不同胰－空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响

目的：研究不同胰－空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响。方法选择行胰十二指肠切除术的80例患者作为研究对象,随机分为两组,每组40例。观察组行改良胰空肠端端吻合,对照组行传统套入吻合。观察两组手术一般情况和术后胰瘘发生率。结果观察组治疗后胰瘘发生率为12．5％,显著低于对照组的42．5％,差异具有统计学意义（P＜0．05）。观察组术中出血量和住院时间分别为（362．25±58．76）mL和（18．84±4．52）d,显著低于对照组的（402．73±68．82）mL和（23．76±7．63）d,差异具有统计学意义（P＜0．05）。结论改良后胰肠端端吻合可显著降低胰十二指肠切除术后胰瘘发生率,且术中出血量较少,住院时间较短。     

低功率CO_2激光焊接鼠小肠的实验研究

目的探讨低功率CO2激光焊接小肠的可行性。方法将60只SD大鼠分为缝合组和激光组,每组各30只。分别以功率0.15 W的CO2激光焊接或临床外科常规缝合鼠小肠,比较两组吻合的时间、术后死亡率和术后第14天各肠管吻合口粘连、狭窄程度、破裂压及组织病理学变化。结果激光组和缝合组的吻合时间分别为（25＋6.24）min和（36＋7.50）min,差异有显著意义（P〈0.05）。根据Sertz＇s评分标准分级激光组和缝合组粘连均值分别为26.12和34.88,差异有显著意义（P〈0.05）。术后第14天两组狭窄指数接近,差异无显著意义（P〉0.05）。破裂压测定：激光组破裂压比缝合组高,且破裂口多位于吻合口以外的正常肠管。激光组吻合口周围炎症反应轻,管壁光滑;缝合组可见明显的炎症反应,管壁不光滑。结论低功率CO2激光焊接小肠组织是可行的,具有一定潜在的临床应用价值。     

氩激光光凝治疗裂孔性视网膜脱离的远期疗效观察

目的 观察原发性单纯性视网膜脱离手术后应用氩激光光凝封闭视网膜裂孔代替术中巩膜外冷凝封闭视网膜裂孔的疗效及其规律。方法 对71例71只眼原发性单纯性视网膜脱离手术后应用氩激光光凝封闭视网膜裂孔代替术中巩膜外冷凝封闭视网膜裂孔（术后激光组），并与同期术中冷凝封闭视网膜裂孔70例70只眼（术中冷凝组）进行对照。结果 随访时间6～54个月，一次治愈率术后光凝组为97．2％，术中冷凝组为97．1％，两组差异比较无显著意义（P〉0．05）。术后6个月脱盲（视力≥0．05）率术后激光组为81．7％（58／71），术中冷凝组为65．7％（46／70），两组差异具有显著意义，（χ^2=4．6480，P=0．0311，P〈0．05）。手术并发症术后光凝组2只眼术后玻璃体浑浊增加，术中冷凝组9只眼术后玻璃体浑浊增加，两组术后并发症发生率差异有显著意义（P〈0．05）。结论 单纯性视网膜脱离手术后应用氩激光封闭视网膜裂孔，定位准确，手术操作简单，术后并发症少，有利于视功能的保留和恢复。     

血管缝合器缝合股动脉的血管并发症及其处理

目的探讨血管缝合器缝合股动脉的血管并发症及其防治。方法选择冠脉造影和(或)冠心病介入治疗(PCI)后采用血管缝合器缝合股动脉病例218例,观察其成功率及血管并发症。结果股动脉血管缝合218例,成功率为91．3％,出现小血肿并伤口感染仅1例,发生率0．5％;无假性动脉瘤、血栓形成以及栓塞事件。结论血管缝合器适用于冠脉造影和PCI术后股动脉血管的缝合止血,其成功率高,而血管并发症发生率低。     

