超声消融联合白体干细胞移植治疗糖尿病足的临床研究

目的观察血管内超声消融联合自体骨髓干细胞移植治疗糖尿病足的疗效。方法37例糖尿病足患者,手术首先抽取自体骨髓干细胞260ml,分离出单个核细胞,制备干细胞悬浊液40ml。采用经皮股动脉穿刺或切开显露,经股浅动脉上部向下插入超声消融导管,在血管造影监视下进行血管内超声消融后,将制备的干细胞悬浊液一次性分点注射于缺血的小腿肌肉内。结果37例患者术后间歇性跛行距离增加大于200m,趾端溃疡面积减小,冷、凉感觉得到改善。结论血管内超声消融联合自体骨髓干细胞移植治疗糖尿病足是一种简单、有效的方法。     

下肢多节段动脉硬化闭塞症的联合治疗

目的探讨下肢多节段动脉硬化闭塞症治疗方法及临床疗效。方法2004年3月至2005年11月,采用髂动脉球囊扩张和支架植入结合动脉旁路术、股深动脉成形术或自体骨髓干细胞移植术治疗下肢多节段动脉硬化闭塞症17例(19条肢体),术前踝肱指数(ABI)为(0.26±0.13),术前常规行血管彩超及CTA检查评价下肢动脉病变情况。结果髂动脉球囊扩张和支架植入19条,股深动脉成形11条,股-动脉人工血管转流术12条,自体骨髓干细胞移植3条,均获得成功。均未出现严重并发症。术后ABI(0.64±0.17)(P<0.05,t检验),随访期间,4例残余间歇性跛行,3例术后3个月行干细胞移植术后症状明显好转。结论多方法联合是治疗多节段多平面下肢动脉硬化闭塞症的有效方法;股深动脉的病变范围与手术治疗效果密切相关;术前正确评价股深动脉的通畅程度十分重要。     

膝下动脉缺血性病变:外科手术和腔内治疗的疗效对比

膝下动脉缺血性病变多发生于糖尿病下肢动脉闭塞症和下肢血栓性脉管炎,它的治疗主要包括下肢远端动脉旁路移植、膝下动脉腔内治疗和自体干细胞移植三种技术.自体干细胞移植目前尚未在全国大规模地推广和普及,因此,前两种治疗方法仍是此类疾病的主要选择.下肢远端动脉旁路移植作为一种常规技术,已有几十年的历史;而血管腔内治疗是最近20年发展起来的技术.两种治疗的疗效对比情况如何?这是血管外科医师和患者都关心的问题.     

自体骨髓干细胞移植治疗严重下肢缺血1例

人男性 ,76岁 ,因右下肢严重缺血 ,糖尿病足第 2、3趾坏疽且伴感染 4个月 ,经过内科长时间治疗无效于 2 0 0 3年 2月 15日入院。入院后下肢动脉造影显示 :下肢远段小腿动脉及足部动脉均已闭塞 ,足部血供仅靠少许侧支血管(图 1)。无法进行下肢远端动脉搭桥。经过充分论证后 ,于 2 0 0 3年 3月 4日接受自体骨髓干细胞移植治疗 ,首先在局麻下抽取自体骨髓 3 0 0mL ,分离出单个核细胞 (可定向分化的干细胞 )悬浊液约 3 0mL ,再在硬膜外麻醉下 ,进行小腿肌肉局部注射。术后每天监测下肢远段经皮氧分压 ,于术后第 3d ,病人开始感觉足部发热 ,第 4…     

