肝动脉解剖变异在肝癌介入治疗中的临床意义

目的探讨肝动脉解剖变异的DSA表现及其在肝癌肝动脉栓塞化疗（TACE）中的临床意义。方法回顾分析223例肝癌患者的DSA资料，对存在解剖变异的肝动脉进一步分析其起源、走行、分布及对TACE的影响，统计每组变异肝动脉的发生率。结果223例中，32例存在肝动脉解剖变异，占14．34％，共40支变异肝动脉，其中变异肝总动脉2支（5％，2／40），变异肝固有动脉1支（2．5％，I／40），变异肝右动脉24支（60％，24／40），变异肝左动脉13支（32．5，13／40），有30支变异肝动脉直接参与肿瘤供血，其中24支行TACE治疗，6支行肝动脉化疗（TAI）。结论正确认识肝动脉的解剖变异特征对提高TACE的成功率、降低手术风险有极其重要的意义。     

Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine

A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age, 41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of bone fusion and minimal loss of correction.     

脑源性神经生长因子和神经干细胞联合移植对大脑中动脉阻塞大鼠神经功能恢复的作用

目的 将脑源性神经生长因子(BDNF)和神经干细胞(NSCs)单独及联合移植应用于大脑中动脉阻塞(MCAo)模型大鼠,观察BDNF和NSCs移植对大鼠缺血性脑卒中神经功能恢复的作用及BDNF对内源性和外源性NSCs增殖、迁移及分化的影响.方法 体外分离、培养新生大鼠海马NSCs,BrdU标记.实验动物随机分为A组(MCAo组);B组(MCAo+BDNF组);C组(MCAo+NSCs组);D组(MCAo+BDNF+NSCs组),每组16只,移植后进行神经功能损害评分(NSS),用免疫组织化学行BrdU、nestin、BrdU/NSE检测,分析结果.结果 移植后的2、4周神经功能评分分别为:A组5.3±0.5、5.3±0.5;B组4.0±0.8、3.8±0.5;C组3.5±0.6、3.5±0.6;D组2.0 ±0.8、1.8±1.0,D组显著好于其他3组(P<0.05),B组与c组显著好于A组(P<0.05).nes.tin阳性细胞数:A组1.24±1.13,B组2.59±1.44(P<0.05),BrdU阳性细胞数:A组0.52±0.68,B组1.65±1.10(P<0.05).BrdU阳性细胞数:C组6.08±1.52,D组10.26±1.96(P<0.05),BrdU/NSE双阳性细胞数:C组1.74±1.04,D组3.58±1.20(P<0.05).结论 BDNF和NSCs移植单独及联合应用对MCAo大鼠的神经功能恢复均有作用,两者联合具有协同作用.BDNF对内源性NSCs的激活、增殖有促进作用,对外源性NSCs的增殖、迁移及分化有促进作用.     

兔内听动脉阻断与听觉改变的关系

目的 探讨实验性内听动脉阻断与术后听力改变的关系及术中听觉监控的方法。方法 实验兔乙状窦后进路暴露小脑桥脑角，下压小脑暴露内听道及第Ⅷ神经复合体，分辨出内听动脉，予阻断不同时间，分别行蜗神经直接复合动作电位(DCAP)和畸变产物耳声发射记录(DPOAE)。结果对照组DCAPN1波潜伏期值无明显改变。内耳血供阻断10s和30s组在压迫开始后3min，DCAPN1波潜伏期值均恢复为初始值。内耳血供阻断1min组在压迫开始后3h，DCAPN1波潜伏期值未恢复为初始值假手术组DPOAE幅值无明显改变，内耳血供阻断10s、30s对DPOAE幅值无影响，内耳血供阻断1min使得DPOAE幅值下降结论兔内耳血供阻断1min可能造成兔听觉不可逆损伤。DCAP、DPOAE能有效、持续地监控内耳血供阻断，是耳神经外科手术中实用的听觉监测手段。     

Melatonin‐evoked potentiation of the juvenile rat tail artery neurogenic reactivity depends on degree of the change in the reactivity

