2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：19-21国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434全机器人不开胸心脏手术4例高长青 杨明 王刚 王加利 李丽霞 赵悦 肖苍松 李佳春 周琪中国人民解放军总医院心血管外科全军心脏外科研究所,北京100853摘　要:目的总结一组全机器人不开胸心脏手术情况，观察其安全性及手术效果。方法2007年1月15日至18日，使用da Vinie S机器人系统，不开胸连续完成房间隔缺损修补3例、微创冠状动脉旁路移植术（加卫cAB）1例。结果病人手术均成功，术后出血明显减小，恢复快，无并发症发生。结论全机器人不开胸心脏手术安全可靠，效果确实、是微创心脏外科的发展方向。[著者文摘]

关键词:达芬奇S机器人系统 心脏外科手术
分类号:　R651[机标]文献标识码：文章编号：栏目信息：论著
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The first 4 patients undergoing totally robotic heart surgery without sternotomyGAO Chang-qing, YANG Ming, WANG Gang, et al. Department of Cardiovascular Surgery, General Hospital of PIA, Beifing 100853, ChinaAbstract:Objective To summarize the first 4 cases that underwent totally robotic heart surgery with no stemotomy. Methods 3 cases of atrial septal defect were repaired with da Vinic S surgical system, and 1 case LIMA was taken down from 15/01/200718/ 01/2007. Results All cases were accomplished successfully without complications. Recovery was accelerated and blood loss was littie. Conclusion The procedures of totally robotic surgery without sternotomy are safe, the results are definite. The totally robotic surgery is the direction of minimally invasive cardiovascular surgery.[著者文摘]

Key words:Cardiac surgical procedure da Vinci S Robotic surgical system

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：21-21国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434微创非体外循环下封堵房间隔缺损王永梅[1] 徐巨林[1] 郭宏伟[1] 庞昕炎[1] 何晓鹏[1] 刘玉胜[2][1]山东大学齐鲁医院心外科,济南250012 [2]山东大学第二医院心内科摘　要:2004年10月至2005年10月，我们为20例房间隔缺损（房缺）病人在经食管超声心动图引导下，采用右侧小切口非体外循环下进行房间隔缺损封堵，现报道如下。[第一段]

关键词:房间隔缺损 非体外循环 封堵 超声心动图引导 微创 右侧小切口
分类号:　R654.2

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：22-24国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434二尖瓣手术并射频消融迷宫术治疗房颤王春生 王邵华 陈昊 洪涛 丁文军 赵强复旦大学附属中山医院心外科,上海200032摘　要:目的评价二尖瓣手术并射频消融迷宫手术（Maze Ⅲ）治疗二尖瓣病变合并房颤的安全性和疗效。方法2003年1月至10月行二尖瓣手术及射频消融迷宫手术66例为研究组，同期二尖瓣病变合并房颤仅行二尖瓣手术的66例为对照组。两组术前数据差异无统计学意义，随访并比较分析两组房颤的消除率、手术疗效和术后并发症的差异。结果平均主动脉阻断时间研究组较对照组长（12．61±3．56）min，两组手术死亡率和并发症率差异无统计学意义。术后即刻、出院时及术后1年以上研究组与对照组的房颤消除率分别为100％、63．7％、76．2％与57．6％、18．2％、14．8％（P〈0．001）。研究组窦性心律恢复率明显高、脑梗发生率低、心功能恢复好。结论心内直视手术合并射频消融行迷宫手术可有效消除房颤，不增加心内手术的风险，安全、有效。而单纯二尖瓣手术未处理房颤者，术后房颤多数仍存在。[著者文摘]

