心外膜和经皮腔内激光心肌血管重建术

激光心肌血管重建术是目前治疗晚期弥漫性冠脉病变最有前途的方法。一般应用ＣＯ２激光或钬激光在心脏的缺血区行心肌打孔,激光孔道３个月后吾血管通道特征。手术后可增加心肌供血,改善临床症状,此种手术优点多,适合于我国冠心病患者。     

血管内照射防止经皮腔内冠状动脉成形术后血管再狭窄

自Ｇｒｕｅｎｔｚｉｇ等于２０年前首次报道用经皮腔内冠状动脉成形术（ＰＴＣＡ）治疗冠状动脉狭窄性疾病以来［１］,随着该技术的不断完善,其应用日趋普及。仅美国每年就开展达４０万例次。但ＰＴＣＡ后血管再狭窄发生率高达３０％～４０％［２,３］,严重影响了该治...     

经皮腔内血管成形术后形态学改变及组织修复过程的实验研究

本文对34只家兔48支血管的实验性髂动脉粥样硬化性狭窄进行了腔内血管成形术(PTA)后即刻至30天的组织学研究。结果表明,内腆及斑块撕裂是PTA的主要机制。球囊扩张后平滑肌细胞(SMC)是修复过程中的主要细胞成份,薄层附壁血栓对维持动脉壁的完整结构有着重要作用。SMC增生程度与内膜撕裂的深浅有关。暴露的中膜比内皮损伤更易发生血小板粘附和血栓形成。3支血管发生再狭窄,2支由于内腆SMC过度增生。另1支由于血栓机化所致。     

低强度红激光局部照射对血管成形术后血管内皮功能的影响

目的　观察低强度红激光照射 (LPRLI)对动脉粥样硬化兔血管成形术后血管内皮修复和功能的影响。方法　新西兰白兔 40只 ,随机分为单纯球囊拉伤组和球囊拉伤并激光照射组各 2 0只 ,建立动脉粥样硬化兔血管损伤模型。激光照射组于球囊拉伤后应用激光球囊导管对损伤血管进行局部照射。对术后第 4周的两组动物 ,固定部位剪取拉伤组和激光照射组损伤的腹主动脉血管 ,采用离体血管功能实验方法 ,观察兔腹主动脉环的张力变化和损伤血管内皮细胞的修复情况。结果　经过LPRLI的兔损伤腹主动脉的内皮依赖性舒张功能明显强于单纯拉伤组血管。右髂动脉损伤段血管损伤面积 ,单纯拉伤组 (6 1 11± 7 12 )mm2 ,激光照射组 (96 71± 8 2 0 )mm2 ,后者的修复面积明显大于前者(P <0 0 1)。结论　LPRLI对动脉粥样硬化兔损伤动脉的内皮依赖性舒张功能具有保护作用并可以促进损伤血管内皮修复     

经皮腔内血管成形术在糖尿病足治疗中的应用

目的探讨介入治疗糖尿病足下肢动脉病变的临床价值。方法选择经介入治疗的18例糖尿病足患者的数字减影血管造影术(DSA)及临床资料,分析动脉狭窄及闭塞的部位、数目、病变动脉分布情况,并观察下肢动脉球囊扩张或支架成形术后效果及并发症。结果下肢动脉病变累及髂动脉3条,股动脉8条,采用6～8 mm直径的球囊进行扩张,支架7～8 mm×60～120 mm覆盖狭窄闭塞段上下两端10～30 mm;胫前动脉15条,腓动脉13条,胫后动脉16条,用长球囊2～3 mm×100mm进行扩张,3mm×30 mm支架置入2枚。以膝下动脉受累范围大及程度重,介入治疗后患者下肢动脉灌注得到改善,静息痛及间歇性跛行减轻,皮温升高,踝肱指数较术前明显升高[(0.86±0.11)vs(0.42±0.14),P<0.01]。结论 DSA可准确了解糖尿病患者下肢动脉病变的阻塞部位及程度,以及侧支建立及流出入道的情况,球囊扩张联合支架成形术治疗,有助于下肢流出入道血管开通及血供改善。糖尿病足血管内介入治疗安全有效。     

经皮腔内冠状动脉成形术的急性血管并发症及处理

我科自１９８７年１２月至１９９４年４月间完成经皮腔内冠状动脉成形术（ＰＴＣＡ）４３０例，共扩张血管７０７支，扩张病变７６４处，成功率分别为９５．１％，９６．９％和９７．１％。其中多支血管行ＰＴＣＡ共２０９例，失败共２１例（４．９％）。发生急性血管并发症４０处（５．２％），其中严重内膜撕裂１７处（２．２％），冠脉痉挛和血栓形成各６处（０．８％），急性闭塞１７处（２．２％），血管穿孔１处（０．１％），     

