川芎醇对血管内皮细胞增殖与损伤保护作用的研究

目的:研究川芎醇促血管内皮细胞增殖与对血管内皮细胞氧化损伤的保护作用。方法:用过氧化氢致人胎儿脐静脉血管内皮细胞(humanumbilicalveinendothelialcells,HUVECs)损伤,以四甲基偶氮唑蓝(MTT)比色法检测细胞存活数量。结果:川芎醇在浓度0.1～1.5mmol·L-1具有促进正常HUVECs增殖的作用,并且浓度依赖性地拮抗过氧化氢抑制血管内皮细胞的增殖,其活性较川芎嗪强。结论:川芎醇具有促血管内皮细胞增殖及保护血管内皮细胞损伤的作用。     

Isolated sigmoid varicose vein rupture and hemorrhage: A case report

Rationale:Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.Patient concerns:A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.Diagnosis:Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins.Intervention:Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.Outcomes:Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection.Lessons:Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.     

Clinical application of hepatic venous occlusion for hepatectomy

Background Most liver resections require clamping of the hepatic pedicle （Pringle maneuver） to avoid excessive blood loss. But Pringle maneuver can not control backflow bleeding of hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from the injuries of the hepatic veins. Although total hepatic vascular exclusion can prevent bleeding of the hepatic veins effectively, it also may result in systemic hemodynamic disturbance because of the inferior vena cava being clamped. Hepatic venous occlusion, a new technique, can control the inflow and outflow of the liver without clamping the vena cava. Methods A total of 71 cases of liver tumors underwent resection with occlusion of more than one of the main hepatic veins. All tumors involved the second porta hepatis and at least one main hepatic vein. Ligation or occlusion with serreflnes, tourniquets and auricular clamps were used in hepatic venous occlusion. Results Of the 71 patients, ligation of the hepatic veins was used in 28 cases, occlusion with a tourniquet in 26, and occlusion with a serrefine in 17. Right hepatic veins were occluded in 38 cases, both right and middle hepatic veins in 2, the common trunk of the left and middle hepatic veins in 24, branches of the left and middle hepatic veins in 2, and all three hepatic veins in 5. Thirty-five cases underwent hemihepatic vascular occlusion, 4 alternate hemihepatic vascular occlusion, 23 portal triad clamping plus selective hepatic vein occlusion, and 9 portal triad clamping plus total hepatic vein occlusion. The third porta hepatis was isolated in 26 cases. The amount of intraoperative blood loss averaged （540±2.83） （range 100 to 1000） ml in the group of total hemihepatic vascular occlusion and in the group of alternate hemihepatic vascular occlusion, （620±317） （range 200-6000） ml in the group of portal triad clamping plus selective or total hepatic vein occlusion. All tumors were completely removed. Conclusions Hepatic venous occlusion     

门静脉、肠系膜上静脉的解剖与临床应用的初步研究

目的 为提高肝门胆管癌和壶腹周围癌的手术切除率,使该区域受肿瘤浸润的血管能同时切除,血管直接重建提供解剖学依据.方法 在实施肝门胆管癌切除术及胰十二指肠切除术中,对病人的肝蒂内门静脉干、胰腺钩突内的肠系膜上静脉干进行解剖学定位并分段测量长度及可以纵向折叠的长度,以此估计可切除的静脉长度及重新再建血管的长度.结果 测量肝蒂内门静脉干104例,男性(5.8±1.99)cm,女性(5.5±O.81)cm,优势长度大于4.5cm者,男性56例占76.7%,女性25例占80.6%.胰腺钩突内段肠系膜上静脉干测量54例,男性(3.7±0.77)cm,女性(3.5±0.64)cm,优势长度大于3.0cm者,男性28例占77.6%,女性14例占77.8%.门静脉纵向折叠移动的范围在1.8～4.2cm,平均折叠2.2(1.8～2.4)cm者占66.3%,平均折叠2.8(2.5～4.2)cm者占33.7%.切除胰十二指肠后胰腺钩突内肠系膜上静脉段纵向折叠范围平均4.0cm,最长达5.2cm.结论 肝门胆管癌和壶腹周围癌切除术合并受浸血管切除在一定范围是可行的.     

