843例肝移植供肝动脉的解剖变异分析

目的 探讨肝移植供肝动脉的解剖类型和避免变异肝动脉损伤的供肝切取及修整方法.方法 回顾性分析2001年4月～2006年7月共计843例供肝切取和修整过程中肝动脉变异资料.结果 在843例供肝中,肝动脉解剖总变异率为20.4%(172/843),其中发生频率最高的是变异肝右动脉来自肠系膜上动脉占6.67%(57/843),其次为肝左动脉来自胃左动脉占6.41%(54/843),来自腹腔干或胃十二指肠动脉占1.66%(14/843),变异肝右动脉来自腹腔干、肝总动脉或胃十二指肠动脉占1.54%(13/843),变异肝左动脉和变异肝右动脉同时存在占0.83%(7/843),肝总动脉来自肠系膜上动脉占1.54%(13/843),肝总动脉来自腹主动脉占0.95%(8/843).结论 肝动脉变异发生率较高,在供肝切取及修整过程中易受到损伤.熟悉肝动脉常见变异类型,并保持肠系膜上动脉主干和腹腔干的完整性是减少供肝变异肝动脉损伤的关键.     

合并供肝动脉变异肝移植肝动脉重建42例临床分析

目的探讨供肝动脉变异对肝移植术后动脉及胆道并发症的影响,总结肝移植肝动脉重建方式。方法查阅我院2005年5月至2015年4月实施的肝移植手术病例210例,其中,合并供肝动脉变异(动脉变异组)42例,未合并供肝动脉变异(非变异组)168例。对病例进行回顾性分析。结果 210例肝移植中,供肝动脉变异42例,变异率20.0%。动脉变异组肝动脉重建后血流均值(174.7±95.1)mL/min,非变异组血流均值(190.9±101.6)mL/min,2组无统计学差异(P=0.519)。共有12例(5.71%)患者发生动脉并发症,其中动脉变异组4例(4/42),非变异组8例(8/168),2者间无统计学差异(χ~2=0.72,P>0.05)。共有25例(11.9%)发生了胆道并发症,其中动脉变异组5例(5/42),非变异组20例(20/167),两组无统计学差异(χ~2=0.05,P>0.05)。结论供肝动脉变异重建不会增加肝动脉及胆道并发症的发生。     

重建肝动脉的大鼠肝移植模型改良的实验研究

目的:探讨稳定、高效地建立肝动脉重建的大鼠原位肝移植模型的手术方法.方法:参照"双袖套"法,在供肝的灌注、切取、肝上下腔静脉吻合等方面进行改良,供、受体肝总动脉间用改良的支架法吻合重建肝动脉血供.结果:共完成大鼠原位肝移植80例,供体手术时间:(40±3)min,受体手术时间:(50±5)min,无肝期时间:(16±2)min,肝上下腔静脉吻合时间:(6～9)min,肝动脉吻合时间:(2～3)min.术中无受体死亡,48 h存活率为96.3%,1周存活率为93.7%,1月存活率为:87.5%.结论:该方法成活率高,稳定性好,是建立肝动脉重建的大鼠原位肝移植模型的理想方法.     

原位肝移植41例报告

目的：探讨肝移植肝动脉重建方式与肝动脉栓塞或吻合口出血的预防与治疗。方法：回顾性分析2001年12月～2007年11月完成的41例肝移植临床资料。供、受者动脉寻找到动脉主干与血管分叉处,剪开分叉处呈喇叭状,注意保护动脉内膜不受损伤。对供肝右肝动脉存在变异者作整形、重建4例,选择动脉内径较粗、内膜完整、口径相匹配的血管进行吻合。结果：1例肝移植术后第6天出现肝动脉吻合口出血,再次手术吻合口修补止血治愈;1例术后第8天肝动脉吻合口血栓形成,经DSA溶栓治疗后吻合口出血,再手术止血,最终死于肝衰竭及DIC;其余39例患者彩超证实未发生肝动脉栓塞或狭窄并存活。结论：肝动脉并发症的防治重点是吻合口的选择、变异血管的重建、操作精细、血管内膜完整、无张力吻合和适当地应用抗凝药物。     

用供体腹主动脉行肝动脉重建小型猪肝移植模型的可行性研究

目的 探讨用供体腹主动脉行肝动脉重建小型猪肝移植模型的可行性.方法 取广西巴马小型猪10头（供、受体各5头）,在取供体时,切取与腹腔动脉相连的一段腹主动脉,在供肝植入时用该段腹主动脉与受体腹主动脉吻合进行肝动脉重建,以获得植入肝理想的入肝血流.结果 5例受体巴马小型猪肝血流再通后在胆管吻合前均见金黄色胆汁流出,受体猪术后24 h均存活,手术获得成功.结论 在巴马小型猪的肝移植术中使用供体腹主动脉进行肝动脉重建是可行的,研究结果 为使用供体腹主动脉进行肝动脉重建的肝移植动物实验研究提供了重要基础.     

