胃左动脉区域灌注化疗治疗胃癌的药代动力学研究

目的 探讨胃左动脉区域灌注化疗治疗胃癌的合理性。方法 观察５－Ｆｕ经胃左动脉和外周静脉给药后的药代动力学变化。结果 胃左动脉给药，门静脉血中５－Ｆｕ浓度为外周静脉给药组的４～４０倍，而且维持５－Ｆｕ高浓度的时间明显延长；癌组织和癌旁淋巴细胞中５－Ｆｕ水平分别为外周静脉给药组１９倍和２３倍。结论 胃左动脉区域灌注化疗可明显提高癌肿局部的化疗药物浓度。     

全反式维甲酸联合化疗药物对胃癌的治疗作用

目的 探讨全反式维甲酸（ＡＴＲＡ）联合５Ｆｕ治疗裸鼠皮下ＳＧＣ７９０１胃腺癌的疗效。方法 以ＡＴＲＡ１０００μｇ／ｄ口服;５－Ｆｕ２７ｍｇ／ｋｇ腹腔注射,隔天给药;联合用药组剂量减半。结果 ５－Ｆｕ、ＡＴＲＡ及两者联合用均能抑制移植瘤生长,治疗７周后创面愈合的体积率分别为５６．８８％、４９．００％和７０．００％,瘤重抑瘤率分别为５１．６４％、５６．１０％６ ７６．９５％;ＡＴＲＡ与５－Ｆｕ的抑瘤作     

氟尿嘧啶经胃左动脉和外周静脉化疗的药代动力学比较

目的 探讨胃左动脉区域灌注化疗治疗胃癌的合理性。方法 比较氟尿嘧啶（５－ＦＵ）经胃左动脉和外周静脉给药后的药代动力学变化。结果 胃左动脉给药组的门静脉 血中５－ＦＵ浓度为外周静脉给药组的４￣２００倍,而且５－ＦＵ高浓度的维持时间明显延长;癌组织和癌旁淋巴组织中５－ＦＵ水平分别为静脉给药组的１９倍和２３倍。结论 胃左动脉区域灌注化疗可明显增加癌肿局部的化疗药物浓度,提高化疗疗效。     

皮下置入药泵区域化疗在治疗不能切除的胰体尾癌中的？…

自１９９５年以来，对８例术中探查为不能切除的胰本尾癌进行皮下置入药泵及脾动脉置管，术后向药泵注入５－Ｆｕ和ＭＭＣ，进行区域动脉化疗，并与１２例不能切除的胰体尾癌仅行外周静脉化疗的病例对照。结果显示，区域性动脉化疗组中位生存期７．０个月，静脉化疗组４．２个月，两组比较差异显著。本方法对延长不能切除胰体尾癌患者的生存期有较好疗效。     

介入治疗左锁骨下动脉闭塞术中胸膜外血肿1例

患者男,64岁,体检超声发现右颈内动脉闭塞、左颈内动脉狭窄收入院;3年前接受冠状动脉支架植入术,术后规律口服抗凝及抗血小板药;无高血压、糖尿病等病史。入院后查体及实验室检查均未见明显异常。颈动脉CT血管造影:右颈内动脉闭塞,左颈内动脉狭窄(70%~90%),前交通动脉开放。经股动脉插管全脑血管造影:右颈内动脉闭塞,左颈内动脉狭窄约90%,前交通动脉开放,左锁骨下动脉闭塞,左椎动脉盗血。     

卡培他滨抑制高转移性人肝癌LCID20生长和转移的研究

目的 观察５－氟尿嘧啶（５－Ｆｕ）前体物质卡培他滨对高转移潜能肝癌ＬＣＩＤ２０生长和转移的抑制作用。方法 用免疫组织化学方法检测６１例人肝癌组织中血小板衍化内皮细胞生长因子（ＰＤ－ＥＣＧＦ）蛋白水平。１８只裸鼠人肝癌高转移模型ＬＣＩＤ２０于肿瘤种植后第３天分别采用ＣＡＰ和５－Ｆｕ治疗。停药后３天处死裸鼠,测量肿瘤的长短径,检测裸鼠肝功能和血浆甲胎蛋白（ＡＦＰ）水平;苏木素－伊红（ＨＥ）染色检测肺转     

自制带阀门血管内支架非开胸堵闭巨大动脉导管未闭

目前：探讨自制带阀门血管内支架堵闭装置在巨大动脉导管未闭（ＰＤＡ）动物模型及临床病例的应用效果。方法：对１０只巨大ＰＤＡ实验模型动物,经股动脉插入血管内支架堵闭装置,完成堵闭ＰＤＡ。６例ＰＤＡ病人,经８￣１４Ｆ血管鞘通过股动脉或股静脉,顺利送入堵闭装置,操作一次成功。结果：所有的实验动物堵闭均一次成功,于术后１￣１８０天解剖动物,行病理检查见ＰＤＡ堵闭完全,达到永久性闭合。临床病例术毕即刻动脉造影     

