Surgical treatment of benign,myomatous rectal tumors

Between 1972 and 1990, 36 patients with leiomyoma of the rectum underwent surgery at the Proctology Institute (Moscow). There were 13 male (36.1 percent) and 23 female (63.9 percent) patients. Their median age was 52.1 years. Electroexcision of the tumors measuring below 1 cm was performed through the endoscope in 12 patients. Leiomyomas with a diameter of 2.5 to 5 cm were removed transanally in 10 patients. Six patients underwent excision of the tumor through the pararectal approach, whereas leiomyomas located in the rectovaginal wall were removed through the vagina in one patient. Abdominoperineal extirpation and abdominoanal resection of the rectum was performed in seven patients with tumors measuring from 8 to 20 cm. Recurrences were noted in nine patients after transanal, pararectal, or transvaginal excision of leiomyomas. In seven of them, malignant transformation of the tumor occurred at terms ranging from 9 months to 9.5 years.     

Preoperative radiotherapy in operable rectal cancer

The effect of preoperative radiotherapy (31.5 Gy in 3.5 weeks) in operable rectal cancer was examined with respect to resectability and prognosis after two surgical procedures, abdominoperineal resection, or low anterior resection. Preoperative radiation did not influence the surgeon's selection of low anterior resection, which was similar (40 percent) in each group. Radiation improved five-year survival probability and decreased the incidence of local recurrence significantly after low anterior resection. In contrast, no improvement of treatment results was found in patients treated by abdominoperineal resection after radiotherapy.     

New perspective in the treatment of low rectal cancer: Total rectal resection and coloendoanal anastomosis

PURPOSE: Presently abdominoperineal resection still remains the most diffuse modality of treatment of low rectal cancer. However, a new surgical approach is now available to avoid such a demolitive surgery and a definitive colostomy. METHODS: From March 1990 to March 1993, 58 total rectal resections were performed in 55 patients affected with primary or recurring cancers of the low rectum. As a restorative procedure, a colic J-shaped pouch and a handsewn pouch-endoanal anastomosis was adopted. All of the primary lesions were within 7 cm of the anal verge; in 74 percent the distal tumor margin was located less than 6 cm from the cutaneous edge. RESULTS: Histologic clearance of the rectum cut edge was documented in all cases. Seven patients relapsed locally from 7 to 14 months after surgery and in 3 more cases distant metastases were documented. Postoperative morbidity is low. After colostomy closure in 78 percent of patients, perfect continence was achieved and in 74 percent less than two bowel movements a day were recorded. Fifty patients are presently alive, 46 without evidence of disease. The follow-up ranged from 2 to 37 (median, 13) months. CONCLUSION: This experience, along with data obtained from last year's literature, indicates that a conservative surgical procedure, such as total rectal resection and coloendoanal anastomosis, can be considered a feasible and radical option for treatment of low rectal cancer.     

Rectal mucosectomy in the treatment of giant rectal villous tumors

PURPOSE: Rectal mucosectomy, a technique adapted from restorative proctocolectomy, has been used to treat large rectal villous tumors. We compared morbidity, tumor control, and functional outcome following rectal mucosectomy with the results of more conventional transanal excision and piecemeal snaring and fulguration in patients with large rectal villous tumors. METHODS: We retrospectively reviewed the charts of inpatients who had undergone transanal surgery for villous tumors. RESULTS: Between 1983 and 1993, rectal mucosectomy, transanal excision, and snaring and fulguration were performed, respectively, in 12, 26, and 23 patients with large rectal villous tumors. Tumors treated by rectal mucosectomy had a larger mean diameter (8.5 cm) than those treated by transanal excision or snaring and fulguration (4.5 cm and 4.2 cm, respectively; P< 0.0001, analysis of variance). After a mean follow-up of 47 months, incidence of tumor persistence was 17 percent following rectal mucosectomy, 20 percent following transanal excision, and 40 percent following snaring and fulguration (P =0.04, chi-squared). Tumor recurrence was 8 percent after rectal mucosectomy compared with 36 and 44 percent, respectively, after transanal excision (P =0.09, chi-squared) and snaring and fulguration (P =0.04, chisquared). Clinically significant postoperative bleeding did not occur after rectal mucosectomy; 17 percent of patients had persistent mild incontinence. CONCLUSIONS: Rectal mucosectomy for villous tumors, a new application of an established technique, is safe and associated with low rates of tumor persistence and recurrence. Rectal mucosectomy may result in mild incontinence and should be reserved for large or circumferential lesions. For smaller lesions, transanal excision results are more reliable tumor eradication than snaring and fulguration.Read at the meeting of The New England Society of Colon and Rectal Surgeons, Stowe, Vermont, March 18 to 19, 1994.     

