重组腺病毒-p53基因颗粒介入治疗中晚期恶性肿瘤的初步探讨

通过对5例中晚期癌症病人的动脉导入重组p53腺病毒基因，同时结合化疗药物灌注的方法，探讨通过动脉途径基因治疗肿瘤的可行性。 1材料与方法 5例病人中男性3例，女性2例，年龄41～72岁，其中中心型肺癌1例，肺转移癌1例，胰腺癌2例，其中1例伴有肝转移，胆囊癌并肝转移1例；分别按TNM分期，临床Ⅲ期2例，Ⅳ期3例，介入治疗方法采用Seldinger法，经股动脉穿刺插管至肿瘤供血动脉，包括左右支气管动脉，腹腔动脉、左右肝动脉、肠系膜上动脉，先行注入选配的不同化疗药物，     

冠脉造影与经皮冠状动脉介入治疗术后并发股动脉假性动脉瘤的护理

目的 探讨对经皮冠状动脉介入治疗（PCI）后出现的股动脉假性动脉瘤（FAP）的患者的护理及FAP的预防方法。方法 入选18例FAP病人，应用弹力绷带加压包扎修复9例，占50％；超声指导下注射凝血酶5例，占28％；自发性血栓形成4例，占22％。结果 18例病人均预后良好。结论 女性、鞘管直径、介入术中血压水平以及围手术期应用抗凝及抗血小板药物是发生FAP的危险因素，经过术前预防及发生FAP后的护理，病人预后良好。     

双头空心螺纹钉加股动脉灌注治疗新鲜股骨颈骨折

自1994—2003年，作者采用牵引或手法整复双头空心螺纹钉内固定加股动脉灌注疗法治疗新鲜股骨颈骨折87例，取得了良好效果。现总结报告如下。     

狗股动脉拉伸损伤后的顺应性变化

采用成年狗正常股动脉段６例，测定其拉伸后的压力一容积关系，并求出其顺应性。另取狗股狗股动脉段３０例拉伸固定后，观测其形态结构变化。发现狗股动脉段拉伸后的Ｐ－Ｖ曲线可用抛物线来拟合，狗股动脉段拉伸１５％后顺应性明显下降，其形态结构无明显改变，拉伸３０％后才出现明显的结构改变。狗股动脉拉伸后顺应性变化的出现较形态结构变化早。     

阴部外动脉阴茎支皮瓣尿道成形术的应用解剖

目的：为设计阴部外动脉阴茎皮瓣转位尿道成形术提供依据。方法：30侧经动脉内灌注红色乳胶的成人尸体，解剖观测阴部外动脉起始、行程；着重阴部外动脉阴茎支在阴茎的走行、分支分布。结果：阴部外动脉始于股动脉，外径1．8±0．4mm，伴行静脉1-2支，汇入大隐静脉。阴茎支可视为本干的延续，经耻骨结节两侧靠近阴茎，分别经2(10)点、3(9)点和1(11)点进入阴茎，多数分出背侧支、腹侧支分布阴茎皮肤。外径0．8±0．2mm。结论：阴茎皮肤血管恒定，以阴茎支为蒂，可在阴茎外侧或背外侧、腹外侧设计皮瓣，用于尿道成形术。术式已在临床应用，效果满意。     

臀下动脉移行为腘动脉罕见变异1例

正常情况下,人体下肢的动脉主干为髂外动脉。髂外动脉在股前区移行为股动脉,股动脉向下穿收肌管至窝上界续为动脉[1,2]。而我们在解剖一具成年女性尸体时,发现其右下肢股动脉终于股前区,股深动脉缺如;臀下动脉向下行于股后区,至腘窝上界移行为动脉(图1)。因此,髂外动脉-股动脉和由髂内动脉发出的臀下动脉共同成为其右下肢的供血动脉主干,现报道如下:图2股动脉发出膝降动脉、旋股外侧动脉和旋股内侧动脉1.髂总动脉2.髂内动脉3.髂外动脉4.股动脉5.髂外静脉6.旋股外侧动脉7.旋股内侧动脉8.膝降动脉9.缝匠肌10.股直肌11.长收肌图1臀下动脉移行为…     

狗股动脉弹性纤维的扫描电镜观察

用甲酸消化法制取正常股动脉弹性纤维标本，冷冻干燥后进行扫描电镜观察。见到内弹性膜上有许多散分布的窗孔，中膜的弹性经组织呈复杂的网状，外膜的弹性组织以粗大的纵向分层排列的弹性纤维为主。     

COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and stenting-related complications can be immediately corrected as well.     

股动脉断裂致小腿坏死误诊骨筋膜室综合征2例

例 1,男 ,2 1岁 ,入院前 3天与他人打斗 ,左下肢被挤压踢打 ,并被刺伤该大腿中部后内侧 ,出血约10 0ｍｌ,伤后能步行约 30ｍ ,经当地医院行“清创缝合”、抗炎治疗。第 2天见伤肢明显肿胀 ,足背动脉触不到 ,经扩血管治疗不见好转 ,第 3天病情加重 ,高热 ,足趾苍白 ,小腿发凉 ,疼痛 ,以“左下肢外伤 ,小腿骨筋膜室综合征”转我院。入院查体 :体温38 8℃ ,脉搏 112次 /分 ,呼吸 2 8次 /分 ,血压 19/8ｋＰａ ,左下肢高度肿胀 ,大腿内后有 30ｃｍ× 2 0ｃｍ皮下出血区 ,中段后内侧有一 3ｃｍ已缝合纵行创口 ,部及小腿后侧有 10ｃｍ× 2 0ｃｍ…     

注射毒品致股动脉假性动脉瘤破裂的急救护理

笔者对9例经股动脉注射毒品致假性动脉瘤破裂的急救护理，发现该类患者主要是由于在注射毒品时缺乏无菌观念和血管解剖知识引起感染创伤，形成假性动脉瘤，其后破裂大出血，造成生命危险；同时，该类患者均有长期吸毒史，身心受到严重的创伤，不利于疾病的治疗和康复。另外，毒品在不断腐蚀人类，危害社会。因此，护士不但要熟练抢救技术和病情变化的预见能力，更必须具备心理 护理能力，重视心理护理，还要倡导医务人员肩负起对群众的健康宣教任务，让全人类来了解毒品的危害性，动员全人类自觉进行抵制毒品，才能从根本与减少本病的发生。