留置不同类型镍钛记忆合金气管支架的动物实验研究

目的比较留置不同类型镍钛记忆合金气管支架后,实验犬的机体反应及气管增生情况,探讨不同气管支架植入的应用价值。方法健康成年杂种犬18只,随机平均分为3组,气管内留置不同类型支架。①组：留置全覆膜支架（全长6cm覆膜）;②组：留置中段覆膜支架（全长6cm,上下两端各1cm不覆膜,覆膜长度4cm）;③组：留置不覆膜支架（全长6cm）。术后观察进食、呼吸情况,饲养24周后分别处死。观察大体气管标本和镜下改变,并行增殖细胞核抗原染色,定量分析增生细胞的阳性表达。结果①各组实验犬均未发生支架留置后的急性呼吸困难,有轻至中度咳,均可正常饮水、进食,发声无异常。部分犬活动减少。②支架不覆膜处,气管内壁组织增生较明显,气管腔狭窄程度大于支架覆膜处。③苏木素-伊红（HE）染色镜下均表现为炎性反应,低柱状上皮细胞鳞状化生、肉芽增生和纤维增生性改变。④全覆膜组与不覆膜组,半覆膜组的覆膜处与不覆膜处的黏膜增殖细胞阳性表达的差异有统计学意义（P〈0.05）。不覆膜处的黏膜增殖细胞比率较高。结论①气管支架覆膜的有无在留置的短期内对于进食、呼吸状况无明显影响。②气管支架留置后,覆膜段气管内膜组织增生水平要低于不覆膜段。③气管支架留置后,覆膜段的黏膜增殖细胞阳性表达小于不覆膜段。覆膜支架的生物相容性好。     

实验犬留置不同类型气管支架的基础研究

目的 探讨不同类型气管覆膜支架植入在实验动物中的应用价值.方法 健康成年杂种犬18只,随机平均分为3组,气管内留置不同类型支架,A组留置全覆膜支架(全长6 cm覆膜),B组留置中段覆膜支架(全长6 cm,上下两端各1 cm不覆膜,覆膜长度4 cm),C组留置裸支架(全长6 cm).术后观察动物进食、排痰、呼吸情况,饲养20周后分别处死.观察气管标本大体和HE镜下改变,并行增殖细胞核抗原(PCNA)染色,定量分析增生细胞的阳性表达.结果 各组实验犬均未发生支架留置后的急性呼吸困难,有轻至中度呛咳,经观察,排痰量并无明显差异.均可正常饮水、进食,发声无异常.部份犬活动减少.支架不覆膜处,气管内壁组织增生较明显,气管腔狭窄程度大于支架覆膜处.各组HE染色镜下均表现为炎性反应,低柱状上皮细胞鳞状化生、肉芽增生和纤维增生性改变.3组覆膜处与不覆膜处的黏膜增殖细胞阳性表达有显著的统计学差异(P＜0.05).不覆膜处的黏膜增殖细胞比率较高.结论 ①气管支架有无覆膜在留置的短期内对于进食、呼吸状况及痰液的排出无明显影响;②气管支架留置后,覆膜段气管内膜组织增生水平要小于不覆膜段;③气管支架留置后,覆膜段的黏膜增值细胞阳性表达小于不覆膜段.覆膜支架的生物相容性好.     

镍钛记忆合金幽门区内支架应用的实验研究

目的；在检测镍钛记忆合金内支架置入幽门区后的开通性、耐腐蚀性和区域组织的生物相容性。材料与方法：健康成犬６条，经腹置入镍钛记忆合金内支架于幽门区后，每卫２周行我胃肠透视观察内支架开通情况，分别在２周、１、２、３、４及６个月不同时间处死。采集标本行肉眼、光镜和电镜观察内支轲区组织细胞形态学改变。结果：１、钡餐透视见内支架全部开通、无塌陷和变形；２、光镜见早期粘组织充血、水肿及坏死，并见溃疡形成，１－     

