腓浅动脉皮支蒂皮瓣的临床解剖

目的　观察腓浅动脉皮支血管的数量、发出的位置、血管的直径、长度以及发出后与主干大体的角度 ,为形成腓浅动脉皮支蒂皮瓣提供解剖学基础。方法　采用经股动脉热红明胶灌注的尸体 18具 (36侧 ) ,经月国动脉灌注的下肢标本 4侧 ,共 4 0侧 ,在手术显微镜下对腓浅动脉及其皮支进行解剖和观察。结果　腓浅动脉有 3～ 5支皮支发出 ,前 3支恒定出现 ,第 1支在腓浅动脉刚出肌间隔处 ,距腓骨小头 13.76± 2 .36cm。 3支的血管外径、长度分别为 0 .6 1± 0 .2 5mm和 2 .12± 0 .32cm ,0 .4 5± 0 .2 0mm和 1.6 3± 0 .4 2cm ,0 .4 3± 0 .2 1mm和 1.72± 0 .4 6cm。距第 1支 3.4 4± 0 .98cm发出第 2支 ,距第 2支 3.5 3± 0 .74cm发出第 3支。第 4支出现率 12 .5 % ,血管直径 0 .0 4mm ,长度 1.6 8± 0 .31cm ,距腓骨小头 2 2 .38± 0 .95cm。第 5支出现率 7.5 % ,外径 0 .19± 0 .0 1mm ,长度 1.5 7± 0 .77cm ,距腓骨小头约 2 4 .12± 1.0 6cm。结论　①浅动脉在出肌间隔及筋膜下段恒定地发出 3～ 5条皮支血管 ;②前 3支出现率高 ,管径及长度差异无显著性 ;③腓浅动脉皮支血管管径较粗 ,可以形成带蒂皮瓣。     

带血管蒂腓骨复合组织瓣修复下颌骨缺损的应用解剖

为带血管蒂腓骨复合组织瓣修复下颌骨提供解剖学依据,作者对下肢作了进一步解剖,对多种应用参数进行了观测.结果:腓骨全长338.4±26.76mm,滋养孔2±0.8个,腓动脉始于胫后动脉者为91.2%,其起始处外径为2.95±0.54mm,腓动脉起点距第一滋养孔长度平均52mm.并有2条静脉伴行.提示:带血管蒂腓骨复合组织瓣是修复下颌骨复合缺损较理想的材料.     

腓骨滋养动脉与腓骨移植

本文对69例尸体下肢的腓动脉与腓滑滋养动脉起点到腓骨小头的距离、腓动脉起点到腓骨滋养动脉起点间的距离、腓动脉的行程、周围关系、直径及滋养动脉的长度和直径进行了测量和观察.并对其中四侧新鲜肢体进行了腘动脉造影,证实了腓动脉、腓骨滋养动脉的分出部位和滋养动脉进入腓骨骨干的确切位置.同时对腓动脉切取的长度与腓骨主要滋养血管的关系及保护支配胫骨后肌、胟长屈肌的神经免受损伤等有关问题进行了讨论.     

带血管蒂游离腓骨移植的应用解剖学

本文研究了成人干燥腓骨400例滋养孔的数目、位置、分布、口径和方向。滋养孔位于腓骨干后面最多,占63.6％。第一滋养孔分布于腓骨中1/3段占96.4％(其中分布于中段上份占58.6％),分布于上1/3段占2.81％(主要分布于上份和下份)。另对1～3岁小儿下肢44例的血管进行了显微外科解剖,观察了腓骨的滋养动脉和弓形动脉。44例中发现滋养动脉共有45支,其中1例为双滋养动脉。观察39例,发现弓形动脉共239支,少者3支,多者10支,平均为6.13支。第一弓形动脉起于腘动脉或胫后动脉,分布于腓骨小头尖,第二弓形动脉起于胫后动脉,分布于腓骨颈;其余起于腓动脉,分布于骨干。如截取带小头的腓骨时,要结扎第一、二弓形动脉,若腓骨无滋养动脉,切取腓骨小头应注意。     

211例腓骨滋养孔的观测

本文对211例成人腓骨的长度、滋养孔的数目、分布、孔向、孔径以及滋养孔至腓骨小头最高点的距离进行了观测。根据测量得出主滋养孔至腓骨小头最高点平均距离为16.06±0.26厘米。主滋养孔指数的平均值为47.70±0.72%。用 Crock 法,将腓骨等分为四段,算出滋养孔在第二、三段腓骨内的数目占总数的95.6%;主滋养孔在此两段内的数目占总例数的98.10%。为进行带血管游离腓骨移植时,宜截取第二、三段腓骨提供了解剖学依据。     

脾、动、静脉的应用解剖

本文测量固定的成人正常脾50例,结果成人脾长10.4±1.5cm,宽7.4±0.9cm,厚3.3±0.3cm。脾静脉外径5.3±1.0mm。脾动脉外径4.4±0.6mm;脾动脉上干长2.4±0.6cm,外径3.2±2.4mm;中干长2.9±0.4cm,外径2.7±0.6mm;下干长2.4±0.5cm,外径3.0±0.8mm;上干上支长1.6±0.5cm,外径2.3±0.4mm;上干下支长1.4±0.5cm,外径2.2±0.5mm;下干上支长1.6±0.4cm,外径2.1±0.2mm;下干下支长1.5±0.4cm。外径2.2±0.5mm;上极动脉外径2.7±0.3mm,下极动脉外径2.6±0.5mm。此外还观察了脾切迹与分叶、副脾等。     

