国产一次性经口胆道镜的动物实验研究

目的　评估国产一次性经口胆道镜在动物胆道镜检查中的有效性和安全性。方法　6头健康巴马小型猪分别于麻醉后行国产一次性经口胆道镜检查,评价其操作性能、图像质量并记录术中和术后并发症。结果　6例动物均完成国产一次性经口胆道镜检查。该胆道镜操作性能良好,能顺利通过十二指肠镜进入胆道,注水、吸引及器械通道通畅。胆道镜图像清晰、颜色分辨率良好,未出现图像变形及失真,可准确评估管腔内情况及清晰观察黏膜表面情况。检查过程中未产生出血、穿孔等操作性损伤,以及呼吸抑制、心脏骤停等不良事件。术后所有猪存活状态良好,无不良反应。结论　国产一次性经口胆道镜操作性能良好,图像质量高,安全性较好。     

一次性电子输尿管软镜和可重复使用纤维输尿管软镜治疗老年上尿路结石的效果及安全性比较

目的 观察一次性电子输尿管软镜(single-use digital flexible ureteroscope, SDFU)和可重复使用纤维输尿管软镜(reusable fiber-optic flexible ureteroscope, RFFU)治疗老年上尿路结石的效果及安全性。方法 本研究采取前瞻性、单盲2、单中心随机对照的试验方法。纳入2020年6月—2022年1月于西南医科大学附属成都三六三医院治疗的老年上尿路结石患者82例,随机分为SDFU组和RFFU组。SDFU组接受一次性电子输尿管软镜钬激光碎石治疗,RFFU组接受可重复使用纤维输尿管软镜钬激光碎石治疗。观察并比较2组围术期指标值、结石清除情况、实验室指标值及术后并发症。结果 SDFU组手术时间、碎石时间少于RFFU组,术后结石清除率高于RFFU组,差异均有统计学意义(P<0.05)。术后,2组血肌酐水平较同组术前升高(P<0.05), 2组血肌酐水平和血红蛋白水平差异无统计学意义(P>0.05)。2组患者术后并发症以GradeⅠ、Ⅱ级为主,并发症总发生率差异无统计学意义(P>0.05)。结论 ...     

实验犬房间隔造口手术模型的方法学研究

目的 采用三种不同方法进行实验犬房间隔造口,比较其优缺点,选择最实用的方法为进一步造口支架植入实验提供方法学保障.方法 共8只实验犬,其中2只采用透视引导下经股静脉穿刺介入性房间隔造口法(简称介入法),2只采用外科开胸阻断上下腔静脉直视下房间隔穿刺造口法(外科直视法),4只采用外科开胸经食管超声引导下非阻断循环下经右房...     

输尿管镜/软镜手术常见并发症的防治

腔道泌尿外科技术的快速发展为输尿管结石的治疗提供了广阔的前景。近年来腔镜技术逐渐替代了传统的开放手术,输尿管镜/软镜技术联合气压弹道技术或钬激光技术广泛应用于上尿路结石的腔内治疗,尤其是输尿管软镜下碎石术被认为可替代经皮肾镜技术。其具有损伤小、住院时问短、无需辅助排石药物治疗等优点,但也存在一定并发症。     

小儿止泻贴抗动物脾虚的实验研究

运用现代科学技术，对脾虚小鼠进行体重恢复期观察，耐寒能力试验，溶血空斑实验（ＰＦｅ）和Ｅ玫瑰花结实验（ＥＲＦｅ）。结果表明，该工能缩短脾虚症状好转时间，提高其耐寒能力，增加ＰＦｃ和ＥＲＦｅ的形成，表明该工绎小鼠脾虚状有良好的治疗作用，并提高其机体的体液免疫和细胞免疫功能。     

纤支镜代胸腔镜诊断病因不明的胸腔积液

目的探讨纤维支气管镜代胸腔镜诊断原因不明的胸腔积液。方法利用国产纤支镜对3例胸腔积液患者局麻下行胸腔检查并取活检。结果肺腺癌胸膜转移1例,恶性胸膜间皮瘤1例,胸膜结核肉芽肿1例。结论以纤维支气管镜代替胸腔镜行胸腔镜检创伤小,费用低,简便易操作。对原因不明胸腔积液者查明病因提供了一种有效的诊断方法。便于在基层医院推广。     

