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′。     

国人肾血管应用解剖学研究及其临床意义

目的为临床肾移植和肾血管腔内微创手术等提供肾血管解剖学依据。方法解剖国人成人尸体30具,其中男性17具,女性13具。对每具尸体的肾动脉和肾静脉的长度、管径、分支部位、肾动脉发出点距髂动脉分叉点的距离,以及副肾动脉存在与否、肾静脉汇入腔静脉角度等进行测量和分析。结果男性:肾动脉平均长度:左侧(2.86±1.11)cm,右侧(4.61±1.72)cm;平均管径左侧(0.62±0.19)cm,右侧(0.69±0.23)cm;副肾动脉出现率为29.4%(5/17),副肾动脉3支发自肾动脉主干,2支发自于主动脉,入肾部位皆位于肾上极。肾静脉平均长度左侧(5.11±1.75)cm,右侧(2.16±0.76)cm;平均管径左侧(1.64±0.58)cm,右侧(1.41±0.50)cm。汇入腔静脉角度左侧为76.2°±28.7°,右侧73.3°±30.1°。女性:肾动脉平均长度:左侧(1.97±1.02)cm,右侧(3.34±1.71)cm;平均管径左侧(0.45±0.22)cm,右侧(0.47±0.19)cm;肾副动脉出现率为23.1%(3/13),2支发自肾动脉,1支发自于主动脉,入肾部位皆位于肾上极;肾动脉过早分叉现象出现率为46.2%(6/13)。肾静脉平均长度左侧(3.53±1.56)cm,右侧(1.43±0.59)cm;平均管径左侧(1.12±0.63)cm,右侧(0.98±0.45)cm。汇入腔静脉角度左侧为53.2°±29.1°,右侧50.3°±27.3°。结论本研究提供国人成人肾血管的应用解剖学数据,对临床肾移植和肾血管腔内微创手术等具有参考价值和指导意义。     

膈中心腱前叶的应用解剖

目的　探讨经腹切开膈中心腱阻断下腔静脉的心包内段行全肝血流阻断术的可行性。方法　在 2 5件成人经福尔马林固定的局部膈标本上解剖观测了膈中心腱前叶的形态和腱纤维的排列分层及血管分布情况。并在 1具童尸上进行模拟手术。全身动脉造影标本 1具 ,并拍片。结果　左膈下动脉前支的右支起始处的外径为 ( 0 .92± 0 .38)mm ,伴行静脉汇入左膈下静脉 ;右膈下动脉的前支的下腔静脉后支外径为 ( 0 .84± 0 .35 )mm ,其伴行静脉汇入右膈下静脉的后属支 ;右膈下动脉的前支的左支外径为 ( 0 .98± 0 .41 )mm ,伴行静脉汇入右膈下静脉的前属支。结论　经腹切开膈中心腱阻断下腔静脉的心包内段行全肝血流阻断术是可行的。     

胎儿第二肝门处肝静脉的解剖学观测

目的解剖观测胎儿肝静脉在第二肝门入下腔静脉的形态特征。方法选择3~10月胎儿肝脏47例,测量肝左、中、右静脉入下腔静脉处直径,记录肝静脉属支数。结果肝左、中、右静脉压扁直径分别为0.34±0.16 cm、0.38±0.21 cm、0.33±0.18 cm;其属支数分别为1.63±0.73个、1.93±0.79个、1.66±0.73个;下腔静脉肝上、肝下压扁直径分别为0.95±0.32 cm、0.52±0.20 cm,后者与前者比为0.57±0.14。结论胎儿肝左、中、右静脉直径较成人细,其中肝中静脉最粗,肝左静脉次之,肝右静脉最细。肝左、右静脉分支以1支居多,肝中静脉以2支居多。胎儿肝上、肝下下腔静脉直径差异较大。     

左下腔静脉一例

下腔静脉的变异,综合国内二十余年之资科,在有M值可查的1136例中,见到14例占1.19±0.33％,其中多数的变异是双下腔静脉,而左下腔静脉的出现率则较低。我们在解剖过程中遇到一例左下腔静脉,为积累国人体质资料,现报告如下。标本是一具女性老年尸体。下腔静脉在第五腰椎左侧由左、右髂总静脉合成。位于左髂总动脉深面,低于腹主动脉分叉处一厘米.右髂总静脉较左髂总静脉粗。右髂总静脉中段血管外直径1cm;左髂总静脉中段血管外直径0.8cm。由起始处沿腹主动脉左侧上行,以后斜过椎体前由主动脉前方转到右侧,共可区分为左段、斜行段、和右段三部。下腔静脉左段在腹主动脉左侧向上,至第三腰椎体上缘,接受左肾静脉。此段长9cm、血管外直径1.8cm。有左卵巢静脉注入左肾静脉根部。斜行段(肾静脉间段):由第三腰椎体上缘与左肾静脉结合后,斜跨腹主动前方,到肠系膜上动脉起始处下方,第二腰椎体上缘高度右肾静脉汇入处。长7.5cm、血管外直径     

