MSCTA观察腹腔干与肠系膜上动脉的解剖学变异

目的采用MSCTA评价腹腔干与肠系膜上动脉及其主要分支的解剖变异。方法收集1000例患者的MSCTA,进行VR、MIP和MPR,观察腹腔干与肠系膜上动脉及其主要分支的起源和走行。结果1000例患者中,880例（88．00％）属于正常解剖学类型（Michels I型）,120例（12．00％）存在不同类型的解剖变异,其中72例（7．20％）属于Mi-chelsⅡ～X型;48例（4．80％）不属于Michels分型,包括腹腔干-肠系膜上动脉共干31例（3．10％）,脾动脉起源于肠系膜上动脉5例（O．50％）,胃十二指肠动脉起源于肠系膜上动脉和脾动脉各3例（O．30％）、肝左动脉1例（O．10％）,腹腔干缺如2例（O．20％）,胃左动脉起源于腹主动脉、脾动脉和肝固有动脉各1例（O．10％）。结论腹腔干与肠系膜上动脉存在广泛的解剖学变异;MSCTA有助于了解变异情况,对腹部血管外科手术具有指导意义。     

多层螺旋CT观察正常肠系膜上动脉

目的探讨国人正常肠系膜上动脉(SMA)的多层螺旋CT(MSCT)表现及相关测量指标,为SMA病变的影像学诊断提供依据。方法 200名(男107名,女93名)接受64层螺旋CT腹部双期增强扫描的正常成人,按年龄分为青壮年组和中老年组,按性别分为男、女两组。选定在左肾静脉入下腔静脉层面测量SMA、肠系膜上静脉(SMV)及腹主动脉(AA)的直径,SMA直径与肠系膜上静脉直径的比值(dSMA/dSMV),SMA直径与腹主动脉直径的比值(dSMA/dAA),SMA后壁至腹主动脉前壁的距离(d1),SMA与腹主动脉的夹角(α);十二指肠中点层面SMA后壁至腹主动脉前壁的距离(d2)。结果 200名受检者的SMA显示清晰,其中变异者有15名,变异率为7.50%。dSMA、dAA、dSMV、α(°)、d1、d2男女两组间差异均有统计学意义(P0.05);dSMA/dAA、dSMA/dSMV男女两组间差异均无统计学意义(P0.05)。各项指标在年龄组间差异均无统计学意义(P0.05)。结论多层螺旋CT能较好地反映SMA的正常解剖和变异。     

供肝动脉解剖变异之修整

目的: 探讨供肝动脉解剖特点，掌握供肝修整技术尤其动脉解剖变异之供肝修整方法及技巧。方法:对64例人肝（含24例无脑胎肝和40例成人肝脏）动脉实施解剖及修整，其中31例应用于临床肝移植。结果:64例中肝动脉解剖变异者共12例（18.75%）。其中24例胎儿供肝中5例（20.83%）肝动脉解剖变异，起源于肠系膜上动脉（SMA）替代肝右动脉型1例；起源于SMA副肝右动脉型3例；肝动脉起自SMA型1例。成人供肝动脉变异7例 (17.5%)，来源于SMA替代肝右动脉型2例；来自胃左动脉替代肝左动脉型2例；来自SMA副肝右动脉型3例。应用于临床原位肝移植的31例供肝中，4例存在肝右动脉解剖变异。肝移植时对变异之供肝动脉根据不同情况，可选用变异血管结扎、就近与胃十二指肠动脉、脾动脉或肠系膜上动脉吻合、应用供体髂总动脉搭桥与受体腹主动脉吻合等方法进行修整。结论:肝动脉的修整在供肝修整中占重要地位，供肝切取时避免损伤变异之肝动脉是保障修整成功的关键，对过细的副肝动脉修整时，术中观察侧支反流后可考虑是否予以结扎。     

腹腔干分支变异及研究进展

腹腔干是一短而粗的动脉干,约于第一腰椎高度发自腹主动脉前壁。继则分为3支,即胃左动脉、肝动脉及脾动脉,分别供给腹腔上部脏器（胃、肝、脾、胰及十二指肠等）。然而以上3支的起点变化较多,国内外学者根据自己的见解,将腹腔动脉的分支列为若干类型,并相互补充。本文从腹腔干的分支变异类型、分型发展及其意义3方面进行探讨,以期为临床提供参考。作者根据胃左动脉、脾动脉和肝动脉的起源对变异类型进行分类,主要分为肝胃脾干型、肝脾干型、肝胃干型及胃脾干型,其他包括肝脾肠系膜干型、肝胃脾肠系膜干型、肝胃脾结肠干型、肝胃脾胰干型、胃脾干加肝肠系膜干型、肝胃脾肝左干型、肝胃脾胰十二指肠干型和肝胃干加肝脾干型等。从Lipshutz、Adachi、Michels分型及张年甲分型等介绍腹腔干变异分型的发展。     

