超声引导经皮穿刺冷冻治疗肝癌的实验和临床研究

目的 探讨经皮穿刺冷冻治疗原发性肝癌的应用价值。方法 ①家猪１２只,腹腔镜下显露肝脏,ｒｏｃａｒ针穿刺腹壁,经一非金属鞘将冷冻头插入肝右叶冷冻;②１１例原发性肝癌,超 引导穿刺扩张皮肤直至肝内肿瘤表面,保留一非金属鞘,ＬＣＳ－２０００冷冻机５ｍｍ冻冷头经鞘管插至肿瘤中心冷冻。结果 ①实验动手术后无腹腔内出血,冷冻穿刺部位无严重冻伤;②１１例病人冷冻后恢复均顺利,其中５例肿瘤缩小≥５０％,１例肿瘤完     

中西医结合治疗成人股骨头缺血坏死120例

采用中西医结合疗法 ,经皮股骨头内减压引流、靶血管脉冲式加压药物灌注、髂内动脉部分血管栓塞灌药和口服中药治疗成人股骨头缺血坏死 12 0例。通过 12～ 36个月的随访观察 ,髋关节疼痛缓解率为 92 5 0 % ,关节活动度改变率为 96 67% ,DSA检查血管增加达 88 33% ,CT、X线片股骨头骨质改变占 5 5 83%。综合疗效优于任何单项治疗     

组合硬化剂治疗肾囊肿远期疗效观察

目的：研究组合硬化剂对家兔胆囊的硬化作用,观察治疗肾囊肿的远期临床疗效。方法：应用四环素与氟美松组合硬化剂注入家兔胆囊,与生理盐水和无水乙醇对比观察其对胆囊壁的作用;与无水乙醇对比观察介入硬化治疗肾囊肿的疗效。组合硬化剂治疗组４１例,男２３例,女１８例,年龄４３岁－７２岁;无水乙醇对对照组４０例,男２８例,女１２例,年龄４５岁－７０岁。     

温血心停跳液与冷晶体心停跳液对狗心率变异性的影响

为探讨体外循环（ＣＰＢ）导致心脏植物神经系统（ＣＡＳ）损伤的机理,了解温血心停跳液能否防止ＣＰＢ后心率变异性（ＨＲＶ）的降低,采用对照方法观察了温血心停跳液与冷晶体心停跳液对狗ＨＲＶ的影响。结果显示：ＣＰＢ后温血心停跳液组（ＷＢ组）和冷晶体心停跳液组（ＣＣ组）的全频谱（ＴＰ）、低频（ＬＦ）和高频（ＨＦ）均较术前明显降低（Ｐ＜０．０５）,而且ＣＣ组比ＷＢ组降低更明显（Ｐ＜０．０５）,但ＬＦ／ＨＦ在组内及组间均无明显变化（Ｐ＞０．０５）。ＣＰＢ后２４小时平均心率（ＭＨＲ）明显增加（Ｐ＜０．０５）,且ＣＣ组高于ＷＢ组（Ｐ＜０．０５）。本研究表明：采用温血心停跳液或冷晶体心停跳液的ＣＰＢ不会干扰ＣＡＳ平衡,但均能使ＨＲＶ降低,温血心停跳液不能防止ＨＲＶ损害。     

2型糖尿病患者四肢血管的彩色多普勒研究

为了解２型糖尿病（ＤＭ）患者四肢动脉血管及血流的改变情况,我们应用Ａｃｕｓｏｎ １２８ ＸＰ／１０ 彩色多普勒超声仪,对５０ 例ＤＭ 患者进行测定并与正常对照组作比较。结果显示：①２ 型ＤＭ 患者动脉血管壁较正常人回声明显增加,内膜增厚,管壁不光滑、僵硬,部分患者四肢血管内可探及粥样斑块回声（１４／５０）,以胫前动脉斑块病变为多（９／５０）。其中１ 例为临床无四肢症状者;②２ 型ＤＭ 患者四肢动脉血管内径明显低于正常对照组（Ｐ＜０．０５）,且有四肢症状存在者较无症状者（除左侧胫前动脉外）血管内径有进一步变细;③正常人四肢动脉频谱形态主要呈三峰,少数出现单峰,而２型ＤＭ 患者频谱形态主要呈单峰且频谱增宽,出现舒张期持续灌注,与正常组比较有显著性差异（Ｐ值分别＜ ０．０１ 和＜ ０．０５）;④２ 型ＤＭ 患者四肢血流峰值流速（ＰＶ）较正常对照有加快,但差异无显著性,有四肢症状存在者较无症状者峰值流速有进一步加快的趋势。本试验结果提示：２ 型糖尿病患者的上、下肢动脉血管均受累,采用彩色多普勒检查患者四肢动脉血流动力学及血管定位改变,对ＤＭ 患者周围血管病变的诊断,尤对无症状患者早期诊断具有一定价值。     

微血管舒张功能障碍及体外反搏的改善作用

目的：通过测定微血管血流灌注来反映微血管的舒张功能,同时观察体外反搏治疗改善冠心病患者微血管舒张功能障碍的效果。方法：应用激光多普勒血流量计（ＬＤＦ） ,测量５８ 个被观察者的前臂皮肤在反应性充血前后微血管血流灌注增加比值,评价血流介导的微血管舒张功能。结果：冠心病组、高胆固醇血症组及吸烟组微血管舒张功能明显低于对照组,比值分别为１．８３±０．３７、２．６３±０．５１、３．１９ ±０．５６ 比３．５６±０．３６ ;Ｐ分别＜ ０．０１,＜０．０１,＜ ０．０５。冠心病组反搏治疗前后比,其微血管的舒张功能明显提高,比值为１．８３±０．３７ 比２．５４±０．４３; Ｐ＜０．０１。结论：ＬＤＦ可检测冠心病患者明显的微血管舒张功能障碍及高胆固醇血症者和吸烟者微血管功能的异常;体外反搏治疗可改善冠心病患者的微血管舒张功能。     

