目的 探讨肝门部胆管癌2种手术方法的疗效。方法 回顾性分析我院1998～2006年期间收治的37例肝门部胆管癌患者的临床资料。结果 37例患者中13例行根治性手术切除, 其1年与3年的生存率分别为100%（13/13）和76.92%（10/13），中位生存期为22.43个月； 另24例行姑息性手术（均为肝内胆管内引流术），其1年与3年生存率分别为54.55%（12/22）和9.09%（2/22），中位生存期为15.42个月。结论 根治性手术是治疗肝门部胆管癌的主要手段； 姑息性手术，如合理的肝内胆管内引流能改善患者的生存质量。
甲状腺外科疾病常见，有许多进展和进步，这是热点； 但许多治疗意见不一，分歧极大，长久难以统一，故又有许多难点
Corresponding author: Y I Ding -hua, E -mail: yidh@fmmu. edu. cnAbstract: Objective To investigate the optimal surgical approaches for coarctation of aorta (CoA ) associated with heart anomalies (CoA -HA ) in infants through analyzing the immediate and long-term outcome post-operation. Methods From May 1998 to November 2006, 29 patients with CoA -HA were admitted to this institute. Subclavian flap angioplasty was performed in three patients, excision of coarctation and end-to-side anastomoses in six pat ients,and end-to-end anastomoses in the remaining 20 pat ients. Their clinical data were retrospect ively reviewed and the long-term follow -up results obtained through telephone o r letters. Results Three patients died of operations, of whom one died of low cardiac output syndrome, one died of sepsis and one died of multiple organs failure. In two months’to eight years’follow -up , no later death and severe neurological complications were found. Two patients suffered from recurrent coarctation, but had no sense of symptoms and free from re-operation. In all pat ients neither systemic hypertension, nor arterial aneurysm and aortic valve regurgitation were found. Conclusions Mortality of surgical corrections is accepted fo r CoA -HA in infants. Preoperative heart dysfunction and prolonged mechanical ventilation are the high risks of operative death. Recurrent coarctation is the major later comp lication.
Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.
Abstract： Objective To investigate clinical characteristics， surgical strategy and prognosis of pulmonary pleomorphic carcinoma， and improve the diagnostic and therapeutic level of pulmonary pleomorphic carcinoma. Methods We retrospectively analyzed clinical data of 7 patients with pulmonary pleomorphic carcinoma who underwent surgical resection from January 2006 to August 2011 in West China Hospital of Sichuan University. There were 5 male patients and 2 female patients with the male/female ratio of 2.5︰1.0 and the mean age of 58.85 （43-69） years old. We also conducted a literature review through PubMed using pulmonary pleomorphic carcinoma and surgery as the key words， and 8 patients with integral clinical data from 2005 to 2011 were identified. There were 7 male patients and 1 female patient with the male/female ratio of 7︰1 and mean age of 70.25 （51-79） years old. All the patients underwent surgical resection and systemic lymph node dissection. Results The mean age of this group was 64.93 （43-79） years old. Among the 15 patients， there were 12 males and 3 females with the male/female ratio of 4︰1. The main symptoms were cough， blood in phlegm， hemoptysis and chest pain. Pathology diagnosis confirmed pleomorphic carcinoma in all the patients. Among the 7 patients of our hospital， there were 3 patients with spindle cell with squamous cell carcinoma， 2 patients with spindle cell with adenocarcinoma， and 2 patients with spindle cell with large cell carcinoma and adenocarcinoma. During follow-up， 3 patients died with the longest survival time of 49 months， and the other 4 patients were still alive. Among the 8 patients in the literature review， there were 4 patients with spindle cell with squamous cell carcinoma， 1 patient with spindle cell with adenocarcinoma， 1 patient with spindle cell with large cell carcinoma and squamous cell carcinoma, and 2 patients with spindle cell with adenocarcinoma and squamous cell carcinoma. During follow-up， 5 patients died with the longest survival time of 22 months， and the other 3 patients were still alive. Conclusion Pulmonary pleomorphic carcinoma is extremely rare and surgical resection is an effective treatment strategy for it.