老年腰椎管狭窄伴下肢动脉硬化性闭塞症的诊治分析

目的：探讨老年腰椎管狭窄症伴下肢动脉硬化性闭塞症的临床特点以及两者的鉴别诊断。方法：对我科自1998年6月-2002年4月，被延误诊治的10例老年腰椎管狭窄症伴下肢动脉硬化性闭塞症患者的临床表现、诊断和治疗过程进行回顾性分析。结果：10例患者均有间隙跛行，首先以腰椎管狭窄症收治，6例骨科手术治疗，4例保守治疗，疗效差。最后被确诊10例均有不同程度的下肢血管硬化性闭塞改变，5例介入治疗，3例药物治疗，2例血管外科手术治疗，对治疗均表示满意。结论：老年腰椎管狭窄症伴下肢动脉硬化性闭塞症的临床表现相似，易混淆。老年下肢间隙性跛行的患者，诊断腰椎管狭窄症的同时必须排除下肢动脉硬化性闭塞症。对下肢血管硬化性闭塞症缺乏认识是其被延误诊治的主要原因。     

骨髓干细胞动员对下肢动脉闭塞症腔内治疗后再狭窄的预防

目的总结下肢动脉闭塞症腔内治疗后再狭窄预防的临床经验,探讨再狭窄的发生原因及其预防对策。方法回顾性总结接受腔内治疗的87例患者的临床资料。围手术期采用自体骨髓干细胞动员和其他干预措施分析对照。术后对病变部位行64排CT血管成像(D0),而后在术后1、3、6、18个月分别对病变部位行64排CT血管成像(D1、D2、D3、D4),对比管径变化,观察临床疗效。结果 87例经腔内治疗的下肢动脉闭塞症患者,围手术期经不同的干预措施,以管径不小于术后90%为通畅。接受自体骨髓干细胞动员者通畅率分别为1个月100%,3个月100%,6个月96%,18个月通畅率92%;接受其他干预措施者通畅率分别为1个月100%,3个月81%,6个月75%、18个月56%。结论下肢动脉硬化闭塞症腔内治疗,围手术期采用不同的干预措施,术后通畅率明显不同,围手术期自体骨髓干细胞动员对于维持术后通畅率有满意的效果。     

自体骨髓干细胞移植治疗下肢动脉闭塞症患者的护理

对3例下肢动脉闭塞症患者采用分离提取的自体骨髓造血干细胞悬液,在患肢进行肌内注射移植,10~20 d后观察患者症状改善情况,并进行各项指标综合评估。结果移植术后患者症状均有不同程度改善,彩色多普勒超声检查提示患肢动脉血液流速有所增快。提出严密监测生命体征、血糖的变化,进行患肢的观察及护理,严格控制感染及注意抗凝、扩管药物治疗的护理等措施是保证治疗成功的重要因素。     

血管、淋巴管

注射吸毒致假性股动脉瘤的修复重建;颈外静脉修复重建股动脉的临床应用;个体化血管重建术治疗下肢多平面动脉硬化闭塞症;自体骨髓干细胞和外周血干细胞移植治疗下肢缺血的对比研究     

下肢动脉硬化闭塞自体干细胞移植围手术期护理

下肢动脉硬化闭塞症（arteriosclerosis obliterans．ASO）是一种常见病、多发病。ASO治疗方法多种，但对于患肢动脉管腔严重狭窄或闭塞无法手术时，自体干细胞移植将自身干细胞分离、纯化通过各种途径移植到缺血局部，促进侧枝循环建立，从而改善缺血症状挽救患侧肢体。Tateishi—Yuyama等首次报道应用骨髓干细胞移植治疗周围血管病获得满意效果。我院2003年1月～2005年10月行自体干细胞移植治疗10例ASO，现将有关围手术期护理报道如下。     

自体骨髓造血干细胞移植治疗糖尿病下肢血管病变临床研究

目的研究分析自体骨髓造血干细胞移植治疗糖尿病下肢血管病变患者的效果：方法50例中老年2型糖尿病下肢血管病变患者随机分为对照组和观察组,每组各25例,对照组采用常规药物治疗,观察组采用自体骨髓造血干细胞移植治疗。结果观察组临床显效率为52．0％（13／25）,高于对照组的24．0％（6／25）,差异有统计学意义（χ^2=4．1596,P〈0．05）;两组治疗后足背动脉血流量、踝肱指数（ABI）均有好转表现,而且观察组ABI好转更明显;两组均未发现明显的不良反应。结论自体骨髓造血干细胞移植治疗糖尿病下肢血管病变患者疗效佳,安全,可在临床中进一步推广。     

