腹主动脉瘤组织中基质金属蛋白酶的蛋白质水平研究

为在蛋白质水平探讨基质金属蛋白酶（MMP）在腹主动脉瘤组织中的含量及分布，将40只健康雄性Wsitar大鼠随机分为两组，实验组20只大鼠以肾下腹主动脉加压灌注法建立腹主动脉瘤动物模型，于术后第14天取肾下腹主动脉标本，对照组直接取肾下腹主动脉标本，中性甲醛固定，石蜡切片，分别做基质金属蛋白酶2（MMP－2）和基质金属蛋白酶－9（MMP－9）的免疫组化染色，染色后用计算机图像分析法进行基质金属蛋白酶的定位及相对定量研究。结果发现，实验组大鼠术后14天腹主动脉扩张率大于100％，MMP－2和MMP－9含量均明显高于正常腹主动脉，腹主动脉瘤瘤壁组织中中膜MMP－2含量明显高于MMP－9。提示MMP－2可能是腹主动脉瘤组织中细胞外基质（ECM）的主要水解酶。     

国产镍钛合金血管内裸支架治疗囊形腹主动脉瘤的实验研究

目的 研究、观察国产血管内支架治疗犬腹主动脉瘤的疗效。方法 采用简单随机分组方法，将健康杂种犬32只随机分为4组，每组8只。组1；对照组，未置入支架；组2：实验组，腹主动脉前壁纵行切口长度≤1cm，置入支架治疗；组3：实验组，腹主动脉前壁纵行切口长度＞1cm且≤2cm，置入支架治疗；组4：实验组，腹主动脉前壁纵行切口长度≥3cm，置入支架治疗。外科方法建立腹主动脉瘤模型后2周行介入治疗。术后每个月行增强CT检查；第6个月处死时，行腹主动脉造影检查。结果 组1在6个月观察期内，CT和腹主动脉造影检查均示瘤腔存在。组2于第1个月CT检查时发现有1只犬瘤腔闭合；第2个月CT检查时有4只犬瘤腔闭合；第3个月有2只犬瘤腔闭合；条4个月有1只犬瘤腔闭合；第6个月腹主动脉造影检查也证实瘤腔闭合。组3CT检查和腹主动脉造影检查发现每只犬均残留有1个小瘤腔，且瘤壁呈向心性增厚。组4CT检查和腹主动脉造影检查发现每只犬均显示有1个大瘤腔。32只犬的腹主动脉均通畅。结论 国产镍钛合金血管内裸支架，对瘤颈直径≤1cm的腹主动脉瘤有治疗作用；对瘤颈直径＞1cm且≤2cm者，可防止动脉瘤继续扩张和迟发破裂；对瘤颈直径≥3cm者则无任何治疗作用。     

腹主动脉瘤修补术后并发十二指肠梗阻

腹主动脉瘤修补术后并发十二指肠梗阻,文献上尚未报道过,作者报告两例。例1,男性,57岁,左下肢跛行,血管造影示腹主动脉肾下段动脉瘤,行主动脉瘤切除和主动脉左股动脉涤纶移植物修补术,术后有肠梗阻症状,第八天上胃肠道造影显示十二指肠第三段完全梗阻,手术发现为粘连引起。例2,男性,74岁,曾做过冠状动脉分流术,发现腹部一有搏动色块,腹主动脉造影显示肾下段有一延伸至双髂动脉的巨大主动脉瘤。用涤纶移植物做动脉瘤修补术,术后六天出院,出院后二天因肠梗阻再次入院,腹平片和CT显示在主动脉前的十二指肠第三段完全梗阻,梗阻后七天,剖腹探     

16层螺旋CTA术前评估主动脉夹层及动脉瘤腔内隔绝术的价值

目的:探讨16层螺旋CT血管成像(16-MSCTA)在主动脉夹层和腹主动脉瘤腔内带膜支架置入术前评估中的价值.方法:40例主动脉夹层和腹主动脉瘤患者术前行16层螺旋CT血管成像检查.采用层面准值16×0.75,螺距1,重建层厚1 mm,间隔0.7 mm;碘对比剂总量按患者体重计算,CTA延迟扫描时间用小剂量对比剂试验法测定;重点运用专用软件测量主动脉夹层及动脉瘤腔内带膜支架置入术所需的所有参数.结果:Ⅲ型夹层26例,单个破口23例,多个破口3例.其中8例符合腔内隔绝术;腹主动脉瘤14例,其中4例符合腔内隔绝术.16-MSCTA提示腹主动脉瘤合并动脉粥样硬化改变11例,与病理诊断结果一致(100%).结论:16-MSCTA可从局部到整体对瘤体进行多方位的观察和测量,提供腔内隔绝术所需的各项参数,为主动脉夹层和腹主动脉瘤选择治疗方案以及术前规划提供更多的信息.     