两种不同弱激光照射对兔牙齿移动牙周组织中碱性磷酸酶活性的影响

目的：比较两种弱激光照射对兔牙齿移动牙周组织中碱性磷酸酶活性的影响。方法：42只大耳白兔随机分为未加力组及加力1、3、5、7、14、21d，共7组，每组6只。于双侧上颌第一磨牙至切牙间拴结不锈钢螺簧。施力80g。每组兔中3只进行He-Ne激光照射，另外3只进行He-Ne激光加CO2激光照射，每只兔右侧为照射侧，左侧为对照侧，全部大耳白兔在不同时间处死，制作组织学标本，进行碱性磷酸酶染色，计算机图像分析，实验结果应用非配对t检验进行统计学处理。结果：激光照射后，牙周组织中碱性磷酸酶染色面积百分比在3、5、7d组照射侧均明显高于对照侧，两侧比较在3、5d组差异有显著意义（P＜0．05）。碱性磷酸酶总数量在3、5、7d组均呈升高趋势，以照射侧明显，3d组差异有非常显著意义（P＜0．01），5、7d组差异有显著意义（P＜0．05）。而两种不同弱激光照射的实验组间的比较，差异无显著意义。结论：He-Ne激光照射与He-Ne激光加CO2激光局部照射比均可提高兔牙齿移动牙周组织中碱性磷酸酶的活性。     

三种复发性喉乳头状瘤治疗方法的疗效分析

目的探讨复发性喉乳头状瘤的有效治疗方法。方法回顾性分析我院2000年1月～2005年12月诊治的67例复发性喉乳头状瘤患者的临床资料。结果67例中未成年患者组47例，占70．1％；成年患者组20例，占29．9％。行喉造口喉乳头状瘤激光切除术34例，16例复发（未成年患者13例，成年患者3例），占47．1％；术后喉狭窄15例（未成年患者12例，成年患者3例），其中9例为再次复发者。行喉部分切除术3例，随访2年未再复发，且均无喉狭窄出现。行支撑喉镜下喉乳头状瘤CO：激光切除术30例，复发7例，占23．3％；术后喉狭窄6例（均为未成年患者）。术后复发23例中，未成年患者20例占87．0％；成年患者复发3例占13．0％。不同术式的术后复发率及喉狭窄发生率差别有统计学意义（均P〈0．05）；不同年龄组的术后复发率及喉狭窄发生率虽有差异，但无显著意义（P〉0．05）。结论支撑喉镜下喉乳头状瘤CO2激光切除术及术后定期复查是目前较为有效的治疗复发性喉乳头状瘤的方法。     

双吻合器在低位直肠癌手术中的临床应用

目的：探讨双吻合器在低位直肠癌手术中的临床应用效果。方法选取治疗的230例低位直肠癌患者,分为对照组110例和观察组120例,对照组患者采用传统手术方法进行治疗,观察组采用双吻合器方法治疗,对比观察两组患者的治疗的临床应用效果。结果观察组患者的手术时间为（88．73±24．41）min,术中出血量为（70．67±20．11）mL,住院时间为（11．32±5．93）d,均显著优于对照组,P＜0．05表示有显著性差异,具有统计学意义。观察组患者吻合口感染的发生率率为3．33％,吻合口瘘的发生率为4．17％,吻合口狭窄的发生率为2．50％,均显著低于对照组,P＜0．05表示有显著性差异,具有统计学意义。对照组复发率为11．82％,观察组复发率为11．67％,两组比较无显著差异,P＞0．05,无统计学意义。结论双吻合器在低位直肠癌手术中的临床应用效果显著,可显著减少手术时间、术中出血量和住院时间,且可有效降低吻合口并发症的发生,值得临床广泛推广应用。     