P‐I‐04 Treatment for Limb Ulcer with Severe Ischemia: Therapeutic Angiogenesis by Autologous Transplantation of Bone‐Marrow

Aim: Limb ulcer due to severe ischemia often needs revascularization. In our hospital, the result of lower extremity bypass surgery for these patients is satisfactory, however, indication of this procedure is limited pathologically and technically. We recently have demonstrated a possibility of efficacy of therapeutic angiogenesis by autologous bone marrow cell transplantation for severe ischemic ulcer of extremity. Methods: Eight patients (9limbs; 3limbs with arteriosclerosis obliterans, 6limbs with Buerger's disease) with ischemic ulcer of lower and/or upper extremity were treated with implantation of autologous bone marrow mononuclear cell into ischemic skeletal muscles. Four weeks after transplantation, efficacy of this procedure were evaluated by Visual Ana log Scale, angiography and Laser Doppler Flow Analysis (LDFA). Results: In 4 out of 9 limbs, the ulcers healed dramatically. Seven limbs revealed angiographically improvement and icrease of blood flow by LDFA. Conclusions: Our findings suggest that therapeutic angiogenesis by autologous bone marrow cell transplantation is an effective and safty strategy for patient with peripheral arterial disease. We considered that it is more effective to Buerger's disease than arteriosclerosis obliterans.     

门脉高压症腹膜后自体单个核细胞移植治疗后门静脉压力变化的临床研究

目的探讨肝炎后肝硬化门脉高压症腹膜后单个核细胞移植对门静脉压力的影响。方法随机对肝炎后肝硬化并门静脉高压症上消化道出血的70例病人分为治疗组和对照组。治疗组36例病人行脾切除、门—奇静脉断流的同时在腹膜后植入自体骨髓单个有核细胞。对照组34例行脾切除、门—奇静脉断流。观察术后再出血率及门静脉压力变化情况,用SAS统计软件分析处理。结果 36例在手术后12个月测门静脉压力降低,随访5a无再出血病例。结论肝硬变并门静脉高压症上消化道出血病人在行脾切除,门-奇断流的同时,在腹膜后植入自体骨髓单个核细胞可以增加门静脉侧支循环,降低门静脉压力,预防再上消化道出血的发生。     

骨髓动员刺激后自体骨髓源单个核细胞移植治疗下肢缺血的初步临床研究

目的观察骨髓动员刺激后自体骨髓单个核细胞移植治疗下肢缺血的初步疗效。方法2005年5月～2005年12月收治下肢缺血35例43侧患肢,男23例,女12例。年龄34～90岁,平均71．3岁。病因：糖尿病下肢缺血30例38侧患肢,单纯动脉硬化闭塞症2例2侧患肢,血栓闭塞性脉管炎3例3侧患肢。其中间歇性跛行期5例5侧患肢;静息痛期15例19侧患肢;组织缺损期15例19侧患肢,其中组织溃疡期9例12侧患肢;组织坏疽期6例7侧患肢。在抽取骨髓前使用粒细胞集落刺激因子刺激骨髓2～3d,每天300μg;抽取骨髓血130-200ml,经分离纯化后再行移植。采用下肢肌肉局部注射13例19侧患肢,下肢动脉腔内注射16例16侧患肢,下肢肌肉局部注射与动脉腔内同时注射6例8侧患肢进行移植。结果术后2个月肢体疼痛改善率为94．7％,冷感改善率为97．1％,肢体麻木改善率为93．3％。5例5侧患肢间歇性跛行距离均有不同程度增加。44．2％患者的踝肱比值（ankle／brachial index ABI）有不同程度增加。39侧患肢行经皮氧分压（transeutaneous oxygen pressure,TeP02）测定,92．3％有不同程度增高。患肢溃疡：在9例11侧患肢中,愈合1侧,明显缩小或缩小3侧,无变化7侧,其中3侧患肢被截肢。术后行血管造影评估25例34侧患肢,91．2％患肢的侧支循环有不同程度增加。并发症：骨髓动员刺激出现发热和轻微乏力各1例,均自行缓解;单个核细胞移植后1周出现轻度心肌梗死1例,药物治疗1周后恢复出院,1个月后因患肢疼痛加重行膝下截肢。32例40侧患肢获随访3412个月,症状消失13侧,明显改善15侧,改善8侧,复发2侧,无效2侧。客观评价标准与术前比较ABI增加25侧;TcPOz测定增加36侧;21侧患肢的血管造影显示90．5％患肢有新生侧支形成;10侧患肢足部溃疡7侧愈合,3侧明显缩小;3侧患肢截除坏疽足趾者于术后2～3个月愈合出院。结论经骨髓动员刺激后的骨髓单个核细胞移植下肢缺血,具有抽取骨髓血少、细胞量多、近期效果好且安全性高的优点,是除自体骨髓单个核细胞移植和外周血干细胞移植外的又一种治疗下肢缺血的新方法。远期效果尚需进一步随访。     

