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消化道吻合器在颈部胃食管吻合中的应用

目的 总结食管癌切除后采用消化道吻合器行颈部胃食管吻合术治疗食管癌患者的临床经验，以降低术后吻合口瘘和吻合口狭窄的发生率，提高手术疗效。 方法 125例食管癌患者，根据采用的手术术式不同分为两组，器械吻合组：行食管癌切除后采用国产常州WGWB-26型吻合器进行颈部胃食管吻合；手工吻合组，行食管癌切除后采用手工方法进行颈部胃食管吻合。 比较两种手术术式的胃食管吻合时间、术后吻合口瘘和吻合口狭窄的发生率。 结果 全组无手术死亡。器械吻合组吻合时间少于手工吻合组（30±5min vs. 55±5 min, Plt;0.05），近期吻合口瘘和吻合口狭窄发生率明显低于手工吻合组（0% vs. 4.8%, 0% vs. 9.5%,Plt;0.05）；器械吻合组随访1～15个月食管X线钡餐检查证实无吻合口狭窄。 结论 使用吻合器行胃食管器械吻合，能增加吻合的可靠性，减少术后并发症，包括吻合口瘘和吻合口狭窄的发生。

The Expression of S100A4 Protein in Tumorstroma of Human Nonsmall Cell Lung Cancer and Its Clinical Significance

Objective To investigate the expression and clinical significance of S100A4 protein in tumorstroma of nonsmall cell lung cancer（NSCLC） to study its correlation with invasion, metastasis and prognosis. Methods Immunohistochemical staining（SP method）for S100A4 protein expression was performed in tissue sections from 130 patients with NSCLC operated and to analyze association of S100A4 protein with clinicopathological parameters in lung cancer and prognosis. Results The total positive expression rates of S100A4 protein in stroma of NSCLC was 72.3%. The positive expression rates of S100A4 protein in stroma of squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell lung cancer were 84.3%，59.6%，70.0% and 75% respectively.The expression of S100A4 protein was significantly associated with lymph node metastasis (χ2=18.91, P=0.000), distant metastasis(χ2=5.51, P=0.019) and TNM stage (χ2=21.54, P=0.000). The 3 years survival rates of patients whose tumourstroma stained positive for S100A4 was lower than that of patients whose tumourstroma stained negative (36.2% vs. 63.9%, P=0.003). Cox’ risk ratio model analysis indicated that age ≤50 years (OR=1.866), lymph node metastasis(OR=1.826), distant metastasis(OR=6.224), lower histology differentiation and undifferentiation (OR=1.793), TNM stage Ⅲ-Ⅳ (OR=2.573) and positive expression of S100A4 protein in stroma of NSCLC(OR=1.776) were significantly independent prognostic factors which affected survival. Conclusion Expression of S100A4 protein in stroma of NSCLC is significantly associated with invasion, metastasis, TNM stage and prognosis. S100A4 protein might become a marker for prediction of tumor progression of disease and clinical therapy.

巨大右房壁瘤伴房间隔缺损一例

心脏瓣膜置换术后并发感染性心内膜炎的外科治疗

目的总结心脏瓣膜置换术后并发感染性心内膜炎的外科治疗经验。方法对21例心瓣膜置换术后并发感染性心内膜炎的患者行再次二尖瓣置换术和主动脉瓣置换术，植入适当大小的机械瓣；术前、术后均进行内科治疗。结果本组近期死亡6例，其中3例患者死于金黄色葡萄球菌感染毒血症及中毒性休克，3例死于术后心力衰竭、多器官功能衰竭。随访15例，随访时间5个月至13年，远期再发感染性心内膜炎4例，其中2例死于感染性心内膜炎复发、败血症及中毒性休克；2例经内科治疗后痊愈。其余患者心功能明显改善（射血分数〉0．45），9例复查心脏超声心动图未发现瓣周漏。结论心瓣膜置换术后发生感染性心内膜炎应早期诊断、适时手术和内外科联合治疗是治疗成功的关键。

Application Value of Intraoperative Epicardial Echocardiography in Cardiac Surgery

Objective To investigate the effect of applying intraoperative epicardial echocardiography (IEE) on preoperative monitoring and evaluating the clinical result of cardiac surgery. Methods We retrospectively analyzed the clinical data of 248 patients treated in the Affiliated 105 Hospital of People’s Liberation Army and the First Affiliated Hospital of Anhui Medical University from June 2008 to May 2015. There were 108 males and 140 females. The age ranged from 7 months to 71 years. There were 113 patients diagnosed with the congenital heart disease (CHD) at the mean age of 11.89±14.74 years. There were 135 patients diagnosed with valvular heart disease at the mean age of 47.20±14.57 years. All patients underwent IEE during operation. Results In 113 patients with CHD, we found new deformities and corrected preoperative diagnosis before cardiopulmonary bypass (CPB) and we identified surgical complications after CPB by IEE. Other deformities and left atrial thrombus were found in 135 patients with valvular heart disease by IEE before CPB. After CPB, paravalvular leak and mitral regurgitation were found, therefore we took action immediately. Conclusions IEE can improve the preoperative diagnosis and reduce perioperative complications, which has value of application during cardiac surgery.