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浅谈3D腹腔镜在低位直肠癌根治术中的应用

直肠癌新辅助治疗后手术方式的选择

二尖瓣成形术的临床应用及疗效分析

摘要： 目的 总结二尖瓣成形术的临床经验，分析其疗效，探讨临床应用方法。 方法 自2000年6月至2009年6月上海交通大学附属胸科医院心血管外科对236例二尖瓣关闭不全患者施行二尖瓣成形术，其中男105例，女 131例；年龄8个月~76岁（53.27±21.60岁）。术前均经彩色超声心动图检查诊断：二尖瓣中度关闭不全79例，重度关闭不全157例。针对236例三种类型不同病变部位的二尖瓣关闭不全，采用人工瓣环植入22例，前叶三角形切除5例，人工腱索植入45例，腱索转移34例，缘对缘技术31例，后叶Sliding技术16例，矩形或楔形切除77例，裂缺修复6例。 结果 全组无死亡，术毕经食管超声心动图检查提示：无反流156例(66.10%)，轻微轻度反流68例(28.81%)，轻-中度反流12例(5.08%)；出现血红蛋白尿3例；术后随访236例，随访时间6~108个月（62.00±38.20个月），超声心动图检查提示：无反流138例，轻微-轻度反流78例，轻中度反流17例，中度反流2例，中重度反流1例; 平均左心室射血分数 58.34%。再手术率为0.84%(2/236)。 结论 灵活应用多种二尖瓣成形技术纠治不同类型的二尖瓣关闭不全，中长期效果良好。

Comprehensive treatment of cardiac surgical patients with chronic left ventricular dysfunction

ObjectiveTo explore the use of comprehensive treatment including drugs, devices and electrophysiology for heart failure patients with surgical indications. MethodsWe collected the clinical data of 65 consecutive cardiac surgical patients with chronic left ventricular dysfunction in our department between March 2014 and May 2016. There were 49 males and 16 females with an average age of 61.3±11.4 years ranging from 37 to 80 years. Their left ventricular ejection fraction was less than 40%. Patients with ventricular dysfunction caused by acute myocardial infarction were excluded. A comprehensive treatment strategy was performed according to patients’ individual disease.ResultsFourty patients underwent cardiopulmonary bypass with asisting time of 55-400 (148.1±69.8) min; 35 patients needed cross-clamping with time of 44-203 (95.7±39.6) min. Intra-aortic balloon pump (IABP) was assisted in 3 patients. Two patients died in hospital. During the follow-up of 13.4 months, the patients’ cardiac function significantly improved and the heart size reduced. Two patients died and two were readmitted for heart failure. Four patients underwent cardiac pacemaker implantation. Other patients with unstable symptoms were stabilized after medical dose adjustment.ConclusionUnder the concept of neuroendocrine inhibition, the comprehensive treatment for heart failure can effectively reduce surgical mortality and improve the patient’s quality of life.

Diagnostic Value of HLA-B27 Tests for Ankylosing Spondylitis in Chinese Population: A Meta-analysis

ObjectiveTo explore the diagnostic value of HLA-B27 for ankylosing spondylitis (AS) in Chinese population. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2015), CNKI, and WanFang data from inception to August 2015, to collect diagnostic studies about HLA-B27 for AS in Chinese population. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed by using Stata12.0 software. ResultsA total of 16 studies involving 3137 AS and 5617 suspect patients were finally included. The results of meta-analysis showed that the pooled Sen, Spe, +LR, -LR and DOR were 0.91(95%CI 0.89 to 0.93), 0.94(95%CI 0.91 to 0.96), 14.90(95%CI 9.60 to 23.10), 0.09(95%CI 0.08 to 0.12) and 157.00(95%CI 90.00 to 275.00), respectively. The AUC of SROC was 0.98(95%CI 0.93 to 0.97). ConclusionsHLA-B27 detection is of great diagnostic value for AS in Chinese population. However, due to the limited quality and quantity of the included studies, more long-term follow-up prospective studies are needed to verify the above conclusion.