恶性肿瘤累及颈动脉的外科处理

为探讨头颈部恶性肿瘤侵犯颈动脉的外科治疗，对５例喉癌或下咽癌颈淋巴结转移累及一侧颈动脉病人，术前经ＣＴ或Ｂ超检查，３例经术前体外颈动脉压迫训练合格后手术切除受累段颈总动脉，２例系术中损伤颈总动脉后紧急切除受轻动脉。其中１例即刻行断端吻合，５例术中，术后均无明显脑缺血表现，３例术后随访２年以上健在，２例尚在随访中。     

Laryngotracheal stenosis in children

The diagnosis of laryngotracheal stenosis should be suspected in children with stridor, feeding difficulties, or atypical croup. Only half of the children with congenital laryngotracheal stenosis require tracheotomy, and many of these children can be decannulated following uncomplicated surgical therapy. In contrast, tracheotomy-dependent patients with acquired laryngotracheal stenosis require more extensive surgical intervention, which should be carried out as early as possible to provide the best opportunity for developing normal oral communication. Received: 8 March 1977 / Accepted: 31 July 1997     

妊高征患者的胎儿血流速度波形改变特点研究

目的：研究妊高征患者的胎儿脐动脉、肾动脉以及大脑中动脉的血流速度波形的变化特点。方法：妊高征患者９６例，正常妊娠１４８例，于产前１周内行彩色多普勒超声检测胎儿脐动脉、肾动脉和大脑中动脉的搏动指数（ＰＩ），产后随访新生儿预后。结果：随着妊高征的加剧，胎儿脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ则改变不明显。在围产儿预后良好和不良的两组中，随着妊高征的加重，胎儿脐动脉、肾动脉和大脑中动脉的ＰＩ均有上升的趋势，但预后不良组的改变比对照组明显。按正常妊娠和轻度、中度、重度妊高征分成４组，胎儿窘迫者脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ下降。结论：妊高征和胎儿窘迫对胎儿脐动脉和肾动脉的血流波形改变有协同作用，对大脑中动脉的改变有阻抗作用     

33例椎-基底动脉瘤的临床观察

目的：探讨椎－基底动脉瘤治疗方法与预后关系。材料与方法：报告３３例椎－基底动脉瘤。动脉瘤破裂致ＳＡＨ１８例，动脉瘤直径从５ｍｍ到４５ｍｍ。其中９例行保守治疗。直接手术治疗中，９例夹闭术，２例瘤壁加固术。１３例行血管内栓塞治疗。结果：９例保守治疗中３例因再次出血死亡。１１例直接手术均痊愈。１３例血管内栓塞治疗后１～３个月后复查造影，闭塞率＞８０％者１２例。结论：椎－基底动脉瘤积极手术治疗可降低死亡率，依动脉瘤部位与大小采用不同手术入路至关重要，血管内栓塞治疗适于直接手术难以达到者，疗效肯定。     

Successful pregnancy after coronary artery bypass grafting for Kawasaki disease

Abstract A 13-year-old girl with a history of Kawasaki disease underwent coronary artery bypass grafting because of angina pectoris due to a giant coronary artery aneurysm on the left main trunk artery. Nine years after the operation, the patient had an uneventful pregnancy followed by a normal vaginal delivery. This is the first case of a successful pregnancy after coronary artery bypass grafting for Kawasaki coronary artery disease.     

L-精氨酸及L-硝基精氨酸对缺氧肺动脉内皮细胞内皮素的影响

目的探讨Ｌ精氨酸（一氧化氮合成的前体物质）及Ｌ硝基精氨酸（一氧化氮合酶抑制剂）对缺氧肺动脉内皮细胞内皮素１分泌及基因表达的影响。方法采用斑点杂交、Ｎｏｒｔｈｅｒｎ杂交及放射免疫分析，对常氧、缺氧、缺氧加Ｌ精氨酸及缺氧加Ｌ硝基精氨酸组的猪肺动脉内皮细胞进行了内皮素１的测定。结果缺氧能增加肺动脉内皮细胞的内皮素１的分泌及基因表达，此作用能被Ｌ精氨酸所抑制。Ｌ硝基精氨酸能增加缺氧时肺动脉内皮细胞的内皮素１分泌及基因表达。结论本实验间接提示，一氧化氮对肺动脉内皮细胞内皮素１的分泌及基因表达起调节作用     

Pyloric motor abnormality in patients with infantile hypertrophic pyloric stenosis

