保留幽门胰十二指肠切除术10例分析

目的：探讨保留幽门的胰十二指肠切除术的疗效及该技术并发症的发生率.方法：本组共10例,均行保留幽门的胰十二指肠切除术,术后病理报告均为腺癌.结果：全组病人术后无胃排空延迟,无胆漏、胰漏、肠漏,无消化道出血发生.全组病例痊愈出院.结论：保留幽门不影响胰头癌及壶腹周围癌根治的彻底性.本组病例术后胃肠功能恢复早、进食早,并发症少,死亡率低,是一种有广泛应用前景的术式.     

幽门及十二指肠上部的血供及其临床意义

目的：为保留幽门的胰十二指肠切除术提供解剖学基础。方法：对30例成年尸体标本幽门、十二指肠上部的血供进行解剖学观测。结果：幽门、十二指肠上部的血供主要来自于幽门十二指肠干100％（30例）、十二指肠胰干79％（24例）、十二指肠上动脉、胃右动脉幽门支及胰十二指肠上后动脉的分支。结论：在PPPD术中，注意保护上述动脉及其分支，是防止PPPD术后十二指肠残端缺血的关键。     

保留幽门胰十二指肠切除术在胰腺癌手术中的应用

目的探讨保留幽门胰十二指肠切除术(PPPD)在胰腺癌手术中的临床应用价值。方法回顾性分析98例胰腺癌手术患者的临床资料,将行胰十二指肠切除术(PD)的患者40例设为对照组,行保留幽门胰十二指肠切除术(PPPD)的58例患者为观察组,观察2组患者的临床疗效。结果 PPPD组患者手术时间明显短于PD组,胃排空延迟的发生率明显高于PD组(P0.05),但是2组患者术中输血、术后住院时间、淋巴结清扫总数和5、6组淋巴结数、术后并发症的发生率及1年生存率均无明显差异(P0.05)。结论 PPPD与PD疗效相似,不影响手术根治性,但PPPD保留了胃的贮存和消化功能,能提高患者远期生活质量。     

胰十二指肠下动脉来源变异1例

笔者在局部解剖学解剖1具成年男性尸体标本时,发现其胰十二指肠下动脉起点高,行程复杂,现报道如下.该例标本的胰十二指肠下动脉起于腹腔干,垂直向下走行1.7 cm,在胰颈背面分出2个分支,经左肾静脉前方,于胰颈下缘穿出,其中右支向右下行,经肠系膜上动、静脉后方分布于胰头及十二指肠降部;左支偏左下行,分出下级分支分布于十二指肠水平部.     

喉返神经的应用解剖学

本文解剖115例喉返神经,从临床应用角度出发。对喉返神经的横径,终未分支;喉返神经与甲状软骨下角,甲状腺下动脉,气管食管沟,甲状腺,喉返神经三角的局部关系进行了研究。提出甲状软骨下角,气管食管沟,喉返神经三角是识别喉返神经的简便,可靠、实用的标志和手术中避免损伤喉返神经的解剖学依据。     

小儿十二指肠的年龄解剖学研究

分六个年龄组观察了180具（男98，女82）小儿尸十二指肠的形态，位置，度量及其与腹膜的关系，小儿十二指肠的形状分四型：I组多为“C”型，Ⅱ-Ⅵ组多为“U”型，小儿十二指肠长度以I－Ⅳ组增长较快，小儿十二指肠起，止部位与椎骨的对应关系与成人基本一致。     

咽升动脉分支的解剖分组及其临床意义

目的:探讨咽升动脉及其主要分支在颈部颅底区域走行规律及其在血管内外治疗中的临床意义。方法:选择以10%甲醛固定并用乳胶灌注的8具（16侧）成人颅颈部标本,自颈总动脉分叉水平向上解剖至颅底骨质,分离显露咽升动脉及周围相关结构,观察咽升动脉的起源部位及主要分支,测量相关解剖学参数。依据咽升动脉主要分支与颈动脉鞘的位置关系分...     