Aim: Dependence of the melatonin‐evoked potentiation of the rat tail artery neurogenic reactivity on degree of the change in the reactivity was studied. Method: Electrical field stimulation‐evoked contractile response of the juvenile rat tail artery segment under isometric conditions was recorded. 0.1 μm melatonin was administered after the change in the response produced both spontaneously and by acidification (pH 6.6) or alkalinization (pH 7.8) of the solution. Results: During the course of experiment, the contraction force continuously declined, being reduced by 12 ± 5, 24 ± 7 and 32 ± 6% at 20, 70, and 170 min after beginning of experiment, respectively. Melatonin applied at these time points increased the contraction by 20 ± 5, 41 ± 10, and 48 ± 8%, respectively, relative to control. This increase in potentiating effect of melatonin during the course of experiment was not because of sensitization of the segment to the hormone. Acidosis‐induced considerable decline in neurogenic contraction was counteracted by melatonin, while after alkalosis‐induced augmentation in the contraction the hormone was not effective. Melatonin increased the artery response to 0.1 μm noradrenaline. Conclusion: These data suggest that melatonin can restore an attenuated neurogenic reactivity of the juvenile rat tail artery. The effect is more pronounced with further decrease in reactivity and might be due to a change in sensitivity of the post‐junctional membrane to noradrenaline.     

支气管动脉栓塞术治疗咯血的疗效分析

目的 评价支气管动脉栓塞术治疗咯血的临床疗效.方法 对45例咯血患者用明胶海绵颗粒、聚乙烯醇(PVA)微球栓塞剂行支气管动脉栓塞术.结果 45例患者均成功行支气管动脉栓塞术,41例咯血完全控制,4例复发,复发率8.9%,5例患者术后出现胸痛和低热不适,无需特别处理,可自行缓解,未出现穿刺部位血肿和截瘫等并发症.结论 支气管动脉栓塞术是治疗咯血的一种快速、安全、有效的方法.     

脊椎错位引起的代偿及其临床意义

脊柱的平衡在发生病理性变化时会打破，但人体有保持自我平衡的能力，脊柱必会发生一系列代偿性变化来重新建立平衡，这就是人体平衡系统作用的结果。当脊椎发生错位，即推拿医生最关心的脊椎错位时，脊柱内部将会发生怎样的代偿性变化及具有什么样的临床意义，下文将给予阐述。     

选择性子宫动脉栓塞治疗症状性子宫肌瘤

目的:评价选择性子宫动脉栓塞 (U AE)治疗症状性子宫肌瘤 (SUF)的临床疗效。方法:12例 SUF患者行双侧子宫肌瘤供血动脉的栓塞治疗 ,栓塞剂为聚乙烯醇微球颗粒 (PVA)。结果:栓塞成功率 10 0 % ,无严重并发症发生。随访 3～ 2 4个月 ,B超示术后 6个月肌瘤平均缩小 4 5 % ,1例肌瘤消失 ,均伴有月经量的明显减少。 结论 :U AE是治疗 SU F的安全方法 ,近期疗效肯定。     

手术治疗心肌桥15例报告

目的探讨外科手术对心肌桥的治疗效果。方法1999年1月～2006年10月,我院对15例心肌桥(13例有典型心绞痛,经正规药物治疗,症状控制不佳,1例急性心肌梗死,1例心悸、晕厥)行手术治疗,其中9例行非体外循环不停跳手术(3例单纯心肌桥切开松解术,2例单纯冠状动脉搭桥术,4例心肌桥切开松解术联合冠状动脉搭桥术),6例行体外循环下手术(5例心肌桥切开松解术联合冠状动脉搭桥术,1例单纯心肌桥切开松解术)。结果15例手术均取得成功,非体外循环不停跳手术组手术时间(2.8±1.9)h;体外循环手术组手术时间(3.5±1.7)h,体外循环时间(59±37)min。无手术死亡及手术并发症,术后3个月心绞痛、心悸症状完全缓解,11例心电图恢复正常。15例随访0.5～7年,(1.9±1.2)年,1例复发心悸,其余患者无心绞痛复发。结论外科手术治疗心肌桥具有良好的近、中期效果。