睾丸静脉应用解剖学研究

目的 :观察睾丸静脉的形态结构。方法 :观测了 70具男性成人尸体的睾丸静脉。结果 :睾丸静脉的长度为 2 2 9 6±0 6 2mm ,外径为 3 6 4± 0 0 2mm。睾丸静脉支数 :在皮下环处为 3 4 8± 0 12支 ,在腹环处为 2 5 1± 0 0 5支。左右睾丸静脉汇入下腔静脉或肾静脉的高度 ,左侧高于右侧者多见 (70 %) ,两侧等高者次之 (2 5 71%)。睾丸静脉内无瓣膜者多见 ,占5 2 5 %,有瓣膜者占 47 5 %。结论 :睾丸静脉内存在无瓣膜情况。本研究为睾丸静脉造影和精索静脉曲张的栓塞疗法等提供解剖学资料。     

离体肝脏的出入静脉关系及临床应用解剖研究

目的：探讨肝静脉属支与肝门静脉分支之间的关系及汇入下腔静脉肝后段的情况,为临床建立肝内门-腔静脉分流术或经下腔静脉肝后段肝内穿刺、肝静脉造影提供解剖学依据。方法：选取离体的肝脏标本40例,通过开放性实验进行解剖,分别测量肝静脉属支（左、中、右静脉）与门静脉左、右支的长度、直径及其之间的距离,并观察汇入下腔静脉肝后段的情况。结果：肝左静脉长度及直径分别为（38.22±15.41） mm和（6.34±1.45） mm;肝中静脉长度及直径分别为（40.61±14.80） mm和（5.83±1.37） mm;肝右静脉长度及直径分别为（50.12±10.46） mm和（7.65±1.52） mm;门静脉主干长度及直径分别为（74.51±6.07） mm和（8.16±3.22） mm,左支长度及直径分别为（9.30±2.11） mm和（6.08±1.86） mm;右支长度及直径分别为（12.24±2.67） mm和（7.53±2.04） mm;门静脉右干末段距离肝右静脉（17.30±8.53） mm,门静脉左干末段距离肝左、中静脉（20.61±9.10） mm及（18.94±8.72） mm;其中,肝左、中静脉合干汇入下腔静脉18例,肝左、中、右静脉单干汇入13例,肝中、右静脉合干汇入9例。结论：肝静脉右支的长度与直径均比左、中支长度与直径粗大,与肝门静脉右支间距离更近,肝内门一腔静脉分流术应首选肝右静脉与门静脉右干末段或分支间进行穿刺;经下腔静脉肝内穿刺、肝静脉造影时需先观察肝静脉属支汇入下腔静脉的组合类型再行操作。     

肾上腺静脉的形态学观察

在53具成人尸体上,对肾上腺静脉的腺内段和腺外段,以及与肾上腺静脉造影有关的静脉作了解剖学的形态观测。主要结果如下:左、右肾上腺静脉腺外段均为一支,左侧的恒定地汇入左肾静脉,右侧的以汇入下腔静脉为主(83.02±5.15％),少数汇入右付肝静脉。肾上腺静脉腺外段(自腺门至汇入处)的平均长度,左侧23.05±5.96(43.25～11.00)毫米,右侧8.73±5.13(18.5～5.50)毫米;平均外径,左侧4.99±0.82(7.10～3.25)毫米,右侧2.93±0.87(4.85～2.00)毫米。左肾上腺静脉与左肾静脉形成交角平均为117.35±11.95°(150～100°);右肾上腺静脉与下腔静脉形成交角平均为47.5±14.53°(75～30°)。测量了自股静脉(腹股沟韧带下缘)经髂外静脉、髂总静脉、下腔静脉至左、右肾上腺门处各段的长度,为肾上腺静脉插管造影提供参考数据。 肾上腺静脉腺内段的形态,可分为单支型、双支型及三支型。其中以单支型最多见(左侧86±4.91％,右侧50±7.07％),三支型仅见于右侧。 本文从解剖学的角度讨论了左右肾上腺静脉插管造影的难易问题。     

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。     

脾静脉25例解剖数据分析

目的 :通过脾静脉解剖情况的调查 ,探讨脾静脉在门静脉高压症时门 -体静脉分流的应用价值和可能性。方法 :经过 2 5具尸体调查脾静脉长度、宽度 ,以及脾静脉与邻近结构的关系。结果 :2 5具尸体的脾静脉长度为 (11.18± 1.75 ) cm,脾门端宽径为 (1.19± 0 .16 ) cm ,门静脉端脾静脉宽径为 (1.34± 0 .2 0 ) cm ;脾静脉与左肾静脉大多平行 ,甚至重叠 ;脾静脉的属支注入部位变异极大。结论 :脾静脉与左肾静脉相近 ,脾 -肾静脉分流相当方便。脾静脉的门静脉端管径比较宽 ,管壁比较厚 ,有一定弹性 ,为远端脾 -肾静脉分流或选择性远端脾 -腔静脉分流手术提供了可能性 ,有一定临床使用价值。     

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…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.