逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区

目的探讨股前外侧皮瓣供区覆盖的新方法，以减少供区并发症。方法2003年12月～2005年12月，在应用股前外侧皮瓣移植修复肢体创伤的同时，采用逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区8例，股前外侧皮瓣修复部位：手背侧损伤伴肌腱缺损骨外露2例，足部开放性骨折伴皮肤缺损2例，小腿Gustilo Ⅲ型开放性骨折伴皮肤缺损3例，前臂掌侧皮肤缺损伴肌腱外露1例。腹壁供区伤口直接缝合。结果移植股前外侧皮瓣全部成活。逆转腹壁浅动脉皮瓣完全成活7例，1例部分坏死，经换药后愈合。股前外侧皮瓣供区伤口平均15d愈合，随访6～18个月（平均12个月），股前外侧皮瓣供区愈合平整，色泽均衡，髋关节和膝关节活动完全正常。腹壁伤口仅留线状瘢痕。结论应用逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区是一种实用而又有创意的方法。     

人胎冠状动脉原位杂交c-myc和jun原癌基因表达

目的研究原癌基因c-myc和jun在人胎冠状动脉发育过程中的表达与平滑肌细胞增殖的关系.方法用原位杂交方法检测,胎龄分别为16周、22周(因治疗需要引产)的胎儿和意外死亡的足月胎儿冠状动脉前降支c-myc mRNA和jun mRNA的表达水平.杂交反应产物用图像分析仪(MIAS300)作定量分析.结果C-myc mRNA原位杂交反应产物与被测血管区域面积的百分比在16周、22周和足月胎儿分别是70、56和10;Jun mRNA的杂交信反应产物与被测血管区域面积的百分比在这三个时期分别是68、53和8.两个原癌基因在不同阶段的表达均具有显著性差异.结论本实验首次报道c-myc和jun在人胎冠状动脉发育过程中平滑肌的表达图型,c-myc和jun在胎儿冠状动脉平滑肌细胞增殖和内膜的形成过程中可能具有重要的调控作用.     

平板运动试验阴性患者最大ST/HR斜率对冠心病的诊断价值

目的探讨平板运动试验阴性患者最大ST/HR斜率对冠心病的诊断价值.方法选择122例平板运动试验阴性而临床有明显冠心病指征的患者进行冠状动脉造影,测定其最大ST/HR斜率.结果平板运动试验阴性患者最大ST/HR斜率诊断冠心病的敏感性为68.2%,特异性为80.8%,准确性为76.2%;运动峰值心率＜预计最大心率之85%组最大ST/HR斜率诊断冠心病的敏感性为92.8%,特异性为86.7%,准确性为89.7%,高于运动峰值心率≥预计最大心率之85%组.结论平板运动试验阴性患者最大ST/HR斜率对冠心病的临床诊断有较高的敏感性、特异性和准确性,尤其是对低运动水平的患者,对减少运动试验诊断的漏诊率具有重要意义.     

冠心病危险因素与冠状动脉病变程度的相关性研究

目的:探讨冠心病危险因素与冠状动脉病变程度的关系.方法:选取150例冠心病患者行冠状动脉造影术及各项化验检查,冠状动脉病变程度以Gensini积分值表示,对冠心病危险因素和冠状动脉病变程度进行统计分析.结果:经多因素线性回归证实:非高密度脂蛋白胆固醇为冠状动脉病变程度的独立危险因素(P=0.030),而性别、年龄、空腹血糖、糖尿病、高血压、吸烟、家族史及甘油三酯、低密度脂蛋白胆固醇均与冠状动脉病变程度无明确相关.结论:非高密度脂蛋白胆固醇对冠状动脉病变严重程度具有重要的影响.     

非体外循环紧急转为体外循环冠状动脉旁路移植术的分析

目的了解导致非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,off-pumpCABG)紧急转为体外循环冠状动脉旁路移植术(on-pump coronary artery bypass grafting,on-pump CABG)的临床的原因,为手术方法的选择提供借鉴。方法回顾分析2002年1月～2006年5月期间546例冠心病患者行off-pumpCABG的临床资料,对术中需紧急转为体外循环下完成手术的患者(off-pump转on-pump组,24例)与同期顺利完成off-pump CABG患者(off-pump组,522例)进行对比分析,并行logistic多因素分析。结果在行off-pump CABG中,24例患者因心室颤动或血流动力学不稳定需紧急改变术式。Off-pump转on-pump组患者中死亡4例,死亡率为16.7%(4/24),明显高于off-pump组[16.7%vs.2.7%(14/522),P<0.001]。多因素logistic回归分析结果提示急性心肌梗死(OR=3.142,P=0.004)、急诊CABG(OR=1.571,P=0.011)和右冠状动脉狭窄≤90%(OR=1.922,P=0.024)为off-pump转为on-pump的危险因素。结论Off-pump紧急转为on-pump时死亡率明显增高,对同时合并有右冠状动脉狭窄≤90%、急性心肌梗死和急诊CABG等高危因素行off-pump CABG时,要做好体外循环的准备。     