CO_2激光焊接SD鼠小肠对吻合口羟脯氨酸和碱性成纤维细胞生长因子含量的影响

目的观察激光焊接与传统肠管缝合的吻合口羟脯氨酸(hydroxyproline,Hyp)和碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)含量在愈合过程中的变化。方法将60只SD大鼠分为实验组和对照组两组,每组30只。2个大组再根据术后观察时间不同分为3小组,分别为术后7 d组、术后14 d组和术后28 d组,每组10只大鼠。实验组采用CO_2激光焊接,用3针等距缝线以牵引固定肠管,激光焊接功率密度19.11 mW/cm~2,光斑直径0.1 cm,持续脉冲时间为0.2 s。激光焊接后将3根缝线抽走,激光焊接点40~50个。对照组采用3-0丝线行单层间断缝合,缝合需9~10针。分别于术后7 d、14 d和28 d,测定吻合口破裂压。另外取吻合口近远端各0.5cm的小肠组织分别测定Hyp和bFGF含量。结果术后60只大鼠均存活。实验组破裂压不同时期均高于对照组,第14和28天均明显高于对照组(P0.05)。术后第7d实验组Hyp含量与对照组比较,差异无显著意义;术后第14和28天实验组Hyp的含量明显高于对照组(分别为P0.05,P0.001)。实验组bFGF的含量不同时期均高于对照组,第7、14天均明显高于对照组(P0.05)。结论 CO_2激光焊接肠管可促进吻合口处小肠组织内羟脯氨酸和碱性成纤维胞生长因子的分泌,从而加速吻合口的愈合。     

3.0T高分辨MRI对颈动脉斑块分型的研究

目的：探讨在3．0T上运用高分辨多序列MRI对颈动脉斑块进行定性、分型的能力。材料和方法：53例经超声筛选的颈动脉斑块病人，包括近期脑卒中者27例，在3．0TMR仪上行多序列（3D—TOF、T1W、T2W和PDW）扫描，参照修改的AHA动脉粥样硬化MRI分型标准，对颈总动脉、颈内动脉和分叉部的斑块进行定性和分型，计算症状侧颈动脉斑块的发病率和比数比，以评估各型斑块发生脑卒中的危险度。计数资料行卡方检验或Fisher切概率检验，P〈0．05有统计学意义；比数比的显著性检验用Mantel—Haenszel法，并计算95％可信区间。结果：①270个部位中，Ⅰ-Ⅱ型占32．2％，Ⅲ型占45．9％，Ⅳ-Ⅴ型占14．4％，Ⅵ型占3．0％，Ⅶ型占4．5％，各型斑块在颈动脉3个部位的分布差异有统计学意义（Fisher确切概率P：0．00596）；②Ⅳ-Ⅴ型、Ⅵ型斑块在症状侧颈动脉的发病率和比数比高于其他类型，Ⅵ型斑块比数比为16．42。结论：在3．0TMR上应用高分辨多序列技术对进展期的斑块具有准确定位及初步分型的能力，Ⅳ-Ⅴ型和Ⅵ型斑块显示了较强的脑卒中发生趋势，尤其是Ⅵ型斑块。     

周围神经端侧吻合新方法大鼠实验模型的建立

目的 设计制作端侧吻合新方法的动物实验模型，并进行检测。方法实验用Wistar大白鼠，共28只。按拟行神经吻合的方式，将大鼠的左下肢定为实验侧，右下肢定为对照侧。实验侧：切断大鼠左侧胫神经，将胫神经的近断端与腓总神经端侧吻合；对照侧：切断大鼠右侧腓总神经，将腓总神经的远断端与胫神经端侧吻合。3个月后，进行电生理检查，比较两侧固定刺激量的波幅、潜伏期、最大波幅。比较实验侧吻合口远、近端的腓总神经纤维计数。结果实验侧与对照侧相比，波幅、潜伏期、最大波幅差异无统计学意义。实验侧吻合口远侧的神经纤维计数多于近侧神经纤维计数（P〈0．05）。结论端侧吻合新方法的轴突再生机制为胫神经轴突发芽，再生的轴突通过吻合口沿着腓总神经外膜或束膜管道向靶肌肉生长。     