普通电极经右颈内静脉床旁临时起搏12例

目的探讨使用普通电极经右颈内静脉在床旁快速、安全安置心脏临时起搏器方法。方法对12例患者在体表心电图指导下,经右颈内静脉途径,结合QRS波群在V1及Ⅱ导联主波方向及起搏阈值对临时起搏电极进行定位。结果临时起搏电极一次送入到位,成功率100%,无穿刺失败、血气胸、栓塞、心包填塞、心律失常等并发症。平均手术时间(11.1±3.4)m in;平均起搏阈值(0.9±0.2)V;临时起搏器保留时间(4.0±2.24)d。结论在体表心电图指导下,经右颈内静脉,使用普通电极床旁安置心脏临时起搏器,安全、快捷、有效。     

改良人原代脐静脉内皮细胞的分离及鉴定

目的:优化人脐静脉内皮细胞(HUVECs)的分离及培养方法。方法:在传统HUVECs分离的基础上进行改进,通过Ⅰ型胶原酶消化分离HUVECs,利用倒置显微镜观察其生长状况、免疫组织化学方法及流式细胞术检测所培养细胞的纯度。结果:改良实验步骤和精简操作后,HUVECs分离不受影响,分离的HUVECs在体外2~4 d可长成单层,倒置显微镜下可见细胞呈"鹅卵石"状排列,Ⅷ因子免疫组化实验阳性,流式细胞术检测细胞纯度达99.37%。结论:用胶原酶消化法分离HUVECs具有培养周期短,所获得的HUVECs纯度较高的优点,有利于体外血管内皮细胞模型的建立。     

急性门静脉和肠系膜上静脉血栓形成CT诊断

目的探讨急性门静脉和肠系膜上静脉血栓形成的CT征象和诊断价值。方法回顾性分析20例临床确诊的急性门静脉和肠系膜上静脉血栓形成的64层螺旋CT表现。结果 CT直接征象表现为平扫见管腔内等密度或略高密度血栓,CT值约53～73HU,增强后显示病变段管腔内不同程度充盈缺损。间接征象表现为病变段管腔不同程度增粗,10例出现腹腔不同程度积液,14例出现肠管扩张积气积液,11例显示肠壁增厚水肿,3例出现肠壁及门脉积气,2例显示肠壁出血,密度增高,5例门脉期显示受累段肝脏灌注不良。结论 CT平扫及增强扫描能够发现急性门静脉和肠系膜上静脉血栓形成,是早期确诊的最有效影像检查方法。     

肠系膜上静脉血栓形成32例诊疗体会

目的探讨肠系膜上静脉血栓形成(MVT)的诊断与治疗。方法回顾性分析我院2000年~2004年收治的32例MVT的临床资料。结果本组行手术治疗14例。其中,有2例行二次手术治疗。治愈29例,死亡3例。结论提高对本病的认识,及时应用螺旋CT三维重建等检查方法早期诊断及围术期采取恰当的溶栓、抗凝治疗是防止复发、降低病死率的重要措施。手术治疗仅适用于出现腹膜炎等肠坏死征象的病例。强调彻底扩大切除坏死肠管及相应系膜。     

单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标的相关性研究

目的探讨单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标之间的相关性。方法将132例单纯性下肢静脉曲张患者分为脉络湿邪阻滞证组、脉络湿邪瘀阻证组、脉络湿毒瘀热证组,分别对3组患者进行超声检查,比较3组大隐静脉近心段管径、返流峰值速度、返流时间。结果 3组大隐静脉近心段管径比较差异有统计学意义(P<0.001),3组中每2组管径比较差异均有统计学意义(P<0.05),大隐静脉近心段管径从粗到细的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流峰值速度比较差异有统计学意义(P<0.001),3组中每2组返流峰值速度比较差异均有统计学意义(P<0.05),大隐静脉近心段的返流峰值速度从高到低的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流时间比较差异有统计学意义(P<0.001),3组中每2组返流时间比较差异均有统计学意义(P<0.05),大隐静脉近心段的返流时间从长到短的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。结论大隐静脉超声观察指标与单纯性下肢静脉曲张的中医证型具有一定的相关性,可为单纯性下肢静脉曲张辨证分型提供客观依据。     

Clinical Importance of Duplication of Internal Jugular Vein

Duplication of internal jugular vein (IJV) is rare. It is the larger channel draining the cranial cavity. We encountered duplication of the IJV while cervical node clearance in a patient with squamous cell carcinoma of left margin of the tongue. IJV divides into two parts anterior and posterior after descending about 2.5 cm from the jugular foramen. IJV is an important landmark in neck surgery. Knowledge of its variations is essential to avoid complications during surgery and to avoid misinterpretation in CT angiography.