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超声心动图在特殊类型房间隔缺损封堵术中的应用 总被引:7,自引:1,他引:6
目的 报告利用超声心动图引导下经导管房间隔缺损封堵术(TCASD)治疗特殊类型房间隔缺损(ASD)的体会. 方法 收集ASD病例229例,经胸和(或)经食管超声心动图(TTE、TEE)行术前筛选、ASD残边评估、封堵器(ASO)型号选择和术后随访观察. 结果 ①边缘不全型ASD 141例,其中前上缘残端不全型123例,成功封堵119例(96.75%);上腔静脉残端不全型10例,均成功封堵(100%);下腔静脉残端及后壁残端不全型8例,成功封堵4例(50.00%);②巨大房缺9例,6例封堵成功(66.67%).TEE测ASD最大径(36.30±1.90)mm (34~38 mm),植入ASO大小为(39.60±2.20)mm (36~42 mm);③多孔型房缺11例,其中双孔型8例,三孔型3例,均成功封堵(100%),残余分流3例(27.27%),术后12个月均消失;④合并ASA 12例,其中多孔型4例,均成功封堵(100%),术后即刻残余分流2例,术后12个月随访均消失. 结论 TCASD治疗特殊类型ASD是安全、可行的,术前尽可能采用TEE了解ASD解剖细节是此类手术顺利成功的保证. 相似文献
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经尿道2μm激光前列腺剜除术治疗良性前列腺增生的疗效分析 总被引:1,自引:0,他引:1
目的 探讨2μm激光剜除技术治疗BPH的疗效.方法 BPH患者107例,年龄52~85岁,平均(67±9)岁.其中伴尿潴留者10例.超声检查测量前列腺体积45~158 ml,平均(72.5±17.6)ml.行RevoLix 2 μm 激光前列腺剜除术治疗.硬膜外阻滞麻醉或全麻.术中首先从膀胱颈5、7点位置至精阜两侧各纵行切成一条状槽沟,深达包膜,并沿精阜两侧弧形向上继续切开尿道黏膜及黏膜下层至尿道外括约肌内弧线.自精阜前缘开始,切开尿道黏膜,分离找到外科包膜平面,以电切镜鞘前端沿包膜平面钝性剥离,并摆动镜鞘扩大包膜平面,中叶增生明显者采用分割切除.同样在12点的位置纵行切开,深达包膜,以逆行方式自精阜两侧的前列腺尖部组织沿包膜用镜鞘剜除侧叶,至1点和11点处,与12点沟槽汇合并保留条索状蒂,使剜除的腺体固定并悬挂在腺窝内.前列腺体积≤60 ml者直接汽化切除增生腺体为小块组织;体积>60 ml者改用普通电切手件,4%甘露醇持续冲洗,将剜除组织切成小块,用冲洗塑料瓶经镜鞘冲出.观察术中出血情况、手术时间、术后尿管留置时间、排尿情况、最大尿流率及住院时间.结果 107例患者均顺利完成手术.手术时间45~150 min,平均(74±12)min.输血5例.未发生尿道狭窄.1例一过性尿失禁者1个月后恢复.术后随访2~6个月,平均3个月,术后留置尿管4~6 d,手术前后血电解质及血红蛋白浓度差异无统计学意义(P>0.05).最大尿流率由术前(6.3±0.6)ml/s升至(17.5±1.5)ml/s,国际前列腺症状评分及生活质量评分分别从26.4±5.5和4.6±0.5降至9.3±2.1和2.8±0.3,手术前后比较差异均有统计学意义(P<0.01).结论 经尿道2 μm激光前列腺剜除术治疗BPH安全、有效,彻底性甚至优于TURP.Abstract: Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm laser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s, average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinary retention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trenches were cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. The incision continued to the urethral mucosa and submucosa along with the verumontanum bilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then the urethral mucosa at the level of the verumontanum was cut and the surgical capsule plane was identified. A retrograde blunt dissection was made along the surgical capsule plane with the resectoscope sheath front-end, and the sheath was swung from side to side to extend the capsule plane. The significantly enlarged middle lobe was treated with laser vaporization resection. In the same way, a trench was made at the 12 o, clock position, and the lateral lobe were removed by the sheath from the verumontanum level, finally only two cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, so that the removed gland tissue was fixed and hung in the gland fossa. For prostate volume less than 60 ml, the laser vaporization resection was carried out directly. If the prostate volume was greater than 60ml, transurethral resection would be performed instead of laser vaporization resection. With 4% mannitol irrigation, the enucleated prostate tissue was then cut into small pieces and washed out by a Braun plastic bottle through the resectoscope sheath. Intraoperative bleeding, operative time, catheterization time, postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital stay were recorded and analyzed. Results All patients successfully completed the transurethral prostate enucleation. The average operative time was 74±12 min (45-150 min). Five cases required blood transfusion. There was no recorded urethral stricture and no urinary incontinence except for one patient who recovered 1 mon after the operation. The follow-up time was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5 ml/s after the operation. The international prostate symptom score (IPSS) and quality of life (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after the operation, respectively, P<0.01. Postoperative secondary bleeding was not observed. Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasive treatment. Its efficacy is superior to open surgery, and even better than TURP. 相似文献
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输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石 总被引:1,自引:0,他引:1
目的:探讨输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石的疗效及其安全性。方法:2005年1月~2009年12月应用NTrap网篮输尿管镜下配合钬激光碎石术治疗输尿管结石206例,并对临床资料进行分析。结果:一次手术碎石成功195例,成功率94.7%(195/206);10例在碎石过程中结石被冲入肾盏内形成结石残留,术后行ESWL治愈;1例双侧输尿管结石因输尿管狭窄中转开放手术取出结石并切除狭窄段输尿管。所有患者术后无严重并发症发生。结论:输尿管镜下NTrap网篮配合钬激光碎石可以有效防止碎石逆行移位,避免术后结石残留于肾盏,是一种安全、有效的工具。 相似文献
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目的 制备用于全合成新型卡泊芬类环六脂肽抗真菌剂的关键脂三肽中间体4′-烷氧基-1,1′-联苯-4-羧酸脂三肽。方法以L-脯氨酸叔丁酯为原料,依次经与N-(9-芴甲氧羰基)-L-苏氨酸叔丁醚(a)或N-(9-芴甲氧羰基)-L-丝氨酸叔丁醚(b)缩合、脱N-保护基后与N^α-(9-芴甲氧羰基)-N^δ-苄氧羰基-L-鸟氨酸缩合、再脱N“-保护基后与4′-烷氧基-1,1′-联苯-4-羧酸-N-羟基苯并三氮唑“活泼酯”(Ie-If)缩合5步反应制备目标脂三肽1。结果以67.4%~80.0%的总收率合成了8个脂三肽1ae-1ah和1be-1bh,其结构经电喷雾质谱(ESI-MS)和元素分析确证。结论该合成路线具有反应条件温和、操作简便、总收率高的优点。 相似文献
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人造血管覆盖支架经皮介入治疗降主动脉夹层八例 总被引:2,自引:0,他引:2
目的探讨人造血管覆盖支架经皮介入治疗降主动脉夹层的方法。方法对8例降主动脉夹层(Stanford B型)患者行人造血管覆盖支架经皮的介入治疗。经股动脉将美敦立公司Talent主动脉覆盖支架置于降主动脉夹层裂口处,支架自膨胀张开使人造血管覆盖支架固定于裂口附近的主动脉壁上将裂口封闭并阻断血流进入假腔。结果8例患者均获得成功,手术成功率100%。平均随访6个月,所有患者内膜裂口完全封闭,假腔内血栓形成,无内漏,假腔明显缩小。结论人造血管覆盖支架经皮介入治疗降主动脉夹层方法安全可靠。 相似文献
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目的:有研究表明硫化氢(hydrogen sulfide, H2S)能减少缺血再灌注损伤心肌细胞的凋亡,但确切机制不清。文中旨在研究心肌细胞缺氧/复氧( hypoxia/reoxygenation , HR)损伤中,H2 S能否通过调节miR-455的表达和减少内质网应激( endoplasmic reticulum stress , ERS)介导细胞凋亡发挥心肌保护作用。方法原代培养新生SD大鼠心肌细胞,建立心肌细胞HR模型。实验分组:对照组(心肌细胞正常培养27 h);HR 组(将心肌细胞更换不含血清的DMEM液后进行HR处理);H 2S 保护组[心肌细胞缺氧前30 min 给予40μmol/L的NaHS( H2 S前体)预处理,其余处理同HR组]。采用MTT法检测细胞活力,全自动化学分析法检测培养液LDH漏出量,流式细胞仪检测心肌细胞凋亡率,RT-PCR法、蛋白印记法分别检测miR-455及ERS介导细胞凋亡信号通路的标志物葡萄糖调节蛋白78(glucose regulated protein 78, Grp78)和caspase-12的mRNA、蛋白的表达。为检测miR-455是否参与H2 S抑制ERS介导的细胞凋亡,将心肌细胞又分为3组,阴性对照组(转染miR-455阴性对照片段24 h);miR-455模拟剂组(转染miR-455模拟剂24 h),miR-455拮抗剂组(转染miR-455拮抗剂24 h),分别给予40μmol/L的NaHS预处理,再进行HR处理,检测Grp78、caspase-12的表达。结果与HR组比较,H2 S保护组可增加HR损伤的心肌细胞活力[(67.02±6.90)%vs (29.27±5.66)%, P<0.05],减少LDH漏出量[(91.33±10.63)U/L vs (168.17±15.38)U/L, P<0.05],同时降低细胞凋亡率[(13.98±1.90)%vs (24.31±2.79)%, P<0.05]。与HR组比较,H2S保护组可降低HR损伤后细胞Grp78、Grp78 mRNA、caspase-12、caspase-12 mRNA的表达( P<0.05)。与阴性对照组比较,miR-455模拟剂组Grp78、Grp78 mRNA、caspase-12、caspase-12 mRNA表达显著升高,而miR-455拮抗剂组表达则显著下降( P<0.05)。结论 H2 S可通过调节miR-455的表达水平,减少HR损伤心肌细胞的ERS介导的细胞凋亡,发挥其对心肌的保护作用。 相似文献
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目的 对比抗心房颤动(简称房颤)起搏器和普通DDD起搏器治疗阵发房颤的疗效。方法 阵发房颇患者19例植入Vitatron型或ST.JudeAFX抗房颤起搏器,21例植入普通DDD起搏器。结果两组生活质量评分提高分别达63.11%(P〈0.05)。显效率分别为47.4%和14.3%(P〈0.05),有效率分别为73.7%和23.8%(P〈0.05)。900E患者房颤负荷降低程度达58.57%(P〈0.05)。结论 抗房颤起搏器治疗阵发房颤优于普通DDD起搏器,可作为传统治疗方法的重要补充。 相似文献
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