注射胰岛素引起的腹直肌鞘血肿的放射性核素显像

报道了一例较少见的继发于腹前壁皮下注射胰岛素所引起的腹直肌鞘血肿经~(99m)Tc-RBC显像揭示病灶.70岁糖尿病患者,每日在腹前壁注射胰岛素,一周前发现注射局部腹壁发蓝,伴上腹痛4天.CT发现左前腹壁一液态密度病灶,延至整个左腹直肌鞘,相当于腹壁发蓝部位.为确定出血位置,静注740MBq~(??m)Tc-RBC后显像,见注射胰岛素部位,相当于腹壁下动脉处有多个出血病灶.延迟显像证实放射性积聚于左腹直肌鞘和股动脉穿刺区域.经血管造影术中用明胶海绵栓塞腹壁下动脉后,血细胞压积保持稳定.本病例通过CT作出腹直肌鞘血肿的诊断,而闪烁显像确定了出血部位.可能由于出血缓慢,血管造影难以显示出血部位.活动性的和持续出血,CT、核磁共振和超声显像往往无法探测而核素显     

T2期直肠癌淋巴结转移相关影响因素

目的 探讨影响T2期直肠癌淋巴结转移的临床病理因素.方法 回顾分析福建医科大学附属第一医院2006年3月至2011年1月间行根治性切除的122例T2期直肠癌患者的临床资料,分析影响其淋巴结转移的相关临床病理因素.结果 122例T2期直肠癌患者中有26例(21 3％)发生淋巴结转移.单因素分析显示,肿瘤距肛缘距离(P＜0.05)、大体类型(P＜0.05)、组织类型(P＜0.01)、分化程度(P＜0.05)及肿瘤浸润深度(P＜0.05)与T2期直肠癌淋巴结转移有关.多因素分析显示,肿瘤浸润深度是影响T2期直肠癌淋巴结转移的独立因素(P＜0.05);直肠癌浸润浅肌层和深肌层者淋巴结转移率分别为13.0％(7/54)和27.9％(19/68).结论 对于局限于浅肌层的T2期直肠癌,因其淋巴结转移率较低,可考虑行经肛局部切除手术.     

同步辐射相位对比X线成像技术的初步研究

Objective To investigate the mouse liver blood vessel images using phase contrast X-ray imaging with synchrotron radiation. Methods 6 female C57BL/6 mice were randomly divided into two groups, 3 mice in each group. In one group, livers excised after hgated arteries, veins and common bile duct. In another group, iodine infused via the portal vein and drained from inferior vena cave until all the blood in the portal veins and hepatic veins was displaced. After infusion, arteries, veins and common bile duct were ligated and livers were excised. Results Blood vessel images were clearly produced by diffraction enhanced imaging. This method can discriminate vessels down to about 40 μm in diameter without contrast agent. Using a contrasting agent more details could be produced. In one liver lobe, the entire branch of the portal vein could be clearly produced by one by one phase contrast image from the main axial blood vessels of liver lobe to the nine generation of branching. Conclusions Phase contrast imaging has the advantage of good contrast and high spatial resolution. [Key wnrds] Synchrotron radiation; Phase contrast imaging; Diffraction enhanced imaging; Blood vessel; X-rays     

鼠离体灌流心脏模型125I-BMIPP与125I-IPPA代谢的对比研究

目的 比较侧链脂肪酸β-甲基碘苯脂十五烷酸(BMIPP)和直链脂肪酸碘苯脂十五烷酸(IPPA)在心肌代谢上的异同和特点.方法 制备大鼠离体灌流心脏模型10只,分为2组,每组5只.基础灌流30 min后,分别于灌流液中加入125I-BMIPP和125I-IPPA,持续灌流3 h后取样灌流液,提取脂溶相处理后行薄层色谱法(TLC)和高压液相色谱法(HPLC)分析,并与加入被测物品初期(5 min)的结果相比较.结果 125I-BMIPP灌流5 min和3 h后脂溶相提取放射性活度分别为注入剂量的99%和92%,而125I-IPPA分别为95%和38%.125I-BMIPP灌流5 min,HPLC分析放射性全部集中于保留时间37 min段.3 h后该处仍呈主峰,其前出现数个小峰,峰值分别对应于代谢产物甲基碘苯脂十四烷酸、对碘苯十二酸、对碘苯十酸、对碘苯八酸、对碘苯六酸、对碘苯四酸和对碘苯乙酸.125I-IPPA灌流初期于HPLC保留时间33 min段显示明显高峰,继续灌流3 h后,该峰值消失.TLC测定125I-BMIPP Rf值为0.52,125I-IPPA为0.45.3 h后,85%的125I-BMIPP仍集中于Rf值0.52处,在Rf值0.31前后有数个小峰.而125I-IPPA持续灌流3 h后Rf值0.45处的峰消失,仅在原点发现放射性.结论 125I-BMIPP不被β氧化,能在心肌细胞内长时间滞留,便于观察脂肪酸在心脏内的分布状况.而125I-IPPA代谢快速,可显示心肌中长链脂肪酸代谢氧化过程.     

