应用国产球囊导管经皮球囊二尖瓣成形术12例报告

本文报告经皮球囊二尖瓣成形术治疗二尖瓣狭窄12例。10例术前平均左房压为18mmHg～40mmHg(26.7±7.15mmHg),术后即刻为4mmHg～18mmHg(10.6±3.86mmHg)P<0.01。跨瓣压差术前10mmHg～40mmHg(19.6±9.05mmHg),术后为0～5mmHg(2.65±2.21mmHg)P<0.01。1例失败,1例术后发生二尖瓣关闭不全急性左心衰竭死亡。     

A Decrease in Pulmonary Vein Diameter After Radiofrequency Ablation Predicts the Development of Severe Stenosis

A decrease in ostial pulmonary vein (PV) diameter was observed in patients on the day after radiofrequency ablation of atrial fibrillation (AF). This study examined whether a relative reduction in PV diameter on day 1 (RRPVD1) after the procedure predicts the late development of severe PV stenosis (PVS). The study included 104 consecutive patients (mean age = 55 years, range 46–61, 34 women) with drug refractory AF. Pulmonary vein diameter was measured using MR angiography (MRA) on the day before and on day 1 after the ablation procedure. The MRA was repeated every 3 months after the procedure. Severe PVS was defined as a >70% diameter reduction from the initial ostial diameter. The cut-off of RRPVD1 was prespecified as 25% decrease in initial diameter. The data are presented as medians and interquartile range. A total of 357 PV were treated. The RRPVD1 was 0.0% (0.0–11.1%). Severe PVS was found in 18 PV during a follow-up of 12 months (range 6–13). The log-rank analysis confirmed a strong association between a RRPVD1 ≥25% and the development of PVS (hazard ratio: 7.1; 95% confidence interval 3.8–13.5, P < 0.0001). By multivariate Cox regression model, after adjustment of procedure variables, RRPVD1 was the strongest predictor of development of severe PVS. RRPVD1 ≥25% was a strong independent predictor of development of severe PVS.     

下腰椎失稳合并椎管狭窄症的手术治疗

目的：观察下腰椎失稳合并椎管狭窄症患者经椎弓根螺钉系统及椎体融合器治疗的效果。方法：采用后路减压，椎弓根螺钉系统内固定，椎体间融合器BAK融合。结果：术后随访1年一4年3个月(平均2年4个月)，椎体间骨性融合率1年89．6％，2年2个月100％，临床症状消失满意率92％。结论：采用椎管减压、椎弓根螺钉系统加椎间融合器固定，可使滑脱失稳的椎体部分或全部复位，保证脊柱骨性融合，达到脊柱稳定、解除症状的目的。     

An improved technique for treating tracheostomal stenosis following laryngectomy

Stenosis of the tracheostome is an occasional complication following laryngectomy. Having tried a number of procedures recommended for correction of such stenoses with limited results, we developed a new technique. This technique which is based on multiple Y-V plasties has been applied to 20 patients. Measurements of the stomal area following surgery in 18 patients showed an average increase in stomal size by a factor of 3.8. One patient apparently had no increase of the stoma. In 2, no post-operative measurements were available. Post-operative infection resulted in recurrence of the stenosis in one patient. He was successfully reoperated using the same technique. Follow-up revealed that none of the patients had complaints related to their stoma.     

Late Ureteral Stenosis Following Renal Transplantation: Risk Factors and Impact on Patient and Graft Survival

The aim of this retrospective study of a cohort of 1787 consecutive kidney transplantations was to analyze the risk factors associated with the occurrence of ureteral stenosis and the impact of ureteral stenosis on graft and patient survival. Between January 1990 and December 2002, 1787 renal transplantations were performed at our center. Only stenosis observed after the first month, were considered. Among the parameters studied were: donor age and serum creatinine before procurement; recipient age, cold ischemia time, delayed graft function (DGF), number of arteries and the presence of a double J stent. The follow-up parameters were the number and timing of acute rejection episodes, cytomegalovirus (CMV) infection, acute pyelonephritis, renal function and death. Ureteral stenosis occurred in 4.1% of patients and was correlated with donor age > 65 years (p = 0.001), kidneys with more than 2 arteries (p = 0.009) and DGF (p = 0.016). Ureteral stenosis did not affect 10-year patient and graft survival rates, which were respectively 90% and 64% for the stenosis group, 86% and 63% for the no-stenosis group (p = NS). These data suggest an important role for donor age, number of renal arteries and DGF for the occurrence of ureteral stenosis following renal transplantation.     