Complications of absorbable pelvic mesh slings following surgery for rectal carcinoma

PURPOSE: To evaluate the intraoperative, postoperative, and long-term complications of an absorbable pelvic mesh sling after surgery for rectal carcinoma. METHODS: A retrospective review of medical records from April 8, 1991, through April 8, 1996. RESULTS: Twenty patients with a mean age of 57 (range, 37–79) years underwent pelvic mesh sling placement. The tumor stages were as follows: Stage I, 5; Stage II, 2; Stage III, 11; and Stage IV, 1. A recurrent perianal basal cell carcinoma was not included in the staging group. Surgery consisted of 18 abdominoperineal resections, 1 total proctocolectomy, and one Hartmann's procedure. Mean follow-up was 18 (range, 2–49) months. There were no intraoperative complications related to mesh placement. Twenty-nine complications occurred in 14 patients during the immediate postoperative period. Five were possibly mesh-related and included a pelvic abscess, perineal seroma, toxic perineal wound, pulmonary embolus, and lower extremity deep venous thrombosis, respectively. A mild postoperative ileus developed in 17 patients (85 percent), and a diet was initiated at a mean of seven (range, 4–24) days. Fourteen patients received postoperative radiotherapy with a mean dose of 5,339 (range, 2,500–7,020) cGy delivered in 180-cGy fractions. There were 14 immediate complications caused by radiotherapy in 11 patients, but only two patients required delays in treatment. Two patients had diarrhea alone, six developed perineal dermatitis alone, and three patients had both diarrhea and perineal dermatitis. All patients with diarrhea had received chemoradiation. One patient developed a partial small-bowel obstruction following radiation. CONCLUSIONS: Absorbable pelvic mesh sling placement can be performed with minimum morbidity and is recommended following surgery for rectal cancer when radiation is anticipated as part of multimodality therapy.     

Endoscopic dilation of rectal strictures

PURPOSE: This study was performed to prospectively evaluate results of endoscopic balloon dilation of strictures of the rectum. METHODS: Eighteen patients with symptoms of rectal strictures at endoscopy or barium enema were treated on 49 occasions with balloon dilation during sigmoidoscopy. RESULTS: Twelve patients were completely satisfied with relief of their symptoms after treatment. Two patients considered the results as poor, and four patients were not subject to follow-up evaluation. One patient had a perforation during the dilation procedure but was completely relieved at follow-up examination. CONCLUSIONS: Endoscopic balloon dilation of strictures in the rectum is a safe method. The method is simple and can be performed on an outpatient basis. The technique shows good results even in narrow strictures.     

Clinical conundrum of solitary rectal ulcer

A retrospective study of 80 patients with biopsy-proven solitary rectal ulcer (SRU) was conducted to review its clinical spectrum. The median follow-up was 25 months. The female-to-male ratio was 1.41.0, and the mean age was 48.7 years (range, 14–76 years). Principal symptoms were bowel disturbances (74 percent) and rectal bleeding (56 percent). Twenty-one patients (26 percent) were asymptomatic and required no treatment. A previous wrong diagnosis was made in 25 percent. Rectal prolapse was identified in 28 percent (full-thickness, 15 percent; mucosal, 13 percent). The macroscopic appearance of the lesion seen in SRU varied widely and included polypoid lesions in 44 percent (the predominant finding in the asymptomatic group), ulcerated lesions in 29 percent (always symptomatic), and edematous, nonulcerated, hyperemic mucosa in 27 percent. Anorectal manometry provided little helpful information in the patients in whom it was performed. Management by bulk laxatives and bowel retraining led to symptomatic improvement in 19 percent of cases. In 29 percent of cases, symptoms persisted despite endoscopic healing of the lesion. Intractability of symptoms led to surgery in only 27 (34 percent) patients. Depending on the presence or absence of rectal prolapse, rectopexy or a conservative local procedure (such as local excision), respectively, appeared to be the optimal surgical treatment. The polypoid variety tended to respond to therapy more favorably than non-polypoid varieties. Thus, the macroscopic appearance of SRU has a significant bearing on the clinical course, and most cases do not require surgery.Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, May 12 to 17, 1991.     

