目的:探讨非小细胞肺癌(NSCLC)组织中着丝粒蛋白F(CENPF)、Krüppel样因子4(KLF4)表达与上皮-间质转化(EMT)和预后的关系.方法:选取2017年1月至2019年12月期间于泰州市第四人民医院行手术切除的120例NSCLC患者的癌组织和距癌组织5cm癌旁组织标本,采用免疫组织化学法和免疫印迹法检测癌组织和癌旁组织中CENPF、KLF4及ETM相关标志物[E-钙粘蛋白(E-cadherin)、波形蛋白(Vimentin)]的阳性表达率和表达量.采用Pearson检验分析CENPF、KLF4与EMT相关标志物的相关性,并分析CENPF、KLF4表达与NSCLC患者预后的关系.结果:NSCLC癌组织中CENPF、Vimentin的阳性表达率显著高于癌旁组织(均P＜0.05),而KLF4、E-cadherin的阳性表达率均显著低于癌旁组织(均P＜0.05).NSCLC癌组织中CENPF与E-cadherin 呈负相关,与 Vimentin 呈正相关(P＜0.05);而 KLF4 与 E-cadherin 呈正相关,与 Vimentin 呈负相关(P＜0.05).NSCLC 癌组织中CENPF、KLF4的阳性表达率与TNM分期和淋巴结转移有关(均P＜0.05).入组患者3年无病生存率(DFS)为60.00％.CENPF阳性表达的NSCLC患者3年DFS显著低于CENPF阴性表达患者(56.25％vs 75.00％,P=0.014),KLF4阳性表达的NSCLC患者3年DFS显著高于KLF4阴性表达患者(68.75％vs54.17％,P=0.048).结论:CENPF的高表达及KLF4的低表达可促进NSCLC的EMT发生、进展,并导致患者预后不良,CENPF和KLF4可辅助预测NSCLC患者的预后.

目的 探索左心瓣膜置换术后再次胸腔镜下右胸小切口心脏不停跳下行三尖瓣手术的治疗效果.方法 2018年5月～2020年7月我院收治的胸腔镜辅助下右胸小切口行三尖瓣成形或置换的再次手术病人28例,9例病人接受三尖瓣成形术,19例接受三尖瓣置换术.所有病人均使用全麻双腔气管插管,右侧抬高位,右侧锁骨中线至右侧腋前线第4肋间5 cm切口为主操作孔,右侧腋中线第5肋间1 cm切口为观察孔,通过股动静脉插管建立体外循环,所有三尖瓣手术均在心脏不停跳下完成.结果 所有手术均在外周体外循环支持、心脏不停跳下进行,无术中转正中切口,术中无股动静脉插管并发症.体外循环时间(78±15)分钟,术后ICU拔除气管插管时间(20.3±8.6)小时,术后住院时间(8.5±3.0)天.围手术期死亡1例,该病人三尖瓣置换术后出现急性肾功能衰竭合并肺部感染,其余病人术后恢复良好.随访12～30个月,术后均存活,心功能均较术前有明显改善.结论 左心瓣膜置换术后再次胸腔镜下右胸小切口行三尖瓣手术是安全可行的优选手术方式.胸腔镜下右胸小切口可简化手术过程,降低术后死亡率及术后并发症发生率.