三维引导下多极高密度标测在右室流出道室性早搏消融中的应用

目的评价多极接触标测在指导三维电解剖引导下右室流出道(RVOT)室性早搏(简称室早)消融的疗效。方法选择32例RVOT室早患者,据术中室早发作的频度分为两组:室早1次/分者采用多极导管高密度标测(多极组);室早≥1次/分者采用单导管逐点标测(单极组);确定激动起源靶点后再进行起搏标测证实并实施消融治疗。比较两组的标测时间、消融次数及时间、X线曝光时间、消融成功率。结果 29例患者完成电生理标测及消融,单极组16例,多极组13例。多极组平均采集有效标测点明显多于单极组;激动顺序标测耗时两组未见差异。多极组总手术时间明显长于单极组,但是在平均消融次数、消融时间、X线透视时间等指标比较,多极组却显著少于单极组,所有患者均达到即刻消融终点。随访(6.9±3.2)个月,单极组1例复发。结论采用多极标测导管对RVOT局部进行高密度电解剖标测快捷、精确,提高消融成功率,尤其是对术中室早发作较少的患者。     

抗纤软肝冲剂预防大鼠肝纤维化的实验研究

目的:观察抗纤软肝冲剂对肝纤维化的预防作用并探讨其机理。方法:采用四氯化碳、高脂、高胆固醇、低蛋白等复合因素制造肝纤维化模型,同时用抗纤软肝冲剂治疗,观察其对肝纤维化指标的影响,以秋水仙碱作为对照,结果:抗纤软肝冲剂对肝纤维化大鼠有升高白蛋白(Alb),降低谷丙转氨酶(ALT)和球蛋白(G)的作用;可调整机体免疫功能,降低血清免疫复合物(IC);具有显著降低血清透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)、肝脏羟脯氨酸(Hyp)的作用;可以改善肝脏病理,抑制纤维化形成。结论:抗纤软肝冲剂具有确切的预防肝纤维化的作用。     

内镜超声引导下肝内门体分流术在实验动物中的应用一例

经颈静脉肝内门体分流术是门静脉高压的一种重要治疗方法,但该方法技术难度高,可能导致严重并发症,故临床推广受到限制。内镜超声引导下肝内门体分流术如以人体自然腔道为入路,有望通过内镜超声的精准定位放置肝内门体分流支架。本文报道国内首例该技术的动物实验过程,为该技术的可行性和进一步研究提供依据。     

输尿管软镜下钬激光治疗肾盂肿瘤的手术室护理配合效果观察

肾盂肿瘤是泌尿外科常见肿瘤疾病,多发于肾盏上皮细胞、肾盂,具有多中心性、复发率高的特点,各年龄段均可发病,严重威胁患者生命健康。目前主要采用手术方案治疗患者。随着医学技术的进步和发展,输尿管软镜下钬激光治疗肾盂肿瘤成为了可行路径,能够明显减轻患者疼痛感,提高患者的生活质量。本文主要对输尿管软镜下钬激光治疗肾盂肿瘤的手术室护理配合方法进行了研究,旨在保障手术顺利进行,取得良好的手术效果。     

Arrested rotation of the outflow tract may explain double-outlet right ventricle

In a previous study the possibility that tetralogy of Fallot and transposition of the great arteries may result of embryonic arrests in the normal rotation of the junction of the outflow tract and the great arteries was investigated. The results suggested that the development of other transposition complexes such as double-outlet right ventricle might also be related to arrests in this process of rotation. To further study this question 20 normal hearts and 15 hearts with double-outlet right ventricle obtained at autopsy were studied. The angle of the aortic-to-pulmonary valve axis relative to the inferior surface of the heart, as viewed from apex to base, was measured from postmortem radiographs. For normal hearts the mean angle was 81 +/- 7(SE) degrees. For 13 of the 15 hearts with double-outlet right ventricle the mean angle was 4 +/- 7(SE) degrees. Two hearts with double-outlet right ventricle showed markedly divergent aortic-to-pulmonary valve angles, with a mean of 228 +/- 11(SE) degrees, and were therefore grouped separately. Although direct comparison of hearts and embryos is difficult because of the differences in methods of determining angles, the valve positions in normal hearts was most similar to Carnegie stage 19, as found in an earlier study. The majority of the hearts with double-outlet right ventricle resembled stage 16 embryos. The results of this study, as well as those of the earlier studies, support the hypothesis that a spectrum of cardiac anomalies with anomalous origin of great vessels arises as arrests in the normal rotation of the semilunar valve region during embryogenesis.     

Ventricular outflow tract obstruction secondary to leiomyosarcoma of the right ventricle

Primary leiomyosarcomas of the heart, particularly those affecting the right ventricle, are uncommon. We report the case of a 70-year-old Belgian woman presenting with the symptoms of progressive exertional dyspnea and left-sided pleuritic pain. A leiomyosarcoma which originated from the right lateral ventricle wall, causing pulmonary outflow obstruction, was diagnosed. Pathology revealed a neoplasm with a myxoid stroma, high mitotic activity and nuclei expressing atypia. Immunohistochemical staining was positive for vimentine and desmin. Seven months after complete surgical resection the tumor relapsed. This case demonstrates the poor outcome, the high relapse rate and inefficiency of treatment associated with primary cardiac leiomyosarcomas. The current literature regarding the incidence, diagnostic techniques, treatment strategies and survival rates of this rare but terminal disease is reviewed.     

