中医药对淋巴管新生与回流功能的作用研究进展＊

淋巴管作为循环系统的重要组成部分之一，具有调节机体体液稳态，协助免疫监视和肠道脂质吸收等重要作用。淋巴管新生是机体生理和病理过程中维持脉管系统结构和功能正常的重要手段，淋巴管新生调控对于防治肿瘤、心血管等诸多疾病有着潜在的临床转化意义；淋巴回流功能则与关节炎症等疾病发病机制关系密切。在循环系统中，相较于中医药调控血管相关疾病的发病机制已取得很大进展，近年来对于淋巴管的研究则明显相对滞后。本文从中医药作用于淋巴管新生及回流功能角度对这一领域的研究进展作一综述，以期为临床上中医药治疗相关疾病提供新的思路与方法。     

Embolization of Urinary Tract Fistulae Using an AMPLATZER Vascular Plug and Glue

Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9–80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7–104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.     

超声引导下经皮经肝胆囊穿刺后继发性脓肿发生的危险因素分析

目的 探讨超声引导下经皮经肝胆囊穿刺置管引流术(Percutaneous Transhepatic Gallbladder Drainage,PTGD)术后发生继发性脓肿(Secondary abscess,SA)的发生率及其危险因素。方法 回顾性分析南京医科大学附属无锡人民医院2010年1月至2017年12月间410例经超声引导下PTGD患者的临床资料,采用单因素和多因素Logistic回归分析相关危险因素。结果 12例(2.93%,12/410)患者PTGD术后出现SA,再次针对SA穿刺引流的成功率100%。对良性疾病梗阻、基础疾病、胆囊大小、腹水、凝血功能、血小板、糖化血红蛋白(HbA_1C)、短期内引流管脱落/自行拔出等混杂因素进行校正后,Logistic回归分析表明短期内引流管脱落/自行拔出(OR=6.64,95%Cl：3.34～13.81,P=0.03)和HbA_1C＞9.0%(OR=3.38,95%Cl：1.22～7.95,P=0.04)是引起术后SA的独立危险因素。结论 SA是超声引导下PTGD术后罕见的并发症,再次穿刺引流是治疗SA有效和安全的方法。临床可通过加强对穿刺引流管的保护和应用降血糖药物,降低PTGD术后SA的发生。     

急性胆源性胰腺炎合并急性重症胆管炎处理策略

急性胆源性胰腺炎合并急性重症胆管炎病情凶险，病死率高。早期诊断，在内科治疗的同时，积极手术，合理选择内镜胆道引流、经皮经肝胆道引流、开放胆总管探查等治疗策略，以期阻止或延缓病情进展，降低并发症发生率及病死率。     

Lingual lymph nodes: Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.     

Study on enhanced lymphatic exposure of polyamidoamin-alkali blue dendrimer for paclitaxel delivery and influence of the osmotic pressure on the lymphatic targeting

In this study, paclitaxel (PTX)-loaded polyamidoamin-alkali blue (PTX-P-AB) was prepared in order to investigate the intralymphatic targeting ability and anti-cancer effect after subcutaneous (s.c.) administration. The physicochemical properties and in vitro drug release were evaluated. The lymphatic drainage and lymph nodes (LNs) uptake were examined by pharmacokinetics and distribution recovery of PTX in plasma, LNs, injection site (IS) and tissues after s.c. injection in healthy mice and in tumor-bearing mice. The osmotic pressure of PTX-P-AB affecting the lymphatic targeting was studied. The anti-tumor activity of PTX-P-AB was investigated in mice bearing S180 metastatic tumors. Results showed that PTX-P-AB with suitable and stable physicochemical properties could be used for in vivo lymphatic studies, and displayed the more rapid lymphatic absorption, the higher AUC value in LNs, the longer LNs residence time and the higher metastasis-inhibiting rate compared with Taxol®. Enhanced lymphatic drainage from the IS and uptake into lymph by increasing the osmotic pressure of PTX-P-AB indicated that PTX-P-AB possesses the double function of lymphatic tracing and lymphatic targeting, and suggested the potential for the development of lymphatic targeting vectors and the lymphatic tracer for treatment and diagnosis.     

冠状动脉旁路移植术后早期发生大量引流原因分析

目的:探讨冠状动脉旁路移植术(CABG)后早期发生大量引流的相关危险因素。方法:回顾性分析我院心脏大血管外科在2015年1月至2019年5月行CABG术治疗的患者375例,收集患者一般资料年龄、性别,贫血、心房颤动、血小板数量、凝血酶原时间、部分凝血活酶时间、国际标准化比值、术前口服抗凝药(华法林、达比加群、利伐沙班等)、是否合并急性心肌梗死、是否合并高血压、高脂血症、糖尿病、术前停用抗血小板药物时间<5 d等;手术情况,如手术时间、是否体外循环>5 h、旁路移植数量、是否同期置换瓣膜、出血量、输血量、自体血输血量、ACT值,对各项观察指标进行单因素和Logistic多因素分析。结果:术后12 h内出现大量引流患者39例,术后平均引流量为:(630.0±210.0)mL,术后12 h内引流量>2000 mL的患者17例,行二次开胸探查加止血患者20例。Logistic单因素分析显示:术前停用抗血小板药物<5 d、体外循环时间>5 h、出血量均与术后早期大量引流发生有关,Logistic多因素分析显示:术前停用抗血小板药物<5 d(OR=1.438,95%CI:0.017~3.154,P=0.003)是影响患者术后早期大量引流的危险因素。结论:术前停用抗血小板药物<5 d、体外循环时间>5 h、出血量均与术后早期大量引流发生有关,术前停用抗血小板药物<5 d是影响患者术后早期大量引流的危险因素。     

负压引流装置在小耳畸形患者皮肤扩张法耳郭再造二期手术中的应用

目的 探讨一种负压引流装置在皮肤扩张法耳郭再造二期手术中的临床应用效果。 方法 收集420例需要外耳再造的小耳畸形患者,应用皮肤扩张器植入法加自体肋软骨移植行耳郭再造术。按照术后引流方式随机分为两组:实验组(290例)采用专用负压引流装置;对照组(130例)常规放置一根负压引流管。比较两组患者皮下血肿的发生率并作统计学分析。 结果 与对照组相比,应用专用负压引流装置组皮下血肿发生率较低,差异有统计学意义(P<0.05)。 结论 在小耳畸形皮肤扩张法耳郭再造二期手术中,应用此负压引流装置可以有效防止术腔血肿,值得临床推广应用。