原位肝移植血管异常的重建(附二例报告)

作者采用供体髂血管架桥方法成功为受体血管异常 2例(肝动脉变异及门静脉栓塞 )患者完成供肝血管重建 ,术后恢复良好。现报告如下。1　临床资料病例 1:男性 ,12岁 ,肝豆状核变性 (腹型 )导致肝硬化失代偿。受体肝动脉变异 ,左肝动脉来源于胃左动脉 ,右肝动脉来源于肠系膜上动脉 ,管径均细小。利用供体髂动脉一段 ,在肾平面下方与腹主动脉端侧吻合 ,穿横结肠系膜在胰腺前方与供肝的肝固有动脉行端端吻合 ,以重建供肝的肝动脉血供。术后用低分子右旋糖酐及肠溶阿司匹林抗凝 ,随访半年 ,架桥血管通畅。病例 2 :男性 ,45岁 ,肝炎后肝硬化失代偿…     

胃十二指肠动脉解剖变异的多层螺旋CT血管造影研究

目的探讨胃十二指肠动脉(GDA)变异的分型、发生率及表现。方法回顾性分析行上腹部多层螺旋CT血管造影(MSCTA)检查且GDA显示完整者1810例,采容积再现(VR)血管生长技术(AV)对GDA进行重建,以GDA起源和分支的解剖学描述为标准,将变异分为3型:Ⅰ型为起源变异,Ⅱ型为分支变异(IIa型为正常起源于GDA的分支发自其他动脉,Ⅱb型为正常起自其他动脉的分支发自GDA,Ⅱc型为上述2型分支变异的混合表现),Ⅲ型为同时存在GDA起源及分支变异,分析各型的表现及发生率。结果 1810例患者中,GDA变异62例,总的发生率3.43%(62/1810),Ⅰ型10例,发生率0.55%(10/1810);Ⅱ型49例,发生率2.71%(49/1810),其中,Ⅱa型8例,发生率0.44%(8/1810),Ⅱb型28例,发生率1.55%(28/1810);Ⅱc型13例,发生率0.72%(13/1810)。胰横动脉起自GDA的发生率0.44%(8/1810),替代和(或)副右肝动脉起自GDA的发生率1.5%(27/1810),胰十二指肠上动脉起自肝固有动脉、肝右动脉、替代或副肝右动脉的发生率1.0%(18/1810)。结论 MSCTA能清楚显示GDA解剖及变异,准确进行分型。     

104例成人间活体肝移植肝动脉重建

目的 探讨成人间活体肝移植的肝动脉重建技术的经验.方法 自2002年1月至2007年8月,四川大学华西医院施行了104例成人间右半肝活体肝移植,包括98例不含中肝静脉(MHV)的右半供肝肝移植及6例双供肝肝移植(双亲属左半供肝1例,亲属右半肝加亲属左半肝3例,亲属右半肝加尸体左半肝2例),104例受者中男86例,女18例,年龄18～63岁(中位年龄38岁),在供受体间肝动脉的重建中,61例供体右肝动脉与受体肝右动脉吻合,15例与受体肝固有动脉吻合,此外与受体左肝动脉吻合7例,与受体肝总动脉吻合3例,与受体肠系膜上动脉发出的副右肝动脉吻合8例,供体右肝动脉与受体肝总动脉自体大隐静脉间置搭桥5例,受体腹主动脉与供体右肝动脉自体大隐静脉搭桥2例,用尸体冷冻保存髂血管行受体腹主动脉与供体右肝动脉搭桥3例,供体肝动脉直径1.5～2.5 mm,分别采用8-0和9-0 Prolene无损伤血管缝线在手术显微放大镜下完成肝动脉重建.结果 104例成人间右半肝活体肝移植,术后1、7 d发生肝动脉血栓形成2例(1.9%),采用自体大隐静脉肾下腹主动脉至供体右肝动脉搭桥术,恢复供肝血流,痊愈出院.1例1个月后发生肝动脉血栓形成,随访期无临床症状未行处理.术后和随访期末发现肝动脉狭窄、肝动脉假性动脉瘤等并发症.全部病例获得随访,随访时间2～60个月,1、2和3年实际生存率分别为89.3%、76.0%和69.3%.结论 根据供受体动脉解剖情况选择最适宜的重建位置和方式,采用显微外科技术是减少围手术期肝动脉并发症保证供肝存活的关键.     

直视下建立大鼠全血供原位肝移植模型

目的:建立稳定的大鼠全血供原位肝移植模型.方法:单人直视以"二袖套"大鼠原位肝移植模型为基础,将供体的肝固有动脉和受体的肝固有动脉行套入式微血管吻合重建肝动脉血供.结果:20例肝移植大鼠,2 d存活率95%(19/20);1周存活率80%(16/20);1个月存活率70%(14/20).结论:单人直视下采用二袖套法加套入式微血管吻合重建肝动脉血供的方法可建立稳定的大鼠全血供原位肝移植模型.     

食道重建和吻合两种方法的比较

[目的]探讨预防食道吻合口瘘和狭窄的方法。[方法]A组140例患者,采用全胃代食道、丝线全层间断缝合行食道胃吻合食道重建。B组80例患者,采用切除贲门、部分胃小弯侧胃壁制成胃管,使用4-0prolene线全层连续锁边缝合行食道胃吻合食道重建。[结果]吻合口瘘和狭窄发生率A组13.57%,B组2.5%(χ2=5.0098,P<0.05)。[结论]切除贲门、部分胃小弯侧胃壁制成胃管,使用4-0prolene线全层连续锁边缝合行食道胃吻合食道重建显著优于全胃代食道、丝线全层间断缝合行食道胃吻合食道重建。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.