阴股沟皮瓣的解剖基础及其在男性会阴部修复重建中的应用?

目的:为临床设计和应用阴股沟皮瓣提供解剖依据和手术方法.方法:解剖15具成年男尸阴股沟区.在尸体标本上,模拟临床皮瓣切取方式,对皮瓣内包含的血管、神经进行观测.依据解剖结果为患者合理设计皮瓣.手术时按设计分离出事先确定的轴心动脉,血管蒂周围组织应适当保留,将皮瓣转移至受区.供区创面直接拉拢缝合,对不能直接拉拢缝合的创面予以植皮处理.结果:阴股沟区动脉血液供应充足,静脉回流丰富,有固定的神经支配.该区的动脉血供有阴部外浅动脉、闭孔动脉前皮支、阴囊后动脉的主干和外侧支,并且位置均比较恒定,其中尤其以阴部外浅动脉和阴囊后动脉最为恒定.3组血管网贯穿了皮瓣的上、中、下部.神经支配主要有4组.临床应用阴股沟皮瓣23例,皮瓣切取最大为17 cm×9 cm,最小8 cm×5 cm,均取得理想的治疗效果.结论:阴股沟皮瓣血运丰富,切取方便,供区隐蔽,修复、重建男性会阴部外形及神经感觉均取得理想疗效,是一种值得推广的方法.     

阴股沟皮瓣转移再造术

1990年6月以来，我们采用阴股沟皮瓣（以阴部外浅及阴唇后动脉为蒂，大小9cm～10cm×4cm～5cm）转移再造阴道3例，取得满意效果．文中详细介绍了阴股沟皮瓣的设计及手术方法，并就其优点和注意事项进行讨论如下，优点：①阴股沟为轴型皮瓣，血供丰富，易成活；②瓣薄，再造阴道不臃肿，柔软洁净，有弹性，无需长期佩带模具；③外阴基本正常；④部位隐蔽；⑤皮瓣感觉良好，性生活满意．注意事项：①必须熟悉该皮瓣解剖知识，了解阴部外浅及阴唇后动脉走向及穿出点位置；②造穴时需以导尿管和手指引导，防止误伤尿道、膀胱及直肠；③阴道外口需设计三角形瓣插入皮筒口部，防止环形狭窄；④加强术前、术后护理，控制饮食及排便，防止感染；⑤避免过早蹲位排便，以防再造阴道皮瓣远端裂开．     

阴股沟皮瓣一期器官(阴茎、阴道)再造

腹股沟向下方延续,会阴与大腿间皱襞,我们定名为“阴股沟”。通过解剖学及临床研究,在阴囊或阴唇外侧至大腿根部无毛区,可分别以阴部外动静脉,会阴动静脉、会阴神经形成岛状或游离皮瓣——阴股沟皮瓣。皮瓣设计成平行四边形,长12～15cm,宽4.5～6.5cm,供区术后可直接缝合。1989年12月,我们以会阴动脉为血管蒂形成阴股沟皮瓣,为1例无阴道妇女再造阴道,术后2周即痊愈出     

阴股沟皮瓣的解剖学基础及临床应用

目的：为临床上应用阴股沟皮瓣再造阴道，阴茎提供解剖学基础。方法。对20侧成人尸体标本红色乳胶液双侧髂外动脉灌注，观察阴股沟皮瓣的血运情况，结果：供应阴股沟皮瓣的血管解剖位置恒定，血运丰富，结论：阴股沟皮瓣血供可靠，在临床上可以应用于先天性无阴道，女性假两性畸形（XXY）的阴道再造，易性癖病女变男的阴茎再造，阴茎缺损，短小的阴茎部分再造及阴茎增长增粗术等。     