16层螺旋CT在腹主动脉瘤中的诊断应用

目的 探讨16层螺旋CT对腹主动脉瘤的诊断价值.方法 对40例腹主动脉瘤患者进行16层螺旋CT扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)图像重组.结果 CT显示腹主动脉呈囊状扩张7例、梭形扩张23例、囊梭形扩张10例.其中多发性腹主动脉瘤3例,并发假性动脉瘤1例.MPR准确显示瘤体的位置、形态、范围及瘤腔内附壁血栓,MIP较好地显示瘤壁或附壁血栓内的钙化,VR以三维形式精确显示瘤体与邻近腹主动脉及其与分支血管的关系.结论 16层螺旋CT是腹主动脉瘤诊断、随诊观察和术后随访最理想的影像技术.     

血管塞治疗腹主动脉瘤主动脉腔内修复术后高流量Ⅰ型内漏4例

【摘要】 目的 探讨血管塞治疗腹主动脉瘤主动脉腔内修复术后高流量Ⅰ型内漏的可行性和安全性。 方法 回顾性分析2019年5月至9月收治的腹主动脉瘤主动脉腔内修复术患者临床资料,其中3例腹主动脉瘤术后即刻造影发现Ⅰa型内漏,1例腹主动脉瘤术后3个月复查CT发现Ⅰb型内漏。4例腹主动脉瘤主动脉腔内修复术后高流量Ⅰ型内漏患者均接受血管塞栓塞治疗。结果 4例患者分别植入血管塞1个,血管塞栓塞封堵内漏均获成功,内漏完全栓塞。术后1例腹痛症状明显好转,无穿刺口出血等严重并发症发生。 结论 血管塞栓塞治疗腹主动脉瘤主动脉腔内修复术后高流量Ⅰ型内漏操作简单安全,栓塞成功率高,疗效确切。     

腹主动脉瘤腔内修复术22例围手术期处理回顾性总结

目的 总结腹主动脉瘤腔内修复术(EVAR)围手术期处理的临床经验.方法 回顾分析22例腹主动脉瘤患者EVAR临床经过,通过术前对主要脏器功能进行评估和保护,CTA测量近远侧瘤颈长度、直径、角度和构型,瘤体与分支动脉的关系,最低肾动脉开口至腹主动脉分叉的距离,导入途径的直径、扭曲和钙化程度.根据CTA测量结果,选择覆膜支架和手术方式.术时采用局麻20例,中转全麻l例,1例通过髂总动脉重建导人途径采用硬膜外麻醉,1例合并Stanf.0rd A型主动脉夹层,术时采用全麻.在支架释放前准确定位最低肾动脉位置,至少保留一侧通畅的髂内动脉,若双侧需要覆盖,分期覆盖或髂内动脉重建.支架植入后复查造影,有无内漏.正确判断内漏类型并进行相应处理.支架近端Ⅰ内漏2例,球囊扩张1例,植入Cuff 1例;支架远端Ⅰ内漏1例,球囊扩张时,动脉破裂,行人工血管补片修补术;Ⅲ型内漏3例,球囊扩张后支架植入1例.1例合并Starford A型主动脉夹层先行胸主动脉腔内修复术,后行EVAR.术后7一10 d复查CTA,以后每年复查1次.结果 EVAR手术全获成功.主要并发症为单侧髂肢扭结继发血栓形成,Fogarty导管取栓并支架植人1例;腹壁切口裂开1例,清创缝合;无手术死亡,随访6个月～5年,患者均存活.结论 CTA图像质量高、测量准确,是EVAR术前评估和术后随访的金标准.EVAR是高危、高龄腹主动脉瘤患者有效的治疗方法.     

