周围血管损作25例诊治分析

为了探讨周围血管损伤疾病的诊断治疗，本文对２５例 （１９７９－１９９２年）我院周围血管损伤病例的诊断、手术方法，术中及术后注意事项进行讨论分析，作者认为：周围血管损伤疾病治疗方面的首要问题是选择手术时机，其次是损伤的性质、程度、时间及有无复合性损伤这些是手术成败的决定因素。治疗应尽早实行血管重建术，术后早期抗凝治疗。     

血管移植材料与组织工程

血管重建在临床外科中有十分重要的地位 ,全球每年大约超过 6 0万人需要各种血管外科手术 ,大多数需要合适的血管移植物。血管移植材料 (Vasculargraft,VGF)一直是研究的热点 ,目前主要有生物血管、高分子合成血管、内皮细胞种植的人工血管、组织工程化血管 (tissue engineering blood vessel,TEBV) ,尤其是 TEBV,因更接近人体生物血管 ,有望解决移植血管小血管再狭窄的难题而倍受重视。　　生物血管　主要有同种及异种血管两大类。同种血管如自体大隐静脉 (ASV)、胸廓内动脉、颈静脉、头静脉等。其缺点是来源有限且很难用作各种血管…     

血管镜在血管外科中的应用研究

血管镜在血管外科中的应用研究第二军医大学附属长海医院血管外科景在平，曹贵松，叶必远，仲剑平，高瀚血管镜（ａｎｇｉｏｓｃｏｐｙ）作为一种先进的高技术设备，其诊断、治疗和科研价值已得到公认。作者在国内率先引进了血管镜的成套设备，现结合我们的初步经验和文献...     

血管内超声对血管内放射防治猪受损髂动脉狭窄形成的疗效观察

目的：通过血管内超声(IVUS)观察血管内放射(IR)对猪受损髂动脉形态学改变的影响，在体情况下探讨IR治疗对管腔重构的作用。方法：对中国小型猪髂动脉进行血管造影及IVUS检查后行球囊扩张损伤术。实验组通过置源管将高剂量铱—192(^192Ir)后装源对受损髂动脉施予总量为20Gy的IR治疗，而损伤对照组仅在受损髂动脉置入假源。动脉损伤后第28天时再次进行血管造影和IVUS检查。通过IVUS测量血管外弹力膜(EEM)横截面积、管腔横截面积检查、管腔最大径和最小径以及面积狭窄率和直径狭窄率。结果：IVUS检查发现，与损伤前相比，动脉损伤后28天时EEM与管腔横截面积以及管腔最小径均明显缩小（P〈0．05)，表明动脉受损后28天时发生明显负性重构(血管回缩)，导致了管腔明显狭窄；20GyIR后，管腔横截面积与管腔最小径均较损伤对照组明显增加(P〈0．05)，EEM横截面积也较对照组有所增加(但末达到统计学意义)，总量为20GyIR治疗使管腔狭窄显著减轻。结论：IUVS检查证实：负性重构是猪髂动脉球囊损伤后狭窄形成的重要原因；20GyIR可明显减轻动脉内膜损伤后狭窄形成，IR防治受损动脉狭窄形成的原因可能与改善血管负性重构有关。     

周围血管损伤25例诊治分析

为了探讨周围血管损伤疾病的诊断治疗，本文对２５例（１９７９～１９９２年）我院周围血管损伤病例的诊断、手术方法、术中及术后注意事项进行讨论分析，作者认为：周围血管损伤疾病治疗方面的首要问题是选择手术时机，其次是损伤的性质、程度、时间及有无复合性损伤这些是手术成败的决定因素。治疗应尽早实行血管重建术，术后早期抗凝治疗。     

中小血管吻合技术

中小血管吻合技术第一医院血管外科向志综述时德审校中图分类号Ｒ６５４．４１９５９年ＨａｌｌｏＷｅｌｌ首先创用金属针贯穿缝合血管创缘以修复血管，这是血管缝合的最初尝试。１８８９年Ｊａｓｓｉｎｏｗｓｋｉ用间断缝合修复人的血管裂伤，１８９６年Ｂｒｉａｕ首先进...     