p53基因(今又生~)联合支气管动脉化疗治疗肺癌15例近期疗效观察

目的探讨瘤内注射或经支气管动脉灌注p53基因联合支气管动脉灌注化疗(BAI)治疗肺癌的安全性、疗效和给药途径。方法经病理证实的15例肺癌,首先在CT引导下经皮穿刺瘤内注射或经支气管动脉灌注p53基因(今又生~),2～5天后,行BAI灌注化疗药物;然后根据病情变化再次进行基因治疗和/或BAI。治疗后常规使用螺旋CT定期复查,评价治疗效果。结果全部15例患者均完成上述治疗,并接受随访2～11个月。有效率(CR+PR)46.7%(7/15),1例肺部肿块消失,6例肺部肿块缩小,3例纵隔淋巴结缩小,1例胸水减少,仅1例观察到肿瘤长大,14例临床症状有不同程度缓解93.3%(14/15)。p53治疗后6例出现发热(38℃～40℃),未观察到基因药物的其它严重副作用,无严重操作有关并发症出现。结论本研究结果初步显示,作为肿瘤综合治疗的一部分,p53基因治疗与BAI联合应用,是一种治疗肺癌安全、有效的方法,提高了BAI的治疗效果。经皮瘤内注射p53是否为一种较好的给药途径值得进一步探讨。     

男性病人冠状动脉病变与吸烟关系的研究

[目的]探讨吸烟对病人冠状动脉病变的影响。[方法]对吸烟组(5 0例)与不吸烟组(3 0例)进行冠状动脉造影,观察记录冠状动脉病变情况并进行统计学分析。[结果]两组冠状动脉病变记分、每日不同吸烟量与冠状动脉病变记分、不同的吸烟年限与冠状动脉病变记分比较均有统计学意义(P <0 .0 1)。[结论]长期吸烟可使冠状动脉病变程度加重,应加强对长期吸烟及冠状动脉介入术后病人的健康教育,有效预防和控制冠心病,提高人群的健康水平。     

Long-term anticoagulant therapy in patients with coronary artery disease.

Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications. The conducted trials are heterogeneous in many ways, concerning comparative medications, patient populations, endpoints and follow-up, which makes a standardized recommendation on the basis of these studies difficult. This review is an overview of the largest and best studies on this topic and discusses the scientific background for a possible use of VKA or an alternative anticoagulant treatment in CAD patients, looking at both the beneficial effects and the risk of bleeding.     

The remucosalizing alar cartilage flap: a reconstructive option for repairing nasal septal perforations

The objective of this study is to assess the results of repairing septal perforations with a vascularized pedicled alar cartilage island flap. Using the external rhinoplasty approach, a vascularized flap of alar cartilage, harvested as a cephalic trim and pedicled on the ascending columellar branches of the superior labial artery was raised. Bilateral mucoperichondrial septal flaps were elevated and the alar flap was transposed and secured within the defect and bilaterally overlaid with temporalis fascia. Silastic sheets were placed and remained in situ until the grafts were revascularized from the peripheries of the defect as well as centrally from the alar flap. The revascularized temporalis fascia acted as a scaffold for nasal remucosalization. The alar flap also increased the long-term structural robustness of the repair. Between 1999 and 2003, 14 patients with septal perforations ranging from 10 to 31 mm underwent septal reconstruction using this technique. There were nine males and five females. The flap was successfully raised in all cases and long-term closure was maintained in 12 patients (86%). The alar cartilage flap is an effective technique for repairing septal perforations in selected patients. It provides vascularized tissue which nourishes the grafts during remucosalization, and a cartilaginous framework, which affords long-term structural support to the repair. It also obviates the need to transpose nasal mucosa and create a secondary defect. The rhinoplasty approach furthermore permits additional nasal deformities to be corrected at the same time. Presented at the British Association of Plastic Surgeons Summer Scientific Meeting, Sheffield, UK (12 July 2006).