脱细胞牛颈静脉血管支架的内皮化研究

目的 探讨在脱细胞牛颈静脉血管支架上进行内皮细胞再种植的可行性.方法 将人骨髓间充质干细胞(BMDCs)诱导分化为内皮种子细胞后种植在脱细胞牛颈静脉血管支架上,分为动态培养和静态培养2组.培养7 d后,对标本进行病理和扫描电镜观察.结果 静态培养的血管支架表面形成连续的单细胞层.动态培养后血管支架表面的细胞仍有50%残留,沿流场方向排列.结论 人骨髓间充质干细胞诱导分化的内皮种子细胞在脱细胞牛颈静脉血管支架上可以黏附生长.     

去细胞牛颈静脉带瓣管道支架生物学与生物力学特性的初步研究

目的比较去细胞牛颈静脉带瓣管道支架与新鲜牛颈静脉组织的生物学和生物力学特性。方法取新鲜牛颈静脉48条,采用随机数字表法分为对照组和实验组,每组24条。对照组为新鲜牛颈静脉组织和实验组为去细胞牛颈静脉组织,采用脱氧胆酸钠+Triton-X-100方法去除瓣膜及血管壁细胞成分。检测两组瓣膜及血管壁的组织厚度、吸水率、保水率、断裂强度及组织伸长率。结果实验组瓣膜及血管壁中内皮细胞、成纤维细胞去除完全,无细胞核碎片;瓣膜及血管壁胶原纤维和弹力纤维呈波浪状排列、整齐,结构完整;瓣膜、血管壁的基因组脱氧核糖核酸含量分别较对照组下降97.58%和97.25%。实验组瓣膜及血管壁的厚度、吸水率、保水率较对照组均轻度增加,但差别无统计学意义(P>0.05)。两组瓣膜及血管壁的断裂强度及组织伸长率差别无统计学意义(P>0.05)。结论去细胞牛颈静脉带瓣管道支架的生物学和生物力学特性稳定,为种植受者细胞的组织工程右心带瓣管道研制提供了可靠的天然纤维支架材料。     

醇类改性牛颈静脉带瓣管道的蛋白吸附实验

目的观察丁二醇改性前后的牛颈静脉带瓣管道植入大白鼠体内后蛋白吸附的情况。方法取新鲜牛颈静脉24根,选择带有瓣膜的血管片置入0.625%的戊二醛液中固定1d,取出后12根置入100%2,3-丁二醇中(丁二醇组),12根置入0.3%戊二醛中(戊二醛组)60d。分别植入大白鼠皮下,3个月后取出。采用考马斯亮兰法测定组织总蛋白含量;采用聚丙烯酰胺凝胶电泳法和光密度法行吸附蛋白的定性和定量分析。结果丁二醇组改性后的管壁及瓣膜组织总蛋白含量均较戊二醛组低(P<0.05);丁二醇组血管壁有六条带、瓣膜有五条带光密度值均较戊二醛组低(P<0.05),但分别比戊二醛组多出一根条带(45.5ku和53.5ku)。结论牛颈静脉带瓣管道在机体内钙化与其蛋白吸附有关,2,3-丁二醇改性可能减轻生物组织材料的蛋白吸附,从而减轻钙化。     

生物材料-牛颈静脉带瓣管道化学改性的实验研究

目的探讨醇类改性牛颈静脉带瓣管道的抗钙化效果及可能机制。方法用戊二醛鞣制的牛颈静脉分别用乙醇和丁二醇保存60d,植入大白鼠背部皮下90d取出试片,管壁和瓣膜分别做光镜、电镜观察及钙含量测定。结果两组试片组织结构保存基本完好;两组管壁平均钙含量为:乙醇(172.79±61.38)μg/mg,丁二醇(180.67±29.17)μg/mg(P<0.05);瓣膜钙含量为:乙醇(2.13±0.85)μg/mg,丁二醇(1.73±1.20)μg/mg(P<0.05);每组内管壁钙含量比瓣膜均显蓍增高(P<0.01)。结论两种醇类均可做为牛颈静脉生物组织材料的一种的改性试剂;牛颈静脉材料的钙化过程与组织材料的致密度有关。     