静脉穿刺的四点体会

垂危病人，特别是血管充盈度差的患者尤其需要过硬的静脉穿刺技术。现将本人在近26年临床工作中的个人体会介绍如下。     

IMPAIRED ANGIOGENESIS FOLLOWING HIND-LIMB ISCHEMIA IN DIABETES MELLITUS MICE

Objective To investigate vascular endothelial growth factor(VEGF) and its signaling pathway spontaneous response in type 2 diabetes mellitus(T2DM) mice to surgery-induced hind-limb ischemia.Methods Sixty mice were randomly divided into two groups,one was fed with normal chow as control,and another was fed with high fat diet to induce T2DM.Fourteen weeks later,mice were surgically induced to hind-limb ischemia.Blood flow restoration was monitored with laser Doppler perfusion imaging.Tibialis anterior muscle was collected after 3 days of hind-limb ischemia.VEGF mRNA and protein expressions were analyzed using real-time PCR and ELISA;expressions of VEGF downstream signal molecules and receptors were analyzed using Western blotting and RT-PCR,respectively.Results Perfusion recovery 10,20,30 days after ischemia was significantly attenuated in T2DM compared with control group(P<0.05).T2DM impaired VEGF signaling pathway although VEGF levels increased in T2DM group.After ischemia,T2DM group had a comparable increase in VEGF expression compared with control group,but still had an impaired VEGF signaling pathway.Conclusion VEGF signaling pathway is abnormal in T2DM mice,although VEGF had a response to the ischemic stimulation.     

子宫内膜异位症患者血清中ENA-78的表达

OBJECTIVE: To investigate the role of serum epithelial neutrophil-activating peptide-78 (ENA-78) in the pathogenesis of endometriosis. METHODS: Serum concentrations of ENA-78 were measured by means of enzyme-linked immunosorbent assay (ELISA) in 42 patients with endometriosis (20 in stages I and II and 22 in stages III and IV) in comparison with 25 women without endometriosis (control group). RESULTS: Serum concentrations of ENA-78 were significantly higher in endometriosis group than in the control group (2.97+/-1.91 ng/ml vs 0.72+/-0.24 ng/ml, P>0.001), and ENA-78 levels in stages III and IV were significantly higher than those in stages I and II (4.48+/-1.25 ng/ml vs 1.30+/-0.74 ng/ml, P>0.001). Significant difference in ENA-78 levels between follicular phase and luteal phase was found in neither of the groups. CONCLUSION: Patients with endometriosis have elevated serum ENA-78 levels, which might be a pathogenic factor of endometriosis.     

血管内皮生长因子在子宫内膜异位症中的作用

目的：探讨血管内皮生长因子（VEGF）在子宫内膜异位症（EM）中的作用。方法：应用RT—PCR方法检测33例子宫内膜异位症患者的33份卵巢子宫内膜异位囊肿及32份在位子宫内膜组织中VEGFmRNA的表达情况，并进行阳性率及半定量的比较。以26例非子宫内膜异位症患者的26份子宫内膜组织作为对照。结果：EM组卵巢子宫内膜异位囊肿VEGFmRNA表达与在位子宫内膜比较，水平较低（P〈0．05），但高于对照组（P〈0．05）；在位子宫内膜与对照组比较VEGFmRNA表达水平较高（P〈0．01）；在不同月经周期中，在位内膜组和对照组分泌期VEGFmRNA表达水平均高于增生期（P〈0．01），在位内膜组分泌期和增生期的VEGFmRNA表达水平均分别高于对照组（P〈0．01）。结论：EM患者的异位子宫内膜中VEGFmRNA的表达，可能与其血管化程度有关；VEGF对EM的发生发展具有重要意义。     

子宫内膜异位症患者腹腔液中MK和VEGF的表达

[目的]探讨中期因子（midkine,MK）和血管内皮生长因子（vascular endothelial growth factor,VEGF）在子宫内膜异位症（endometriosis,EMT）发病中的作用。[方法]采用双抗体夹心酶联免疫吸附（enzyme linked immunosorbent assay,ELISA）法检测36例不同程度EMT患者（实验组：Ⅰ-Ⅱ期4例为轻度组,Ⅲ-Ⅳ期32例为重度组）及17例非EMT患者（对照组）腹腔液（peritoneal fluid,PF）中MK、VEGF的浓度。[结果]MK水平重度组明显高于对照组（P﹤0.05）,而轻、重度组间差异无统计学意义（P﹥0.05）;VEGF水平重度组明显高于对照组、轻度组（P﹤0.01,P﹤0.05）。实验组MK水平分泌期明显高于增生期（P﹤0.05）,而对照组差异无统计学意义（P﹥0.05）;对照组和实验组VEGF水平增生期和分泌期差异均无统计学意义（P﹥0.05）。实验组MK与VEGF的表达呈具有显著意义的正相关（r=0.525,P﹤0.05）。[结论]EMT患者PF中MK、VEGF水平升高,提示二者可能共同参与了EMT的发生发展。     

