原位肝移植术后胆漏的诊断和治疗

目的　探讨原位肝移植 (orthotopiclivertransplantation ,OLT)术后胆漏的诊断和治疗方法。方法　回顾性分析 12例患者OLT术后胆漏的诊断和治疗。 12例中男 9例 ,女 3例 ,平均年龄 (45±10 )岁。 3例行经典式OLT ,9例行背驮式OLT。胆管重建方式均为胆总管端端吻合术 ,其中 9例放置“T”形管引流。诊断主要依据临床表现及胆管造影。胆漏平均诊断时间为 (8± 6 )d。 7例经非手术治疗 ,包括保持腹腔引流通畅、重置引流管、鼻胆管引流、B型超声引导穿刺抽吸引流及抗炎治疗 ;5例经手术治疗 ,包括胆总管 空肠吻合术、“T”形管重置术或吻合口修补术。结果　 10例治愈 ,2例死于严重全身感染。结论　OLT术后胆漏的诊断主要依据临床表现及胆管造影。高龄患者或合并有胆道缺血者预后差。     

鼻部不同部位缺损的修复

目的：探讨鼻部分或全部缺损的手术修复。方法：根据鼻部不同范围的缺损选择不同的方式进行修复，包括邻近皮瓣、岛状皮瓣、复合组织游离移植等。结果：31例鼻部缺损组织瓣修复中鼻唇沟皮瓣13例，邻近滑行皮瓣8例，额部岛状皮瓣5例，耳廓复合组织游离移植5例均成活。术后鼻外形均满意。结论：鼻缺损修复方式较多，应根据缺损的部位，范围选择不同的修复方式。     

Comparison between the antero-posterior and posterior only approaches for treating thoracolumbar tuberculosis (T10-L2) with kyphosis in children: a minimum 3-year follow-up

Purpose

There are few papers in the literature comparing outcomes between antero-posterior and posterior-only approaches for treating thoracolumbar tuberculosis (T10–L2) in children

Methods

We performed a retrospective review of 47 children who were diagnosed and treated as thoracolumbar tuberculosis (T10–L2) in our department from January 2005 to June 2009. Forty-seven cases of thoracolumbar tuberculosis were treated by two different surgical approaches. All the cases were divided into two groups: 25 cases in group A underwent one-stage posterior debridement, transforaminal fusion, and instrumentation, and 22 cases in group B underwent anterior debridement, bone graft, and posterior instrumentation in a single- or two-stage procedure. Two approaches were compared in terms of average operative time, blood loss, hospitalizations, bony fusion, intraoperative and postoperative complications, the Oswestry disability index score, neurological status, and the angle of kyphosis.

Results

All 47 patients (24 M/23F), averaged 9.1?±?2.6 years old (range 5 to 14 years), who were followed up for mean of 49.3?±?8.6 months (range 36 to 65 months). Spinal tuberculosis (TB) was completely cured, and the grafted bones were fused in 9 months in all cases. It was obviously that the average operative time, blood loss, hospitalization, and complication rate of group A was less than those of group B. Good clinical outcomes were achieved in both groups.

Conclusions

Both the antero-posterior and posterior approaches can effectively heal T10–L2 vertebral tuberculosis, but the average surgical time, blood loss, complications, and hospital stay following the posterior approach are prominently less than those following the antero-posterior approach. It might be a better surgical treatment for thoracic spinal tuberculosis in children with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.

     

Evaluation of vertical traction radiography for predicting the outcome of moderate to severe rigid scoliosis correction

Objective: To determine the efficacy of imaging patients in a state of traction (“traction imaging”) for selection of upper and lower vertebrae to undergo instrumentation (UIV and LIV, respectively) to correct moderate to severe, rigid scoliosis. Methods: Twenty‐seven patients aged 11–21 years (average, 15.5 years) who had been treated at our institution for scoliosis of the thoracic spine between 2004 and 2008 were retrospectively analyzed. All patients were treated with the third multiple hook‐screw and rod instrumentation system. Standardized radiographic measurements (anteroposterior, sagittal, bending, fulcrum, traction) were taken and Cobb's angles, apical vertebra translation (AVT), and traction‐stable vertebrae determined. Results: All patients were followed for 6–36 months (average, 14.7 months). The Cobb's angles under preoperative vertical traction correlated positively with those measured postoperatively in standing anteroposterior film (P < 0.01). Preoperative AVT under vertical traction was significantly different from that measured postoperatively in standing anteroposterior film (P < 0.01). The traction radiography‐determined UIV slant angles were significantly different from those preoperatively without traction and the postoperative values, whereas traction radiography‐determined LIV values were not significantly different from those found preoperatively without traction (P > 0.05). Conclusions: Traction radiographic imaging is an effective, feasible preoperative assessment for determining which vertebrae are stable, designing the surgical strategy and choosing the UIV and LIV for correcting moderate to severe, rigid scoliosis.     

