彩色多普勒超声在诊治股动脉穿刺并发症中的应用

目的探讨彩色多普勒超声在股动脉穿刺并发症监测治疗中的应用。方法首先对术后存在皮下淤血、软组织肿胀的350例患者进行彩超检测,确定是否存在并发症、并发症的种类及性质,如果确定为假性动脉瘤即用彩超引导压迫治疗并评价其疗效。结果共有150例患者发生皮下血肿,30例发生假性动脉瘤,5例发生动静脉瘘,5例发生静脉血栓,2例股动脉出现管腔节段性狭窄（由于周围血肿较大压迫所致）。结论彩色多普勒超声对股动脉穿刺的各种并发症能够作出准确诊断,并可指导压迫治疗假性动脉瘤。     

Trends in the Prenatal Detection of Major Congenital Heart Disease in Alberta From 2008–2018

ObjectiveThe effect of expanded obstetrical ultrasound cardiac views on the diagnosis of fetal congenital heart disease (CHD) has not been fully examined at a population level. We hypothesized there has been a significant increase in the prenatal detection of CHD in Alberta, particularly for CHD associated with cardiac outflow tract and 3-vessel view abnormalities.MethodsUsing provincial databases, we retrospectively identified all fetuses and infants diagnosed between 2008 and 2018 in Alberta with major CHD requiring surgical intervention within the first postnatal year. We evaluated individual lesions and categorized CHDs into the following groups based on the obstetrical ultrasound cardiac views required for detection: (1) 4-chamber view (e.g., hypoplastic left heart syndrome, Ebstein’s anomaly, single ventricle); (2) outflow tract view (e.g., tetralogy of Fallot, d-transposition, truncus arteriosus); (3) 3-vessel or other non-standard cardiac views (e.g., coarctation, anomalous pulmonary veins); and (4) isolated ventricular septal defects using any view.ResultsOf 1405 cases of major CHD, 814 (58%) were prenatally diagnosed. Over the study period, prenatal detection increased in all groups, with the greatest increase observed for groups 1 and 2 (75%–88%; P = 0.008 and 56%–79%; P = 0.0002, respectively). Although rates of prenatal detection also increased for groups 3 and 4 (27%–43%; P = 0.007 and 13%–30%; P = 0.04, respectively), fewer than half of the cases in each group were detected prenatally, even in more recent years.ConclusionsWhile rates of prenatal detection of CHD have significantly improved during the past decade, many defects with abnormal 3-vessel and non-standard views, as well as isolated ventricular septal defects, still go undetected.     

动脉正常吻接和张力吻接后顺应性对比研究

通过在体测定狗股动脉正常吻接和张力吻接后不同时相点吻合口段的压力与直接相应的数据,从而得出动脉在正常及张力吻接后的顺应性,以及顺应性与平均血压的关系。结果表明：在各时相点,张力吻接组吻合口段动脉的顺应性均低于正常吻接组,反映出动脉张力吻接合吻合口段的可扩张能力较正常吻接动脉有明显减弱,术后14天减弱最显著,张力吻合对吻合口段动脉的功能有较大影响。     

楔状缺损患者咬合情况的调查

目的 分析楔状缺损与He的关系。方法 选择125例患楔状缺损的中老年人,按楔状缺损的严重程度分为正常、轻、中、重四组。采用临床咬合诊断方法进行安氏咬合分类、颞下颌关节功能、He的分类、He功能情况的检查。结果 楔状缺损患者的安氏错He及偏侧咀嚼人数比例明显高于未患牙;楔状缺损的工作侧He干扰人数多于正常人,患牙的工作侧He干扰牙数也高于未患牙。结论 楔状缺损的发生与He力负担过重及异常He力有关。     

羟基聚磷酸钙钠与聚羟基丁酸酯膜联合修复骨缺损的实验研究

目的 评价羟基聚磷酸钙钠（Hydroxy-poly(calcium natrium phosphate）,HPA）与聚羟基丁酸酯（Polyhydroxybutiric ester,PHB）膜联合使用修复骨缺损的效果。方法 采用HPA充填狗股骨人工缺损区,同时覆盖PHB膜,与PHB膜覆盖及空白对照作比较,通过组织形态学及定量检测,观察1周、1、2、3个月缺损修复情况。结果 HPA与PHB联合用组,2个月内骨密度及形态优于PHB组,3个月后二组相当,均优于空白对照组。结论 HPA与PHB联合使用,可早期获得骨缺损修复强度与外形并举的效果。     

