Morphological consideration of the bronchial arteries and its interventional angiography

The authors dissected the bronchial arteries macroscopically in 40 human adults. (1) Two right and two left bronchial arteries were most commonly observed in 19 cases (48%). (2) Besides the intercostobronchial artery, one more right bronchial artery was mainly distributed to the lower lobe of the right lung. (3) Relationship between the intrapulmonary distribution of each bronchial artery and the lobe of the lung was not definite. Technological considerations of the BAG were presented from the results of this study.     

支气管封堵器与双腔支气管导管用于食管癌根治术患者单肺通气的效果比较

目的：比较支气管封堵器与双腔支气管导管用于食管癌根治术患者单肺通气的临床效果。方法：将在本院行食管癌根治术患者60例随机分为两组,其中支气管封堵器组（BB组）30例,双腔支气管导管组（DLT组）30例。麻醉诱导后,在胸腔镜下DLT组和BB组分别插入双腔支气管导管、支气管封堵器。比较两组患者插管情况以及并发症发生率。结果：与BB组比较,DLT组插管时间和导管定位时间长,肺萎陷评分高,术后总的并发症、声嘶和喉痛发生率低（P〈0．05）,但是两组拔管时间、单肺通气时间、导管移位发生率、低氧血症和术后肺部感染的发生率比较差异无统计学意义（P〉0．05）。结论：支气管封堵器与双腔支气管导管用于食管癌根治术患者单肺通气的效果相似,在适应证下建议首选支气管堵塞管。     

支气管动脉栓塞术治疗大咯血46例临床观察

目的：观察支气管动脉栓塞术治疗大咯血的临床效果。方法：46例大咯血患者行胸部CT,支气管动脉造影检查确定出血部位后,使用明胶海绵、PVA颗粒栓塞病变血管。结果：支气管动脉栓塞治疗后24例（52.17%）即刻咯血停止;15例（32.61%）咯血显著减少,3d内咯血逐渐停止;共计治疗显效39例（84.78%）。7例（15.22%）治疗无效,其中2例（4.35%）死亡,5例转外科治疗。8例患者出现并发症,症状均较轻,在3~5d后症状消失。结论：支气管动脉栓塞治疗大咯血安全、有效、微创。为常规内科止血治疗无效,无外科手术指征的患者提供了一种较好的治疗手段。     

肺结核大咯血支气管动脉栓塞治疗的远期疗效观察

目的评价支气管动脉栓塞治疗肺结核大咯血的远期疗效。方法42例均为继发性肺结核，双侧肺结核27例，单侧肺结核15例。采用支气管动脉插管造影，证实为出血动脉后，将PVA微粒或丝线段缓慢注入靶血管内，直至血流停止。结果一次栓基后34例达到立即止血的目的，7例咯血明显减少，1例无效，近期有效率97．6％，无严重并发症：术后随访6月～7年，24例达临床治愈，显效7例，有效5例，复发6例，远期有效率85．7％结论支气管动脉栓塞治疗肺结核大咯血是一安全、迅速有效的治疗方法，远期止血效果好，并发症少，结合抗痨治疗有利于巩固疗效。     

Angiographic anatomy of arterial branches to the caudate lobe of the liver with special reference to its effect on transarterial embolization of hepatocellular carcinoma

The arterial branches to the caudate lobe of the liver have been little studied angiographically, so it has been thought that the branches can be rarely recognized on the hepatic angiogram. We evaluated it with the stereo or stereo-magnification angiograms in 106 cases. They were identified in 90 cases (84.9%), one branch in 75 cases, two branches in 15 cases. The branches had a variable origin. In 50%, it originated from the right hepatic artery. In some cases, it came from both the right and left hepatic arteries. Recently we treated 10 cases of hepatocellular carcinoma in the caudate lobe with transcatheter arterial embolization (TAE), the results were poor in them except for one. We think that the proximal and variable origins of the caudate lobe arteries are the main cause of the poor effect of TAE.     

