双球囊导管促宫颈成熟在延期妊娠 引产中的应用效果及对妊娠结局的影响研究

目的 研究双球囊导管促宫颈成熟在延期妊娠引产中的应用效果及对妊娠结局的影响.方法 前瞻性选择2016年1月至2019年12月安徽医科大学附属宿州医院产科收治的80例延期妊娠产妇作为研究对象,采用随机数字表法将其分为2组:对照组40例采用传统的缩宫素引产,研究组40例采用双球囊导管引产.比较2组宫颈成熟度、引产效果、分娩...     

普罗布考和科素亚对血管成形术后生长因子表达的影响

目的 :研究普罗布考和科素亚对血管成形术后再狭窄的预防作用和对生长因子表达的影响。方法 :新西兰白兔30只均予高脂饮食 ,1周后进行髂动脉球囊拉伤术 ,随机分为对照组 (C组 )、普罗布考组 (P组 )、科素亚组 (L组 )。术后第 4周进行血管形态学检查 ,用免疫组化方法检测胰岛素样生长因子 - 1受体 (IGF- 1 R)、血管内皮生长因子(VEGF)、增殖细胞核抗原 (PCNA)表达。结果 :与 C组相比 ,P组和 L 组血管腔面积明显扩大 (P<0 .0 1 ) ,IGF- 1 R、VEGF和 PCNA表达明显减少 (P<0 .0 1 ) ,P组和 L组相比无显著性差异 (P>0 .0 5 )。结论 :普罗布考和科素亚可以显著减轻兔髂动脉血管成形术后再狭窄的形成 ,抑制 IGF- 1、VEGF和 PCNA的表达 ,而两药之间则无显著性差异     

内镜乳头球囊扩张术治疗非扩张性肝外胆管结石的疗效分析

目的 分析内镜乳头球囊扩张术(EPBD)和EST治疗非扩张性肝外胆管结石的疗效.方法 回顾性分析1999年1月至2008年4月太钢总医院收治的317例非扩张性肝外胆管结石患者的临床资料.其中119例行EPBD治疗,198例行EST治疗.各选取62例进行对照研究,分别设为EPBD组和EST组.EPBD组的患者在经ERCP检查确诊后,沿导丝置入柱状球囊,使其中部位于十二指肠乳头开口处.完成扩张后,用网篮或拖石气囊取石,术后常规行ENBD.EST组的患者在经ERCP检查确诊后,采用退刀切开法切开十二指肠乳头,在数字减影血管造影X线监视下,用网篮或拖石气囊取石.两组疗效分析采用χ2检验.结果 EPBD组和EST组的一次取石成功率分别为92%(57/62)和94%(58/62),两组比较,差异无统计学意义(χ2=0.222,P>0.05).EPBD组患者发生高淀粉酶血症、胰腺炎的例数略多于EST组,而发生十二指肠穿孔的例数略少于EST组,两组比较,差异均无统计学意义(χ 2=0.286,1.000,2.000,P>0.05).EPBD组患者发生乳头出血和胆道感染的例数明显少于EST组(χ2=4.000,7.000,P<0.05).两组患者均随访24个月.在术后的第6、12、24个月的随访统计中,EPBD组出现胆管结石复发及胆道逆行感染的例数明显少于EST组(χ2=4.000、5.000、6.000,6.000、8.000、11.000,P<0.05).结论 EPBD后取石+ENBD是治疗非扩张性肝外胆管结石的首选.该方法具有保护十二指肠乳头的功能、创伤小、恢复快等优点.     