关键词:心房颤动 心脏瓣膜疾病 心脏外科手术
分类号:　R473.5[机标]文献标识码：文章编号：栏目信息：论著
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Efficacy of radiofrequency Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery：a controlled studyWANG Chun-sheng, WANG Shao-hua, CHEN Hao, et alDepartment of Cardiac Surgery, Zhongshan Hospital, Fudan University,Shanghai, 200032, ChinaAbstract:Objective To evaluate the efficacy of radiofrequency Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery. Methods From January 2003 to October 2004, 66 patients underwent radiofrequeney Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery （study group） .They were compared to 66 patients with atrial fibrillation who underwent mitral valve surgery without Maze procedure during the same period （control group）. Patients in the two groups were similar in age, gender, preoperative NYHA heart function classification, duration of atrial fibrillation, preoperative left atrial dimension, and type of valvular diseases and combined procedure. The elimination rate of atrial fibrillation, operative outcome and postoperative complication were retrospective analyzed in two groups. Results The duration of aortic cross damp were （ 12.61 ± 3.56） minutes longer in study group than control group. However, mortality and morbidity were similar in two groups. The elimination rate of atrial fibrillation were 100%, 63.7% and 76.2% at postoperative moment, the time of discharge and 1 postoperative year for study group, and 57.6%, 18.2% and 14.8% for control group （ P 〈 0.001 ）. More sinus rhythm recoverly, less thromboembolic events and better heart function reoverly were achieved in study group during follow-up. Conclusion Radiofrequency Maze Ⅲ procedure proved reliable and efficient technique for atrial fibrillation combined by mitral valve diseases, most patients remain in atrial fibrillation after mitral valve without Maze procedure.[著者文摘]

Key words:Atrial fibrillation Heart valve diseases Cardiac surgical procedures

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：25-27国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434多排螺旋CT在PA／VSD／MAPCAs诊治中的价值丁以群[1] 黄美萍[2] 张镜芳[1] 庄建[1] 陈欣欣[1] 陈寄梅[1] 岑坚正[1][1]广东省人民医院广东省心血管病研究所心脏外科,广州510100 [2]广东省人民医院广东省心血管病研究所放射科,广州510100摘　要:目的探讨多排螺旋CT在肺动脉闭锁合并室间隔缺损、体肺动脉侧支血管围术期的应用价值。方法2004年4月到2006年1月，56例肺动脉闭锁合并室间隔缺损、体肺动脉侧支血管病人中男35例，女21例；年龄最小7d，最大21岁。其中40例接受多排螺旋CT检查。21例接受手术治疗，包括早期2例单纯行术前心血管造影检查，后期19例单纯行术前多排螺旋CT检查。根据多排螺旋CT检查结果，确定侧支血管起源及走行，计算全肺动脉指数。结果行多排螺旋C=11检查者均顺利完成扫描过程，无并发症。21例手术病儿中，18例全肺动脉指数大于150mm^2/m^2，1例小于103mm^2/m^2，其余2例介于100～150mm^2／m^2间。术后早期死亡3例。术式包括：根治术、单纯肺血管单一化、肺血管单一化及右心室流出道重建、主动脉一肺动脉分流术及双向Glenn术。结论根据多排螺旋CT结果，可以准确定位侧支血管的起源及走行；与经胸超声心动图相结合，可综合判断病儿心血管畸形发育状况；通过计算全肺动脉指数，能合理选择术式。[著者文摘]

关键词:心脏缺损 先天性 肺动脉瓣闭锁 体层摄影术 发射型计算机
分类号:　R814.42[机标]文献标识码：文章编号：栏目信息：论著
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An invaluable tool for surgical treatments of PA/VSD/MAPCAsDING Yi-qun, HUANG Mei-ping, ZHANG ring-fang,at alDepatment of Cardiac Surgery, Guangdong Provincial People＇s Hospital, Guangdong Cardiovascular Institute, Guangzhou 510100, ChinaAbstract:Objective To assess the values of multidetector-row computed tomography （MDCT） on perioperative managements of pulmonary atresia with ventricular septal defect and major aortopulmonary arteries （PA/VSD/MAPCAs）. Methods From April 2004 to January 2006, consecutive 56 eases of PA/VSD/MAPCAs, including 35 males and 21 females, were admitted to Guangdong Provincial People＇s Hospital. 40 patients in this group were scanned with MDCT, and 21 patients underwent a variety of surgeries. According to the information of MDCT, all patients supposed to perform operations were evaluated the origins and the traces of MAPCAs as well as the total neopulmonary arterial index （TNPAI）. Results All 40 patients were scanned with MDCT uneventfully without obvious complications. Among 21 surgical cases, TNPAIs of 18 patients were more than 150 mm^2/m^2, and only one＇s was less than 100mm^2/m^2. Several surgical procedures were adopted, including unifecalization and repair, unifec.alization and/or RVOT reconstruction, aortopulmonary shunt and bidirectional Glenn procedure. 3 cases died in the early term after operations. Conclusion Assisted with MDCT, MAPCAs can be located and traced more easily and accurately. Generally, combined with transthoracic echocardiography （TIE）, surgeons can obtain hill-scale information of the specific cardiovascular abnormality and make surgical decisions to manage PA/VSD/MAPCSs.[著者文摘]