Background: Overexpression of human epidermal factor receptor 2 (HER2) is seen in 15-20% of breast cancer and results in more aggressive clinical behavior and poor prognosis. This study (ChiCTR2000030618) analyzed the efficacy and safety of pyrotinib plus trastuzumab and nab-paclitaxel in patients with previously untreated HER2-positive locally recurrent or metastatic breast cancer.Methods: Patients with previously untreated HER2-positive locally recurrent or metastatic breast cancer received pyrotinib (400 mg, qd), trastuzumab (H, 8 mg/kg loading dose, followed by 6 mg/kg every 3 weeks) and nab-paclitaxel (260 mg/m² every 3 weeks) until disease progression or an unacceptable adverse event (AE). The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and AEs.Results: A total of 28 patients (median age: 55.5 years [28-78]) were enrolled from April 2020 to June 2021. All 28 patients (100%) had Eastern Cooperative Oncology Group performance status of 1. The metastatic sites were in brain (14.29%), liver (25.00%), bone (28.57%) and lung (53.57%). HR+ and HR- for primary tumor accounted for 57.14% and 42.86%, respectively. Trastuzumab was previously administered in the (neo)adjuvant setting to 17(60.71%) patients. Eight patients with measurable lesions were evaluable for response. 5 (62.50%) patients had partial response (PR) and 3 (37.50%) patients achieved stable disease (SD), resulting in an ORR of 62.50% and DCR of 100.00%. Median PFS has not yet been reached. Twenty-one patients were included in the safety assessments. The most common AE was diarrhea (85.71%), but only 3 (14.29%) patients reported Grade ≥ 3 diarrhea which could be well controlled. The median onset of diarrhea was 1.5 days after start of treatment and the median duration was 9 days. Most diarrhea events were reported during the first cycle of treatment and the frequency persistently declined in the following cycles. Moreover, the AEs of all grades that were documented in ≥20% of patients included leukopenia (28.57%), anemia (23.81%), thrombocytopenia (19.05%), γ-glutamyltransferase increased (19.05%), vomiting (19.05%), rash (19.05%) and alanine aminotransferase increased (19.05%). No treatment-related deaths were reported.Conclusion: Pyrotinib plus trastuzumab and nab-paclitaxel showed promising efficacy in first-line HER2-positive breast cancer and were well tolerated. More data would be analyzed and reported in the future. Citation Format: Hui Xie, Wei Li, Yufeng Yao, Sujie Ni, Tongbo Yi, Jinling Cheng, Qi Fang, Lei Zhang, Jun Zhou, Xiaohong Wu, Chunbin Wang, Yanan Zhang, Jianwei Qin, Qing Shao, Tao Zhao, Xiaohong Huang, Lingyun Xu. First-line pyrotinib plus trastuzumab and nab-paclitaxel for patients with HER2-positive advanced breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-41.

目的:探讨左心瓣膜术后再发三尖瓣重度关闭不全行全胸腔镜下三尖瓣置换的近期临床疗效,与经右胸小切口技术的临床结果进行比较.方法:2018年1月-2020年12月回顾性分析南京医科大学第一附属医院50例左心瓣膜术后出现三尖瓣重度关闭不全患者的临床资料.采用心脏不停跳技术,并根据手术方式的不同分为行全胸腔镜组(24例)及经右胸小切口组(26例).对比两组术中体外循环(cardiopulmonary bypass,CPB)时间,手术时间、24h引流量、呼吸机使用时间、术后住院时间,以及术后并发症.结果:全腔镜组和小切口组各1例住院30 d死亡,两组差异无统计学意义.全胸腔镜组CPB时间较小切口组稍长,但两组差异无统计学意义(P＞0.05).全胸腔镜组在手术时间、术后住院时间,均显著小于小切口组.术后随访1～36个月,全胸腔镜组术后三尖瓣无瓣周漏及传导阻滞,小切口组1例瓣周漏,术后心功能恢复两组无明显差异.结论:全胸腔镜下心脏不停跳再次三尖瓣置换近期疗效满意,和小切口三尖瓣置换相比较,具有创伤小、恢复快的特点,是左心瓣膜术后再次三尖瓣置换的重要治疗方式.

