活体胃血供的特点及其临床意义

目的 了解活体胃血供的特点，旨在探索中晚期胃癌的局部灌注化疗方法。方法 对36例胃溃疡患者在行胃大部切除治疗时，进行亚甲蓝染色，观察活体胃各分支动脉自然血供区域和血流阻断后血供范围的变化。结果 术中见左、右胃网膜动脉和左、右胃动脉分别为胃大、小弯近、远段相应区域提供血液，胃壁组织染色时间很短；阻断动脉血流后，染色范围扩展，染色时间延长；阻断伴行静脉后，染色范围进一步扩展，染色时间再度延长。结论 胃左动脉和胃网膜右动脉为胃血供的主要动脉，其他动脉分支为辅助性动脉；一般情况下，经动脉灌注的亚甲蓝在胃组织停留时间极短；阻断伴行静脉后，可使该染料在组织停留时间延长。推测此法可使化疗药物在胃组织中存留时间延长，从而有利于胃癌的局部化疗。     

猪急性缺血性肝衰模型的建立和辅助性异位部分肝移植的作用

目的: 探讨急性缺血性肝衰模型的制备、辅助性异位部分肝移植的作用. 方法: 用家猪配对开展辅助性异位部分肝移植.分三组,A组:受体肝脏和肝动脉保持原状,其门静脉缩窄;供肝植入受体右肝下,仅建立门静脉血供,不建立动脉血供.B组:受体肝动脉结扎,其他手术内容与A组相同.C组:受体肝动脉结扎,供肝动脉和门静脉血供均建立,其他手术内容与A组相同.监测各组受体存活情况,肝功能和肝脏血流情况,病理及供肝胆汁分泌情况. 结果: A组、C组受体3 d以上成活率显著高于B组.A组、C组手术前后胆红素无显著改变,B组术后胆红素显著高于术前,术后第二天B组胆红素显著高于A组、C组.C组供肝胆汁分泌和血供良好,肝细胞存活并有活跃的代偿性增生;A组、B组供肝无或仅有少量胆汁分泌,肝细胞大片坏死. 结论: 受体肝动脉结扎、门静脉缩窄足以造成急性肝衰模型;保留受体肝脏动脉血供、减少门静脉血供对受体肝脏功能无严重影响;辅助性异位部分肝移植能取得良好的效果,足以纠正急性肝衰.     

Assessment of photoplethysmographic signals for the determination of splanchnic oxygen saturation in humans

The need for a clinically applicable method of detecting splanchnic hypoxia has led to experimental animal studies which indicated the usefulness of intestinal pulse oximetry. Pulse oximetry relies on detection of photoplethysmographic signals. Before developing a pulse oximeter for the measurement of organ oxygen saturation peri-operatively, we designed a system based on a reflectance photoplethysmographic probe to investigate photoplethysmographic signals from human viscera (bowel, liver, and kidney). Recordings were obtained simultaneously from the abdominal viscera and the finger using identical probes. The probe was held sequentially for up to 2 min on the surface of viscera of 12 patients during routine laparotomy. Measurable splanchnic photoplethysmographic signals were recorded for the first time in humans. There were no statistically significant differences between photoplethysmographic amplitudes from viscera and those from the finger. Our results indicate the feasibility of pulse oximetry for the measurement of visceral oxygenation in humans.     

Temporo-spatial distribution of blood vessels in human lumbar intervertebral discs

While there is consensus in the literature that blood vessels are confined to the outer anulus fibrosus of normal adult intervertebral disc, debate continues whether there is a vascular in-growths into inner parts of the intervertebral disc during degeneration. We therefore tested the hypothesis that vascular in-growth is not a distinct feature of disc degeneration. The specific endothelial cell marker CD 31 (PECAM) was used to immunohistochemically investigate 42 paraffin-embedded complete mid-sagittal human intervertebral disc sections of various ages (0–86 years) and varying extent of histomorphological degeneration. Additionally, 20 surgical disc samples from individuals (26–69 years) were included in this study. In discs of fetal to infantile age, blood vessels perforated the cartilaginous end plate and extended into the inner and outer anulus fibrosus, but not into the nucleus pulposus. In adolescents and adults, no blood vessels were seen except for the outer zone of the anulus fibrosus adjacent to the insertion to ligaments. The cartilaginous end plate remained free of vessels, except for areas with circumscribed destruction of the end plate. In advanced disc degeneration, no vessels were observed except for those few cases with complete, scar-like disc destruction. However, some rim lesions and occasionally major clefts were surrounded by a small network of capillary blood vessels extending into deeper zones of the anulus fibrosus. A subsequent morphometric analysis, revealed slightly “deeper” blood vessel extension in juvenile/adolescent discs when compared to young, mature and senile adult individuals with significantly “deeper” extension in the posterior than anterior anulus. The analysis of the surgical specimens showed that only sparse capillary blood vessels which did not extend into the nucleus pulposus even in major disc disruption. Our results show that vascular invasion deeper than the periphery was not observed during disc degeneration, which supports the hypothesis that vascular in-growth is not a distinct feature of disc degeneration. This study was supported by a grant from the AO/ASIF Foundation Switzerland (00-B72) and a grant from the AO Spine (SRN 02/103).     