支气管肺动脉成形术在中心型支气管肺癌治疗中的应用

[目的]探讨支气管肺动脉成形术治疗中心型支气管肺癌的效果。[方法]回顾性分析2001年6月～2009年6月施行支气管肺动脉联合成形肺叶切除治疗的36例中心型支气管肺癌患者的临床资料,其中鳞癌26例,腺癌8例,小细胞未分化癌2例。pTNM分期:Ⅱa期8例,Ⅱb期12例,Ⅲa期16例,行左上支气管肺动脉成形术14例,右上肺动脉支气管成形术22例。[结果]全组无手术死亡病例,术后4例出现肺不张,4例并发肺感染,2例并发心律失常,均经对症、抗感染等处理后治愈,无支气管胸膜瘘、出血等严重并发症发生。术后随访时间5～65个月,平均32个月,全组术后1、3、5年生存率分别为88.9%(32/36)、55.6%(20/36)、44.4%(16/36)。[结论]肺动脉支气管成形术肺叶切除符合最大限度地切除肿瘤又最大限度保留肺功能的基本原则,特别是用于心肺功能储备差、不能耐受全肺切除的局部晚期患者,扩大了手术适应证。     

腹腔镜胆囊切除术胆囊动脉出血的预防及处理

目的 探讨腹腔镜下行胆囊切除术,术中胆囊动脉出血的预防及处理对策及临床应用效果.方法 回顾性分析某院2008年10月～2011年12月间收治腹腔镜下行胆囊切除术中发生胆囊动脉出血的150例患者的临床资料,分析胆震动脉出血的原因、处理方法及其应用效果.结果 术中发生胆囊动脉出血的原因主要有游离胆囊管时损伤胆囊动脉(104例),胆囊动脉变异导致出血(31例),分离胆囊床时损伤胆囊动脉分支(11例),胆囊穿支血管出血(4例).在术中采用钛夹钳夹、电凝止血等方法进行止血.所有患者无中转开腹者,无术后继发出血者.结论 解剖Calot三角方法不当或三角处粘连、变异,分离困难是腹腔镜胆囊切除术胆囊动脉出血的主要原因.清楚解剖,正确处理Calot三角,出血后遵循耐心压迫止血,钳夹、电凝的处理原则,控制胆囊动脉出血,达到患者满意的手术效果.     

The role of bronchoscopy in examination and treatment of esophageal tumours

The role of bronchoscopy in examination and treatment of esophageal tumours. The esophageal tumours are diagnosed in many cases in inoperable stage, and if a surgical resolution is possible, it's a heroic, great operation with high mortality rates and poor results. The involvement of great airways should be explored preoperatively by imaging methods, but bronchoscopy is also mandatory. The authors report their one year's experience of 121 bronchoscopic examinations in esophageal cancer patients. The finding was negative in 40.5% of all examinations, and 29.7% was concerned the cancer propagation to bronchial system. 29.8% of all examinations resulted a suspicion of propagation. The opinion of bronchologist can be decisive postoperatively if a fistula is suspected, or after an esophageal stent implantation airway symptoms occur. Bronchoscopy is a standard method for removal of airway excretion. The author's overview is comparing their fifteen years experience with international literature.     

同轴微导管超选择性支气管动脉栓塞治疗咯血的疗效观察

目的 评价同轴微导管超选择支气管动脉栓塞（SSBAE）治疗咯血的可行性、安全性、疗效,并发症。方法 29例咯血病人,男24例,女5例。年龄35－71,平均54岁。支气管扩张9例,肺结核12例,肺癌8例。共32例次SSBAE治疗。结果 29例病人,进行超选择支气管动脉插管33次,插管成功率96．9％（32／33）,32次栓塞成功病人获立即止血效果：完全控制的21例（65．6％）,不完全止血10例次（31．3％）,无效1例（3．1％）。止血不完全的10例病人中,1例支扩,3例慢性纤维空洞性肺结核,6例原发性肺癌。随访2－32月,7例复发出血,其中3例为慢纤空肺结核,余4例为肺癌病人。所有病人均无严重并发症发生。结论 同轴微导管超选择支气管动脉栓塞治疗咯血是一安全,止血迅速、疗效确切的治疗措施,除肿瘤外,期止血效果好,并发症少,值得临床推广。     

研究与开发128层螺旋CT在冠状动脉造影中的应用

目的开发128层螺旋CT冠状动脉造影的临床应用。方法对121例患者行128层螺旋CT冠状动脉造影检查,利用其先进的后处理功能对冠状动脉进行重组,以显示冠状动脉各主支及分支,并对冠状动脉病变进行诊断。对其中两例诊断冠状动脉狭窄病例行选择性血管造影检查。结果121例行128层螺旋CT冠状动脉造影均成功显示冠状动脉各主支及分支,发现冠状动脉管壁钙化59例,软斑块形成27例,其中64例冠状动脉伴有不同程度的狭窄。结论128层螺旋CT冠状动脉造影对于冠心病的诊断是一种安全可靠的检查方法。     

