外伤性脾破裂保脾治疗32例临床分析

目的:探讨保脾治疗在外伤性脾破裂中的应用.方法:采用保脾疗法治疗外伤性脾破裂患者32例.结果:10例行非手术治疗;22例行保脾手术治疗,其中16例行缝合修补术,4例行脾部分切除术,2例行脾切除加自体脾片移植术.32例均治愈,随访无并发症发生.结论:只要符合保脾条件,非手术治疗和保脾手术治疗外伤性脾破裂是可行的,年龄越小越倾向于保脾治疗.     

脾动脉栓塞的临床应用

随着对脾脏功能研究的不断深入,脾脏不仅具有重要的免疫功能,而且具有内分泌、调节周围血循环量等多种功能,是维持患者高质量生存的重要器官。因此,脾修补、脾部分切除、脾切除后脾组织自体移植、脾动脉缩扎、结扎等保脾手术广泛应用于临床。近年来,由于微创外科手术的兴起及影     

介绍一种简单安全的脾创伤保留术

脾创伤行全脾切除术的病人常因“脾切除后暴发性感染”(OPSI)而死亡,因而保脾尤为重要。常用的保脾术是缝合式修补法,其中大网膜或明胶海绵修补可用可不用。本文报道的是对上述手术方法的进一步改进。     

胃切除术中脾损伤17例临床分析

目的探讨胃切除术中脾损伤的原因及预防和治疗方式。方法结合文献对17例胃切除术中脾损伤病例进行回顾分析。结果胃切除术中脾损伤率为0．68％。脾下极撕裂10例，脾上极撕裂4例，上极和脾门撕裂2例，脾门撕裂1例。行脾切除术10例，ZT胶粘合1例，缝合＋填塞5例，缝合＋填塞＋ZT胶粘合1例。结论胃切除术中脾损伤主要是术中操作错误引起；熟悉脾胃解剖，防止过度牵拉脾周韧带，注意保护脾脏有利于预防脾损伤发生；脾损伤应作缝合修补为主的保脾手术，胃癌术中脾损伤可同时行脾切除术。     

腹部手术脾损伤16例教训

目的探讨腹部手术时脾损伤的原因及处理原则。方法对于本院2000年1月-2007年12月的16例腹部手术对于脾脏损伤的回顾性分析结果行脾切除1例；脾部分切除3例；行修补缝合12例；修补加脾动脉结扎6例。结论腹部手术对脾脏损伤大部分Ⅰ级-Ⅱ级伤、行修补缝合止血是安全可靠的。     

胎儿脾动脉（脾外部分）的解剖学观察

本文用30例胎尸,经灌注后进行解剖剥离.在手术放大镜下进行观察,并对脾动脉的分支及侧支循环进行了观察,其结果如下.(1)脾动脉均起于腹腔干并沿胰腺上缘走行,脾动脉发出胰腺支,胃短动脉,胃网膜左动脉,胃后壁动脉,脾叶动脉和脾极动脉.(2)脾动脉的侧支循环十分丰富,脾动脉与胃左动脉,左膈下动脉,胃网膜右动脉,肠系膜上动脉,胰动脉等均有侧支吻合,并且胃网膜左动脉与胃网膜右动脉吻合形成网膜弓.     

脾外伤手术的局解浅析

我院自１９９４年１２月至１９９７年２月共收治脾外伤性破裂２７例。根据脾脏的脾叶动脉，脾段动脉的分型，以及脾损伤情况，而分别采取脾叶、段切除术，脾修补术，脾切除术。从中发现脾的损伤与脾脏的局部解剖有关，同时脾门的脾叶动、脾段动脉的解剖分型对手术方法的选择有指导意义 。     

脾动脉栓塞治疗外伤性脾破裂的临床应用

目的探讨脾动脉栓塞治疗外伤性脾破裂的临床疗效及应用价值。 方法穿刺股动脉,行脾动脉造影后行脾动脉栓塞,治疗外伤性脾破裂6例。 结果6例患者术后均出现左上腹不同程度胀痛,术后均出现发热,最高体温38.5 ℃,5例患者出现少量胸腔积液。6例患者术后均未再出现出血,保脾成功,顺利出院。 结论在病情允许情况下,脾动脉栓塞治疗外伤性脾破裂止血效果确切,有效保留脾脏免疫功能,且患者创伤小,恢复快。     

保留胃短动脉的保脾手术3例

近年许多文献强调对外伤性脾破裂应尽量采用保留全睥或部分脾组织的保守手术．以保留脾功能。我科自1990年4月～1996年8月共收治外伤性脾破裂102例．采用单纯缝合或部分切除保留脾手术18例。其中采用保留胃短动脉的保留脾手术3例，效果较好现报道如下：     