目的 比较Del Nido心脏停搏液与冷含血停搏液在复杂心脏手术中的心肌保护效果.方法 回顾性分析2018年1月至2019年10月体外循环(CPB)下行复杂心脏手术(主动脉阻断时间＞120 min)75例患者的病例资料,按照使用的心肌保护液不同将其分为Del Nido停搏液组37例和冷含血停搏液组38例.收集两组患者身体质量指数(BMI)、术前及术后射血分数(EF)、体外循环时间、主动脉阻断时间、后并行时间、停搏液灌注次数及总量、两组心脏的自动复跳率、除颤率、术后24h和术后48 h血清肌钙蛋白(cTnT)和肌酸磷酸激酶同工酶(CKMB)浓度,术后机械通气时间、ICU滞留时间、术后住院时间、术后正性肌力药物使用天数、术后肝肾功能等临床资料.结果 两组患者均顺利完成手术.A组的后并行时间、停搏液灌注次数、除颤率明显低于B组,差异有统计学意义(P＜0.05,P＜0.01).A组术后24 h、48 h CKMB、cTnT水平较B组明显降低,差异有统计学意义(P ＜0.05,P＜0.01).结论 Del Nido心脏停搏液与冷含血停搏液相比,在复杂心脏手术中,前者灌注次数更少,除颤率更低,后并行时间更短,术后24 h、48 h CKMB、cTnT水平明显降低,心肌保护效果要优于冷含血停跳液.Del Nido心脏停搏液在复杂心脏手术中的临床应用是安全可行的.

OBJECTIVES:Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect.METHODS:Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups.RESULTS:The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups.CONCLUSIONS:TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.

目的 比较Del Nido停搏液、HTK停搏液与改良St.Thomas停搏液三种不同心肌保护液在心脏瓣膜置换术中的心肌保护效果.方法 回顾性分析2016年1月至2018年12月行体外循环(CPB)下瓣膜置换术的120例患者的临床资料,按照使用心肌保护液的不同分为三组:Del Nido停搏液组40例患者,HTK停搏液组40例患者,改良St.Thomas停搏液组40例患者.收集CPB时间、主动脉阻断时间、停搏液灌注次数、自动复跳率、除颤率、术后24h和术后72 h外周血肌钙蛋白Ⅰ(cTnⅠ)和肌酸磷酸激酶同工酶(CK-MB)浓度、术后正性肌力药使用天数、气管插管时间、人住重症监护室时间、术后住院天数、停跳液治疗费用、术后射血分数(EF)等临床资料.结果 三组患者性别、年龄、体重、术前射血分数等基本资料差异无统计学意义(P＞0.05);三组患者均顺利完成瓣膜置换手术.三组体外循环时间、自动复跳率、血液指标、气管插管时间、入住重症监护室时间、术后住院天数差异无统计学意义.与改良St.Thomas停搏液组相比,Del Nido停搏液组、HTK停搏液组灌注次数均明显减少,主动脉阻断时间缩短,除颤率降低,差异具有统计学意义.与HTK停搏液组相比,Del Nido停搏液组治疗费用明显降低.结论 DelNido停搏液具有与HTK停搏液同样的心肌保护效果,且治疗费用更低,易于配制,与改良St.Thomas停搏液相比,前两者阻断时间缩短,灌注次数减少,除颤率明显降低;Del Nido停搏液在成人心脏瓣膜手术中的临床应用是安全可行的.

目的 总结复杂型主动脉缩窄的临床特点和外科治疗经验.方法 回顾性分析2010年1月至2017年6月经超声心动图及CT血管造影确诊、采用一期手术矫治的15例复杂型主动脉缩窄患者的临床资料.患者均在体外循环下先行心内畸形矫治,然后采用选择性脑灌注或者深低温停循环,切除缩窄段后端端吻合术矫治主动脉缩窄,本组患者弓部-降主动脉直接吻合7例,升主动脉-降主动脉人工血管旁路5例,升主动脉-腹主动脉人工血管旁路2例,缩窄段人工血管补片扩大成形1例.分析其临床表现、治疗方法及转归.结果 手术经过顺利,术后早期死亡1例,死于心力衰竭;因术野渗血多延迟关胸1例;术后二次开胸手术止血1例;透析1例.14例均获得随访,随访时间11个月至8年,平均随访49个月.患者上、下肢血压差均小于20 mm Hg(1 mm Hg =0.133 kPa),2例成人患者术后需长期服用抗高血压药,超声心动图和CT血管造影检查显示人工血管血流通畅,吻合口无假性动脉瘤形成.结论 根据复杂型主动脉缩窄患者的临床特点,选择个体化的治疗方案,一期手术安全、有效.