兔颈动脉CO_2激光环形连续吻合与缝线吻合的组织病理学变化比较

目的比较CO2激光环形连续吻合与缝线吻合血管的组织损伤程度及血管正常结构恢复速度。方法将24只家兔的左右颈动脉切断后分别用CO2激光环形连线吻合或缝线吻合,于吻合术后24h、3d,1、2、4和8周分别取材进行血管吻合口的光镜和扫描电镜观察。结果激光吻合组,血管内膜损伤小,管壁各层次结构清晰,炎症反应轻;缝线吻合组,血管内膜损伤重,管壁各层次结构紊乱,有断裂损伤,炎症反应重。激光吻合组术后血管内皮细胞增生早,弹力纤维含量多,平滑肌细胞排列有序;缝线吻合组血管内皮细胞增生晚,缝线周围纤维组织增生明显,管壁有肉芽组织增生。结论用CO2激光环形连续吻合小血管比用缝线吻合,血管组织损伤小,术后恢复快。     

异物创伤性动脉瘤犬模型构建的初步探讨

目的：建立异物创伤性动脉瘤的犬模型,为伴血管损伤软组织异物一站式介入治疗研究提供动物模型。 方法：随机选取2年龄的健康雄性比格犬7只,分为颈动脉瘤造模5只和未造模2只,造模于右侧颈动脉共5支血管为研究组,其左侧颈动脉及未造模2只犬两侧颈动脉共9支血管为对照组。研究组将长约15~20 mm的离断颈静脉剪开、缝合于同侧颈总动脉前璧上,以弯型断针穿破静脉片及动脉前壁,静脉片-动脉壁间腔搏动性充盈且无缝缘渗漏后,断针部分留存于该间腔甚或动脉腔内,逐层缝合手术区域组织。然后,经皮经股动脉插管选择性颈总动脉进行数字减影血管造影（DSA）。对照组颈动脉仅于其旁以缝针经皮扎伤软组织且无明显出血及血肿。术前、术后行颈部CT血管成像（CTA）和数字放射摄影（DR）检查与评估。 结果：研究组5支右侧颈动脉断针创伤性动脉瘤均成功造模,技术成功率100%;DSA清晰显示动脉破口、动脉瘤状动脉突起及断针异物,载瘤动脉局部轻度痉挛及狭窄,创伤性动脉瘤模型的瘤颈宽度为（2.1±1.3）mm,瘤体宽（9.7±1.1）mm,瘤体高（4.2±1.7）mm;CTA不如DSA显示效果佳。对照组9支颈动脉均正常。 结论：采用颈静脉片侧-侧吻合于同侧颈动脉前壁上并以断针穿破静、动脉壁且断针部分留置于其间的技术与方法,成功构建了异物创伤性动脉瘤犬模型。     

Appropriate interval between embolization and surgery in patients with meningioma

BACKGROUND AND PURPOSE: The best time for surgery after embolization of meningiomas remains unclear. We used the tumor-softening effect of embolization to determine this time. METHODS: Forty-two patients with intracranial meningiomas that received more than 50% of their blood supply from the external carotid artery underwent embolization before surgery. The interval between embolization and surgery and the tumor consistency at the time of surgery were recorded. The interval between embolization and surgery was divided into 3-day segments, and an average tumor consistency score was obtained in segments. Patients were assigned to two groups: group 1 underwent surgery on a specified day after embolization; group 2 underwent surgery at a later date. We compared tumor consistency, blood loss, length of hospitalization, surgical resection time, Simpson grade at surgery, and complication rate in both groups. RESULTS: On the polynomial regression curve, greatest tumor softening occurred 7-9 days after embolization. When the postembolization interval exceeded 10 days, no further softening occurred. Compared with group 1 patients, group 2 patients did not have an increased blood loss, a longer hospitalization, or a higher complication rate. In group 2, the surgical procedure required less time, and the Simpson grades were lower. CONCLUSION: In meningiomas that receive more than 50% of their blood supply from the external carotid artery, the optimal interval between embolization and surgery is 7-9 days. This interval allows the greatest degree of tumor softening, which makes it possible to remove the tumor more safely and easily.     

