腹腔镜下肾蒂的显微解剖学研究

目的 为腹腔镜活体取肾术提供解剖学依据,同时也为人体体质学积累资料.方法 模拟腹腔镜活体取肾术,对30例成人防腐尸体左右肾蒂的长度、左右肾蒂内侧端、外侧端、中1/2处的外径及其结构、左右肾蒂的长轴与腹主动脉、下腔静脉的长轴的下夹角进行了观测.结果 左右肾蒂的长度平均分别为44.3、20.1 mm,左肾蒂内侧端、外侧端、中1/2处的外径平均分别为23.2、25.7、20.4 mm,右肾蒂内侧端、外侧端、中1/2处的外径平均分别为 16.7、22.9、15.6 mm,左右肾蒂长轴与腹主动脉、下腔静脉长轴的下夹角平均分别为68.5°、80.7°.结论 明确肾蒂内的血管位置关系更有利于腹腔镜取肾术的开展.     

CTA显示肠系膜上动脉起始段解剖的价值及临床意义

目的 探讨CTA对肠系膜上动脉（SMA）起始段解剖的价值及临床意义。方法 对21例正常患者和4例胡桃夹现象患者的腹部螺旋CT动脉期及延迟期图像进行矢状位重组,测量SMA与腹主动脉的夹角、左肾静脉层面SMA后壁与腹主动脉前壁的距离以及左肾静脉最小前后径并观测左侧精索或卵巢静脉是否扩张。结果 本组21例正常人及4例胡桃夹现象患者均行MIP、MPR、VR后处理,均清晰显示SMA起始段走行,及与左肾静脉、腹主动脉之间的立体血管解剖关系;21例正常人左肾静脉均走行于腹主动脉前方、SMA后方,未见左肾静脉近段及左侧精索静脉或卵巢静脉扩张;SMA与腹主动脉夹角为51.5~98.7°（71.4±14.2）°、左肾静脉层面SMA后壁与腹主动脉前壁的距离为9.0~22.3mm（13.7±4.5）mm、左肾静脉最小前后径为4.0~10.3mm（6.9±1.2）mm。4例胡桃夹现象患者SMA与腹主动脉夹角均明显变小,分别为25.7°、26.3°、28.5°、29.3°,左肾静脉层面SMA后壁与腹主动脉前壁的距离分别为3.7mm、2.6mm、5.0mm、4.1mm、左肾静脉最小前后径分别为1.9mm、2.2mm、3.4mm、3.1mm,均显示左肾静脉近段及左侧精索静脉或卵巢静脉扩张。统计学显示胡桃夹现象患者SMA与腹主动脉夹角、左肾静脉层面SMA后壁与腹主动脉前壁的距离、左肾静脉最小前后径与正常人比较差异均有显著性（P＜0.05）。结论 多层螺旋CTA可清晰显示SMA起始段、腹主动脉与左肾静脉之间的解剖关系;CTA对诊断胡桃夹现象具有可靠的客观依据。     

经股肾上腺静脉插管术的应用解剖

35例成人尸体左肾上腺静脉均为一支,其中97.1％汇入左肾静静,外径为4.45±0.95mm;右肾上腺静脉一支者有34例,其中77.7％汇入下腔静脉,外径为3.45±0.85mm。经右股静脉至左、右肾上腺静脉的长度分别为284.60±16.58mm和310.82±30.57mm。左肾上腺静脉与左肾静脉的夹角为121°29′±18°50′,左肾静脉与下腔静脉之夹角为78°37′±15°51′。     

右肾双肾动脉1例

笔者在制作标本过程中发现右肾肾动脉供应异常,现报道如下。男尸,约5 0岁,身高1 75cm ,右肾动脉分肾上、下动脉,直接起自腹主动脉。肾上动脉在第1、2腰椎间盘高度起于腹主动脉右侧壁,经下腔静脉、肾静脉后方,横行向右,至肾门外侧3 5cm处分为前后两支,其中后支直接经肾门入肾,前支至肾门外侧2 5cm处又分为上、下两支,进入肾门上端。肾上动脉全长6 3cm ,近、远侧端压扁径分别为0 8cm、0 75cm ,其前、后支近、远侧端压扁径分别为0 4cm、0 38cm ,前上、下支近、远侧端压扁径分别为0 2cm、0 1 8cm。肾下动脉于第4腰椎高度起于腹主动脉前壁…     

