三种不同重建肝静脉回流术式的背驮式肝移植临床对比研究

目的：探讨背驮式肝移植（PBLT）不同重建肝静脉回流术式的优缺点。方法：自1995年9月至2002年1月,对59例各种不同适应证的终末期肝病患者施行了63例次PBLT,其中4例为再次背驮式肝移植（RTLPB）.PBLT对肝静脉重建采用3种吻合方法:A组17例,采用经典式背驮式肝移植（standared piggyback liver transplantation,SPBLT）技术,即供肝肝上下腔静脉（sup-H-IVC）与受体成型的肝静脉行端端吻合术（EEAT）,为EEAT组：B组12例,采用改良的背驮式肝移植（APBLT）技术,即供、受体sup-H-IVC端侧吻合术（ESAT）,为ESAT组;C组34例,采用APBLT技术,即供肝肝后下腔静脉后壁与受体肝后下腔静脉前壁侧侧吻合（SSAT）,为SSAT组。结果：EEAT组与ESAT组均有肝静脉回流受阻综合征、肝功能恢复延迟等并发症,SSAT组无上述并发症。结论：SSAT组技术易掌握,避免了EEAT组和ESAT组技术上的弊病,减少了并发症,为肝移植术后康复提供了技术保障。     

改良背驮式肝移植的术式选择

目的 探讨背驮式肝移植手术的术式改良.方法 结合文献介绍之术式,对几种改良术式进行评价.结果 改良背驮式肝移植术式在病肝切除时间、肝流出道重建时间、无肝期及术中出血量等指标上,优于传统背驮式肝移植术;4种改良背驮式肝移植术式中,3种不保留肝静脉干的吻合术式优于保留肝静脉干的吻合术式.结论 供受体下腔静脉吻合的改良背驮式肝移植应为背驮式肝移植的首选术式.     

背驮式肝移植

目的：肝移植治疗肝脏终末期病变。方法：采用改良的背驮式肝移植技术即保留肝后下腔静脉的全病肝切除；将供肝植于受肝原位：供、受体肝上下腔静脉，供、受体体门静脉。供、受体肝动脉行对端吻合；结扎供肝肝下下腔静脉。用FK506、晓悉和强的松三联免疫抑制剂抗排斥反应。加强术后监护和感染的控制。结果：患者目前分别存活6、3月余。基本生活自理。结论：肝移植是治愈肝脏终末期病变的可靠方法。     

改良背驮式肝移植(附8例报告)

目的总结8例改良背驮式肝移植经验。方法从2003年4月实施首例肝移植至2006年4月连续进行了8例肝脏移植手术。原发性肝癌1例,肝炎后肝硬化失代偿期7例,其中2例为重症肝炎肝昏迷。所有病例在手术中均未行转流。供肝的流出道采用缝合供肝下腔静脉两端,部份阻断受体下腔静脉,将受体下腔静脉前壁及供体下腔静脉后壁各纵行剪去一块长约6㎝卵圆形的的血管壁,行侧侧吻合。结果全部肝移植手术获得成功。结论改良背驮式肝移植适合于绝大多数肝移植患者,疗效肯定。     

改良的背驮式肝移植 (附3例报告)

日的：探讨背驮式肝移植的改良技术。方法：对3例肝脏终末期病变行改良背驮式肝移植术。结果：3例病人无肝期均为50分钟，手术时间5．1—5．5小时，病人均未发生供肝输出道梗阻。结论：改良式背驮式肝移植解决了供、受者血管口径不匹配等问题，修正了经典式背驮式肝移植的技术缺陷，避免了移植后出现布加式综合征等并发症。     

经典背驮式肝移植的护理

目前肝移植已成为某些终末期肝病最有效的治疗方法．也是目前器官移植手术中难度最大的，护理较复杂的手术之一．背驮式肝移植不需要体外静脉转流，简化手术操作步骤．保留受体下腔静脉的原位肝移植。即在切除受体的病肝时保留其肝后下腔静脉．将供肝肝上腔静脉与受体肝静脉共干进行吻合，供肝肝下腔静脉进行结扎。术中无需静脉转流．避免了静脉转流引起的并发症和不必需购置价格昂贵的     

背驮式同种原位肝移植术1例报告

报告一位患原发性胆汁性肝硬化合并门静脉高压症的终末期病人作了背驮式同种原位肝移植术，手术获得成功，术后恢复良好。认为该术式由于保留受体的肝后下腔静脉，具有术中血液动力学稳定，肾功能不受影响，术后恢复快等优点，因此可以作为肝移植常规术式。但是对手术前一般情况差或者估计无肝期时间长的病人，采用背驮式手术时应加作门静脉—腋静脉（成人颈静脉）转流。作者提出了改良Ｓｔａｒｚｌ介绍的吻合肝动脉的生长因素法（ＧｒｏｗｔｈＦａｃｔｏｒ），不但适用于小动脉的吻合，也适用于静脉吻合，可以避免或减少吻合血管的狭窄和血栓形成。在胆管重建时强调保证胆管血供的重要性并且放弃了胆总管的Ｔ管引流法，改用经胆囊管插管引流，可以减少胆总管的损伤和术后胆管狭窄的机会。     

改良背驮式肝移植麻醉中电解质的变化及调控

目的 探讨改良背驮式肝移植手术患者围术期电解质的变化及处理方法.方法 4例终末期肝病患者接受改良背驮式肝移植手术,观察围术期不同时间点的血浆钾、钠、钙离子浓度.结果 围术期血钙偏低,血钠在正常范围,血钾在新肝开放时有一过性升高.结论 肝移植患者围术期应采用补充氯化钙、胰岛素、纠正酸中毒等综合措施以维持电解质的稳定.     

背驮式同种原位肝移植的临床研究

对１ 例原发性肝癌患者作了背驮式原位全肝移植术,历时１１ ｈ ３０ ｍｉｎ ,手术获得成功。病肝的切除采用“左右翻转法”,肝静脉重建采用供肝肝上下腔静脉与受者下腔静脉行端侧吻合,其夹角宜在３０⒓～４５⒓。术中在无体外静脉转流的情况下,血流动力学保持平稳,术后恢复良好。术后第６１ 天因胸、腹腔广泛转移死于呼吸衰竭。认为背驮式原位肝移植对全身血流动力学干扰较小,但对较晚期肝癌应慎重。     

改良犬原位背驮式肝移植模型的建立

目的介绍一种改良犬背驮式原位肝移植(PBOLT)动物模型.方法选择40只本地杂交犬,体质量10～17 kg,供体质量小于受体3～5 kg,共实施改良PBOLT 20例次.供体手术依次游离肝脏、冷灌注、切肝、修肝和4℃Euro-Collins保存.受体手术切除门静脉左支供血的肝叶,以供肝肝上腔静脉与受体肝左静脉端端吻合,供肝门静脉主干与受体门静脉左支端端吻合,端端吻合肝动脉,胆道置管外引流,最后结扎门静脉右支,切除剩余的肝叶.结果20例肝移植术后全部苏醒,存活时间48 h以上4例、24 h以上6例、24 h内死亡10例.手术无肝期0 min,失血(190±55)ml,输血(300±100)ml,术中血流动力学稳定,无胃肠淤血发生.结论改良犬PBOLT模型术中无需转流或分流,血流动力学稳定,胃肠道无淤血,肾功能保护好,可用于临床前技术训练和实验研究.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.