术前区域动态灌注化疗治疗乳癌

目的 评价术前动脉灌注化疗药物在乳癌治疗中的作用。方法 采用Ｓｅｌｄｉｎｇｅｒ江经皮股动脉穿刺,将导管置于锁肌下动脉与胸廓内动脉开口交界处的近侧,用充气止血带高于患者收缩压阻断患侧肱动脉血流后,注入化疗药物。根据病人情况３－４周重复灌注化疗１次。化疗方案：吡喃阿霉素,或阿霉素,或表阿霉素５０－７０ｍｇ／ｍ＾３,卡铂３００－４００ｍｇ／ｍ＾２,５氟－脲嘧啶（５－Ｆｕ）７５０－１０００ｍｇ／ｍ＾２,甲     

区域动脉灌注5—Fu和抗生素降低急性坏死性胰腺炎？…

目的 探讨５－Ｆｕ合并抗生素泰能区域动脉灌注（ｒｅｇｉｏｎａｌ ａｒｔｅｒｉａｌ ｉｎｆｕｓｉｏｎ,ＲＡＩ）能否降低急性坏死性胰腺炎（ＡＮＰ）感染和死亡率。方法 选择ＡＮＰ５３例,分为Ａ、Ｂ、Ｃ组。Ａ组１６例,静脉途径给予５－Ｆｕ及泰能;Ｂ组２２例,ＲＡＩ途径给予５－Ｆｕ,静脉给予泰能;Ｃ组１５例,ＲＡＩ途径交替使用５－Ｆｕ和泰能。结果 Ｃ组感染率（０）明显低于Ａ组（５０．０％）和Ｂ组（２７．３％     

兔膀胱5—氟尿嘧啶微球化学栓塞的实验研究

采用以５－氟尿嘧啶、人血清白蛋白为材料制成的微球，注入实验兔髂内动脉、测定髂内动注入微球后的血药浓度及膀胱组织药物浓度。同时对５只兔以同法注入等量常规５－Ｆｕ作为对照。结果：制成的微球直径３５－７５μｍ，含药量均为１０％。     

等距对称分叶法吻合小血管的实验及临床应用研究

目的：吻合口管壁等距对称分叶后吻合小血管，确保吻合口管壁完全外翻；内膜平整对合，降低血管危象的发生率，提高通畅率。方法：将吻合口管壁纵形剪开分叶，剪开的深度为管壁厚的２倍，小血管分３叶者吻合６针，４叶者８针。用二定点法先缝合叶部，后缝合２叶之间。用此法共吻合大白鼠尾动脉１００个吻合口，免股动脉和肱动脉１２０个吻合口，免耳皮瓣自体交叉移植２０个，用此法进行断手指再植１５例，游离皮瓣移植５例。结果：１００个大白鼠尾动脉吻合后即刻通畅率为１００％，１２０个股、肱动脉吻合后３周其通畅率为９７．５％（３个吻合口因伤口感染栓塞），吻合前、吻合后３周时吻合口内径经ｔ检查无显著差异（Ｐ＞０．０５），兔耳皮瓣全部成活，临床应用２０例全部成功。未发生血管危象。吻合口经扫描电镜观察，愈合过程优于端端吻合法。结论：此法吻合微小血管能确保其吻合口管壁外翻，内膜平整对合，减少缝合针数。有利于吻合口的无创操作，使血管的通畅率提高，血管危象减少     

Scanning electron microscopy studies of needle and suture damage in rat carotid and femoral arteries

Using the scanning electron microscope (SEM), we compared the areas of endothelial disruption 45 minutes after penetration of rat femoral and carotid artery walls with 75- and 100-mu taper point and taper cut microsurgical needles, with and without restoration of blood flow. Four experimental groups were designated: needle puncture only, single loose, suture loop, end-to-end anastomosis, and end-to-side anastomosis. The vessels were perfused with normal saline, immersed in 3% buffered glutaraldehyde, and mounted under slight tension to simulate physiological wall distention before SEM examination. Endothelial craters at vessel puncture sites were measured on SEM photomicrographs at 300 X magnification. All vessels were patent when examined. Crater diameters averaged less than double the needle size. Although taper cut needles produced craters that were 25% larger (P less than 0.05), vessel penetration was easier than with the taper point needle and bleeding times were the same. Suture loop produced craters that were 36% larger (P less than 0.05) than needle puncture alone. Craters were 20% larger when blood flow was restored and 50% larger in the femoral than in the carotid artery. Although craters seen after end-to-end anastomosis were not significantly larger than those after end-to-side anastomosis, interrupted sutures appeared to cause more endothelial damage than continuous sutures. These results suggest that the use of cutting needles, passage and tying of sutures, vessel distention by blood flow, and suturing of more muscular and less elastic vessel walls (femoral artery) may increase endothelial disruption but do not reduce patency.     

