Clinical Value of Interventional Embolization for Sacral Chordoma before Surgical Treatment

Objetive:To evaluate the efficacy of preoperative transcatheter arterial embolization in the treatment of sacral chordoma,and to explore the choice of embolization timing.Methods:32 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma.Intraoperative bleeding amount of each patient was recorded and compared between-group differences at different operation times.Results:After embolization,12 patients were received resection within 24 hours(group A),that of 10 cases between 24~48h(group B),of another 10 cases between 48~72h(group C).All of the 32 tumors were removed intact with intraoperative bleeding about(894±199)ml,without any shock or death,nor injuries on abdominal organs such as rectum and ureter.There was no statistical significance in tumor size among group A,B and C(P>0.05).Data gave statistical significance in intraoperative blood loss between group A and B(P<0.01),there was no statistical differences between group B and C(P>0.05),in spite of group B slightly less than group C.Conclusion:Preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss,make the surgical field clear,and facilitate the maximal removal of the sacral chordoma.It would be best to select the embolization timing within 24 hours before surgical operation.     

Willis覆膜支架与弹簧圈栓塞治疗颅段颈内动脉瘤效果的比较

目的 比较Willis覆膜支架和弹簧圈栓塞治疗颅段颈内动脉瘤的临床效果.方法 89例经皮动脉穿刺行全脑选择性血管造影术证实的颅段颈内动脉瘤患者,根据其意愿分为A组43例,行Willis覆膜支架治疗;B组46例,行弹簧圈治疗.术后3、6、12个月及之后每年1次进行脑血管造影及临床随访,搜集血管造影及临床资料进行分析.对2组患者的手术成功率及并发症发生率进行x2检验,对即刻血管造影结果、手术时间、住院时间进行独立样本t检验.结果 A组患者支架成功置入42例,失败1例;B组46例弹簧圈栓塞均获成功,2组差异无统计学意义(Fisher精确概率法,P=0.999).即刻肭血管造影显示A组34例动脉瘤完全闭塞(81%),B组24例完全闭塞(52%);平均手术时间A组(103±13)min,B组(143±39)min,2组间差异有统计学意义(t=6.20,P＜0.01＝.并发症A组6例,B组8例,2组差异无统计学意义(x2=0.20,P＞0.05).A组41例随访6～41个月,脑血管造影显示39例动脉瘤完全闭塞(95%);B组45例随访7～47个月,22例完全闭塞(49%),2组差异有统计学意义(P＜0.01＝.最后一次随访结果显示,完全康复A组22例、B组27例,2组间差异无统计学意义(x2=0.352,P＞0.05).结论 脑血管造影结果显示Willis覆膜支架置入术治疗颅段动脉瘤的结果优于弹簧圈栓塞术,而临床表现2组无明显差别.

Abstract：

Objective To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n = 43, group A) or coil embolization (n =46, group B) according to the patients'will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results Endovascular covered stent placement and coil embolization were technically successful in all patients,except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81%, 95% CI: 69%, 93% ) and 24 patients of group B (52%, 95% CI: 37%, 67% ) ( P ＜0. 05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41,95%,95% CI: 88%, 102% ) and 22 patients of group B (22/45,49%, 95% CI: 34%, 64% ,P ＜0. 01 ). The average procedure time was(103 ± 13)min in group A and (143 + 39) min in group B (P＜0. 01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization.     