胰头与十二指肠的血供关系及其临床意义

目的　了解胰头及十二指肠的血管走行,为在DPPHR术中如何保护十二指肠的血供及是否行Kocher操作提供更多的形态学资料。 方法　随机选取40具尸体,充分解剖暴露肠系膜上动脉、胃十二指肠动脉及胰十二指肠前后动脉弓,对供应十二指肠的动脉及伴行的静脉行径进行仔细观察和记录。 结果　在97.5%的标本中（n=39）, 胰十二指肠后动脉弓及伴行的静脉均位于胰后筋膜内;在90%的标本中（n=36）, 胰十二指肠下前动脉及伴行的静脉走行于胰十二指肠沟内,易于保留;在个别标本中（10%, n=4）, 没有完整的胰十二指肠前动脉弓;其中1例标本（2.5%,n=1）,没有完整的胰十二指肠后动脉弓,但供应十二指肠的动脉及其伴行静脉仍位于胰后筋膜内。 结论　DPPHR手术的关键在于保留胰十二指肠后动脉弓,同时尽可能地保留部分胰十二指肠前动脉弓,而Kocher操作有利于保护胰十二指肠后动脉弓;在个别标本中,没有完整的胰十二指肠前动脉弓,此时施行DPPHR可能伤及十二指肠血供,导致手术失败。     

子宫动脉上行支的解剖学研究及临床意义

目的:为设计保留子宫动脉上行支及卵巢支的子宫剥除术式提供解剖学依据。方法:随机收集108例新鲜离体子宫连带一侧或双侧附件标本,解剖观测子宫动脉上行支及其各分支的起点外径、位置和分布走行;观察上行支主干与宫壁肌层间紧密度。结果:子宫动脉上行支主干左为(2.81±0.57)mm,右为(2 86±0.56)mm;卵巢支左为(2.00±0.50)mm,右为(1.74±0.51)mm;输卵管支左为(1.33±0.40)mm,右为(1.23±0.43)mm;宫底支左为(1.66±0.39)mm,有为(1.63±0.41)mm。在宫角部上行支的分支分布类型有3型Ⅰ型占58％,Ⅱ型占34％,Ⅲ型占8％;卵巢支分支部位在圆韧带附着子宫角下缘后方至下方3cm之间;上行支主干与宫颈峡部接触较为紧密且呈较大幅度迂曲状,向上行走后逐渐平直且与子宫壁间渐为疏松,至卵巢支分支处大约有0.5 cm。结论:子宫动脉上行支及卵巢支管经较粗,且与子宫外壁保持一定间距,经临床实践,在保留卵巢的子宫切除手术中可完整保留,且不必连带子宫肌层。     

Development of the coronary arteries and cardiac veins in the dogfish (Scyliorhinus canicula)

The development of the coronary system in the Dogfish was studied using light microscopy. The sample examined consisted of 44 embryos and four newborns. The chronology of events occurring during the process was referred to the total length (TL) of the specimens. The nourishment of the developing myocardium first takes place by means of intertrabecular sinusoids. This system is later switched to a circulation through coronary vessels. The cardiac veins develop earlier than the coronary arteries. The earliest evidence of development of heart vessels in the present sample was the appearance of a diverticulum from the sinus venosus in three embryos of 31 mm TL. This diverticulum outlined the future coronary sinus. Both the atrioventricular and conoventricular venous rings were completely developed in an embryo of 36 mm TL. Coronary artery vessels appeared for the first time in embryos of 40 mm TL. In these specimens, two arteries arose from the midventral hypobranchial artery and divide to give rise to the four coronary artery conal trunks. In a 51-mm TL embryo it was already possible to follow the course of the coronary arteries, from the hypobranchial artery to the conoventricular groove. All main coronary vessels were fully developed in embryos of more than 58 mm TL. However, the arteries supplying the atrium were firstly recorded in a newborn of 77 mm TL. Birth usually occurs when the shark reaches about 72–76 mm TL. © 1993 Wiley-Liss, Inc.     