下颌骨缺损即刻修复的临床研究

目的 :回顾性调查我院 1980年以来下颌骨缺损即刻修复的临床资料 ,与病人建立长期随访关系 ,以探讨不同手术方法对术后长期疗效的影响。方法 :术后定期复查 ,根据面部外形恢复满意程度、咬合关系、颞下颌关节变化情况对术后效果进行分级 ,各组间资料进行统计学比较。结果 :各种方法行下颌骨缺损修复均可取得较好的远期效果 ,但在面部外形恢复的满意程度上存在差异。结论 :根据下颌骨缺损及周围软组织情况选择适应证是取得手术成功的关键因素     

应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损

目的探讨应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损（ASD）的临床效果。方法71例ASD患儿。男33例,女38例;年龄2～15岁,平均（7±4）岁;体重10～50kg,平均(22±11)kg。在经胸超声（TTE）的四腔心切面和剑下切面观察ASD的位置并测量ASD直径,测量房间隔（IAS）直径。在X线和超声帮助下用Amplatzer测量球囊导管测量ASD最大伸展径。根据所测得的ASD伸展径选择与之相同或比ASD大1～2mm腰部直径的Amplatzer闭合器堵闭71例患儿的ASD。术后随访疗效,追踪残余分流率和并发症。结果应用此法关闭71例ASD,全部成功。其残余分流率为2.8％。此方法并发症较少,疗效较好。本组资料分析示TTE测得的ASD径与测量球囊导管测得的ASD伸展径相关性好,从TTE测得的ASD径推算ASD伸展径的直线回归方程式6.54+0.97×TTE测得的ASD径（心尖四腔心）。结论经导管关闭继发孔ASD适应证为（1）年龄≥2岁,体重≥10kg,ASD直径≤30mm的单纯继发孔ASD或合并肺动脉瓣狭窄;（2）IAS≥ASD伸展径＋14mm;（3）ASD下缘与二尖瓣距离＞5mm,上下腔缘、后缘≥5mm,前缘≥2mm。超声心动图对病例的选择和对经导管监视关闭ASD术有不可忽略的作用,TEE还能弥补TTE的不足。Amplatzer双盘闭合器关闭ASD在儿科有较好的结果,但其疗效仍需长期随访。     

Silo construction from a sterile adhesive film and polypropylene mesh in the repair of gastroschisis and omphalocele

 A simple technique of constructing a silo for the treatment of gastroschisis (GS) and omphalocele (OMP) is described. A polypropylene mesh covered on both sides with a sterile transparent adhesive film (incise drape) was used; both these items are freely available in the operating room. The resultant silo is sterile, soft, flexible, sturdy, internally smooth, provides a reasonable barrier, and allows enough visibility of the bowel. This silo was used in the treatment of 25 cases of GS and 13 cases of OMP with acceptable results. Survival was better in patients in whom primary closure could be achieved in both OMP and GS. Silo treatment was associated with higher mortality from septic causes. Accepted: 24 August 2000     

Morphometric Assessment of Hirschsprung's Disease: Associated Hypoganglionosis of the Colonic Myenteric Plexus

ABSTRACT At present, there are no generally acceptable criteria for the evaluation of hypoganglionosis of the myenteric plexus. The aim of this morphometrical investigation was to examine the most important quantitative characteristics of hypoganglionosis. Colon specimens from 35 children with Hirschsprung's disease were assessed morphometrically. Twenty specimens with Hirschsprung's disease and proximal hypoganglionosis of the myenteric plexus were compared with 15 specimens with Hirschsprung's disease and normal innervation in the proximal myenteric plexus. All native surgical specimens were caudocranial coiled and sectioned in a cryostat. Nerve cells and ganglia were selectively stained with an enzyme-histochemical lactic dehydrogenase reaction. Morphometric measurements were done with an optic-electronic image analysis system. Hirschsprung's disease–associated hypoganglionosis of the myenteric plexus is characterized by a significant decrease in ganglion cross-sectional area (−56.2%) and in plexus area per mm colon (−53.5%). Together with these data, an increase in ganglion distance (+20%) was also determined, and the number of nerve cells per mm colon was decreased by −25.5%. The decrease in ganglion area and in the number of nerve cells per mm colon in the myenteric plexus proved to be the most characteristic parameters of a hypoganglionosis. Received July 13, 1999; accepted December 13, 1999.