活体肾上腺血管的解剖观测及临床意义

目的：研究活体肾上腺血管的应用解剖。方法：对１８例２４侧肾上腺手术时分离出血管，测量血管外径及长度，对６个完整肾上腺灌注染色。结果：右膈下动脉从下腔静脉右缘至末支肾上腺上动脉长８．５（７．５～１１．０）ｃｍ，外径２．５～３．０ｍｍ；左膈下动脉从腹主动脉左缘至末支肾上腺上动脉长８．０（７．０～９．０）ｃｍ，外径２．５～３．１ｍｍ；肾上腺上动脉１～６支，均源于膈下动脉。肾上腺中动脉右侧长１．７～２．２ｃｍ，外径１．０～１．５ｍｍ；左侧长１．５～２．０ｃｍ，外径１．０～１．５ｍｍ。肾上腺下动脉两侧基本相同，长１．５～２．０ｃｍ，外径１．０～２．０ｍｍ。肾上腺中心静脉右侧长０．４～０．８ｃｍ，左侧长３．０～４．０ｃｍ，外径３．０～４．０ｍｍ。结论：肾上腺血管加部分膈下血管的长度可供带血管蒂肾上腺转位治疗柯兴氏病；活体切取供移植的肾上腺；选择性肾上腺血管造影等。     

前锯肌下部肌皮瓣移植的应用解剖

目的：为前锯肌下部肌皮瓣移植提供解剖学基础。方法：在２５具（５０侧）成人尸体标本上，对前锯肌下部的形态、血供和神经支配进行了应用解剖学观测。结果：前锯肌下部的血供主要来自胸背动脉的前锯肌支，外径１．３±０．２ｍｍ，伴行静脉外径１．５±０．２ｍｍ，长４．９±１．１ｃｍ；由胸长神经支配，其横径为１．７±０．４ｍｍ，神经干长７．７±１．４ｃｍ。结论：以胸背血管及前锯肌支为血管蒂和胸长神经为蒂可切取前锯肌下部１２．０ｃｍ×９．０ｃｍ的肌皮瓣，修复较大创面或重建肌动力     

大鼠肝、肾、胰器官簇移植的解剖基础研究

目的：为大鼠肝、肾、胰器官簇移植的开展提供解剖学基础。方法：35只大鼠显微镜下解剖观察肝肾、胰主要血管、胆管、胰管、输尿管的分布及其形态规律。结果：35只大鼠腹主动脉、肝上下腔静脉、肝下下腔静脉直径分别为（2．2±0．4）mm、（8．8±0．6）mm、（7．8±0．6）mm；肝、肾、胰血管细小（〈0．3mm．1．0±0．2mm，〈0．2mm）；肝动脉、胰腺血管有变异（分别为6／35、6／35）；采用腹主动脉、下腔静脉可以完成器官簇的移植手术。结论：肝、肾、胰器官簇移植在解剖学上比单一器官移植更简单，为大鼠肝、肾、胰器官簇移植手术模型建立提供了解剖学基础。     

腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

腓骨上段移植重建第1跖骨的解剖学基础

目的：为腓骨上段移植重建第１跖骨提供解剖学依据。方法：在３０具骨骼标本上,对腓骨上段及第１跖骨进行形态学测量。结果：腓骨上段、第１跖骨形态比较,横径：腓骨头为（２．１±０．３）ｃｍ,跖骨头为（２．１±０．２）ｃｍ;腓骨颈为（１．１±０．１）ｃｍ,跖骨体为（１．４±０．１）ｃｍ。长度：腓骨头为（２．２±０．３）ｃｍ,跖骨头为（ １．５ ± ０．２）ｃｍ。矢状径：腓骨头为（２．６ ± ０． ３）ｃｍ,跖骨头为（ １． ９ ± ０． ２）ｃｍ。跖骨长度为（５． ８ ± ０． ３）ｃｍ。结论：腓骨上段与第１跖骨形态相似,设计带血管的腓骨上段移植重建第１跖骨具有可行性,临床已应用４２例,效果满意。     

