覆膜支架和密网支架在复杂内脏动脉瘤的治疗应用(附12例病例分析)

目的评价覆膜支架和密网支架在复杂内脏动脉瘤治疗中的安全性和疗效。方法回顾分析12例内脏动脉瘤患者(脾动脉瘤6例,腹腔干动脉瘤3例,肠系膜上动脉动脉瘤2例,肠系膜下动脉瘤1例)临床及影像学资料,其中6例脾动脉动脉瘤患者行覆膜支架置入治疗,余6例行密网支架重叠置入,所有患者术后均给予抗凝治疗。术后1个月、6个月、1年、2年行CTA检查观察动脉瘤闭塞情况及支架和载瘤动脉通畅情况。结果 12例患者支架均成功置入,6例脾动脉瘤患者覆膜支架置入后造影显示支架管腔通畅,动脉瘤未再显影;其余6例内脏动脉瘤患者密网支架重叠置入后造影显示动脉瘤显影浅淡或基本不显影,穿支动脉未累及。术后近期随访(1个月),1例出现轻度腹痛,给予对症处理后症状消失,所有患者均未见动脉瘤破裂,支架内急性血栓形成等严重并发症。远期随访6例覆膜支架置入患者动脉瘤均未再显影,无内漏及支架内狭窄;6例密网支架置入者动脉瘤较前均缩小或消失,其中1例CTA显示支架轻度狭窄,狭窄<25%同时合并部分穿支动脉闭塞,但无明显临床症状,余患者支架、穿支动脉均通畅。结论覆膜支架和密网支架置入是治疗复杂内脏动脉瘤的安全、有效方法。     

兔颈总动脉侧壁型动脉瘤模型制作的改进

目的 对兔颈总动脉侧壁型动脉瘤模型进行改进,以评价建模的成功率及支架植入后颈总动脉的通畅率.方法 取新西兰大白兔20只,饲养1周后行左侧颈内动脉结扎.1个月后行颈部3.0 TMRA检查评价颈动脉与椎动脉的变化情况.采用间断式外翻缝合法吻合静脉囊与颈总动脉,建立侧壁型动脉瘤.在植入覆膜支架前、术后即刻、3个月、6个月行血管造影.结果 20只实验兔均顺利行左侧颈内动脉结扎.MRI示结扎前右颈总动脉中段平均直径为(2.35±0.08) mm,结扎后1个月右颈总动脉中段平均直径为(2.89±0.22) mm,与术前比较差异有显著统计学意义(P＜0.01).MRA示17只兔右颈总动脉明显增粗,而双侧椎动脉略增粗;3只兔颈总动脉增粗不明显,而双侧椎动脉明显增粗.建立兔颈总动脉囊状动脉瘤模型17只,术后均健康成活.DSA示覆膜支架植入前所有动脉瘤及右颈总动脉通畅,4个动脉瘤腔内有少量血栓形成,但无自发性完全闭塞.Willis或镁合金覆膜支架植入术后即刻造影示动脉瘤闭塞,右颈内动脉通畅.术后3个月DSA示16只兔右颈内动脉通畅,1只闭塞.术后6个月DSA示16只兔右颈内动脉通畅.动脉瘤模型的成功率为100％ (17/17),覆膜支架植入后右颈总动脉的通畅率为94.1％(16/17).结论 兔颈总动脉侧壁型动脉瘤模型制作的改进提高了动脉瘤模型的成功率及覆膜支架植入后右颈总动脉的通畅率.     