基于多层螺旋CT的供肝动脉解剖变异与新解剖分型研究

背景与目的:供肝动脉解剖变异较多,目前肝动脉解剖分型以Michels和Hiatt分型为主,但不断有新发现的解剖变异情况。既往分型不能满足临床需要。本研究通过影像学观察统计供肝动脉解剖变异情况,提出精准分型,为临床工作提供科学准确的依据。方法:回顾性分析2019年1月—2019年3月行腹部多层螺旋CT双期增强扫描患者的影像资料,观察供肝动脉状态,记录相关数据,并进行分类统计。结果:总共纳入1520例患者的CT影像资料,男967例,女553例。符合Michels分型者1504例(98.95%),16例(10.53‰)不符合Michels分型。符合Hiatt分型者1507例(99.14%),13例(8.55‰)不符合Hiatt分型。从肝总动脉(CHA)起源、副左肝动脉(ALHA)起源、供肝动脉类型3个方面对供肝动脉解剖进行分析,笔者提出了供肝动脉解剖分型的七分法(根据CHA起源)与五分法(根据左右供肝动脉的解剖变异及不同变异的组合情况)。七分法中Ⅰ型1471例(96.78%)、Ⅱ型25例(1.64%)、Ⅲ型7例(0.46%)、Ⅳ型5例(0.33%)、Ⅴ型4例(0.26%)、Ⅵ型4例(0.26%)、Ⅶ型4例(0.26%)。五分法中Ⅰ型1381例(90.86%)、Ⅱ型87例(5.72%)、Ⅲ型38例(2.50%)、ⅣⅥ型10例(0.66%);Ⅴ型4例(0.26%)。结论:本研究提出的供肝动脉解剖新分型方法囊括了各种可能的解剖变异,简化了既往研究将CHA和供肝动脉同时纳入分型的复杂情况,分型思路清晰,符合解剖实际与临床认知,可为临床工作提供理论依据与指导。     

主动脉夹层合并难治性肠系膜上动脉缺血的手术治疗策略及疗效分析

目的探讨主动脉夹层合并难治性肠系膜上动脉(SMA)缺血的手术策略与临床疗效。方法本研究为回顾性病例系列研究。收集2010年8月至2020年8月复旦大学附属中山医院血管外科收治的24例主动脉夹层合并难治性SMA缺血患者的临床资料。男性21例, 女性3例, 年龄(50.3±9.9)岁(范围:44～72岁)。A型主动脉夹层(TAAD)9例, B型主动脉夹层(TBAD)15例。患者入院后均行CT血管造影检查, 根据影像学特征将患者分为3型:Ⅰ型, 仅SMA真腔重度狭窄或闭塞;Ⅱ型, 降主动脉合并SMA真腔狭窄(分离型);Ⅲ型, SMA上段胸腹主动脉合并SMA真腔狭窄(延续型)。根据影像学分型不同采用相应的SMA腔内治疗方法。记录患者的影像学分型、手术情况及并发症情况;采用Kaplan-Meier法绘制生存曲线, 并计算生存率及再干预率。结果 24例患者中, Ⅰ型17例(70.8%), Ⅱ型4例(16.7%), Ⅲ型3例(12.5%)。14例Ⅰ型患者采用TEVAR加SMA支架植入术治疗;3例Ⅰ型及1例Ⅱ型患者仅行SMA重建(1例慢性TAAD患者行髂动脉-SMA旁路术治疗);3例Ⅱ型及3例Ⅲ型患者...     

肠系膜下动脉CT动脉造影分型与淋巴结转移相关性研究

目的 通过CT动脉造影（CTA）对肠系膜下血管（IMA）分型,研究其对结直肠手术的指导价值。方法 随机选取大连医科大学附属第一医院2011年1月至2013年4月间77例接受腹腔镜辅助结直肠癌手术病人采用容积再现（VR）血管生长技术（AV）进行血管重建,对IMA及其分支的变异进行分型。结果 77 例IMA均发自腹主动脉。根据左结肠动脉（LCA）、乙状结肠动脉（SA）及直肠上动脉（SRA）的起点,IMA的变异可分为4种类型,A型为三分支均发自同一起点;B型为SA发自LCA;C型为SA发自SRA;D型为SA分别发自LCA及SRA。上述分型与年龄、性别、肿瘤浸润深度、淋巴结转移以及肿瘤距肛门距离无统计学相关性,而淋巴结转移与肿瘤距肛门距离显著相关（P=0.002）。结论 IMA的变异较大,其中No.242淋巴结转移与SA变异相关。术前行IMA CTA有助于腹腔镜手术下寻找并保留LCA及减少淋巴结清扫不彻底。     

