主动脉缩窄合并心内畸形的外科治疗策略

目的 总结主动脉缩窄合并心内畸形的外科治疗经验.方法 武汉协和医院心血管外科2003年1月至2008年1月用3种术式共行主动脉缩窄合并心内畸形矫治18例.分期手术4例,一期主动脉缩窄修复,Ⅱ期室间隔缺损闭合(组Ⅰ);双切口一期手术8例,在循环阻断或局部灌注心肺转流下行主动脉缩窄修复和室间隔缺损闭合(组Ⅱ);正中切口一期手术6例,正中开胸非心肺转流下缩窄修复.同期闭合室间隔缺损(组Ⅲ).结果 组Ⅰ中死亡3例,1例出血心跳骤停,2例术后低心排综合征.组Ⅱ2例死于术后多器官功能衰竭.组Ⅲl例死于术后低心排综合征.12例术后随访6个月～4年,残余轻度主动脉缩窄,组Ⅱ2例、组Ⅲ1例,均无症状且无需再次手术.各组均未发现体循环高血压、动脉瘤形成和主动脉瓣返流等并发症.结论 主动脉缩窄合并心内畸形的外科手术策略主要根据心内畸形和缩窄病变特点决定.能一期手术矫治者最好一期手术,其效果优于分期手术.     

去端肽胶原介导小干扰RNA抑制大鼠静脉移植物内膜增生

Objective To evaluate the efficacy of using small interfering RNA targeting TF as a therapy for vein graft failure. Methods External jugular vein to carotid artery interposition vein grafts, which were applied to a low flow condition, were made in 120 Sprague-Dawley rats weighing 260 to 300 g. These rats were randomly divided into 4 groups, 30 rats each group. Group A was atelocollagen-TF Stealth<'TM> Select RNAi group. Group B was atelocollagen-TF Stealth<'TM> RNAi group. Group C was atelocollagen group. Group D was control group. Small interfering RNA mixed with atelocollagen was administrated to the external wall of grafted veins. The TF protein expression of vein gratis was analyzed by Western blot at 1, 3, 7, 14, and 28 d postoperatively, and by immunochemistry at 3 d postoperatively. The proliferation index was determined at 14 d postoperatively. Neointimal hyperplasia was evaluated at 28 d postoperatively. BLOCK-iTTM fluorescent oligo was used to confirm its stability and successful transfer into the vein graft wall at 3 and 7 d postoperatively for another group (n = 12). Results Fluorescence of BLOCK-iT<'TM> fluorescent align could be detected in the graft wall even at 7 d postoperatively. Knockdown of the TF expression was achieved by perivascular application of siRNA using atelocollagen. Compared with control group, the intima thickness at 28 d after grafting was significantly reduced (P ＜ 0.05). This phenomenon was preceded by significant reduction of cell proliferation in siRNA-treated grafts at 14 d postoperatively (P ＜0.05). Conclusion The expression of TF in vein grafts can be effectively inhibited by specific siRNAs using a atelocoilagen-based nonviral delivery approach/n vivo, so that the neointimal thickening can be prevented.     

双片法冠状静脉窦隔入右心房治疗完全性房室隔缺损

完全性房室隔缺损是一种复杂先天性心脏病.我院于2003年1月至2007年3月共手术治疗完全性房室隔缺损25例,现总结如下.     

冠心病外科治疗的新进展

冠状动脉旁路移植术（coronary artery bypass grafting，CABG）是冠心病治疗的有效方法，在世界范围内得到广泛开展。虽然微创心脏外科（minimally invasive cardiac surgery，MICS）最近几年得到迅速发展，但CABG仍存在一些需待解决的问题，本文将其中存在较大争议的几点总结如下。     

去端肽胶原介导小干扰RNA抑制大鼠静脉移植物内膜增生

Objective To evaluate the efficacy of using small interfering RNA targeting TF as a therapy for vein graft failure. Methods External jugular vein to carotid artery interposition vein grafts, which were applied to a low flow condition, were made in 120 Sprague-Dawley rats weighing 260 to 300 g. These rats were randomly divided into 4 groups, 30 rats each group. Group A was atelocollagen-TF Stealth<'TM> Select RNAi group. Group B was atelocollagen-TF Stealth<'TM> RNAi group. Group C was atelocollagen group. Group D was control group. Small interfering RNA mixed with atelocollagen was administrated to the external wall of grafted veins. The TF protein expression of vein gratis was analyzed by Western blot at 1, 3, 7, 14, and 28 d postoperatively, and by immunochemistry at 3 d postoperatively. The proliferation index was determined at 14 d postoperatively. Neointimal hyperplasia was evaluated at 28 d postoperatively. BLOCK-iTTM fluorescent oligo was used to confirm its stability and successful transfer into the vein graft wall at 3 and 7 d postoperatively for another group (n = 12). Results Fluorescence of BLOCK-iT<'TM> fluorescent align could be detected in the graft wall even at 7 d postoperatively. Knockdown of the TF expression was achieved by perivascular application of siRNA using atelocollagen. Compared with control group, the intima thickness at 28 d after grafting was significantly reduced (P ＜ 0.05). This phenomenon was preceded by significant reduction of cell proliferation in siRNA-treated grafts at 14 d postoperatively (P ＜0.05). Conclusion The expression of TF in vein grafts can be effectively inhibited by specific siRNAs using a atelocoilagen-based nonviral delivery approach/n vivo, so that the neointimal thickening can be prevented.     