CT灌注负荷试验评价慢性脑缺血的实验研究

目的:利用慢性缺血动物模型探讨CT灌注负荷试验的应用价值.方法:42号鼠随机分6组SD大鼠的双侧椎动脉和右侧颈总动脉,实验组结扎分别在术后1天、3天、7天、14天、21天(每组7只)行CT灌注检查.每只大鼠行两次灌注检查:静息状态和负荷状态(吸入8%的CO2 10min后).比较实验组和对照组两侧大脑半球(右/左)脑血流量和脑血容量的相对比值rCBF、rCBV的变化.结果:对照组大鼠两侧大脑半球灌注对称,静息状态下实验组rCBF、rCBV在血管结扎后均有明显下降,但很快即恢复正常水平(7天之后);而负荷状态下,rCBF、rCBV下降到7天时达到最低,之后逐渐恢复,在21天时与对照组比较仍有显著性差异(P＜0.01).负荷状态下rCBF、rCBV明显低于静息状态,统计学差异有显著性(P＜0.01).结论:相对于静息状态CT灌注,负荷试验显示了更严重的脑血液动力学损害.且两种状态下损害的时间过程不一致.提示负荷试验可更敏感地反应慢性脑缺血的状态.     

A simplified arteriovenous malformation model in sheep: feasibility study.

BACKGROUND AND PURPOSE: Recently, a swine model of a cerebral arteriovenous malformation (AVM) has been developed that closely resembles a human AVM of the brain. The creation of such a model requires sophisticated neurointerventional techniques. The purpose of this study was to develop a simple and cost-effective AVM animal model that does not require additional endovascular techniques. METHODS: A surgical anastomosis was created in seven sheep between the common carotid artery and the ipsilateral jugular vein, followed by ligation of the jugular vein above the anastomosis and of the proximal common carotid artery below the anastomosis. The anastomosis was created on the left side in four animals and on the right side in three. Cerebral angiography from the contralateral carotid artery was performed before and immediately after surgery to delineate the relevant cerebral vascular anatomy and to determine the direction of blood flow. RESULTS: An angiographic appearance simulating an AVM was found in all the animals. The ramus anastomoticus and arteria anastomotica functioned as the feeding vessels to the rete mirabile, which represented the nidus in our model, and to the jugular vein, which represented the draining vein from the malformation. Extensive collateral flow through the rete mirabile into the distal segment of the external carotid artery above the ligature was observed angiographically, with retrograde flow through the surgical anastomosis into the jugular vein. CONCLUSION: A simple surgically created experimental model for cerebral AVMs was developed in sheep without the need for additional complex endovascular catheter manipulations of intracranial branches. Such an animal model can substantially reduce the cost of research and training in the neurointerventional or radiosurgical management of AVMs.     

Use of technetium-HMPAO to demonstrate changes in cerebral blood flow reserve following carotid endarterectomy

Cerebral perfusion through stenosed internal carotid arteries is usually maintained by autoregulation. However, flow reserve may be reduced, suggesting hemodynamically significant stenosis, and such reduction should be improved by carotid endarterectomy. This concept was studied in 20 subjects with unilateral internal carotid artery stenosis (major stenosis greater than or equal to 70%, minor stenosis less than or equal to 50%). Thirteen had experienced recent transient ischemic attacks and seven had no definite focal symptoms. Subjects underwent Tc-HMPAO cerebral SPECT during acetazolamide dysautoregulation before and after internal carotid endarterectomy. Nine (45%) had perfusion defects that improved after surgery, suggesting surgery had improved cerebral flow reserve. Seven had defects that did not improve after surgery. Four had worsened or new defects after surgery, suggesting perioperative infarcts. The relatively large proportion of patients with improved cerebral blood flow reserve after surgery suggests that this technique may have a significant role to play in assessing which patients might benefit from carotid endarterectomy.     