ABSTRACTNon‐small‐cell lung cancer (NSCLC) is one of the most common human malignancies. Amentoflavone (AF) is one of bioflavonoid compounds isolated from Selaginella tamariscina Spring. This study was designed to examine the effect of AF on NSCLC. Our results indicated that AF decreased cell viability of both H1299 and H358 cells. Colony formation assay also showed that AF was able to suppress the anchorage‐independent growth of NSCLC cells. AF also triggered cell cycle arrest by downregulating cyclin D1, CDK4, and CDK6. The pro‐apoptotic activity of AF was confirmed by Hoechst staining and flow cytometry. The effect of AF on activation of caspase‐3, upregulation of Bax, and downregulation of Bcl‐2 was examined by western blot. The anti‐growth and pro‐apoptotic activities of AF were further validated in xenograft murine model. iTRAQ assay showed that cancerous inhibitor of PP2A (CIP2A) expression was markedly downregulated by AF treatment in H1299 cells. In addition, qRT‐PCR and western blot also showed that AF was able to dose‐dependently inhibit CIP2A expression. Meanwhile, the activity of protein phosphatase 2A (PP2A) was enhanced by AF treatment. The mRNA and protein expression of CIP2A as well as PP2A activity in xenograft tumor tissue were examined, which indicated that the in vivo anticancer activity of AF was associated with downregulation of CIP2A and reactivation of PP2A. Moreover, our results showed that the anti‐growth and pro‐apoptotic activities of AF were augmented by CIP2A knockdown and attenuated by ectopic CIP2A expression. Our results indicated that AF exhibited anticancer activity in NSCLC by targeting CIP2A. Anat Rec, 302:2201–2210, 2019. © 2019 American Association for Anatomy

目的 比较置入三尖瓣成形环及三尖瓣人工瓣膜治疗功能性重度三尖瓣关闭不全(TR)的早期及晚期效果.方法 回顾性分析2008年1月至2013年1月合并左心系统瓣膜病变的功能性TR患者80例,所有患者均于左心系统手术同时保持心脏停搏下行三尖瓣手术,其中38例(47.5％)行三尖瓣置换术(TVR)为换瓣组,42例(52.5％)行三尖瓣成形环术(TVr)为成形环组.比较两组围手术期和术后5年治疗效果,术后5年随访中度及以上TR复发率.结果 两组术前左心系统瓣膜病变中,换瓣组二尖瓣病变少于成形环组,双瓣病变多于成形环组(P＜0.05,P＜0.01).术前超声评估TR均为重度.术中换瓣组主动脉阻断时间明显长于成形环组(P=0.004).两组术后2周右心房舒张期左右径(RAD)、右心室收缩期内径(RVD)及肺动脉收缩压(PASP)较术前均有改善(P均＜0.05),左心射血分数(LVEF)与术前比较差异均无统计学意义(P均＞0.05).完成术后5年随访者,换瓣组31例,成形环组40例,其中换瓣组死亡2例,死亡原因为抗凝并发症;成形环组死亡1例,死亡原因为感染性心内膜炎继发右心衰;三尖瓣中度及以上反流复发率换瓣组明显低于成形环组,差异有统计学意义(6.5％ vs32.5％,P=0.009).换瓣组PASP均优于成形环组(P＜0.01).结论 与TVr相比,TVR在功能性重度TR患者治疗中有可接受的近期和远期的效果.对于不适合行TVr的患者,TVR是有效的选择.

目的 探讨射血分数(EF)<40％瓣膜病患者的外科治疗.方法 选取该科2012年1月至2017年12月行手术治疗的75例低EF瓣膜病患者作为研究对象,总结手术及围手术期处理要点.所有患者均采取全身麻醉低温体外循环手术治疗.结果 围手术期死亡6例,其余患者随访3～75个月,6例失访,2例患者在随访期内死亡,获随访的61例患者心功能均明显改善,1年随访EF为(48.2±5.1)％,左心室舒张末期内径(60.7±2.1)mm.结论 充分的术前准备,良好的心肌保护,正确的术式选择及迅捷的手术,术后围手术期管理的加强,均是低EF瓣膜病患者外科治疗成功的关键.