异种牛颈静脉带瓣管道重建右室流出道研究

目的 观察去细胞牛颈静脉带瓣管道( BJVC)重建猪右心室流出道后的细胞生长特性、抗钙化性能及血流动力学性能.方法 应用经去细胞、鞣制、改性(B组,n=8)及未去细胞(A组,n=8)的BJVC分别进行猪肺动脉与右心室连接,行光镜及电镜观察宿主内皮细胞及肌成纤维细胞生长特点,原子火焰法检测组织钙含量,超声心动图检测 BJVC 血流动力学参数.结果 术前A组BJVC试片表面无内皮细胞,术后12个月内膜表面50％～60％的表面覆盖卵圆形内皮细胞,基质层未见宿主成纤维细胞迁入;术前B组去细胞后BJVC已基本无细胞成分,术后12个月内皮细胞覆盖率约80％ ～90％,宿主肌成纤维细胞已爬行迁移至基质层的1/3.术后A组近端及远端吻合口管壁、瓣膜组织钙含量显著大于B组(P＜0.05),B组上述各项指标均显著大于新鲜BJVC(P ＜0.05).术后当天A组及B组各项血流动力学指标比较差异无统计学意义(P＞0.05),B组术后当天及术后12月各项指标比较差异无统计学意义(P＞0.05);术后12月A组远端吻合口口径显著小于B组(P＜0.05),远端吻合口压差、跨瓣压差、牛颈静脉返流量显著大于B组(P＜0.05).结论 去细胞化后鞣制、改性的牛颈静脉是一种更好的重建右室流道材料,但远期效果需进一步研究.     

γ射线消毒对不同保存方法牛颈静脉管道机械性能的影响

目的探讨γ射线消毒对不同保存方法牛颈静脉管道机械性能的影响,寻求牛颈静脉管道合适的灭菌和保存方法。方法：将采集、制作好的牛颈静脉拉力条按不同保存方法分为6组：新鲜对照组(A组),冷冻干燥组(B组),溶剂干燥组(C组),深冻组(D组),PBS缓冲液保存组(E组),60％乙醇保存组(F组)。各组经25 kGyγ射线消毒(A组不进行γ射线消毒)后分别行单轴拉伸试验、细菌培养及组织形态学观察。结果上述5种方法保存的牛颈静脉管道经γ射线消毒后,其最大负荷与极限抗张强度分别为(25．23±15．95)N、(4．6±2．53)Mpa(B组),(35．28±14．66) N、(7．10±2．08)Mpa(C组),(25．44±7．97)N、(5．20±1．43)Mpa(D组),(31．55±12．32)N、(6．20±2．72)Mpa(E组),(32．02±18．44)N、(6．80±2．03)Mpa(F组)。与对照组[(23．43±11．21)N、(5．12±3．06)Mpa]相比,P＞0．05。断裂延伸率分别为(86．08±31．21)％(B组)、(137．99±38-80)％(C组)、(133．39±42．19)％(D组)、(153．23±55．00)％(E组)和(142．09±54．03)％(F组),与对照组(193.80±37．53)％相比,P＜0．05。细菌培养结果全部为阴性。组织切片显示B组和D组组织呈空腔空泡状改变。结论经25 kGyγ射线消毒后,上述五种保存方法处理牛颈静脉管道其最大负荷与极限抗张强度变化不明显,但其断裂延伸率均下降,尤以冷冻干燥保存组为甚。     

带瓣牛颈静脉作为右室肺动脉连接管道的研究

许多心脏疾病，如法洛四联症、肺动脉闭锁、右室双出口等以及主动脉病变行Ross手术者，均需重建右室肺动脉连接，常用的材料有自体心包、异种材料、同种异体主动脉带瓣管道、人工材料如Gore-tex片、人工合成的带瓣管道。这些材料均存在局限性，Gore-tex片一般不能重建瓣膜结构；自体心包构造带瓣的结构，效果不理想；由于右心系统压力低，血流速度慢，     

