颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

动脉栓塞对骨盆肿瘤手术疗效的影响

[目的]探讨供血动脉栓塞对骨盆肿瘤手术疗效的影响。[方法]本组16例，脊索瘤7例，骨巨细胞瘤3例，骨转移瘤3例，骨肉瘤2例，神经纤维瘤1例。术前1d行肿瘤血管造影并用明胶海绵进行供血动脉栓塞。与对照组（结扎双侧髂内动脉骨盆肿瘤切除术）比较，观察其对术中出血量、手术时间、住院时间、术后下床时间、伤口愈合时间及术后各种功能恢复的影响。[结果]骨盆肿瘤切除术前肿瘤供血动脉栓塞与结扎双侧髂内动脉比较，除术中出血量外（P〉0．05），手术、住院、术后下床及伤口愈合时间在统计学上均有非常显著性差异（P〈0．001），而且结扎双侧髂内动脉可能对患者的性功能、排便功能等存在着不良的影响。[结论]肿瘤供血动脉栓塞骨盆肿瘤切除术可大大缩短手术、住院、术后下床、伤口愈合时间，且能更好地保护盆腔内外各组织器官的血运，从而避免其功能的损害。     

Smart Prep技术在肾动脉CTA中的临床应用

目的:探讨Smart Prep技术在肾动脉多层螺旋CT血管造影中的应用。方法:20例行同层动态增强扫描,通过时间-密度曲线获得肾动脉的有效浓度阈值。65例行肾动脉CTA造影,经肘静脉团注370mgI/ml优维显1.5ml/kg后,应用Smart Prep软件实时监控靶血管浓度,当感兴趣区对比剂浓度达有效浓度阈值时触发增强扫描完成数据采集,重组和重建图像显示肾动脉。结果:65例肾动脉CTA造影均获成功,58例(89.2%)增强时相处于最佳扫描时期。增强扫描的延迟时间15~38s不等,个体差异明显,而肾动脉CT值持续位于有效浓度阈值(100HU)以上。结论:Smart Prep技术实时监控肾动脉对比剂浓度变化并及时触发增强扫描,它不受个体差异影响即可确保增强扫描的实施,优于小剂量试验。     

铜代谢异常相关疾病研究

铜是人类和动物重要的必需微量元素，参与体内蛋白质、氨基酸、核酸等营养物质的代谢，铜代谢异常会造成多种疾病。本文主要综述铜在糖尿病、动脉粥样硬化、冠心病、高脂血症、骨质疏松等的发生发展以及治疗方面的作用。     

12例开放性腋动脉损伤的诊治

目的探讨开放性腋动脉损伤的诊治体会。方法1996年-2002年，共诊治12例开放性腋动脉损伤的患者，从受伤到入院时间为3～14h，入院时均处于不同程度的休克状态，桡动脉搏动减弱或消失。在积极抗休克治疗的同时，急诊进行清创、血管神经探查和修复术。其中行腋动脉修补5例，腋动脉直接吻合6例，自体静脉移植修复1例。结果伤后8h内腋动脉再通8例，8～16h内腋动脉再通4例，无病例发生截肢或死亡。术后伤口均Ⅰ期愈合，桡动脉搏动良好。结论对开放性腋动脉损伤早期诊断和及时手术探查是控制休克、获取良好疗效的关键。     

前循环缺血性卒中老年患者颈动脉斑块及其稳定性与血流壁切应力的关系

目的通过探讨前循环缺血性卒中老年患者颈总动脉分叉处血流壁切应力的水平分析其在颈动脉斑块形成过程中的影响。方法本研究选择前循环缺血性卒中老年患者,应用经皮血管彩超测量颈动脉斑块及其稳定性以及对研究对象测量患侧颈动脉血流速度、血管内径和血液粘滞度,通过公式计算血流壁切应力。结果无斑块组和有斑块组之间、高回声和低回声斑块组之间血流壁切应力均有显著性差异(P<0．01)。结论血流壁低切应力促进颈动脉斑块、尤其是不稳定斑块的形成。     

冠状动脉瘘的诊治及新进展

冠状动脉瘘是一种罕见的冠状动脉畸形,绝大多数属于先天性畸形,极少数可由后天因素引起。由于冠状动脉血流向有关心腔、血管异常分流,导致引流部位负荷加重、瘘远端心肌缺血而引起相应临床症状。目前,绝大多数冠状动脉瘘已能由超声心动图明确诊断并可经内科介入技术或外科手术治愈。     