主动脉夹层或瘤的腔内隔绝术临床评价(附23例报道)

目的:评价应用腔内血管支架治疗腹主动脉瘤的优点。方法:对24例患者行DSA和带膜血管腔内支架植入隔绝手术治疗,其中Stanford B型夹层动脉瘤19例,真性腹主动脉瘤4例,假性腹主动脉瘤1例。所有病例均采用TALENTTM带膜支架移植物系统。术后对所有患者行螺旋CT随访。结果:除1例因胸主动脉夹层破口位于左锁骨下动脉开口处,无法放置腔内血管支架而行开胸手术外,余23例均顺利放入,术后患者症状完全消失,全部患者在随访期间均未出现术前症状,未见相关并发症。结论:应用带膜支架治疗胸主动脉Stanford B型夹层、真性和假性腹主动脉瘤,其效果较单纯开放式手术效果好且不良反应小,值得在临床上推广和应用。     

CO_2激光焊接SD鼠小肠对吻合口羟脯氨酸和碱性成纤维细胞生长因子含量的影响

目的观察激光焊接与传统肠管缝合的吻合口羟脯氨酸(hydroxyproline,Hyp)和碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)含量在愈合过程中的变化。方法将60只SD大鼠分为实验组和对照组两组,每组30只。2个大组再根据术后观察时间不同分为3小组,分别为术后7 d组、术后14 d组和术后28 d组,每组10只大鼠。实验组采用CO_2激光焊接,用3针等距缝线以牵引固定肠管,激光焊接功率密度19.11 mW/cm~2,光斑直径0.1 cm,持续脉冲时间为0.2 s。激光焊接后将3根缝线抽走,激光焊接点40~50个。对照组采用3-0丝线行单层间断缝合,缝合需9~10针。分别于术后7 d、14 d和28 d,测定吻合口破裂压。另外取吻合口近远端各0.5cm的小肠组织分别测定Hyp和bFGF含量。结果术后60只大鼠均存活。实验组破裂压不同时期均高于对照组,第14和28天均明显高于对照组(P0.05)。术后第7d实验组Hyp含量与对照组比较,差异无显著意义;术后第14和28天实验组Hyp的含量明显高于对照组(分别为P0.05,P0.001)。实验组bFGF的含量不同时期均高于对照组,第7、14天均明显高于对照组(P0.05)。结论 CO_2激光焊接肠管可促进吻合口处小肠组织内羟脯氨酸和碱性成纤维胞生长因子的分泌,从而加速吻合口的愈合。     

多模态影像评估鼠腹主动脉瘤模型腔内血栓对动脉瘤增长的促进作用

正摘要目的评估鼠弹性蛋白酶诱导的腹主动脉瘤(AAA)模型的影像变化,着重分析腔内血栓(ILT)的作用。方法采用超声显示22只鼠AAA直径增长特点。术后2~8 d14次MRI检查显示13只鼠出现ILT,术后2~27 d 18-氟脱氧葡萄糖(18-FDG)PET/微型CT检查显示10只鼠出现ILT。     

有氧运动对小鼠动脉血红素加氧酶-1表达的影响及在动脉粥样硬化形成中的作用研究

目的:探讨有氧运动对小鼠动脉血红素加氧酶-1(heme oxygenase-1,HO-1)的影响及其在抗动脉粥样硬化(atherosclerosis,AS)形成中的作用。方法:采用8周龄C57小鼠和ApoE基因敲除小鼠(ApoE-/-小鼠,饲以高脂饮食饲料建立动脉粥样硬化模型),分为ApoE-/-安静组(AC组)、ApoE-/-运动组(AE组)、C57运动组(CE组)、C57安静组(CC组)4组,每组15只。运动组进行12周中等强度跑台运动(10米/分×30→13米/分×60分,5次/周)。实验12周后安静时取材,采用HE染色、免疫组织化学方法及图像分析系统测定主动脉弓、腹主动脉、颈动脉组织解剖结构及HO-1表达。结果:CC组和CE组动脉组织结构正常。AC组主动脉多为纤维粥样硬化期病变,AE组多为脂纹脂斑早期病变。CC组主动脉无HO-1表达,CE组主动脉内皮层有HO-1表达。AC组主动脉内皮细胞和斑块可检测到HO-1大量表达,AE组比AC组表达减少。经图像分析,和AC组比,AE组主动脉弓、腹主动脉和颈动脉HO-1表达显著下降(分别为P<0.01、P<0.05、P<0.05),其中主动脉弓减少比腹主动脉、颈动脉明显。结论:有氧运动增强正常动脉的抗氧化能力(HO-1表达增加)。运动延缓AS形成中的动脉病变,可能与其降低主动脉的氧化应激水平(氧化应激标志HO-1降低)有关。这些改变均以主动脉弓表现明显。     

