椎动脉发育不良致椎基底动脉供血不足的MRA影像及临床研究

目的：探讨椎动脉发育不良所致椎基底动脉供血不足的诊断和治疗,方法：1999年1月－2001年1月,42例拟诊为椎动脉型颈椎病患者接受椎动磁共振血管成像（MRA）检查,男30例,女12例,年龄32－70岁,平均53岁,在MRA上观测椎动脉成像走行并测量椎动脉内径。结果：本组42例中35例椎动脉发育正常,其正侧椎动脉内径平均为4．1mm,右侧平均3．8mm,7例先天性椎动脉发育不良,左侧椎动脉2例,右侧5例,发育不良侧椎动脉在MRA上显示为全程均匀性纤维,狭窄,内径1．1－1．7mm,平均1．5mm,为正常椎动脉的1／3－1／4,7例患者临床症状与转颈无明显相关性,药物非手术治疗可缓解症状。结论：先天性椎动脉发育不育可造成椎基底动脉供血不足的临床症状,目前尚无理想的药物和手术治疗方法。     

先天性椎动脉发育不良所致椎动脉型颈椎病

目的：探讨椎动脉发育不良所致椎动脉型颈椎病的诊断和治疗。方法：1999年1月～2000年8月，33例拟诊为椎动脉型颈椎病患者接受椎动脉磁共振血管造影（MRA）检查，男24例，女9例，年龄32～70岁，平均53岁，在MRA上观测椎动脉成像走行并测量椎动脉内径。结果；本组33例，28例椎动脉发育正常，其左侧椎动脉内径平均为4.1mm，右侧平均3.8mm。5例先天性椎动脉发育不良，左侧椎动脉1例，右侧4例。发育不良侧椎动脉在MRA上显示为全程均匀性纤细、狭窄，内径1.1～1.7mm，平均1.5mm，为正常椎动脉的1/3～1/4。5例患者临床症状与转颈无明显相关性，药物保守治疗可缓解症状。结论：先天性椎动脉发育不良可表现出椎动脉型颈椎病的临床症状，目前尚无理想的药物和手术治疗方法。     

颈椎骨折脱位合并椎动脉损伤

目的　探讨颈椎骨折脱位与椎动脉损伤的相关性。方法　 2 0例闭合性颈椎创伤患者 ,同时接受颈椎MRI和椎动脉磁共振血管成像 (MRA)检查。结果　 2 0例闭合性颈椎损伤中 ,5例无椎动脉血流成像 ,均为单侧 ,左侧 2例 ,右侧 3例。其中颈椎骨折 3例 ,单侧小关节脱位 1例 ,无放射影像的异常脊髓损伤 1例。 4例椎动脉损伤患者无任何症状 ,1例有轻度头昏、嗜睡。结论　颈椎骨折脱位可并发椎动脉损伤 ,由于缺乏特异性症状 ,前瞻性MRA检查是最重要的方法。     

闭合性椎动脉损伤的MRA诊断与病理变化的比较研究

目的：对闭合性椎动脉损伤的MRA影像与病理变化进行比较观察。方法：26只犬建立颈椎屈曲损伤的撞击伤模型．撞击后摄颈椎X线片，24～36h后行椎动脉二维时间飞逝效应磁共振血管成像（2DTOF MRA）检查．然后切取椎动脉进行病理学观察。对319例闭合性颈椎损伤患者，采用2D TOF MRA技术进行前瞻性检查。结果：26只犬中，14只在屈曲撞击暴力下发生小关节脱位，MRA发现7只犬一侧椎动脉损伤，2只犬一侧椎动脉成像不完整．MRA诊断可疑阳性。17只犬MRA椎动脉成像正常。病理检查显示MRA诊断为阳性的7只犬中，4只犬椎动脉内膜、中膜有撕裂，附壁血栓形成；3只犬椎动脉内膜撕裂伴血栓形成。MRA诊断为阴性的17只犬椎动脉内膜均正常。MRA诊断为可疑阳性的2只犬，1只椎动脉内膜完整无损伤，另1只椎动脉内膜撕裂．迟发性附壁血栓形成。临床319例颈椎创伤患者，52例伴发有椎动脉损伤，单侧椎动脉损伤51例，其中左侧22例．右侧29例；双侧椎动脉损伤1例。结论：2D TOF MRA是诊断闭合性椎动脉损伤的有效方法，但在损伤早期难以准确鉴别血管痉挛和小面积内膜损伤。     