Histological changes in the midbrain around the aqueduct in congenital hydrocephalic rat LEW/Jms

Primary aqueductal stenosis is one of the main causes of congenital hydrocephalus in humans and experimental models. The congenitally hydrocephalic rat strain LEW/Jms is one such model. In this report, we describe further detailed histological features of periaqueductal structure, including the posterior commissure, subcommissural organ (SCO), and ependyma, and discuss the changes in these structures in relation to the cause of hydrocephalus. Coronal sections of the aqueduct in normal rats showed that the usual ependyma was absent in the center of the base facing the dorsal side, which was replaced by tall columnar cells. On the other hand, in hydrocephalic rats the ependyma encircled the aqueductal cavity. In midline sagittal sections, normal and hydrocephalic rats showed the SCO, although the SCO in hydrocephalic rats was shorter than in normal rats. There was also a marked difference between normal and hydrocephalic rats in the dorsoventral dimension of the rostral midbrain. In hydrocephalus, this dimension was large in comparison with normal rats. The superior collicular commissure located caudal to the posterior commissure ran along the ventral side of the midbrain in rats with hydrocephalus, and there was a cell-depleted area just dorsal to the superior collicular commissure. The same findings were observed from the 17th day of gestation until the postnatal period. Although the role of the SCO has been widely discussed from the viewpoint of secretory function, the present study indicated that this organ might be involved in the formation of the shape of the aqueduct.     

Kongenitale Duodenalstenose im Erwachsenenalter

Zusammenfassung Eine hochgradige Duodenalstenose im Erwachsenenalter kann in seltenen Fällen angeboren sein und findet ihre Ursache in einer intraduodenal gelegenen Membran. Die Anamnese zeigt Wachstumsstörungen mit Erbrechen und Meteorismus und abdominelle Beschwerden. Eine Perforationsöffnung in dieser Membran ist die Ursache fur ein Überleben bis ins Erwachsenenalter. Die Röntgendarstellung und die tiefe Duodenoskopie lassen auf einfache Weise die Diagnose stellen. Differentialdiagnostisch müssen der Volvulus bei Malrotation, Ladd-Bänder und das Pancreas anulare, sowie die Kompression des Duodenums durch Mesenterialgefäße erwogen werden. Das operative Verfahren der Wahl ist die Resektion der intraduodenalen Membran. Dabei ist v. a. die Papilla Vateri darzustellen, da diese nicht selten im Bereich des Septums mündet. Das längs eröffnete Duodenum wird quer verschlossen. Bei der Wind-Sock-Web-Anomalie sollte das Duodenum an der Ansatzstelle des Diaphragmas eröffnet werden. Die Anlage einer Gastrojejunostomie ist inadäquat und zu vermeiden.

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Congenital duodenal stenosis in adulthood

A high-grade duodenal stenosis in adults can, in rare cases, be congenital, and its cause is found in an intraduodenally sited membrane. The anamnesis reveals growth disorders with vomiting and meteorism and abdominal complaints. A perforation opening in this membrane is the reason for survival into adulthood. The X-ray appearance and deep duodenoscopy make the diagnosis easy. Volvulus in cases of malrotation, Ladd's ligaments, anular pancreas, and compression of the duodenum by mesenteric vessels must be considered in the differential diagnosis. When the intraduodenal membrane is resected it is most important to expose the papilla Vateri, since this not uncommonly ends in the area of the septum. If necessary, a duodenoduodenostomy is performed. If the windsock web abnormality is present the duodenum should be opened at the point of attachment of the diaphragm. The construction of a gastrojejunostomy should be avoided.

     

二尖瓣狭窄的外科治疗(附85例报告)

本文报告1972年8月至1987年8月我院85例风湿性二尖瓣(犭央)窄或伴有轻度关闭不全病人的外科手术疗效。80例行闭式扩张术,5例行直视扩张术。贵州地区病人体型较小,瓣膜损害较重。瓣口扩张2.8～3.5cm,较一般要求偏小。手术后近期疗效较好。     

血管内支架成形术治疗颅内动脉狭窄

目的:探讨颅内动脉狭窄血管内球囊支架成形术的可行性、安全性及其疗效。方法:17例患者术前3天给予阿司匹林300mg/天和噻氯吡啶250mg/天,6F(Envoy)导引导管放置到颈内动脉远段或椎动脉近颅底段,造影获得工作位,评价血管狭窄程度:狭窄率=(1-狭窄处管径/狭窄远端管径)×100%,微导丝在路途导引下通过颅内动脉狭窄段,向远端直至P2或M2段,确保足够的支撑力。选择支架大小的依据为狭窄远端正常血管的直径,导丝引导下支架通过狭窄部位,造影确定支架位置正确,充盈球囊至5～6大气压,支架释放后造影确认展开良好,回撤球囊,无并发症,操作完毕。随访3～10月。结果:17例患者颅内动脉狭窄处植入支架,技术成功100%,造影显示狭窄由术前(78.3±12.9)%降至术后(6.8±7.3)%,狭窄的动脉管径恢复,短期随访(3～10个月)显示很好临床效果。术中出现一例蛛网膜下腔少量出血(SAH),对症治疗痊愈。6例随访造影未见血管再狭窄。结论:颅内动脉狭窄支架植入增加血管内径,改善血流量,减轻临床症状,是一种安全、可行有效的治疗方法。     

颈动脉支架置入术治疗颈动脉狭窄

颈动脉支架置入术(CS)作为一种治疗颈动脉狭窄(CAS)的新方法，与传统的颈动脉内膜剥离术相比较，具有易操作、创伤小、并发症低等优点，作者就CS的现状、操作方法及并发症处理作一综述。