Phase‐contrast MRI‐based elastography technique detects early hypertensive changes in ex vivo porcine aortic wall

Purpose

To measure the elastic properties of ex vivo porcine aortas in control and hypertensive groups using a phase contrast magnetic resonance imaging (MRI)‐based elastography technique.

Materials and Methods

Female domestic pigs were randomized to a normal control group (N; n = 5) or a renovascular hypertension group (HT; n = 5) for the duration of 3 months. Mean arterial pressure was significantly higher in the hypertension group than in the control group (173 ± 12 vs. 115 ± 11 mmHg, P ≤ 0.05). The animals were euthanized after 3 months of hypertension and abdominal aortas harvested. The ex vivo aortic samples were then examined using a phase‐contrast MRI‐based elastography technique.

Results

The Young's modulus‐wall thickness product, a reflection of vascular stiffness, was significantly higher in the hypertension group than in the control group (0.571 ± 0.080 vs. 0.419 ± 0.026, P < 0.05). Histological analysis and staining confirmed increased intima‐media thickness and collagen content in the hypertensive aorta, while elastin staining showed no difference.

Conclusion

The current study shows that MR elastography offers a method to study the physiologic changes in the arterial wall secondary to early hypertension. J. Magn. Reson. Imaging 2009;29:583–587. © 2009 Wiley‐Liss, Inc.     

MR imaging of the thoracic aorta in Marfan patients

A characteristic shape of the ascending aorta has been reported in patients with Marfan syndrome. To evaluate the capability of magnetic resonance (MR) imaging to distinguish between marfanoid and other aortic aneurysms, 11 Marfan patients (group 1), eight patients with ascending aorta enlargement (group 2), and 20 normal subjects (group 3) had transverse and sagittal MR of the thoracic aorta. Aortic diameter was measured at the sinuses of Valsalva (SV), the caudal portion of the ascending aorta, the prearch region (PA), the middle arch, and the descending aorta. The ratio SV/PA was significantly greater (p less than 0.001) in group 1 compared with groups 2 and 3. The SV/PA in all Marfan patients exceeded 1.4 but was less than 1.3 in subjects of groups 2 and 3. Magnetic resonance imaging provides definitive measurements of aortic dimensions and is potentially the method of choice for establishing the diagnosis of aortic involvement in Marfan syndrome and monitoring the course of aortic enlargement.     

Increased prevalence of cholelithiasis in patients with abdominal aortic aneurysm: sonographic evaluation

We performed a prospective study to determine the prevalence of cholelithiasis in patients with abdominal aortic aneurysm. Over an 18-month period, the gallbladder and the abdominal aorta were evaluated routinely in all consecutive patients referred to us for sonography of the abdomen and retroperitoneum. The patients were divided into two groups: those with an abdominal aortic aneurysm (aorta greater than 3 cm in transverse diameter) (n = 96) and those whose aorta measured less than 3 cm in transverse diameter (n = 538), who served as control subjects. Cholelithiasis was found in 50% of patients with and 26% of patients without aneurysm (p less than .0001). A stepwise logistic regression analysis found age alone to be predictive of cholelithiasis (p = .030). However, age was not predictive of cholelithiasis when included with abdominal aortic aneurysm in a multivariate model. Diabetes mellitus and gender were not predictive of cholelithiasis. We found cholelithiasis in approximately half of the patients who had abdominal aortic aneurysms. This is almost double the prevalence in the general elderly population. A pathophysiologic explanation for this observation remains to be found.     