阴囊皮肤多源性血供系统应用解剖学研究

目的探讨阴囊皮肤血供模式,明确可能的阴囊皮瓣供区。方法对10具(20侧)成年男尸阴囊皮肤进行解剖学研究。结果阴囊前动脉来自阴部外浅动脉,于阴茎根部侧方分成内、外侧支,分布于阴囊前外侧皮肤,内侧支口径为(0.54±0.34)mm和(0.69±0.09)mm;来自闭孔动脉前皮支的阴囊外侧动脉[出现率为85％,外径(0.62±0.19)mm]分布于阴囊外侧中1/3区皮肤;阴囊后动脉于阴囊后极处,分成阴囊后动脉外侧支与阴囊中隔动脉,前者[外径(0.8±0.1)mm]分布于阴囊后外侧区皮肤,后者[外径(0.9±0.2)mm]分布于阴囊中隔及阴囊中缝侧方皮肤。结论上述4组血管均在阴囊肉膜层内走行,其终末支血管相互吻合,在每一侧阴囊形成一个较为完整的动脉网络,由此提出4种类型的阴囊皮瓣切取方式,其他类型的阴囊皮瓣是上述阴囊皮瓣切取方式的变化形式。     

胃癌血管内皮生长因子的表达与微血管密度的关系及其临床意义

目的探讨胃癌组织中血管内皮生长因子（VEGF）的表达和微血管密度（MVD）的关系,以及这两项指标与临床病理特征和预后之间的关系。方法观察分析116例胃癌组织中VEGF的表达和计算微血管密度(MVD),分析VEGF的表达与MVD间的关系及它们与临床病理因素和预后的关系。结果116例胃癌组织中,VEGF的阳性率为60.34%。VEGF阳性组中的MVD值明显高于VEGF阴性组（分别为26.16±8.50和19.22±8.20,P<0.01)。在淋巴结转移组中VEGF表达的阳性率明显高于无淋巴结转移组(P<0.05)。在肿瘤分期晚的病人中,其VEGF表达的阳性率也明显高于分期早的(P<0.05)。MVD与胃癌的淋巴结转移及腹腔内转移有关(P均<0.01),且随TNM分期而增加(P<0.01)。VEGF表达阴性组和低MVD组(MVD<23)的5年生存率均明显高于VEGF表达阳性组和高MVD组(MVD≥23)(均P<0.01)。多因素分析表明,MVD和VEGF的表达均是独立的预后因素。结论胃癌组织中VEGF的表达和MVD能反映胃癌的恶性程度,是判断预后和指导辅助治疗的有效指标。     

Role of aquaporin water channels in kidney function studied using transgenic mice

Several aquaporin (AQP) water transporting proteins are expressed in mammalian kidney: AQP1 in plasma membranes of proximal tubule, thin descending limb of Henle, and descending vasa recta; AQP2 in collecting duct luminal membrane; AQP3 and AQP4 in collecting duct basolateral membrane; AQP6 in intercalated cells; and AQP7 in the S3 segment of proximal tubule. To define the role of aquaporins in renal physiology, we have generated and characterized transgenic null mice deficient in AQP1, AQP3, and AQP4, individually and in combinations, as well as AQP2 mutant mice, in which the T126M mutation causing human nephrogenic diabetes insipidus was introduced. AQP1-deficient mice are polyuric and unable to concentrate their urine in response to water deprivation or vasopressin administration. AQP1 deletion greatly reduces osmotic water permeability in proximal tubule, thin descending limb of Henle, and descending vasa recta, resulting in defective proximal tubule fluid absorption and medullary countercurrent exchange. Mice lacking AQP3 have low basolateral membrane water permeability in cortical collecting duct and excrete large quantities of dilute urine. Mice lacking AQP4 have low water permeability in inner medullary collecting duct, but manifest only a mild defect in maximum urinary concentrating ability. These data, taken together with phenotype analyses of brain, lung, and gastrointestinal organs, support the paradigm that aquaporins facilitate rapid near-isosmolar transepithelial fluid absorption/secretion, as well as rapid vectorial water movement driven by osmotic gradients. The renal phenotype data in aquaporin knockout mice suggests the utility of aquaporin blockers as novel aquaretic-diuretic agents. Received: March 19, 2001 / Accepted: March 22, 2001     