桡动脉-冠状动脉旁路移植术的应用解剖

目的：为桡动脉与冠状动脉搭桥术提供解剖学基础。方法：２７具成人尸体,上肢标本（其中左侧２７侧;右侧２５侧）,分别进行解剖观察及测量,可作为冠状动脉搭桥术的桡动脉长度、外径。结果：①桡动脉左侧长（１０．３ ±１．２）ｃｍ;右侧长（１０．２ ±１．２）ｃｍ。②左侧上、中、下段外径分别为：（４．２ ± ０．８）ｍｍ;（４． １± ０．８）ｍｍ;（４．０ ± ０．８）ｍｍ。右侧上、中、下段外径分别为：（４．２ ± ０．９）ｍｍ;（４．１ ± ０．９）ｍｍ;（４．５ ± ０．８）ｍｍ。结论：桡动脉下２／３段位置浅表,并有足够的长度和管径,可作为冠状动脉搭桥术的供体。     

带血管蒂大收肌腱转位修复胫侧副韧带的应用解剖

目的：为带血管蒂大收肌腱转位修复胫侧副韧带提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了大收肌腱和胫侧副韧带的形态、毗邻关系以及前者的血管分布等。结果：①大收肌腱的肌腱部长６．７５±１．２２ｃｍ,平均宽度为９．６±２．０ｍｍ,平均厚度２．２±０．６ｍｍ;②胫侧副韧带长约５．８±１．１ｃｍ,平均宽１１．２±２．０ｍｍ,平均厚度１．２±０．２ｍｍ;③大收肌腱的血供源于膝降动脉的关节支,该动脉参与形成膝关节动脉网。结论：大收肌腱血供丰富,肌腱长,位置靠近,可作为胫侧副韧带损伤修复的供体。     

股骨内侧髁骨皮瓣移植重建下颌的应用解剖

在４０侧成人下肢标本上，解剖观测了膝降动脉及其伴行静脉。膝降动脉起点距内上髁平均９．１ｃｍ，外径１．８ｍｍ，可游离长度７．７ｃｍ。该动脉以其３支合干型为多见（６５．０％）。其伴行静脉压扁宽度平均２．６ｍｍ。关节支外径为１．４ｍｍ，可游离长度达６．７ｃｍ，分布于内侧髁及膝内侧皮肢，隐支外径平均１．２ｍｍ，可游离长度达９．６ｃｍ，分布于小腿内上１／３￣１／２皮肤。以膝降血管为蒂设计股骨内侧髁骨皮瓣对修     

睾丸静脉与腹壁浅静脉分流治疗小儿精索静脉曲张的应用解剖

目的：为临床行睾丸静脉分流术治疗小儿精索静脉曲张症提供应用解剖学资料。方法：在３４侧小儿标本上，解剖观测了睾丸静脉、腹壁浅静脉的起始、位置、外径及分离长度。结果：腹壁浅静脉由脐下浅静脉汇成，以腹股沟为标志线，静脉在距前正中线３．５±０．８ｃｍ处，位于浅筋膜内几乎垂直下行注入大隐静脉，分离长度６．０±１．７ｃｍ，中１／３外径２．０±０．３ｍｍ。结论：腹壁浅静脉是治疗小儿精索静脉曲张症较为理想的分流血管。     

胸小肌移位修复习惯性肩关节前脱位的应用解剖

在１５具（３０侧）新鲜尸体标本上解剖观测了胸小肌的形态、血供和神经支配。胸小肌血供主要来自胸肩峰动脉的胸肌支，外径约１．６±０．４ｍｍ，长约４．７±０．９ｃｍ．胸小肌主要由胸内侧神经支配，神经长５．２±１．０ｃｍ，横径为１．２±０．４。血管神经从胸小肌的中、外１／３处入肌。依据解剖学观察，设计将胸小肌止点连同喙突切取，移位固定到肱骨上端治疗习惯性肩关节前脱位１０例，术式设计符合力学原理，且对胸小肌     

Infections in Liver,Kidney, Pancreas,and Intestinal Transplant Recipients

Patients who need abdominal organ transplantation are at high risk for community-acquired, nosocomial, and opportunistic infections. In part, this is due to the invasive procedures they undergo, as well as the immunosuppression they require. This review highlights the infections that these vulnerable patients may develop. The current epidemiology, diagnosis, and management of common infections in liver, kidney, pancreas, and intestinal transplant (IT) recipients are summarized here.     