三磷酸腺苷结合盒运转体A1与颈动脉粥样硬化斑块的关系

目的 探讨三磷酸腺苷结合盒运转体A1(ATP binding cassette transporter A1,ABCA1)在人颈动脉粥样硬化斑块中的表达变化及作用机制.方法 收集24例人颈动脉粥样硬化斑块标本和10例肠系膜动脉标本(对照组),采用RT-PCR测定ABCA1 mRNA和视黄酸X受体α(RXRα)mRNA表达水平,并采用Western Blot检测ABCA1及RXRα的蛋白表达水平.24例人颈动脉粥样硬化斑块标本按病理分级,比较病理组织为Ⅲ级和Ⅰ级动脉粥样硬化组织间ABCA1 mRNA、RXRαmRNA表达水平及蛋白表达水平.结果 颈动脉粥样硬化斑块组的ABCA1 mRNA(0.79±0.04)和RXRα mRNA(0.73±0.04)表达与对照组相比上调,差异有统计学意义(P＜0.05);ABCA1 mRNA与RXRα mRNA增加水平相关(P＜0.05);颈动脉粥样硬化斑块的ABCA1蛋白表达(0.22±0.03)下调水平与对照组(0.53±0.03)相比差异有统计学意义(P＜0.05);Ⅲ级和Ⅰ级动脉硬化斑块ABCA1mRNA、RXRα mRNA及蛋白表达水平差异有统计学意义(P＜0.05).结论 ABCA1及RXRα蛋白表达水平下调可能是进展性动脉粥样硬化损害的关键因素.     

Coronary endarterectomy on beating heart: Our experience

Introduction Coronary artery bypass grafting (CABG) associated with Endarterectomy is a high risk procedure. After the first report of coronary endarterectomy by Bailey et al in 1951, the preference for this surgical procedure was decreased due to increased morbidity and mortality In patients with total or subtotal large coronary artery obstructions in which there is no possibility to receive a conduit as graft for myocardial revascularisation, endarterectomy remains the procedure of choice. This study was designed to study early and midterm results of off pump coronary artery endarterectomy. Methods Of 172 Consecutive Off Pump CABG done at our institution from Jan 2003 to July 2005, 22 patients underwent supplementary coronary endarterectomy. 16 patients had chronic stable angina 4 had unstable angina two required emergency CABG with endarterectomy following perioperative infarction. The mean ejection fraction was 29.2±4.3 and all of the patients were in New York Heart Association (NYHA) III or IV. All patients were planned for complete total arterial revascularisation using Left Internal Mammary Artery (LIMA). Right Internal Mammary Artery (RIMA), Radial composite “Y” graft, Two patients operated for periop infarct received vein graft. In 16 patients closed endarterectomy was done in five patients double endarterectomy in single vessel was done to chase the plaque distally, in one patient open left anterior descending (LAD) endarterectomy with vein patch reconstruction was performed. Results There were no deaths. None of the procedures were converted to on pump operation. All endarterectomies and bypasses were performed on Beating Heart, all patients were completely revascularised. Peri operative cardiac enzymes studied showed no significant rise in the Creatinine Phoshpokinase (CPK)-Creatinine Phosphokinase myocardial Band (CPK-MB). The mean postoperative Ejection Fraction (EF) was 36.7%±7.2% which was significantly higher than the Preoperative one (p<.05). At the end of four months to one and half year 22 patients were in NYHA class I to II and all were angina free in canadian cardiovascular society class.f Conclusions Coronary End Arterectomy without cardiopulmonary bypass can be performed in patients who are expected to benefit from complete revascularisation. It can be performed with closed as well as open method. However to achieve complete endarterectomy by closed technique in some patients it is essential to chase the plaque. Early and mid term results are encouraging.     

进展性卒中与脑动脉狭窄的脑血管造影研究

目的探讨进展性脑梗死的影像学特点及与脑动脉狭窄之间的相关性。方法选择我院29例进展性脑梗死患者并与同期收治的31例完全性脑梗死患者比较,所有患者均行头颅MRI (或头颅CT)及脑血管造影检查(DSA检查),分析进展性脑梗死的影像特点及其与脑动脉狭窄的相关性。结果进展性脑梗死组分水岭脑硬死或侧脑室体旁梗死发生率72．4％(21／29)及脑动脉狭窄发生率75．86%(22／29)均明显高于完全性脑梗死组22．6％(7／31),35．48％(11／31)。进展性脑梗死组中重度狭窄发生率为55．17％(16／29),高于完全性脑硬死组的12．90%(4／31)。溃疡性斑块发生率在进展性脑梗死组48．28%(14／29)高于完全性脑梗死组16．13％(5／31)。结论中重度脑动脉狭窄及溃疡是进展性卒中的重要危险因素,应早期检查及处理脑动态狭窄以防止病情进展。