英脱利匹特增强超声多普勒血流信号作用的实验研究

目的：研究英脱利匹特增强超声多普勒血流信号的作用。方法：在１０ 只兔中应用经颅超声多普勒检测静脉推注４ 种不同剂量（０ ．２、０．５、１．０、２．０ｍｌ／ｋｇ）２０ ％ 英脱利匹特前后的动脉血流信号,并以等量的生理盐水作对照。结果：各种剂量２０ ％ 的英脱利匹特注射后多普勒血流信号强度明显增强, 平均比生理盐水及注射前血流信号强度高２６．８±９．７ｄＢ。注射生理盐水后多普勒血流信号强度未见明显改变。结论：静脉注射２０ ％ 英脱利匹特能够增强血流信号,提高多普勒检测的敏感性。     

超声照射对声振微泡稳定性的影响

目的与方法造影剂微泡浓度、大小是影响心肌声学显影最重要因素。本研究采用２×２×４析因分析法分析不同超声照射条件对造影剂微泡浓度及直径的影响,即声波频率、能量以及照射时间对微泡浓度、大小的单独及交互作用。为临床行静脉心肌声学造影检查时选择适宜的超声照射条件提供参考。结果能量越大、照射时间越长,微泡破坏越多,平均直径越小：照射频率对微泡浓度影响不大,但影响微泡大小,频率越高,微泡越小。结论为减少超声照射对微泡的破坏,提高心肌声学造影效果,应尽可能选用低能量、低频率超声波,并减少不必要的照射时间。     

Colour Doppler ultrasound assessment of the inferior vena cava in patients with Wilms' tumour

OBJECTIVE: To assess the diagnostic accuracy of colour flow Doppler ultrasound in diagnosing inferior vena caval (IVC) extension of tumour thrombus in patients with Wilms' tumour. MATERIALS AND METHODS: Over a 3-year period from June 1994 to June 1997, 74 patients with Wilms' tumour were referred to our institution. In this retrospective study we reviewed the preoperative colour flow Doppler ultrasound reports of 64 of these patients and compared the reports with the intra-operative findings in 51 patients who underwent surgery. RESULTS: Vena caval extension of tumour thrombus was present in 12 patients (18.7%) and in six of these patients (9.4%) there was also atrial extension of the tumour. Colour flow Doppler ultrasound correctly diagnosed IVC extension of tumour thrombus in nine patients and correctly predicted the cranial extent of the tumour thrombus in eight patients. CONCLUSION: Colour flow Doppler ultrasound has an overall positive predictive value of 73.4% in assessing IVC patency and correctly diagnosing IVC extension of tumour thrombus, in patients with Wilms' tumour. However, non-diagnostic ultrasound examinations can occur in over 20% of patients.     

Effects of a leucocyte depleting arterial line filter on perioperative proteolytic enzyme and oxygen free radical release in patients undergoing aortocoronary bypass surgery

BACKGROUND: Proteolytic enzymes and oxygen free radicals released from activated leucocytes contribute significantly to the organ dysfunction associated with cardiopulmonary bypass. Leucocyte depletion during extracorporeal circulation should reduce the release of these toxic compounds and thereby improve postbypass myocardial and pulmonary function. Recently, a leucocyte-specific arterial line filter to achieve leucocyte depletion during clinical perfusion has become commercially available. The aim of this study, therefore, was to evaluate the influence of the leucocyte depleting arterial line filter on proteolytic enzyme release, oxygen free radical release and postbypass pulmonary and myocardial function in patients undergoing bypass surgery. METHODS: Forty patients undergoing elective aortocoronary bypass surgery were included into this prospective, randomized clinical study, 20 in the leucocyte depletion (LG-6 group, leucocyte-specific arterial line filter) and 20 in the control group (AV-6 group, standard arterial line filter). White cell count, differential white cell count, plasma elastase concentration, plasma malondialdehyde concentration and C-reactive protein were determined before, twice during and immediately after cardiopulmonary bypass, at the end of surgery and 6 and 20 h thereafter. RESULTS: White cell count, differential white cell count, malondialdehyde and C-reactive protein were not significantly different between LG-6 and control patients. Plasma elastase concentrations were significantly (P < or = 0.03) higher during and immediately after extracorporeal circulation in LG-6 group patients. Need for inotropic support, arterial pO2 after extracorporeal circulation and perioperative CK MB mass and troponin I release were not different between the two groups of patients. CONCLUSION: The use of a leucocyte depleting arterial line filter is associated with an increased release of the proteolytic enzyme elastase, but does not reliably and consistently achieve effective leucocyte depletion during clinical perfusion. In contrast to previous studies, we could not demonstrate any significant difference in postbypass pulmonary or myocardial function between patients perfused with the leucocyte-specific arterial line filter and control patients. Our data do not support the routine use of a leucocyte depleting arterial line filter during clinical perfusion in patients undergoing elective aortocoronary bypass surgery.