永久起搏电极植入途径及起搏类型的探讨

目的评价起搏电极的植入途径及永久起搏器的类型.方法选择1987～1999年安置的80例永久起搏器患者.结果经颈外静脉植入电极6例,手术时间为256±75分;经头静脉植入电极48例,手术时间为247±65分(P＞0.05);经锁骨下静脉途径植入电极26例,手术时间为118±35分(P均＜0.01).其中,AAI型3例(4%),DDD型5例(6%),VVI型72例(90%).结论经锁骨下静脉植入起搏电极,方法简单,组织损伤小,手术时间短,优于其它途径.VVI型起搏器在我国仍然是主要使用的起搏器.     

双水止负压输液器的应用研究

为改进一次性输液器因回血量少 ,影响穿刺成功率。我们将输液器改装为双水止负压输液器 ,产生管内负压。经临床试验 ,负压组总回血长度 3 90 .4cm ,平均回血长度 8.76cm/例。对照组总回血长度 3 9.9cm ,平均回血长度 0 .89cm/例。经方差处理p <0 .0 0 1 ,有明显临床意义。其优点 :增加穿刺回血量 ,提高了穿刺成功率 ,减少病人的痛苦。操作简单易行 ,减少了中间环节 ,避免了污染的输液反应     

股浅静脉戴戒术治疗原发性下肢深静脉瓣膜功能不全

目的 用股浅静脉戴戒术治疗原发性下肢深静脉瓣膜功能不全。方法 本文应用股浅静脉戴戒术治疗原发性下肢深静脉瓣膜功能不全34例,并应用无创性光电容积描记（PPG）结合临床症状改善状况对手术疗效进行评估。结果 手术前后静脉返流时间（VRT）有显著差异（P＜0．01）,临床症状改善。结论 股浅静脉戴戒术是治疗下肢深静静脉瓣膜功能轻度不全的有效方法,PPG检查结合临床改善程度是判断手术疗效更有效的方法。     

ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

Functional transition: Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization

BACKGROUNDPreoperative portal vein embolization (PVE) is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant. PVE induces hypertrophy of the future liver remnant (FLR) and a shift of the functional reserve to the FLR. However, whether the increase of the FLR volume (FLRV) corresponds to the functional transition after PVE remains unclear.AIMTo investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional (3D) computed tomography (CT) and ^99mTc-galactosyl-human serum albumin (^99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODSThirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I, Hokkaido University Hospital between October 2013 and March 2018 were enrolled. Three-phase dynamic multidetector CT and ^99mTc-GSA SPECT scintigraphy were performed at pre-PVE, and at 1 and 2 wk after PVE; 3D ^99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system. Functional FLRV (FFLRV) was defined as the total liver volume × (FLR volume counts/total liver volume counts) on the 3D ^99mTc-GSA SPECT CT-fused images. The calculated FFLRV was compared with FLRV.RESULTSFFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE (P < 0.01). The increase in FFLRV and FLRV was 55.1% ± 41.6% and 26.7% ± 17.8% (P < 0.001), respectively, at 1 wk after PVE, and 64.2% ± 33.3% and 36.8% ± 18.9% (P < 0.001), respectively, at 2 wk after PVE. In 3 of the 33 patients, FFLRV levels decreased below FLRV at 2 wk. One of the three patients showed rapidly progressive fatty changes in FLR. The biopsy at 4 wk after PVE showed macro- and micro-vesicular steatosis of more than 40%, which improved to 10%. Radical resection was performed at 13 wk after PVE. The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSIONThe functional transition lagged behind the increase in FLRV after PVE in some cases. Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.     