Prospective evaluation of local excision for small rectal cancers

OBJECTIVE: Most data on local excisions for rectal cancer are based on retrospective studies. We review the results of a prospective registry of patients eligible for local excision of rectal cancer using a transanal, transsphincteric, or transcoccygeal technique combined with multimodality therapy for lesions penetrating the muscularis propria (T2) or perirectal fat (T3). METHODS: Patients with lesions less than 4 cm in diameter and less than 10 cm from the dentate line, with no evidence of distant metastases or invasion into the perirectal fat, were eligible for local excision. Patients with invasion into the muscularis propria (T2) or greater (T3) received adjuvant chemoradiation therapy. RESULTS: Forty-eight patients have been followed prospectively. Average age is 63 years. Thirty-three patients underwent a transanal excision. Fifteen patients underwent either a transsphincteric or technique excision. There was no perioperative mortality. Pathology revealed 1 Tis, 21 T1, 21 T2, and 5 T3 cancers. Mean follow-up is 40.5 months. Cancerrelated overall mortality was 4 percent. Overall local or distant recurrence rate was 8 percent(4/48). Recurrence appeared to be related to presence of a positive margin or aggressive histology (lymphatic invasion). Local recurrences were treated with salvage therapy. CONCLUSION: Local excision can be used selectively for small rectal cancers, with minimum morbidity. Recurrence rates are low (8 percent). Patients with either a positive margin or lymphatic invasion need to be considered for further therapy, including abdominoperineal resection, even with T1 lesions. Adjuvant chemoradiation appears to be a benefit for all T2 or T3 cancers.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995. Winner of the Harry E. Bacon Foundation Award.     

Endoluminal ultrasound diagnosis and operative management of rectal endometriosis

PURPOSE: Endorectal ultrasound was performed in patients with endometriosis to evaluate the role of this technique for rectal wall involvement and to evaluate the position of preoperative diagnosis in the operative management of rectal endometriosis. METHODS: Sixteen patients with suspected fixation of endometriomas to the rectal wall during bimanual examination were included in the study. Endorectal ultrasound was performed using a real time unit with a 7.5 MHz endorectal transducer. The probe was introduced via a rectoscope into the rectum up to the rectosigmoid. RESULTS: Endometriosis was confirmed histopathologically in all patients. In six patients rectal wall involvement was diagnosed, in two patients endometriomas were adjacent to the rectal wall, and in eight patients rectal wall involvement could be excluded. Preoperative diagnosis was confirmed in all patients during operation. Laparotomy was performed in those patients with preoperatively diagnosed rectal wall involvement, whereas the remaining patients were treated laparoscopically. Endometriomas with rectal wall involvement were treated in five of six patients with resection of the affected bowel predominantly by low anterior resection. CONCLUSIONS: Preoperative endorectal ultrasound is a reliable technique to visualize perirectal endometriomas and to assess rectal wall involvement. Based on preoperative endosonographic diagnosis, an operative management was established with laparotomy and resection of the affected bowel in cases of rectal wall involvement.     

Fecoflowmetry: A new parameter assessing rectal function in normal and constipated subjects

Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes that occur in the flow against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 88 chronically constipated patients. Simultaneous recording of the fecal flow rate and intra-abdominal and rectal neck pressures were performed. A water or paste enema was given to the individual. Upon feeling the desire to defecate, he or she was placed on a fecoflowmeter commode and was asked to defecate. Evaluation of the obtained defecation flow curve comprises the reporting on the defecated volume, flow time, mean and maximum flow rates, time to maximum flow, and shape of the curve. In the 88 constipated patients, two fecoflowmetric patterns were recognized: nonobstructive (inertia) and obstructive. They differ from each other in parameters and curve configuration. The defecated volume as well as mean and maximum flow rates were lower in outlet obstruction than in the inertia type, whereas flow time and time to maximum flow were longer. The ascending limb in the obstructive-type curve rose less steeply than in inertia; the curve had a long plateau, and the descending limb sloped more gradually. To conclude, fecoflowmetric studies could differentiate between defecation of normal and constipated subjects, and in the latter between the obstructive and inertia types of constipation. The technique was developed to simulate natural defecation. It provides quantitative and qualitative data concerning the defecation act. The technique is simple, easy, noninvasive, and nonradiologic. It can be used as a screening tool in defecation disorders.     

