目的 总结桥式连接技术在漏斗胸手术中的应用价值.方法 回顾性分析首都医科大学附属北京儿童医院胸外科2018年7月至2021年1月收治的25例漏斗胸患儿临床资料,其中男21例,女4例;年龄10岁5个月至16岁9个月(平均年龄14岁4个月);Haller指数3.16～6.78(平均4.93);轻度1例(Haller指数＜3.2),中度2例(Haller指数3.2～3.5),重度18例(Haller指数3.5～6),极重度4例(Haller指数＞6).患儿均在胸腔镜辅助下行Nuss手术并采用桥式连接技术进行固定,总结并分析所有患儿一般资料、手术效果及并发症情况.结果 25例均顺利完成手术,无一例发生术中并发症.术后出现并发症3例,其中双侧胸腔积液1例(1/25,4％),于B超定位下穿刺抽液后缓解;桥式连接片螺母螺钉脱离2例(2/25,8％),均为单侧单个固定片螺母脱落,支架未出现移位,胸壁外观未受影响,脱落螺母于取支架手术时同期取出.取支架后进行手术效果评估,优良率100％,无一例复发.结论 桥式连接技术矫治儿童漏斗胸安全有效,可降低钢板移位风险,获得满意矫正效果.

Objective:To summarize the preliminary experiences of Da Vinci surgical robot for mediastinal tumor surgery and explore the feasibility and safety of robotic thoracic surgery in children.Methods:From March 2021 to April 2021, 26 children with mediastinal tumors underwent Da Vinci robot-assisted thoracoscopic tumor resection. There were 14 boys and 12 girls with a mean age of 7.5 years and a mean weight of 32.1 kg. The perioperative and follow-up conditions of tumor type, size, surgical incision, operative duration and intraoperative hemorrhage were analyzed.Results:All surgeries were completed successfully without intraoperative mortality. There were anterior mediastinal tumors (n=6), middle mediastinal tumors (n=3) and posterior mediastinal tumors (n=17). Pathological examinations hinted at neurogenic tumors (n=15), bronchogenic tumors (n=4), vascular tumors (n=3), teratomas (n=3) and rhabdomyosarcoma (n=1). One case was converted into thoracotomy due to intraoperative hemorrhage. The average longest diameter of tumor was 6.0 cm. Four (n=22) and three (n=4) incisions were made. The average total operative duration was 107.3 min, the average intraoperative blood loss 26.8 ml and the average hospital stay 7.1 days. During a follow-up period of 1-2 months, all children recovered well without recurrence.Conclusions:With some limitations, da Vinci surgical robot is both safe and feasible for mediastinal tumor surgery in children. However, surgeons should attain a technical proficiency for open surgery in case of emergency management.

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Objective:To explore the causes of perioperative complications in children with congenital pulmonary cystic disease undergoing thoracoscopy and discuss the methods of reducing the complications.Methods:From May 2012 to December 2019, clinical data were collected from 672 children with pulmonary cystic disease undergoing thoracoscopy.There were 418 boys and 254 girls with a median operative age of 14(1-189)months.The surgical approach of lobectomy or segmentectomy was selected according to disease extent.Postoperative routine electrocardiography(ECG)monitoring, percutaneous blood oxygen monitoring and low-flow oxygen inhalation for 24 h were implemented; a normal diet resumed at postoperative 6h; routine use of antibiotics based upon blood routine and clinical manifestations for adjusting medication; when drainage tube volume<50 ml/d, chest radiology indicated excellent pulmonary recruitment and there was no pneumothorax or effusion after removing thoracic drainage tube.Results:All operations were successful.The median operative duration was 56(10-260)min and the median intraoperative volume of blood loss 2(1-100)ml.Intraoperative hemorrhage(n=5, 0.7%), lymphatic leakage(n=1, 0.1%)and tracheal injury(n=1, 0.1%)occurred.And there were postoperative onsets of chylothorax(n=2, 0.3%), Horner syndrome(n=2, 0.3%)(including 1 case with diaphragmatic elevation at operated side), atelectasis(n=2, 0.3%), postoperative persistent air leakage(n=2, 0.3%)and residual lesions(n=3, 0.4%).Conclusions:Thoracoscopy is both safe and effective for congenital cystic disease in children.The risk of perioperative complications should be fully assessed and postoperative complications recognized early and managed promptly.

