微创小切口人工全髋关节置换术在晚期股骨头坏死治疗中的应用

目的探讨微创小切口人工全髋关节置换术在晚期股骨头坏死治疗中的应用价值。方法2003年3月始，采用微创技术治疗18例22髋国际骨循环学会（Association Research Circulation Osseous，ARCO）分期Ⅲ、Ⅳ期股骨头坏死患者，其中男13例，女5例，年龄24～57岁；体重指数（body mass index，BMI）24．6（17．1～30．1），术前髋关节Harris评分平均46分。均采用改良的后外侧切口、非骨水泥假体行人工全髋关节置换术（微创组）。与同期常规人工全髋置换术的18例22髋（对照组，术前髋关节Harris评分平均43分）进行比较，包括：围手术期出血量、切口长度及术后早期功能恢复情况等。结果术后两组均获随访6～20个月，平均11个月。对照组1髋术后2d脱位，微创组中无并发症发生；微创组手术切口长9．3cm（8．7～10．5cm），较对照组16．8cm（14．0～20．0cm）短，差异有统计学意义（P〈0.01）；两组术后随访6个月时Harris评分分别为92、90分，差异无统计学意义（P〉0.05）；手术时间相近，但围手术期出血量及引流量微创组较少，两组差异有统计学意义（P〈0．05）；微创组术后恢复较快。结论微创小切口全髋关节置换术，手术创伤小、出血少，术后恢复较快，但开展此手术的初期，应由有经验的医师及有相应设备的医院、有选择地用于晚期股骨头坏死患者的治疗。     

原位背驮式同种异体肝移植供肝修整并发症分析

目的总结分析原位背驮式肝移植手术后并发症与供肝修整的关系。方法回顾性分析我院12例行原位背驮式同种异体肝移植患者的资料。结果本组12例肝移植围手术期无死亡；手术成功率为100％。12例中行动脉血管变异整形2例．门静脉搭桥吻合1例；各韧带修剪后缝合7例．未缝合5例。手术后发生腹腔内出血3例，其中2例与供肝修整有关，即修肝时各韧带未仔细缝合及结扎而导致细小血管出血，另1例系凝血功能障碍所致；在供肝修整中注意了血管的变异整形及胆管的血供．术后无动脉及门静脉血管并发症和胆道并发症发生。结论修肝质量的好坏，直接关系到术中植肝时手术操作的难度、术后供肝的存活质量、并发症的发生和患者的康复。     

腹部肿瘤联合脾切除212例临床分析

目的探讨腹部肿瘤联合脾切除适应证的选择、围手术期最佳处理以及脾切除对机体的影响。方法对1993年1月至2004年7月经手术治疗的212例腹部肿瘤联合脾切除病人的临床资料进行回顾性分析。结果腹部原发肿瘤以胃癌最为多见(117/212,55·2%),其次为肝癌合并肝硬化脾功能亢进(28/212,13·2%)和胰体尾癌(23/212,10·8%)。212例病人共行324例次不同类型的手术,共有33例(15·6%)术后发生59例次并发症,发生率为27·8%,以感染最为多见。结论联合脾切除术后并发症的发生与原发疾病和手术种类密切相关,应严格掌握手术适应证,加强围手术期处理是提高近期疗效的关键。     

骨形态发生蛋白2基因治疗与缓释载体修复骨缺损的比较研究

[目的]比较骨形态发生蛋白2（BMP-2）基因治疗与生长因子缓释方法修复节段性骨缺损效果。[方法]于兔双侧桡骨中段造成1．5cm骨缺损，采用4种方法修复：A组植入转基因骨髓间质干细胞（MSCs）与PLA／PCL（聚乳酸／聚己内酯）支架的复合物；B组植入单纯MSCs与含重组BMP-2的PLA／PCL缓释载体的复合物；C组植入单纯MSCs与PLA／PCL复合物；D组植入单纯PLA／PCL。术后4、8、12周行X线、组织学、生物力学和骨密度等检测，[结果]A组体内植入4周后，成骨细胞和间质细胞呈BMP-2强阳性表达；其成骨速度及成骨质量均明显优于B组，12周时骨缺损完全修复、C组成骨能力较弱，而D组则无新骨形成，残留骨缺损。[结论]BMP-2基因治疗是修复节段性骨缺损的好方法。     

IgA抗精子抗体对精子顶体反应的影响

目的 探讨精浆中IgA抗精子抗体对人精子顶体反应的影响。方法 利用免疫珠法（IBT）筛选出IgA抗精子抗体阳性精浆标本同正常人精子孵育，以孕酮诱发精子顶体反应；以特异性荧光标记物．络合异硫氰酸荧光素的花生凝集素（FITC-PNA）标记精子顶体，通过流式细胞仪检测精子顶体完整性。结果 与IgA抗精子抗体阳性精浆孵育的精子，其孕酮诱发的顶体反应发生率明显低于正常精浆及精子培养液组（P〈0．01），正常精浆组及精子培养液组间无显著性差异（P〉0．05）；IgA抗精子抗体阳性精浆组、正常精浆组、精子培养液组自发顶体反应的发生率无显著性差异（P〉0．05）。结论 免疫性不育患者精浆中的IgA抗精子抗体可以明显抑制孕酮诱发的顶体反应的发生，可能是导致不育的原因之一。     

肾动静脉瘘的血管造影诊断与超选择性栓塞治疗(附19例报告)

目的总结肾动静脉瘘的诊治经验,提高肾动静脉瘘的诊治效果。方法回顾性分析我院19例肾动静脉瘘患者诊治的临床资料。结果19例肾动静脉瘘患者经肾动脉造影明确诊断,并行超选择性肾动脉栓塞治疗,全部治愈。随访5个月至3年,无症状复发。结论选择性肾动脉造影和栓塞术是诊治肾动静脉瘘的重要方法。     

