套管法小鼠颈部异位心脏移植模型的建立

目的 探讨提高套管法建立小鼠颈部异位心脏移植模型成功率的经验.方法 采用套管法连接供心血管与受体颈部血管进行模型的建立,观察手术成功率、手术时间及移植心脏存活时间.结果 手术成功率92.5%,手术时间(105.6±8.9)min,移植心脏3 d存活率87.5%、7 d存活率72.5%、30 d存活率5%.结论 血管外翻的套管法可以提高小鼠颈部异位心脏移植模型的成功率,值得大力推广.     

肝肠联合移植的实验研究

目的：建立一种新肝肠联合移植手术模型,探讨移植肝脏对移植小肠的保护作用。方法：Ｗｉｓｔａｒ 大鼠同种异体肝肠联合移植,先进行肝脏移植,再进行小肠移植,门静脉、肝下下腔静脉袖套式吻合,肠系膜上动脉与左肾动脉吻合,供体肠系膜上静脉袖套式与受体左肾静脉吻合,回肠下端在左下腹部造瘘,完成肝肠联合移植。　结果：手术成功率为６２－５ ％ （１５／２４） 。手术平均存活为１１－２ ｄ 。手术后组织学发现：移植肝脏和小肠发生排斥反应。结论：（１） 袖套式血管吻合技术在大鼠身上建立的肝肠联合移植模型是可行的。（２） 肝肠联合移植后移植的肝脏不能起到保护移植小肠的作用。     

DA→LEW大鼠肝脏急性排斥反应模型的技术改进与评价

目的:建立大鼠肝脏移植急性排斥反应模型并改进其手术技巧,对所建模型进行评价。方法:采用近交系雄性DA大鼠60只,Lewis大鼠120只,分为两组,其中A组30例:Lewis大鼠为供体(n=30),Lewis大鼠为受体;B组60例:DA大鼠为供体(n=60),Lewis大鼠为受体。采用改良“二袖套”法建立肝脏移植模型,观察手术成功率、平均存活时间、术后第1、3、5、7和10 d各时相点血清丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平以及移植肝脏的病理学变化。结果:手术成功率为93.3%(84/90);总耗时(90.0±15.0)min;无肝期时间(14.2±2.6)min;平均存活时间A组超过100d,B组(16.2±1.4)d;术后第5 d B组血清ALT和TBIL升高,与A组比较差异非常显著(P<0.01);B组移植肝脏病理检查有明显的排斥反应,而A组没有。结论:DA→LEW(Lewis)大鼠的品系组合是稳定的肝脏移植急性排斥反应模型;通过改进手术技巧提高了手术成功率,为进一步研究提供技术保障。     

疝修补克氏针在后尿道狭窄切除吻合术中的应用

目的：疝修补克氏针在后尿道吻合术的疗效。方法：总结我院近来2年来疝修补克氏针应用于后尿道吻合术23例患者的临床资料。结果：术后1个月拔出尿管,随访1年,成功率达100%,无再次狭窄。结论：疝修补克氏针应用于后尿道吻合术,可以缩短手术时间,提高手术的成功率。     

人工颈椎间盘置换术围术期护理

目的：提高人工颈椎间盘置换手术的成功率。方法：加强围手术期护理,强化心理护理、疾病护理、康复锻炼、出院指导,避免了并发症的发生,提高了手术的成功率。结果：术后随访6～24个月,无术后感染,假体脱落及异位骨化等并发症,患者吞咽功能基本正常,颈椎稳定性良好。结论：做好手术全过程的护理,尤其是加强术后护理,对巩固手术疗效和促进患者康复至关重要。     

阴腹联合彩色多普勒诊断异位妊娠的临床价值

目的：探讨阴腹联合彩色多普勒超声对异位妊娠诊断的临床价值。方法：对529例临床疑似异位妊娠患者行阴腹联合彩色多普勒超声检查,对其声像图进行分析并与手术病理结果进行对照,作回顾性分析。结果：529例中术前超声检出486例,诊断符合率达91.87%,误诊43例。结论：阴腹联合彩色多普勒的检查方法,提高了早期异位妊娠的确诊率。     