目的:探索微创胸骨上段J型小切口行主动脉瓣置换术的安全可行性以及临床优势.方法:回顾性分析20例胸骨上段J型小切口行主动脉瓣置换和同期20例传统胸骨正中切口主动脉瓣置换术患者资料,对比两组术中升主动脉阻断时间,转机时间,手术时间、术后引流量、胸管拔除时间、术后拔出气管插管时间、术后出院时间以及住院费用.结果:两组均无手术死亡,两组术中升主动脉阻断时间、体外循环时间及手术时间无显著性差异.与传统正中切口相比,胸骨上段J型小切口术后第1天引流量及术后总引流量减少,胸管拔除时间更早,术后拔出气管插管时间更早,术后住院天数明显缩短,住院整体费用明显降低.结论:胸骨上段J型小切口主动脉瓣置换术是安全可行的手术方式.

目的 探讨磁共振成像(MRI)引导下射频消融术对乳腺癌的临床应用.方法 11例经穿刺病理确诊的晚期乳腺癌患者,经4～6周期化疗或内分泌治疗及靶向治疗等综合治疗后乳腺残留病灶难以进一步缩小,影像学检查乳腺仍残存病灶,再次穿刺病理活检证实有活性肿瘤组织细胞残存.随机对乳腺残存病灶行射频消融治疗.术后3、6、12个月进行临床及影像学随访.结果 本组11例患者都顺利完成射频消融治疗,仅1例发生皮肤局部烧伤.MRI检查示肿瘤病灶均发生坏死,瘤内血供消失,无强化区.皮肤烧伤患者,经对症处理,2个月后烧伤痊愈.1年后检查显示乳腺病灶模糊或者消失.乳腺病灶全部达到完全缓解,有效率为100％.术后随访12～24个月所有患者均生存.结论 MRI引导下射频消融术对乳腺癌安全有效.

Objective To investigate the clinical efficacy and prognosis of bipolar radiofrequency ablation for atrial fibrillation in patients with cardiac valve disease.Methods Sixty patients with atrial fibrillation and valvular heart diseases who merely underwent cardiac valve surgery were selected as the control group,and seventy-five patients who underwent bipolar radiofrequency ablation modified Maze procedure along with concomitant cardiac valve surgery were selected as the observation group.The perioperative technological characteristics and postoperative restoration of sinus rhythm in different time-points of the two groups were retrospectively analyzed.Results There was no significant differences in terms of the surgical pathway and types of replaced cardiac valves (P ＞ 0.05),but the cardiopulmonary bypass time and aortic-cross clamping time of the observation group were significantly longer than those in the control group(P ＞ 0.05).Successful restoration of sinus rhythm in the observation group was significantly higher than that of the control group 3 months,6 months,and 1 year after operation respectively.Conclusion Bipolar radiofrequency ablation modified Maze procedure along with concomitant cardiac valve surgery is clinically effective during the short term for the patients with atrial fibrillation and valvular heart diseases.

Objective To evaluate the efficacy of interventional MRI in radiofrequency ablation (RFA)of breast cancer.Methods 12 patients with breast carcinoma proven by core-needle biopsy-were enrolled in this study.Among them, 7 patients were in phase Ⅳ(6 with lung metastasis, 1 with bone metastasis),and 5 patients were in phase Ⅲ(all of them rejected the surgical operation because of various contraindications,including severe hypertension,diabetes mellitus,liver or kidney dysfunction,and advanced age).Moreover, all of the tumor size could not be further shrunk after medical treatment (such as 4-6 cycles chemotherapy, endocrine therapy or targeted therapy).Additionally,breast lesions were still remained to be confirmed by imaging examination and biopsy pathology.Then the tumor and surrounding breast tissue were ablated with radiofrequency,followed by clinical follow-up and imaging examination after 1, 3, 6 and 12 months.Results All the patients completed 18 times RFA treatment.MRI showed that all the tumor lesions were necrotic, blood supply was disappeared and therewas no enhancement.Radiographic examination showed the original breast lesions were fuzzy or disappeared.All the tumors were achieved complete remission (CR) examined by imaging,and the effective rate was 100%.All the postoperative patients survived 1 year according to the follow-up data.Conclusion Interventional MRI is safe and effective method in the radiofrequency ablation of breast cancer.