新型抗钙化牛颈静脉带瓣管道的实验研究

目的探索对戊二醛（glutaraldehyde,GA）固定的牛颈静脉改性的新抗钙化处理方法,以期研制出一种新型抗钙化牛颈静脉带瓣管道（BJVC）。方法取新鲜牛颈静脉,依次经戊二醛、Triton X-100和环氧氯丙烷（epoxychloropropane,EC）处理,制备出新型抗钙化牛颈静脉带瓣管道。分别比较新鲜组、单纯戊二醛处理组（GA组）和新型抗钙化组（EC＋Tr组）牛颈静脉管道的大体形态、组织学特点、热皱缩温度、拉伸强度和断裂伸长率。建立大鼠皮下包埋动物模型,以GA组为对照,通过大体观察、HE染色和原子吸收光谱仪测定钙含量,评价EC＋Tr组血管片包埋8周后的抗炎、抗钙化性能。结果 EC＋Tr组牛颈静脉管道的热皱缩温度、拉伸强度和断裂伸长率均较新鲜组显著提高（86.15±0.92℃vs.69.94±0.92℃,t=35.239,P=0.000;5.31±0.14mPa vs.3.15±0.95mPa,t=6.362,P=0.000;265.11%±27.80%vs.165.21%±25.06%,t=7.550,P=0.000）;以上指标EC＋Tr组亦明显高于GA组（86.15±0.92℃vs.82.73±1.28℃,t=6.137,P=0.000;5.31±0.14mPa vs.4.52±0.56mPa,t=3.871,P=0.002;265.11%±27.80%vs.237.85%±17.41%,t=2.351,P=0.034）。而动物皮下包埋结果显示：EC＋Tr组血管片结构致密,炎性细胞浸润少;EC＋Tr组的钙含量明显低于GA组（51.22±2.69μg/mg vs.73.24±3.82μg/mg,t=11.545,P=0.000）。结论通过Triton X-100、EC对戊二醛固定的牛颈静脉进行联合改性处理,可显著提高牛颈静脉管道的生物力学性能,并延缓其体内钙化进程,是一种有效的、抗钙化的牛颈静脉带瓣管道处理方法     

环氧交联去细胞牛颈静脉带瓣管道的血液相容性实验研究

目的评价环氧化合物（PC）交联去细胞牛颈静脉带瓣管道（BJVC）的血液相容性,探讨其在心血管外科和组织工程中的应用前景。方法选取本地健康杂种犬20只,采用随机数字表法分为实验组（n=10）和对照组（n=10）。实验组用PC交联的去细胞BJVC,对照组采用戊二醛（GA）交联的BJVC。运用兔血进行体外溶血实验计算溶血率,绘制时间-吸光度曲线;采用人全血测定D-二聚体和补体C3a des Arg水平评价其体外血液相容性。采用PC和GA制备的BJVC重建犬右心室-肺动脉连接,两组犬饲养10个月后,观察有无血栓形成评价其体内血液相容性。结果实验组溶血率（0.23%）低于对照组（0.35%）,符合医用生物材料的国家标准（〈5%）。实验组的凝血时间曲线较对照组平缓。实验组D-二聚体水平低于对照组,两组差异有统计学意义（0.10±0.01μg/ml vs.0.12±0.02μg/ml,t=3.277,P=0.004）,但均在正常范围内。实验组补体C3a des Arg水平低于对照组,两组差异有统计学意义（0.74±0.09μg/ml vs.1.02±0.19μg/ml,t=4.183,P=0.001）。犬右心室-肺动脉连接重建术后10个月每组各有8只生存,各有2只死于心室颤动。对照组3例有血栓形成,实验组无血栓形成。结论与GA交联相比,PC交联的BJVC体外、体内血液相容性均具优势,临床应用前景良好。     

戊二醛结合肝素处理牛颈静脉带瓣管道防钙化性能研究

牛颈静脉带瓣管道(BJVC)是近年用于复杂先天性心脏病右室流出道重建的新型生物带瓣管道[1]。我们应用戊二醛(GA)结合肝素方法对BJVC进行处理,采用大鼠皮下包埋方法,观察该方法的抗钙化性能。一、材料与方法1.BJVC试片制备:自动物屠宰场获取8条新鲜牛颈静脉,浸入生理盐水。剔除外周筋膜组织,将牛颈静脉纵向剪开分成两半,分A、B两组。两组均在其瓣窦处,剪取包含一个瓣叶及管壁试片,大小为1cm×1cm。A组浸入1%鱼精蛋白液内1h蒸馏水冲洗。放入0.625%GA液中,固定时间为120mim,温度25℃。蒸馏水冲洗。将试片浸入1%肝素盐水液中(24h,45℃)…     