Screening for abdominal aortic aneurysms during routine lumbar CT scan: modification of the standard technique

INTRODUCTION: Abdominal aortic aneurysms (AAAs) are often incidental findings in patients undergoing US, CT or MRI studies. The recommended field of view (FOV) for standard CT examinations of the spine is 14 cm. This FOV does not allow full visualization of the abdominal aorta. PURPOSE: To justify a larger FOV for male smokers older than 55 years and women older than 65 years, with a higher incidence of AAA. MATERIALS AND METHODS: The lumbar CT examinations of 100 consecutive patients (age: mean 68 years, range 55-85 years) presented with low-back pain were retrospectively reviewed. Measurements of the abdominal aorta and lumbar abnormalities were analysed. A control study in 850 patients who underwent abdominal CT scans for other causes was available for comparison. RESULTS: There were three men with AAAs measuring 4.5, 5.5 and 5.6 cm (mean 5.2 cm). Findings related to the clinical problem were disk prolapse or herniation, spondylosis, spinal stenosis and grade I spondylolesthesis. In the control group, 17 patients were found with AAAs with diameter greater than 4 cm (2%). CONCLUSIONS: Patients with low-back pain, older than 55 years of age, examined with lumbar spine CT, should also be screened for aortic disease, since the prevalence of AAA is similar with that of an age-matched control group. Appropriate modification in the applied FOV is recommended.     

Stanford B型主动脉夹层腔内修复术后早期死亡患者术前多层螺旋CT特征分析

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),χ2=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),χ2=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),χ2=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30 d死亡的独立危险因素。     

3.0T MR成像对兔腹主动脉粥样硬化斑块破裂及血栓形成模型的成像研究

目的 探讨3.0T高分辨MRI对兔腹主动脉粥样硬化模型药物诱发斑块破裂和血栓形成的成像研究.方法 20只雄性新西兰白兔,采用数字表法随机分为实验组16只,对照组4只,采用间断高脂饲料喂养结合球囊拉伤腹主动脉技术建立动脉粥样硬化模型,并在建模3个月后给予蝰蛇毒+组胺药物诱发试验,以期斑块破裂和形成血栓.在药物诱发试验前后...     

正常与粥样硬化血管壁荧光光谱机理研究

本文研究了离体正常与粥样硬化人主动脉壁的荧光光谱。用荧光分光光度计，以308nm为激发波长，分别记录市售动脉各种已知成分及动脉壁提取成分的荧光光谱。用紫外-可见吸收分光光度计测人血红蛋白吸收光谱、动脉壁经超声后上清液吸收光谱。对荧光光谱和吸收光谱进行分析，结果显示，正常和粥样硬化动脉荧光光谱分别以弹性蛋白和胶原蛋白为主构成，418nm波谷是由于血红蛋白再吸收形成的。     

Aortic volume as an indicator of disease progression in patients with untreated infrarenal abdominal aneurysm

Objective

The maximal diameter of an abdominal aortic aneurysm (AAA) and the change in diameter over time reflect rupture risk and are used for surgical planning. However, evidence has emerged that aneurysm volume may be a better indicator of AAA remodeling. The purpose of this study was to assess the relationship between the volume and maximal diameter of the abdominal aorta in patients with untreated infrarenal AAA.

Materials and methods

This was a retrospective study of 100 patients with infrarenal AAA who were followed for more than 6 months. We examined 2 sets of computed tomography images for each patient, acquired ≥6 months apart. The maximal diameter and volume of the infrarenal abdominal aorta were determined by semiautomated segmentation software.

Results

At baseline, mean maximal infrarenal diameter was 5.1 ± 1.0 cm and mean aortic volume was 139 ± 72 mL. There was good correlation between the maximal diameter and aortic volume at baseline (r² = 0.55; P < 0.001). The mean change in maximal diameter between studies was 0.2 ± 0.3 cm and the mean volume change was 19 ± 19 mL. However, the correlation between diameter change and volume change was modest (r² = 0.34; P = 0.001). Most patients (n = 64) had no measurable change in maximal diameter between studies (≤2 mm), but the change in volume was found to vary widely (−2 to 69 mL).

Conclusion

In patients with untreated infrarenal AAA, a change in aortic volume can occur in the absence of a significant change in maximal diameter. Additional work is needed to examine the relationship between change in AAA volume and outcomes in this patient group.