99Tcm-环丙沙星炎症显像的动物实验研究

目的 用99Tcm标记环丙沙星并评估其生物学性能.方法 制备99Tcm-环丙沙星,测定其稳定性,并研究其在健康昆明小鼠体内和在炎症模型昆明小鼠及新西兰兔体内的分布.结果 99Tcm-环丙沙星标记率＞90%,6 h内放化纯均＞98%.99Tcm-环丙沙星静脉注射后主要分布在血供丰富的器官,如肾、肝、脾中.血液清除快,主要经泌尿系统排泄.新西兰兔炎症模型显像表明:注射99Tcm-环丙沙星1 h后即可显影;给药后3 h为炎症小鼠模型最佳显像时间,此时炎症组织/肌肉放射性比值为5.76.99Tcm-环丙沙星能高度特异地浓聚于细菌性炎症病灶.结论 99Tcm-环丙沙星是早期诊断细菌性炎症的一种特异性显像剂,其临床应用前景较好.     

吻合器痔上黏膜环切术治疗痔41例报告

吻合器痔黏膜环切术(以下简称PPH)是近年来出现的治疗痔新术式.笔者自2001年3月起应用PPH治疗痔取得满意的效果,现报告如下.     

食管超声多普勒监测急性高容量血液稀释对血液动力学的影响

目的　应用经食管超声多普勒血液动力学监测仪 ,观察全麻下急性高容量血液稀释(HHD)的血液动力学和氧供 (DO2 )变化。方法　选择 1 5例ASAI～II级择期行非心脏手术患者。麻醉诱导插管后持续监测心输出量 (CO)、每搏量 (SV)、心脏指数 (CI)、血流峰速度 (PV)、血流加速度(Acc)和左室射血时间指数 (LVETi) ,每隔 5分钟输入MAP值后计算出系统血管阻力 (SVR)值。麻醉平稳和各项监测完成后 1 0min ,在 30min内输注 6 %羟乙基淀粉 (HES) 2 0ml/kg。记录 6 %HES输注前、输注 1 5和 30min时的各项监测数据 ,并抽取动脉血液样本行血气分析并计算DO2 。结果　与HHD前相比 ,血气各参数 (pH、PaO2 、PaCO2 、BE)均无明显差异 (P >0 0 5 ) ,而 6 %HES输注 1 5和30min血红蛋白 (Hb)含量、红细胞比积 (Hct)均明显下降 (P <0 0 5和P <0 0 1 )。 6 %HES输注 1 5和 30min时的CaO2 比HHD前明显下降 (P <0 0 5 ) ,而DO2 显著增加 (P <0 0 5 )。与HHD前测量值相比 ,6 %HES输注 1 5min ,CO、SV、CI、PV和Acc明显升高 ,SVR显著降低 (P <0 0 5 ) ;6 %HES输注 30min ,SV、PV和Acc进一步升高 (P <0 0 1 ) ,而CO、CI和SVR与 6 %HES输注 1 5min时无明显变化。MAP、HR和LVETi在HHD期间无明显变化。结论　术前输注 6 %HES 2 0ml     

微囊化SD大鼠周围神经组织移植促进周围神经再生的实验研究

目的　采用微囊化组织研究技术 ,研究微囊化神经组织移植对周围神经再生的影响。方法　将 12只SD大鼠随机分为实验组和空白组。切断SD大鼠左侧坐骨神经并行显微缝合 ,实验组 8只 ,加入制备好的微囊化同种异体周围神经颗粒无血清培养液 30 μl,约含微囊颗粒 30 0个 ;空白组 4只 ,加入不含微囊颗粒的无血清培养液 30 μl。术后 4周取材做组织形态学检查。结果　实验组周围神经再生明显优于空白组。结论　微囊化周围神经移植有促进周围神经再生的作用     

经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.     

呋塞米与多巴胺联合应用对肝移植术无肝期肾功能及尿量的影响

目的比较背驮式原位肝移植术中持续输注小剂量多巴胺或呋塞米和多巴胺联合应用对无肝期肾功能和尿量的影响。方法背驮式原位肝移植术患者42例,ASAⅢ~Ⅳ级,随机分为多巴胺组(D组)和呋塞米-多巴胺组(F组),每组21例。两组均于麻醉诱导后静脉泵注多巴胺(2~5μg.kg-1.min-1)至术毕,F组则在无肝期开始时静注呋塞米0.1mg/kg。观察无肝期输液量、血液动力学和尿量,检测血清肌酐(Cr)和肌酐清除率(CCr)。结果与D组比较,F组无肝期尿量明显增多(P<0.05);两组无肝期时间、输液量和心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏量(SV)、心输出量(CO)、全身血管阻力(TSVR)、Cr、CCr差异无显著意义。结论肝移植术中持续泵注多巴胺和呋塞米联合应用可明显增加无肝期尿量。