利用脱细胞基质预构小口径组织工程血管的实验研究

目的 在犬腹腔内预置脱细胞基质后形成结缔组织管,观察将其作为血管替代物的力学特征及移植于自体股动脉后的组织结构变化.方法 在犬腹腔内埋置长8～12 cm用硅胶棒支撑的制备好的脱细胞基质,3周后将硅胶棒周围形成的管状物作为血管替代物移植于自体股动脉,同时对此管状物作力学、组织学检测及与颈动脉、股静脉的对比分析.在移植术后6个月观察血管通畅情况.光镜、透射及扫描电镜观察替代物的组织结构.结果 ①血管替代物的力学性能弱于正常动脉而强于正常静脉.②组织学观察:形成的管状物内腔有少量的间皮细胞黏附;弹性纤维、胶原纤维结构较完整;纤维网中充满成纤维母细胞.6个月后内皮细胞在替代物内壁覆盖连续,平滑肌细胞与对照组相近.③移植6个月后脱细胞基质组血管全部通畅.结论 ①用脱细胞基质预构的血管替代物力学性能符合血管移植、血运重建的需要.②所形成的血管替代物移植6个月后组织相容性良好,替代物管壁厚度及组织结构已接近正常血管.     

Acute intraoperative arterial elongation: an experimental study.

OBJECTIVES: small arterial defects resulting from either trauma or resection of an aneurysm often present difficult problems to the vascular surgeon. DESIGN: to demonstrate that certain arterial gaps as a result of traumatic injury or aneurysm resection could be closed with acute intraoperative arterial elongation. Materials: fifteen mongrel dogs underwent acute intraoperative arterial elongation of the right superficial femoral artery, with the left side used for a control vessel. METHODS: arterial defects created surgically (median 50 (range 25 to 60 mm) mm). Appropriate length of artery was then undermined. A Foley catheter was placed proximally and distally directly beneath this undermined portion of vessel. The vessel is lengthened following 3 expansion/relaxation cycle of Foley catheter. Arterial gaps were closed by end to end anastomosis. Arterial pressure study was performed in all vessels. RESULTS: acutely, arterial pressure differences proximal and distal to the anastomosis were seen only when arterial gaps were exceeded 55 mm. There was no occlusion either acutely or after 4 weeks follow-up period. Light microscopic examination of arterial specimens revealed partial disruption of internal elastic lamina. At the end of the follow-up period, formation of neointima with regeneration of the internal elastic lamina was demonstrated. Scanning electron microscopy revealed minimal endothelial denudation. CONCLUSIONS: we believe that, acute intraoperative elongation can be used as an alternative technique to vein grafting for the repair of small traumatic arterial defects in selected cases.     

The effect of short-term antifibrinolytic therapy on experimental vasospasm

BACKGROUND: Antifibrinolytic therapy is effective in preventing rebleeding in cases of aneurysmal subarachnoid hemorrhage (SAH). The major disadvantage of this therapy is the increase in ischemic complications, which is supposed to be due to cerebral vasospasm. In this study the effect of short-term antifibrinolytic therapy on arterial vessel narrowing after SAH was investigated utilizing the rat femoral artery vasospasm model. METHODS: Twenty-four rats were divided into four groups of six animals each. Autologous blood (0.1 mL) was applied to the 1-cm segment of right femoral artery wrapped with a silicone cuff. In Group 1 the animals did not receive any treatment. In Groups 2, 3, and 4 150 mg/kg tranexamic acid (AMCA) was given orally for 3, 5, or 7 days respectively, starting from postoperative day 1. A 1 cm segment of each femoral artery was harvested on the 8(th) postoperative day. Morphologic analyses were performed using the parameters, radial wall thickness and cross luminal area under the light microscope. In addition, two samples from each group were examined by transmission electron microscope (TEM) to confirm the morphologic changes. RESULTS: There was a gradual decrease in cross luminal area and gradual increase in vessel wall thickness directly proportional with time. However, the vasospastic changes that occurred in Group 2 (received AMCA for 3 days) were not significantly different from those of Group 1 (nontreated). CONCLUSION: It was concluded that antifibrinolytic treatment for the first 3 days may prove useful in cases of clinical aneurysmal SAH. However, if this treatment is used for more than 3 days, arterial vessel narrowing is significantly increased.     

Long-term result of arterial grafts interposed for arterial defects using the telescoping anastomotic technique: histological and angiographic study.