颈椎闭合性创伤合并椎动脉损伤的机制及MRA诊断

目的探讨颈椎闭合性骨折脱位继发椎动脉损伤的机制及MRA诊断.方法本组95例颈椎闭合性创伤,男76例,女19例,年龄16～65岁,平均34岁.所有患者接受颈椎MRI和椎动脉MRA检查,当椎动脉预期位置完全无血流成像,MRI T2横断面上椎动脉内有高信号血栓影像时,即确诊为椎动脉阻塞.结果本组95例中,19例合并有椎动脉闭塞,均为单侧,左侧9例,右侧10例,其中颈椎骨折5例,双侧小关节突脱位6例,单侧小关节突脱位7例,无放射影像异常的脊髓损伤1例.18例椎动脉损伤患者无任何症状,1例有轻度头昏、嗜睡.结论椎动脉损伤易继发于有小关节突脱位的颈椎创伤,前瞻性MRA检查是首选的方法.     

测量MRA椎动脉及CT横突孔探讨椎动脉型颈椎病发病原理

目的测量MRA椎动脉及CT横突孔直径探讨椎动脉型颈椎病发病原理。方法测量对象分二组：①正常组50例,②椎动脉型颈椎病组26例。结果正常人MRA椎动脉左侧4．10±0．79 mm,右侧为3．20±0．83 mm。正常人CT横突孔正常值左侧：6．30±0．41mm,右侧：6．55±0．83 mm。椎动脉型颈椎病异常椎动脉直径1．70±0．81 mm。椎动脉型颈椎病CT横突孔直径：5．78±0．60 mm。结论椎动脉本身受压是椎动脉型颈椎病的主要原因。但是椎动脉无受压及横突孔无狭窄也不能完全排除椎动脉型颈椎病,可考虑某些特殊原因。     

症状性椎基底动脉狭窄经皮腔内支架成形的初步研究

目的探讨经皮腔内支架成形治疗椎基底动脉狭窄的临床疗效及适应证。方法2004年4月-2006年12月共收治22例患者：优势侧椎动脉狭窄4例；双侧椎动脉狭窄3例；一侧椎动脉狭窄、对侧椎动脉闭塞8例；单纯基底动脉狭窄5例；优势或“孤立”椎动脉狭窄合并基底动脉串联病变2例。治疗的24处病变：椎动脉开口8例，V4段椎动脉9例，基底动脉7例；Mori A型病变16例，B型病变8例。结果22例患者技术成功率95％，术前平均狭窄率为78．3％，术后残余狭窄率平均15％（P〈0．01）。除1例基底动脉支架成形致血管破裂出血死亡，余病例在围手术期内未发生严重并发症。17例患者随访1～24个月（平均13．5个月），Malek评分为1分者12例，2分者4例，3分者1例。结论症状性椎基动脉狭窄支架成形术疗效确切，但手术的难度和风险仍较大，临床就其适应证和长期疗效需要进一步积累经验。     

椎动态MRA在预椎病变中的应用

目的：探讨椎动脉核磁共振血管成像（Magnetic resonace angiographyMRA)在颈椎病变中的应用价值,方法：本组8例,男5例,女3例。年龄7－42岁,平均26岁。病变范围C1－C6,X线片及CT显示椎体均有破坏,其中4例侵犯－侧横突,横突孔被包裹在病灶组织内。术后病理证实颈椎结核4例,慢性炎症1例,嗜酸性肉芽肿2例,血管瘤1例。全部患者术前行椎动态MRA检查,观察双侧椎动脉成像及走行。结果：3例患侧椎动脉发生扭曲并偏移向中线,2例椎动脉局部受压,3例椎动脉平直行走无扭曲。无1例椎动脉阻塞、管壁侵蚀,假性动脉瘤形成。结论：结椎病变如肿瘤,结核,炎症等常造成椎动脉走行变异,前瞻性MRA检查是预防中椎动脉损伤的有效方法。     