一期大动脉调转术的主要问题及对策

目的 总结一期大动脉调转术(ASO)治疗完全性大动脉转位(TGA)存在的主要问题并探讨其应对策略.方法 对 2006 年 5 月至 2007 年 8 月收治的 14 例患儿实施一期大动脉调转手术.患儿平均年龄(2.6±0.8)个月(0.5～14 个月);平均体重(3.85±1.30)kg(3～9 kg).室间隔完整 TGA(TGA/IVS)12 例,均合并房间隔缺损(ASD),同时合并动脉导管未闭(PDA)11 例;TGA 合并室间隔缺损(TGA/VSD)2 例,均同时合并 PDA 和 ASD.11 例合并中度肺动脉高压,3 例合并重度肺动脉高压,术前均使用前列腺素 E1(PGE1).手术在全麻、中低温、低流量体外循环下完成.在主动脉、肺动脉瓣上方横断,将左右冠状动脉开口移栽至肺动脉近端.经肺动脉分叉下方,吻合肺动脉近端和升主动脉远端.用自体心包修复主动脉近端缺失部分,并在新主动脉开放后吻合主动脉近端和肺动脉远端.结果 3 例 TGA/IVS患儿术后肺部感染,2 例(分别为 13 个月、3 个月)患儿分别于术后 10 h及12 h 突发室颤死亡.未发生与冠状动脉移植相关并发症.术前肺动脉高压患儿,特别是重度肺动脉高压,术后肺动脉压力均明显下降.12 例术后顺利恢复出院.随诊 3～12 个月,全部患儿心功能恢复良好,无远期并发症和死亡.结论 一期大动脉调转手术对于 TGA 有较好早期治疗效果.针对术中主要问题作出适当的手术应对措施,可以获得满意治疗效果.     

前列腺癌包膜外侵犯对根治性前列腺切除术中性神经保留决策的影响

保留性神经（NS）的根治性前列腺切除术（RP）能够促进术后性功能的恢复，但可能增加术后切缘阳性率与生化复发的风险，尤其是对于存在前列腺癌包膜外侵犯（EPE）的患者。预测EPE是根治性前列腺切除术制定手术方式的关键。文章就术前预测EPE的手段做一综述，以期为临床RP提供依据。     

组织因子在心血管疾病中的分子机制及其意义

组织因子是外源性凝血途径关键启动因子,内皮细胞、血管平滑肌细胞、单核细胞等在受到不同刺激后通过各自信号转导途径诱导其表达.组织因子在心血管疾病中有着重要意义,利用组织因子反义RNA、抗组织因子抗体、FⅦai、rTFPI、rNAPc2等抑制其表达已取得一定进展,而组织因子小干扰RNA可能成为最有效的手段之一.     

不同培养条件对人脂肪源性干细胞生长状态的影响

目的 观察不同培养条件对人脂肪源性干细胞(hADSCs)体外生长状态的影响.方法 取腹部手术患者皮下脂肪组织,用0.1％的Ⅰ型胶原酶消化法分离出hADSCs,将获得的细胞分别在以下3组培养条件下培养:高糖DMEM培养基、高糖DMEM培养基+碱性成纤维生长因子(bFGF)、间充质干细胞培养基(MSCM).取第2代或者第3代细胞进行以下实验:细胞免疫荧光及流式细胞仪行细胞表面标志物CD31、CD34和Stro-1鉴定;绘制细胞生长曲线观察3组细胞的生长状态;采用不同的培养条件对3组细胞进行体外培养,观察细胞的增殖.结果 通过胶原酶消化法可成功地分离出hADSCs.流式细胞仪检测DMEM组CD31、CD34、Stro-1阳性率分别为0.9％、2.9％、56.7％;DMEM+ bFGF组CD31、CD34、Stro-1阳性率分别为1.3％、2.5％、73.5％;MSCM组CD31、CD34、Stro-1阳性率分别为0.7％、2.4％、84.5％.采用不同的培养条件对hADSCs进行培养,DMEM组、DMEM+ bFGF组、MSCM组细胞的倍增时间分别为93.7、64.5、49.1h,差异有统计学意义(p＜0.01).此外,各组中所培养的细胞在MSCM和高糖DMEM+ bFGF的培养条件下的增殖速率明显高于高糖DMEM培养条件(P＜0.05).结论 采用MSCM培养hADSCs可以在短期内获得大量细胞,在传统的高糖DMEM培养基中加入bFGF后也可以获得相似的效果,可以满足组织工程研究的种子细胞数量的要求.     

肾细胞癌的CT影像特点分析

随机选取我院2009年4月～2012年4月收治的肾细胞癌患者72例,术前均行CT检查,并回顾性分析CT影像特点,对比病理结果。结果颗粒细胞癌2例,集合管癌2例,多房囊性肾细胞癌4例,嫌色细胞癌6例,乳头状癌8例,透明细胞癌50例;按照现行病理分型,在透明细胞癌中纳入多房囊性肾细胞癌、颗粒细胞癌,该类型有着丰富的血液供应,扫描增强后显著强化;而嫌色细胞癌及乳头状癌则血液供应相对较少,强化程度明显低于透明细胞癌。在CT影像表现方面,各种类型肾细胞癌无明显特异性,其分型最终仍需借助于病理,而详细分析肾细胞癌的病理与CT影像特点之间的关系,对肾细胞癌的鉴别及其诊断有着极大的帮助,医务人员应当予以高度重视。