镍钛记忆合金支架治疗气管狭窄的护理

近年来金属内支架技术的应用越来越普遍,在气管疾病领域的应用也取得了良好的效果。支架通常用于大气道,缓解各种原因造成的、不能手术治疗的气管造成狭窄。该方法保持呼吸道通畅,可立即解除呼吸道梗阻的症状,使频临死亡的患者生命得以挽救。气管狭窄的患者多数病情危重,因此护理工作对治疗成功与否起着相当重要的作用。我科自2001年11月至2003年6月共收治气管狭窄患者12例,现将护理体会总结如下。     

镍钛记忆合金支架治疗食管狭窄的实验研究

镍钛记忆合金支架治疗食管狭窄的实验研究１００８５３北京解放军总医院刘阳孙玉鹗代为民黄孝迈关键词食管肿瘤；食管狭窄；合金中国图书资料分类号Ｒ６５５．４各种原因所致的食管狭窄，如晚期食管癌所致狭窄，或是食管良性狭窄，当扩张失败而又不宜手术时，至今尚无理想...     

纤维支气管镜直视下置入镍钛记忆合金支架治疗气管手术后气管狭窄2例报告

气管肿瘤手术后围术期内出现气管狭窄，病情危重，处理比较棘手，我科在纤维支气管镜(以下简称纤支镜)直视下放置镍钛记忆合金支架治疗气管肿瘤手术后引起的气管狭窄2例，取得满意效果。     

镍钛记忆合金支架治疗支气管癌性闭塞1例

我们应用镍钛记忆合金支架治疗左主支气管内癌组织增殖引起管腔完全闭塞1例获得成功。报告如下。1　病例报告　　患者女,64岁。因患肺结核25年,咳血痰3个月于1997年4月15日入院。X片及CT检查示右上肺空洞型肺结核,左肺舌叶4cm×5cm块影,左下肺2cm×3.4cm块影,可见胸壁及肋骨破坏,纵隔淋巴结肿大。纤维支气管镜检查,见左主支气管内多个绿豆大肿物沿管壁浸润生长,管腔变小,左上叶管口粘膜肿胀。肿物活检病理报告为小细胞未分化癌。经化疗后出院。6月24日因呼吸困难2d再次入院。查体见患者端坐呼吸,大汗淋漓,体温36.6°C,脉搏114/min,呼吸30/…     

镍钛记忆合金支架治疗恶性中心气道狭窄21例临床分析

中心气道 (气管、隆突、左右主支气管及中间段支气管 )狭窄常引起严重的呼吸困难而危及生命[1] 。引起中心气道狭窄的主要病因是气管 -支气管原发与转移性恶性肿瘤[1] ,临床治疗非常困难。肿瘤致气管狭窄后 ,多数已无手术指征。化疗、放疗早期因肿瘤组织水肿可导致更为狭窄。内     

镍钛记忆合金网状支架治疗高危前列腺增生症13例报告

镍钛记忆合金网状支架治疗前列腺增生症 (ＢＰＨ) ,特别是对高危ＢＰＨ导致的急性尿潴留患者 ,疗效已被国内外同行所肯定[1] ,它具有在冷水中呈压缩状态 ,在温度 2 5℃以上自动恢复原有超弹性的特点 ,将合金丝编织成网状支架 ,植入尿道前列腺部 ,利用其超弹性特点 ,对增生的前列腺起支撑作用 ,又由于疗效维持时间短 ,故一般只用于高龄且全身情况较差 ,不能耐受手术者。我院行镍钛记忆合金网状支架共治疗前列腺增生 13例 ,疗效较好 ,现报告如下。1　临床资料1 1　一般资料　本组 13例均有明确的前列腺增生导致的急性尿潴留史 ,且伴有严重心肺…     

镍钛记忆合金气管支架治疗良恶性气管狭窄

目的 观察置入气管支架对良恶性气管狭窄的治疗效果及不良反应.方法 对25例气管良恶性肿瘤致气管狭窄置入气管支架患者进行回顾分析.结果 25例患者均一次性顺利经纤维支气管镜或气管插管,置入气管支架,解除气管狭窄引起的呼吸困难,术后患者气促症状明显改善.结论 气管支架对良恶性肿瘤引起的气管受压性狭窄,气管软化引起的气管狭窄,有良好的缓解症状,改善生活质量的作用.     

