目的 探讨低剂量CT结肠成像(LDCTC)筛查结直肠癌及癌前病变的价值.方法 纳入筛查104例,问卷调查表参考中国结直肠癌早诊早治专家共识2020版,筛查流程参考中国结直肠癌早期筛查流程专家共识意见2019版.高危人群在肠道清洁准备后做LDCTC,完成后即刻行肠镜检查.结果 104例中80例完成问卷筛查,顺应性为76.9％,35例一般人群粪便隐血筛查后有4例高危人群,2例完成肠镜复筛,复筛顺应性为50％.47例高危人群中结直肠癌3例占6.4％,息肉9例占19.1％,其中腺瘤6例占12.8％.LDCTC筛查结直肠占位性病变的灵敏度是77％,特异度为94％,Kappa值为0.73.结论 在普通人群中76.9％的愿意接受结直肠癌的问卷筛查,一般人群中粪便隐血实验转高危人群占11.4％,而高危人群中发现结直肠癌的概率是6.4％,发现息肉病变的概率是19.1％,LDCTC和肠镜筛查结直肠癌的一致性较好,可以作为结直肠癌的有效筛查方式之一.

Background The situation of the COVID-19 outbreak in the border areas of China and Vietnam is complex, and its progress may affect the willingness of urban and rural residents to receive the vaccine. Objective This study aims to understand the influence of the COVID-19 epidemic situation on the willingness of urban and rural residents in China-Vietnam border areas to get vaccinated and the factors that affect the vaccinations. Methods A cross-sectional survey was conducted in Hani-Yi Autonomous Prefecture of Honghe, a border area between China and Vietnam, using online and paper questionnaires from April 1 to June 4, 2021. A total of 8849 valid questionnaires were surveyed to compare the differences in the willingness of urban and rural residents to receive the COVID-19 vaccine. Single factor analysis and multivariate logistic regression analysis were used to explore the influence of the epidemic situation on the willingness to be vaccinated. Results In the border areas between China and Vietnam in Yunnan Province, both urban and rural residents had a high willingness (> 90%) to receive the COVID-19 vaccination, with a higher level of willingness in urban than in rural areas and a higher willingness among residents aged ≥ 56 years. Rural residents mainly concerned about the vaccination were different from urban residents ( p < 0.05). About 54.8% of urban respondents and 59.2% of rural respondents indicated that their willingness to get COVID-19 vaccine would be affected by new COVID-19 cases. Respondents who were divorced, had an occupation other than farming, had contraindications to vaccination, were concerned about the safety of vaccines and worried about virus mutation, thought that the epidemic situation would not affect their willingness to get vaccinated ( p < 0.05). Conclusion The prevention and control of epidemics in border areas is of considerable importance. It is necessary to conduct targeted health education and vaccine knowledge popularization among urban and rural residents to increase the vaccination rate and consolidate the epidemic prevention and control at the border.

目的 探讨我国西南边疆高原地区红河哈尼族彝族自治州世居彝族冠心病危险因素及血生化的临界值.方法 选取红河哈尼族彝族自治州各县市2014年1月～2020年9月于红河州滇南中心医院住院经冠状动脉造影检查确诊的世居彝族冠心病患者222例纳入冠心病组,选取同期于该院住院的世居彝族非冠心病患者222例纳入非冠心病组,收集两组患者的基本信息、临床诊断、冠状动脉造影结果及血液生化指标,计算血浆致动脉硬化指数(atherogenic index of plasma,AIP),采用多因素Logistic回归分析探讨影响彝族冠心病发病的危险因素,并绘制受试者操作特征曲线.结果 低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、空腹血糖(fasting blood glucose,FBG)、高血压、糖尿病均为彝族冠心病患者的独立危险因素(均P<0.05),AIP降低为彝族冠心病患者的保护因素(P<0.05);校正年龄、性别、血糖、血脂等危险因素后,同时合并高血压与糖尿病的彝族人群患冠心病的风险是无高血压和糖尿病人群的2.4倍(OR=2.437,95％CI:1.592～3.729,P<0.05).入院时LDL-C与FBG水平预测彝族冠心病发生的曲线下面积分别为0.597和0.652,敏感度分别为45.0％和49.1％,特异性分别为71.2％和78.4％.结论 高血压、糖尿病、LDL-C、FBG均是边疆高原地区彝族冠心病的危险因素,严格防控糖尿病和高血压,及早干预异常的LDL-C、FBG水平可能对冠心病的预防有积极意义.