Effect of octreotide on anal pressure and rectal compliance

PURPOSE: The somatostatin analog, octreotide, has previously been found to influence rectal sensation and may also influence anal resting pressure. METHODS: We studied the effect of octreotide on anal resting pressure and rectal compliance in eight healthy patients. Octreotide was administered intravenously as a bolus injection in doses of 100 and 10 g or as infusion of 250 g/ hour on separate days and compared with placebo. RESULTS: Within one minute after a bolus injection of 100 g of octreotide, anal resting pressure increased from 56±12 to 96±16 cm H ₂ O (P<0.005). Octreotide had no effect on rectal sensitivity or compliance measurements. Octreotide counteracted rectoanal reflex by increasing anal pressure almost to the level found with an empty rectum. CONCLUSION: Somatostatin thus seems to contribute to the regulation of rectoanal reflex.     

Role of proctography in severe constipation

As referred to in the literature, patients complaining of constipation may have a spastic or, in the case of chronic straining, weak pelvic floor. Twenty-two severely constipated patients who did not improve after a high fiber diet were submitted to whole gut transit time (TT), proctographic, and anorectal manometric studies. A control group consisting of five subjects for TT, five subjects for proctogram, and ten subjects for manometry was also studied. Transit time was delayed ( P < 0.001) in all patients. Manometry in the constipated group showed a high rectal threshold (64.1 vs. 17.1 ml of air,P < 0.01), but no other significant difference. Proctograms in 10 of 22 patients (Group A) showed no differences in the anorectal angle (ARA) and in its distance from the pubococcygeal line (DLPC) in respect to the control group; 12 of 22 patients (Group B) had a paradoxical closure of the ARA at straining in respect to resting position (101.2 vs. 120.1), and a higher DLPC than Group A and the control group in all positions studied. There was no difference in TT for rectal stasis of radiopaque markers between the two pathologic groups. Patients in Group B were older than patients in Group A (55.3 vs. 42.9 years,P <0.05). In conclusion, proctograms showed alterations of the pelvic floor, but there was no correlation between proctographic data and rectal or colonic stasis of the radiopaque markers, or clinic severity of constipation, but a correlation between ages did exist.     

Immediatevs. Salvage resection after local treatment for early rectal cancer

PURPOSE: There is an increasing awareness of local procedures to treat early stage rectal cancer. Abdominoperineal resection (APR) or low anterior resection (LAR) has been recommended if adverse pathologic findings are encountered in the local excision specimen. No data compare the impact on survival of immediate resection for adverse featuresvs. salvage resection for clinical recurrence. METHODS: We reviewed retrospectively 155 patients who underwent initial curative treatment of invasive rectal cancer by excision (91), snare-cautery (44), and fulguration (20). RESULTS: Twenty-one patients underwent APR/LAR immediately after initial local treatment, whereas another 21 patients underwent salvage APR/LAR for local recurrence. The disease-free survival after APR/LAR was 94.1 percent for the immediate group and 55.5 percent for the delayed group (P<0.05). CONCLUSION: This decreased survival observed after delayed resection supports the recommendation for immediate APR/LAR when adverse pathologic features are present in the excision specimen. Presented at the Annual Cancer Symposium of the Society of Surgical Oncology, New York, New York, March 15 to 18, 1992.     

Influence of loperamide and loperamide oxide on the anal sphincter

The objective of this study was to investigate the effects of the opioid loperamide and its recently synthesized pharmacologically inactive prodrug loperamide oxide on the anal sphincter. In a double-blind, placebo-controlled crossover study, anorectal manometry was performed in 12 healthy volunteers five hours after oral bolus application of 10 mg of loperamide, loperamide oxide, or placebo. Loperamide significantly increased the threshold volumes for minimal perception and urgency to defecate (P <0.05) and raised the volume required to abolish recovery of the rectoanal inhibitory reflex (P < 0.05). These findings suggest that loperamide has a specific continence-improving action on the anal sphincter. However, anal resting pressure and maximal squeeze pressure were unaffected in our study and do not seem to be responsible for this effect. The effects under loperamide oxide showed a similar tendency but were without statistical significance.     