足踝部肌腱的多层CT低剂量三维成像研究

目的 探讨足踝部肌腱的低剂量CT扫描三维成像的可行性和合理性.方法 搜集足踝部骨折的连续病例45例,依序分3组:A组(80 kV、100 mAs)、B组(110 kV、60 mAs)、C组(常规组,130 kV、60 mAs),每组各15例,双侧踝部行6层CT扫描,采集模式1.0 mm ×6.分别测量足底部拇展肌CT值及噪声标准差(SD),记录容积CT剂量指数(CTDIvol)值,盲法评价各病例肌腱VR图像质量.对所获数据进行独立样本的单因素方差分析(ANOVA)方法检验或独立样本非参数检验(Kruskal-Wallis H).结果 A组肌肉平均CT值[(71.6±12.0)HU]明显高于B组[(66.8±9.2)HU,P=0.010]和C组[(66.1±7.1)HU,P=0.004];SD值分别为11.9、9.1、7.0 HU,差异有统计学意义(F=37.124,P=0.000),以A组最大,C组最小;CTDIvol平均值分别为(3.01±0.08)、(4.63±0.11)、(7.02±0.24)mGy,差异有统计学意义(H=39.185,P=0.000),A组最小,C组最大;肌腱VR图像评分分别为(2.3±0.5)、(3.7±0.5)、(4.8±0.4)分,差异有统计学意义(H=72.779,P=0.000),图像质量以A组最差,C组最佳,B组图像质量达到诊断标准以上.结论 6层CT的110 kV与60 mAs组合、1 mm准直足踝部肌腱CT成像有良好图像质量而满足诊断需要.

Abstract：

Objective To study the feasibility and reasonability of low-dose multi-slice CT(MSCT)with three dimensional rendering of the tendons of foot and ankle. The statistical methods including ANOVA and Kruskal-Wallis H was used. Methods Forty-five consecutive patients with fractures of foot and ankle were enrolled and evenly grouped into A (80 kV, 100 mAs), B(110 k V ,60 mAs) and C (130 kV,60 mAs).The MSCT scanning range was 6 slices of 1.0 mm. The CT value and standard deviation (SD) of the muscle and the CTDIvol were recorded. The image quality of volume rendering of the tendons was blindly evaluated.Results The CT value of muscle in group A (71.6 ± 12.0) HU was significantly higher than group B [(66.8±9.2) HU, P=0.010]and C[(66. 1 ±7. 1) HU, P =0.004]. The SD average values were 11.9, 6. 1 and 7.0 HU for three groups, and there were significant differences among the three groups(F =37. 142, P=0. 0000). Group A had the highest SD value, group C had the lowest SD;CT1DIvol average value were (3.01 ± 0. 08) , (4. 63 ± 0. 11), (7.02 ± 0. 24) mGy respectively, which were significant different among the three groups (H =39. 185, P =0. 000). Group A had the lowest CTDIvol, while group C had the highest CTDIvol. Volume rendering of the tendons was evaluated as 2.3 ± 0. 5、3.7 ± 0. 5、4. 8 ±0. 4, and there were significant differences among the three groups (H = 72. 779, P = 0. 000). Group A had the worst VR images, while group C had the best VR images. All VR images in Group B were good for diagnosis. Conclusion The protocol of 110 kV, 60 mAs, and 1 mm × 6 with three-dimensional volume rendering would be enough for evaluating the tendons of foot and ankle.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

去铁胺对大鼠脑室出血后慢性脑积水的疗效观察

Objective To discuss the effect of deferoxamine in the treatment of chronic hydrocephalus (CH) after intraventricular hemorrhage (IVH) in rats. Methods A total of 184 female Sprague Dawley rats were randomly divided into normal saline group ( NS group), intracerebroventricular blood infusion group (Group A ) and deferoxamine plus intracerebroventricular blood infusion group ( Group B). The rat CH models were made by infusing autologous whole blood ( 130 μl) into the right lateral cerebral ventricle. The escape latency time was detected by Morris water maze at days 14 and 28.The rats were sacrificed 1,3, 7, 14, 28 days later, the transverse diameter of the lateral ventricle on the coronal slice of rat brain 0.4 mm posterior to the bregma was measured for evaluation of hydrocephalus and the index of ventricle. Pathological changes of the brain were observed. Results No CH was found in the NS group. The incidence of CH in the Group A was 73% (11/15), which was significantly higher than 27% (4/15) in Group B at day 28. The escape latency time in the NS group was (8.21 ± 2.00) s,which was significantly shorter than ( 16.36 ±5.93 ) s of the Group A ( P ＜0.01 ). There was no significant difference in the escape latency time between the NS group and Group B [(11.38 ± 2.57 )s] (P ＞0.05 ). The index of ventricle in the NS group was 1.05 ± 0.41, which was smaller than 4.53 ± 1.70 in Group A and 2.77 ± 1.53 in Group B (P ＜ 0.05 ). There were no obvious pathological changes in the NS group at different time points. There found edema of white matter surrounding the ventricle, twist and engorged callosum, proliferation of rhagiocrine cell as well as hemosiderin deposit in Group A. However, no hemosiderin deposit was found in Group B. Conclusions The content of iron in the cerebrospinal fluid may be correlated with hydrocephalus after IVH. Preventive use of deferoxamine can reduce incidence of hydrocephalus after ICH.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

