气管瘢痕狭窄动物模型的建立和病理学研究

目的建立犬气管瘢痕狭窄的动物实验模型,观察其气管瘢痕形成的病理学过程,探讨气管瘢痕的形成机制。方法 6支成年比格犬,行颈部气管切开+气管前壁黏膜刮除术,刮除3 cm长气管管腔前1/2黏膜,创面裸露。建立气管瘢痕狭窄的动物模型,术后1周、2周、1个月、2个月、4个月、6个月麻醉后观察瘢痕的形成过程,行常规病理及免疫组化和透视电镜观察研究瘢痕的病理学变化和特征。结果6支动物均成活到预期的时间,气管瘢痕形成并逐渐狭窄,动物模型成功建立。结论我们成功建立了犬气管瘢痕动物模型,并初步研究了瘢痕的病理学特点,为下一步深层次的瘢痕形成机制和治疗的研究奠定了基础。     

食管癌手术误伤气管膜部5例

由于食管中上段与气管膜部相邻,因此食管癌外侵常累及气管膜部,术中易致损伤。我院自1998-01以来共发生5例。本组5例均为男性,年龄57～69岁,病程3～6个月,平均4.6个月。肿瘤位于胸上段3例,长度分别为3cm、4cm、4.5cm;中段2例,长度为7cm、7.5cm。术前食管钡餐造影均见有管腔狭窄,管壁僵硬,粘膜破坏中断,并见软组织肿块影。采用左胸后外侧径路,食管胃颈部吻合3例,食管胃弓后上吻合2例。术中见肿瘤均与气管膜部紧密侵润粘连,正常间隙消失,钝性分离肿瘤时,气管膜部破裂,破口直径大小分别为0.6cm、0.8cm、1.0cm、1.2cm、1.3cm。术中给予缝合修补,…     

移植气管组织中TNF-α的蛋白表达与管腔狭窄相关性研究

目的探讨移植气管组织中TNF-α蛋白表达与管腔狭窄相关性。方法建立兔同种异体气管移植模型,测定移植气管的通畅度,免疫组化方法检测移植气管组织中TNF-α的蛋白表达。结果应用免疫抑制剂,移植物中TNF-α蛋白表达明显下降,管腔轻度狭窄。结论气管移值后TNF-α促进管腔狭窄。     

气管支气管支架置入治疗已插管气道狭窄25例临床分析

目的观察国产气管支架治疗已气管插管的重度气道良恶性狭窄的疗效。方法对因恶性肿瘤（17例）、气管结核（6例）及气管疤痕狭窄（2例）已气管插管的重度气管狭窄患者,在局麻及静脉基础麻醉下,拔除气管插管的同时置入国产镍钛记忆合金支架。结果 25例患者均一次性手术成功,呼吸困难等症状立即解除,顺利拔除气管插管。随访3-15个月,恶性肿瘤17例中有7例患者放置支架后未经任何治疗,生存期为2-6个月;10例患者放置后配合放射治疗及化学治疗,生存期明显延长,达6-15个月,中位生存期7个月。8例良性病变狭窄段远端阻塞性肺炎均未再发生,支气管腔保持通畅状态。结论采用气管支架治疗已气管插管的重度气道良恶性狭窄,效果良好,安全,简单,创伤小。     

豚鼠离体气管平滑肌舒缩性压力测量法

离体气管平滑肌舒缩性的检测是许多相关实验研究所必须具备的方法。传统的检测方法主要包括有气管片法、气管环法、气管螺旋条法和气管容积法等[1～ 3] ,这些方法都分别具有操作复杂 ,灵敏度较低 ,记录曲线粗略 ,破坏气管完整性等不足 ,为克服上述缺点 ,本实验室试用测压法检测完整离体气管平滑肌舒缩功能 ,获得比较满意的结果。1　材料与方法动物用豚鼠 ,♀♂不拘 ,体重 3 5 0～ 4 5 0ｇ。击其后脑至昏 ,立即剖开颈部 ,取出 2～ 3ｃｍ完整气管段 ,放入充氧克氏液中 ,剥去外附组织 ,克氏液冲净管腔。取两根直径为 2 5～ 3 5ｍｍ的塑料管分…     