Objective:To summarize and analysis the clinical manifestations, pathological types and treatment of pediatric lung tumors in a single center.Methods:The data, including age, gender, operation time and intraoperative blood loss, of 170 children with pulmonary tumor undergoing surgical treatment from November 1989 to October 2021 was retrospectively analyzed.In descriptive analysis, counting data were described by frequency and composition ratio, while measurement data were described by median.Results:Among the included 170 children with lung tumors, there were 99 males and 71 females with the median age at diagnosis of 62 months (0.8-211 months).163 cases received lung tumors resection (100 cases of thoracotomy, 63 cases of laparoscopic surgery), including 5 cases of pneumonectomy (1 case on the left side, 4 cases on the right side) with the median operation time of 73 minutes (15-300 minutes), and median intraoperative blood loss of 10mL (2-500mL). In the resection group, there were 57 cases (57/170, 33.5%) of pleural pulmonary blastoma (PPB), 36 cases (36/170, 21.2%) of inflammatory myofibroblastoma (IMT), 47 cases (47/170, 27.6%) of pulmonary metastasis, and 30 cases (30/170, 17.6%) of other tumors.Conclusion:The clinical symptoms of pediatric lung tumors are not typical, imaging findings are not specific, and clinical diagnosis is difficult, and most of the tumors are malignant lesions, so early diagnosis and treatment are extremely important for prognosis.

目的 观察对比固定矫治和无托槽隐形矫治早期成人患者菌斑指数和龈上菌斑中三种致龋菌的变化,进而探索固定矫治和无托槽隐形矫治对牙体健康潜在的影响.方法 选择20名成年女性患者,分别接受固定矫治和无托槽隐形矫治.在矫治前,开始矫治后第1、3个月检查患者菌斑指数并采集上颌6颗前牙唇侧的龈上菌斑,利用实时荧光定量PCR技术检测龈上菌斑样本中三种致龋菌(变形链球菌、粘性放线菌、嗜酸性乳酸杆菌)的绝对和相对含量,然后进行组间组内不同时间点对比分析.结果 在3个月的观察期内,与矫治前相比固定组患者矫治后菌斑指数发生显著增大,而隐形组患者菌斑指数无显著增大,两组患者变形链球菌的数量均发生显著增长,而变形链球菌在总菌中的比例和其余两种致龋菌的数量及在总菌中的比例无显著增大.在不同时间点进行组间比较,结果显示两组间各观察指标均无明显差异.结论 相比无托槽隐形矫治,固定矫治器更不利于口腔卫生的维护.两种正畸方式在早期阶段均可能引起患者龋易感性增大,但二者对患者牙体健康的影响在早期无明显差异.

胰腺癌是恶性程度极高的消化道肿瘤之一,多数患者发现时已处于晚期且5年生存率极低,不足10％.目前临床诊疗策略仍以化疗为主,但疗效欠佳.90％的胰腺癌患者携带KRAS基因突变.鉴于KRAS基因改变与恶性肿瘤发生发展密切相关,近年来靶向KRAS基因的抗肿瘤药物成为研发热点,相应研究也取得了一定进展.本文就KRAS突变型胰腺癌的药物治疗研究进展进行综述,包括靶向治疗药物、免疫治疗药物、表观遗传学药物和抗代谢类肿瘤药物.