目的 用冠脉造影检查评估重复住院冠心病患者二次住院的原因及影响因素,以指导临床诊疗决策、减少重复住院.方法 回顾性分析2013年1月至2019年12月主因心血管病初次住院并行冠脉造影/冠脉介入治疗的冠心病患者316例(初次住院组),按照性别1:1匹配,连续收集同期因心血管病二次重返住院且行冠脉造影检查/冠脉介入治疗的冠心病患者316例(二次住院组),每组男性235例,女性81例,男女比2.9:1.2组平均年龄为(59.45±10.09)岁、(60.47±10.16)岁,二次住院的平均间隔时间为(14.30±11.67)月,其中首次确诊冠心病且行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)者265例,占83.9％.结果 2次住院,2组患者LDL-C、TG、糖尿病史,抽烟史、饮酒史、首次发病临床诊断、各支血管(RCA、LAD、LCX)病变严重程度(Gensini积分)、各支血管放置支架情况差异有统计学意义(P<0.05),二次住院组患糖尿病的比例增多,差异有统计学意义(P<0.05).多因素Logistic回归分析显示LDL-C控制不达标,达标率低(13.6％、31.0％)为影响冠心病患者二次住院的独立危险因素(OR=1.985,95％CI 1.506～2.617);RCA、LM/LAD、LCX放置支架是冠心病患者二次住院的保护因素[(OR=0.304,95％CI 0.144～0.642)、(OR=0.184,95％CI 0.099～0.343)、(OR=0.228,95％CI 0.123～0.424),P<0.05];相对于首次发病诊断为ST段抬高型心梗(STEMI)者,积极的血运重建治疗为二次住院再次诊断为稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、非ST段抬高型心梗(NSTEMI)再住院的保护性因素[(OR=0.071,95％CI 0.031～0.163)、(OR=0.294,95％CI 0.117～0.743)、(OR=0.323,95％CI 0.117～0.888),P<0.05];而年龄、TC、HDL-C、Cre、BUN、UA、FPG水平、高血压及各支冠脉血管病变数,差异无统计学意义(P>0.05).结论 冠心病患者严格控制LDL-C水平达标,有效防控糖尿病的进展,积极地对首次住院时严重病变的冠脉血管行有效的血运重建可减少二次住院的发生.

目的:了解新型冠状病毒肺炎疫情期间影响医师及护士(医护人员)抗击疫情的主要因素,为疫情防控提供策略.方法:用网络问卷与Likert五分量表法定量评价三级医院医护人员795例,探讨影响医护人员疫情防控的疾病认知情况、防护行为、家庭支持及防控信念等相关因素,根据疫情对医护人员工作、生活、学习及心理健康总体影响程度,分为影响程度非常大组453例和影响程度不大/较小组342例,比较两组相关影响因素的差异性,并进一步作logistic多因素回归分析探寻主要影响因素.结果:医护人员工作生活及心理健康受影响的程度与疫情的进展速度、疾病传染强度、疫情防控能力、害怕自身被感染程度成正相关(r=0.237、0.253、0.351、0.408,P均<0.001),与自己及家人防护措施程度、家属对自己工作的支持程度、战胜疫情的信心及学历成负相关(r=-0.135、-0.070,-0.118、-0.161、-0.093,P均<0.001);医护人员支持"抗疫"的行为、参与抗疫情的意愿、宣传并纠正错误谣言的行为、到疫区战疫情的意愿与疫情造成的严重影响程度成正相关(r=0.194、0.220、0.208,0.175,P均<0.001),与不同性别、不同年龄段、不同职称间无相关性;Logistic多因素回归分析显示,医护人员害怕感染[优势比(OR)=1.408,95％可信区间(CI):1.066～1.860,P=0.016)]是应对传染病疫情的主要影响因素.结论:加强医护人员对疫情相关知识的储备、提升其心理应对能力、保障防疫物资供给、关注医护人员心理健康状态、强化医护人员社会家庭支持对提升医护人员应对重大传染病疫情据有重要意义.