供肝动脉变异的术中处理

目的 探讨供肝动脉的变异类型及植入前重建的方法.方法 采取快速切取法获取供肝528例,对肝动脉解剖进行Hiatt分型,存在肝动脉变异者,肝移植前先行肝动脉重建,方法是将变异动脉与脾动脉端端吻合或与胃十二指肠动脉端端吻合,或将肠系膜上动脉远端(或近端)与肝总动脉(或腹腔干吻合),肠系膜上动脉的另一端与受者的备选动脉吻合.供肝的动脉重建以及供肝血管与受者的吻合均在3.2～3.5倍手术放大镜下进行.结果 528例供肝中,肝动脉解剖正常者(Hiatt Ⅰ型)436例(82.6 %,436/528),肝动脉变异者92例(17.4 %,92/528).变异肝动脉中,Hiatt Ⅱ型38例(7.2%,38/528),Hiatt Ⅲ型47例(8.9 %,47/528),Hiatt Ⅳ型3例(0.5 %,3/528),Hiatt Ⅴ型2例(0.4 %,2/528),Hiatt Ⅵ型2例(0.4 %,2/528).92例肝动脉变异者中,53例的异常动脉拥有共同起始之大干,能与受者的动脉直接进行吻合,故无需在植入前进行动脉重建;其余39例需在移植前对变异的动脉进行重建,其中18例将变异动脉与脾动脉端端吻合,13例将变异动脉与胃十二指肠动脉端端吻合,8例将肠系膜上动脉远端(或近端)与肝总动脉(或腹腔干)吻合,另一端与受者的备选动脉吻合.结论 肝动脉的变异率较高,切取和修整供肝时应准确辨认,避免误伤;对于变异的肝动脉,必须确保其入肝血流的连续性完整,否则需进行植入前血管重建,重建方式应根据动脉变异的类型和解剖学特点来决定.     

Riolan动脉弓的MSCT血管成像表现

目的探讨MSCT血管成像（MSCTA）Riolan动脉弓的影像表现。方法收集6例Riolan动脉弓病变患者,3例男性患者为高血压动脉粥样硬化性疾病,3例女性患者均为多发性大动脉炎。采用16层（4例）、64层（2层）螺旋CT扫描行腹部CTA检查,对病变血管行VR、MIP和MPR重建。结果 6例Riolan动脉弓血管直径为3.5～10.0mm,平均（6.7±0.4）mm。3例腹主动脉粥样硬化性病变中,肠系膜上动脉（SMA）近端闭塞2例,远端与肠系膜下动脉（IMA）形成Riolan动脉弓,其中1例伴有腹主动脉瘤,同时SMA、IMA与腹腔动脉干形成动脉吻合弓;IMA近端闭塞1例,远端与SMA形成Riolan动脉弓。3例多发大动脉炎中,2例SMA狭窄,SMA与IMA间形成Riolan动脉弓,1例SMA、IMA同时与腹腔动脉干形成动脉吻合弓;1例IMA近端狭窄,IMA与SMA间形成Riolan动脉弓。结论 MSCTA可以显示SMA与IMA间Riolan动脉弓结构,其特征性影像表现是SMA与IMA间的纡曲扩张的血管弓。出现Riolan动脉弓提示SMA或IMA管腔闭塞或狭窄。     

肝移植受体肝动脉异常的诊断及处理

目的研究肝移植受体肝动脉解剖变异、病理异常与吻合部位选择的关系。方法回顾性分析2004年3月至2006年7月期间我院80例成人肝移植患者的临床资料。术前磁共振血管成像结合术中动脉解剖鉴别动脉变异、病理异常及其类型，记录动脉吻合部位和口径，对动脉解剖变异组与无变异组的吻合部位和吻合口直径进行比较。结果全组受体肝动脉解剖变异率为11．3％（9／80），肝右动脉变异8／9例，分别来自胃十二指肠动脉（GDA）、肝总动脉（CHA）、腹腔动脉或肠系膜上动脉。吻合部位为CHA（7／9例）或GDA（2／9例）分支袖片。病理异常为2例，其中肝动脉内、外膜分离1例，以CHA端吻合；肝动脉狭窄1例，选择肾上腹主动脉前壁吻合。解剖变异组与无变异组吻合部位差异有统计学意义（x^2=18．679，P〈0．01），解剖变异组CHA分支袖片吻合口径与无变异组肝固有动脉或CHA分支袖片比较差异均无统计学意义（P〉0．05）。结论受体肝动脉解剖变异影响吻合部位选择，CHA分支袖片是首选部位；无变异组肝固有动脉分支袖片与变异组CHA分支袖片的吻合口径相似，前者可作为无动脉变异时的常用吻合部位。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.