Objective:To summarize the clinical manifestations and surgical strategies of pediatric mediastinal teratoma (MT).Methods:156 cases of MT diagnosed with surgery and pathological results from January, 2012 to December, 2021 were recruited.There were 74 males and 82 females with the mean age of 6.25 years old (17 days-15.75 years). The patients' tumors located in the anterior mediastinum ( n=129), posterior mediastinum ( n=22, including 10 in vertebral canal), pericardium ( n=2), lung ( n=2), and esophagus ( n=1). Results:Clinical manifestations of the total 156 patients: cough ( n=79), chest pain ( n=45), chest tightness ( n=40), no symptoms ( n=10), lower limbs myasthenia ( n=4), hemoptysis ( n=2), chest wall deformity ( n=2), coughing up foreign body ( n=1), cardiac murmur ( n=1), and abdominal pain ( n=1). The procedures of tumor resection were performed via robotic surgery ( n=3, 1.9%), thoracoscopic surgery ( n=65, 41.7%), thoracoscopic surgery transfered to thoracotomy ( n=16, 10.3%), and thoracotomy ( n=72, 46.2%). All cases were confirmed with MT by postoperative pathological examination, of which 142 were mature teratoma, 14 were immature teratoma (including 7 cases of grade WHO Ⅰ, 2 cases of grade WHO Ⅱ, and 2 cases of grade WHO Ⅲ). The average follow-up time was 60 months (1-121 months), one patient suffered postoperative recurrence and received the second operation.There were 1 case of pericardial effusion, 2 cases of chylothorax, and 6 cases of diaphragmatic eventration after surgery. Conclusion:Pediatric MT has complex clinical symptoms and imaging features, which requires to combine the clinical manifestations with imaging findings of MRI, CT, ultrasound for accurate diagnosis.Complete excision of mature teratoma has a favorable prognosis.In summary, surgical treatment is a safe and effective method for children with MT.Early diagnosis and ideal surgery timing and treatment based on the clinical feature of the teratoma are the key to obtain good prognosis.

Objective:To summarize the clinical features, diagnosis and treatment experience of esophageal hamartoma in children.Methods:From December 2013 to December 2019, 3 cases of esophageal hamartoma were admitted to our hospital, and a retrospective analysis was conducted.Results:There were 1 male and 2 females, with an average age of 6.4 years old. The clinical manifestations were vomiting in 2 cases and dysphagia with esophageal foreign body sensation in 1 case. Esophagography, chest contrast-enhanced CT, and esophagoscopy showed esophageal stenosis or esophageal mass effectg, and esophageal dilatation above the affected segment. The tumor was found in upper esophagus in 1 case and lower esophagus in 2 cases. Tumors were complete resection in all 3 cases and the patients were discharged smoothly. All the 3 cases were followed up after surgery for 10-74 months(average 37 months), and 1 case had gastroesophageal reflux. No stenosis or recurrence was found in all the cases, and all the patients could eat normal diet.Conclusion:The main manifestations of esophageal hamartoma in children are vomiting and choking. Complete surgical resection is the main treatment method, and the prognosis is good.

目的 观察肝动脉栓塞化疗(TACE)联合索拉非尼在原发性肝癌治疗中的应用效果,以及其对患者免疫功能相关指标的影响.方法 回顾性分析首都医科大学附属北京潞河医院自2018年1月至2020年2月收治的84例原发性肝癌患者的临床资料.将患者随机分入TACE组和联合组,每组各42例.TACE组采用TACE方式进行治疗,联合组在TACE基础上联合索拉非尼进行治疗.比较两组的临床治疗有效率,治疗前后的免疫功能指标,以及不良反应发生率.结果 联合组临床治疗有效率高于TACE组,差异有统计学意义(P<0.05).治疗后,TACE组和联合组CD3+、CD4+、CD4/CD8水平均较治疗前升高,且联合组高于TACE组,差异有统计学意义(P<0.05);同时,CD8+水平较治疗前降低,且联合组低于TACE组,差异有统计学意义(P<0.05).联合组不良反应发生率低于TACE组,差异有统计学意义(P<0.05).结论 TACE联合索拉非尼治疗原发性肝癌安全有效,可增强患者免疫功能.