气管袖式切除治疗气管癌1例

患者男，３６岁。进行性呼吸困难４个月，伴痰中带血２０d。纤支镜检查于隆突上５cm处有一２．５cm×２．５cm×１．５cm菜花样肿物，位于气管右后壁，占据气管腔２／３，质脆，易出血。活检病理诊断为腺癌。CT扫描距声门６．５cm气管腔内有一２．５cm×１．５cm肿块影，位于气管软骨环与膜部间，堵塞管腔２／３，受累气管右后壁增厚。以气管癌收入院。经术前准备后于２００１－１０－２３在静脉复合麻醉下手术。首先，经口腔插入气管插管至声门下５cm处，然后，经右后外侧切口自第四肋间入胸。结扎并切断奇静脉，探查肿瘤位于气管中部右后…     

游离腓骨(皮)瓣修复肢体长段骨缺损

目的探讨四肢大段骨缺损修复方法及疗效。方法自2002年6月至2009年6月对18例四肢长骨骨缺损(其中6例合并皮肤缺损),皮肤缺损8cm×3cm~20cm×7cm,骨缺损6~14cm;采用吻合血管的腓骨(皮)瓣移植加自体植骨治疗,其中切取骨皮瓣面积9cm×4cm~23cm×8cm,切取腓骨瓣长8~18cm。结果 6例骨皮瓣及12例骨瓣全部成活;随访12~36个月,平均18个月,骨生长良好,骨折全部愈合,获得满意外形及功能,移植骨12个月后增粗与受区骨基本相似。结论游离腓骨(皮)瓣是修复四肢长段骨缺损伴皮肤缺损的较好方法。     

气管套管外管断裂致气管异物一例

患者男,38岁。因车祸外伤后致严重喉狭窄,气管切开后不能拔管,长期戴套管已6年。4个月前因内管管腔破裂不能放入外管内,因经济困难未更换新套管,仅戴外管。某日晨起床下地干活,突感呼吸不畅,阵发性刺激性咳嗽,低头时,突感气管套管底板离开了气管切开造口处,下方无套管,随即来我     

经皮扩张气管造口术与气管切开术在ICU应用比较

气管切开术是临床上常选择的人工气道方式,由于其管腔大,路径短,减少了气道阻力和死腔通气,尤其是应用于危重患者,不但保持呼吸道通畅,改善呼吸状况,而且可以减少呼吸机相关性肺炎[1]。经皮穿刺气管造口术(PDT)具有操作简单、快捷、创伤小的优点,与外科气管切开术相比,优势明显。现将两种术式术中情况、术后并发症及切口预后进行比较,报告如下。1资料与方法1.1一般资料2006年7月~2007年7月患者22例,男14例,女8例,年龄36~82岁,平均56岁。重症肺炎12例,成人呼吸窘迫综合征4例,双侧喉返神经损伤2例,脑血管意外昏迷4例。随机分为PDT组11例,外科气管切开术(切开)组11例。两组年龄、性别、病种无明显差异性,具有可比性。1.2方法患者取头后仰过伸位,常规消毒。标记第2~3气管软骨环,2%利多卡因5 m l逐层浸润麻醉,麻醉针突破气管行气管表面麻醉并标记进针角度(45~°65°为宜)及深度。标记处,横向切开1~1.5cm皮肤至脂肪层。套管针带2~3 m l生理盐水于切口中点参照麻醉进针角度、深度进针,回抽见空气时退针留置套管鞘。(当有气管插管时应先将气管导管退至声门以上,以免影响进针)延鞘内进入金属导丝...     

超声引导下血管腔内成形术治疗内瘘血栓性闭塞效果研究

目的 分析血管腔内成形术(Percutaneous transluminal angioplast,PTA)治疗内瘘血栓性闭塞的疗效。方法 回顾性分析我院医联体单位2020年6月～2021年3月收治的因内瘘血栓性闭塞患者14例,包括自体动静脉内瘘9例和人工血管5例。行超声引导下经PTA治疗,观察术后血流通畅性及内瘘通畅持续性。结果 14例血透患者手术成功率为100.0%,术后5天内均可正常透析,自体动静脉内瘘患者3个月和6个月通畅率分别为100.0%和88.9%,人工血管3个月和6个月通畅率分别为60.0%和40.0%。结论 PTA能及时有效治疗内瘘血栓性闭塞,对于自体动静脉内瘘疗效更显著,可延长瘘管使用时间,保护有限的血管资源。     