The arterial grafting model for arterial defects provides an ideal environment for the microvascular telescoping anastomosis because tension of the repaired vessel is maintained low and deformities of the inserted vessel end is minimal due to the thick arterial wall. The left femoral artery was grafted in 46 rats into the defect created in the right femoral artery using the telescoping anastomotic technique at both the proximal and distal anastomoses. The grafts were seen histologically and angiographically 3 to 4 months postoperatively in order to fairly evaluate the telescoping anastomosis in terms of long-term patency, stenosis, and changes in the outer and inner walls at the anastomosis. All arterial grafts were patent 3 to 4 months postoperatively and there were no aneurysms at the anastomoses. Enlargement of the graft diameter was minimal. The rate of stenosis at the anastomosis was smaller than that 1-day postoperatively. Even though the thick arterial wall was initially inserted and the intimal hyperplasia was still present at the anastomosis 3 to 4 months postoperatively, the long-term stenosis was relatively mild due to the atrophy in the overlapped walls.     

A rat femoral artery model for vasospasm

A new animal model for vasospasm using rat femoral artery has been developed. Whole blood, washed erythrocytes, or leukocytes in platelet-rich plasma were selectively applied to the adventitial surface of the femoral artery for 7 days in 15 rats, after which the vessels were perfusion-fixed and examined by light and transmission electron microscopy and immunohistochemistry. As compared with matched control arteries, there was a prominent reduction in luminal cross-sectional area after 7 days in vessels exposed to whole blood or washed erythrocytes, but not in those exposed to leukocytes in platelet-rich plasma. In arteries with luminal narrowing, light and transmission electron microscopy demonstrated marked morphological changes throughout the vessel wall similar to those seen in cerebral vasospasm after subarachnoid hemorrhage. Immunohistochemistry disclosed a prominent loss of immunoreactive actin in smooth muscle cells of arteries exposed to whole blood or erythrocytes. To assess the time course of arterial narrowing in this model, whole blood was selectively applied to the adventitial surface of femoral arteries in 23 rats for periods from 2 to 20 days. As compared with control arteries, arterial narrowing was variably present at 2 days, progressively increased by 5 days, was maximal at 7 to 10 days, and returned to near control levels by 20 days. The presence and severity of ultrastructural changes in vessel wall corresponded to the degree of arterial narrowing over time. These results suggest that chronic narrowing in rat femoral artery exposed to periadventitial blood is analogous to that observed in cerebral arterial vasospasm after subarachnoid hemorrhage. This new model represents a simple and reliable means to investigate pathogenic mechanisms and potential therapies for vasospasm.     

梯形对称二等分叶法吻合小血管

目的　探索一种安全、快捷的小血管吻合方法。方法　将吻合口管壁两侧 0°和 180°位斜形4 5°对称剪去一小等腰三角形管壁 ,剪去三角形的各边为血管管径的 1/3,使吻合口管壁前后呈梯形对称二等分叶 ,先用两定点缝合法吻合 0°和 180°位叶间 ,而后缝合梯形叶部和梯形叶边。结果　大鼠尾动脉 2 0个吻合口、颈总动脉和股动脉 4 0个吻合口 ,即刻通畅率 10 0 %。大鼠颈总动脉和股动脉吻合口近期通畅率 (2周 )为 10 0 % ,吻合前后血管口径无明显狭窄 (P >0 0 5 )。吻合口经光镜及扫描电镜观察愈合过程良好。临床应用 2 4例全部成功 ,未发生血管危象。结论　该法吻合小血管克服了对端吻合法中两定点吻合时进针困难的缺点 ,最大限度地减少了血管内膜损伤机会 ,避免了小血管吻合时误穿对侧管壁的弊端 ,确保吻合口管壁完全外翻 ,内膜平整对合。该法操作简单 ,吻合速度快 ,通畅率高 ,可减少血管危象发生 ,值得临床推广应用     

Intimal hyperplasia: the permeation of serum-derived substance into the arterial autovein graft under abnormal blood flow

The etiology of intimal hyperplasia in autogenous vein grafts used for arterial replacement was experimentally studied in dogs. We previously developed an experimental model, which mimicked a human extremity with poor run-off of peripheral arteries. This model characterized the abnormal flow by a weak fluctuation of wall shear stress at the site adjacent to the vessel wall. In this model we found that an autogenous vein implanted into the femoral artery under such abnormal flow conditions exhibited remarkable intimal thickening; 200-400 micron at 1 month and 300-500 micron at 6 months. A fluorescence microscopic study revealed that Evans blue-albumin complex entered the inner wall of vein grafts transplanted in abnormal flow conditions until about 2 weeks after implantation, after which further permeation was no longer observed. A similar observation was made in the fibrinogen distribution of subendothelial tissue. These results showed that abnormal flow conditions enhance the permeation of certain substances into immaturely repaired intimal tissues of autovein grafts. This phenomenon is thought to be responsible for the proliferation of smooth muscle cells, leading to hyperplasia of autovein grafts.