子宫内膜异位症患者血清中ENA-78的表达

目的 研究上皮细胞来源的中性粒细胞激活肽(ENA-78)在子宫内膜异位症发病中的作用。方法 应用ELISA法,检测42例子宫内膜异位症患者(Ⅰ~Ⅱ期20例、Ⅲ~Ⅳ期22例)血清ENA-78的浓度,并与25例非子宫内膜异位症患者(对照组)进行比较。结果 子宫内膜异位症组血清中ENA-78浓度明显高于对照组(2.97±1.91ng/ml vs 0.72±0.24ng/ml,P<0.001),Ⅲ、Ⅳ期比Ⅰ、Ⅱ患者血清中ENA-78增高更明显(4.48±1.25ng/mlvs1.30±0.74ng/ml,P<0.001)。增殖期与分泌期比较,两组血清ENA-78的表达均无显著差异。结论 子宫内膜异位症患者ENA-78明显升高,可能为子宫内膜异位症发病的因素之一。     

血清血管内皮生长因子对诊治子宫内膜异位症的临床价值

目的探讨血清血管内皮生长因子（VEGF）诊治子宫内膜异位症（EM）的价值。方法采用酶联免疫吸附法（ELISA）检测100例EM患者和43例非内异症患者（对照组）手术前后血清中VEGF的含量。结果EM患者术前血清中VEGF水平明显高于对照组（P〈0．01）;Ⅲ-Ⅳ期EM患者血清VEGF水平高于Ⅰ-Ⅱ期者（P〈0．01）,术后EM患者血清VEGF水平迅速下降（P〈0．01）。以血清VEGF142ng／L为EM诊断界点时,其诊断灵敏度、特异度、阳性预测值和阴性预测值分别为0．930、0．930、0．968、0．833;血清VEGF为260ng／L时,可对Ⅰ-Ⅱ期及Ⅲ-Ⅳ期EM患者进行分期。结论血清VEGF的水平对EM有重要的诊断价值,并可作为判定疗效、评价复发的重要指标。     

SERUM LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN PATIENTS WITH ANGINA PECTORIS AND ACUTE MYOCARDIAL INFARCTION

ＩＮＴＲＯＤＵＣＴＩＯＮ　　Ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ (ＶＥＧＦ)ｏｒｖａｓｃｕｌａｒｐｅｒｍｅａｂｉｌｉｔｙｆａｃｔｏｒ (ＶＰＦ)ｃｏｎｓｉｓｔｓｏｆａｆａｍｉｌｙｏｆｐｏｌｙｐｅｐｔｉｄｅｉｓｏｆｏｒｍｓｔｈａｔｓｐｅｃｉｆｉｃａｌｌｙｒｅｇｕｌａｔｅｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｆｕｎｃｔｉｏｎ ,ｉｎｃｌｕｄｉｎｇｅｎｈａｎｃｅｍｅｎｔｏｆａｎｇｉｏｇｅｎｅｓｉｓ( 1) ,ｅｎｈａｎｃｅｍｅｎｔｏｆｍｉｃｒｏｖａｓｃｕｌａｒｐｅｒｍｅａｂｉｌｉｔｙ ( 2 ) ,ａｎ…     

DYNAMIC CHANGES OF SERUM VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN A RAT MYOCARDIAL INFARCTION MODEL

ＩＮＴＲＯＤＵＣＴＩＯＮ　　Ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ(ＶＥＧＦ) ,ａｈｏｍｏｄ ｉｍｅｒｉｃ 34 ｔｏ 46 ｋＤａｈｅｐａｒｉｎ ｂｉｎｄｉｎｇｇｌｙｃｏｐｒｏｔｅｉｎ ,ｉｓａｐｏ ｔｅｎｔｓｔｉｍｕｌａｔｏｒｏｆｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｒｅｐｌｉｃａｔｉｏｎａｎｄｉｓｒｅｇａｒｄｅｄａｓｏｎｅｏｆｔｈｅｍｏｓｔｓｐｅｃｉｆｉｃｏｆｔｈｅｋｎｏｗｎａｎｇｉｏｇｅｎｉｃｍｅｄｉａｔｏｒｓｂｅｃａｕｓｅｔｈｅｌｏｃａｌｉｚａｔｉｏｎｏｆｉｔｓｒｅｃｅｐｔｏｒｓｉ…     