肾的矢状断面解剖学研究

在３０套成年男性腹部连续矢状断层标本上，左、右肾的绝对出现范围在正中矢状断面左、右侧各３．７～７．３ｃｍ之间；肾上腺不贴附于肾的上面，而居其前内上方；左肾大于右肾；左、右肾的后仰角分别为１６．１±７．９°和１９．６±１０．０°；还对左、右肾在连续矢状断面上的毗邻、肾门和肾蒂进行了探讨。     

左肾静脉受压及血流动力学变化与精索静脉曲张的关系

目的探讨精索静脉曲张与左肾静脉受压的关系,以及左肾静脉血流动力学的变化。方法精索静脉曲张病人28例,健康志愿者10例,测量肠系膜上动脉与腹主动脉夹角处及远侧的左肾静脉内径,多普勒血流频谱测量上述两处的血流速度。结果:精索静脉曲张病人肠系膜上动脉与腹主动脉夹角处左肾静脉内径(0.275±0.107cm)明显小于对照组(0.374±0.100cm)(P<0.01),该处血流速度(87.0±29.8cm/s)明显高于对照组(65.0±22.8cm/s)(P<0.05);远侧左肾静脉内径(0.991±0.196cm)明显大于对照组(0.783±0.113cm)(P<0.01),该处血流速度(14.8±2.8cm/s)明显低于对照组(18.3±4.6cm/s)(P<0.01)。结论精索静脉曲张病人存在左肾静脉受压,导致血流受阻而减慢。     

肾的矢状断面解剖学研究

在３０套成年男性部连续矢状断层标本上，左，右肾的绝对出现范围在正中矢状断面左，右侧各３．７～７．３ｃｍ之间，肾上腺不贴附于肾的上面，而居其前内上方；左肾大于右肾，左，右肾的后仰角分别为１６．１±７．９°和１９．６±１０．０°；还对左，右肾在连续矢状断面上的毗邻，肾门和肾蒂进行了探讨。     

左位下腔静脉合并右肾静脉变异 1 例

笔者在解剖 1 具成年女尸时,发现其下腔静脉左侧变异,现报道如下。 1 一般资料 该具成年女尸下腔静脉由左、右髂总静脉在腹主动脉分叉(分为左、右髂总动脉)的左后方合成,约平第 5 腰椎下缘水平沿腹主动脉左侧上行,根据其从下向上走行,下腔静脉分为左侧段、斜行段和右侧段 3 部分。下腔静脉上行至第 1 腰椎下缘水平,斜行穿越过腹主动脉的前方移行为斜行段,此段长约 4.7 cm,在腹主动脉的右侧与右肾静脉汇合后入肝脏面的腔静脉窝。腹主动脉位置、走行均属正常。下腔静脉在腹腔内的行程属右侧异位,部分下腔静脉的属支也相应发生了变化：(1)左肾静脉在第2腰椎处平行于左肾动脉的下方直角注入下腔静脉,而右肾静脉在第 2 腰椎水平行于右肾动脉的上方,上升 2.6 cm 后,以锐角汇入下腔静脉;(2)左侧卵巢静脉横径 0.8 cm 注入下腔静脉,而右侧卵巢静脉横径 1.0 cm 却注入右肾静脉,这两条静脉均与正常相反的位置回流,这种变异很可能与下腔静脉的移位有关。同时左右肾的位置和左右输尿管过骼血管的位置也发生了与正常相反的变化。左肾下端低于右肾下端 1.5 cm,左肾位于第 12 胸椎至第 3 腰椎体之间,右肾上端平第 11 胸椎,下端平第 2 腰椎体。左输尿管过骼外动脉起始处进入盆腔,右侧输尿管则过骼总动脉的末端进入盆腔。两肾门的位置均属正常,约与第1腰椎平齐,左肾明显缩小平右肾。肾上腺形态位置属正常。     

彩超诊断左肾静脉压迫综合征

左肾静脉压迫综合征临床上又称为"胡桃夹"现象.解剖上起自腹主动脉的肠系膜上动脉及腹主动脉间构成45～60°夹角而后注入下腔静脉.正常时此夹角处被肠系膜脂肪、淋巴结及腹膜等充塞,而防止左肾静脉受压.     

左侧睾丸动脉变异1例

某男尸,约35岁,标本显示腹后壁腹膜后隙。解剖肾蒂时发现左侧睾丸动脉起始及近段变异:左睾丸动脉与到达左肾上腺的动脉小支共同以一短干起始于左肾动脉与主动脉腹部交界处的上角,起始后的短干与左肾动脉约呈45°。此动脉自短干起始后在左肾静脉末端上后面斜向左上方并穿过主动脉肾神经节向下形成了一纤维环,行至距左肾静脉上缘8mm处斜向左下方,逐渐下行至左肾静脉的前面距肾门11mm处下行,继续内     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.