目的 探讨CT测量腹部脂肪相关参数对诊断冠心病的价值.方法 对211例疑诊冠心病患者于30天内行冠状动脉造影及腹部CT平扫,分析冠心病发生危险因素,采用ROC曲线观察各危险因素单独及联合诊断冠心病的效能.结果 211例中,经冠状动脉造影明确诊断冠心病112例,非冠心病99例.单因素分析结果显示,冠心病与非冠心病患者间年龄、性别、吸烟、糖尿病、高血压、高密度脂蛋白胆固醇(HDL-C)、内脏脂肪(VAT)面积、皮下脂肪(SAT)面积及VAT面积/SAT面积(VAT/SAT)差异均有统计学意义(P均＜0.05),体质量指数(BMI)、腹围(WC)及腹部总脂肪(TAT)面积差异均无统计学意义(P均＞0.05).多元Logistic回归分析结果显示,年龄、吸烟、糖尿病及VAT/SAT为冠心病独立危险因素(P均＜0.01).ROC曲线显示年龄、吸烟、糖尿病及VAT/SAT诊断冠心病的AUC分别为0.67、0.61、0.62及0.73,4者联合的AUC为0.80,高于各参数单独检测(P均＜0.05).结论 CT测量的腹部脂肪相关参数可用于诊断冠心病.

Objective:To evaluate the safety and efficacy of limited segmental resection (LSR) combined with enucleation and/or ablation for multiple colorectal liver metastases.Methods:The clinical data of 42 patients with colorectal liver metastases who underwent LSR combined with enucleation and/or ablation in our department form Jan 2012 to Dec 2017 were retrospectively reviewed. The surgical procedures, clinical data and outcomes were calculated and analyzed.Results:All the patients were undergone the operations according to the previous plan successfully. The procedures included LSR combined with enucleation (n=21), with radiofrequency ablation (n=4), with enucleation and radiofrequency ablation (n=17). The average of operation time was (232.5±147.8)min, and the volumes of intraoperative blood loss were (304.2±151.4)ml. 121 lesions were resected. The resection margin in 88% of all patients was ≥1 mm. The morbidity rat was 12%. There was not liver failure and perioperative dead in all patients. The times of diseases-free survival time was 29 mon(95% CI: 22.7-35.3 mon). The 1-, and 5-years overall survival rate were 83% and 45% respectively. Conclusions:LSR combined with enucleation and ablation is safe and effective technique for multiple colorectal liver metastases patients. It could not only retain residual functional liver volume to the maximum but alsoget radical rection.

目的 探讨术前多层螺旋CT(MSCT)对Stanford B型主动脉夹层血管腔内修复术后早期死亡的预测价值.方法 回顾性分析2014年1月至2018年12月采用腔内修复术治疗的158例急性期和亚急性期Stanford B型主动脉夹层患者临床随访资料和术前MSCT图像.测量和记录破口位置、破口大小、降主动脉最大直径、气管分叉平面主动脉直径、气管分叉平面假腔面积占该平面主动脉管腔总面积百分比、重要分支血管受累情况、假腔状态、腹主动脉是否受累等CT参数.分析术前CT各参数与患者术后30 d死亡的关系.结果 腔内修复术紧急干预88例,非紧急干预70例,术后30 d死亡率为9.5％(15/158).术后30 d死亡单因素分析显示,紧急干预患者术后30 d死亡率显著高于非紧急干预患者[13.6％(12/88)对4.3％(3/70),x2=3.967,P=0.046];术后30 d死亡组患者气管分叉平面假腔面积占该平面主动脉管腔总面积≥50％患者[93.3％(14/15)对0.7％(1/143),x2=135.581,P＜0.001]和重要分支血管受累患者[66.7％(10/15)对32.9％(47/143),x2=6.725,P=0.010]显著高于术后30 d生存组患者;两组患者破口位置、破口大小、降主动脉最大直径、气管分叉平面主动脉直径、假腔状态、腹主动脉是否受累比较,差异无统计学意义(P＞0.05).Logistic回归多因素分析显示,紧急干预(OR=1.31,95％CI=1.08～3.53,P=0.026)和气管分叉平面假腔面积占该平面主动脉管腔总面积≥50％(OR=9.53,95％CI=3.69～12.47,P＜0.001)是Stanford B型主动脉夹层腔内修复术后30 d死亡的独立危险因素.结论 术前MSCT对预测Stanford B型主动脉夹层腔内修复术后患者早期死亡具有重要价值,紧急干预和气管分叉平面假腔面积占主动脉管腔总面积≥50％是术后30d死亡的独立危险因素.