经皮血管腔内成形术治疗髂股动脉硬化闭塞症

目的评价经皮腔内成形术及支架植入术治疗髂股动脉硬化闭塞症的临床疗效。方法自1999年4月-2004年8月,为13例髂股动脉硬化闭塞症患者联合应用导管接触性溶栓和导丝机械性开通的方法开通闭塞段,行腔内成形及支架植入术,共植入25枚Wallstent支架,采用多普勒超声或DSA随访。结果13例患者均一次性开通血管闭塞段并植入支架。经8个月～5年(平均26.2个月)随访,1例于术后23d支架内急性血栓闭塞,经导管接触性溶栓治疗再次成功开通;1例于术后19个月临床症状加重,造影证实支架处髂总和髂外动脉闭塞并同侧股浅动脉闭塞,于外科行血管旁路术,其余病例于随访期内血流通畅,临床疗效满意。结论接触性溶栓结合导丝机械性开通法开通闭塞血管成功率高,血管腔内成形术作为髂股动脉硬化闭塞症的有效治疗方法创伤小,再狭窄率低。     

内支架植入加旁路转流术在周围血管闭塞性病变中的临床应用

目的：评价内支架植入结合旁路转流术在四肢动脉闭塞性疾病中的临床应用价值。资料与方法：8例支动脉慢性闭塞患者，左下肢2例，右下肢5例，左上肢1例。采用介入方法将内支架植入髂动脉或锁骨下动脉狭窄段，同时行远侧肢体动脉病变段旁路转流术。结果：内支架植入及手术均全部成功，无1例发生相关并发症。临床症状明显改善。随访8个月－2年的均保持通畅。结论：内支架植入加旁路转流术是治疗四肢血管闭塞性疾病的一种安全有效的方法。     

平肾主动脉-髂动脉闭塞性病变腔内治疗

目的 探讨腔内治疗平肾主动脉-髂动脉闭塞性病变的效果.方法 回顾性分析2013年1月至2015年6月采用腔内微创治疗和血运重建的21例平肾主动脉-髂动脉闭塞性病变患者,所有患者均在置管溶栓后接受腔内血管重建,术后3、6、9、12个月随访,每年复查主动脉CTA.结果 21例均置管溶栓24 h,完全采用裸支架倒Y型腔内重建11例(植入主动脉裸支架和外周自膨裸支架41枚),覆膜支架对吻成形2例(植入Gore Viabahn支架4枚),Gore Excluder覆膜支架腔内重建8例,技术成功率为100％.围手术期无死亡患者及严重并发症发生,所有患者术后下肢缺血症状均得到缓解.术后随访6～24个月,未见支架移位及内漏发生,裸支架治疗组1例术后8个月髂动脉支架内血栓闭塞,予以药物保守治疗;Gore Excluder覆膜支架组1例术后18个月一侧髂支远端狭窄,予以裸支架成形后通畅;其余移植物随访期通畅.结论 腔内微创治疗平肾主动脉-髂动脉闭塞近、中期效果好,但需个体化选择治疗方案,以提高手术成功率,降低并发症发生率.     

覆膜支架在周围血管病变中的应用

目的回顾性分析覆膜支架治疗周围血管性病变的方法和疗效。方法11例患者,其中动脉瘤8例(包括假性动脉瘤3例),动-静脉瘘2例,血管损伤破裂1例。病变部位位于锁骨下动脉2例、颈总动脉1例、肾动脉1例、髂动脉5例、股动脉1例、胫前动脉1例。均采用经皮股动脉穿刺,在相应的病变段植入覆膜支架,使病变与主支血管隔绝。结果所有患者均成功植入覆膜支架,术后造影原病变完全消失。术中有1例发生血管痉挛。未发生血管闭塞、破裂等并发症。通过超声或DSA随访3～6个月,无复发和主支血管闭塞等。结论随着介入技术的不断发展,覆膜支架的应用日益增多,治疗周围血管性病变取得极好效果。     

可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤可行性研究

目的 评价可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤的可行性.方法 20只新西兰大白兔饲养1周后采用间断式外翻缝合法将右侧颈总动脉与静脉囊吻合,构建20枚颈总动脉侧壁型动脉瘤.72 h内分别实施可降解镁合金覆膜支架植入术和Willis覆膜支架植入术.术前、术后即刻、术后3、6、12个月作DSA造影检查,对比动脉瘤闭塞、内漏、血管痉挛、血管损伤、血栓事件、血管闭塞和狭窄等情况.结果 可降解镁合金覆膜支架和Willis覆膜支架各植入10枚,技术成功率为100％.支架植入术后即刻造影显示所有动脉瘤腔完全闭塞,载瘤动脉通畅,可降解镁合金覆膜支架组血管痉挛3例,Willis覆膜支架组血管痉挛1例;术后3、6、12个月复查造影显示动脉瘤完全消失,载瘤动脉通畅.结论 可降解镁合金覆膜支架治疗兔颈总动脉侧壁型动脉瘤是可行的.     