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

BackgroundSaphenous veins are regular bypass conduits selected in non-left anterior descending artery (LAD) coronary artery bypass graft (CABG) surgery. Despite the technical errors, acute thrombosis, intimal hyperplasia and arteriosclerosis which could lead to saphenous vein graft (SVG) failure, the metal-clipping-related SVG failure is unique and rare. This study was conducted to investigate the clinical and underlying mechanisms of the metal-clipping-related SVG failure.MethodsWe collected 6 typical cases of the metal-clipping-related SVG failure in 41 patients who were diagnosed graft stenosis by coronary angiograph after CABG in the Department of Cardiology, Beijing Anzhen Hospital, from January 2020 to September 2021. Furthermore, we built an in vitro model to verify the identical intravascular ultrasound (IVUS) pattern of metal clip.ResultsThere were 6 in 41 cases of SVG stenosis caused by clipping of the side branches. We found that the stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. In this situation, great resistance could be felt when pushing the instruments through the stenosis and crystallized cholesterol was rarely caught by the distal protection device. We verified the similar IVUS pattern of metal clip at the side-branches of SVG in vitro.ConclusionsThe metal-clipping-related stenosis may lead to SVG failure. The stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. IVUS showed great modality for clarification.     

应用冠脉技术成功治疗重度肺动脉瓣狭窄一例

我国于20世纪80年代中期开展经皮球囊肺动脉瓣成形术(PBPV)技术,现已成为治疗先天性肺动脉瓣狭窄(PS)的首选方法。但对于重度狭窄瓣口面积极小的婴幼儿,常规的球     

双气囊内镜在中消化道疾病诊断中的应用价值研究

目的 探讨双气囊内镜(DBE)在中消化道疾病诊断中的应用价值.方法 对53例行DBE检查的疑似中消化道疾病患者的临床资料进行回顾性分析,总结病变检出情况以及并发症、不良反应发生情况.结果 53例均顺利完成DBE检查,其中单纯经口进镜者26例、单纯经肛进镜者9例、经口+经肛进镜者18例,共46例(86.79％)发现病变,包括上消化道病变3例(5.66％)、中消化道病变41例(77.36％)和下消化道病变2例(3.77％).53例患者均能耐受麻醉及内镜检查,无一例发生消化道出血、穿孔、肠道扭转、肠系膜撕裂、胰腺炎等严重并发症,亦未出现麻醉相关的并发症及意外.部分患者术中出现腹部胀气、一过性腹痛;经口进镜者术中出现不同程度的咽喉部不适或少量鼻腔出血;1例术中因外套管根部硅胶管与气管插管摩擦松脱形成嵌顿,放气并拔出气管插管后松解;术后1d有2例出现轻微腹泻伴低热,于48 h内自然缓解.结论 DBE在中消化道疾病的诊断中具有较好的临床价值,安全性较高.     

A RE I NTERFACILITY G ROUND T RANSPORTS OF P ATIENTS U TILIZING I NTRA - AORTIC B ALLOON P UMPS S AFE ?

Objective. To determine whether the interfacility ground transport of patients with intra-aortic balloon pumps results in morbidity or mortality during transfer. Methods. Charts of all intra-aortic balloon pump transports by a private ambulance company occurring from January 1998 through December 1999 (24 months) were reviewed retrospectively. Records were assessed by a single reviewer for adverse events, explicitly defined as any notation on the record describing death, chest pain, dyspnea, altered mental status, device malfunction, bleeding, unstable vital signs (heart rate <50 beats/min or ≥120 beats/min, respiratory rate <12 breaths/min or ≥30 breaths/min, systolic blood pressure <90?mm?Hg), or hypoxia (oxygen saturation <93%). Unstable vital signs as defined above did not count as adverse events if they represented a patient's baseline condition prior to transport. Results. Thirty-two transports were identified during the study period. Twenty-seven patients (84.4%) had no adverse events. There were no mortalities. Adverse events, none of which resulted in morbidity, were: 1) chest pain and transient paroxysmal atrial tachycardia (relieved with increasing the nitroglycerin infusion); 2) continuous mild chest pain (began during transport and diminished with giving sublingual nitroglycerin and increasing the nitroglycerin infusion); 3) dyspnea and hypoxia (relieved with increased oxygen); 4) transient hypotension (spontaneously resolved); 5) hypotension (resolved by increasing the dopamine infusion). Conclusion. Although a few adverse events occurred, interfacility ground transport of patients with intra-aortic balloon pumps was not associated with morbidity or mortality in this study.     