Objective:To review retrospectively clinical data of children with mediastinal lipoblastoma and lipoblastomatosis so as to provide guidance for clinical practices.Methods:From March 2007 to July 2019, the relevant clinical data of 30 children with mediastinal lipoblastoma and lipoblastomatosis were collected and their clinical manifestations, imaging features, treatment protocols, pathological features and prognosis analyzed. There were 19 boys and 11 girls with a median age of 2.9 (0.5-15.8) years. According to different surgical approaches, they were divided into two groups of thoracoscopy (n=14) and open surgery (n=16). The inter-group differences of operative duration, volume of intraoperative blood loss, indwelling duration of thoracic drainage tube and hospital stay were compared and rank sum test was utilized for statistical analysis.Results:There were cough (n=15), mediastinal neoplasm detected during routine physical examination (n=9), dyspnea (n=4), cervical mass (n=4) and Horner's syndrome (n=2). Tumors were located in upper mediastinum (n=11), posterior-upper mediastinum (n=6), posterior mediastinum (n=5), anterior mediastinum (n=3), anterior-upper mediastinum (n=3) and other locations (n=2). Preoperative examinations of computed tomography (CT) and magnetic resonance imaging (MRI) revealed an inhomogeneous mass with mixed density of fat and soft tissue. Surgery was performed for all children. The median operative duration was 72.5(25.0-230.0) min, the median volume of intraoperative blood loss 4(2-400) ml, the median duration of thoracic drainage tube 4(2-17) days and the median hospital stay 8(4-30) days. Postoperative pathology hinted at lipoblastoma (n=24) and lipoblastomatosis (n=6). The median volume of intraoperative blood loss, median operative duration and median postoperative hospital stay of two groups were 2(2-5) ml and 10(2-400) ml, 65(25-115) min and 77.5(60-230) min, 5.5(3-11) days and 7.0(5-23) days respectively. The former was less and shorter than the latter and the differences were statistically significant ( P<0.05). And 26 cases (86.7%) were followed up for a median period of 56.4(2-144) months. One recurrent case at Month 7 postoperatively was not re-operated for a lack of oppressive symptoms. The remainders recovered well and there was no malignant change or metastasis. Conclusions:Lipoblastoma and lipoblastomatosis in mediastinum are clinically rare. Imaging examination is an important auxiliary tool while pathological examination aids a definite diagnosis. Surgical resection is efficacious. Usually there is no need for combined postoperative chemotherapy or radiotherapy.

Objective:To explore the diagnosis and treatment of bronchopulmonary foregut malformation (BPFM).Methods:Clinical characteristics, diagnosis and treatment were reviewed for 17 BPFM children from October 2000 to June 2019. There were 10 boys and 7 girls with an average age of 3.22 (1/6-11) years. The clinical manifestations included cough (n=14), choking after eating (n=8), fever (n=5), chest pain (n=1) and hemoptysis (n=1). On enhanced computed tomography (CT), the sites of pulmonary sequestration were right lower (n=8), left lower (n=7), left upper (n=1) and right neck (n=1). It was intrapulmonary (n=13) and extrapulmonary (n=4). Detection was made by upper gastrointestinal contrast examination (n=11), ultrasonography (n=1) and operation (n=5). Pulmonary sequestration was associated with lower esophageal fistula (n=13), upper esophageal fistula (n=2) and gastric fistula (n=2).Results:The clinical types were ⅠB (n=1), Ⅱ (n=2) and Ⅲ (n=14). Except for one child giving up treatment, 16 cases were operated. The procedures included thoracoscopy (n=6), thoracotomy (n=9) and neck surgery (n=1). Lobectomy was performed for intrapulmonary pulmonary sequestration (n=8), extrapulmonary pulmonary pulmonary sequestration (n=4), hypoplastic lung (n=3) and intrapulmonary pulmonary sequestration (n=1). The amount of blood loss ranged from 2 to 60 ml. The operative duration was 50 to 200 min. One child abandoned treatment because of severe postoperative pneumonia. Postoperative esophageal fistula occurred in 1 case while the remainder had a decent prognosis without any complication.Conclusions:Early and accurate preoperative diagnosis is vital for selecting surgical approaches and predicating the prognosis of BPFM.