Key words:Heart defects, congenital Pulmonary atresia Tomography, emicsion-computed

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：28-30国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434不同N1状态对胸段食管鳞癌预后的影响傅剑华 黄伟钊 黄植藩 杨名添 林鹏 龙浩 曾灿光 王欣 王思愚 戎铁华中山大学肿瘤防治中心胸外科华南国家肿瘤重点实验室,广州510060摘　要:目的探讨不同N1状态对胸段食管鳞癌预后的影响。方法连续收治并行根治性切除胸段食管鳞癌的N1病人341例，以淋巴结转移数、转移度、转移区域数等因子进行单因素和多因素分析，探讨其与预后的关系。结果单因素分析显示，淋巴结转移数1～3个与大于3个、淋巴结转移度≤20％与〉20％、转移的区域数不同、是否有喉返神经旁淋巴结转移，其1、3、5年生存率差异有统计学意义。但多因素分析显示，仅淋巴结转移的个数对预后有显著影响，P=00001。结论淋巴结转移数、转移度、转移的区域多少与胸段食管鳞癌病人预后有关，仅淋巴结转移个数是其独立预后因素，转移数大于3个者预后较差。[著者文摘]

关键词:食管肿瘤 淋巴转移 预后 肿瘤分期
分类号:　R735.1[机标]文献标识码：文章编号：栏目信息：论著
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~l~e impact of different NI status on the prognosis of thoracic esophageal squamous cell carcinomaFU Jian-hua , HUANG Wei-zhao, HUANG Zhi-fan, et alDepartment of Thoracic Surgery, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in in southern China, Guangzhou 510060, ChinaAbstract:Objective To explore the impact of different N1 status on prognosis in patients with thoracic esophageal squamous cell carcinoma（ESCC ）. Methods A cohort of sequential 341 patients with N1 ESCC of the thoracic esophagus who underwent radical resection in our hospital was studied. The factors including the number, percentage, area and location of nodal metastasis were chosen to be analyzed with Univariate and multivariate survival analysis. Results The overall 5-year survival rate was 23.9%. The 1, 3, 5 year survivsl rates of the patients with the number of lymph node metastases in 1 - 3 or 〉 3 were 77.4%, 34.8% and 27.8% or 59. 5%, 22.6% and 8.5% respectively, P=0.001. The 1, 3, 5 year survival rates of the patients with metastasis percentage in ≤ 20% or〉 20% were 76.6%% and 31.8% or 70.4%, 23.8% and 14.2% respectively, P=0.003; The 3, 5 year survival rates of the petients with metastasis areas in lor 2 or 3 were 35.9%, 28.0% or 24.0%, 15.7% or 25.7%, 0, respectively, P = 0.009; True 1 , 3, 5 year survival rates of the patients with positive or negative recurrent laryngeal nerve node were 74.8%, 33.0% and 25.2% or 59.2% ,24.7% and 0, respectively, P = 0.032. Analysis with the multivariate Cox proportional hazard model revesled that the prognosis in the patients with ESCC was influenced by the number of metastatic nodes significanfly （ P = 0.001 ）. Conclusion The prognosis of patients with N1 ESCC of the thoracic esophagus who underwent radical resection is associated with the number, percentage and area of nodal metastasis. The number of metastatic node is an independent prognosis factor, and the prognosis is worse when the patient with the more than three metastatic nodes.[著者文摘]