Influence of atherosclerosis on vascular responsiveness in isolated rabbit vascular smooth muscle

Summary Coronary arteries and aortic rings were isolated from rabbits fed either a control diet or a high cholesterol (1 to 2%) diet for 8 to 11 weeks and studied for their vasoactive properties to a variety of vasoconstrictor and vasodilator agents. Perfused coronary arteries without intact endothelium constrict markedly to a thromboxane A₂ agonist (i.e., carbocyclic thromboxane A₂, CTA₂) and dilate markedly to iloprost, a prostacyclin analog. No differences occurred between the coronary arteries isolated from control or atherosclerotic rabbits. Additional studies were conducted on rabbit aortic vascular smooth muscle rings containing functionally intact endothelium and in rings denuded of their endothelium. Acetylcholine (20 to 2000 ng/ml) neither constricted nor dilated control aortic rings without endothelium, and markedly dilated aortic rings with intact endothelium in a concentration dependent manner. In atherosclerotic aortic rings, acetylcholine constricted preparations without endothelium, and dilated rings with endothelium to a much lesser extent than that observed in control rings. Similar reductions in responsiveness occurred with adenosine diphosphate (ADP), another endothelium-dependent vasodilator, but not with iloprost, a nonendothelium-dependent dilator. No differences were observed in constrictor responses to norepinephrine. Aortae from atherosclerotic rabbits produced less prostacyclin in response to arachidonic acid than control aortae. These data point to an important role of the endothelium in modulating the vascular response to vasodilators in atherosclerotic rabbit arterial vessels.This study was supported in part by Research Grant No. HL-25575 from the National Heart Lung and Blood Institute of the NIH.John A. Osborne is a Predoctoral Fellow of the Foerderer Foundation. Jian-zhong Sun is a WHO Postdoctoral Fellow.     

Rectal mucosal electrosensory testing—Evidence for a rectal sensory neuropathy in idiopathic constipation

Rectal sensation is usually assessed using balloon distention. The authors describe a more precise technique that avoids the variables of balloon dynamics and rectal diameter and compliance. Using both methods, rectal sensation was assessed in 13 healthy control women and 26 women with severe idiopathic constipation. Balloon distention in the rectum revealed an elevated sensory threshold (16.9±4.4 vs. 30.4±3.1 ml air, controls vs. patients,P =0.018) and volume required to elicit a call to stool (61.1±9.1 vs. 97.5±6.4, P=0.003) in subjects with severe constipation. The maximum tolerated volume was similar in the two groups. Rectal mucosal electrosensitivity was then tested using a bipolar ring electrode supplying a constant current. This demonstrated an elevated sensory threshold in the constipated subjects (16.3±3.0 vs. 27.4±2.1 mAmps, P=0.005). There was a significant correlation between the sensation thresholds for balloon distention and electrical stimulation for the entire subject group (r=0.39,P =0.01). Two other patients with severe constipation after suspected extrinsic nerve damage were also studied and demonstrated a markedly abnormal electrical sensory threshold. Electrical testing avoided the variables inherent in balloon distention and was well tolerated, accurately quantifiable, and reproducible. The raised threshold to electrosensory mucosal testing suggests the presence of a rectal sensory neuropathy in patients with severe idiopathic constipation.Presented in part at the American Gastroenterological Association meeting, New Orleans, Louisiana, May 1988.Michael A. Kamm is supported by the St. Marks Research Foundation.     

Passivevs. closed suction drainage after perineal wound closure following abdominoperineal rectal excision for carcinoma