激光血管成形术

<正> 用激光再通阻塞血管的基础及临床研究迅速在美国及世界上许多国家得到广泛开展,主要研究激光的性能,激光对组织的作用,激光器械,近、远期生物效应等,证实了这一技术的有效性、可行性及安全性.一、激光及其对生物组织的作用激光的生物效应是光的波长、效率、光照时间、通过的时间、通过的介质和组织吸收能量的综合效果,对于与激光照射有关的吸收或穿透是由组织的     

经皮腔内动脉血管成形术治疗多发性大动脉炎5例

经皮腔内动脉血管成形术治疗多发性大动脉炎５例山东医科大学附属医院（２５００１２）刘同涛，李继福，鹿庆华，陈玉国，李贵双，王树春，纪求尚临床资料：男１例，文４例，年龄１３～２８岁。病程为１个月～１４年。主要表现为血压明显升高，多在２４～３４．６６／１４...     

犬脑血管痉挛经皮腔内血管成形术治疗

目的　探讨经皮腔内血管成形术 (PTA)治疗顽固性脑血管痉挛的可行性和效果。方法　成年杂种犬 2 0只 ,采用枕大池两次注血模型。应用扩张后直径为 1.5mm的硅胶球囊 ,扩张压力为 2个大气压、持续时间 10s,在痉挛的基底动脉近、远端分别扩张 1次。结果　 2 0只犬的基底动脉均发生痉挛 ,为其中的 14只进行了PTA治疗 ,成功13只、死亡 1只 ;另外的 6只犬 ,由于血管解剖原因 ,无法进行PTA操作。PTA治疗后 ,痉挛的基底动脉明显扩张 ,犬神经功能恢复明显加快。 2 0d后复查脑血管造影 ,接受PTA治疗犬的基底动脉显影基本正常 ,而未进行PTA治疗犬的基底动脉仍有明显的痉挛。结论　PTA是治疗顽固性脑血管痉挛的一种有效方法     

THE HEALING PROCESS OF GASTRIC ARTIFICIAL ULCERS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Background: Due to the remarkable progress of endoscopic resection techniques, endoscopic submucosal dissection (ESD) has been widely performed for larger mucosal tumors that would result in large arti?cial ulcers. The healing process of peptic ulcers has been previously studied in detail; however, no precise investigation for arti?cial ulcers after ESD has been reported. To con?rm the validity of the treatment from the aspect of wound healing, we aimed to clarify the healing process of large gastric arti?cial ulcers after ESD. Methods: Seventy patients with gastric mucosal tumors treated by ESD were enrolled. The size, location and time of scar formation of the ulcers were reviewed using endoscopic pictures taken from the same view and angle. Follow‐up endoscopy was performed at 1, 4, 8 and 12 weeks after ESD. For postoperative medication, all patients received normal doses of proton pump inhibitors and sucralfate for 8 weeks. Results: The average size of the resected specimen was 34.7 mm (20–90 mm). Irrespective of ulcer size and location, all of the cases healed up to scarring stages within 8 weeks. Conclusions: Gastric arti?cial ulcers after ESD healed within 8 weeks regardless of size and location using normal doses of medication as peptic ulcers. The fact that even giant ulcers after ESD heal within 8 weeks could be helpful information for candidates for ESD and for postoperative management of patients after ESD.     

低能量He-Ne激光血管内照射疗法在脑囊虫病后遗症治疗中的应用

目的　探讨脑囊虫病所致后遗症的疗法。方法　采用低能量He-Ne激光血管内照射疗法(ILIB)对脑囊虫病后遗症者进行治疗。结果　多数病人症状得到明显改善,其中头痛、头晕临床治愈率分别为17.24%和64.71%;头痛、头晕和记忆力减退总有效率达100%;在癫痫发作控制方面,总有效率(包括显效和有效)达76.19%;ILIB治疗后81.82%的病人脑电图及脑电地形图出现明显改善。结论　ILIB在治疗脑囊虫病后遗症方面疗效明显。     

实验性肺动脉高压与血浆内皮素和肺小动脉改变

施行兔左肺动脉与降主动脉吻合术。术前及术后测定血浆内皮素（ＥＴ），发现ＥＴ分泌增加发生在肺动脉高压（ＰＨ）形成及肺血管病变发生之前。阿司匹林加硝苯地平（心痛定）可降低ＥＴ的峰值并减轻或延缓肺血管病变的发生，结果提示ＥＴ可能是ＰＨ形成的原因之一。     