目的 分析CT对主动脉瓣置换术后继发夹层的影像表现.提高对该病的认识,指导临床手术方式的选择.方法 回顾性分析11例主动脉瓣置换术后再发夹层病例的临床及CT检查资料.结果 8例为单纯AVR术后,2例为主动脉瓣置换术后并冠状动脉搭桥术后,1例为主动脉瓣、二尖瓣置换术后;主动脉瓣置换术后复查CT时间4月～11年不等.CTA显示9例为Stanford A型夹层,2例为Stanford B型夹层;11例均出现升主动脉不同程度扩张,扩张严重处内径达89mm;1例夹层近段累及左、右冠状动脉开口;3例主动脉弓上三分叉血管不同程度受累;6例腹腔血管不同程度受累.结论 主动脉瓣置换术后继发夹层重在预防,对于升主动脉扩张大于4cm者应积极行升主动脉置换.

BACKGROUND: Induced pluripotent stem cells are a type of reprogrammed cells with similar characteristics to embryonic stem cells, which are capable of differentiating into phenotypes associated with patient specific diseases. Moreover, their clinical application avoids ethical issues. OBJECTIVE: To review the research progress of induced pluripotent stem cells in myocardial regeneration and repair, cardiovascular disease models, drug development and screening, and drug toxicity testing. METHODS: PubMed (2006-2018) and CNKI (2013-2018) databases were retrieved for relevant articles using the keywords of "induction of pluripotent stem cells; myocardial infarction; arrhythmia; cardiovascular disease; heart failure; heart transplantation; disease model; drug toxicity" in English and Chinese, respectively. The data were reviewed one by one, and the citations involved in the literatures were also reviewed. RESULTS AND CONCLUSION: Induced pluripotent stem cells have great potential value in myocardial regeneration and repair, establishment of cardiovascular disease models, new drug development and screening, and drug toxicity detection. The application prospect of the cells is broad, but most of the research is still in the experimental stage. In addition, safety problems, such as low induction efficiency and tumorigenicity, will limit the clinical application of induced pluripotent stem cells.

Objective To summarize and analyze the characteristics and differences of coronary angiography (CAG) findings in coronary artery disease patients of various age groups to help make decision-making for clinical diagnosis and treatment. Methods A retrospective analysis was made on 2742 patients who underwent CAG at the Fifth Affiliated Hospital of Kunming Medical University/Hong-He Central Hospital of Southern Yunnan from January 2013 to December 2016. The patients were divided into a youth group [n=126; age, 18-40 years; mean age, (35.10±4.91) years], middle-aged group [n=1774; age, 41-65 years; mean age, (55.00±6.60) years], and old age group [n=842; age, ≥66 years; mean age, (71.68±4.49) years]. The self-developed CAG Epidata database was used to collect basic information and the data for coronary artery lesions, including the lesion characteristics of the left main coronary artery (LM), left anterior descending branch (LAD), left circumflex branch (LCX), and each vessel of the right coronary artery (RCA), TIMI blood flow, placement of stents, and surgery. Gensini score was calculated according to the American Heart Association′s evaluation criteria for coronary stenosis. Results The composition ratios of patients in the young, middle-aged, and elderly groups were 4.6%, 64.7%, and 30.7%, respectively, with middle-aged and elderly patients accounting for the highest proportion (95.4%). The ratios of males (84.1%, 65.8%, 58.7%), age [(35.10±4.91) years, (55.00±6.60) years, (71.68±4.49) years], LM lesions (0.8%, 5.4%, 12.4%), RCA lesions (38.9%, 62.5%, 77.7%), LAD lesions (55.6%, 81.0%, 92.2%), and LCX lesions (23.0%, 52.5%, 71.1%) differed significantly among the three groups (P 0.05). The percentages of patients with grade 3 TIMI blood flow in RCA, LAD, and LCX lesions [RCA: 61.1%, 86.0%, 84.9%; LAD: 54.8%, 75.2%, 82.5%; LCX: 75.4%, 47.9%, 62.6%, grade 0 TIMI blood flow in LAD lesions (15.1%, 7.7%, 7.6%), grade 1 TIMI blood flow in LCX lesions (1.6%, 0.3%, 1.7%), and grade 2 TIMI blood flow in LCX lesions (15.9%, 1.5%, 2.0%) differed significantly among the three groups (P 0.05). Conclusion Coronary lesions are different in different age groups. The incidence of coronary artery lesions increases with age. The ratios of LM, RCA, LAD and LCX coronary lesions as well as the percentages of patients with diffuse lesions, calcification lesions, collateral circulation, and severe lesions differ significantly in different age groups. Gensini score increases with age. Patients of different ages have the highest rate of LAD lesions among different arteries. LCX lesions have the most significant difference in grades 1 and 2 TIMI blood flow. Key words: Different ages; Coronary angiography; Characteristics of coronary lesions; TIMI blood flow grading; Gensini score