不同压力高压氧治疗对大鼠脊髓损伤后细胞凋亡的影响

目的 观察不同压力的高压氧(HBO)对大鼠脊髓损伤(spinal cord injury,SCI)后细胞凋亡的影响,探讨HBO治疗SCI的最佳压力.方法 90只SD大鼠采用Allen's打击法造成SCI后随机分为5组:对照组(A组)、0.15 MPa HBO组(B组)、0.20 MPa HBO组(C组)、0.22 MPa HBO组(D组)和0.25 MPa HBO组(E组).损伤后第3、7、14天分别对5组大鼠进行取材,采用Tunel法检测凋亡细胞,光镜下观察,并对结果进行统计学分析;神经功能评价采用开放场地实验评估大鼠后腿运动功能(BBB评分).结果 与A组比较,HBO各压力组在3个时间点凋亡的细胞数有所减少,神经功能有所改善,且差异有统计学意义(P＜0.05).与B组比较,C、D和E组凋亡的细胞数有所减少,BBB评分改善,且差异有统计学意义(P＜0.05).与C组比较,E组于第3和第7天的差异有统计学意义(P＜0.05);第14天的差异无统计学意义(P＞O.05).结论 HBO能抑制SCI后细胞的凋亡,其作用在一定范围内与压力的升高相关.

Abstract：

Objective To study the effects of HBO at different pressures on apoptosis following spinal cord injury in rats and also to investigate ideal pressure value of hyperbaric oxygen(HBO) on spinal cord injury (SCI). Methods The SCI model was established with Allen's weight dropping by using 90 SD rats. Then, the animals were randomly divided into 5 groups following SCI: the control group ( group A); the HBO treatment group at 0. 15 Mpa (group B); the HBO treatment group at 0. 20MPa (group C); the HBO treatment group at 0. 22 Mpa ( group D); the HBO treatment group at 0.25 Mpa ( group E). Segments of injured spinal cord were collected from the animals of the 5 groups for studies on the 3rd, 7th, and 14th days after injury. The apoptosis cells were labeled with Tunel and the neurologic function of the spinal cord was assessed in the open field ( the BBB score ). Results The number of Tunel - positive cells decreased considerably and the BBB score improved significantly in all the animals of the HBO groups when compared with those of group A ( P ＜ 0. 05 ). Same results were found when the group C, group D and group E were compared with group B, with statistical significance( P ＜0. 05). The number of Tunel-positive cells were decreased considerably and the BBB score improved significantly on 3rd and 7th days in group E, when compared with those of group C( P ＜ 0. 05 ), with statistical significance( P ＜ 0. 05 ). However, no statistical significance could be noted on the 14th day (P ＜0.05). Conclusions HBO could inhibit apoptosis in rats following spinal cord injury, which might be correlated with the increase of pressure within a certain range.     