检测日本血吸虫病家兔尿中循环抗原的实验研究

本研究首次用单克隆抗体证实了日本血吸虫病家兔尿液中存在日本血吸虫肠相关趋阴极抗原。用McAb-RIHA和McAb-Dot-ELISA平行对比检测浓缩5倍的重感染家兔尿样61份和正常空兔尿样30份。两法的阳性率分别为81.97％和78.69％;假阳性率分别为13.33％和O％。认为可进一步用于检测日本血吸虫病患者尿排泄抗原的研究。     

阿苯达唑治疗旋毛虫病幼虫形态的变化

以阿苯达唑治疗兔旋毛虫病，疗程结束后逐周解剖旋毛虫幼虫观察在药物作用下形态学的改变。结果于停药１ｗｋ后幼虫开始死亡，虫体结构破坏，轮廓模糊不清，虫休缩小、断裂、钙化。至第５ｗｋ后虫体基本被吸收，偶见残留部分虫体，最终被完全机化，肌肉组织逐步修复。对照组囊包完整，虫体光滑。结果表明阿苯达唑用于治疗旋毛虫病幼虫效果满意。     

CLINICAL AND ENDOSCOPIC HEALING AFTER INFLIXIMAB TREATMENT IN PATIENTS WITH CROHN's DISEASE

Background: Intestinal mucosal lesions in Crohn's disease were endoscopically evaluated before and after giving infliximab, and the usefulness of this treatment was investigated. Patients and methods: The present study included 12 patients with active Crohn's disease who could undergo colonoscopy before and after giving infliximab. (i) The treatment assessment consisted of evaluations of short‐term and long‐term therapeutic effects. The clinical evaluation was conducted using the Crohn's disease activity index (CDAI). The results of the clinical evaluation were compared with those of the colonoscopic evaluation. (ii) The endoscopic evaluation findings were divided into polyposis, ulcer and stenosis, and the area ranging from the rectum to the terminal ileum. The scores for the findings at seven sites were totaled. In the short‐term therapeutic effect, characteristics of ulcer morphology and background factors were investigated endoscopically. Results: (i) The efficacy rate was 92% clinically and 67% endoscopically in the evaluation of short‐term therapeutic effects. The efficacy rate was 86% clinically and 86% endoscopically in the evaluation of long‐term therapeutic effects. (ii) On the endoscopic evaluation, the ulcer score was significantly (P = 0.03) improved after giving infliximab, while there was no remarkable change in the polyposis score and the stenosis score tended to worsen. On the evaluation of therapeutic effects based on ulcer morphology, infliximab was endoscopically effective in patients with longitudinal ulcers. On the evaluation of therapeutic effects based on background factors, the treatment was effective in patients given a combination of infliximab and immunosuppressants. Conclusion: The ulcerative lesions were found to be markedly improved, but the intestinal stenosis tended to worsen, after giving infliximab. It is necessary that the severity of intestinal stenosis be adequately understood before giving infliximab. Giving immunosuppressants should be used for combined treatment.     

32例食管和贲门早期浅表癌内镜激光治疗远期疗效

对内镜Ｎｄ：ＹＡＧ激光治疗细胞消失的３２例食管和贲门早期浅表癌病人进行了３３～７８个月（平均５５．２５个月）的前瞻性随访。应用ＰｒｏｄｕｃｔＬｉｍｉｔＥｓｔｉｍａｔｅ方法计算其存活率，并与１１７例早期食管癌和贲门癌的自然病程对比分析。内镜激光治疗五年存活率为９７％，未经治疗的早期食管贲门癌的五年存活率为６７％（Ｐ＜０．０１），表明内镜激光是一种有效的治疗方法。在对影响疗效的因素中，发现抗癌基因Ｐ５３是一个非常有价值的独立预后因素。     

旋毛虫病治疗前后血清抗体的观察

应用旋毛虫幼虫冰冻切片抗原免疫酶染色试验（ＩＥＳＴ）观察旋毛虫病治疗前和阿苯达唑治疗后血清抗体水平的变化。结果表明，感染后（治疗前）第２ｗｋ开始出现阳性反应，第４ｗｋ后阳性率均达到９０％以上；治疗后抗体阳性率第１ｗｋ为１００％，第３ｗｋ开始下降，第５ｗｋ后抗体滴度维持于阳性低水平，１２ｗｋ后未见阳性反应。此现象可作为一种治疗有效的客观指标，对旋毛虫病近期及远期疗效考核均有一定价值。     

旋毛虫感染家兔治疗前后血清IgG抗体水平的变化

应用旋毛虫肌肉内成囊期幼虫的盐水浸出液为抗原，用ＥＬＩＳＡ间接法检测了旋毛虫感染家兔治疗前后血清ＩｇＧ水平的消长情况。血清ＩｇＧ于感染后７周达高峰，１０周下降，治疗后抗体水平明显升高。认为血清学检测在旋毛虫病的疗效考核中有一定价值。