Objective To explore the safety and efficacy of localized anatomical segmental resection (LASR) in the treatment of patients with centrally located large hepatocellular carcinoma (HCC). Methods Clinical data of 34 patients with centrally located large HCC underwent LASR in the First Affiliated Hospital of Kunming Medical University between January 2011 and January 2016 were analyzed retrospectively. There were 30 males and 4 females, aged from 36-68 and with a median age of 53 years old. All the patients were with graded A liver function by Child-Pugh Classification, and 31 were complicated with cirrhosis. The informed consents of all patients were obtained and the local ethical committee approval was received. The porta hepatis was dissected first in all patients. The portal vein and left primary and right secondary branches of hepatic artery were suspended respectively. Corresponding vessels were cut off or clamped according to the extent of planned resection, the ischemic line was determined and the liver was resected by ultrasonic scalpel with clamping technique. Results All patients underwent LASR as scheduled, and no perioperative death occurred. The mean length of operation was (233±48) min. The intraoperative blood loss was (304±151) ml. Four patients received blood transfusion during the operation. The postoperative overall incidence of complications was 24%(8/34), including 1 case of liver failure who was cured with conservative treatments. All patients were followed up for 12-60 months, during which recurrence or metastasis occurred in 24 patients. The median disease-free survival time was 29 months, and the 1, 5-year overall survival was 83% and 45%. Conclusions LASR is safe and effective in the treatment of patients with centrally located large HCC, especially for patients with cirrhosis, and it can reduce the incidence of liver failure and operative mortality.

Objective:To investigate changes of serum cardiac tropnin T/I in ESRD patients in different hemodialysis mode,assess the myocardial injury and the difference among the different hemodialysis mode.Methods:We recruited 160 MHD patients in this blood purification center,and 40 normal individuals as the controls.The MHD patients were divided into four groups:who in A-group were treated five times in two weeks in standard dialysis,in B-group were treated two times weekly in standard dialysis,in C-group were treated three time weekly in standard dialysis,and in D-group were treated more than two times weekly hemofiltration.Serum cTnT/I,myohemoglobin (Myo),serum Creatine (sCr),serum high-sensitivity C-reactive protein (hs-CRP),creatine kinase (CK),creatine kinase MB (CKMB)and Doppler Echocardiography were measured.Results:1 .Serum cTnT was significantly higher (P<0.05)in all MHD patients than in the control,which was considered statistically significant.2.Serum cTnI in A-group and B-group was significantly higher (P<0.05)than in the control,which was considered statistically significant,too.But,Serum cTnI in C-group and D-group failed to be significantly higher than the control(P>0.05).3.There were no difference of Serum cTnT/I in all MHD patients be-tween the groups(P>0.05).4.Serum cTnT/I was positively correlated with hs-CRP,LVMI,CK-MB,Myo,Hb level (P<0.05),whereas the EF was negatively correlated with Serum cTnT/I(P<0.05).Conclusion:1.We can observe that myocardium impairments were prevalent in MHD patients by the serum cardiac tropnin T/I measurement.The sensitivity of cTnT is higher than that of cTnI,which significantly elevated in insufficient hemodi-alysis patients.2.There were no significance in different hemodialysis mode.3.When the MHD patients in micro-inflammation,anemia,left cardiac hypertrophy and dysfunction,there were significant myocardium impairments.

肝切除术经历了不同的手术发展阶段,目前认为精准肝切除是新的肝脏外科理念.传统的影像学检查不能满足精确术前评估要求.利用计算机辅助肝脏及肝内管道结构的三维重建并进行虚拟手术是目前研究热点之一[1].本文对行肝切除手术患者进行三维可视化重建,据此进行术前评估,观察三维重建在肝切除术中的临床应用效果.

Objective To explore the dual-source CT diagnostic value of complex congenital heart disease .Methods Retro-spective analysis of 31 cases of complex congenital heart disease dual-source CT and echocardiographic images .Results The di-agnosis accuracy of DSCT and ECHO in diagnosing cardiac anomaly were 87.8%(29/33) and 97%(32/33) respectively, two groups has no statistical difference (χ2 =0.866, P >0.05).The accuracy of DSCT and ECHO in diagnosing cardiovascular fit-ting and peripheral vascular anomaly were 97.9%(48/49) and 71%(35/49) respectively, the difference of two groups was sta-tistical significant (χ2 =11.335, P <O.05).The diagnosis accuracy of all the lesions in DSCT and ECHO were 93.9%(77/82) and 81.7%(67/82).The difference was statistical significant (χ2 =5.694, P <0.05).Conclusion DSCT is better than ECHO in diagnosing for peripheral vascular abnomaly .