PURPOSE: Because evacuation of effusion or collection could depend on the type of drainage, we compared the effects of closed suction drainage with passive drainage through tubes or undulated drains after abdominoperineal rectal excision for carcinoma on early and late perineal wound healing. METHODS: Of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma between January 1983 and August 1990, unsatisfactory hemostasis or gross intraoperative septic contamination were recorded in 48 patients who were not included in the trial. After rectal excision and closure of the perineum, the remaining 186 patients were randomized to receive passive drainage (PD; n=96) or closed suction drainage (SD; n=90). Eighteen patients were withdrawn because of protocol violation, and three were lost to follow-up, leaving 165 (89 PD and 76 SD) patients for analysis. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of ascites), intraoperative and pathologic findings (Dukes stage), and postoperative courses (recurrence, late mortality) were similar in both groups. All patients were followed up for 12 months or until death. RESULTS: The rate of perineums healed at one month was significantly lower (P <0.05) in PD (55/89=61 percent) compared with SD (54/72=75 percent) patients. At three months, the rate of healed perineums no longer differed between the two groups (70/87=81 percent vs.60/72=84 percent). The number of vaginal fistulas, secondary reopenings, and perineums not healed at 12 months was similar in both groups. Median duration to complete healing was similar in both groups (23 vs. 21 days, respectively). On the other hand, three retained drains were seen in PD patients only. The median duration of hospital stay was identical in both groups (22 days). Seven patients died in the early postoperative period, including one in the PD group and six in the SD group. There was no significant difference in the number of late deaths (3 vs. 7) in PD and SD patients, respectively. CONCLUSION: These results suggest that closed suction drainage should be used after abdominoperineal rectal excision with satisfactory hemostasis or absence of gross intraoperative septic contamination.     

Role of laparoscopy in colorectal surgery A prospective evaluation of 200 cases

PURPOSE: The aim of this study was to prospectively evaluate the role of laparoscopic-assisted surgery in patients presenting for routine colorectal surgical procedures. METHODS: Two hundred consecutive patients were assessed for the possible use of laparoscopic surgery. The decision regarding suitability of the patient for the procedure was made by the operator. For the purpose of analysis, patients were assigned to open, converted, and laparoscopic groups. RESULTS: Ninety-five of 200 patients were considered appropriate for laparoscopic surgery, 62 (65.3 percent) being successfully completed. These completed operations included right colectomy (24/30), sigmoid colectomy (22/36), appendectomy (9/10), anterior resection (3/8), abdominoperineal resection (3/5), and left colectomy (1/2). Complications attributable to laparoscopy were infrequent (6.3 percent) and were not responsible for any deaths. Patients in the laparoscopic group required less analgesia, tolerated oral intake earlier, and were discharged from the hospital earlier than those who were converted or who had open procedures. CONCLUSIONS: Laparoscopic assisted surgery is safe, effective, and applicable to many of the standard colorectal procedures. Observed benefits include less postoperative pain and shorter hospital stay.Read in part at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.     

Sensory nerve endings in the puborectalis and anal region of the fetus and newborn

The study was carried out in seven fetuses (ovulation ages were 16, 18, 20, 22, 26, 28, and 31 weeks, respectively) and in five full-term newborn babies. The modified Bielschowsky method and Barker's block silver impregnation were used. It was found that the muscle spindle was arranged in the puborectalis and the external sphincter muscles from the 20th week onward; the tendon organ was located in association with the musculotendinous junction of the puborectalis from the 20th week onward; the Pacinian corpuscle lay in the plane of cleavage between the internal anal sphincter and the external anal sphincter from the 22nd week onward, and in the presacral space from the 28th week onward, and the later lagged behind the former in development; the globular endings lay in the presacral space from the 28th week onward; and the free nerve ending was distributed in the epithelium of the anal mucosa and the epidermis around the anus from the 31st week onward. These sensory nerve endings tend to mature gradually with increasing age. It was concluded that these endings may be responsible for the reflex of the external anal sphincter and the anal sensation.     

动脉平滑肌细胞一氧化氮合酶与高血压发病的关系

目的 探讨高血压病患者血管平滑肌细胞（ＶＳＭＣ）一氧化氮合酶（ＮＯＳ）活性和ＮＯＳ基因表达的特点及其与高血压发病的关系。方法 采用复合胶原酶法分离培养高血压病患者和血压正常者动脉ＶＳＭＣ,并以血红蛋白分光光度法、原位反转录聚合酶链反应检测ＶＳＭＣ的ＮＯＳ活性和诱生型ＮＯＳ（ｉＮＯＳ）ｍＲＮＡ表达量。结果 （１）高血压组ＶＳＭＣ的ＮＯＳ活性和ｉＮＯＳ ｍＲＮＡ表达量均显著低于正常组（Ｐ〈０．０１）;