升主动脉缩窄鼠升主动脉瘤的扫描电镜观察

目的：观察升主动脉缩窄鼠升主动脉瘤的形态特征，为动脉瘤的临床和实验研究提供资料。方法：以幼年wistar大鼠制作升主动脉缩窄鼠动脉瘤模型，取出动脉瘤，用扫描电镜观察。结果：动脉瘤的弹力板出现肥大、断裂，弹力板间的弹力纤维广泛破坏；动脉瘤壁中有炎性细胞浸润；平滑肌细胞大部分萎缩或消失；动脉瘤内皮严重受损，部分动脉瘤壁中有红细胞浸润。结论：动脉瘤存在超微结构的改变，提示以上形态学改变是动脉瘤发生的重要病理学基础。     

先天性纠正性大动脉换位的病理特点分析

目的　采用彩色多普勒超声心动图分析先天性纠正性大动脉换位的病理分型和合并畸形,研究该病病理特点。  方法 　2000年1月-2012年6月,40例经心血管造影或CT或手术证实为先天性纠正性大动脉换位(CCTGA)的患儿纳入研究,首次诊断年龄2天~4岁7月(平均年龄1.6±1.3岁),采用节段诊断法进行诊断。  结果　S.L.L（心房正位,心室左袢,主动脉左位）28例,均为左位心,I.D.D（心房反位,心室右袢,主动脉右位）12例,4例为左位心,8例为镜像右位心;合并畸形中最常见的是三尖瓣畸形导致的关闭不全（27例,67.5%）,其次是室间隔缺损（15例,37.5%）和肺动脉瓣狭窄和/或肺动脉瓣下狭窄导致的左室流出道狭窄（14例,35%）;室间隔完整25例的患儿全部合并三尖瓣畸形导致的关闭不全,无1例合并左室流出道狭窄;室间隔缺损的15例患儿14例（93.3%）合并肺动脉瓣狭窄和/或肺动脉瓣下狭窄导致的左室流出道狭窄,仅2例合并三尖瓣畸形导致的关闭不全（13.3%）。  结论　S.L.L是先天性纠正性大动脉换位最常见的分型、三尖瓣畸形导致的关闭不全,室间隔缺损和肺动脉瓣狭窄和/或肺动脉瓣下狭窄导致的左室流出道狭窄是最常见的合并畸形,室间隔完整的CCTGA最常合并三尖瓣畸形导致的关闭不全,伴有室间隔缺损的CCTGA最常合并肺动脉瓣狭窄和/或肺动脉瓣下狭窄导致的左室流出道狭窄。     

Surgical pathology of chronic ascending aortic dissections

AIMS: A majority of aortic dissections affect the ascending aorta and are acute in nature. Chronic dissections in this region are uncommon. This report characterises the clinicopathological features of 15 non-iatrogenic chronic ascending aortic dissections. METHODS: Among 65 patients who had surgery for ascending aortic dissection over a period of 6 years, 15 showed morphological evidence of chronic dissection. Clinical data and morphological features of these were analysed. RESULTS: Twelve patients (80%) were over the age of 50 years, with a male predominance (11 patients, 73.33%). Exertional dyspnoea was the most common presenting symptom, while chest pain was noted in three cases. An echocardiographic diagnosis of dissection was made in six patients. The disease was restricted to the ascending aorta in nine (60%) and all had aortic regurgitation of varying severity. Areas of recent dissection were also noted in three specimens. The risk factors or pathogenetic mechanisms noted were hypertension in four and Marfan's syndrome, penetrating atherosclerotic ulcer, patent ductus arteriosus, and vehicular accident, in one patient each. The aortic segment of the latter patient had shown intimal flaps to be associated with multiple saucer-shaped depressions with thin walls. These features were also noted in two of the seven patients without risk factors and in two hypertensives. This raises the possibility of subclinical intimal injury sustained during sudden deceleration with blunt chest trauma. Significant aortopathy was seen in 10 cases. CONCLUSIONS: Chronic dissections as a cause of aortic regurgitation and aneurysmal dilatation, especially in the elderly, should be kept in mind. This may follow sudden deceleration intimal injuries, superimposed on aged-related medial degeneration.     

