小肠内固定术治疗粘连性肠梗阻

目的评价小肠内固定术治疗粘连性肠梗阻的疗效。方法回顾性分析28例粘连性肠梗阻行小肠内固定术患者的临床资料。结果28例患者中有5例发生切口感染,无手术死亡和小肠瘘发生。其中25例患者平均随访23.6个月,1例肠梗阻复发,保守治疗后好转。结论小肠内固定术是治疗预防粘连性肠梗阻可行、有效的方法,但需要注意手术操作细节。     

不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.     

肱骨远端复杂AO-B3型骨折的内固定治疗

目的探讨肱骨远端复杂AO-B3型骨折的手术方法及治疗效果。方法回顾性分析自2009年1月至2017年1月三个创伤中心收治的肱骨远端复杂AO-B3型骨折手术患者26例,男9例,女17例;患者年龄19~75岁,平均43.6岁。采用肱骨远端后外侧入路18例,鹰嘴截骨入路8例。单纯采用Herbert螺钉固定14例,Herbert螺钉结合克氏针固定5例,Herbert螺钉结合肱骨远端外侧解剖钢板固定7例。功能评估采用肘关节活动度(屈曲、伸展、旋前和旋后)、Mayo肘关节功能评分、患者主观满意度视觉模拟评分(visual analogue scale,VAS)。结果所有患者获得随访,随访时间1.5~5.5年,平均2.6年。随访结束时肘关节活动度屈曲(132.0±16.5)°,伸展(5.0±9.0)°,旋前角度(85.5±7.2)°,旋后角度(70.2±5.8)°;Mayo肘关节功能评分(94.2±3.0)分,主观满意度VAS(8.2±1.6)分。其中1例患者内固定松动,骨块移位,再次手术复位内固定。所有骨折完全愈合,其中5例出现肘关节僵硬,经功能锻炼后恢复正常,无感染和血管、神经损伤,无异位骨化。结论肱骨远端复杂AO-B3型骨折需采用手术切开复位内固定,Herbert螺钉是有效的固定方式,有时需结合克氏针及钢板才能取得可靠的固定效果,配合术后早期积极的功能康复,可取得良好的临床效果。     

G蛋白偶联受体激酶相互作用蛋白1对BMSCs向内皮细胞分化的影响机制研究北大核心CSCD

目的通过比较G蛋白偶联受体激酶相互作用蛋白1(G protein coupled receptor kinase interacting protein 1,GIT1)野生型及GIT1基因敲除型小鼠BMSCs向内皮细胞分化过程,探讨GIT1影响血管形成的机制。方法 GIT1杂合子小鼠雌雄配对饲养,对获得的新生小鼠采用PCR法行基因型鉴定。取GIT1野生型与GIT1基因敲除型小鼠胫骨及股骨,分离培养BMSCs并传代。取第2代BMSCs分为4组,分别为野生型对照组(A组)、野生型实验组(A1组)、基因敲除型对照组(B组)、基因敲除型实验组(B1组);A1、B1组细胞采用内皮细胞诱导液培养,A、B组细胞进行常规培养。Western blot检测各组细胞VEGF受体2(VEGF receptor 2,VEGFR-2)、VEGFR-3、磷酸化VEGFR-2(phospho-VEGFR-2,p VEGFR-2)、p VEGFR-3蛋白表达;流式细胞仪检测各组内皮细胞标志物血管性血友病因子(von Willebrand factor,v WF)、血小板内皮细胞黏附因子1(platelet-endothelial cell adhesion molecule 1,PECAM-1)、血管内皮黏钙蛋白(vascular endothelial cadherin,VE-Cadherin)表达。另取GIT1野生型小鼠第2代BMSCs分为4组:Ⅰ组,原细胞培养液培养;Ⅱ组,细胞培养液中加入VEGFR-3阻断剂SAR131675;Ⅲ组,内皮细胞诱导液培养;Ⅳ组,内皮细胞诱导液中加入SAR131675。流式细胞仪检测各组内皮细胞标志物v WF、PECAM-1、VE-Cadherin表达。结果 Western blot检测示,A、A1、B、B1组细胞的VEGFR-2、p VEGFR-2蛋白表达无明显差异,A1组VEGFR-3、p VEGFR-3蛋白表达明显高于其余3组。流式细胞仪检测示,A1组v WF、PECAM-1及VE-Cadherin表达均显著高于A、B、B1组,B1组显著高于A、B组(P<0.05);A、B组间比较差异无统计学意义(P>0.05)。阻断VEGFR-3实验中,Ⅲ组v WF、PECAM-1及VE-Cadherin表达均显著高于Ⅰ、Ⅱ、Ⅳ组,Ⅳ组高于Ⅰ、Ⅱ组(P<0.05);Ⅰ、Ⅱ组间差异无统计学意义(P>0.05)。结论 GIT1通过VEGFR-3影响小鼠BMSCs向内皮细胞分化,进而影响血管形成。     