覆膜支架在外周动脉瘤及动脉夹层治疗中的应用

目的 探讨覆膜支架在外周动脉瘤及动脉夹层治疗中的可行性及安全性.方法 2008年11月至2012年5月收治24例外周血管病变患者,其中锁骨下动脉假性动脉瘤10例、髂动脉夹层5例、髂动脉假性动脉瘤4例、髂动脉瘤3例、颈内动脉瘤1例、下肢多发动脉瘤1例.所有患者在经股动脉穿刺血管造影明确病变后,植入覆膜支架行腔内隔绝术.结果 所有患者均成功植入覆膜支架行腔内隔绝治疗,即时封闭效果满意,无手术相关并发症.随访2～42个月,有1例锁骨下假性动脉瘤患者在覆膜支架植入后4个月时支架两端又出现假性动脉瘤,再次植入覆膜支架,其余23例患者均未出现相关并发症.结论 覆膜支架腔内隔绝术是一种微创、安全且高效的外周血管完整性修复方法.     

Willis覆膜支架治疗犬颈内动脉虹吸段动脉瘤的影像学和组织病理学研究

目的建立一种犬颈动脉虹吸段(CS)动脉瘤模型,并观察12个月以测试新型Willis颅内覆膜支架系统的机械性能;评价植入支架在弯曲段血管内的组织学反应。方法通过外科手术方法建立12只犬24枚颈动脉直段侧壁囊性动脉瘤(A组),和12只犬12枚CS动脉瘤(B组)。每枚动脉瘤行1枚覆膜支架植入治疗。以血管造影方法评价支架植入即刻,1、3、6和12个月随访动脉瘤闭塞、支架内漏、支架成角、载瘤动脉是否通畅及再狭窄率等情况。支架段血管行光镜和扫描电镜检查,评价动脉瘤腔内血栓形成,内膜增生和内皮化情况。结果B组中,支架植入即刻血管造影显示2枚动脉瘤存在轻度内漏,3枚支架存在轻度成角现象;12个月时随访,内漏均消失,1支载瘤动脉发生闭塞,3支载瘤动脉有轻度狭窄(<50%)。A组中,1支载瘤动脉闭塞,2支载瘤动脉轻度狭窄(<50%)。电镜检查所有支架内均有新生内膜形成,动脉瘤腔内均充满血栓。B组动物,12个月时才完成完全内皮化过程,内皮细胞排列与血流动力学方向具有很强的相关性。结论应用Willis覆膜支架治疗犬CS动脉瘤方法学上可行。与直段血管相比,弯曲段血管内覆膜支架植入后,支架内皮化时间延长。     

锁骨下动脉狭窄或闭塞支架治疗中期疗效评价

目的 评价血管支架治疗锁骨下动脉狭窄或闭塞的中期临床疗效.方法 经彩超、CTA明确诊断的31例锁骨下动脉狭窄或闭塞患者,其中狭窄18例(19条),闭塞13例(13条).导丝开通病变血管后置入支架.术后问诊及彩色多普勒超声进行随访.结果 除4例闭塞血管开通失败外,27例共计28条病变动脉共成功置入28枚支架.术后患者症状、体征均明显改善.术前有锁骨下动脉窃血征象14例,术后12例消失.27例随访6～62个月(平均24.0个月±16.5个月).术后3例患者再狭窄:1例发生于术后9个月,经PTA后随访12个月血管开放良好;1例术后10个月,PTA后随访8个月开放良好;1例术后12个月再狭窄,转为外科搭桥手术.1例大动脉炎术后8个月死于脑出血;1例术后14个月死于脑梗死.余均无症状、体征再发,多普勒超声提示血管通畅.结论 血管支架可安全、有效治疗锁骨下动脉狭窄/闭塞并有良好中期疗效.     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