Pulmonary embolization-induced thymus hyperplasia in rabbits

The effects of pulmonary embolization on the thymus glands of rabbits were studied morphologically, morphometrically and immunohistochemically. Pulmonary embolization was induced by an intravenous injection of 0.4 ml of Sephadex bead suspension (particle size; 150 to 300 microns, about 2,000 per ml). Both mean weight and volume of the thymus of rabbits killed at 2 weeks after embolization, were about 1.5 times more than those in control animals treated with physiologic saline. Histological examinations showed enlargement of the cortex and medulla of the thymus, and the embolized Sephadex beads in the branches of pulmonary arteries of the lung. The area ratios of medulla/cortex, in the embolization group and in control, were not significantly different. The cells with immunohistochemically positive staining of anti-nuclear antigen of monoclonal antibody of Ki-67, were found in both portions of the medulla and cortex. These data suggest that pulmonary embolization in the rabbit induces true thymic hyperplasia. An intravenous injection of India ink into the right highest intercostal artery revealed the distribution of bronchial arteries, which send the branches to the right lobe of the thymus. In 2 out of 4 animals killed 2 weeks after pulmonary embolization, the left lobe of the thymus as well as the right were stained with the injected ink. As it is known that pulmonary vascular obstruction caused a marked increase in the bronchial blood flow, these data suggest that the thymus blood supply from the bronchial arteries increases in the conditions of pulmonary embolization, which might contribute to thymus hyperplasia.     

经导管支气管动脉灌注、栓塞治疗中晚期肺癌60例分析

目的：探讨支气管动脉灌注和支气管动脉栓塞治疗中晚期肺癌的临床价值。方法：对60例已确诊中晚期支气管肺癌进行了灌注,对24例无明显侧支循环进行了栓塞。结果：近期有效率达（CR＋PR＋MR）≤94%。结论：支气管动脉灌注和栓塞是治疗中晚期支气管肺癌的有效方法。     

320排螺旋CT冠状动脉造影对冠心病的筛选诊断

目的：探讨320排螺旋CT冠状动脉成像与冠状动脉血管造影对冠心病的诊断价值。方法：对100例冠心病患者进行CT冠状动脉造影检查后,其中25例患者亦进行了介入冠状动脉造影检查,比较2组检查结果间的差异。结果：以冠状动脉造影结果为金标准,320排螺旋CT冠状动脉成像诊断冠状动脉狭窄敏感度高,与冠状动脉造影检查的结果基本一致。CT冠状动脉造影能清晰地显示冠状动脉的左右主支及分支的全貌图像,能直观地观察到冠状动脉血管壁有无狭窄、钙化等情况。结论：320排螺旋CT冠状动脉造影对血管的狭窄、钙化病变及支架管腔显示准确率较高,且操作相对简单,时间短、无创、费用低,可作为常规冠心病的筛查体检和冠状动脉支架术后复查的检查方法。     

64排螺旋CT血管成像诊断肠系膜上动脉病变

目的探讨64排螺旋CT血管成像在临床诊断肠系膜上动脉病变及肠系膜上动脉相关病变的价值。方法以31例初步诊断为疑似肠系膜上动脉病变或肠系膜上动脉相关病变的患者作为研究对象。对所有患者行全腹部多层螺旋CT容积扫描。待获取扫描原始数据后,采用图像后处理技术进行图像的后处理,包括：三维最大密度投影（3DMIP）、多平面重组（MPR）、容积再现（VR）。并对扫描结果进行分析。结果所有患者经多螺旋CT血管成像均可使肠系膜上动脉及其分支清晰显示。其中,肠系膜上动脉压迫综合症12例,包括＂胡桃夹＂综合征7例和十二指肠淤滞症5例;肠系膜上动脉夹层3例,包括孤立性肠系膜上动脉夹层1例和胸腹主动脉夹层累及肠系膜主动脉2例;肠系膜上动脉缺血性病变15例。结论 64排多螺旋CT血管成像可清晰观察到肠系膜上动脉及其周围血管的各种病变情况,对肠系膜上动脉病变及肠系膜上动脉相关病变的诊断具有重要价值,值得在临床肠系膜上动脉病变的诊断中推广应用。     

选择性支气管动脉灌注抗癌药物治疗晚期肺癌(附43例报告)