碘油磁液经肝动脉栓塞热疗兔VX2肝癌的实验研究

目的 探讨碘油磁液经肝动脉栓塞热疗术对荷瘤兔肝、肾功能的影响及其疗效.方法 VX2兔肝癌模型32只,数字表法随机等分成4组:碘油磁液栓塞热疗组(A组)、碘油磁液栓塞组(B组)、单纯碘油栓塞组(C组)、对照组(D组).A、B两组实验兔经肝动脉注入碘油磁液0.5～0.8 ml栓塞病灶,C组实验兔仅用碘油栓塞.栓塞后仅A组实验兔在交变磁场下诱导热疗.实验兔分别于栓塞或栓塞热疗术前1 d和术后1、7、14 d经耳缘静脉取血,行肝、肾功能检查.肝功能指标选取丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST),肾功能指标选取血清尿素氮(BUN)和血清肌酐(Cr).栓塞术前、术后即刻、术后7、14 d行CT扫描并随访,观察碘油磁液或碘油在瘤内沉积分布情况并分别测量肿瘤大小.术后14 d处死实验兔,完整切取肝脏、脾、肾和肺,作病理检查.各组测量数据以重复测量方差分析进行统计学分析.结果 A组实验兔术前1 d和术后1、7、14 d ALT分别为(43.9±19.0)、(795.1±327.1)、(67.0±9.3)、(41.9±10.8)U/L,AST分别为(50.2±13.6)、(1011.2±655.9)、(62.4±24.1)、(51.6±7.9)U/L;B组ALT分别为(45.0±19.1)、(580.8±160.4)、(67.2±31.0)、(47.6±7.8)U/L,AST分另U为(52.9±20.3)、(735.2±186.1)、(57.9±24.8)、(50.9±9.8)U/L;C组ALT分别为(47.4±14.6)、(558.5±167.8)、(63.5±21.9)、(48.0.±9.3)U/L,AST分别为(51.8±9.5)、(752.5±112.0)、(56.5 ±20.6)、(51.4±8.6)U/L;术后1 dALT和AST较术前和D组明显升高(P值均<0.01),术后7、14 d所测值与术前比较差异无统计学意义.栓塞术前后4组实验兔BUN和Cr值组间和组内比较,差异均无统计学意义.术后7 d CT示A、B、C 3组瘤区碘油磁液和碘油沉积分布与栓塞或栓塞热疗前相比无明显变化.术后14 d CT示A组瘤区碘油磁液沉积更集中、密实,B、C两组共5例肿瘤瘤周碘油磁液或碘油移位、部分消失.术后14 d,A组肿瘤体积[(6.1±0.6)cm~3]较术前[(7.8±1.4)cm~3]平均缩小约21.7%(F=17.56,P<0.01),而术前B、C两组肿瘤体积分别为(7.9±1.1)、(7.8±0.9)cm~3,治疗后14 d分别为(9.1±0.8)、(9.3±1.0)cm~3,较术前平均增大16.2%、18.9%(F值分别为25.23、55.50,P值均<0.01).病理检查,栓塞14 d后,A组肿瘤坏死均达80%以上,B、C两组肿瘤坏死约30%~50%.结论 碘油磁液对兔VX2肝癌行选择性肝动脉栓塞热疗是安全有效的,具有可行性.     

α-氰基丙烯酸正丁酯栓塞治疗肝细胞癌并肝动脉-门静脉瘘的临床价值

目的 探讨α-氰基丙烯酸正丁酯(N-butyl 2-cyanoacrylate,NBCA)在肝细胞癌(HCC)并肝动脉-门静脉瘘(arterio-portal fistural,APF)栓塞治疗中的临床应用价值.方法 回顾性分析分别使用NBCA(NBCA组,26例)和无水酒精(无水酒精组,54例)栓塞治疗HCC合并APF患者的临床资料.治疗方法为常规经导管动脉化疗栓塞(TACE)过程中先使用液体栓塞剂对APF进行治疗.NBCA组根据APF的动静脉循环时间(≤1、1～2和≥2 s)分别使用不同浓度的NBCA(分别为40%～50%、28%～33%和20%～25%)进行栓塞;无水酒精组则根据APF的分流程度用无水酒精加海绵颗粒等栓塞治疗.两组栓塞中的疼痛反应和肝功能受影响程度的比较采用x2检验,1年生存率的比较采用Log-rank检验,一次性栓塞闭塞成功率的比较采用Fisher's精确检验.结果 栓塞过程中NBCA组有4例、无水酒精组有52例患者感到不同程度疼痛,两组差异有统计学意义(x2=58.86,P＜0.01);一次性栓塞闭塞成功率NBCA组92.3%(24/26)、无水酒精组68.5%(37/54),差异有统计学意义(P＜0.05);两组栓塞前后肝功能的变化(x2=0.652)以及1年生存率差异均无统计学意义(P＞0.05).结论 NBCA柃塞治疗HCC合并的APF安全、有效、准确性高,为HCC合并APF的栓塞治疗提供了一种新的可选择的方法.     