三种不同材质与不同构型静脉内支架的实验研究

目的 优选一种性能良好的静脉内支架,以推广至临床应用。方法 将3种静脉内支架置入犬体内,按分组时限（置入后2周,4周,8周,6个月,9个月）定期处死动物,处死前行血管造影,处死后取支架区血管行组织学检查（包括大体病理,光镜,扫描电镜）,观察支架的性能,开通情况及内皮化过程,计量资料用方差分析及q检验,计数资料用X2检验,半计量资料用Ridit分析,结果 不锈钢＊（国产Z形支架）,记忆合金（国产网状支架）镀金支架（国产Z形支架）的移位率分别为：１３．３％,１３．３％,７．７％,差异无显著性意义（Ｘ２＝０．２８１,Ｐ＝０．８６９）,展开不全率分别为：6．7％,46．7％,P＜0．05,与镀金支架比较,精确检验,P＝0．0054）;属支静脉开 通率分别为：72．7％,35．7％,55．6％,差异无显著性意义（X2＝3．421,P＝0．181）;血栓形成程度经Ridit分析,差异无显著性意义（R值95％可信限分别为0．304 9－0．533）,0．4306－0．7213,0．3708－0．6399,P＞0．05）,开通率分别为：93．3％,66．7％,84．6％,差异无显著性意义（X2＝3．649,P＝0．161）,支架置入静脉后4周时内皮化接近100％,镀金支架4周时可见镀层脱落,不锈钢丝及记忆合金丝9个月时仍未见表面腐蚀,结论 Z形不锈钢支架具有良好的抗凝血性,抗腐蚀性和生物相容性,是目前一种较理想的静脉用内支架。     

Evaluation of in-stent stenosis by magnetic resonance phase-velocity mapping in nickel-titanium stents

PURPOSE: To evaluate different grades of in-stent stenosis in a nickel-titanium stent with MRI. MATERIALS AND METHODS: Magnetic resonance phase velocity mapping (MR-PVM) was used to measure flow velocity through a 9-mm NiTi stent with three different degrees of stenosis in a phantom study. The tested stenotic geometries were 1) axisymmetric 75%, 2) axisymmetric 90%, and 3) asymmetric 50%. The MR-PVM data were subsequently compared with the velocities from computational fluid dynamic (CFD) simulations of identical conditions. RESULTS: Good quantitative agreement in velocity distribution for the 50% and 75% stenoses was observed. The agreement was poor for the 90% stenosis, most likely due to turbulence and the high-velocity gradients found in the small luminal area relative to the pixel resolution in our imaging settings. CONCLUSION: The accuracy of the MRI velocities inside the stented area renders MRI a modality that may be used to assess moderate to severe in-stent restenosis (ISR) in medium-sized vascular stents in peripheral vessels, such as the iliac, carotid, and femoral arteries. Advances in MR instrumentation may provide sufficient resolution to obtain adequate velocity information from smaller vessels, such as the coronary arteries, and allow MRI to substitute for invasive and expensive catheterization procedures currently in clinical use.     

胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗多发性肋骨骨折的临床研究

目的研究胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗多发性肋骨骨折(fracture of multiple ribs,FMR)的临床效果。方法 2013年1月—2017年6月河南省人民医院收治的FMR患者136例,其中男性88例,女性48例;年龄24~79岁,平均43.38岁。致伤因素:道路交通伤82例,高处坠落伤34例,砸伤20例。依据随机数字表法分为实验组(n=68)与对照组(n=68),实验组行胸腔镜下形状记忆肋骨环抱接骨板内固定治疗,对照组行开胸形状记忆肋骨环抱接骨板内固定治疗。观察两组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间,两组术前、术后7d白介素-6(IL-6)、白介素-8(IL-8)、C-反应蛋白(CRP)等炎性因子水平及肺活量,两组术前、术后1、3、5、7d疼痛评分,术后肺不张、肺炎发生情况。结果实验组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间分别为(189.76±19.53)m L、(58.97±5.92)min、(1.97±0.21)d、(2.33±0.24)d、(7.92±0.83)d,均低于对照组的(221.68±22.65)m L、(80.76±8.18)min、(3.69±0.38)d、(4.79±0.49)d、(13.19±1.33)d,P0.05。术后7d,实验组IL-6、IL-8、CRP分别为(90.85±9.11)ng/L、(112.86±11.21)ng/L、(4.74±0.48c)mg/L,均低于对照组的(136.57±13.62)ng/L、(228.42±22.49)ng/L、(6.64±0.68)mg/L,肺活量(2116.76±213.65)m L高于对照组(1789.95±181.75)m L(P0.05)。术后1、3、5、7d,实验组疼痛评分(疼痛强度数字评分法评价)均低于对照组(P0.05)。实验组术后肺不张、肺炎发生率(4.41%、7.35%)低于对照组(14.71%、20.59%),P0.05。结论胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗FMR创伤小,固定牢固,术后恢复快,值得临床应用。     

新型可降解防移位食管支架实验研究

【摘要】 目的 通过动物实验探讨新型可降解防移位食管支架的安全性、降解性能及设计策略。 方法 采用医用聚对二氧环己酮［poly（p-dioxanone）,PPDO］编制有“倒刺结”结构（实验组）和无“倒刺结”结构（对照组）的全覆膜分段式食管支架,分别植入巴马猪食管。术后每周1次胃镜检查,直至支架降解滑落。胃镜下观察支架移位、支架降解和食管黏膜增生情况。结果 实验组（n=9）、对照组（n=9）实验猪分别植入有“倒刺结”、无“倒刺结”食管支架各9枚,手术均获成功。未出现食管破裂出血、生命体征异常等并发症。术后1、2、4周两组支架移位程度评分差异有统计学意义（P＜0.05）。两组支架降解和黏膜增生反应相当,每周评分差异均无统计学意义（P＞0.05）。结论 新型可降解防移位食管支架植入安全,未发生严重并发症。早期（1～4周内）防移位效果显著,不影响支架降解,不增加食管黏膜增生,有一定的临床应用前景。     

Experimental study of the intraurethral placement of expandable metallic stents

Various types of Gianturco expandable metallic stents were implanted into the urethra of four dogs in order to evaluate the suitable expandability of the stents in urethra and also to determine the effect of the stents on the urethral wall. The stent of 1.5 cm in length and constructed of 0.010 inch round stainless steel wire with twelve zigzag bends showed the suitable expandability on the canine urethra compared to the other stents. The urethra remained patent and the inflammatory changes on the urethral wall were moderately noted. No hematuria or calcifications around the stents were noted in any dogs. The experimental data showed a potential clinical application.     