Objective: This study aims to investigate the expression, biological function and associated mechanisms of miR-106b in the breast cancer. Methods: We collected 53 fresh tumor samples from patients with breast cancer to detect miR-106b expression by qRT-PCR method. Through transfection of miR-106b mimics into MCF-7 cells, the effects on the proliferation, cell cycle, invasion and metastasis were checked by CCK-8 assay, Transwell migration assay, and Flow cytometry methods, respectively. The potential target gene sex determining region Y box 4 (SOX4) was detected in MCF-7 cells after over-expressing miR-106b. The dual luciferase assay was used to validate that SOX4 was directly targeted by miR-106b through complementary binding to 3’UTR of mRNA sequence. Results: MiR-106b expression was significantly decreased in tumor tissues of breast cancer, and the expression level was negatively correlated with the clinical staging. MiR-106b expression was lower in tumor tissues with lymph node metastasis than in tumor without lymph node metastasis. Results in vitro showed that miR-106b inhibited the proliferation, invasion and metastasis of MCF breast cancer cells. SOX4 protein expression was down-regulated after over-expression of miR-106b. The results from dual luciferase assay further validated that miR-106b directly targeted SOX4 to regulate its expression. Conclusion: MiR-106b expression was significantly down-regulated in breast cancer tumor cells, which was also associated with lymph node metastasis and clinical stages. Through directly down-regulating SOX4 expression, miR-106b plays as tumor suppressor gene to inhibit the proliferation, invasion and metastasis of MCF cells.

Objective: This study is to investigate the expression of miRNA-433 in tumor tissues, circulating tumor cells and mammary gland of patients with breast cancer, and to investigate the mechanism of infiltration and invasion of breast cancer. Methods: From January 2013 to March 2015, blood and breast duct fluid specimen were collected from 56 patients with breast cancer. Blood and breast duct fluid specimen from 31 patients without breast cancer were collected as the control group. Breast cancer tumor specimens were collected and peritumoral tissues were also collected as a negative control group; Circulating cell sorting kit was used to collect and count the circulating tumor cell in the blood. The qRT-PCR was used to detect miRNA-433 and metastasis-associated in colon cancer 1 (MACC1) mRNA. Western Blot and ELISA were performed to detect level of MACC1 protein. Results: Compared with the control groups, the circulating tumor cells in the blood of patients with breast cancer were significantly increased (P < 0.05). The expression of MACC1 mRNA and MACC1 protein in tumor tissues, mononuclear cells in the blood and breast duct fluid were significantly up-regulated (P < 0.05). However, the expression of miRNA-433 was significantly down regulated in these samples (P < 0.05). Conclusions: MACC1 expression increase may be related to the expression of miRNA-433. MiRNA-433 may regulate the infiltration and invasion of breast cancer by MACC1. Especially, miRNA-433 in circulating tumor cells may become a marker of breast cancer.

目的 总结风湿性二尖瓣狭窄伴主动脉瓣关闭不全合并低左心室射血分数(LVEF)的外科治疗效果.方法 回顾性分析32例风湿性二尖瓣狭窄伴主动脉瓣关闭不全合并低LVEF患者的临床资料,比较手术前后左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、肺动脉收缩压(PASP)及LVEF变化.结果 32例患者中,术后死亡1例.其余患者术后LAD、LVEDD、LVSDD及PASP均较术前缩小(P＜0.01),LVEF较术前明显改善(P＜0.05).结论 风湿性二尖瓣狭窄伴主动脉瓣关闭不全合并低LVEF的患者可行外科治疗,疗效满意.