卵泡液和血清EG-VEGF、VEGF和TGF-β1水平与IVF妇女卵巢反应的关系及其对妊娠结局的预测价值

目的 探讨卵泡液和血清中内分泌腺来源的血管内皮生长因子(EG-VEGF）、血管内皮生长因子（VEGF）和转化生长因子β1（TGF-β1）水平与体外受精（IVF）妇女卵巢反应的关系及其对妊娠结局的预测价值。方法 选择60例因输卵管和（或）男性因素而接受体外受精-胚胎移植(IVF-ET)治疗的不孕症患者作为研究对象。ELISA法检测取卵当日卵泡液中和取卵后第2天血清中EG-VEGF、VEGF和TGF-β1的水平,分析其与卵巢反应和IVF妊娠结局的关系。结果 卵泡液EG-VEGF、血清EG-VEGF、卵泡液VEGF浓度均与控制性超排卵周期中人绒毛膜促性腺激素(hCG)注射日血清雌二醇（E₂）浓度呈显著负相关（r=－0.622, P<0.01; r=－0.511, P<0.01; r=－0.427, P<0.01）,卵泡液EG-VEGF与卵泡液VEGF浓度呈显著正相关（r=0.354, P<0.01）。60例不孕症患者中,妊娠31例,未妊娠29例。与非妊娠组比较,妊娠组hCG注射日血清E₂浓度较低（P<0.05）,而血清EG-VEGF浓度较高（P<0.01）;而两组间卵泡液和血清VEGF、TGF-β1的浓度比较,差异均无统计学意义（P>0.05）。结论 卵泡液和血清EG-VEGF及卵泡液VEGF水平均与卵巢反应呈显著负相关。黄体早期血清EG-VEGF水平与IVF妊娠结局相关,可能具有预测IVF妊娠结局的潜在价值。     

武汉地区正常育龄妇女月经周期血清中七种激素的放射免疫测定

选抒12例正常月经周期的武汉地区妇女,研究她们的内分泌图象,采用放射免疫测定法测定每天血清中促黄体生成激素(LH)、促卵泡生成素(FSH)、垂体催乳素(PRL)、雌二醇(E_2)、孕酮(P)、睾丸酮(T)和皮质激素(C)的浓度。其中LH、FSH、E_2和P的周期变化和水平与其他文献报告的结果相同,月经中期LH峰值是50mIU/ml,FSH峰值为12mIU/ml,排卵前E_2峰值为252pg/ml,P值为16ng/ml,在大多数周期中,PRL在月经中期水平是高的,但黄体期PRL平均水平高于滤泡期,月经中期T和C值无明显变化,而滤泡期C水平(91ng/ml)高于黄体期(81ng/ml)。     

Effect of percutaneous intervention on adrenomedullin and tumor necrosis factor in the coronary circulation]

OBJECTIVE: To evaluate the effect of percutaneous intervention (PCI) on coronary circulation levels of adrenomedullin (ADM) and tumor necrosis factor alpha (TNF-alpha) in patients with coronary heart disease (CHD). METHODS: Thirty-three CHD patients underwent percutaneous transluminal coronary angioplasty (PTCA) and stenting (altogether 48 stents were implanted). Blood samples were collected from the coronary sinus and femoral artery at the time points of immediately before and after angioplasty, immediately after PTCA or stenting, 10 min after procedures, respectively. RESULTS: The ADM and TNF-alpha levels in the coronary sinus varied little after coronary angiography, but were elevated markedly following PTCA from the basal levels of 36.3+/-1.3 pg/ml to 28.9+/-1.9 pg/ml (P<0.01) and from 11.10+/-0.46 ng/ml to 8.84+/-0.37 ng/ml (P<0.01), respectively. Further increases of ADM and TNF-alpha levels were detected immediately after stent deployment. ADM recovered to basal levels 10 min after completion of the procedures, while TNF-alpha underwent further increase. Before the procedure, ADM and TNF-alpha levels were higher in the coronary sinus than in the femoral artery (28.9+/-1.9 pg/ml vs 22.6+/-0.8 pg/ml, P<0.01; 8.84+/-0.37 ng/ml vs 7. 56+/-0.23 ng/ml, P<0.01, respectively), and their levels in the femoral artery did not undergo significant changes in response to the operations. CONCLUSION: The coronary circulation levels of ADM and TNF-alpha increase after PTCA and stenting but not after coronary angiography in CHD patients, which might be attributed to injuries by the procedures as well as the mechanical stimulation by the stent.