新疆石河子地区奶牛隐性乳房炎的调查与分析

采用LMT法对新疆石河子地区三个规模化奶牛场泌乳牛群进行了隐性乳房炎检测,共检测994头泌乳牛3976个乳区.结果表明:奶牛隐性乳房炎阳性率为81.9%,乳区阳性率为49.1%.数据分析表明,不同年龄、胎次以及有无卧床奶牛的隐性乳房炎阳性率差异显著(P<0.05),后乳区的隐性乳房炎感染率显著高于前乳区感染率(P<0.05),隐性乳房炎乳区发生数也明显影响当日产奶量(P<0.05).     

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits

Objectives

Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated.

Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Background

The local muscular endurance of knee flexors, during eccentric work in particular, is important in preventing or delaying kinematic changes associated with fatigue during treadmill running. This result, however, may not be transferable to overground running.

Objective

To test the hypothesis that overground running is associated with eccentric hamstring fatigue.

Methods

Thirteen runners (12 male and one female) performed an isokinetic muscle test three to four days before and 18 hours after a marathon. Both legs were tested. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions.

Results

There were no significant differences between peak torque before and after the race, except that eccentric peak hamstring torque (both thighs) was reduced.

Conclusion

Overground running (running a marathon) is associated with eccentric hamstring fatigue. Eccentric hamstring fatigue may be a potential risk factor for knee and soft tissue injuries during running. Eccentric hamstring training should therefore be introduced as an integral part of the training programme of runners.     

肺心病慢性呼吸性酸中毒合并代谢性酸碱失衡判断方法探讨(附80例次血气分析)

目的：对42例肺心病慢性呼吸性酸中毒患者的80例次血气测定结果。方法：用不同的酸碱图（卡）及代偿公式进行酸碱类型的初步差别分析。结果：结合临床表现、各种影响因素与治疗反应等作出综合判定。结论：比较二种判定的差异，并提出较为实用、可靠的判断建议，以助于复合型呼吸性酸碱失衡的临床诊断与处理。     

Oxalosis in primary hyperoxaluria in infancy

Primary hyperoxaluria (PH1) is a rare inborn autosomal recessive metabolic disorder due to the deficiency of hepatic alanine-glyoxylate-aminotransferase. This deficiency results in excessive synthesis and urinary excretion of oxalate, inducing renal stone formation and deposition of calcium oxalate in the kidney, bone, myocardium, and vessels (systemic oxalosis, SO) in the most severely affected individuals. We report renal and skeletal changes in a 3-month-old girl with PH1 and SO. Intense cortico-medullary hyperechogenicity and increased homogeneous radiopacity of normal-sized kidneys suggested the diagnosis of SO. Skeletal survey showed osteopenia and characteristic symmetrical metaphyseal transverse bands in long bones, progressively becoming more dense and migrating towards the diaphysis. Multiple pathological and slowly healing fractures of the limbs occurred at the dense band level. A radiopaque rim was then observed in flat bones, epiphyseal nuclei, and vertebral bodies. Inflammatory granulomatous reaction, induced by the presence of oxalate crystals in the marrow spaces, coexisted with progressively evident radiological signs of secondary hyperparathyroidism, with partially overlapping features. The patient was treated by peritoneal dialysis and hemodialysis until combined liver–kidney transplantation. There are no previous reports of infants treated with hemodialysis for more than 2 years.     

Interventional radiology in oncology in private practice

Interventional oncology in private practice requires expert training and can be performed in a stand-alone facility for type 1 procedures in a hospital setting for type 2 and 3 procedures where subspecialized radiologists, state-of-the-art equipment, and postprocedure hospital monitoring are available. A multidisciplinary effort with oncologists, internal medicine physicians and anesthesiologists is necessary. The practice of interventional oncology requires around the clock availability, meticulous and established protocols and procedures and a financial investment. On the other hand, it is professionally gratifying because of constant technical advances and the impact on patients.