Establishment of simultaneous pancreas and kidney transplantation (SPK) model with cuff technique and portal venous drainage in rats

Objective: To establish a simultaneous pancreas and kidney transplantation (SPK) model in the rat. Methods: SD rats served as donors and recipients. The donor portal vein and the recipient superior mesenteric vein were anastomosed and the donor renal veins and recipient renal veins were anastomosed by cuff method. Arterial reconstruction was carried out by end to side anastomosis of the donor abdominal aorta to the recipient abdominal aorta. Enteric drainage was performed by side to side anastomosis between donors' duodenum and recipients' jejunum. The donor ureter -bladder valve was anastomosed to the bladder of recipients.Results: Out of 30 cases of SPK transplantation, 24 had normal serum glucose and serum creatinine after operation. The successful rate was 80 %. Conclusion: This model of SPK in rats is stable and reliable, which could be applied for further scientific research.     

肝移植供肝切取与修整技术

目的：总结临床肝移植供肝切取与修整技术。方法：采用原位腹主动脉、门静脉双路灌注及肝。肾联合快速切取法切取供肝及。肾40例次，并施行同种异体肝移植40例，其中3例行肝。肾联合移植。结果：全组供肝平均热缺血时间为4min，切取时间为25min，保存时间为6h。全组移植肝均于恢复血流10min内有金黄色胆汁泌出，1周左右肝功能恢复正常。结论：我院开展的供肝、肾的切取与修整技术在临床实际应用中取得满意的效果，为移植手术的成功提供了可靠的保证。     

Artificial organs and transplantation

Nowadays artificial devices are not able to totally and undefinitely replace the loss of function of all vital organs and artificial organs can be used only to bridge the time to transplantation, which must be considered the first choice in the therapeutical approach for many chronic diseases. Since general population aging process is leading to an increase of organ demand, the gap between performed and requested transplantation is hard to fill. Xenotransplantation is nowadays only an experimental alternative solution and we have to do our best using available artificial organs to increase and improve the survival of patients waiting for transplantation. In this meeting we particularly dealt about organ function replacing therapy, especially regarding the kidney, heart, liver, pancreas and ear.     

Intraductal papillary–mucinous neoplasm of the pancreas associated with polycystic liver and kidney disease

A case of intraductal papillary–mucinous neoplasm (IPMN) of the pancreas associated with polycystic liver and kidney disease is reported. A 63-year-old man was admitted to hospital with heartburn and upper abdominal pain. CT indicated multiple cysts in the liver and bilateral kidneys, and also showed multiple cystic lesions in the pancreatic head. Pancreatoduodenectomy was performed, and a pathological diagnosis of intraductal papillary–mucinous adenoma of branch duct type of the pancreas was made. He died of renal failure and hepatic failure due to recurrent cholangitis 12 years after the operation. An autopsy confirmed multiple cysts in the liver and kidneys. Multiple hepatic cysts were lined by biliary-type epithelium with no connection to the bile ducts. Peribiliary cysts were observed, and histology of the liver indicated von Meyenburg complexes. The kidneys showed that the cysts originated from all segments of the renal tubule. The autopsy findings suggested that the patient had suffered from autosomal-dominant polycystic kidney disease (ADPKD), but he did not have a family history of ADPKD. This case demonstrates that IPMN of the pancreas can occur as an extrarenal complication in patients with polycystic liver and kidney disease.     

