单纯碎裂电位指导心房颤动消融的初步临床观察

Objective To evaluate the feasibility of mdiofrequency catheter ablation of atrial fibrilla-tion (AF) guided by complex fractionated atrial electrograms (CFAEs). Methods Twenty-two patients with drug refractory and symptomatic AF(16 paroxysmal, 6 persisten) were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identi-fied. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients(59%)were converted to sinus rhythm, (7 cases conver-ted directly to sinus rhythm, and 6 via the intermediate atrial tachycardia(AT) or atrial flutter (AFL). The re-maining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 pa-tients (5 AT/AFL, 1 paroxysmal AF). During(10.9 ±4.8) months follow-up, 16 patients (73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[(157 ± 18) ms vs (211 ± 32) ms, P < 0.05]. Only one patient had pericardial tamponade that required pericardiocentesis. Conclusion Radiofrequeney catheter abla-tion of atrial fibrillation (AF) guided by CFAEs is safe and effective.     

Revascularized fibula for tibia replacement in adamantinoma

Adamantinoma of long bones is one of the rarest of malignant bone tumors; it is commonly located in the middle or lower third of the diaphysis of the tibia. A case with multiple occurrences affecting both the tibia and fibula is presented. En bloc resection with wide operative margins was performed, and a large tibial defect of 23 cm was effectively bridged by a revascularized free fibular flap. At 13 months follow-up, there was no sign of local recurrence or metastasis, and the patient was mobile.     

83例6个月以下婴儿室间隔缺损的外科治疗

目的 总结外科手术治疗小婴儿期室间隔缺损(VSD)的临床经验.方法 对2000-2005年83例＜6月龄VSD患儿,年龄12 d至6(4.3±1.2)个月,体重3～6.5(5.1±0.8)kg.膜周部VSD 74例,干下型VSD 8例,膜周部并肌部VSD1例.术前中、重度肺动脉高压69例(83.1%).所有患儿均在浅低温体外循环下手术.结果 全组手术死亡4例,手术病死率为4.8%.术后主要并发症为肺动脉高压危象、肺部感染和心律失常.结论 随着麻醉、体外循环、手术技术和围术期监护处理措施的进步,在小婴儿期施行VSD的外科手术已成为安全的治疗方式.术后对肺高压的处理是手术成功的关键.     

心钠素对心肌血管钙超载的影响

提要本研究是在大鼠VD_3+Nicotine引起的心血管钙超载模型上观察心钠素(ANF)治疗(10ug ·kg~-1/d),对钙超载的影响。结果发现,钙超载组动物主动脉、心肌组织钙含量较对照组分别增高24倍(54.4±2.2vs 2.3±0.04fumol/gww)和9倍(16.9±2.1vs1.8±0.1umol/gww)。ANF治疗能显著抑制钙超载的发生,主动脉和心肌组织钙含量较钙超载组分别降低92％(3.8±0.4 umol/gww)和66％(5.6±0.6umol/gww)。离体滋流的钙超载血管环较对照组对去甲肾上腺素收缩反应增强;对乙酰胆碱舒张反应减弱,对硝普钠舒张反应无影响。ANF能显著改善钙超载所致的血管反应性障碍。实验结果表明,ANF具有显著的防治心血管钙超载的作用。     

骨外露及皮肤软组织缺损的修复

目的　评价和探讨修复骨外露及皮肤软组织缺损的各种方法 ,使其更好地用于临床。方法　 3 5例不同部位的骨外露分别采用皮片移植、皮瓣及肌皮瓣转移、皮瓣及肌皮瓣游离移植等方法 ,覆盖外露的骨面。结果　 3 1例全部存活 ,1例皮瓣部分坏死 ,2例创口延迟愈合 ,1例游离皮瓣失败。结论　对骨外露及皮肤软组织缺损应尽量在早期修复 ,最常用的方法是皮瓣及肌皮瓣的转移或移植。     

应用皮瓣移植修复足跟部皮肤软组织缺损

目的通过8种不同皮瓣的临床应用,总结足跟部皮肤软组织缺损的修复效果。方法采用了游离足背皮瓣、游离背阔肌皮瓣、游离肩胛皮瓣、桥式胫后动脉岛状皮瓣、桥式携带背阔肌皮瓣或桥式携带肩胛皮瓣、胫后动脉岛状皮瓣、胫后动脉皮支岛状皮瓣、跖底内侧动脉岛状皮瓣,对足跟部皮肤软组织缺损进行修复的临床应用。结果95块皮瓣修复足跟部皮肤软组织缺损,成活93块,成功率为97.9%。随访1～15年,治疗效果满意。结论应用皮瓣移植的方法,才能使足跟部皮肤软组织缺损得到有效的修复。     