Omeprazole in the treatment of peptic ulcers resistant to H2-receptor antagonist

Thirty patients with peptic ulcers resistant to at least 8 weeks of continuous therapy with full-dose H2-receptor antagonists alone or followed by other anti-ulcer drugs, were treated with the gastric proton pump inhibitor omeprazole (40 mg), administered orally once daily for up to 8 weeks. The study design was non-comparative and open; healing was verified by endoscopy. After only 2 weeks of treatment, 21 out of 23 (91%) duodenal ulcer patients were healed, as well as 2 out of 2 patients with both duodenal and gastric ulcer and 1 out of 3 patients with prepyloric ulcer. After 4 weeks, all duodenal ulcers, 1 out of 2 gastric ulcers and 2 out of 3 pre-pyloric ulcers were healed. A further month of therapy healed the gastric ulcer to give an overall healing rate of 97% and leaving only one patient (pre-pyloric ulcer) unhealed at the end of the study. Of 19 patients suffering ulcer symptoms at entry, only two patients reported any symptoms at 2 weeks and one of these (who remained unhealed) continued to have symptoms throughout the study. One patient reported mild asthenia; otherwise, no clinical or biochemical side-effects were recorded. It is concluded that omeprazole is highly effective in healing refractory peptic ulcers.     

气管狭窄的外科诊治探讨

目的总结气管狭窄的治疗经验,提高治疗效果。方法回顾性分析自2005、2-2013、2我院收治18例气管狭窄患者的临床资料,手术治疗13例,11例为气管袖状切除（气管节段性切除）,2例在纤维喉镜下肿瘤切除,支架植入5例。结果恶性肿瘤4例,2例为鳞癌,2例为腺样囊性癌,良性狭窄14例,乳头状瘤5例,外伤后气管狭窄3例（1例气管切开术后,2例外伤后瘢痕狭窄）,结核性气管狭窄3例,气管平滑肌瘤1例,肉芽组织增生2例。结论手术切除是气管狭窄的有效治疗方法,对不能耐受常规手术的患者,气管腔内支架植入是辅助治疗手段之一。     

Pharmacological study on the pathological changes of the gastric mucosa in Helicobacter pylori-infected Mongolian gerbils]

Helicobacter pylori (H. pylori) infection has been recognized to be a causal factor of gastritis, ulcers and gastric cancer in man. Using Mongolian gerbils (M. gerbils), which are suitable for an H. pylori infection animal model, we examined 1) how H. pylori infection, indomethacin and their combination affects the healing of gastric ulcers and whether or not such factors provoke a relapse of healed acetic acid ulcers; and 2) whether or not eradication of the bacteria with drugs at specified times after infection prevents the development of mucosal changes, including gastric adenocarcinoma. 1) H. pylori infection significantly delayed ulcer healing 4 weeks following infection. Indomethacin treatment showed a tendency to delay ulcer healing. Ulcer healing in H. pylori-infected M. gerbils was significantly delayed by indomethacin. H. pylori infection resulted in a relapse of healed ulcers from 1 to 6 months after infection, with a gradual increase in size. Omeprazole markedly prevented the ulcer relapse caused by H. pylori infection. 2) Four or 8 months after H. pylori inoculation, eradication was performed by concurrent treatment with omeprazole + clarithromycin. Immediately after treatment ended in both the 5 and 9 month groups, it was verified that H. pylori were completely eradicated. Autopsy performed 18 months after H. pylori inoculation revealed gastric hyperplastic polyps with erosive lesions and ulcers that were grossly visible; and atrophic gastritis, intestinal metaplasia, carcinoids, and adenocarcinomas were histologically observed in the non-treated control group. In animals eradicated after 4 months and autopsied after 18 months, however, such mucosal changes were not observed. In contrast, intestinal metaplasia and mucosal atrophy was observed in animals eradicated after 8 months and autopsied after 18 months. It was concluded that 1) H. pylori infection delayed the healing of preexisting gastric ulcers and resulted in the relapse of healed ulcers, yet indomethacin had little or no effect on ulcer healing or relapse; and 2) early eradication of H. pylori infection with drug therapy can prevent severe gastric mucosal changes, to include adenocarcinomas, in M gerbils.     