Key words:Esophageal neoplasms Lymphatic metastases Prognosis Neoplasm staging

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：31-33国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434Ⅰ期细支气管肺泡癌和肺腺癌增殖凋亡和转移特性的研究李道堂[1] 钟小军[1] 李秀玲[2] 穆殿斌[3] 张兴国[1] 王兴武[4] 张德贤[3] 罗景玉[1] 邹磊[1] 李俞慧[3] 孙菊杰[3][1]山东省肿瘤医院胸外科,济南250117 [2]山东省肿瘤医院放疗科,济南250117 [3]山东省肿瘤医院病理科,济南250117 [4]不详摘　要:目的探讨新定义后的细支气管肺泡癌与肺腺癌生长和转移性的差异。方法采用流式细胞术检测15例工期细支气管肺泡癌和19例普通肺腺癌的DNA指数、增殖指数（PI）、总s期细胞比率（SPF）和凋亡细胞比率（PA），免疫组织化学检测E—Cadherin、Collagen Ⅳ和VEGFR2的表达。结果细支气管肺泡癌的PA大于普通肺腺癌，PI和SPF值在普通肺腺癌与细支气管肺泡癌中差异无统计学意义；细支气管肺泡癌的E-Cadherin、Collagen Ⅳ指标表达水平高于普通肺腺癌，VEGFR2在普通肺腺癌、细支气管肺泡癌中的表达差异无统计学意义。结论早期细支气管肺癌与普通肺腺癌相比，具有相同增殖水平，较高的凋亡水平和更低的转移倾向。[著者文摘]

关键词:肺肿瘤 腺癌 细支气管肺泡 增生 细胞凋亡 肿瘤转移
分类号:　R734.2[机标]文献标识码：文章编号：栏目信息：临床研究
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A study on the differences in proliferative, apoptotic and metastatic activities between the stage Ⅰ bronchioloalveolar carcinoma and adenocarcinoma ofthe lungLI Dao-tang, ZHONG Xiao-jun, LI Xiu-ling, et al.Department of Thoracic Surgery, Shandong Tumor Hospital, Jinan 250117, ChinaAbstract:Objective To analyze differences in proliferative, apoptotic and metastatic activities between stage Ⅰ peripheral BAG and adenocarcinoma of the lung. Method Flow cytometry and immunohistochemistry examinations of paraffin-embeded specimens were perfomed in 15 patients with BAC and 19 patients with adenocarcinoma of the lung. Determination of the S-phase fraction, proliferative index, DNA index and proportion of apoptotic ceils to assess cancer ceil proliferation and apoptosis, and the expression of E-Cadherin, Collagen Ⅳ and VEGFR2 were used to assess cancer cell metastatic activity. Results The results of flow cytometry revealed no difference in distribution among the S-phase fraction, Proliferative index, DNA index, but Proportion of apoptotic cells in BAC was higher than that in ad Any differences in immtmohistochemical staining for VEGFR2 in adenocarcinoma and BAC. In BAC, the level of expression for E-Cadherin, Collagen IV was higher than that in adenocarcinoma. Conclusion BAC had higher apoptotic activity and lower metastatic activity than common adenocarcinoma of the lung.[著者文摘]

Key wordsulmonary neoplasms Adenocarcinoma bronchiolo-alveolar Hyperplasia Apoptosis Neoplasm metastasis

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：34-35国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434FAS及FAS—L在心脏黏液瘤组织中的表达及临床意义姜楠[1] 阮昕华[1] 刘岩[2] 徐美林[2] 李庆和[1][1]天津市胸科医院心外科,300051 [2]天津市胸科医院病理科,300051摘　要:近年研究表明，细胞调亡与肿瘤等许多人类疾病相关，心脏黏液瘤是心脏最常见的原发性肿瘤，其具体发病机制尚不清楚㈨。为探讨Fas及Fas-L在心脏黏液瘤发生发展中的作用，我们用免疫组织化学方法对其进行检测，现报道如下。[第一段]

关键词:心脏黏液瘤 临床意义 FAS 瘤组织 免疫组织化学方法 原发性肿瘤 Fas-L 疾病相关
分类号:　R732.1

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：35-35国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434先天性冠状动脉瘤合并急性心肌梗死1例许锁春 闫炀 董安平 李刚西安交通大学第一医院心血管外科,西安710061摘　要:病人 女，45岁。胸骨后压榨性疼痛2d，突发性晕厥4h。查体无任何阳性体征。心电图ST段（Ⅰ、aVL）呈下余型压低，ST段（Ⅱ、Ⅲ、aVF、V9）抬高0.2mv,Ⅱ、Ⅲ、aVF出现Q波，提示急性下壁、后壁心肌梗死。[第一段]