原花青素处理去细胞牛颈静脉带瓣管道的生物学特性

目的 观察原花青素处理去细胞牛颈静脉带瓣管道的生物学特性.方法 分别比较去细胞处理、原花青素去细胞联合处理、戊二醛处理和新鲜未处理带瓣牛颈静脉管道管壁、瓣膜的厚度、大体形态、组织学特点、含水量、热皱缩温度及断裂强度,并进行可溶性蛋白含量的测定.结果 原花青素去细胞联合处理组牛颈静脉带瓣管道较未处理组的管壁、瓣膜厚度[管壁:(0.81±0.17) mm比(0.79 ±0.14) mm,瓣膜:(0.23±0.07) mm比(0.21 ±0.05) mm,P＞0.05]、组织含水量[管壁:(85.30 ±2.13)％比(88.10±2.93)％,瓣膜:(87.30±2.67)％比(91.40±3.41)％,P＞0.05]无明显变化;管壁、瓣膜断裂强度[管壁:(10.32±1.07)N比(6.83±1.03)N,瓣膜:(7.49±0.81)N比(3.21 ±0.57)N,P＜0.05]和热皱缩温度[管壁:(85.30±1.21)℃比(70.40 ±0.32)℃,瓣膜:(87.30±2.67)℃比(70.70±0.61)℃,P＜0.05]明显提高,与戊二醛处理组比较差异无统计学意义(P＞0.05)原花青素去细胞联合处理组可溶性蛋白的含量较未处理组明显减少[管壁:(0.041 ±0.011)％比(0.178 ±0.037)％;瓣膜:(0.096±0.017)％比(0.311 ±0.063)％;P ＜0.05].结论 原花青素去细胞联合处理牛颈静脉带瓣管道材料具有较好的生物学特性.     

Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer

BACKGROUND: Microvascular free flaps are becoming the reconstructive option of choice for many head and neck defects. Many previous studies have examined factors predicting free flap survival. No study has compared differences in free flap survival when anastomosed to the internal or external jugular systems. METHODS: Retrospective review of all free flaps performed at an academic medical center by a single head and neck microvascular surgeon during the period July 1995 to December 1999. Flaps were closely monitored postoperatively and taken back to the operating room urgently for arterial insufficiency or venous congestion. RESULTS: On hundred fifty-six free flaps were performed during this time period. Sixty-five free flaps were anastomosed to the external jugular (EJ) vein and 86 to the IJ system (62 to the proximal common facial vein, 17 end-side on the IJ, and 7 to other branches). Five had either two venous anastomoses or were anastomosed to other veins and were excluded from statistical analysis. Six (4%) vascular thromboses occurred; 5 were venous and 1 arterial. Success by group was 99% for IJ anastomosis (1 arterial thrombosis) and 92% for EJ anastomosis (5 venous thromboses, p =.03). Urgent anastomotic revision and reperfusion salvaged 5 of the 6 flaps (overall success 99%). CONCLUSIONS: Although the overall success rate (96% success with 99% success with salvage) is comparable to other large series, microvascular free flaps anastomosed to the external jugular vein failed at a significantly higher rate than those anastomosed to the IJ system. This suggests that the IJ system should be used as a recipient vessel when feasible.     

Central venous access via the external jugular vein in cardiovascular surgery

In 115 consecutive adult patients scheduled for cardiovascular surgery, 150 catheterizations of the innominate or superior caval veins via an external jugular vein were attempted. The Seldinger technique was employed. In 99 (96-100)% of the attempts a straight, J-modified straight or a J-wire could be passed into the central venous system. One hundred and forty-six (97 (93-99)% of the subsequent catheter insertions were successful. Thirty-five patients had bilateral catheter insertions. Both sides proved to be equally suitable. Six anesthetists participated in the study and the longest catheterization time was 16 min. All catheterization procedures were uncomplicated.     

Prediction of a small internal jugular vein by external jugular vein diameter

The relationship between internal jugular vein diameter as measured with an ultrasound imaging machine (SiteRite, Dymax) and external jugular vein diameter was studied in 50 anaesthetised patients undergoing elective cardiac surgery. There was an inverse correlation between external jugular vein diameter and internal jugular vein diameter ( r  = −0.47, p < 0.001). All patients with an external jugular vein diameter of 7 mm or greater had an internal jugular vein diameter of less than 15 mm. No patient with an external jugular vein diameter of less than 7 mm had an internal jugular vein diameter of less than 20 mm. No other patient dimension (height, weight, body mass index, neck circumference) predicted internal jugular vein size. These results suggest that a large external jugular vein (i.e. 7 mm or greater in external diameter) may be associated with a small internal jugular vein. A size 5.0-mm internal diameter tracheal tube may be used to provide a rapid assessment of external jugular vein diameter.     