白芨微球与无水乙醇行兔门静脉栓塞的实验研究

目的　探讨门静脉栓塞的安全范围及白芨微球作为门静脉栓塞剂的可行性与有效性。材料与方法　新西兰大白兔 30只 ,随机分为两组 ,分别以白芨微球和无水乙醇行兔门静脉不同分支栓塞治疗 ;栓塞后行连续随访2 8d ,定期复查肝功能、CT、门静脉造影及动物处死后组织病理检查等 ,并将所获的数据行统计学处理。结果　术后丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)变化较明显 ,术后第 1d开始增高 ,术后 5d达到最高峰 ,白芨微球组显著高于无水乙醇组 (P <0 .0 5 ) ,但两组均于栓塞后 14d逐步恢复正常。栓塞部位比较 :两组均以右上支加左内支栓塞小组增高最为明显 ,且均有 1只兔于术后 14d死亡。 2种栓塞剂均可导致门静脉段及段以下分支完全性、急性闭塞 ,邻近的门静脉分支未见异位栓塞 ;无水乙醇栓塞后 2 8d ,肝实质呈不规则散在液化坏死 ,部分栓塞的门静脉出现再通现象 ;而白芨微球栓塞后 ,肝实质呈大片状气化坏死 ,未见栓塞区门静脉再通 ;两组术后再通率与不全坏死率有显著性差异 (P <0 .0 5 )。结论　门静脉栓塞的安全性与栓塞范围密切相关 ,其安全范围应小于或等于 3个段 ;白芨微球可作为一种末梢性门静脉栓塞剂 ,其安全性与无水乙醇相似 ,但栓塞效果佳 ,值得进一步临床应用与推广。     

兔肝缺血再灌注损伤CT灌注参数与肝损伤关系的研究

目的 观察兔肝缺血再灌注损伤(IRI)后CT灌注参数演变规律及与肝脏酶学[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)]的相关性.方法 新西兰大白兔阻断肝左叶血供60 min后,恢复血供,按再灌注后行CT扫描的时间分为6、12、24 h IRI组以及假手术(sham)组(每组6只).各组分别行CT全肝灌注成像、肝酶学和病理检查.多组均数间差异性分析采用单因素方差分析,血中肝脏酶水平与CT灌注参数相关性采用Pearson相关分析.结果 在IRI后6h肝左叶开始呈现出灌注减低区;在低灌注的肝组织中,除6 h IRI组的肝动脉灌注量(HAP)[ (25.1±9.3)ml·min-1·100 mg-1]外,其余各IRI组HAP[12 h IRI组(19.5±13.6)ml·min-1·100 mg-1、24 h IRI组(8.0±2.7)ml· min-1·100 mg-1]、HPP[6 h IRI组(10.8±5.5)ml· min-1·100 mg-1、12 h IRI组(14.4±5.2)ml· min-1· 100 mg-1、24 h IRI组(7.8±3.3)ml·min-1·100 mg-1]、TLP[6 h IRI组(35.9±14.0) ml· min-1· 100 mg-1、12 h IRI组(33.9±16.1)ml·min-1·100 mg-1、24 h IRI组(16.0±5.5)ml·min-1·100 mg-1]均低于sham组[HAP、HPP和TLP分别为(21.2±10.5)、(63.5±24.0)和(81.4±24.8)ml·min-1·100 mg-1](F值分别为8.376、25.950、16.925,P值均＜0.01),而肝动脉灌注指数(HPI)[6 h IRI组、12 h IRI组和24 h IRI组分别为(65.9±3.9)％、(54.2±16.7)％和(48.9±10.0)％]则高于sham组[(24.1±7.5)％,F=43.664,P＜0.01];而在灌注相对正常的肝组织中各灌注参数均呈下降趋势.各IRI组血清AST、ALT、ALP显著上升(P＜0.05).在IRI组中灌注减低肝组织CT灌注参数HPP、TLP分别与AST、ALP存在负相关(P＜0.01),而AST与HPI间存在正相关(r=0.751,P＜0.01).结论 CT灌注参数能够动态监测兔肝IRI后血流动力学,其灌注参数(HPP、TLP、HPI)与肝损伤的程度具有密切的相关性.     