术中即时三维导航引导下螺钉固定治疗Ⅱ型齿突骨折

目的 介绍术中即时三维导航引导下螺钉固定治疗Ⅱ型齿突骨折的临床经验,评价导航下置入齿突螺钉的安全性和准确性.方法 回顾性分析2005年11月至2009年12月采用螺钉固定治疗的20例Ⅱ型齿突骨折的患者资料,男14例,女6例;平均年龄39岁(19～64岁).16例患者为新鲜骨折,受伤至手术时间为3～21 d,平均10 d;4例为陈旧性骨折,受伤至手术时间为1～4个月(平均2.9个月).所有螺钉均在术中即时三维导航引导下置入.术后应用领托制动6个周.结果 20例患者的螺钉均准确置入,无与螺钉置入相关的并发症发生.所有患者术后获3～14个月(平均8.7个月)随防.18例患者均获骨性愈合,愈合率达90%.骨折愈合的患者无临床不适症状.结论 术中即时三维导航引导下置入齿突螺钉可以减少患者与医生的X线暴露量,有较高的安全性和准确性.     

GE PROSPEED SX ADVANTAGE螺旋CT机高压故障检修

我科所用ＧＥ公司ＰＲＯＳＰＥＥＤＳＸＡＤＶＡＮＴＡＧＥ螺旋ＣＴ在高压部分曾出现过一次较大故障 ,现将检修过程介绍如下。故障现象 :扫描时出现错误信息Ｅｒｒ 117-ＸＧＥｒｒｏｒ0 0 0 0 0 5 41。分析检修 :查错误码信息后知此错误为阳极过流 ,说明故障出在Ｘ线发生系统 ,它包括以下几个部分 :1.Ｘ -ｒａｙｔｕｂｅ(球管 )。2 .ｋＶｃｏｎｔｒｏｌｂｏａｒｄ(ｋＶ控制板 )。3.ｆｉｌａｍｅｎｔｂｏａｒｄ(灯丝加热板 )。4.ＣＰＵｂｏａｒｄ(高压发生器中央处理板 )。5 .ＨＶｉｎｖｅｒｔｅｒａｎｄｏｐｔｉｃａｌｃａｂｌｅｓ(高压逆变…     

lncRNA ANCR调节骨质疏松大鼠脂肪源性干细胞分化成骨细胞及对Wnt信号通路的作用机制

目的探讨lncRNA ANCR调节骨质疏松(osteoporosis,OP)大鼠脂肪源性干细胞分化成骨细胞及对Wnt信号通路的作用机制。方法将lncRNA ANCR siRNA慢病毒载体及慢病毒空载体分别转染至脂肪源性干细胞,分为siRNA组、空载体组、干细胞组。分别通过碱性磷酸酶染色观察ALP染色效果、Western blot法检测Wnt/β-catenin蛋白水平、茜素红染色实验检测成骨染色效果、免疫组化法检测Wnt/β-catenin信号阳性表达的差异性。结果与空载体组、干细胞组相比较,siRNA组细胞中ALP染色显著加深(P均0.05),成骨染色更为显著(P均0.05);与空载体组,干细胞组相比较,siRNA组细胞Wnt/β-catenin蛋白表达显著上升(P均0.05),Wnt/β-catenin阳性数显著升高(P均0.05);空载体组与干细胞组比较,细胞中Wnt/β-catenin蛋白、ALP表达水平、Wnt/β-catenin阳性数相近,无显著差异(P0.05)。结论 lncRNA ANCR的表达水平与骨质疏松大鼠体内脂肪源性干细胞的分化存在显著相关性,下调lncRNA ANCR能够促进脂肪源性干细胞向成骨细胞分化,其作用机制可能与调控Wnt/β-catenin的表达有关。     

多层螺旋CT仿真肝癌模型在介入治疗中的价值

目的 探讨多层螺旋CT仿真肝癌模型在介入治疗中的价值.方法 对42例原发性肝癌病人介入治疗前行螺旋CT增强扫描,利用选择性容积重建后处理技术建立仿真肝癌模型,观察仿真肝癌模型对肿瘤供血动脉、动静脉瘘和门脉癌栓的显示,并以此进行插管治疗,记录插管时间.结果 42例病人多层螺旋CT仿真肝癌模型和DSA对肝癌供血动脉及其走行的显示有很好的一致性,其中肝动脉解剖变异5例,膈动脉参与血供3例,胃左动脉参与血供2例,肋间动脉参与血供2例,肾上腺下动脉参与供血2例;多层螺旋CT仿真肝癌模型和DSA对肝动静脉瘘、门静脉癌栓的显示无差别(P>0.05);TACE插管时间较常规缩短.结论 多层螺旋CT仿真肝癌模型可清晰显示肿瘤血管及其走行,用于指导肝癌TACE治疗,可明显缩短插管和手术时间,获得较完全的栓塞,具有较大的临床价值.     

手术治疗色素痣1200例组织病理及疗效观察

2000年1月～2008年12月,我们采用常规手术治疗色素痣1200例,标本做组织病理检查,术后门诊及电话随访,疗效满意,现报道如下。     

腓动脉穿支腓肠神经营养血管逆行岛状皮瓣的临床应用

我们应用腓动脉穿支腓肠神经营养血管逆行岛状皮瓣修复足踝部皮肤缺损15例,效果满意,报告如下.……