Comparison of laparoscopic and retroperitoneoscopic approaches to the great vessels in a porcine model

Summary

Conventional laparoscopy has not yet been widely adopted for procedures involving the retroperitoneal organs, due to the problems of adequate bowel retraction and the poor access afforded by the position of the root of the mesentery. Developments in retroperitoneal laparoscopy facilitated by balloon dissection have afforded a new minimally invasive approach to the retroperito-neum. We have compared retroperitoneoscopic and laparoscopic approaches to the great vessels in a porcine model.     

导尿管球囊扩张术不同介入时机对脑卒中后环咽肌失弛缓症疗效的影响

目的 观察导尿管球囊扩张术介入时间不同对脑卒中后环咽肌失弛缓症疗效的影响.方法 选取经电视X线透视吞咽功能检查(VFSS)诊断为脑卒中后环咽肌失弛缓症的吞咽障碍患者48例,根据导尿管球囊扩张术介入时间的不同,将患者分为A、B、C和D4组,每组12例.4组均采用注水方式使球囊充盈以扩张环咽肌,同时辅以低频电刺激及吞咽康复行为治疗.分别于治疗前和治疗终点(恢复经口进食或治疗满6周后)采用吞咽功能临床评价和VFSS分别对4组患者所需球囊扩张次数、咽通过时间、吞咽障碍程度及疗效进行评定.结果 治疗终点时,4组患者所需球囊扩张次数分别为(8.12±4.35)次、(9.68 ±4.26)次、(13.59 ±5.47)次、(19.85 ±8.61)次,A组、B组及C组患者所需的球囊扩张次数明显少于D组(P＜0.05),A组、B组患者所需的球囊扩张次数亦少于C组(P＜0.05),但A组与B组间差异无统计学意义(P＞0.05).治疗终点时,A组和B组均有11例患者可进食水、流质物、糊状物及固体食物,而C组可进食上述4种性状食物的患者分别为9、9、10和9例,D组则分别为6、6、7、5例,A组、B组及C组的吞咽功能均优于D组(P＜0.05),A组、B组的吞咽功能亦显著优于C组(P＜0.05),但 A组与B组间差异无统计学意义(P＞0.05).A、B、C、D 4组患者治疗后的咽通过时间较治疗前均缩短[(0.14 ±0.07)s对(0.22 ±0.04)s、(0.14±0.08)s对(0.22 ±0.06)s、(0.16 ±0.05)s对(0.21 ±0.08)s、(0.19 ±0.09)s对(0.23±0.10)s,均P＜0.05],A组、B组及C组的咽通过时间显著短于D组(P＜0.05),A组、B组的咽通过时间亦短于C组,但A组与B组间差异无统计学意义(P＞0.05).治疗终点时,A、B、C、D4组VFSS有效率分别为91.66％、91.66％、83.33％、58.33％,A组、B组及C组的有效率显著优于D组(P＜0.05),A组、B组的有效率亦显著优于C组(P＜0.05),但A组与B组间差异无统计学意义(P＞0.05).结论 早期介入导尿管球囊扩张术可有效改善脑卒中后环咽肌失弛缓症患者的吞咽功能,提高其生活质量.     

Anatomy of coarctation,hypoplastic and interrupted aortic arch: relevance to interventional/surgical treatment

Obstructive lesions in the aortic arch are comprised of discrete coarctation, tubular hypoplasia and interruption. This review discusses the anatomy of the lesions relevant to interventional treatment. Catheter intervention, using not only balloon angioplasty but also stent implantation for coarctation, has been developed over the past couple of decades as an alternative treatment to surgery. Several studies have reported long-term outcome and the benefits of surgery and catheter intervention for treating obstructive lesions in the aortic arch but more studies are needed for comparable evaluations. The development of imaging and further improvement of surgical and catheter intervention, such as hybrid intervention or new devices, will help in removing the obstruction safely.