17-β雌二醇对大鼠肝切除肝缺血再灌注损伤肝细胞凋亡和Bcl-2、Bax表达的影响

目的 观察17-β雌二醇预处理对肝切除肝缺血再灌注损伤肝脏组织细胞凋亡及Bcl2、Bax表达的影响,并探讨其肝保护的机制.方法 建立大鼠肝切除肝缺血再灌注损伤模型,75只雄性SD大鼠随机分为3组:假手术组(Sham组)、缺血再灌注组(IR组)和17-β雌二醇预处理组(E2+ IR组).检测各组大鼠再灌注后lh、3h、6h、12 h、24 h肝功能变化.光镜下观察肝组织病理学改变.TUNEL法观察再灌注后12 h大鼠肝细胞凋亡情况、流式细胞学方法测定再灌注后12h肝细胞凋亡率.Western blot法检测再灌注后12 h Bcl-2和Bax的表达情况.结果 与Sham组相比,在IR组各时间点均可见ALT和AST增高,且在再灌注后的12h达到了最高值;病理学检查可见肝细胞肿胀,肝窦变窄,嗜中性粒细胞浸润和片状坏死等变化;在再灌注后12h,凋亡细胞增多及细胞凋亡率明显升高;肝脏组织Bcl 2表达减少,Bax的表达增加.17-β雌二醇预处理组在灌注后各时间点ALT和AST值明显下降,肝脏病理损伤改善;在再灌注后12h,凋亡细胞减少及细胞凋亡率明显降低,肝脏组织Bcl-2表达增加,Bax的表达减少.结论 17-β雌二醇对大鼠肝缺血再灌注损伤有明显的保护作用,其可能通过促进Bcl-2表达及抑制Bax表达,从而抑制肝细胞凋亡.     

男性激素避孕临床研究的某些进展

随着社会的发展 ,迫切需要研制可供男性选用、安全高效、可复性和可接受性均好的避孕药。男性激素类避孕是当今最有前途的方法之一 ,其基本原理是通过外源性激素来抑制垂体促性腺激素和睾丸内睾酮的合成与分泌 ,进而抑制精子发生 ;同时给予的外源雄激素维持男性性征和性功能。研究中的男性激素避孕方法 ,包括单用雄激素、雄激素与孕激素合用、GnRH类似物与雄激素合用、激素相关的免疫途径等 ,寻求更长效、使用更方便、副作用小的雄激素制剂也是当今研究的重点之一     

新生小鼠睾丸组织和作为异种移植物的人类胎儿睾丸组织在免疫缺陷小鼠中的发育情况(英文)

目的:采用同种和异种睾丸组织移植的方法,研究新生小鼠睾丸组织及人类未成熟睾丸组织异种移植物在免疫缺陷小鼠体内发育不同时期生精细胞的组成和基因表达情况中生精细胞的发育情况。方法:以免疫缺陷小鼠为受体,新生小鼠睾丸组织和人类未成熟睾丸组织为供体,分别进行同种和异种移植。通过对移植物的组织形态学观察和分子生物学检测,对各个时期同种移植物中的生精细胞组成及其特异性基因的表达情况进行评估并与末受损小鼠的情况相比较;对人睾丸组织异种移植物的存活及其生精细胞在异体异位的发育情况进行探讨。结果:新生小鼠睾丸组织在成年雄性去势免疫缺陷小鼠体内的发育状况在移植开始的一个阶段与在体睾丸组织的发育情况基本相同,各级生精细胞的出现及其基因表达均与在体睾丸组织中相类似,而移植7-8星期后生精小管发生退化现象。人未成熟睾丸组织在受体中存活并且进一步生长;组织学观察还发现,生精细胞的发育速度与在体相比具有加速的倾向。结论:新生小鼠睾丸组织同种移植物的发育与在体情况基本相同,而人类未成熟睾丸组织异种移植物的发育与正常生理状态相比较呈现出加速的倾向。     

原生质体融合技术选育高效菌株降解聚乙烯醇

从自然界中分离聚乙烯醇(PVA)的降解细菌，经紫外线诱变，得到两株具有单重抗药性的突变菌株S7(Str^s，Kan^r)和K15(Str^r，Kan^s)，两者对PVA的去除率分别达到52％和58％．将S7和K15作为亲本菌株进行原生质体融合，并对融合条件进行优化，融合子F4菌株对PVA去除率达到79．9％，将其培养成活性污泥后，PVA去除率可达87％，是普通活性污泥的三四倍．     

下颌骨外板修复面斜裂鼻眶骨畸形

目的 探讨采用下颌骨外板修复面斜裂患者鼻眶骨骼畸形的适应证及临床意义。方法 经口内入路显露颏孔、下颌体、下颌角、下颌升支中下份的外侧骨面，用小裂钻和骨凿在下颌升支下份咬合平面水平、下颌骨外斜线及颏孔后3～5mm垂直线范围内劈开外板后取出骨块。将下颌骨外板进行适当塑形后，配合钛合金钉、板坚强内固定系统植入或贴附于需行骨骼重建部位。结果 采用下颌骨外板修复面斜裂骨骼发育不良或缺损7例。随访6个月～3年，移植骨与邻近相接骨组织愈合良好，局部骨骼重建效果完美稳定。结论 下颌骨外板与颅骨外板的骨密度接近但采取更加方便，并不遗留任何皮肤瘢痕，是目前修复面斜裂骨骼发育不良或缺损的比较理想的材料和方法。