Objective The aim of this study was to explore the clinical value of dual-source CT(DSCT)in the diagnosis of coronary artery fistula(CAF)before and after surgery. Methods A retrospective analysis was performed in 15 cases of patients with CAF,11 cases of which was treated by surgery during extracorporeal circulation. Results CAF arose from right coronary artery in 8 cases and left coronary artery in 7 cases,with the latter including 3 cases of ramus nodi sinuatrialis fistula,2 cases of anterior descending branch fistula,and 2 cases of left circumflex fistula. CAF entered into right atrium(6 cases),right ventricle(5 cases),left ventricle(4 cases)and left atrium(1 case). There were dilatation of coronary artery in 8 cases,localized aneurysm in 4 cases,normal coronary artery in 3 cases,single fistula orifice in 11 cases,and multiple fistula orifice in 4 cases. 11 patients underwent surgery under cardiopulmonary bypass(CPB).The postoperative imaging revealed fistula has been sutured in 10 patients with no residual fistula,including fistula vascular ligation in 3 cases,the proximal imaging and distal occlusion in right coronary artery angioplasty in 1 case,and pseudo diverticulum in 2 cases. Conclusion DSCT examination has significant value in preoperative diagnosis and postoperative follow-up for CAF.

Objective To investigate the CT imaging features and differential diagnosis of anterior mediostinum tumors , so that to improve the correct diagnostic rate .Methods The clinical manifestation and CT image characteristics of 39 ca‐ses of anterior mediastinum tumors confirmed by surgery and pathology ,were retrospectively analyzed .Results In all 39 cases of anterior mediastinum tumors ,there were thymoma in 14 cases (2 cases of invasive thymoma ,12 cases of noninva‐sive thymoma) ,thymic cyst in 4 cases ,thymic carcinoma in 6 cases (2 cases of small cell carcinoma ,3 cases of squamous cell carcinoma ,1 case of carcinoid tumor ) ,teratoma in 6 cases ,germ cell tumor in 5 cases ,lymphoma in 4 cases .Conclu‐sion CT examination for anterior mediastinum tumor types and benign or malignant judgment has a high accuracy ,it can also display the location and extent of the tumor .The imaging features have important values for making the treatment plan and evaluating the prognosis .

Hepatolithiasis is one of the most prevalent benign biliary tract diseases in Southwest China, and surgery is the optimal treatment for this disease. However, hepatolithiasis has insidious onset and complicated course, as well as high rate of residual stones and recurrence and high incidence of cholangiocarcinoma after operation, and some patients undergo surgery several times due to inappropriate initial therapeutic strategy, resulting in more severe condition and more difficult treatment. Therefore, initial surgical treatment is the key to the short-term and long-term outcomes of hepatolithiasis. For previously untreated patients, comprehensive diagnosis and adequate disease assessment, standardized and individualized therapeutic strategy, and appropriate operation time are warranted, the procedures based on hepatic segments and hepatic lobes are preferred, and the choledochoscope and B-mode ultrasound should be properly used during the operation, so as to resect the lesions, prevent recurrence, and reduce the reoperation rate.

目的 评价双源CT对改良Cabrol术治疗前后的应用价值.方法 回顾性分析11例升主动脉病变合并主动脉瓣关闭不全患者行Cabrol术前及术后双源CT检查的影像资料.结果 术前11例均显示升主动脉不同程度扩张,主动脉瓣关闭不全、左室扩大;7例为升主动脉瘤合并主动脉瓣关闭不全;4例为Standford A型夹层动脉瘤,合并主动脉瓣关闭不全.7例中有1例可见主动脉瓣二叶畸形;2例显示冠脉轻度狭窄;1例为主动脉瓣钙化并赘生物形成,累及右冠开口.4例夹层中1例显示右冠窦内膜撕裂,有冠起于假腔.术后CTA显示主动脉瓣置换,升主动脉为人造血管代替,人造血管周围血栓机化;人造血管与左、右冠脉开口分别吻合后与带瓣管道吻合.6例可见自体升主动脉瘤壁包绕人造血管与右心耳内转流,其中1例可见瓣周瘘,1例行右冠搭桥术.4例夹层术后可见主动脉弓降部象鼻支架植入.结论 双源CT心胸联合扫描在Cabrol术治疗前后的评价中有非常重要的价值.