Effects of 6-hydroxydopamine on pre- and post-junctional 5-HT1-like receptor-mediated responses in dog saphenous vein

Summary To investigate whether 5-HT₁-like receptor-mediated inhibition of adenosine 3 : 5-cyclic monophosphate (cyclic AMP) accumulation occurs in nerves or smooth muscle of saphenous vein, infusions of 6-hydroxydopamine (6-OHDA) were administered to dogs with the aim of inducing sympathetic nerve damage. The effects of 6-OHDA on other 5-HT₁-like receptor-mediated responses at the pre- and post-junctional level were investigated for comparison by studying 5-hydroxytryptamine (5-HT)-induced inhibition of ³H-noradrenaline release and contraction of smooth muscle respectively.Disruption of nerve function by 6-OHDA was revealed by the lack of catecholaminergic fluorescence and neurogenic contractile responses in saphenous veins from dogs treated with 6-OHDA. In addition, severe impairment of neuronal uptake mechanisms were apparent since basal efflux of ³H-noradrenaline, electrically-evoked release of ³H-noradrenaline and remaining ³H-noradrenaline content were considerably reduced. Some ³H-noradrenaline was taken up and released in 6-OHDA treated tissues which is consistent with the existence of nerve varicosities resistant to the present dosing regime of 6-OHDA, an observation substantiated by electron microscopy studies showing inconsistent lesions of nerve terminals.6-OHDA pre-treatment potentiated the smooth muscle contractile responses mediated by 5-HT₁-like receptors as well as potentiating 5-HT-evoked inhibition of prostaglandin E₂-stimulated cyclic AMP accumulation. It did not, however, affect 5-HT-induced inhibition of ³H-noradrenaline release. The present results suggest that inhibition of cyclic AMP accumulation by 5-HT occurs predominantly in smooth muscle. Correspondence to A. J. Kaumann at the above address     

猪单纯门静脉血流阻断安全时限的研究猪单纯门静脉血流阻断安全时限的研究

目的 通过对猪单纯门静脉血流阻断,全面评估猪耐受门静脉血流阻断的安全时限。方法 将18只健康荣昌种猪随机分为假手术组（SO）、单纯门静脉阻断45min（PVC－45′）、60min（PVC－60′）组,通过对门静脉血流阻断,了解其存活情况、血流动力学改变、肝脏及肠道病理改变等。结果 ①SO、PVC－45′、PVC－60′组长期存活率分别为100％、100％、66．7％;②PVC组阻断前后血流动力学参数波动较大;③PVC－45′、60′组均有肝脏缺血灌注损伤,但PVC－60′组病理损害比45′组重;④PVC组肠粘膜的病理损伤是随门静脉阻断时间延长而加重;⑤PVC组肠粘膜通透性明显升高,肠系膜淋巴结肠道菌属培养阳性率及门静脉血内毒素随阻断时间延长而上升。结论 在本实验条件下正常猪耐受单纯门静脉阻断的安全时限为45min。     

健胎液对人脐静脉内皮细胞分泌血管活性物质的影响

采用血清药理学方法观察健胎液对缺氧人脐静脉内皮细胞（HUVEC）分泌血管活性物质——内皮素（ET）、前列环素（PGI2)、一氧化氮（NO)的影响,以及对缺氧HUVEC形态结构的保护作用,旨在探讨健胎液防治胎儿宫内生长迟缓（IUGR）的机理。结果表明健胎液可显著提高缺氧HUVEC合成分泌PGI2、NO（P<0.05,P<0.01）,同时减少ET的释放(P<0.05);从超微结构上观察,健胎液能明显减轻缺氧对HUVEC细胞器和细胞核的损伤。结果提示健胎液通过增强HUVEC对缺氧的耐受性,调节血管活性物质的分泌是其防治胎儿宫内生长迟缓的机制之一。     

非增强门静脉磁共振成像技术研究

目的 通过使用不同成像序列及接收线圈,寻找最佳非增强门脉磁共振成像技术。方法 对２０例上腹部受检者行门静脉成像。以轴位为定位像,行冠状位扫描。其中１０例ＧＲＡＳＳ、ＧＲＡＳＳ＋ＥＡＴＳＡＴ、ＳＰＧＲ、ＳＰＧＲ＋ＦＡＴＳＡＴ４种序列扫描;１０例以体线圈、ＧＰＦ线圈及胸腰椎线圈和ＧＲＡＳＳ扫描。所得图像均进行ＭＩＰ重建,并对ＭＩＰ重建图像门静脉显示效果进行对比评价。结果 ＳＰＧＲ,ＧＲＡＳＳ信噪比、对