Relationships Between the Changes of Serum Levels of OPG and RANKL with Age, Menopause, Bone Biochemical Markers and Bone Mineral Density in Chinese Women Aged 20-75

The correlations between the serum levels of OPG, RANKL with age, menopause, bone markers, and bone mineral densities (BMDs) at the lumbar spine and proximal femur were studied in 504 pre- and postmenopausal Chinese women aged 20–75 years. We found that age was positively and negatively correlated with serum concentrations of OPG (r = 0.442, P < 0.001) and RANKL (r = –0.263, P < 0.001), respectively. Compared with premenopausal women, postmenopausal women showed higher serum OPG levels (107.6 ± 3.0 vs 72.0 ± 1.8 pg/ml, P < 0.001), lower serum RANKL concentrations (4.7 ± 0.4 vs. 5.8 ± 0.3 pg/ml, P < 0.001) and RANKL/OPG ratios (0.045 ± 0. 004 vs. 0.099 ± 0.008, P < 0.001). Neither serum levels of OPG nor RANKL or RANKL/OPG ratio correlated with BMDs after adjustment of age and menopause. They also showed no differences among normal, osteopenic and osteoporotic postmenopausal women. Serum levels of OPG were positively correlated with urinary excretion of NTx (r = 0.1453, P = 0.006). Serum levels of RANKL (r = –0.1928, P < 0.001) and RANKL/OPG ratio (r = –0.1303, P = 0.013) were inversely correlated with serum concentrations of OC. In multiple regression analysis, up to 20% variance (R² = 0.106–0.224) of the OPG-RANKL system in peripheral circulation can be explained by age, menopause and bone markers.These results suggest that although serum OPG and RANKL concentrations were unrelated with BMDs, the age– and menopause– dependent changes of serum OPG and RANKL might be a protective mechanism against the accelerated bone loss in postmenopausal women.     

Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms

OBJECT: Utilization of covered stent grafts in treating neurovascular disorders has been reported, but their efficacy and safety in vertebral artery (VA) dissecting aneurysms needs further investigation. METHODS: Six cases are presented involving VA dissecting aneurysms that were treated by positioning a covered stent graft. Two aneurysms were located distal to the posterior inferior cerebellar artery, and 4 were located proximal to the posterior inferior cerebellar artery. Aspirin as well as ticlopidine or clopidogrel were administered after the procedure to prevent stent-related thrombosis. All patients were followed up both angiographically and clinically. RESULTS: Five of the 6 patients underwent successful placement of a covered stent graft. The covered stent could not reach the level of the aneurysm in 1 patient with serious vasospasm who died secondary to severe subarachnoid hemorrhage that occurred 3 days later. Patient follow-up ranged from 6 to 14 months (mean 10.4 months), and demonstrated complete stabilization of the obliterated aneurysms, and no obvious intimal hyperplasia. No procedure-related complications such as stenosis or embolization occurred in the 5 patients with successful stent graft placement. CONCLUSIONS: Although long-term follow-up studies using a greater number of patients is required for further validation of this technique, this preliminary assessment shows that covered stent graft placement is an efficient, safe, and microinvasive technique, and is a promising tool in treating intracranial VA dissecting aneurysms.     

Vein and artery growth after anastomosis with vascular closure staple clips vs interrupted polypropylene suture: application in pediatric vascular surgery

Background/Purpose

Alternatives are still being sought in vascular surgery to address the problem of arrested growth after anastomosis in growing vessels, and opinions differ widely regarding the most suitable technique. This study compared vascular growth and permeability after anastomosis using the latest-generation vascular closure staple (VCS) system and the conventional suture technique to ascertain which approach yielded better results.

Methods

Thirty 55-day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6-month growth period, after which lambs were euthanized.

Results

Both VCS clips and polypropylene suture allowed longitudinal and transverse vessel growth; however, longitudinal growth was significantly greater in clip-closed vessels than in either sutured or untreated vessels.

Conclusions

The results obtained for vascular growth and permeability suggest that VCS clips may provide a suitable alternative to conventional suture in pediatric vascular surgery.     

腹腔镜肝门肠吻合术治疗胆道闭锁的探讨(12例报告)

目的:探讨经腹腔镜辅助行肝门解剖和肝门肠吻合术治疗先天性胆道闭锁的临床效果。方法:先天性胆道闭锁患儿12例,29~87d11例,5.5个月1例。2例为肝总管闭锁(Ⅱ型),肝门部有直径1.2~2.5cm囊肿与肝内胆管相通;10例为肝门部胆管闭锁(Ⅲ型)。于脐部纵切口置入10mmTrocar,然后分别于右上腹、右中腹和左上腹置入3个5mmTrocar。术中胆道造影,确诊为胆道闭锁,暴露肝门;切除胆囊,游离切除肝门纤维块,空肠行Roux-en-Y吻合术保留肝支30~35cm,然后将肠管送回腹腔,将空肠肝支经结肠后拉至肝门下;用5-0可吸收缝线将空肠与肝门端侧连续吻合。结果:本组12例患儿中1例因肝门渗血中转开腹手术;另11例均在腹腔镜辅助下完成手术,手术时间平均为3.5h(3.1~4.6h),出血量约10ml,没有需在术中和术后输血者,全组患儿无手术后肠粘连梗阻和腹腔感染。结论:经腹腔镜行肝门肠吻合术治疗先天性胆道闭锁安全可靠,具有暴露肝门清晰、肝门纤维块分离和切除准确、对患儿打击小等优点。