目的 探讨L型钙通道α1C亚单位蛋白在人类食管鳞状细胞癌组织中的表达及临床意义.方法 回顾性收集首都医科大学附属北京友谊医院并经病理证实的48组人食管鳞状细胞癌及配对癌旁组织标本,同时收集患者的临床病例资料,采用免疫组织化学方法检测食管鳞状细胞癌及配对癌旁组织中L型钙通道α1C亚单位蛋白的表达情况.根据食管鳞状细胞癌组织中α1C亚单位蛋白的表达水平分为阴性表达、弱阳性表达、中度阳性表达、强阳性表达,L型钙通道α1C亚单位在食管鳞状细胞癌、配对癌旁组织表达阳性率比较应用配对秩和检验,采用Pearsonχ2检验或连续性校正χ2检验进一步分析L型钙通道α1C亚单位蛋白的强阳性表达水平与食管鳞状细胞癌患者性别、年龄、肿瘤浸润深度、分化程度、淋巴结是否转移的相关性.结果 L型钙通道蛋白α1C亚单位蛋白在人食管鳞状细胞癌组织中的表达水平明显高于配对癌旁组织,免疫组织化学检测结果显示在肿瘤组织中,有66.67％(32/48)的病例呈强阳性表达;而在癌旁正常组织中,只有12.50％(6/48)的病例呈强阳性表达,两者比较差异有统计学意义(P<0.05).结果 表明L型钙通道蛋白α1C亚单位蛋白的强阳性表达与食管鳞状细胞癌淋巴结转移相关(P<0.05),但与患者的性别、年龄、肿瘤细胞的分化程度等无显著关联(P>0.05).结论 食管鳞状细胞癌组织中L型钙通道α1C亚单位的蛋白表达水平显著高于配对的癌旁组织,且强阳性表达与食管鳞状细胞癌淋巴结转移相关,提示L型钙通道α1C亚单位的过度活化可能是食管鳞状细胞癌发生中的一个重要分子事件,而L型钙通道α1C亚单位的高表达可作为食管鳞状细胞癌淋巴结转移标志.

Objective:To explore the clinical features, laparoscopic repairing and outcomes of children with Morgagni hernia (MH).Methods:From 2008 to December 2018, 24 MH children at a single pediatric hospital were retrospectively reviewed. Clinical presentations, surgical approaches and outcomes were evaluated. There were 17 boys and 7 girls with a median diagnostic age of 1.87(2/3-4) years. Associated anomalies were present in 12/17. Intraoperative hemorrhage, operative duration and postoperative hospitalization stay were compared between gasless laparoscopic and single-site umbilical laparoscopic groups.Results:The procedures were gasless laparoscopy (n=8), two-site umbilical laparoscopic repair (n=1) and single-site umbilical laparoscopic repair (n=15); The mean operative duration was (76.88±29.15) versus (31.47±13.44) min in gasless laparoscopic and single-site umbilical laparoscopic groups. And the difference was statistically significant ( P<0.05). The mean intraoperative hemorrhage was (2.00±1.31)versus 1.00 ml and the difference was significant ( P<0.05); the mean postoperative hospitalization length was (8.75±2.12) versus (4.80±0.86) days and the difference was statistically significant ( P<0.05). All children underwent full-thickness abdominal wall repair and none had a conversion into open surgery. Hernia sacs were not resected. Colon was the most commonly herniated organ. There was one recurrence in gasless laparoscopic group during a follow-up period of 2-122 months. Conclusions:Laparoscopic-assisted MH repair is a safe and effective treatment for single-site umbilical and full-thickness abdominal wall repair. This simple mini-invasive procedure is well-tolerated and worthy of a wider popularization.

