旁路转流术治疗下肢动脉闭塞症104例临床分析

目的 总结104例下肢动脉闭塞症人工血管或自体大隐静脉旁路转流术的治疗经验.方法 回顾性分析1995～2006年对104例下肢动脉闭塞症实施的113次动脉旁路转流术的临床资料,其中腹主-双侧髂股动脉人工血管旁路15例(3例联合实施腰交感神经切断术),腋-双股动脉人工血管旁路4例,髂-股动脉人工血管旁路25 例次,股-腘动脉旁路40例次,股-股动脉人工血管旁路25例次,腘-胫后动脉旁路4例次.结果 10例切口皮缘坏死致愈合延迟,5例术后出现肢体坏疽行截肢术,其余病人术后恢复良好.踝肱指数由术前0.30±0.09增至0.77±0.09(t=3.787,P＜0.01).结论 动脉粥样硬化短段、局限病变以介入方法治疗为首选,长段闭塞或多节段闭塞的病变以手术治疗为主,并应正确选择流入道、流出道及血管代用品.     

腋-股动脉旁路术治疗主髂动脉闭塞性疾病的疗效分析

目的 探讨腋-股动脉旁路术在治疗主髂动脉闭塞性疾病中的意义.方法 回顾性分析采用腋-股动脉旁路术治疗的35例主髂动脉闭塞性疾病患者,其中有间歇性跛者5例,下肢静息痛11例,合并溃疡或坏疽19例.闭塞原因包括动脉硬化闭塞症29例、血栓形成5例、主动脉夹层1例.术式为腋-双股动脉旁路术19例,腋-单侧股动脉旁路术16例,使用的旁路移植血管均为聚四氟乙烯(Gore-Tex)人工血管.结果 本组病例围手术期未发生死亡,术后患肢间歇性跛行或静息痛消失,皮肤温度、颜色明显改善.远期随访时间3～80个月,总的术后1、3、5年移植血管的通畅率分别为:93％、87％、81％.结论 腋-股动脉旁路术具有侵袭性小,疗效确切等特点,是治疗主髂动脉闭塞性疾病的有效方法之一.     

经股、肱动脉联合治疗髂、股动脉长段动脉硬化闭塞症

目的探讨联合经肘/股动脉入路治疗长段髂-股动脉病变的有用性。方法本组共20例患者,男17例,女3例,年龄54～85岁,全部病例均有间歇性跛行、静息痛及下肢发凉。术前踝肱指数0-0.43,PWV为0-1076。全组病例均经CTA或动脉造影证实一侧髂动脉合并对侧股浅动脉长段（≥5cm）闭塞12例,两侧髂动脉合并一侧股浅动脉长段（≥5cm）闭塞3例,一侧髂动脉合并两侧股浅动脉长段（≥5cm）闭塞5例。所有病例均同时行肘/股动脉穿刺。结果 18例患者成功进行腔内球囊/支架治疗,2例未能开通闭塞段。术后踝肱指数0.72±0.15（P〈0.05）,PWV1783-2532（P〈0.05）,与术前相比有显著差异。术后随访1-24个月。其中有1例在随访过程中因心脏疾病死亡,有2例分别在术后6、9个月出现间歇性跛行或静息痛,CTA提示髂股动脉有慢性闭塞,再次成功行球囊扩张术。结论当单一经股动脉路径难以实施时,联合经肘/股动脉入路治疗长段髂-股动脉病变可提高治疗成功率。     

主髂和股胭动脉闭塞症的手术治疗

目的 探讨主髂和股Guo动脉闭塞症的最佳术式。方法 对1986年以来笔者经治的41例（45肢）动脉硬化性闭塞症进行回顾分析。其中采用主-股旁路术5例,髂-股旁路术41例（45肢）动脉硬化性闭塞症进行回顾分析,其中采用主-股旁路术5例,髂-股旁路术3例,股-Guo动脉旁路术6例,解剖外股-股或髂-股转流术16例,腋-股动脉转流术5例（其中腋-双股转流术1例）、腹主-股深旁路术1例和血栓内膜切除术5例。结果 术后血运改善效果良好,且Doppler和A/B指数有不同程度改善者38例（92.7%）。截肢3例（7.3%）,其中死亡1例（2.4%）。随访33例（80.5%）,5年通畅率为70.7%。结论 各种类型的旁路术疗效优于取栓或病变切除后旁路术,是治疗主髂和股Guo动脉闭塞症的最佳术式。     

股深动脉血流重建加大隐静脉动脉化治疗下肢动脉硬化闭塞症

目的探讨股深动脉血流重建加大隐静脉动脉化治疗下肢动脉硬化闭塞症的经验及疗效。方法选择无理想旁路术流出道,股浅动脉、动脉及其分支全段或多节段闭塞或严重狭窄,股深动脉起始部狭窄、闭塞的FontaineⅢ期、Ⅳ期下肢动脉硬化闭塞症患者25例,施行股深动脉血流重建加大隐静脉原位Ⅰ期动脉化。结果23例患者得到随访,随访时间3个月-4年,10例FontaineⅢ期术后静息痛消失,15例FontaineⅣ期术后静息痛消失13例,减轻2例,5例足（趾）坏死者术后2周行截足（趾）术。患者手术前后进行踝/肱血压指数比较,差异有统计学意义。结论股深动脉血流重建加大隐静脉动脉化治疗严重的下肢动脉硬化闭塞症安全、简单、有效,特别适合年老体弱且下肢无理想旁路术流出道的患者。     