Computerized tomography studies of normal morphology and volumetry of parenchymatous epigastric organs in humans

Variations in the area and dimensions of the liver and spleen in the craniocaudal direction show a similar behaviour despite individual differences in the size and shape of the organs. The liver has its largest areal extent in the upper half of the organ. In the case of the spleen, it is not possible for the largest areal extent to be assigned to a particular region of the organ. The 5-type liver classification of FROMMHOLD and KOISCHWITZ (1982) provided the basis for a study of the frequency distribution of those types among a total of 116 organs. Type 2 (location of the greater part of the liver to the right of the vertebral column) was found to be the most frequent type, whereas type 5 (left lobe of the liver larger than the right one) could not be found. Of the 183 splenic organs included in these studies, 21% showed lobulation and 6%, an accessory spleen. The morphological studies of 334 adrenal glands enabled the most frequent variants of form to be represented summarily. The determination of liver dimensions, which was done on 37 organs, yielded a mean value of 16.6 cm for the craniocaudal extent, 15.5 cm for the dorsoventral extent, and 16.6 cm for the lateromedial extent. From the examinations performed on 38 individuals it was possible to determine a mean value of 11.1 cm for the craniocaudal extent of the spleen, 11.8 cm for the anatomical length of the spleen, 10.4 cm for the width of the spleen, and 4.2 cm for the thickness of the spleen. The mean value of the width of pancreas was 20.5 mm at the head, 19.6 mm at the corpus, and 18 mm at the tail. The mean length of pancreas was of the order of 129 mm. These results were obtained from examinations made on 96 pancreatic organs. Evaluation of a total of 200 computer tomograms yielded mean values of 22 mm for the length. 14 mm for the width, and 5 mm for the leg thickness of the left adrenal gland. The respective mean values obtained for the right adrenal gland were 28 mm, 9 mm, and 4 mm respectively. Determination of the volume of liver on 37 organs yielded a mean value of 1,331 cm3. For the spleen, examinations performed on 38 organs showed the mean volume to be in the order of 169 cm3. For the volume of pancreas, a mean value of 40.4 cm3 was determined.     

夫妻间活体供肾移植

背景：近几年随着各项移植法规相继出台,中国做为器官移植大国,发展迅速,除了尸体肾移植外,活体肾移植亦得到健康快速发展,夫妻供肾做为没有直接血缘关系的活体移植,在器官移植界占据着重要地位。 目的：观察夫妻间供肾亲属活体肾移植的疗效。 方法：郑州人民医院器官移植科2008-10/2010-09进行夫妻间供肾移植11例,同期尸体供肾肾移植83例为对照组。两组受者均采用供肾静脉与髂外静脉端侧吻合,供肾动脉与髂内动脉端端吻合,输尿管-膀胱乳头式吻合,隧道包埋。免疫抑制诱导方案采用甲基泼尼松龙,基础免疫抑制采用钙调磷酸酶抑制剂(他克莫司或环孢素)、吗替麦考酚酯、肾上腺皮质激素(激素)三联免疫治疗,根据血药谷浓度调整他克莫司或环孢素的用量。移植后6个月内进行随访,评价两组受者移植后的肾功能恢复及早期并发症发生情况。 结果与结论：肾移植后两组急性排斥反应、移植物功能延迟恢复等早期并发症发生率比较,夫妻肾移植组优于尸体肾移植组,差异有显著性意义(P < 0.05)。结果提示夫妻间肾移植由于移植前准备充分,肾脏缺血时间短及夫妻间长期共同生活产生相应的免疫耐受,其疗效优于同样无血缘关系的尸体供肾移植。     