Transcatheter-covered stent implantation in an unusual post-surgical right ventricle outflow tract stenosis

Stenting of the right outflow tract has been reported in caseof surgical conduit or as propedeutical procedure before percutaneouspulmonary valve placement. Treatment of isolated right outflowtract in the adult has not been previously reported. A 33-year-oldfemale, operated three times before for a left outflow tract     

Multimodality imaging of tumefactive lipomatous hypertrophy of the right ventricle extending to the right ventricular outflow tract

Lipomatous hypertrophy of the right ventricle is a rare entity that is usually asymptomatic and diagnosed incidentally in an otherwise healthy individual. Accurate diagnosis and assessment of possible hemodynamic consequences of this pathology is, however, necessary to secure an appropriate treatment. Multimodality imaging with echocardiography, CT, and cardiac MR can provide useful functional and anatomic information that can help to reach this goal.     

Successful ablition of aortic cusp tachycardia from right ventricle outflow tract using a superior approach

We report a case of successful radiofrequency catheter ablation of idiopathic aortic cusp tachycardia arising close to right coronary artery ostium performed safely from the right ventricular outflow tract (RVOT) by unconventional superior approach. As both activation mapping and pace mapping of the tachycardia were suboptimal from transfemoral RV endocardial approach, retrograde aortic mapping was performed. This revealed that the site of ventricular tachycardia (VT) origin to be on the right coronary sinus. Due to close proximity of VT site of origin and the right coronary ostium, an alternate approach to ablation was considered. We approached this area easily and successfully ablated the VT with an ablation catheter introduced from a right-sided superior approach (jugular vein). The patient has remained free from recurrences over an 18 month follow-up period.     

普通级动物实验室开展结核菌动物实验的生物安全性探讨

目的 对普通级实验动物房进行适当的改造,在进行结核菌动物实验时采取严密的防范措施,观察是否会对环境和工作人员造成危害.方法 对普通级动物房进行适当改造,加强消毒灭菌措施,检测实验废物及环境中的结核菌污染情况;实验人员进行实验前后健康检测.结果 对实验室排风口过滤槽中的消毒液、实验室废液、废物进行多次涂片镜检和培养,均未发现结核菌.实验密切接触者的跟踪调查:实验结束1年后,对参与实验的人员进行了X线胸片检验和结核菌纯蛋白衍生物(PPD)试验.密切接触实验的6人中,肺部X线胸片均无异常.PPD试验的红肿大小与实验前无差异.结论 普通级动物房经过适当改造后,并加强消毒和防护措施,能避免对周围环境和实验密切接触者的危害,具有进一步探讨的价值.     

Differences in arrhythmogenicity between the canine right ventricular outflow tract and anteroinferior right ventricle in a model of Brugada syndrome

BACKGROUND: The Brugada syndrome is characterized by ST-segment elevation on the ECG, especially in the right precordial leads sensitive to the right ventricular outflow tract (RVOT). OBJECTIVES: The purpose of this study was to evaluate the hypothesis that right ventricular electrophysiologic heterogeneity caused arrhythmogenicity in the Brugada syndrome. METHODS: Action potentials (APs) were mapped on the epicardium of 14 RVOT preparations and on the transmural surfaces of 15 pairs of RVOT and right ventricular anteroinferior (RVAI) preparations isolated from canine hearts. Brugada ECG and arrhythmias were induced with pilsicainide (2.5-12.5 micromol/L), pinacidil (1.25-12.5 micromol/L), and terfenadine (2.0 micromol/L). RESULTS: Low doses of drugs elevated the J-ST segment and induced APs with both short and long action potential durations (APDs) in contiguous RVOT epicardial regions. In addition, APs in the RVOT had a larger phase 1 notch and longer APD than in RVAI. The longest APDs were in the epicardium in RVOT but in the endocardium in RVAI regions. High doses of drugs eliminated the phase 2 dome of the AP and abbreviated APDs in the epicardium but not in endocardium and reduced the epicardial heterogeneity of APs but increased the transmural gradient of APD in 14 (93%) of the RVOT preparations. In contrast, abbreviations of epicardial APDs occurred in only 4 (27%) of the RVAI preparations. Ventricular tachycardia occurred more frequently in the RVOT (47%) than in paired RVAI preparations (7%). Blocking the transient outward current reduced the heterogeneity of APs and eliminated arrhythmogenicity in all preparations. CONCLUSION: Compared with the RVAI region, the RVOT has greater electrophysiologic heterogeneity that contributes to arrhythmogenicity in this model of Brugada syndrome.