本组对４３例资料齐全,经细胞学或组织学确诊为晚期肺癌的病人,采用Ｓｌｄｉｎｇｅｒ技术,行选择性支气管动脉灌注抗癌物治疗共９３例次,结果表明,肺癌肿块完全消失或缩小者３７例。占８６％,临床症状消失或部分缓解者４０例,占９３％。５例患者经二次灌注,行手术治疗,手术切除率１１．６％。     

支气管动脉栓塞术治疗支气管扩张难治性咯血的疗效分析

[目的]探讨应用支气管动脉栓塞术治疗支气管扩张难治性咯血的临床疗效。[方法]对10例药物保守治疗无效的支气管扩张咯血患者行选择性支气管动脉造影及栓塞术。[结果]10例患者均顺利完成支气管动脉栓塞术,其中6例栓塞术后咯血完全控制,4例患者术后有少量咯血,均于1周内咯血逐渐消失,2例患者分别于术后半年、1年半后咯血复发,行再栓塞术后咯血完全控制,有效率为100%。2例患者术后d2出现胸痛或背痛,均自行缓解,1例出现穿刺部位血肿,无脊髓损伤等严重并发症出现。[结论]支气管动脉栓塞术是治疗支气管扩张难治性咯血安全、快速、有效的方法。     

支气管动脉灌注联合125I粒子植入治疗中晚期肺癌的临床分析

目的：分析中晚期肺癌患者采用支气管动脉灌注联合125I粒子植入治疗的临床疗效。方法：回顾本院收治的120例中晚期肺癌患者的临床资料,将其分为实验组（支气管动脉灌注、125I粒子植入联合）和对照组（支气管动脉灌注）两组,比较两组临床疗效。结果：实验组术后肿瘤大小、有效率优于对照组（P〈0.05）。结论：对于中晚期肺癌患者来说,实施支气管动脉灌注联合125I粒子植入治疗效果显著,成为首先治疗方案。     

Vascular compression of the duodenum.

Compression of the third or fourth part of the duodenum by the superior mesenteric artery or one of its branches is the anatomic basis for some cases of duodenal obstruction. Two cases of vascular obstruction of the duodenum after surgical correction of scoliosis are presented. The embryologic and pathoanatomic bases for this condition, and the rationale for treatment, are described.     

应用64排螺旋CT评价阿托伐他汀对冠状动脉斑块的影响

目的：评价阿托伐他汀对冠状动脉粥样斑块的影响。方法：对43例经64排螺旋CT冠脉CTA检测出的粥样斑块患者,给予阿托伐他汀20 mg/d口服,6个月后复查粥样斑块情况。结果：43例患者有119支冠状动脉存在132个粥样斑块,治疗后各种斑块大小有不同程度的下降,其中脂质斑块下降幅度16.4%,纤维斑块下降幅度8.1%,混合斑块下降幅度10.7%,而钙化斑块下降幅度不明显。结论：阿托伐他汀可逆转或稳定冠脉粥样斑块,从而降低急性冠状动脉事件的发生;64排螺旋CT可定量评价粥样斑块的变化,为临床治疗提供客观依据。     

支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较

目的 比较支气管堵塞器(BB)与双腔气管导管(DLT)在单肺通气中对呼吸力学和血气的影响.方法 将36例择期行肺叶切除术和食管癌根治术患者按投硬币法随机分为BB组(17例)和DLT组(19例).BB组完成单腔管插管后在纤维支气管镜引导下置入BB,DLT组完成插管后用纤维支气管镜检查确定DLT位置.摆好体位后记录两组双肺通气和单肺通气的气道峰压(Pmax)与肺动态顺应性(CLayn),单肺通气20 min后采动脉血,行动脉血气分析:动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2).结果 两组双肺通气时的Pmax和CLdyn比较差异无统计学意义(P＞0.05).单肺通气时BB组Pmax[(21.00 ±3.59)cm H2O,1 cm H2O=0.098 kPa]明显低于DLT组[(26.89 ±4.21)cm H2O](P＜0.05),CLdyn[(28.10 ±6.24)ml/cm H2O]明显高于DLT组[(24.00±7.13)ml/cm H2O](P＜0.05);两组单肺通气20min后PaO2、PaCO2、SaO2比较差异无统计学意义(P＞0.05).结论 使用BB行单肺通气对呼吸力学参数的影响较使用DLT小,具有很好的临床应用价值.

Abstract：

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.