目的 营养不良是恶性肿瘤患者常见的并发症之一,往往对患者的临床表现和疾病预后产生诸多不利影响.本研究旨在评估国人恶性肿瘤患者服用添加免疫营养素的肠内营养补充剂全优膳后的营养状态和生活质量变化.方法 本研究为前瞻性、单臂、开放标签、全国多中心的临床观察性研究.自2018年5月1日至2019年8月31日,按照统一的纳入和排除标准,参与的10家研究中心入组多种中晚期恶性肿瘤患者共206例,以特医食品全优膳作为营养补充制剂,推荐用量为每天2罐,持续服用30天.记录患者服用全优膳期间的实验室检查指标、营养状态评分以及生活质量评分等,统计分析患者的体重、体质量指数(BMI)、血红蛋白、前白蛋白、白蛋白、血脂水平、主观整体营养状况量表(PG-SGA)评分、QLQ-C30 V3.0评分、血清免疫球蛋白水平、依从性和不良反应发生情况.结果 服用全优膳30天后,患者的体重和BMI均有明显的增加(均P<0.05),PG-SGA评分状况明显好转,生活质量评分亦较前升高.患者血红蛋白、前白蛋白和白蛋白水平有所升高,但差异未达到统计学意义.发生率较高的不良事件依次为轻度恶心、腹泻和腹痛.结论 对于国人恶性肿瘤合并营养不良的患者,口服特医食品全优膳,具有良好的营养补充作用且耐受性好,值得在临床上进一步研究和推广应用.

目的 探讨内镜在以消化道症状为首发表现的腹型过敏性紫癜(HSP)中的应用价值,总结HSP临床特点及内镜特征,提高其诊疗水平.方法 回顾性收集首都医科大学附属北京友谊医院自2012年1月至2020年5月收治的32例以消化道症状为首发表现的腹型HSP患者的临床资料,其中成人患者23例,儿童患者9例;男性19例,女性13例.患者均完善血常规、尿常规、便常规、肝肾功能、电解质、白蛋白、C反应蛋白、凝血功能、胸片、腹盆CT等一般检查,以腹痛或消化道出血为主要症状的患者进行胃镜、结肠镜、小肠镜或胶囊内镜检查.结果 本研究中消化道症状最常见的是腹痛29例(90.6％),消化道出血13例(40.6％),腹泻9例(28.1％),恶心呕吐5例(15.6％),皮肤紫癜32例(100.0％).19例患者紫癜症状与消化道症状同时出现,13例晚于消化道症状4～13 d出现.实验室检查发现,血常规示血白细胞升高15例(46.9％),血红蛋白降低25例(78.1％),生化示白蛋白降低11例(34.3％),尿蛋白阳性13例(40.6％),血肌酐升高2例(6.25％),凝血示D二聚体升高28例(87.5％),B超或CT提示腹腔、盆腔积液10例(31.3％).内镜下的表现为黏膜充血水肿、红斑淤点、片状糜烂、浅表溃疡、点片状或弥漫性出血等,病灶呈多发性,不规则性,严重者出现环周黏膜病变,胃镜所见以十二指肠降部为多发、严重,结肠镜检查显示病变主要分布在回肠末端及直肠乙状结肠,溃疡性病变在回肠末端比直肠乙状结肠更常见.14例患者行内镜下病理活检,呈慢性炎14例(100.0％),伴炎性渗出物4例(28.6％),伴炎性肉芽组织增生3例(21.4％),伴嗜酸粒细胞浸润2例(14.3％).结论 腹型HSP的内镜表现以十二指肠降部、回肠末端最为常见,腹痛为最常见临床表现,结合内镜表现可提高该病认识,提高诊疗水平.