外伤脾切除后自体脾组织移植的临床应用

近年来,脾脏外科有了长足进展,主要标志之一是对脾脏功能有了新的认识,对脾脏功能认识程度的逐步加深又促进了脾脏外科的发展,两者相得益彰,不可或缺。自体脾组织移植(以下简称脾组织移植)在国内外已被接受为脾破裂进行保脾手术的主要措施之一。我院自1999年1月至2000年4月,因外伤脾破裂无法修补,行全脾切除术后自体脾组织移植32例,术后随访观察均获得满意疗效。     

Splenic Artery Avulsion in a High School Football Player: A Case Report

OBJECTIVE: To present the case of a high school football player who sustained avulsion of 2 branches of the splenic artery from his spleen as he was tackled and landed on the football. BACKGROUND: A high school football player was tackled and fell onto the football, left side first. He was examined by a certified athletic trainer and an internist. On evaluation, he had a positive Kehr sign, exquisite left upper abdominal quadrant tenderness, and complaint of nausea. He also exhibited signs of the onset of shock, including diaphoresis, a rapid pulse, and hypotension. He was immediately transported by ambulance to the local emergency facility. DIFFERENTIAL DIAGNOSIS: Splenic rupture, splenic laceration, splenic artery avulsion, or ruptured viscus. TREATMENT: Emergency surgery was performed, with removal of 2800 mL of blood and ligation of the 2 arterial branches avulsed from the spleen. The patient fully recovered within 6 weeks and was cleared to resume all sports activities. UNIQUENESS: Injury to the spleen in football is a known yet very uncommon injury. Even more unusual is the avulsion of splenic artery branches from the spleen. CONCLUSIONS: It is critical that athletic trainers and team physicians have an understanding of the mechanisms, signs, and symptoms of splenic injury. Because the spleen is a highly vascular organ, severe hemorrhage can be fatal in just minutes if not recognized and appropriately treated.     

非手术治疗创伤性脾破裂112例分析

目的探讨Ⅰ-Ⅳ级外伤性脾破裂治疗方式的选择。方法回顾分析我院近5年来112例Ⅰ-Ⅳ级外伤性脾破裂患者临床资料。结果112例Ⅰ-Ⅳ级外伤性脾破裂患者中一般保守治疗81例，介入栓塞止血11例，急诊开腹手术13例，中断保守治疗行开腹手术7例；入院时查CT腹腔未见游离液体或少量游离液体67例，保脾治疗成功67例；腹腔中量游离液体者45例，保脾治疗成功25例；按美国外伤外科学会AAST分级制订的脾脏损伤程度分级标准，Ⅰ级24例，Ⅱ级30例，Ⅲ级42例，Ⅳ16例。结论有选择的保脾治疗脾破裂是安全、有效的治疗方法，其中入院时血压稳定，腹腔无或少量游离液体者能保持较高的保脾治疗成功率；介入栓塞止血能显著提高保脾治疗的成功率。     

心肌缺血损伤小型猪模型内关穴位埋针后血管新生及成纤维细胞生长因子mRNA和蛋白的表达

背景：血管生成及成纤维细胞生长因子与心肌缺血损伤后修复关系密切,针刺内关防治心肌缺血损伤的机制是否与此有关尚不清楚。 目的：观察内关穴位埋针对心肌缺血损伤小型猪血管新生及成纤维细胞生长因子基因和蛋白表达的影响。 方法：将32只小型猪随机分为4组,采用左冠状动脉前降支结扎法建立心肌缺血模型,假手术组穿线但不结扎,内关组和膈俞组分别在造模的基础上进行内关、膈俞穴埋针治疗,模型组和假手术组不进行任何干预。 结果与结论：免疫组织化学染色显示小型猪经冠脉结扎后心肌毛细血管密度降低(P < 0.01),内关、膈俞穴埋针治疗7 d,损伤心肌组织毛细血管密度增加(P < 0.05或P < 0.01),内关组优于膈俞组(P < 0.05);Real time PCR和Western blot检测显示小型猪经冠脉结扎后心肌组织成纤维细胞生长因子mRNA和蛋白表达量显著增高(P < 0.05或P < 0.01),内关和膈俞穴位埋针治疗均可上调成纤维细胞生长因子mRNA和蛋白表达量,以内关埋针效果最明显(P < 0.05)。揭示内关、膈俞穴位埋针均可通过上调成纤维细胞生长因子mRNA和蛋白的表达,增加心肌毛细血管密度,改善缺血心肌的损伤,且内关优于膈俞。     

Vascular responses of the spleen to nerve stimulation during normal and reduced blood flow

1. The splenic artery flow, the splenic weight and the arterial blood pressure were recorded in cats anaesthetized with sodium pentobarbitone.