There are no published data of manometric studies of pyloric motor function in patients with infantile hypertropic pyloric stenosis (IHPS). The present study attempted to examine the characteristics of motor abnormality of the pylorus in five children with IHPS. Using a transducer-built-in manometric catheter cannulated through the pylorus under fluoroscopy, the pressure in the pyloric canal was recorded continuously over 3 h during fasting. Clusters of high-amplitude spastic contractions of over 300 mmHg were recorded at intervals. The frequency was 1–3/min (mean 1.7 cpm) and the duration was 7–15 s. These periodic spastic contractions were suppressed temporarily for 20–30 min after intravenous injection of 0.01 mg/kg atropine. After pyloromyotomy, these spastic contractions decreased remarkably in amplitude, but there were no changes in frequency. It is concluded that the underlying motor abnormality observed in hypertrophied pyloric muscle is clusters of high-amplitude contractions, although more precise measurements of basal pyloric pressure are needed to explore the pathophysiology of IHPS in detail. The effect of pyloromyotomy may be related to the decrease in high-amplitude contractions. Accepted: 26 May 1998     

Tracheal Transplantation: Superior and Inferior Thyroid Artery Perfusion Territory

Objective: To determine the perfusion territories of the superior and inferior thyroid arteries in humans. Tracheal transplantation is a potential option for management of long-segment tracheal stenosis. However, the maximum length of vascularized trachea that can be reliably transplanted has not been established. Study Design: The tracheal vascular territory of individual superior and inferior thyroid arteries was determined separately in 10 humans postmortem. Methods: India ink was infused unilaterally under controlled pressure into the superior (n = 5) and inferior (n = 5) thyroid arteries of cadaveric tracheas. Tracheas were sectioned longitudinally and the caudalmost extent of mucosal dye staining was determined via microscopic assessment. Results: The tracheal perfusion territory of the superior thyroid artery was two to five rings (1.7 ± 0.5 cm) and the inferior thyroid artery, nine to 13 rings (6.5 ± 1.1 cm). In both cases, the tracheal mucosa on the contralateral side was stained to the same caudal level. Conclusions: The inferior thyroid artery was shown to perfuse the trachea maximally to the 13th ring (8.1 cm). As such, the unilateral inferior thyroid artery would serve as a suitable vascular component for long-segment tracheal transplantation in humans.     

肺动脉重建在肺癌切除术中的应用

１９９３年７月～１９９７年５月间，在１７例肺癌患者手术中进行了肺动脉切除和重建。肺动脉袖状切除１２例，侧壁切除５例。同时作总支气管袖状切除１０例，楔形切除２例，残端成形１例，上叶支气管移位吻合２例。１例双袖状右上中联合肺叶切除后，又切断下肺静脉。下叶肺置于肝素溶液中（１２５００Ｕ／５００ｍｌＮＳ），１５ｍｉｎ后将下肺静脉移植于上叶静脉残端，再作支气管、肺动脉吻合。随访１～４４个月，无手术近期死亡。术后１３个月死于心肺衰竭１例，１２、１７、１８、１９个月各有１例死于肿瘤复发，余１２例生存良好，最长存活４４个月。作者认为当肿瘤或（及）肿大淋巴结环绕肺动脉或其分支起始部时，则应行肺动脉切除和重建，其必要性和可行性均在术中确定。双袖状右上中肺联合肺叶切除术中，当总支气管或肺动脉切除过长时可将下肺静脉移植于上肺静脉残端以缓解吻合口张力，作者主张围手术期应行抗凝治疗。     

黄芪、前胡、白蒺藜对培养的肺动脉平滑肌细胞增殖及胶原分泌的影响

目的:寻找抑制肺动脉高压肺血管重建的药物。方法:体外培养的肺动脉平滑肌细胞(PASMC)加入中药制剂黄芪口服液、前胡口服液、白蒺藜口服液分别大、小两个剂量(大剂量10mg/ml,小剂量1mg/ml)干预,并掺入~3H-胸腺嘧啶脱氧核糖核苷(`3H-TdR),~3H-脯氨酸(~3H-Pro)检测每分钟液闪值(cpm),反映 PASMC 增殖及胶原合成分泌的改变。结果:~3H-TdR掺入值在加入黄芪、前胡、白蒺藜口服液后,无论大、小剂量,PASMC 均被抑制(P<0.001);对~3H-pro 的掺入值,在加入黄芪、前胡口服液后,大剂量、小剂量皆有阻抑作用(P<0.01和 P<0.05),白蒺藜只在大剂量时有作用(P<0.01)。结论:中药制剂黄芪、前胡、白蒺藜口服液可不同程度地阻抑 PASMC 的增殖和胶原合成过程,可能对肺动脉高压肺血管结构的重建起一定防治作用。