鼻内窥镜下鼻中隔矫正术

目的 :研究鼻内窥镜下鼻中隔矫正术的优点。方法 :鼻内窥镜下鼻中隔矫正术 5 0例 ,同期施行传统的鼻中隔矫正术 5 0例作为对照 ,分析两者手术时间、术中出血量及疼痛情况。结果 :鼻内窥镜组治愈率为96% ,手术时间 ( 35 .5 0± 5 .2 0 ) min,术中出血量 ( 2 3.2 2± 4.2 5 ) ml,疼痛发生率为 1 6% ;传统手术组治愈率为 90 % ,手术时间 ( 4 5 .64± 6.34) min,术中出血量 ( 31 .34± 5 .64) ml,疼痛发生率为 38%。经统计学分析两组治愈率差异无显著性 ( P>0 .0 5 ) ,鼻内窥镜组手术时间明显缩短 ( P<0 .0 1 ) ,术中出血量明显减少 ( P<0 .0 5 ) ,术中疼痛发生率明显降低 ( P<0 .0 5 )。结论 :鼻内窥镜下鼻中隔矫正术照明好 ,术野清晰 ,直视下手术 ,易剥离粘连处和及时发现粘膜损伤 ,手术时间短 ,术中出血量少 ,疼痛轻 ,术后并发症少 ,特别是鼻中隔矫正同期完成功能性鼻内窥镜手术及歪鼻矫正手术时更显示其优越性     

应用膀胱三角区壁瓣成形尿道治疗女性外伤性尿道缺损(附5例报告)

目的：探讨膀胱三角区壁瓣成形尿道治疗女性外伤性尿道损伤的疗效。方法：自膀胱颈后唇向上，取梯字形壁瓣，形成锥状管，经膀胱颈口，自阴道前壁外拉至外阴部，在原尿道外口处固定，替代尿道。结果：3例随访8年，1例6年，1例5年，平均随访7年，均排尿通畅，无尿失禁和尿道狭窄。结论：女性外伤性尿道缺损，应用膀胱三角区壁瓣形成锥状管替代尿道法治疗，手术简单，对患者打击小，成功率高，远期效果好。     

No Correlation Between Atrial Natriuretic Peptide Concentrations and Echocardiographic Measurements of Left Atrial Size or Left Ventricular Size and Function in Patients with Persistent Atrial Fibrillation

Atrial fibrillation (AF) may be associated with activation of atrial natriuretic peptide (ANP). The exact trigger for the release of ANP is still being debated. Atrial volume, pressure, and wall stretch are considered to be the main determinants of ANP activation. The aim of the study was to evaluate plasma ANP concentrations in patients with persistent AF and to analyze the echocardiographic determinants of ANP concentration in this group. The study population included 67 patients, 59 ± 7 years of age, with a median AF duration of 5.5 months (range 0.1–12). The relationship between plasma ANP concentrations and echocardiographic left atrial (LA) diameter and volume, and left ventricular (LV) diameter and ejection fraction (EF) was analyzed by logistic regression analysis. The median baseline plasma ANP concentration was 63 pg/mL (range 21–126) in the study group versus 34 pg/mL (range 16–73) in a control group. The mean left antero-posterior atrial dimension, LA volume, LV enddiastolic diameter, and LVEF were 48 mm, 104 mL, 52 mm, and 54%, respectively. A significant linear positive correlation was found between plasma ANP concentration and maximal LA volume (r = 0.62, P < 0.01). A negative correlation was found between LVEF and plasma ANP concentration (r =−0.42, P = 0.01). However, by multivariate regression analysis, no echocardiographic parameter was an independent predictor of plasma ANP concentration. Plasma ANP concentrations were independent of echocardiographic measurements of LA size or LV size and function in patients with persistent AF.     

应用上唇外侧组织瓣旋转修复下唇缺损

目的:探求上唇外侧组织瓣在修复较大面积下唇缺损中的作用。方法:根据患者下唇缺损情况,设计上唇外侧组织瓣,旋转后插入缺损组织,同时在缺损吻合处,将上层外侧旋转瓣内侧粘膜肌肉向外牵拉形成部分新的红唇,然后逐层相对缝合,修复缺损。结果:自2003年1月应用此方法修复患者6例,术后随访1～2年,唇部外形好,无流涎,无口闭合不全,效果满意。