经颞浅动脉-甲状腺上动脉介入化疗的临床应用解剖

目的探讨临床经颞浅动脉-甲状腺上动脉介入通路的形态学参数.方法在动脉灌注红色乳胶的成人尸体教学标本24具(48侧)(男18具,女6具),测量甲状腺上动脉起点处至颞浅动脉颧弓上缘处和至喉上动脉发出部的距离;甲状腺上动脉与其起源动脉(颈外动脉)的夹角;颞浅动脉在颧弓上缘处和甲状腺上动脉起点处的内径.在3具铸型标本上,观察甲状腺的动脉上、下及左、右之间的吻合情况.结果甲状腺上动脉起点至颞浅动脉颧弓上缘处的距离男(8.78±0.12)cm、女(8.56±0.11)cm;至喉上动脉发出部的距离男(1.04±0.12)cm、女(0.99±0.14)cm;甲状腺上动脉与其起源动脉向内的夹角为(116°±17°);颞浅动脉在颧弓上缘处和甲状腺上动脉起点处的内径分别男1.85 mm、1.81mm,女1.81 mm、1.75m.结论经颞浅动脉-甲状腺上动脉介入路径短、弯曲少,操作可行和便捷.     

肩部血管蒂骨膜(骨)瓣的解剖学基础与术式设计

目的 :为肩部带血管蒂骨膜 (骨 )瓣移位治疗肩关节周围骨不连、骨缺损、肱骨头缺血性坏死的术式设计提供解剖学依据。方法 :在 4 0侧经动脉内灌注红色乳胶的成人上肢标本上 ,观察并测量肩关节周围动脉网有关血管的起始、走行、分支、分布及吻合情况。结果 :肩关节周围动脉网有关血管来自 :①胸肩峰动脉 ,主要分支中锁骨支长度 (2 .0± 0 .1)cm、外径 (1.2± 0 .2 )mm ;肩峰支长度 (5 .1± 0 .4 )cm、外径 (1.5± 0 .2 )mm ;三角肌支外径 (1.9± 0 .2 )mm ,发出点至三角肌和胸大肌入肌点长度分别为 (4 .8± 0 .5 )cm和 (3.2± 0 .4 )cm。②旋肱前动脉 ,主要分支中外侧降支长度 (6 .0± 0 .7)cm、外径 (1.2± 0 .2 )mm ,起点距肱骨大结节最高点为 (4 .1± 0 .7)cm ;内侧降支外径 (1.0± 0 .7)mm ,起点距肱骨头最高点距离为 (4 .0± 0 .6 )cm。③旋肱后动脉 ,其大结节骨膜支起点外径 (1.2± 0 .2 )mm ,供骨面积为 3.0cm× 5 .0cm。④肱动脉肌间隙支发升支直接骨膜支 ,上行连接旋肱前动脉内侧降支 ,其外径 (1.1± 0 .3)mm。上述动脉存在丰富的吻合。结论 :以肩部血管为蒂的骨膜 (骨 )瓣 ,是治疗肩关节周围骨不连、骨缺损及骨坏死的重要供区之一     

带伴行营养血管蒂腓肠神经电缆式神经移植体的设计

目的 探讨设计带伴行营养血管蒂腓肠神经电缆式神经移植体的解剖学基础。方法 观察26例成人下肢腓肠内侧皮神经(MSCN),腓神经交通支(PCN),腓肠神经(SN)及其伴行营养血管等。设计带伴行营养血管蒂腓肠神经电缆式神经移植体。结果 (1)腓肠内侧皮神经、腓神经交通支、腓肠神经的长度分别为20.01±0.61 cm、20.19±0.80 cm、12.98±0.61 cm,其横径分别为1.51±0.10 mm、2.50±0.10 mm、2.95±0.12 mm。(2)腓肠内侧皮神经伴行动脉(ANV)1支,外径为0.80±0.04 mm,伴行神经干的长度为8.78±0.52 cm。腓神经交通支伴行营养动脉1支,外径为0.91±0.03 mm,伴行神经干的长度为7.61±0.41 cm。结论可设计和应用带伴行营养血管蒂腓肠神经电缆式神经移植体桥接神经缺损。     

膈下动脉的应用解剖学研究

目的 :丰富国人膈下动脉的解剖学资料 ,为以膈下动脉为蒂的膈瓣移植提供依据。方法 :在尸体上观察膈下动脉的起始 ,测量其始端外径。截取膈 ,在体视学显微镜下观察膈下动脉在膈的走行、分支及分布范围 ,测量膈下动脉的可游离长度。结果 :膈下动脉起始于腹主动脉 ,占起始总数的 4 6.19% ;起始于腹腔动脉 ,占起始总数的 36.4 4 %。左膈下动脉起始端外径 ( 1.55± 0 .4 3) mm,右膈下动脉起始端外径 ( 1.81± 0 .39) mm;可游离长度左侧为 ( 15.4 2± 3.2 8) mm,右侧为 ( 17.69± 7.34 ) cm。结论 :国人膈下动脉主要起源于腹主动脉和腹腔动脉。膈下动脉在膈的分布范围广阔 ,可游离长度充分。     

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.