保守治疗异位妊娠94例临床分析

目的：探讨MTX联合米非司酮治疗非破裂型输卵管妊娠的疗效。方法：观察组采用单次肌肉注射MTX 50 mg/m2,肌注MTX当晚及第二晚各空腹顿腹米非司酮片150 mg,共300 mg,不使用甲酰四氢叶酸钙。对照组单次肌肉注射MTX 50 mg/m2。治疗后第4 d,7 d各测血β-HCG一次,如连续下降或下降≥15%,继续观察。结果：观察组46例病例中41例治愈,成功率89.10%;对照组48例病例中42例治愈,成功率87.50%。结论：MTX联合米非司酮和单用MTX治疗异位妊娠治愈率无显著差异,但显著提高了用药后第1周血β-HCG下降速度,从而减少了异位妊娠破裂的机率,减少了手术损伤。两者联合副作用小,使用安全。     

腹腔镜治疗异位妊娠58例临床分析

目的：总结腹腔镜手术治疗异位妊娠的临床疗效和体会。方法：对本院2005-01～2008-12腹腔镜手术治疗异位妊娠患者58例的临床资料进行回顾性分析。结果：手术成功率100%。平均手术时间（20～40）min。结论：腹腔镜手术治疗异位妊娠具有安全、快速、痛苦小、疗效好的特点。     

猴异体心肺移植的研讨

在1986年犬异体心肺联合移植动物实验的基础上,1987年作者等又对猴异体心肺移植实验进行了研讨。猴与人同属灵长类动物,更有利于技术经验的临床过渡。 方法 本组共施行猴异体心肺移植手术12次。供猴体重5.5～8.5kg,平均7.2kg。受猴体重6.3～9.0kg,平均7.9kg。受者手术采取分别切除心肺的方法,以免损伤膈神经、迷走     

两种保守方法治疗异位妊娠120例疗效比较

目的：探讨异位妊娠保守治疗的临床效果。方法：选取120例异位妊娠病例进行不同方法的治疗,分成A组采用氨甲蝶呤,0.4 mg/（kg.d）,肌注,5 d;B组采用氨甲蝶呤,0.4 mg/（kg.d）,肌注,5 d,联合米非司酮25 mg,q 12 h,连服3 d。结果：A组成功率为75%,B组成功率为90%,在血β-HCG的转阴时间上无明显差异,但是在盆腔包块的消失时间上,A组、B组差异有显著性（P〈0.01）。结论：氨甲蝶呤联合米非司酮联合治疗异位妊娠,疗效确切,尤其在盆腔包块的消失时间方面效果显著。     

雷公藤联合小剂量环胞素A对移植心存活的影响

观察中药雷公藤联合小剂量环孢素Ａ对移植心存活期的作用。方法复制大鼠同种异位心脏移植模型,术后动物分别给雷公藤４ｍｇ／ｋｇ,然后加小剂量ＣｓＡ２．５ｍｇ／ｋｇ或加全量ＣｓＡ５ｍｇ／ｋｇ,观察各组移植心存活时间。     

Posttransplantation lymphoproliferative disorder: manifestations in pediatric thoracic organ recipients