Effectiveness of using autologous mono-nuclears of the bone marrow in treatment of patients with ischemic heart disease

The authors have analyzed their experiences with treatment of 50 patients with ischemic heart disease using transplantation of autologous mono-nuclears of the bone marrow. It was shown that this operation resulted in an improvement of indices of the heart functions and myocardium metabolism. Transplantation of stem cells as mononuclear fraction of the bone marrow is indicated in treatment of different groups of patients: in recurrent diseases after previous operations on the coronary arteries; in patients with distal lesions of the coronary bed; transplantation of autologous stem cells of the bone marrow is expedient simultaneously with coronary artery bypass grafting or coronary angioplasty (stenting).     

Cure of malignant lymphoma in dogs with peripheral blood stem cell transplantation

Twelve dogs with spontaneous malignant lymphoma in chemotherapy-induced remission were treated with total-body irradiation (TBI) and transplantation of autologous peripheral blood mononuclear cells collected following chemotherapy-induced expansion of the stem cell pool. Four animals (33%) died of transplant-related complications, five (41%) relapsed, and three (25%) are long-term disease-free survivors. Recovery to 1000 white cells/mm3 occurred by day 16 and dogs no longer required platelet transfusions by day 37. With the exception of delayed platelet recovery these results are virtually identical to those previously reported using autologous bone marrow transplantation for canine lymphoma. This study therefore suggests that autologous peripheral blood mononuclear cells collected following chemotherapy-induced expansion of the stem cell pool may offer a realistic alternative to autologous marrow transplantation in patients with malignant lymphoma for whom autologous marrow is not available.     

Serum levels and receptor expression of tumor necrosis factor-alpha following human allogeneic and autologous bone marrow transplantation.

We have investigated tumor necrosis factor-alpha levels in serum samples of patients before and after allogenic (16 patients) or autologous (8 patients) bone marrow transplantation. A sensitive immunoradiometric assay for monitoring levels of endogenous tumor necrosis factor-alpha was used. The serum levels of tumor necrosis factor-alpha were found to be relatively low (ranging from less than 15 to 77 pg/ml). Among 13 patients having graft-versus-host disease following allogeneic bone marrow transplantation 8 patients did not have detectable tumor necrosis factor-alpha (less than 15 pg/ml) while 4 out of 8 patients undergoing autologous bone marrow transplantation had detectable tumor necrosis factor-alpha levels (15 pg/ml), indicating a lack of correlation between tumor necrosis factor-alpha serum levels and the occurrence of graft-versus-host disease. Because the tumor necrosis factor-alpha levels detected in patient sera could be regulated by TNF-receptor expression, the presence of TNF-receptor on patients' peripheral blood mononuclear cells was also studied using fluorescent liposome-conjugated tumor necrosis factor-alpha and immunofluorescence analysis. Our data indicate that peripheral blood mononuclear cells of some patients receiving either autologous or allogeneic bone marrow transplantation expressed significant levels of TNF-receptors, suggesting a lack of correlation between TNF-receptor expression and graft-versus-host disease development.     