椎动脉缺血型颈椎病的MRA改变及临床意义

目的用三维动态MRA无创成像技术探讨椎动脉缺血型颈椎病MRA表现及其临床意义。方法眩晕者共76例,均行MRA椎动脉检查。结果测量出椎动脉正常值,左侧为(4.1±0.79)mm,右侧为(3.2±0.83)mm。根据MRA表现将椎动脉缺血型颈椎病分为3型Ⅰ型(椎动脉受压型),Ⅱ型(椎动脉硬化型),Ⅲ型(椎动脉畸形型)。通过椎动脉MRA成像特点能够对受累椎动脉作出精确、定性诊断。对5例椎动脉Ⅰ型患者行椎动脉松解术后,MRA显示椎动脉的上述改变已改善或消失,疗效优良。结论MRA是椎动脉缺血型颈椎病的一重要筛检诊断工具,对治疗方法的选择及其预后判断具有重要价值。     

颈椎闭合性创伤合并椎动脉损伤的机制及MRA诊断

目的 探讨颈椎闭合性骨折脱位继发椎动脉损伤的机制及MRA诊断。方法 本组95例颈椎闭合性创伤，男76例，女19例，年龄16－65岁，平均34岁。所有患者接受MRI和椎动脉MRA检查，当椎动脉预期位置完全无血流成像，MRIT2横断面上椎动脉内有高信号血栓影像时，即确诊为椎动脉阻塞。结果 本组95例中，19例合并有椎动脉闭塞，均为单侧，左侧9例，右侧10例，其中颈椎骨折5例，双侧小关节突脱位6例，单侧小关节突脱位7例，无放射影像异常的脊髓损伤1例。18例椎动脉损伤患者无任何症状，1例有轻度头昏，嗜睡。结论 椎动脉损伤易继发于有小关节突脱位的颈椎创伤，前瞻性MRA检查是首选的方法。     

Haemangioblastoma with multiple dural arterial supply

Summary A case of primary haemangioblastoma with a marked blood supply from multiple meningeal branches of the internal and external carotid arteries is reported, and the clinical implication of detailed angiographic study of unusual feeders in this highly vascular tumour is discussed.     

MYCOTIC CERVICAL CAROTID ANEURYSM

Mycotic aneurysms of the extracranial carotid arteries are rare. with only 27 cases reported in the English literature.¹ The causative organism is most frequently Staphylococus but infections due to Streptococcus, Salmonella and Klebsiella have been reported.²Escherichia coli has been reported as the causative organism in three cases. Mycotic aneurysms usually present in the setting of generalized sepsis such as postoperative infection, septicaemia. dental sepsis, drug addiction or bacterial endocarditis. We report a patient who presented with a mycotic aneurysm of the internal carotid artery 2 months after undergoing a laparotoiny for perineal sepsis.     

Accessory left hepatic artery arising from common hepatic artery

The knowledge of anatomical variations in hepatic artery are of importance to surgeons and radiologists while performing complicated procedures like liver transplantation and transarterial chemo-embolization for hepatic tumors. The incidence of accessory left hepatic artery is less common than the right accessory hepatic artery. Here we report an anomalous accessory left hepatic artery arising from common hepatic artery in a 55 year old male cadaver.     

暂时性体外胫后动脉旁路术的解剖学研究

目的 为暂时性体外胫后动脉旁路术提供解剖学依据.方法 对5例成人尸体10侧下肢标本的胫后动脉、胫前动脉、腓动脉及其分支进行解剖学观测.结果 本组研究未发现胫后动脉缺如,全长(291±31)mum,显露部下端外径(2.8±0.5) mm.胫后动脉在小腿内侧发出穿支皮动脉存在率100％,平均发出(4±2)支,动脉外径(1.5±0.5) mm,发自中上1/3的穿支皮动脉长度最长(6.5±3.5) cm.结论 胫后动脉及小腿内侧穿支皮动脉在小腿走行恒定,变异率小,管径粗大,易于操作,供区影响小,是暂时性体外胫后动脉旁路手术的理想选择.     