镍钛记忆合金支架在气管狭窄中的应用

目的 :探讨镍钛记忆合金支架在治疗喉气管外伤所致的气管缺损或狭窄中的疗效。方法 :经颈正中皮肤切口或经支气管镜下放入镍钛记忆合金支架治疗气管狭窄及缺损 8例。随访 3个月～ 12个月。结果 :8例全部成功拔管 ,恢复正常呼吸 ,治愈率为 10 0 % ,术后X线片显示支架处气管正常大小 ,管腔光滑。结论 :镍钛记忆合金支架在治疗喉气管外伤所致的气管缺损或狭窄中可迅速解除呼吸困难 ,见效快 ,疗效稳定可靠 ,术后反应轻 ,无毒副作用 ,是治疗气管狭窄的理想方法。     

人工听骨植入术后听力再下降的原因及对策

目的探讨人工听骨植入术后听力再次下降的原因及处理对策。方法回顾性分析2003年5月～2012年2月5例人工听骨植入术后听力再次下降患者的临床资料。结果 2例行自体听骨植入术,3例行钛质人工听骨植入术。5例术后2个月平均气骨导差（A-BGap）为（19.80±8.56）dBHL,再下降后为（49.20±6.72）dBHL。听力再下降原因有人工听骨脱出、咽鼓管功能不良、鼓膜内陷、鼓室粘连、胆脂瘤复发、自体听骨吸收、人工听骨脱位。3例行鼓室探查术重新植入人工听骨,1例行开放式乳突切除＋鼓室成形术,二次手术后无面瘫、脑脊液漏、感应神经性耳聋等并发症,术后2个月平均气骨导差（A-BGap）为（19.73±8.74）dBHL,随访1～3年鼓膜愈合好,听力未下降。1例人工听骨完全排出后鼓膜自愈,患者放弃重新听骨植入。结论严格的手术适应证选择,术中彻底清除病变,保证人工听骨放置角度、长度及与镫骨连接的松紧度合适,使人工听骨与鼓膜良好接触,术后规范换药,是人工听骨植入术成功的重要因素。发现术后听力再下降应查明病因,尽早施行鼓室探查术。     

刘氏烫伤膏对深Ⅱ度烫伤新西兰兔创面治疗作用的研究

目的研究刘氏烫伤膏对深Ⅱ度烫伤新西兰兔创面治疗作用。方法将新西兰兔麻醉后,采用恒温水浴法复制深Ⅱ度烫伤模型;每只动物采用自身对照法,各有5 个烫伤部位,分别给予生理盐水、5% 磺胺嘧啶锌软膏、刘氏烫伤膏低、中、高剂量;采用透明硫酸纸法比较各组动物烫伤创面愈合率;比较5 个部位创面完全愈合时间;取创缘组织制作病理切片,苏木精-伊红染色,按照组织学标准定量评价,比较各组创面愈合情况。结果在给药后第4,7,10,14,21 和28 天,与阴性对照组比较,阳性对照组、刘氏烫伤膏各剂量组创面愈合率明显提高（P 〈0. 01）;创面完全愈合时间缩短（P 〈 0. 05）;第7 和21 天各组病理组织切片评分之间无显著性差别（P 〉0.05）,但第14 天各组组织病理切片表皮结构、胶原束和皮肤结构、表皮再生、粒细胞浸润评分有显著性差别（P 〈0. 05）,阴性对照组评分低于阳性对照组、刘氏烫伤膏各剂量组。结论刘氏烫伤膏可明显提高深Ⅱ度烫伤新西兰兔创面愈合率,缩短创面愈合时间,加速创面愈合。     

SELECTIVE DEVELOPMENT OF TOLERANCE TO β-ADRENOCEPTOR AGONISTS IN SKELETAL MUSCLE AS COMPARED WITH AIRWAY SMOOTH MUSCLE FROM THE GUINEA-PIG

1. Guinea-pig were fed with a diet containing terbutaline or placebo for 4--5 days. The trachea, soleus muscle and the extensor digitorum longus (EDL) from these animals were prepared for recording of isometric contractions in vitro. 2. After treatment with terbutaline in vivo, the response of the pilocarpine-contracted trachea to terbutaline and isoprenaline was slightly suppressed with no change in maximum relaxation. 3. After treatment with terbutaline in vivo the maximum depression of the incomplete tetanic contractions of the soleus muscle brought about by terbutaline or isoprenaline was diminished by about 70%. The response of the EDL was also attenuated after previous treatment with terbutaline in vivo. 4. These data indicate a selective development of tolerance to the effects of beta-adrenoceptor agonists in skeletal muscle as compared with tracheal smooth muscle. 5. The present results provide an experimental analogue to the clinical observation that patients being treated with beta-adrenoceptor agonists become tolerant to the tremorogenic rather than to the bronchodilating effect.     