冠状动脉旁路移植术同期经旁路血管移植自体干细胞治疗缺血性心衰

目的 评价冠状动脉旁路移植手术同期经旁路血管移植自体骨髓干细胞治疗缺血性心衰的可行性和安全性.方法 40例需外科手术治疗的陈旧性心梗伴左室功能不全病人,在冠状动脉旁路移植手术同期经旁路血管移植自体骨髓单个核细胞.结果 全组手术死亡1例.手术早期无心梗发生,无肝、肾功能衰竭,无新发恶性心律失常.结论 冠状动脉旁路移植术同期经旁路血管移植自体骨髓单个核细胞治疗冠心病陈旧心梗,为缺血性心衰病人提供了一个全新的综合治疗选择.     

骨髓动员与非动员自体骨髓源单个核细胞移植治疗血栓闭塞性脉管炎的疗效比较

目的观察骨髓动员与非动员自体骨髓干细胞移植治疗血栓闭塞性脉管炎（TAO）的疗效并进行对比分析。方法25例严重缺血的TAO患者分为A、B两组,A组12例为骨髓动员组,B组13例为非动员组。两组患者抽取骨髓血150～200ml,分离纯化后行下肢肌肉注射法移植术,观察丰观及客观指标进行疗效评价。结果移植2个月后两组多数患者疼痛和冷感有缓解,但缓解率两组无差异,两组溃疡愈合率无差异;经平均10个月随访,两组主观症状缓解率及溃疡愈合率差异无统计学意义（P〉0．05）。移植2个月后踝肱指数（ABI）和经皮氧分压（TcPO2）较术前有显著提高,A、B两组间差异有统计学意义;经平均10个月随访,两组间ABI和TcPO,差异有统计学意义（P〈0．05）。两组各有2例2条患肢溃疡无改善,无步匕亡及高位截肢者,全部患者无严重并发症发乍。结论骨髓动员和非动员两种方式自体骨髓干细胞移植均是安全、有效的治疗TAO手段．尤其对改善患肢症状及促讲溃疡的愈合效果明显,而骨髓动员组的疗效优于非动员组．     

Intracardial transplantation of mononuclear cells of the autologous bone marrow in complex treatment of patients with valvular heart diseases

The authors present the first clinical experience with intramyocardial transplantation of the mononuclear fraction of cells of the autologous bone marrow in complex surgical treatment of 10 patients with valvular heart disease. The cellular transplantation was fulfilled intraoperatively when making a prosthetic mitral (5 patients) and aortal (5 patients) valves on the open heart under conditions of extracorporeal circulation. Simultaneously direct revascularization of the myocardium (aorto-coronary and mammary-coronary shunts) was performed in 4 patients (1--with a mitral and 3--with aortal heart diseases). An investigation of the results of the examination including ECG, EchoCG and investigation of the myocardium perfusion using one-photon emission computed tomography fulfilled in the early postoperative period and within 6-12 months after operation has shown that the cell cardiomyoplasty with mononuclear fraction of cells of the autologous bone marrow improves the myocardium perfusion, however, in the early postoperative period the appearance of transitory impairments of the heart rate is possible.     

自体骨髓单个核细胞移植配合中药治疗下肢慢性缺血

目的:研究自体骨髓单个核细胞移植与中药合用对各种原因所致下肢缺血的治疗作用.方法:用集落细胞刺激因子使患者骨髓处于增生活跃状态,抽取骨髓血分离单个核细胞.移植采用缺血肢体远端动脉腔内及肌肉多点注射.观察患者手术前后肢体疼痛、冷感、间歇性跛行、溃疡创面情况评分以及踝肱比(ABl)变化.结果:治疗后患肢疼痛及冷感明显改善,跛行距离延长,创面愈合加快,ABI在术后短期内无明显升高.结论:自体骨髓单个核细胞移植结合中药治疗可以迅速改善下肢缺血患者的疼痛及冷感,促进伤口愈合,中远期有效改善局部的血液循环.