Pulmonary artery diameter: means and normal limits—assessment by computed tomography angiography

Open in a separate window OBJECTIVESNormal pulmonary artery (PA) diameter remains blurred and the definitions of PA aneurysm are heterogenous. We aimed to assess PA diameters, identify a threshold for normal diameters, define PA aneurysms, possible predictors of PA size and evaluate the correlation with mid-ascending aortic diameters.METHODSBetween April 2018 and August 2019, 497 consecutive patients who underwent whole-body computed tomographic angiography were reviewed. Clinical and imaging data were collected from our institutional database. Precise three-dimensional centreline measurements were taken. Linear regression analysis was performed to detect parameters associated with PA diameter. A two-stage model was created to identify potential predictors and the resulting statistically significant interactions were tested. Data were grouped and PA, standard deviation, and upper normal limits were calculated.RESULTSAmong 497 patients with an average age of 51.4 (20.2) (74.6% males), the mean PA diameter measured 32.0 (4.6) mm [female: 31.2 (4.7) mm vs male: 32.2 (4.5) mm; P = 0.032]. The mean PA length, left PA and right PA diameters were similar between male and female patients. We found a significant correlation (r = 0.352; P < 0.001) between the PAs and mid-ascending aortic diameters. Body surface area (P = 0.032, β =  4.52 [0.40; 8.64] 95% CI) was the only significant influencing variable for PA diameter.CONCLUSIONSThe normal mean PA diameter in a reference cohort is 32.0 (4.6) mm. Body surface area is the only influencing variable of PA diameter. The normal diameters measured and corresponding upper limits of normal revealed that a PA aneurysm should not be considered below a threshold of 45 mm.     

锁骨下动脉、腋动脉、肱动脉血管广泛血栓形成1例

1病例资料患者,男,44岁。右上肢肿胀刺痛1个月加重伴手指麻木发凉5d,于2007年12月13日18：00急诊入院。患者自述于1个月前出现右侧手指指尖麻木,近5d右上肢麻木、胀痛明显加重,自测不到脉搏,右上肢皮肤苍白,皮温低,呈持续性,伴胸闷、气短、大汗。心电图：窦性心率（正常心电图）;右上肢血管超声：右侧锁骨下动脉下段、腋动脉、肱动脉血管闭塞（完全性血栓形成）;血压16／10kPa;血糖正常。以“左上肢动脉栓塞”收住入院。患者既往有小儿麻痹症病史,右下肢发育短小、无力,长期扶双拐行走;常伴有右上肢苍白,皮肤发凉,肱动脉、桡动脉、尺动脉脉搏测不到。     

Successful surgical management for aneurysms of single coronary artery with a fistulous connection to the right ventricle

While a coronary artery fistula with aneurysmal formation is rare, a fistula/aneurysm combination occurring in single coronary artery is even rarer. Here, we report the successful surgical correction of a right ventricular fistula with a large aneurysm of 30 mm and a daughter aneurysm within a case of single coronary artery.     

非体外循环双侧乳内动脉完全心肌血运重建

目的 评估非体外循环双侧乳内动脉完全心肌血运重建治疗的效果。方法 2000年10月至2004年8月，共行双侧乳内动脉“Y”形吻合冠状动脉旁路移植（冠脉搭桥）52例，年龄33～78岁，平均56岁。3支病变者42例（80．8％），左主干病变者10例（19．2％）。心功能分级Ⅱ级46例，Ⅲ级4例。脑CT检查示陈旧性脑梗者11例（21．2％），颈动脉病变者21例（40．4％）。制备双侧乳内动脉，将游离的右侧乳内动脉吻合于左侧乳内动脉成“Y”形。均在心脏不停跳下进行冠脉搭桥，左侧乳内动脉序贯吻合对角支、左前降支，右侧乳内动脉序贯吻合于中间支、回旋支（钝缘支、左室后支）、后降支。并应用Tranortie H1311流量计进行桥血管的流量测定。结果 全组52例共行冠脉搭桥171支，平均3．3支/人。全组病人无死亡。围术期心梗2例，应用IABP 1例，开胸止血1例。全组无脑部并发症，无胸骨纵隔感染。结论 非体外循环下双侧乳内动脉“Y”形冠状动脉搭桥是安全、有效的手术方式，可以实现全动脉化的完全心肌血运重建，手术近期效果满意，远期效果有待进一步的随访观察。     

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve

Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's ‘learning curve’. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. Methods: Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. Results: There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the ‘learning curve’. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. Conclusions: Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.