PURPOSE: To describe and correlate the clinical and imaging features of posttransplantation lymphoproliferative disorder (PTLD) in young thoracic organ transplant recipients. MATERIALS AND METHODS: The authors retrospectively reviewed the medical and imaging records of 31 PTLD episodes in 27 patients with PTLD out of 183 young patients who survived for at least 1 month after thoracic organ transplantation: 18 (14%) heart transplant recipients and nine (16%) lung or heart-lung transplant recipients. Four patients had two separate PTLD episodes. The distribution, timing, and imaging features of the disease were analyzed. RESULTS: Seventeen (55%) of 31 episodes involved intrathoracic PTLD manifesting as multiple pulmonary nodules (n = 10), a solitary nodule (n = 3), alveolar consolidation (n = 3), and/or mediastinal adenopathy (n = 8). Extrathoracic PTLD occurred in 21 (68%) of 31 episodes and involved the abdomen (n = 15), head and neck (n = 11), and/or central nervous system (n = 3). The imaging findings of these episodes included bowel wall thickening, lymphadenopathy, and focal masses. Intrathoracic PTLD occurred more commonly in lung transplant recipients (89%) than in heart transplant recipients (44%); no cases of lymphoma involved the thorax. The frequency of extrathoracic manifestations was higher in heart transplant recipients (83%) than in lung transplant recipients (33%). In lung transplant recipients, the prevalence of early-onset PTLD was significantly greater than that in heart transplant recipients (P <.05). Intrathoracic PTLD tended to manifest early. CONCLUSION: PTLD in young thoracic transplant recipients involves the lungs and extrathoracic organs, tends to have an early onset, and manifests predominantly in the thorax in lung transplant and heart-lung transplant recipients, as opposed to heart transplant recipients.     

输液患儿的心理反应及适时护理干预

目的：探讨儿童静脉输液时的心理反应及其相应护理干预。方法：观察248例儿童在行静脉输液时的心理情况,根据不同的心理反应类型进行相应的护理干预。结果：全部儿童在行静脉输液时均出现不同的心理反应,在合理的护理干预下均能配合治疗,临床效果满意。结论：相应的护理干预能影响儿童静脉输液的心理反应,并可提高患儿对输液的依从性。     

B超引导下经皮肾穿刺活检围手术期的护理

目的：探讨B超引导下经皮肾穿刺活检术前、术中、术后的护理措施。方法：对30例狼疮性肾炎患者行B超下肾穿刺活检，在术前、术中及术后各期进行相应的护理。结果：术后极少部分出现并发症，经相应的对症治疗、护理后，均痊愈。结论：B超引导下的经皮肾穿刺活检术是一种安全准确的诊断技术，但细致周到的护理工作也是穿刺成功的重要保证。     

大鼠颈部异位心脏移植模型的建立与超声心动图观察

目的:探讨高频超声心动图观察大鼠颈部异位心脏移植模型的可行性及观察方法。方法:23例大鼠建立颈部异位心脏移植模型,其中同系移植6例,同种移植17例。术前对原位心脏行超声心动图观察,常规记录原位心左室长轴切面、乳头肌水平左室短轴切面、心底短轴切面及心尖四腔切面,测量舒张末期、收缩末期左室内径、舒张末期左室壁厚度、左室射血分数。术后立即对移植心脏行超声心动图观察,并显示上述切面,测量相应超声指标,所测指标与术前原位心比较。结果:23只实验鼠原位心可显示乳头肌水平短轴、心底短轴、左室长轴和心尖四腔切面各为19例、11例、10例和9例;异位移植心与原位心比较,移植心左室短轴内径明显减小;左室射血分数明显减低。结论:大鼠颈部异位心脏移植模型与原位心和腹腔异位移植心脏相比较乳头肌水平左室短轴切面是评价移植心脏形态、大小与心肌功能改变较为理想的切面。     

Heart-lung transplantation

Since the successful clinical reintroduction of heart and lung transplantation in 1981, more than 350 of these procedures have been performed worldwide. Although survival following this operation is less than that reported for heart transplantation, the results are improving. It is clear that the increased technical difficulty of the procedure combined with the exquisite susceptibility of the transplanted lung to postoperative injury from infection, rejection or other causes account for these differences. In this report we provide an overview of the experience in heart-lung transplantation and discuss recent advances. The late complication of chronic obliterative bronchiolitis, which may progress inexorably, has cast a shadow over the potential long-term success of this therapeutic procedure. Current research efforts are directed toward the cause, diagnosis, and treatment of this complication.     

