Objective To explore clinical application and significance of coronary angiography （CAG） prior to heart valve replacement for patients with rheumatic valvular heart disease （RVHD）. Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results，313 patients were divided into two groups. In the coronary artery lesion （CAL） group，there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion （non-CAL）group，there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL，and the overall prevalence of CAL was 9.27%. In CAL group，11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient （3.45%） died of low cardiac output syndrome （LCOS）. In non-CAL group，5 patients （1.76%） postoperatively died mainly because of LCOS，ventricular fibrillation，sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group （P＜0.05）. There was no statistical difference in postoperative mortality，incidence of LCOS，acute renal failure，respiratory failure，reexploration for bleeding，intraoperative blood loss，mechanical ventilation time or hospital stay between the two groups（P＞0.05）. There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years （OR=5.534，P=0.005），male gender （OR=2.335，P=0.038） and diabetes mellitus （OR=4.265，P=0.006） were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL （age≥55 years，male gender and diabetes mellitus），CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.
目的 探索无法行手术及化放疗等治疗措施的原发性周围性肺癌患者行微波消融治疗的安全性及效果。 方法 我院 2013 年 12 月至 2015 年 11 月 39 例原发性肺癌患者（其中男 24 例、女 15 例，年龄 44～83 岁，中位年龄 67 岁）行微波消融治疗，肿瘤平均直径 3.5 cm。评价肿瘤局部疗效，随访时间 0.5～2.0 年。 结果 全组 39 例患者进行病灶消融后，病灶立即均质化，CT 值下降，供血终止，6 个月后病灶开始逐步缩小，瘢痕化。随访 39 例患者中有 3 例手术后生存 1.0～1.5 年因肿瘤全身广泛转移死亡；2 例患者手术后 6 个月复查增强 CT 见局部有少许血供予以再次消融；全组患者无 1 例严重并发症发生。 结论 微波消融对原发性小细胞肺癌患者的治疗效果佳、创伤小、手术风险小、安全性高。
Microwave ablation (MWA), a form of thermal ablation in interventional radiology, uses electromagnetic waves to produce tissue-heating effects which generating tissue necrosis within solid tumors. Due to its exact effect, safety, high thermal efficiency, MWA became a minimally invasive surgery for lung cancer and a palliative treatment in patients who are nonsurgical candidate and solid tumors. MWA is accurate and effective for peripheral lung cancer and can effectively relieve airway obstruction, obstructive symptoms of pneumonia, atelectasis, breathing difficulties for central lung cancer. This review focuses on the application of MWA in the treatment of lung cancer.