螺圈加胶水法封堵兔肺支气管的实验研究

目的评价对于兔支气管最佳的螺圈加胶水封堵组合。方法分别以3mm螺圈 生物蛋白胶(A组)、3mm螺圈 NBCA胶(B组)、2mm螺圈 NBCA胶(C组)及4mm螺圈 NBCA胶(D组)封堵兔两肺前叶支气管,每组共8个部位。分别观察螺圈咳出、移位、肺叶萎陷、炎症程度及螺圈处异物肉芽肿的状况(分别记为0~2分)。结果B组评分明显高于其他组,与A组差异有显著性(P=0.009),与C组、D组差异亦有显著性(P值均为0.015)。结论适当大小的螺圈(直径3mm)可减少咳出、移位率和并发症;此外,NBCA胶比生物蛋白胶能更有效地造成肺萎陷。     

Uterine damage in swine following uterine artery embolization: comparison among gelatin sponge particles and two concentrations of N-butyl cyanoacrylate

Purpose

To compare the degree of uterine damage caused by uterine artery embolization (UAE) with gelatin sponge particles (GSPs) and N-butyl cyanoacrylate (NBCA) in swine.

Materials and methods

Fifteen swine were divided into three groups of five according to embolic material: group A (1-mm GSPs), group B (NBCA:Lipiodol = 1:1), and group C (NBCA:Lipiodol = 1:7). The uterine arteries were completely occluded bilaterally. The uteri were removed 3 days after embolization, and radiographs of the removed specimens were obtained in groups B and C to evaluate the distribution of the NBCA. The macroscopic necrosis rates of the uteri were calculated, and the uteri were evaluated histologically.

Results

Uterine necrosis rates were 4.9 ± 6.1, 1.3 ± 3.3, and 41.4 ± 28.8 % in groups A, B, and C, respectively, and were significantly higher in group C than in groups A (p = 0.0014) and B (p < 0.001). Uterine necroses were found in all 9 of the uteri with distal distributions of NBCA, and in only 1 of the 11 uteri with proximal distributions of NBCA.

Conclusions

Dilute NBCA caused more damage to the uteri than GSPs and concentrated NBCA did. Distal embolization using NBCA caused large necroses. Therefore, proximal UAE using concentrated NBCA should be considered in clinical situations.     

平阳霉素碘油乳剂栓塞治疗肝海绵状血管瘤对肝功能的影响

 目的 探讨平阳霉素碘油乳剂栓塞治疗肝海绵状血管瘤对肝功能的影响。方法 选取2010-03至2016-12医院收治且随访资料完全的肝海绵状血管瘤患者62例,均行平阳霉素碘油乳剂栓塞治疗,分别于术前、术后3 d及术后14 d检测血液中丙氨酸氨基转移酶(alanine amiotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、γ-谷氨酰转移酶(y-glutamyl transpeptadase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)、血清总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)等指标,并对检测结果进行统计学分析。结果 术后3 d,TBIL为(16.33±6.66)μmol/L,DBIL为(3.63±2.08)μmol/L,ALT为(80.09±82.63) U/L,AST值为(40.31±19.46)U/L,均较术前增高,差异有统计学意义(P<0.05);术后14 d再次复查肝功能指标,ALT为(16.14±6.38)U/L,AST为(17.97±4.54)U/L,TBIL为(12.17±4.68)μmol/L,DBIL为(2.13±1.09)μmol/L,与术前相比差异无统计学意义。GGT、 ALP、IBIL等指标治疗前后没有统计学差异。结论 平阳霉素碘化油乳剂栓塞治疗肝血管瘤在短时间内会引起肝功能相关指标增高,一般在14 d内即可恢复正常,无严重胆道毁损并发症发生。     

