甲狀腺外科疾病常見，有許多進展和進步，這是熱點； 但許多治療意見不一，分歧極大，長久難以統一，故又有許多難點
目的 總結單心室瓣膜反流的外科治療經驗，觀察治療效果。 方法 回顧性分析2006年7月至2012年1月上海交通大學醫學院附屬新華醫院61例單心室患者的臨床資料，其中男36例，女25例；手術年齡2個月至 20歲；體重2～58 kg。右心室型41例，左心室型13例，未定型型7例。根據瓣膜反流程度不同分為3組，無/微量反流組：28例，瓣膜未行處理；輕/中度反流組：21例，瓣膜未行處理；重度反流組：12例，手術同期行瓣膜成形。收集所有患者住院及隨訪資料，分析輕/中度反流組、重度反流組瓣膜反流變化趨勢，以及影響瓣膜反流的因素。結果 住院死亡5例，住院死亡率8.2% （5/61）。重度反流組患者行瓣膜成形術后反流程度較術前明顯減輕（由術前4.00級下降至術后2.08級）。隨訪56例，隨訪時間6～38個月，重度反流組隨訪10例，隨訪期間死亡2例，其余8例中重度反流2例，中度反流3例，輕度反流2例，微量反流1例；瓣膜反流程度增加趨勢明顯（由術后平均2.08級增加至平均2.75級）。輕/中度反流組隨訪19例，隨訪中無死亡，其中反流程度增加至重度3例（原1例輕度反流，2例中度反流），反流程度由輕度增加至中度3例，瓣膜反流程度由術后平均2.33級增加為平均2.58級。輕/中度反流組瓣膜反流增加率與無/輕微反流組比較差異無統計學意義（瓣膜反流增加率為31.5% vs. 19.2%，χ2=0.36，P=0.55）。單因素分析結果顯示，瓣膜反流增加者在隨訪過程中心功能較瓣膜反流無變化或減輕者明顯降低（術后左心室射血分數53.11%±5.61% vs. 59.65%±3.32%，t =-5.49，P=0.00），而左心室舒張期末容積較瓣膜反流無變化或減輕者明顯增加（t =2.58，P=0.01）。 結論 單心室合并重度瓣膜反流行瓣膜成形術近期效果較好，但隨著心功能下降、心室擴張，瓣膜反流程度加重趨勢明顯；輕/中度瓣膜反流可暫不進行處理，但部分患者瓣膜反流有增加趨勢，提示應注重術后隨訪。
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.
Abstract： Objective To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR. Methods Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve. Results There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level ameliorated in different degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children. Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up. Conclusion For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.
Objective To summarize our clinical experience of pulmonary artery banding （PAB） for the treatment of complex congenital heart diseases as a palliative procedure.?Methods?From January 1997 to November 2010, 138 patients with complex congenital heart diseases underwent PAB in Fu Wai Hospital. There were 87 male patients and 51 female patients with their age of 22.2±26.5 months and average body weight of 7.5±4.6 kg. All the 138 patients were divided into 3 groups according to the purpose of PAB：left ventricular retraining （group 1, n=55）, initial procedure for functional single ventricle with unobstructed pulmonary blood flow （group 2, n=32） and initial palliative procedure followed by later biventricular repair （group 3, n=51）. The intraoperative and postoperative clinical parameters of all participants were observed, and follow-up was made for these 3 groups of patients.?Results?The in-hospital mortality of PAB was 5.1% （7/138）. Three patients underwent re-banding procedure to adjust the size of banding. In group 1, there was 1 postoperative death. Among the 55 patients, 36 patients with dextro-transposition of great arteries received PAB at an average age of 19.6±29.5 months, 29 patients of whom underwent concomitant modified Blalock-Taussig shunt. After an average training interval for 42 days, 83.3% of them（30/36）successfully received arterial switch operation. The other 19 patients in group 1 with isolated corrected transposition of great arteries received PAB at an average age of 45.3±27.2 months. Afteran average training interval for 9 months, 42.1% of them （8/19） successfully received double-switch operation. In group 2, there was 2 postoperative death. Thirty-two patients with functional single ventricle and unobstructed pulmonary blood flow received PAB at an average age of 14.1±14.9 months. Their postoperative mean pulmonary artery pressure decreased significantly from 34.00±10.00 mm Hg to 23.00±7.40 mm Hg, and their oxygen saturation of blood （SpO2） significantly decreased from 92.60%±5.90% to 83.30%±6.30%. After a median interval of 2 years, 18.8% of them （6/32） underwent right heart bypass operation. In group 3, there was 4 postoperative death. Fifty-one patients received PAB at an average age of 20.60±25.60 months. After PAB procedure, the ratio of systolic pulmonary artery pressure and systolic blood pressure significantly decreased from 0.81±0.14 to 0.46±0.15, and their SpO2 significantly decreased from 93.10%±7.60% to 85.00%±10.00%. After a median interval of 6 months, 23.5% of them （12/51） received biventricular repair.?ConclusionAlthough PAB is a palliative procedure with comparatively high risks, it still plays an indispensable role in terms of protecting pulmonary vascular beds, retraining ventricular function and two-stage surgical correction for the treatment of complex congenital heart diseases.