Three liver grafts from a deceased whole liver

Although the lateral segment (LS) from the split-liver of a deceased donor or a live donor can increase the organ pool of pediatric patients awaiting liver transplantation, the shortage of organ donation in Asia countries is still serious and results in high death rates of pediatric patients. The medial segment (MS) of the liver is sacrificed during the standard technique of splitting a whole liver into an LS and an extended right liver because the cutting sites of portal vein, hepatic artery and bile duct are all in the bifurcation of the liver hilum to have adequate length of vascular and biliary pedicles for easier grafting. However, the surgical techniques of vascular and biliary reconstructions for liver transplantation, particularly from the experiences of living donor liver transplantation, have been much improved in the last decade. Therefore it may be possible for an additional MS of the liver to be an isolated graft for a small recipient on the premise that grafts of right lobe (RL) and LS are minimally injured. In light of detailed reviews of anatomies of hepatic arteries, hepatic veins, portal veins and bile ducts, the dissection and reconstruction of vessels and bile ducts for the MS can possibly be performed if the extra-hepatic length of the artery to the MS is long enough. As the artery for the MS, middle hepatic artery (MHA), usually derives from a branch of the left hepatic artery and often in the liver parenchyma, the length is usually too short to be reconstructed. If the MHA for the MS is isolated and its extra-hepatic length is more than 1cm, triple liver grafts from a deceased whole liver, consisting of the RL, MS and LS may be possible. The anatomies of the hepatic artery in abdominal computed tomography (CT) or magnetic resonance imaging (MRI) for live liver donors in our institution were retrospectively analyzed. The results showed that three types of hepatic arterial anatomies could be considered for possible recovery of triple segments: type I is an accessory left gastric artery to feed the lateral segment; type II is an isolated MHA; type III is an early bifurcation of the left hepatic artery and MHA.     

自体骨髓间充质干细胞经动脉介入移植治疗犬糖尿病*

背景：目前多数研究倾向于将骨髓间充质干细胞经静脉移植等方法移植入糖尿病动物模型体内,而缺少将骨髓间充质干细胞经动脉介入移植入糖尿病动物模型胰腺内的相关研究。 目的：用自体骨髓间充质干细胞经动脉介入移植入糖尿病犬胰腺内,观察骨髓间充质干细胞的分布、分化、对糖尿病的治疗效果及安全性。 方法：将30只家犬随机分为骨髓间充质干细胞组(治疗组,n=13),糖尿病模型对照组(模型组,n=10)和对照组(n=7)。治疗组及模型组通过静脉注射四氧嘧啶建立糖尿病模型。造模后,治疗组进行胰岛素治疗,同时进行自体骨髓间充质干细胞的动脉介入移植。模型组仅接受胰岛素治疗,对照组则不接受任何治疗。 结果与结论：与模型组比较,治疗组于移植后第12周的胰岛素用量明显减少(P < 0.05),血清C-肽水平明显升高(P < 0.05)。治疗组于移植后第4周及12周的组织病理切片显示,心脏、肝脏、脾脏、肺脏、肾脏的组织结构清晰,均未发生坏死、纤维化,与模型组及对照组比较,移植后各器官组织形态无明显异常改变。移植后第4周,骨髓间充质干细胞主要分布在胰腺及肾脏内,免疫荧光发现胰腺内存在CM-DiI和胰岛素共表达细胞。表明将骨髓间充质干细胞经动脉介入移植入糖尿病犬胰腺内来治疗糖尿病的方法,是安全有效的。关键词：胰腺;移植;骨髓间充质干细胞;糖尿病;胰岛素 doi:10.3969/j.issn.1673-8225.2012.19.026     

Invasive fungal infection in solid organ transplantation: toward evidence-based prophylaxis and preemptive treatment]

Although the opportunity to discuss infectious complications in solid organ transplantation is increasing in Japan as elsewhere, the length of clinical experience in extra-renal transplantation is still short and even experience in living donor organ transplant is very limited except for those involving the kidney or liver transplantation. Risk of invasive fungal infection in organ transplant recipients is highly dependent on the immunocompromised status accompanying end-stage organ failure before transplant operation and on the resultant history of infectious complications. These factors as well as surgical and postoperative should be incorporated in a systematic and dynamic manner to evaluate risk of invasive fungal infection. In addition to prophylactic management based on such risk evaluation, it is desirable that preemptive treatment be started on quantification of clinical symptoms, imaging diagnosis, screening culture, and serological indices. Emergence of newer and more potent antifungal agents with lower toxicity potentially changes the concept of antifungal treatment. On the other hand, early and impression-oriented preemptive treatment has tended to increase. It is still questionable whether the knowledge obtained from Western experience can be directly applied to solid organ transplant medicine in Japan. Extensive and detailed clinical experience is mandatory to pursue diagnosis, epidemiology, and risk factors in Japan and establish our criteria for prophylactic and preemptive use of antifungal agents.