包含颈外静脉的颈阔肌肌皮瓣修复口腔癌切除后缺损

目的探讨将颈外静脉包含在颈阔肌肌皮瓣内修复口腔癌切除后缺损的手术方法。方法先形成蒂在颌缘下包含颈外静脉的颈阔肌肌皮瓣，待口腔肿瘤切除后，将肌皮瓣经口底隧道引入口腔修复缺损。结果临床应用17例，肌皮瓣均无血运障碍，100％存活，其中有2例发生口面痿，经换药后痿口完全闭合。结论将颈外静脉包含在颈阔肌肌皮瓣内有助于肌皮瓣血循环的改善和存活率的提高。     

Percutaneous catheterization of the internal jugular vein in infants and children.

Two methods are described for percutaneous catheterization of the internal jugular vein in children. The technique can be used even in premature babies. No serious complications were observed from the catheterization in 100 cases.     

颈外静脉切开置入带涤纶套中央静脉导管在特殊患者中的临床应用

目的 探讨颈外静脉切开置入带涤纶套中央静脉导管在特殊患者中的临床应用效果及评估其安全性.方法 将42慢性肾脏病（chronic kidney disease,CDK）5期并欲行带涤纶套中央静脉导管置入术的患者设为A组,以颈外静脉切开方法置管;同期选取36例已行右颈内静脉置入术的患者设为B组,置管方法为经皮穿刺右颈内静脉经撕脱鞘置入带涤纶套中央静脉导.观察术中、术后并发症.记录透析前后血肌酐、尿素氮变化以及透析中血流量、回血静脉压指标,计算尿素清除指数（Kt/V）值并比较.A组42例患者行颈外静脉切开置管患者根据原发病：糖尿病肾脏疾病、Ⅱ型心肾综合征进展至终末期肾脏疾病（end stage renal disease,ESRD）、慢性肾小球肾炎、强直性脊柱炎肾损害进展至终末期肾脏疾病、急性肾损伤,比较导管留存时间、导管中位留存时间.结果 2组患者Kt/V值均达标,血流量、回血静脉压无统计学差异（P＞0.05）,且透析前后血肌酐、尿素氮水平变化存在统计学差异（P＜0.05）.2组手术后未出现出血、血流量不佳导管相关性血流感染等并发症.A组中心肾综合征及急性肾损伤（acute kidney injury,AKI）患者导管留存时间与糖尿病肾脏疾病相比存在统计学差异（P＜0.05）.结论 尽管带涤纶套中央静脉导管置入方法推荐首选经典撕脱鞘置管,该方法安全成功率高,术后并发症少,但是经颈外静脉切开置入带涤纶套中央静脉导管术式在特殊患者中的临床应用中手术安全,能够保证透析充分性,并发症少,临床值得推荐.     

Central venous access in children via the external jugular vein

Sixty-two children undergoing cardiac surgery were surveyed for the presence of external jugular veins. When present, these were used as a route for central venous catheterisation using a 'J' wire Seldinger technique. Only 54% of attempted insertions were successful but the results support greater efficacy in older children.     

一种改良中路法在颈内静脉穿刺术中的应用

目的:为常规颈内静脉穿刺困难的患者提供寻求一种更好的颈内静脉穿刺方法.方法:将预计常规颈内静脉穿刺困难的100名患者随机均分为两组,试验组采用改良中路法,常规颈内静脉穿刺组作为对照组.比较两组穿刺成功率、穿刺时间、并发症发生率.结果:试验组49例(98％)穿刺成功,对照组39例(78％)穿刺成功(P＜0.0l);试验组和对照组穿刺时间分别为(4.3±3.0)min、(8.5±5.1)min(P＜0.01);试验组1例(2％)误穿动脉,对照组7例(14％)误穿动脉(P＞0.05).结论:与传统穿刺法相比,改良中路法操作更简单快捷,穿刺成功率更高.