall procedure may be considered the surgical treatment of choice with respective advantages and disadvantages. Satisfactory clinical outcomes can be achieveed if surgical indications and procedures are properly employed.

60岁以上心瓣膜病患者的外科治疗与随访

目的 总结≥60岁心瓣膜病患者的外科治疗经验及随访结果，以提高手术疗效。 方法 2000年7月至2008年12月, 86例≥60岁的心瓣膜病患者接受了心瓣膜置换术治疗，其中男43例，女43例；年龄60~74岁，平均年龄63.8岁。二尖瓣病变55例，主动脉瓣病变9例，二尖瓣及主动脉瓣双瓣膜病变21例，三尖瓣病变1例；风湿性心瓣膜病65例，退行性心瓣膜病21例。心房颤动59例，窦性心律27例。心功能分级(NYHA)Ⅲ级79例，Ⅳ级7例。行二尖瓣置换术55例，双瓣膜置换术21例，主动脉瓣置换术9例，二尖瓣置换术后三尖瓣置换术1例；同期行三尖瓣成形术16例，改良射频迷宫术8例，左心房血栓清除术7例。 结果 围术期因心律失常死亡1例。术后有3例患者因胸骨哆开而再次行胸骨固定术，１例患者因瓣周漏而再次行心瓣膜置换术，3例患者因呼吸功能不全行气管切开术。85例患者均治愈出院。术后左心房内径（51.1±13.8 mm vs.56.2±17.2 mm,P=0.001）和右心房内径(48.8±9.6 mm vs. 52.1±13.9 mm,P=0.012)较术前明显缩小，左心室、右心室内径、射血分数和缩短分数与术前比较差异均无统计学意义（Pgt;0.05）。随访84例，随访时间2~96个月(24±22个月)，失访1例。随访期间有1例患者于术后5个月因抗凝强度不足发生左心房血栓，经治疗后血栓消失；另1例术后6年因抗凝强度不足发生脑梗死，经住院治疗肢体偏瘫未能恢复。 结论 只要适当把握手术指征和手术时机，注重术前准备及围术期处理，对≥60岁患者行心瓣膜置换术效果良好。术后与抗凝有关的主要问题为抗凝不足。对这些患者术后应加强国际标准化比率(INR)监测及持续的心功能调整。

Fifteen Years Follow-up of 259 Patients of Mitral Valve Replacement with Chinesemade C-L Pugesturt Tilting Disc Mechanical Valve Prosthesis

Abstract： Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect，so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and longterm followup of 259 patients who had undergone the Chinesemade C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay.The hospital mortality was 4.63% (12/259).There were no mechanical valverelated complication in the earlier postoperative period.The mortality fell to 2.59% since 1996.Among the 235 patients,12 patients were lost during the followup,the rate of followup was 95.1%(235/247).The time for followup was 9.77±3.09 years. There were 26 late deaths.During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and l5 years survival rates were 86.80%±2.30%, 78.20%±3.33% and 55.23%±4.34% respectively; the thromboembolic event free rates for 5 years, 10 years and l5 years were 95.95%±0.74%, 92.52%±4.11% and 80.52%±4.11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and l5 years were 94.64%±1.75%, 89.55%±3.28% and 79.39%±4.43% respectively.There were 141 patients(67.46%) in New York Heart Association(NYHA) classⅠ, 56 patients(26.79%) in class Ⅱ, 10 patients(4.78%) in class Ⅲ and 2 patients(0.95%) in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinesemade C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.

生物瓣心瓣膜置换术后远期疗效

目的评价生物瓣心瓣膜置换术后远期疗效。方法1979年1月至2001年12月施行生物瓣心瓣膜置换术303例，按年龄分为两组，≥55岁者123例（≥55岁组）；（55岁者180例（〈55岁组）。其中160例早期使用经戊二醛处理的猪主动脉瓣，143例使用经环氧氯丙烷改性的新型猪主动脉瓣。所有心瓣膜置换术均在全身麻醉体外循环下进行。结果术后早期死亡9例，随访267例（90．8％），随访时间3～20年，5年生存率94．1％±2．3％，10年生存率85．0％±2．7％，15年生存率78．3％±1．2％。51例出现瓣膜衰坏，40例再次手术；5年、10年、15年累计瓣膜未衰坏率分别为90．1％±2．2％、79．4％±3．6％和36．8％±1．6％。且≥55岁组患者瓣膜未衰坏率高于（55岁组（P〈0．05）。经环氧氯丙烷改性的新型生物瓣10年瓣膜未衰坏率明显高于早期戊二醛处理的生物瓣。全组血栓发生率低，15年为0．014％。发生感染性心内膜炎7例，3例治愈，4例死亡。结论人工生物瓣心瓣膜置换术后疗效良好，尤其适合老年患者。经环氧氯丙烷改性的新型生物瓣有较强的抗衰坏能力；术后发生感染性心内膜炎应予以足够的重视。