Ventricular function during the acute rejection of heterotopic transplanted heart: Gated blood-pool studies

Twenty patients who had undergone a heterotopic heart transplant were studied prospectively to determine the relationship between rejection and ventricular dysfunction assessed from gated blood-pool studies. A fully automated method for detecting ventricular edges was implemented; its success rate for the grafted left and right ventricles was 94% and 77%, respectively. The parameters, peak ejection and filling rates, were calculated pixel per pixel using a two-harmonic Fourier algorithm and then averaged over the ventricular region of interest. Peak filling and ejection rates were closely related with the severity of the rejection, while the left ventricular ejection fraction was not. Peak filling rates of both ventricles were the indices closely related to the presence of moderate rejection. Despite the low number of patients, these data suggested that gated blood-pool-derived indices of ventricular function are associated with ventricular dysfunction resulting from myocarditis rejection. Radionuclide ventriculography provides parametric data which are accurate and reliable for the diagnosis of rejection.     

双源CT在冠状动脉造影技术方法的探讨

目的：探讨双源CT（DSCT）对冠状动脉造影具有再次重新定义的价值。方法：对520例患者进行常规冠脉造影检查,分析双源CT冠状动脉造影的技术方法,步骤及特殊的射线剂量调控技术（适应ECG门控剂量调控技术）及其功能。结果：520例患者中心率小于100次／min的患者共有390例,占75％,其平均心率为75±5．6次／min（60—100次／min）。心率高于100的患者有130例,占25％,其平均心率为（110．6＋10．8）次／min（101～130次／min）。冠状动脉重建的最佳时相均为心脏收缩期。结论：双源CT比传统CT少50％的放射剂量,在不需要控制心率的情况下完成心脏成像,提供高质量的冠状动脉和心脏图像,提高诊断冠状动脉病变的准确性。     

MSCT在盆腔和下肢血管联合成像中的方法研究

目的:探讨MSCT双筒变速注射法在盆腔和下肢血管联合成像中的应用价值。方法:63例患者随机分成A、B、C3组,A、B组常规应用高压注射器等速一次注射对比剂;C组应用双简变速连续注射对比剂。由2位高年资医师单独作出血管评价,共分4级并分别计分。另外,分别选取左右髂总动、静脉近端和下肢动、静脉远端相对固定的平面测量各组于扫描起始及结束时的CT值,进行数据统计并采用配对样本t检验分析,检验水准α=0.05,观察各组间CT值差别及意义。结果:血管显示总优、良率达92.06%(58/63)。以C组评价计分最高,B组最低。CT值测量以C组最高,B组最低,A组近端与C组无明显差别,远端较低,与C组差异有统计学意义。结论:MSCT双筒变速注射法在盆腔和下肢血管操作简便、实用,具有重要的应用价值。     

Ventricular function during the acute rejection of heterotopic transplanted heart: gated blood-pool studies.

Twenty patients who had undergone a heterotopic heart transplant were studied prospectively to determine the relationship between rejection and ventricular dysfunction assessed from gated blood-pool studies. A fully automated method for detecting ventricular edges was implemented; its success rate for the grafted left and right ventricles was 94% and 77%, respectively. The parameters, peak ejection and filling rates, were calculated pixel per pixel using a two-harmonic Fourier algorithm and then averaged over the ventricular region of interest. Peak filling and ejection rates were closely related with the severity of the rejection, while the left ventricular ejection fraction was not. Peak filling rates of both ventricles were the indices closely related to the presence of moderate rejection. Despite the low number of patients, these data suggested that gated blood-pool-derived indices of ventricular function are associated with ventricular dysfunction resulting from myocarditis rejection. Radionuclide ventriculography provides parametric data which are accurate and reliable for the diagnosis of rejection.