Cimetidine: an advance in gastric ulcer treatment?

Sixty patients with endoscopically confirmed gastric ulceration took part in a single-blind trial of cimetidine 1 g daily compared with conventional treatment--namely, carbenoxolone in patients aged under 60 and Caved-(S) in those over 60. Twenty-nine patients received cimetidine: in 12 (41%) ulcer healing was complete after one month, in 26 (90%) healing was complete after two months, and all ulcers were healed after three months of treatment. In the under-60s, ulcers were healed in a greater proportion of patients given cimetidine than in those given carbenoxolone. The difference, however, was significant only at the 5% level, which owing to small numbers was of doubtful clinical validity. In the over-60s cimetidine and Caved-(S) were of similar efficacy. The 54 patients with healed ulcers are being followed up for two years; so far there have been 16 recurrences (30%). Further trials are needed, which should include maintenance treatment aimed at lowering the unacceptably high recurrence rate.     

覆膜血管内支架治疗StanfordB型胸主动脉夹层临床分析

目的探讨覆膜血管内支架治疗StanfordB型胸主动脉夹层的近期疗效,总结主要并发症的发生及防治。方法回顾性分析2005年1月至2009年8月间我科收治的76例急慢性StanfordB型胸主动脉夹层患者接受覆膜血管内支架治疗的效果。患者于术后即刻行数字减影血管造影（DSA）,并于术后1个月、半年及以后每年1次行胸腹主动脉增强CT扫描,随访患者的生存状态、内漏类型及夹层真假腔最大直径。结果63例患者获得随访,平均随访时间（14．3±10．9）个月。术中DSA造影发现I型内漏5例,术后1个月胸主动脉增强CT扫描发现I型内漏1例,术后8d闪大量内漏致胸主动脉破裂死亡1例,术后半年随访时自行封闭2例,3例少量内漏持续存在,但假腔直径未进一步扩大。术中封闭左锁骨下动脉开口16例,无脑干缺血发生,亦未见窃血综合征及左上肢缺血发生,1例封闭迷走右锁骨下动脉开口致急性右上肢缺血,术后6h急诊取栓并行腋-腋转流术治愈。术后支架段假腔内血栓完全形成7例,降主动脉夹层最大直径与术前比较[（56．3±11．7）mmVS（65．7±17．8）mm,P〈0．05]有明娃缩小。结论覆膜血管内支架治疗StanfordB型胸主动脉夹层安全、有效,近期随c方结果满意。内漏足该术式主要并发症,许可导致患者死亡,远期疗效有待进一步观察。     

OCT对无载体纳米药物洗脱支架抑制再狭窄和促进内皮化的动物观察研究

目的：评价新型无聚合物涂层雷帕霉素药物洗脱支架在抑制内膜增生、降低炎性反应等方面的安全性和有效性。方法随机选择猪冠状动脉前降支、右冠状动脉或回旋支置入金属裸支架、聚合物载体雷帕霉素洗脱支架（Partner支架）和无聚合物载体雷帕霉素洗脱支架。置入后1个月和3个月行冠脉造影,光学相干断层成像和定量冠脉狭窄分析,测量新生内膜面积、面积狭窄百分比、新生内膜覆盖率等,而后处死动物,进行组织形态学检查和病理积分分析。结果置入后1个月光学相干断层成像、定量冠脉狭窄分析以及组织形态学分析提示,相比金属裸支架、Partner药物洗脱支架和无聚合物载体雷帕霉素洗脱支架明显减少新生内膜面积及管腔丢失。术后3个月,相比金属裸支架和Partner药物洗脱支架,无聚合物载体雷帕霉素洗脱支架明显减少新生内膜面积、管腔丢失。随访期间,BMS组和PFSES组炎症反应及损伤积分之间差异无显著性,但术后3个月 PSES组的炎症积分显著升高。结论无聚合物载体雷帕霉素洗脱支架在小型猪模型中,炎性反应程度更轻,无支架内血栓形成,可以有效抑制新生内膜增殖,表现出良好的组织相容性。