The Euro-Team Early Pregnancy (ETEP) protocol for recurrent miscarriage

The underlying causes and rationale for treatment of recurrentabortion are not entirely clear. The Euro-Team early pregnancyprotocol was developed as a diagnostic work-up based on theevaluation of risk factors. Possibilities for therapy can bebased only on the expectancy that elimination of some risk factorsmay improve the prognosis.     

Cervical Carotid and Circle of Willis Arterial Anatomy of Macaque Monkeys: A Comparative Anatomy Study

Macaque monkeys are used in many research applications, including cerebrovascular investigations. However, detailed catalogs of the relevant vascular anatomy are scarce. We present our experience with macaque vessel patterns as determined by digital subtraction angiography of 34 different monkeys. We retrospectively analyzed digital subtraction angiograms obtained during experimental internal carotid artery (ICA) catheterization and subsequent injection of 1‐methyl 4‐phenyl 1,2,3,6‐tetrahydropyridine. Results were catalogued according to vascular distribution and variants observed. Macaque monkeys have a bovine aortic arch. The carotid vessels generally bifurcate, but are occasionally observed to divide into three vessels. The external carotid gives rise primarily to two trunks: an occipital branch and a common vessel that subsequently gives off the lingual, facial, and superior thyroid arteries. The internal maxillary artery may be present as a terminal branch of the external carotid or as a branch of the occipital artery. The ICA is similar in course to that of the human. The anterior circle of Willis was intact in all monkeys in our study. Its primary difference from that of the human is the union of the bilateral anterior cerebral arteries as a single (azygous) median vessel. Macaque cervical carotid and circle of Willis arterial anatomy differs from humans in a couple of specific patterns. Knowledge of these differences and similarities between human and macaque anatomy is important in developing endovascular macaque models of human diseases, such as ischemic stroke. Anat Rec, 2009. © 2009 Wiley‐Liss, Inc.     

Spontaneous rupture of non-aneurysmal ascending aorta

Two autopsy cases with pericardial tamponade and spontaneous rupture of non-aneurysmal ascendlng aorta are described. In case 1, no apparent predisposing factor was clinically noticed in a 74 year old male patient, but postmortem examination revealed laceration of the ascending aorta associated with aortic valvular deformity and slight dilatation of the ascending aorta. In case 2, a 61 year old man, a mild to moderate grade of aortic regurgitation was noticed clinically 5 months before death. Postmortem examination revealed a slight dilatation of the aortic annulus and post-valvular portion of the ascending aorta. These two cases emphasize the clinical significance of aortic valvular disease with subsequent disordered blood flow, even when asymp tomatic, as a potential causative factor for spontaneous rupture of the ascending aorta.     

Immunology: Outcome of pregnancy in women with recurrent spontaneous abortion following immunotherapy with allogeneic lymphocytes

The efficacy of immunotherapy in the prevention of habitualabortion remains controversial. It has been suggested that thebenefits are predominantly due to psychological factors. Wehave evaluated the success of pregnancy outcome following immunotherapywith allogeneic lymphocytes, in relation to the subsequent developmentof anti-paternal cytotoxic antibodies (APCA). It was observedthat in women who developed an APCA titre of 1:16, live birthsoccurred in 16 out of 21 cases (76%), while only two out ofseven (28%) women who failed to achieve an APCA titre of 1:16had successful pregnancies (P <0.05). In eight women whohad an APCA titre of 1: 16 on initial screening, and were, therefore,excluded from the trial, successful pregnancy outcome was notedin 62.5% of cases. Although these results are based on a smallsample and on an open, non-randomized trial, they show thatthe efficacy of immunotherapy is related to immune responseto allogeneic lymphocytes, and is not simply a placebo effect.Measurement of APCA titre could serve as a marker for immunopotentiation.     

复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎的临床观察

目的观察并评价阴道应用复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎（RVVC）的疗效。方法对500例RVVC患者阴道应用复方沙刺籽油栓每晚一粒，每月用12天，共6个月，观察疗效及副反应。结果①第一次复诊时治愈率为93．20％，第二次复诊时97．40％。②患者满意和较满意在第一次复诊可达90％，第二次复诊时达98％。③无严重不良反应发生。结论阴道应用复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎（RVVC）有效、安全且依从性好。