关键词:急性心肌梗死 先天性冠状动脉瘤 心电图ST段 后壁心肌梗死 突发性晕厥 阳性体征 aVF 胸骨后
分类号:　R542.22

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：36-39国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434组织工程心脏瓣膜内皮细胞的整合素β1表达王晓伟[1] 叶福林[2] 徐志云[1] 黄盛东[1] 韩林[1] 张宝仁[1][1]第二军医大学附属长海医院胸心外科 [2]解放军第九七医院胸心外科摘　要:目的体外构建组织工程心脏瓣膜（TEHV），初步探讨内皮细胞黏附生长的分子机制。方法猪主动脉瓣膜经胰酶-EDTA、表面活性剂、核酸酶处理，去除猪主动脉瓣叶的细胞成分，测定瓣叶脱细胞后的生物力学特性；将扩增的人脐静脉血管内皮细胞（HUVECs）种植在瓣叶上，体外静态构建TEHV，观察内皮细胞的生长状态。消化瓣膜内皮细胞，半定量RT-PCR检测内皮细胞整合素＆mRNA的表达，Western-Blot检测内皮细胞膜上整合素＆蛋白的表达。结果猪主动脉瓣膜中的细胞成分能完全去除，脱细胞瓣叶的生物力学特性同新鲜瓣叶相比无明显变化；种植的HUVECs在瓣叶表面生长状态良好，长成一层连续的细胞层。瓣膜内皮细胞可检测到整合素岛mRNA和蛋白的表达。结论脱细胞猪主动脉瓣膜作为支架，HUVECs做种子细胞可以成功构建TEHV，瓣膜内皮细胞可以表达整合素岛。[著者文摘]

关键词:组织工程 主动脉瓣 分子生物学 抗原 CD29
分类号:　R318.11[机标]文献标识码：文章编号：栏目信息：实验研究
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Molecular mechanism of endothelial cells about adhesion and proliferation in tissue engineering heart valve of seeding human umbilical vein endothelial cells on decellular porcine aortic valveWANG Xiao-wei, YE Fu-lin, XU Zhi-yun, et al.Department of Cardiothoracic Surgery in Changhai Hospital, Second Military Medicol University, Shanghai 200433, ChinaAbstract:Objective To create the tissue engineering heart valve（TEHV） by seeding human umbilical vein endothelial cells （HUVECs） on decellar porcine aortic valve and investigate its mechanism of endothelial cells in adhesion and proliferation. Methods The porcine aortic valve was acellularized by using trypsin,EDTA,Triton X-100,RNase and DNase treatment. Biomechanical characteristics of fresh valves and aceUularized valves were tested, HUVECs were cultured and seeded on decelluar valve to create TEHV in vitro. Histology and growth condition of cells were observed. The integrin β1 expression of HUVECs was tested by RT-PCR and Western blot. Results The acellularization resulted in complete removal of the cellular components. There was no significant difference of biomeehanical characteristics between acellular valves and fresh valves. In vitro TEHV by seeding HUVECs on decellular porcine aortic valve was created successfully. HUVECs formed a continuous monolayer on the surface of valve . The integrin β1 mRNA and protein expression was identified. Conclusion TEHV can be created using HUVECs as seeding cells on decellular porcine aortic vaive.[著者文摘]

Key words:Tissue engineering Aortic valve Molecular biology Antigens, CD29

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：39-39国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434创伤性膈肌破裂的外科治疗马金山 努尔兰 杨勇伟 李先峰 王小雷 阿不力米提 肖开提新疆维吾尔自治区人民医院胸外科,乌鲁木齐830001摘　要:1987年1月至2002年5月我们共收治创伤性膈肌破裂23例，占同期胸部损伤3．12％（23／737例），现就其诊疗体会报道如下。[第一段]

关键词:创伤性膈肌破裂 外科治疗 胸部损伤 诊疗体会
分类号:　R655.6