带血管蒂阴股沟皮瓣阴道重建术

<正> 我院于1992年12月开始应用带血管蒂阴股沟皮瓣重建阴道4例,效果满意,特报告如下。手术方法一、阴道穴位成形硬膜外麻醉,膀胱截石位。放置导尿管。膀胱直肠间隙注射生理盐水300ml+肾上腺素10滴。会阴前庭凹陷处做"口"形切口,两食指钝性分离,使人造腔穴深12厘米,可容纳四横指。二、阴股沟皮瓣设计及切取取两侧阴肌沟处带血管蒂皮瓣长10～12Cm,宽5～6Cm,皮瓣下缘略带弧形与阴道口下极平行。沿设计线在深筋膜下自上而下,由外向内切取皮瓣,结扎切断阴部外动静脉,到蒂部时小心分离出阴唇后动脉(或闭孔动脉皮支或旋股内动脉皮支),只要有一条血管进入皮瓣,     

左下肢双股动脉1例

我们在制作解剖学标本过程中 ,使用连续层次解剖法 ,对一老年女性尸体 (身高 14 0ｃｍ ,下肢长 76ｃｍ )进行了解剖 ,发现左下肢为双股动脉。髂外动脉穿过腹股沟韧带深面以后 ,在其稍下方约 0 2ｃｍ处分成 2条股动脉。内侧者 ,其根部直径为 0 8ｃｍ ,从起始部至收肌腱裂孔的长度为 2 6 9ｃｍ ,该动脉除在起始部发正常分支到阴部、腹下壁等处外 ,还在距其根部 6 5ｃｍ处发一管径 0 2ｃｍ的分支斜向内下方 ,穿过大腿内收肌群后终止于半膜肌 ,其主干出收肌腱裂孔后入窝移行为动脉。外侧者 ,其根部直径为 0 6ｃｍ ,从起始部至进入股二头肌…     

阴部神经的临床应用解剖

目的:研究阴部神经的应用解剖,为临床工作提供理论基础。方法：取12侧成人尸体标本,于臀部进行解剖,观察阴部神经、阴部内动静脉的走行、直径及体表投影。结果：阴部神经的体表投影为髂后上棘与坐骨结节连线的中下1/3内侧12 mm,其可游离的最大长度（自起始处至骶结节韧带上缘）为(38.74±1.39)mm。 结论：应用脊髓损伤平面以上的周围神经与阴部神经吻合来恢复截瘫患者的排便、排尿及性功能具有可行性。     

MSCT血管造影探讨胃左动脉解剖变异及临床意义

目的：探讨MSCT血管造影在胃左动脉正常解剖中的临床应用价值。方法：200例（男89例,女111例）接受腹部CT增强扫描的受检者,测量胃左动脉起始处血管内径（dLGA）、胃左动脉主干的长度（lLGA）,在横断面测量胃左动脉与腹腔动脉的夹角（aLGA∕CA）。结果：200例受检者的胃左动脉显示清晰,其中起源变异者22例,变异率为11.0%。男、女组患者比较,dLGA、lLGA、aLGA∕CA差异有统计学意义（P〈0.05）,不同年龄段患者比较,以上指标差异无显著意义（P〉0.05）。结论：MSCT血管造影可以清晰而立体地显示胃左动脉的正常解剖及变异情况。     

阴股沟皮瓣阴道成形术的临床应用

目的：介绍阴股沟皮瓣阴道成形术的手术方法及临床应用经验。方法：对２０例先天性无阴道患者采用阴股沟皮瓣移位法阴道成形术；其中，已婚但性生活困难者４例，未婚者１６例。染色体检查均为ＸＸ核型，第二性征发育正常。合并前庭直肠瘘１例。结果：２０例患者手术均获成功。成形后的人工阴道质软，富有弹性，术后不需配带阴道模具，性生活满意。结论：本术式创伤和痛苦小，易于解剖和切取，术后不破坏外阴形态，值得推广。     

以耳后动脉为蒂的耳后发际皮瓣转位修复兔唇的应用解剖

目的：探讨以耳后动脉为蒂的耳后发际发瓣转位修复兔唇的应用解剖。方法：取经过福尔马林固定、动脉内灌注红色乳胶的30侧成人头颅标本,对耳后动脉和枕动脉的可游离长度进行测量,并测量人中与乳突间的距离。结果：耳后动脉可游离长度16．5±2cm,末梢血管管径为0．2mm,下颌角至人中的距离为13．8±2cm。结论：以耳后动脉为蒂的耳后发际皮瓣可以用于免唇的修复。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.