经动脉灌注纳米微粒治疗兔肝VX2肿瘤的实验研究

目的:研究羟基磷灰石纳米微粒(nHAP)对兔肝VX2肿瘤的治疗作用.方法:将成功接种肝VX2肿瘤的模型兔随机分成3组,每组15只,用显微外科手术临时阻断肝总动脉血流,经胃十二指肠动脉插管给药行介入治疗,术毕结扎胃十二指肠动脉.A组为生理盐水组(对照组),注射生理盐水5 ml;B组为碘油组(疗效对比组),注射超液化碘油0.5～1.0 ml;C组为nHAP组,注入0.5% nHAP 0.5～1.0 ml.3组实验动物分别于治疗前、治疗后7、14天行多层螺旋CT肝脏扫描,测量肿瘤的大小,并计算肿瘤生长率.治疗前,治疗后第1、7天测血清天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT);记录各组术后生存天数.结果:术后7、14 d,A组动物的肿瘤生长率分别为(350±116)%和(1098±337)%、B组为(234±18)%和(730±32)%,C组为(233±15)%和(723±30)%.B、C两组与A组相比差异有显著性意义(P＜0.05), B组与C组相比差异无明显意义(P＞0.05).术前各组血清AST、ALT水平差异无统计学意义(P＞0.05),术后1天,A、B、C组血清AST、ALT均升高,B、C组上升幅度稍高,但与A组相比差异无统计学意义(P＞0.05).术后7天,各组AST、ALT均降至正常范围.A、B、C组瘤兔的生存期分别为(38.0±5.4) d、(54.0±8.1) d、(56.0±8.2) d,B、C两组与A组相比生存期明显延长(P＜0.05).结论:经动脉灌注nHAP治疗兔肝VX2肿瘤能有效抑制肿瘤生长,延长瘤兔的生存期,而无明显肝功能损害.     

介入性灌注热碘油栓塞兔VX_2肝癌的疗效研究

目的评价热碘油对兔VX2肝癌的疗效及安全性。方法将30只载瘤兔,随机分为两组,每组15只。A组为常温30℃碘油灌注,B组为60℃热碘油灌注。经导管由肝动脉分别灌注常温碘油和热碘油,10 d后观察两组肿瘤体积及血清AST水平,观察载瘤兔的存活期。结果 B组肿瘤生长率(0.90±0.18)与A组(1.28±0.27)相比有统计学差异(P<0.05);A组存活期(42.0±2.0)d与B组(32.5±3.0)d相比有统计学差异(P<0.05)。A组血清AST水平与B组相比无统计学差异(P>0.05)。结论 60℃热碘油栓塞兔VX2肝癌可明显降低肿瘤生长率并延长存活期。     

腹腔镜胆囊切除术后血清TBIL、ALT、AST水平变化的对比性临床研究

目的：探讨腹腔镜胆囊切除术（LC）术后血清TBIL、ALT、AST升高原因。方法：1999－09－10我院收治的95例胆囊结石患者,随机分为A、B组各32例,C组31例。A组患者LC术中CO2气腹压设置在1．3kPa,单极电刀切除胆囊,胆囊床普遍电凝处理,B组患者LC术中CO2气腹压同A组,弯剪刀切除胆囊,钛夹钳闭止血、常规置放腹腔引流,C组患者LC术中CO2气腹压设置在2kPa,切除胆囊方法同B组。术后1、3、5、7d抽外周静脉血送实验室测定TBIL、ALT、AST含量。结果：术后1d血清TBIL、ALT、AST含量A组患者明显升高,B、C组患者无升高,三组相比（F检验）,A组有显著性临床意义（P＜0．01）。结论：LC术中电刀对肝外胆管热效应和对局部肝组织热损伤是术后血清TBIL、ALT、AST升高的主要原因,近期可恢复正常,远期对肝功能无影响。