Metallic stents for treatment of benign biliary obstruction: a long-term study comparing different stents

PURPOSE: To investigate the role of metallic stents in the treatment of benign biliary strictures and analyze the differences in primary patency associated with the various types of stents deployed. MATERIALS AND METHODS: Between 1990 and 1997, 21 patients with benign obstructive jaundice were treated with transhepatic placement of metallic stents (11 Wallstents in 10 patients, nine Palmaz stents in seven patients, and four tantalum Strecker stents in four patients). Nineteen patients presented with strictures not responding to balloon angioplasty (postsurgical, n = 13; cholangitis, n = 5; unknown, n = 1). Estimates for cumulative patency, patency rate in the different stent groups, and survival were calculated with use of life-table analysis; the log-rank test was used to compare the different stent groups. The prognostic relevance of the selected variables-stent type, stent length, etiology, and location-were modeled with respect to patency according to Weibull distribution. RESULTS: The median follow-up time was 80.5 months (range, 2-116 months). The median survival time was 91 months. One patient was lost to follow-up after 3 months. Repeat intervention for recurrent obstructive jaundice was necessary in 11 patients (55%), and the median patency rate was 26 months (range, 2-96 months). The Palmaz stent was the most effective in achieving long-term patency, with a median patency duration of 36 months (range, 22-96 months), versus 9 months (range, 3-67 months) for the Wallstent and 6 months (range, 2-15 months) for the tantalum Strecker stent. The cumulative patency rate with the Palmaz stent was significantly higher than for the tantalum Strecker stent (log-rank test, P = .017) and nonsignificantly higher compared with the Wallstent (log-rank test, P = .07). Multivariate analysis showed that the type of stent (Wald test, P = .003) and stent length (Wald test, P < .0001) influenced the patency rate. CONCLUSIONS: These results suggest that the type of stent and the stent length have a significant influence on the patency rate. In this series, the Palmaz stent was most effective in achieving long-term patency in benign biliary strictures.     

应用记忆合金带膜支架治疗食管恶性狭窄的护理

我院自2001年3月-2004年11月对不能手术的67例食管恶性狭窄的患者行置入记忆合金带膜支架术。效果良好，现总结如下。     

可回收全覆膜金属支架治疗良性气管狭窄

气管狭窄段切除后端端吻合术是治疗良性气管狭窄的标准方法[1],然而随着气管内介入治疗技术不断发展,良性气管狭窄治疗的方法逐渐多样化、微创化,其中气管支架是介入治疗的主要方法之一.笔者旨在探讨可回收全覆膜金属支架在良性气管狭窄治疗中的临床效果、并发症的处理和取出时间,评价该方法在良性气管狭窄治疗中的应用价值.     

Small intestinal submucosa covered expandable Z stents for treatment of tracheal injury: an experimental pilot study in swine

PURPOSE: To evaluate efficacy of small intestinal submucosa (SIS) as a stent covering in healing experimentally created tracheal defects and to explore the trachea's reaction to placement of SIS-covered stents. MATERIAL AND METHODS: A tracheal defect with a diameter of approximately 10 mm was created in six swine with use of a blade or electrocauterization. A double-body, self-expandable SIS-covered Gianturco R?sch Z stent was placed into the trachea to cover the defect. The animals were observed, and were killed when they developed respiratory problems. Autopsy and histologic studies were performed. RESULTS: The SIS-covered stents were accurately placed without immediate complications related to placement. All animals developed respiratory problems on follow-up. One animal died 9 days after procedure because of pneumonia, the others five were killed at 12, 17, 18, 28, and 56 days because of stridor, wheezing, and cough. At autopsy and histology, the tracheal defects were found to be completely healed, with epithelial lining and regeneration of submucosal glands. Animals whose defects were created with a blade demonstrated cartilage remodeling between 9 and 18 days, and apparent deposition of new cartilage at 28 days after SIS placement. The defects made by electrocauterization showed only fibrous tissue with no cartilage regeneration. The tracheal lumen was narrowed by overgrowth of granulation tissue, particularly at the end wires of the stents. In three animals, polypoid masses caused 60%, 70%, and 80% tracheal obstruction, respectively. CONCLUSION: Placement of SIS-covered stents contributed to rapid and effective healing of large tracheal defects. Rigidity and oversizing of Gianturco R?sch Z stents led to secondary changes of the tracheal wall, causing significant airway obstructions. Smaller size and flexible stents should be selected for future work.