64层螺旋CT脑灌注联合CT血管造影对颈内动脉狭窄或闭塞的应用

目的探讨64层螺旋CT脑灌注(CTP)联合CT血管造影(CTA)对颈内动脉狭窄或闭塞的应用价值。方法根据病史或临床症状及体征诊断为颈内动脉及其分支的狭窄或闭塞50例患者分别行CTP和CTA扫描,评价CTP参数平均通过时间(MTT)、对比剂峰值时间(TTP)、脑血流量(CBF)、脑血容量(CBV)以及造影后颈内动脉狭窄程度。结果36例TIA患者患侧MTT延长较健侧具有显著性意义,rCBF侧较健侧无显著性意义,rCBV患侧较健侧无显著性意义。34例梗死组患者患侧MTT延长较健侧有显著性意义,rCBF患侧较健侧无显著性意义,rCBV患侧较健侧无显著性意义。结论 CTP联合CTA可以同时判断颈内动脉狭窄和脑组织局部血流灌注情况。     

冠心病患者颈动脉粥样硬化与内皮舒张功能的超声检测及临床意义

目的　探讨颈动脉粥样硬化病变的发生与冠心病的关系 ,研究冠心病患者内皮功能的变化。方法　应用高频超声检测 1 2 0例住院接受冠脉造影患者的颈动脉内中膜厚度 (IMT)及粥样硬化斑块 ,同时检测肱动脉血流介导和硝酸甘油 (GTN)引起的舒张反应。结果　根据冠状动脉造影结果将 1 2 0例患者分为冠心病组 (90例)和对照组 (30例 ) ,冠心病组IMT明显大于对照组 ,但不同病变支数的冠心病患者之间无差异。冠心病组颈动脉硬化斑块的检出率 (以分叉部为最高 ,其次为颈总动脉和颈内动脉 )明显高于对照组 ,且与冠脉病变的严重程度有关。总胆固醇、低密度脂蛋白、胆固醇水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。冠心病组的肱动脉基础内径略大于对照组 ,但差异无统计学意义 (P >0 0 5 )。冠心病组由血流介导和硝酸甘油引起的肱动脉舒张反应均明显低于对照组(P <0 0 1 )。结论　颈动脉粥样硬化严重程度与冠心病发生呈正相关。颈动脉超声检测对冠心病有一定的预测价值。颈动脉超声及血管内皮功能检查不仅可能为早期发现、预防和治疗冠心病提供依据 ,还可能作为监测和评估病情变化的指标     

Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries

RATIONALE AND OBJECTIVES: Ultrasonography is widely used in cardiovascular research to quantify early atherosclerotic vessel wall changes. In this article, we examined the short- and long-term reproducibility of this technique in the common carotid artery, carotid bifurcation, common femoral artery, and superficial femoral artery. Furthermore, we assessed the effect of progressed atherosclerosis on reproducibility. METHODS: Repeated ultrasound examinations were performed by one observer on 15 healthy individuals and 18 patients suffering from coronary heart disease. Intima-media thickness was determined by B-mode ultrasonography. The examinations were repeated by the same observer after a short time interval (short-term) and after a few weeks (long-term) and expressed as the mean difference between the measurements and the coefficient of variation (CV). RESULTS: The reproducibility of the intima-media thickness determination turned out to be best in the common carotid artery and the superficial femoral artery when performed in healthy controls (CV 5.6% and 5.5%, respectively). Reproducibility was less in patients with clinical atherosclerosis; this especially affected the reliability of the superficial femoral artery measurement (CV in healthy controls was 5.5%; in coronary heart disease patients, 17.5 %). The reliability of the intima-media thickness measurements in the common carotid artery (CV in healthy controls was 5.6%; in coronary heart disease patients, 9.5%) proved to be least affected by progressed atherosclerosis. A longer time interval between measurements did not affect the reproducibility of intima-media thickness measurements in healthy controls, whereas in the patients it led to some decrease of reproducibility and to a major decrease in reproducibility of the superficial femoral artery measurements (CV changed from 12.7% to 17.5%). CONCLUSIONS: Ultrasonography is a reliable and accurate technique to determine intima-media thickness in superficial arteries. In studies in which the intima-media thickness determination is used as a marker for generalized and coronary atherosclerosis, the common carotid artery should always be included, whereas the benefit of inclusion of other arteries depends on age and the expected extent of atherosclerosis in the individuals studied.