股-股动脉血管移植术一例报告

本文报道一例左髂股动脉硬化性闭塞,经血栓内膜切除后,取同侧大隐静脉作左股-腘动脉转流术,并用直径8mm的真丝人造血管经耻骨上2cm的皮下隧道作左右股-股动脉血管架桥转流术,术后下肢症状消失,动脉造影显示血流通畅。随访3年9个月,情况良好。     

股深动脉成形术治疗下肢动脉闭塞症疗效分析

目的观察股深动脉成形术治疗下肢动脉闭塞症的疗效。方法将2005年9月至2006年7月收治的26例下肢动脉闭塞症患者,随机分为股深动脉成形术组(治疗组)和传统血管旁路手术组(对照组),每组各13例,对两组的踝/肱指数、症状改善情况、住院时间及并发症发生情况进行比较。结果术后3个月随访,治疗组疗效优于对照组,两组治疗后踝/肱指数与治疗前比较,均有统计学意义;治疗后两组踝/肱指数、症状改善情况及住院时间比较均有统计学意义,治疗组并发症少于对照组,但无统计学意义。结论在股浅动脉广泛闭塞时,选用股深动脉成形术作为重建患肢血液循环的通道是一种有效的手术方法。手术创伤小,操作方便,更适宜老年患者。     

慢性长段股腘动脉闭塞病变介入治疗分析

目的评价慢性长段股腘动脉完全闭塞病变腔内介入治疗技术及其临床意义。方法回顾总结56例慢性长段股腘动脉完全闭塞性病变,多种介入治疗技术如血管再通术、导管溶栓术、PTA及内支架置入术等的综合应用治疗效果。结果技术成功率92.9%（52/56）。52例开通者治疗后肢体状态改变为：＋3：14例;＋2：29例;＋1：9例。踝/肱指数（ABI）由术前平均0.46±0.12增至术后平均0.83±0.08。随访48例,＋3：11例;＋2：24例;＋1：6例;0：4例;-1：1例;-2：2例。症状改善总有效率为85.4%（41/48）。结论多种介入技术治疗股腘动脉完全闭塞病变安全、有效。     

彩色多普勒超声在下肢动脉硬化闭塞症动脉转流术中的诊断价值

目的:探讨应用彩色多普勒超声(color Doppler flowimaging,CDFI)对动脉硬化闭塞症(Arterilsclerotic Obliterance,ASO)的诊断价值及其对动脉人工血管转流术的术前指导意义。方法:通过对2005年3月~2007年3月我院收治的42例实行动脉转流术进行治疗的下肢动脉硬化闭塞症患者进行回顾性分析,术前全部进行彩色多普勒超声检查,其中11例同时行磁共振血管造影(Magnetic Resonance Angiography,MRA)检查。应用二维及彩色多普勒超声检测下肢动脉走行、管壁、内膜、管径、内径、狭窄百分比、闭塞节段、远端流出道情况、彩色血流变化、血流频谱形态及性质;应用磁共振血管造影(Magnetic Resonance Angiogra-phy,MRA)观察动脉管壁、管腔狭窄程度、闭塞阶段;并将两种检查结果与术中所见进行对比。结果:42例患者动脉管腔皆可见闭塞节段,占100%;腹主动脉下段闭塞3例,腹主动脉分叉处闭塞5例,髂总动脉闭塞18例,髂外动脉闭塞15例,股总动脉8例,股浅动脉闭塞27例,腘动脉闭塞15例,胫前动脉闭塞5例,胫后动脉闭塞8例,足背动脉闭塞6例。42例中,发现闭塞处最小长度2cm,最大长度16cm,32例显示侧支。结论:应用彩色多普勒超声诊断下肢动脉粥样硬化性闭塞症,能够准确判定动脉闭塞节段及狭窄程度,准确提供病变动脉远端流出道情况,对于动脉转流术的施行具有重要的术前指导意义。     

主髂和股动脉闭塞症的手术治疗

目的　探讨主髂和股动脉闭塞症的最佳术式。方法　对 1 986年以来笔者经治的 4 1例 ( 45肢 )动脉硬化性闭塞症进行回顾分析。其中采用主—股旁路术 5例 ,髂—股旁路术 3例 ,股—动脉旁路术 6例 ,解剖外股—股或髂—股转流术 1 6例 ,腋—股动脉转流术 5例 (其中腋—双股转流术 1例 )、腹主—股深旁路术 1例和血栓内膜切除术 5例。结果　术后血运改善效果良好 ,且 Doppler和 A/B指数有不同程度改善者 38例 ( 92 .7% )。截肢 3例( 7.3% ) ,其中死亡 1例 ( 2 .4 % )。随访 33例 ( 80 .5 % ) ,5年通畅率为 70 .7%。结论　各种类型的旁路术疗效优于取栓或病变切除后旁路术 ,是治疗主髂和股动脉闭塞症的最佳术式。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.