化疗药物对轴型皮瓣血运影响的组织学观察

目的探讨抗癌药物动脉灌注后对局部轴型皮瓣血运影响的组织学评价。方法在猪腹部的腹壁上动脉插管灌注抗癌药物,10d后在猪腹部形成以腹壁上血管为蒂的岛状皮瓣,通过对灌注区域轴型血管供养的岛状皮瓣的成活率、光镜、透射电镜及血管铸型透明标本的组织学观察,显示其血管结构及构筑的变化。结果抗癌药物用于局部动脉灌注后,使局部轴型血管支配的血管网有损伤的表现,岛状皮瓣远端的血运显著降低。结论抗癌药物经动脉灌注后可影响局部轴型皮瓣的血运,使皮瓣血供的安全范围缩小,为提高相关修复手术的成功率提供可靠的科学依据。     

腰椎体退变与血液供应减少相关：基于一项双期增强CT研究

目的观察腰椎血液供应随老龄化发生的变化,分析其对腰椎退变的影响。方法横截面研究。研究对象为2012年1月~2012年12月间来我院体检的正常人,随机抽取180例不同年龄段对象。采用Siemens Somatom Definition AS 4D CT进行腰3椎平扫及双期增强扫描,三维薄层重建腰3椎体平扫及双期增强矢状面图像,选择正中矢状面为兴趣区层面,观察腰3椎体CT平扫骨质密度、增强动脉期和血池平衡期对比剂密度在不同性别间以及不同年龄组间的差异及相互间的关系。结果男性组腰3椎体CT增强动脉期对比剂密度与平扫骨质密度呈正直线相关(r=0.420,P0.01),与年龄呈负相关性(r=-0.674,P0.01),血池平衡期对比剂密度与年龄呈正相关性(r=0.685,P0.01)。女性组腰3椎体CT增强动脉期对比剂密度与平扫骨质密度呈正直线相关(r=0.296,P0.01),与年龄呈负相关性(r=-0.448,P0.01),血池平衡期对比剂密度与年龄呈正相关性(r=0.752,P0.01)。结论腰椎体退变与血液供应减少相关,两者互为影响、形成不良循环。     

人肝癌裸鼠皮下移植瘤早期血液供应模式的定量研究

目的 定量评估不同时间点人肝癌裸鼠皮下移植瘤内血液供应模式的变化。方法 将1×10⁷/mL的MHCC97-H细胞悬液同一时间接种于40只裸鼠（0.2 mL/鼠）的左侧腹股沟皮下,分别于种瘤后第2、3、4、5周取瘤行HE染色和免疫组化染色（CD34和CD34/PAS双染色）,定量分析血管参数,包括微血管面积（microvascular area,MVA）、微血管密度（microvessel density,MVD）、血管生成拟态（vasculogenic mimicry,VM）,评估肿瘤内血管供应模式的变化。结果 随着肿瘤生长时间的延长,MVA先减小后增大,第3周肿瘤MVA小于第2周[（13 720.8±2 375.6）μm² vs.（28 795.5±3 412.7）μm²,P=0.013],第4周肿瘤MVA大于第3周[（29 221.3±3 958.5）μm² vs.（13 720.8±2 375.6）μm²,P=0.025];VM百分比呈明显升高趋势,第4周肿瘤VM百分比高于第2周（84.2%±15.4% vs.50.1%±14.6%,P=0.015）。结论 在人肝癌裸鼠皮下移植瘤新生血管形成的早期阶段,随着肿瘤生长时间的延长,VM逐渐成为肿瘤的主要血液供应模式。