目的 探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果，分析影响患者生存期的因素。 方法 回顾性分析2005年1月－2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料，其中男35例，女11例；年龄35～67岁，平均53.2岁；所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术，其中肺叶切除术42例，全肺切除术4例，术后全部患者行全脑放射治疗，部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验，分析影响生存率的因素。 结果 术后病理检查提示腺癌27例，鳞癌15例，大细胞癌2例，其他类型2例。患者1年生存率80%，2年生存率41%，3年生存率14%，中位生存期23个月，平均生存期（27.8 ± 4.5）个月（乘积极限法）。对数秩检验结果提示N0与N1患者比N2患者生存率高（P=0.024），腺癌患者生存期比非腺癌患者生存期长（P=0.002）。 结论 外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果，腺癌患者及无纵隔淋巴结转移的患者生存期长。
【摘要】 目的 探讨活动期感染性心内膜炎（infectiue endocarditis，IE）患者心脏手术的最佳时期。 方法 回顾分析1999年9月-2009年9月行外科治疗的92例IE患者的临床资料。IE诊断标准为修订的Duke标准。采用SPSS 12.0软件包，分析了年龄、性别、是否是院内感染IE、合并症（糖尿病、慢性阻塞性肿疾病、癌症）、病原菌、手术时间等因素与手术并发症及6个月病死率的关系。 结果 56例患者在确诊为IE后7 d内手术，36例患者在确诊7 d后，并抗生素治疗完成后手术。葡萄球菌为主要感染菌株，与栓塞、脓肿及感染性休克显著相关。最常见的手术指征是重度的瓣膜关闭不全合并心功能不全。6个月的病死率为12%。早期手术与晚期手术比较，病死率增高。单因素分析显示，与6个月病死率相关的因素包括葡萄球菌感染和感染性休克。多因素分析显示感染性休克为6个月内死亡的预测因子。感染性休克的患者尽管行了早期手术，病死率仍为67%。严重瓣膜关闭不全的患者，若未出现心衰，无手术（早期或晚期）死亡。 结论 手术患者的预后由是否发生过感染性休克决定。晚期手术组患者结果好于早期手术组，但结果的差异可能并不是手术的时期不同，而是感染性心内膜炎的严重程度不同造成的。对于有重度瓣膜返流但无心衰的患者，早期手术可能在缩短住院时间，预防心衰发生上有帮助。【Abstract】 Objective To discuss the optimal time of cardiac operations in patients with infective endocarditis (IE). Methods We analyzed the clinical data of 92 patients with IE diagnosed by the modified Duke criteria between September 1999 and September 2009. SPSS 12.0 was used to analyze predictors of 6-month mortality, including age, sex, nosocomial origin of infection, comorbid conditions (diabetes, chromic obstructive pulmonary disease, cancer), the causative microorganisms, the timing of cardiac operation, and the complications. Results Fifty-six patients underwent operation within the first 7 days after diagnosis of infective endocarditis, and 36 received operation at the completion of antibiotic treatment 7 days after the diagnosis. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 12%. Early operation showed an increased mortality compared with late operation. Univariate analysis showed that factors associated with 6-month mortality included staphylococci infection and septic shock. Multivariate analysis revealed that septic shock was a predictor of 6-month mortality. Despite early operation for patients with septic shock, 67% of them died. No death occurred to patients with severe regurgitation but without heart failure after undergoing (early or late) operations. Conclusions The prognosis for surgically treated patients is determined by the occurrence of septic shock. The outcome in patients undergoing late operations is favorable compared with patients undergoing early operations. This difference is probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefits in shortening the length of hospitalization and preventing development of heart failure.