Objective:To explore the feasibility and safety of applying a sliding knot-tying technique for tensile tissue during diaphragmatic eventration surgery.Methods:Retrospective analysis was conducted for clinical data from June 2009 to December 2018. A total of 161 children of diaphragmatic eventration underwent mini-invasive thoracoscopic diaphragmatic plication. There were 116 boys and 45 girls with a mean age of 1.6(0.3-9) years. During surgery, an extracorporeal assisted technique of intracorporeal sliding knot-tying was employed. Follow-ups were conducted for observing the instances of knot loosening or recurrence.Results:All procedures were safely and successfully performed without serious complications or mortality. The mean knotting time was 36.1(26-69) seconds, the average operative duration 56.1(30-165) min, the average volume of blood loss 2(1.0-5.0) ml and the average hospital stay 7.6(5-18) days. After a follow-up period of 1 to 9 years, all children recovered well postoperatively without recurrence or knot loosening.Conclusions:Both safe and feasible, the above knotting method is suitable during mini-invasive procedures, especially for tensile tissue. With a short learning curve, it is ideal for surgeons with fundamental endoscopic skills.

目的 检测L型钙通道特异性阻滞剂硝苯地平、维拉帕米、地尔硫艹卓对食管鳞癌细胞系KYSE410、EC9706增殖和细胞周期的影响.方法 选择食管鳞癌细胞系KYSE410、EC9706,将细胞种植于96孔板培养24 h,然后加入不同浓度的L型钙通道特异性阻滞剂硝苯地平、维拉帕米、地尔硫艹卓共同孵育0、24、48、72 h,最后加入3-(4,5-二甲基噻唑-2)-2,5-二苯基四氮唑溴盐(MTT)并进行吸光度检测.采用流式细胞术方法了解L型钙通道特异性阻滞剂硝苯地平、维拉帕米、地尔硫艹卓对KYSE410、EC9706细胞周期的影响.结果 细胞培养结果表明,硝苯地平、维拉帕米和地尔硫艹卓对KYSE410、EC9706细胞株的增殖具有剂量依赖性,组间差异具有明显统计学意义(P<0.01).硝苯地平、维拉帕米、地尔硫艹卓对于EC9706细胞增殖抑制具有周期特异性特点,可将EC9706细胞停滞于G0/G1期,其抗增殖作用与细胞周期G 1期阻滞有关.结论 L型钙通道特异性阻滞剂硝苯地平、维拉帕米和地尔硫艹卓可通过阻滞L型钙通道从而抑制食管鳞癌细胞株KYSE410、EC9706的增殖,具有浓度依赖性特点,同时将细胞周期停滞于G 0/G1期,其抗增殖作用与细胞周期G1期阻滞有关.

Objective To evaluate the thoracic status of patients with funnel chest by quantitative evaluation of chest Xray,and to explore the effect of Nuss surgery.Methods From October 2006 to February 2011,according to the inclusion criteria,there were 47 cases enrolled our group at last,then divided the cases into 3 groups,including pre-operative of Nuss procedure,recent post-bar removal and further post-bar removal.We measured data on chest radiography and statistical analysis,including the maximal distance of the outer boundary of each rib pairs (C,from the 1 st pair to the 9th),the distance between lung apex to the costophrenic angle (H) and the distance between the two costophrenic angles(W).Results All the 47 cases completed the Nuss procedure and Nuss bar removal safely and effectively.All the patients were followed up from 30 to 36 months,without recurrence or long-term complications.Three groups of thoracic data showed an increasing trend,recent post-bar removal and further post-bar removal compared with the same age normal children,the thoracic data of the Nuss bar position were shortened.With the prolongation of time after Nuss bar removal,thoracic data gradually approaching normal.Conclusion We can evaluate the level of pectus excavatum and effect of Nuss procedure through measuring the chest wall data.The chest wall of post-bar removal was significantly improvement compared to the cases of pre-Nuss procedure.There is some restrictions on the thoracic by the Nuss bar.we learn that the limitation of thoracic can be improve after some time.

Objective To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique.Methods A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution,5 males and 3 females.The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20 (range 3.60-5.19).All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions.Results All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml).There was one patient suffered pneumothorax after operation.The patients were followed up for4 months to 13 years with an excellent and good outcome.Conclusion Sternal suspension technique is a safe and effective procedure for pectus excavatum.To improve the security and reduce the incidence of cardiac injury,sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease.