奇静脉的应用解剖学观察

解剖观察了27具成人尸体的奇静脉。奇静脉起始于脊柱的右侧或前方，在上行过程中向左侧偏移率达81．48％，其中部分跨过脊往中线者占59．26％．与一般教科书中描述的沿脊柱右侧上升不一致，这种走行在胸部断层图象检查中奇静脉的定位时应加以注意。     

脊髓缺血性再灌注损伤和预处理保护作用的实验研究

目的：探讨缺血预处理对家兔须缺血性损伤的保护作用。方法：家兔18只，随机分为Ⅰ组（假手术组）、Ⅱ组（缺血预处理组）和Ⅲ组（缺血再灌组），每组6只，Ⅰ组开腹后，在左肾动脉起点以下0．5cm处暴露并分离腹主动脉即关腹；Ⅲ组一次性阻断腹主动脉血流30min，松夹后关腹；Ⅱ组阻断腹主动脉血流5min，松夹后再灌注10min（如此反复2次），最后再持续夹闭腹主动脉30min，松夹后关腹。结果：Ⅰ组术后后肢运动功能全部正常，光镜和电镜检查显示组织结构变化甚微。Ⅲ组术后后肢运动功能发生严重障碍，脊髓组织严重损伤，与Ⅲ组比较，Ⅱ组术后后肢运动功能障碍较轻微，须组织损伤明显减轻，神经功能评价各组差异具有显著性（P12h=0.006和P36h=0.001)。结论：缺血预处理能够促进神经功能的恢复，减轻脊髓组织损伤，提示预处理对脊因再灌注损伤具有保护作用。     

下腔静脉肝下段中断延续为奇静脉的手术治疗

食管上段癌经右侧开胸切除时,可先将奇静脉结扎切断,以便肿瘤切除及淋巴结清扫。但是患者若合并下腔静脉肝下段中断延续为奇静脉并汇入上腔静脉时绝对不能结扎奇静脉。本文报道2例上段食管癌并下腔静脉肝下段中断延续为奇静脉的手术治疗体会如下,供同行参考。     

右锁骨下静脉的应用解剖学研究

病人的急救、长期输液、肠外营养、心导管检查、介入治疗、中心静脉压测定等项目时，采用最多的是中心静脉穿刺置管，而锁骨下静脉口径大，右锁骨下静脉口径粗，管壁和周围组织密切融合，位置固定，借前斜角肌作为安全保护层与其深面的锁骨下动脉、臂丛隔开，位置恒定表浅，具备这些条件为中心静脉的穿刺之首选静脉。本研究的目的是为l临床上行锁骨下静脉穿刺提供应用解剖学资料。     

碱性成纤维细胞生长因子对脊髓缺血／再灌注损伤的保护作用

目的观察碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF）对脊髓缺血／再灌注损伤的保护作用。方法建立大鼠脊髓缺血／再灌注损伤动物模型。实验分对照组、缺血／再灌注组和bFGF组。测定血浆丙二醛、肌酸磷酸激酶、谷草转氨酶和乳酸脱氢酶含量。测定脊髓标本丙二醛、内皮素、细胞线粒体钙含量和组织湿／干重比值。结果缺血／再灌注组与对照组比较,血浆和脊髓的各项生化指标显著增高（P〈0．05）;使用bFGF后,血浆及脊髓各项测定指标较缺血／再灌注组相比明显降低（P〈0．05）。结论bFGF可减轻脊髓缺血／再灌注损伤,对脊髓有保护作用。     

己酮可可碱对兔缺血再灌注损伤脊髓的保护作用及机制

目的： 对己酮可可碱(PTX)在脊髓缺血再灌注损伤中神经元的保护作用及其机制进行初步探讨。方法: 采用日本大耳白兔腹主动脉夹闭法建立脊髓缺血再灌注损伤动物模型，随机分为A组（假手术组，8只）、B组（对照组，20只）、C组（夹闭血管前用药组，20只）、D组（再灌注即刻用药组，20只）。于再灌注后12 h、24 h、48 h、72 h检测血TNF-α活性、组织MPO活性、免疫组化法观察并检测PECAM-1及caspase-3表达、HE染色观察神经元并计数坏死神经元、TUNEL染色观察并计数凋亡神经元、电镜观察坏死及凋亡神经元形态改变，并于再灌注后48 h进行运动功能评分（改良Tarlov评分）。结果: 用药组（C组及D组）改良Tarlov评分明显高于对照组（P<0.05），血TNF-α、组织MPO含量、免疫组化PECAM-1及caspase-3表达强度均明显下降，HE及TUNEL染色切片中坏死细胞及凋亡细胞均明显减少，与对照组有显著差异（P<0.05）。假手术组未见坏死及凋亡细胞。结论: 己酮可可碱在脊髓缺血再灌注损伤中能够发挥抑制神经元坏死及凋亡的双重脊髓保护作用。     

冠状静脉逆行灌注碱性成纤维细胞生长因子的体内浓度梯度

背景：体外研究发现,碱性成纤维细胞生长因子浓度梯度能够促进干细胞的迁移和增殖。然而,采用冠状静脉逆行灌注途径能否建立在体碱性成纤维细胞生长因子浓度梯度尚不明确。 目的：评价冠状静脉逆行灌注实验方法的安全性,建立并检测冠状静脉与局部缺血心肌间的碱性成纤维细胞生长因子浓度梯度,探讨逆行灌注后碱性成纤维细胞生长因子浓度梯度存在的时间窗。 方法：开胸结扎法建立犬急性心肌梗死模型,1周后经冠状静脉逆行灌注碱性成纤维细胞生长因子。灌注结束后球囊充盈时间分别为0,5,10,15 min。解除球囊充盈后即刻处死动物,ELISA法测量血浆和梗死区心肌、梗死边缘区心肌组织匀浆中碱性成纤维细胞生长因子的浓度,在体评价在不同时间点冠状静脉血液与梗死区心肌以及梗死边缘区心肌之间的碱性成纤维细胞生长因子浓度梯度。 结果与结论：逆行灌注成功率为100%,无死亡、心脏压塞和恶性心律失常等并发症发生。灌注后5 min和10 min,冠状静脉血液与梗死区心肌之间碱性成纤维细胞生长因子浓度的差异有显著性意义,梗死区心肌浓度明显高于其他2种组织。球囊充盈15 min后2组之间浓度差异无显著性意义。结果表明,经冠状静脉逆行灌注碱性成纤维细胞生长因子后,球囊充盈的时间为5-10 min能在冠状静脉血液与梗死心肌之间建立稳定的碱性成纤维细胞生长因子浓度梯度,而且在梗死心肌区域浓度最高。此时间窗内灌注干细胞有望增强其移行活力。     

快速检测SEP在手术中脊髓监护的应用

介绍了利用体感诱发电位进行手术中脊髓监护的方法,介绍了手术中脊髓监护的原理及实验系统的构成,给出了利用伪随机序列技术实现快速检测体感诱发电位的算法,实验结果显示,本文的研究较传统方法有一定,值得进一步研究。     

CT检查中对比剂注射部位及延迟扫描时间不同对奇静脉弓瓣显示的影响

目的 探讨CT检查时对比剂注射部位、延迟扫描时间不同对奇静脉弓瓣显示的影响。方法 回顾性研究。纳入2021年11月—2022年2月山东大学齐鲁医院德州医院562例行CT检查的患者的影像学资料。其中,头颈CTA检查276例,男165例、女111例,年龄10~84（62.3±10.9）岁,左肘注射对比剂18例,右肘注射258例;胸部增强CT检查286例,男179例、女107例,年龄11~85（61.7±11.3）岁,均为右肘注射对比剂。观察项目：（1）比较不同部位（左、右肘）注射对比剂时奇静脉弓瓣显示率的差异;（2）观察胸部增强CT检查患者的动脉期（短延迟扫描时间）与静脉期（长延迟扫描时间）奇静脉弓瓣显示率的差异。（3）观察奇静脉弓瓣的形态。结果 （1）左肘注射18例患者中有1例（1/18）显示奇静脉弓瓣,右肘注射的544例患者中245例（45.04%,245/544）显示奇静脉弓瓣,右肘注射显示率明显高于左肘注射,差异有统计学意义（χ²=11.03,P=0.001）。（2）胸部增强CT检查中,短延迟扫描时间奇静脉弓瓣显示率为28.32%（81/286）,高于长延迟扫描时间的显示率（2.10%,6/286）,差异有统计学意义（χ²=75.00,P<0.001）。（3）562例患者共显示奇静脉弓瓣246例,其中二叶瓣（224例）明显多于三叶瓣（22例）。二叶瓣的患者中,两个瓣叶的排列方向呈左右垂直奇静脉弓排列188例、呈上下垂直奇静脉弓排列36例。结论 CT检查中,右肘注射对比剂、短延迟扫描时间时奇静脉弓瓣的显示率更高。奇静脉弓瓣有二叶瓣和三叶瓣,其中二叶瓣更常见,其2个瓣叶的排列方向以左右垂直奇静脉弓为多。     

深低温停循环下双侧脑灌注对DeBakeyI型夹层手术患者的脑保护作用

急性主动脉夹层DeBakeyⅠ型病情危重，死亡率高，多采用深低温停循环下手术。由于脑组织对缺血缺氧非常敏感，停循环易致中枢神经功能障碍，深低温停循环期间的脑灌注保护对保证手术成功至关重要。本文报道DeBakeyⅠ型主动脉夹层患者在深低温停循环期间行选择性单侧或双侧顺行脑灌注保护效果。     

A newly developed cerebral perfusion catheter for aortic arch operation

The object of this study was to develop a better catheter for selective cerebral perfusion during aortic arch operation. Flow through the catheter was evaluated in an in vitro study under 40 mmHg pressure at 25°C using 40% glycerin when the catheter was straight or right-angled with either a gentle or a sharp curve. Two catheters of 14, 16, or 18 French were connected with a Y-shaped tube, and the flow through each catheter was tested in the same way when the catheters were straight or right-angled. Moreover, we evaluated the operative outcome using this new catheter in 38 patients who underwent total arch replacement. The correlation between right radial artery pressure and catheter tip pressure was examined in 17 of these 38 patients. The difference in oxygenation between the right and left hemispheres was also exmained by two-channel nearinfrared spectroscopy. The results showed that flow through the catheter was almost identical, regardless of the type of its configuration. When two catheters of different sizes were connected with a Y-shaped tube, the total flow and flow ratio between the two catheters were also similar in both the straight and the right-angled configuration. As regards the clinical outcome, there were no in-hospital deaths, no permanent neurological dysfunction, and one temporary neurological dysfunction. Dissociations between right radial artery pressure and catheter tip pressure were seen in 3 of the 17 patients. No difference in oxygenation between the two hemispheres was found. We conclude that the new catheter provided an uncluttered operative field and may contribute to improved surgical results.     

逆灌注脑保护技术研究与进展

脑逆灌注技术 (RCP)是一种较新的脑保护措施 ,它从静脉系统逆行灌注氧合血到脑组织。在心血管手术中体循环停止时 ,利用该技术可向大脑提供富氧血 ,延长脑缺血耐受时限 ,为手术赢得更充裕的时间 ;同时它也可在脑卒中时缩短脑再灌流时间 ,从而延长脑卒中治疗的时间窗 ,提高药物治疗的疗效。本文概述了该技术近 2 0年的发展状况及临床应用 ,并对未来的发展方向进行了展望。     

不同神经示踪剂组合对大鼠脊髓运动神经元的逆行标记效率比较

目的:探讨神经示踪剂荧光金(FG)、真蓝(TB)和荧光红(FR)两两组合对脊髓运动神经元的标记效率差异,为再生神经重支配准确性研究奠定基础.方法;采用大鼠胫神经示踪模型,采取神经内注射与神经横断后近侧断端浸泡(20 min)2种方式,分别对FG、TB和FR的两两组合进行示踪试验.示踪术后5d,取脊髓腰膨大段冷冻纵切,共聚焦显微镜进行显微成像和计数.结果:FG联合TB示踪标记的运动神经元数量最多,其次为FG联合FR,而FR联合TB组标记细胞数最少,双标比例也最小.神经断端浸泡方式使用示踪剂时标记效率仅为神经内注射的2/3左右.结论:FG联合TB以及FG联合FR示踪对脊髓运动神经元的标记效果较好,且神经内注射使用示踪剂效果优于持续20 min的神经断端浸泡.     

成年家犬胸腰段脊髓营养动脉的解剖学研究

目的 :了解成年家犬胸腰段脊髓营养动脉的数目、管径和配布特点。方法 :7只成年家犬动脉灌注乳胶后取脊髓全长 ,对其胸腰段脊髓营养动脉进行观测。结果 :胸腰段脊髓的前根髓动脉 (12 .6± 2 .1)条 ,管径 (0 .2 182± 0 .0 773 )mm ,基本不成对分布 ,左侧者居多 ;最大前根髓动脉位于中腰髓 ,管径 (0 .3 83 6± 0 .0 3 3 1)mm ,动脉干长 (9.17± 1.68)mm。胸腰段脊髓后根髓动脉数目 (12 .7± 3 .4)条 ,管径 (0 .1663± 0 .0 3 72 )mm ,多不成对分布。前正中动脉在胸髓较细 ,管径为 (0 .14 68± 0 .0 2 5 2 )mm ,在腰髓较粗 ,管径为 (0 .2 677± 0 .0 414 )mm。两条后外侧动脉均较细 ,其间多吻合。结论 :与人类不同 ,成年家犬胸腰段脊髓动脉血供相当丰富 ,以犬为实验动物 ,制作急性脊髓缺血损伤模型时必须考虑到被阻断血流动脉的级别、节段、侧别、数目等因素对局部脊髓血供的影响。     

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

This study develops a means of delivering electrical stimuli directly to the pial surface of the spinal cord for treatment of intractable pain. This intradural implant must remain in direct contact with the cord as it moves within the spinal canal. Therefore, magnetic resonance imaging was used to measure the movement of the spinal cord between neutral and flexed-back positions in a series of volunteers (n?=?16). Following flexion of the back, the mean change in the pedicle-to-spinal cord dorsal root entry zone distance at the T10-11 level was (8.5?±?6.0) mm, i.e. a 71% variation in the range of rostral-caudal movement of the spinal cord across all patients. There will be a large spectrum of spinal cord strains associated with this observed range of rostral-caudal motions, thus calling for suitable axial compliance within the electrode bearing portion of the intradural implant.     

There is no loss of motor neurons in the rat spinal cord during postnatal maturation

Motor neurons are lost during embryonic development, but it remains controversial whether motor neuron cell death occurs during postnatal life. In this study we investigated the effect of postnatal maturation on the number of intact spinal motor neurons in the rat using retrograde labelling with model-based counting, and an unbiased stereological counting technique. To determine the number of motor neurons innervating a specific forelimb muscle in rats of different postnatal ages FluoroGold was injected into the flexor carpi radialis. Before postnatal day 21 there were higher numbers of retrogradely labelled motor neurons than in adult rats, suggesting a 'loss' with postnatal maturation. This loss may be attributed to tracer diffusion to adjacent muscles and to the permeability of the muscle spindle capsule in younger animals. To obtain an unbiased estimate of the number of motor neurons in the C7 and C8 segments of the postnatal rat cervical spinal cord the fractionator/optical disector counting technique was used. This method did not show a loss of spinal motor neurons between birth and adulthood. The main conclusion from this study is that there is no loss of spinal motor neurons during postnatal maturation.     

杂交手术治疗累及弓部的主动脉夹层的临床研究

目的 探讨杂交手术治疗累及主动脉弓部的主动脉夹层的方法及疗效.方法 自2009年1月至2012年1月,成都军区总医院共对16例累及主动脉弓部的主动脉夹层患者完成了杂交手术治疗.其中男性11例,女性5例,年龄50～72岁[(56.3±7.1)岁].Stanford A型主动脉夹层(夹层起源于升主动脉)5例,B型夹层(夹层起源于降主动脉)11例,病变均累及主动脉弓,不适宜单独行腔内隔绝治疗.11例采用胸骨正中切口或加颈部切口行升主动脉至头臂动脉旁路移植,5例单纯颈部切口行头臂动脉间旁路移植,然后行股动脉切口逆行主动脉腔内覆膜支架植入.术后即刻行升主动脉造影,术后3个月、1年及2年随访CT资料,观察支架和人工血管通畅情况.结果 所有患者均成功完成血管旁路手术,并植入覆膜支架.术中血管造影证实支架植入定位准确,无明显内漏和移位.主动脉夹层真腔血流恢复正常,旁路血管血流通畅,围手术期无死亡和严重并发症发生.随访16例,随访时间3.0 ～ 48.0个月[(24.O±8.2)个月],所有患者均生存,并恢复正常生活.术后3个月和术后1年、2年复查主动脉增强CT示:支架无移位和内漏,支架内及人工血管旁路血流通畅,未见脑部和肢体的缺血征象.结论 累及弓部的主动脉夹层可根据受累的部位及程度采用不同的杂交手术方法,杂交手术治疗累及主动脉弓部的主动脉夹层安全、有效,能明显减轻患者的创伤和痛苦,该治疗方法扩大了介入覆膜支架腔内治疗的适应证,但远期疗效有待迸一步观察.     

Identification of neuroanatomic circuits from spinal cord to stomach in mouse: retrograde transneuronal viral tracing study

To determine the spinal innervation and neuronal connections is important for studying gastric carbohydrate metabolism and motor responses. Neurons involved in the efferent control of the stomach were identified following visualization of pseudorabies virus (PRV)-614 retrograde tracing. PRV-614 was injected into the ventral stomach wall in 13 adult C57BL/6J strain male mice. On the fifth day postinjection, animals were humanely sacrificed, and spinal cords were removed and sectioned, and processed for PRV visualization. The virus injected into the ventral stomach wall was specifically transported to the thoracic spinal cord. At 5 d after injection of the PRV-614, stomach enlargement and tissue edema were found, and PRV-614 positive cells were found in the intermediolateral cell column, the intercalates nucleus or the central autonomic nucleus of spinal cord segments T3 to L1, and major PRV-614 labeled cells were focused in the T6-10 segment. Our results revealed neuroanatomical circuits between stomach and the spinal intermediolateral cell column neurons.     

Use of a soft reservoir bag in a fully heparin-coated closed-loop cardiopulmonary bypass system for distal aortic perfusion during aortic surgery

A fully heparin-coated closed-loop cardiopulmonary bypass system has recently been introduced into clinical practice. Without a venous reservoir, however, it does not allow control of the preload to the heart. We connected a soft reservoir bag in parallel with a centrifugal pump to enable preload control and clinically evaluated this modified system for distal aortic perfusion during aortic surgery. We have used the modified system in 17 patients since November 2002. For venous drainage, we use long narrow cannulae (21 ± 2 French). We administered 1 mg/kg heparin without cardiotomy suction and 2 mg/kg heparin with suction. We compared the clinical results with those in 13 patients who underwent distal aortic perfusion with an open cardiopulmonary bypass circuit between January 2002 and February 2004. We also analyzed factors affecting the coagulation system in these 30 patients using multiple regression analysis. With the modified system, venous drainage was adequate despite the use of smaller cannulae, and heparin reduction was not associated with thrombotic complication or elevated D-D dimer levels. Abrupt rises in proximal aortic pressure on aortic cross-clamping could be avoided by allowing blood to drain into the soft reservoir bag. Clinical results were not different from those with an open system. In the multiple regression analysis, the peak activated clotting time tended to correlate with postoperative platelet counts. This system is effective in controlling the preload to the heart and allows the safe reduction of heparin dosage. It therefore seems useful for distal aortic perfusion during aortic surgery.