肝切除治疗肝内胆管结石疗效分析

目的 探讨肝内胆管结石外科治疗的方法及效果。方法 回顾分析1995年至2000年10月采用肝切除治疗肝内胆管结石44例。结果 肝内结石以左肝较多见,共40例占90．9％。肝切除以左外叶为主,术后残余结石13例占29．5％,复发结石1例,复发率2．3％。结论 肝段肝切除的联合手术能有效降低术后的残石发生、症状复发和再手术率,是当前治疗肝胆管结石并狭窄的首选术式。     

逆行筋膜蒂桡骨茎突骨瓣移植及BMP复合物植入治疗腕舟骨骨不连

目的 探讨治疗腕舟骨阵旧性骨折骨不连的手术方法。方法 对11例腕舟骨陈旧性骨折骨不连,采用筋膜蒂逆行桡骨突骨瓣移植及骨形态发生蛋白（bone morphogenetic protein,BMP)与纤维蛋白（fibrin sealant,FS)复合物植入的手术方法治疗。结果 术后随访4－24个月,腕部疼痛及无力症状均消失。11例在术后3－6个月内,X线片示骨折已全部骨性愈合。结论 带筋膜蒂的桡骨茎突骨瓣移植及BMP复合物植入法,治疗腕舟骨陈旧性骨折骨不连,操作简单,成骨作用强,并可促进骨折愈合。     

腰椎黄韧带骨化并椎管狭窄

黄韧带骨化可见于脊柱各节段，临床相关报道均集中于颈椎及胸椎，腰椎黄韧带骨化较少提及。与胸椎黄韧带骨化的起因不同，腰椎黄韧带骨化多为腰椎管狭窄症中黄韧带增生、肥厚及钙盐沉着为特征的一种退行性变，严重者易导致不可逆性重度椎管狭窄。自2000年7月至2006年10月共收治该类患者5例，本文就其临床表现、影像学特征、治疗方法等问题进行探讨。     

组合式四肢骨折通用型外固定器治疗胫腓骨骨折

目的：探讨组合式四肢骨折通用型外固定器对胫腓骨骨折的临床治疗效果。方法：37例胫腓骨骨折患者均采用组合式四肢骨折通用型外固定器治疗,其中男28例,女9例;年龄22～76岁,平均47.8岁。横形骨折7例,粉碎性骨折18例,螺旋形骨折8例,斜形骨折4例。闭合性骨折29例,开放性骨折8例。结果：37例患者获得随访,随访时间6～13个月,平均9个月,骨折全部愈合。结论：组合式四肢骨折通用型外固定器治疗胫腓骨骨折具有创伤小、操作难度低、安装拆卸方便、固定稳固、骨折愈合率高等优点,膝踝关节运动不受影响,甚至可戴外固定器行走,无须长期卧床。     

广泛性下肢脱套伤的外科处理

随着工农业技术及交通事业的发展,由于意外事故造成广泛下肢脱套伤的情况临床并不少见,近二年来,我科共收治此类病人8例,由于处理及时妥当,均获得令人满意效果,现报告如下.     

锁骨下动脉损伤的外科处理

目的 探讨锁骨下动脉损伤的外科治疗特点。方法 1990年7月～2006年1月，对12例锁骨下动脉损伤患者，取锁骨上下联合切口，充分显露锁骨下动脉全段，分别采用动脉破口修补、包裹修复、血管吻合及人造血管移植修复重建损伤动脉。均为男性，年龄18～36岁，平均22.6岁。损伤部位：锁骨下动脉第1段1例，第2段4例，第3段7例。损伤类型：均为不完全断裂及破损，其中动脉破损区小于动脉周径1／3者4例，小于动脉周径2／3者5例，大于动脉周径2／3者3例。伴全臂丛神经损伤1例，神经干缺损5cm；部分臂丛神经损伤3例，其中2例仅前束损伤，神经缺损分别为4cm和6cm；正中神经完全损伤及尺神经不完全损伤1例，神经缺损4cm。损伤至手术时间3h～1.5个月。结果 术后无死亡及肢体坏死。获随访2个月～12年，平均5年2个月。10例桡动脉搏动恢复良好，2例桡动脉搏动不明显，均为动脉直接吻合者。4例合并臂丛神经损伤患者，前束损伤者术后肢体功能基本恢复正常，屈肘肌力Ⅳ级；全臂丛神经完全损伤者术后上肢功能基本无改善。结论 锁骨下动脉解剖位置特殊，动脉损伤后显露、修复均较困难。锁骨上下联合切口可在直视下显露动脉全段，修复重建安全可靠。     

肩胛骨颈部骨折合并肱骨头脱位的外科治疗

目的　探讨肩胛骨颈部骨折合并肱骨头脱位或半脱位的解剖学基础及外科治疗方法。方法　 1 992年 7月～ 2 0 0 1年 1 1月收治肩胛骨颈部骨折合并肱骨头脱位或半脱位 7例。骨折部位 :解剖颈骨折 2例 ,其中 1例合并喙突骨折 ;外科颈骨折 5例 ,合并肩胛冈骨折 2例 ,合并体部骨折 1例。 7例中合并肱骨头脱位 1例 ,合并肱骨头半脱位 6例 ,7例均行切开复位 ,钢板螺丝钉内固定术。结果　本组随访时间为 1个月～ 8年 ,7例肩胛骨颈部骨折愈合时间在 6～ 9周。 6例术后功能恢复优良。结论肩胛骨颈部构造特殊 ,手术切开复位内固定适用于不稳定性骨折 ,钢板螺丝钉可有效地对骨折进行固定     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.     

抗前列腺干细胞抗原单克隆抗体制备及治疗鼠前列腺癌移植瘤的实验观察

目的探索抗前列腺干细胞抗原(PSCA)单克隆抗体(McAb)对裸鼠前列腺癌移植瘤的治疗效果.方法应用淋巴细胞杂交瘤技术制备抗PSCA单抗;BALB/c裸小鼠皮下注射激素非依赖性前列腺癌细胞株PC-3细胞,建立前列腺癌实体性移植瘤动物模型;选择肿瘤体积相近的10只荷瘤鼠,随机分成治疗组和对照组治疗组荷瘤鼠腹腔注射Anti-PSCA mAb 200μg,每3天1次,共3次,对照组使用等量PBS;观察5周,记录鼠存活情况,检测血清PSA,处死存活裸鼠,测量残存肿瘤重量、体积并计算肿瘤体积抑制率.取肿瘤组织行光镜及透射电镜检查.结果制备出抗PSCA单克隆抗体,免疫扩散鉴定为IgG1亚类,具有较好的前列腺组织特异性;治疗组和对照组裸鼠均存活,血清PSA平均值分别为(3.28±0.55)ng/ml和(7.26±0.43)ng/ml,平均瘤重分别为(0.95±0.17)g和(3.08±0.18)g,肿瘤体积分别为(164.59±14.08)mm3和(548.49±19.79)mm3,组间差异有统计学意义(P＜0.05).治疗组肿瘤体积抑制率为69.98%.光镜显示治疗组肿瘤组织内出现大片组织坏死性改变,并可见大量炎症细胞浸润,透射电镜显示肿瘤细胞的凋亡现象.结论初步制备出抗PSCA的单克隆抗体细胞株,对裸鼠前列腺癌实体性移植瘤有显著的治疗效果.