2. Oscillations in splenic artery flow and splenic weight were observed. Following occlusion and release of the splenic artery, there was a brief increase in flow to above the pre-occlusion level and the oscillations in flow were greatly increased in amplitude. It is suggested that the brief increase is a consequence of the reduction of arterial pressure and that the oscillations are due to synchronization of rhythmic activity of smooth muscle within the spleen.

3. Stimulation of the splenic nerves resulted in decreases in splenic artery flow and splenic weight. The size of the responses varied with the frequency of stimulation and maximum responses in both flow and weight were obtained at about 3 impulses/sec.

4. After stimulation for 10 min, the splenic weight response was maintained while the flow response showed some recovery towards the control level.

5. When the splenic artery flow was reduced to about half the control level for periods up to 2 hr, the flow and weight responses to stimulation of the splenic nerves remained unchanged; the significance of this after a haemorrhage is discussed.

6. Intravenous administration of atropine or propranolol did not affect the responses to nerve stimulation. After phenoxybenzamine, nerve stimulation caused a smaller decrease in splenic weight, while the splenic artery flow increased to above the control level. This increase was unaffected by atropine but abolished by propranolol.

     

The effect of aimaline on auricular and ventricular arrhythmia in dogs

Summary The anti-arrhythmic action of aimaline was studied on two models of arrhythmia in dogs. Auricular tibrillation was provoked by mechanical injury and subsequent stimulation of the auricles with induced current; ventricular arrhythmia was caused by ligating the descending branch of the left coronary artery. It was established that aimaline arrests auricular arrhythmia and either sharply reduces the frequency of ventricular extrasystoles or completely eliminates them and decelerates the cardiac activity.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 51, No. 4, pp. 71–75, April, 1961     

Caroli's syndrome leading to splenic artery aneurysm: a rare presentation

Splenic artery aneurysm is a rare disorder (0.7%) that arises mainly as a sequlae to portal hypertension. Other causes of splenic artery aneurysm are atherosclerosis, arterial wall injury due to trauma, pancreatitis, and medial dysplasias of the wall. However, though Caroli's disease is known to cause portal hypertension, the rise of vascular pressure leading to aneurysm is not yet reported (extensive Medlar search failed to reveal any publication). Every effort should be made to diagnose this condition as early as possible because 25% of ruptured splenic aneurysms are fatal. A unique case of Caroli's disease giving rise to splenic artery aneurysm and its possible pathogenesis is reported.     

参元丹后处理对心肌缺血/再灌注大鼠血清MDA、SOD水平的影响

目的:研究参元丹后处理对心肌缺血/再灌注大鼠血清丙二醛(MDA)、超氧化物岐化酶(SOD)水平的影响.方法:采用结扎前降支方法建立缺血/再灌注模型,即经历30min缺血和180min持续再灌注.40只大鼠随机分为5组,假手术组、缺血/再灌注模型组(模型组)、缺血后处理组、缺血后参元丹低剂量处理组(参元丹低剂量组)、缺血...     

大鼠在体心脏缺血后处理模型的建立与优化

目的建立并优化大鼠在体心脏缺血后处理(I-postC)模型。方法采用冠状动脉左前降支垫扎球囊法建立在体心脏I-postC模型,健康雄性SD大鼠随机分为7组(n=8):缺血/再灌注(I/R)组(冠状动脉左前降支缺血45min/再灌注2h)、缺血预处理(IPC)组(I/R前先行3轮缺血5min/再灌注5min处理)、I-postC组(包括4个亚组,于冠脉缺血45min后先进行3或4轮再灌注30s/缺血30s或再灌注60s/缺血60s后处理后再进行冠脉再灌注)以及假手术(sham)组。氯化三苯四氮唑(TTC)法测定心肌梗死面积,试剂盒检测血浆乳酸脱氢酶(LDH)和心肌组织超氧化物歧化酶(SOD)活性。结果I/R引起明显的心肌梗死和组织损伤,采用冠状动脉左前降支垫扎球囊法进行I-postC可以显著减少I/R后心肌梗死面积,尤以3或4轮再灌注30s/缺血30s组保护作用明显,其梗死区占缺血区百分比分别比I/R组下降30.26%和58.81%(P分别<0.05),与IPC保护效果相近。结论I-postC可以减轻心肌I/R损伤,其中4轮再灌注30s/缺血30s诱导的I-postC在限制心肌梗死面积方面作用最明显,是理想的大鼠在体心脏I-postC模型。