超声诊断在脾外伤的应用评估

超声诊断在脾外伤的应用评估沈阳医学院附属中心医院普外科（１１００２４）曾克，郎晓讴沈阳医学院附属中心医院电诊科徐凤媛辽宁省中医研究院普外科（１１００３１）王佳禾在腹部脏器的损伤中，脾脏的损伤是最多见的，其发病率几占各种腹部损伤的４０～５０％（１）。单...     

PN在普外临床的应用体会

胃肠道外营养(parenteral nutrition PN)现在已广泛应用于临床，我院普外一科在1997年—1998年末，应用PN对围手术期病人进行治疗22例，观察病人的营养支持，机体的代谢，体重的增加以及各种营养要素的维持，收到满意的效果，减少了危重病人的术后并发症，缩短了病程。     

三维电解剖标测指导疑难右侧游离壁旁路的导管消融

Objective To demonstrate the electroanatomic substrates of right-sided free wall (RFW)accessory pathways (APs) which were refractory to conventional catheter ablation utilizing three-dimensional (3D) mapping. Methods Seventeen patients with RFW APs that failed initial conventional catheter ablation(s)by a mean of 1～3(1.8±0.6) attempts were enrolled in the study. Electroanatomic mapping of the right atrium was performed during right ventricular pacing in 14 patients and orthodromic reciprocating tachycardia in 3patients. Radiofrequency energy was delivered via irrigation catheter to the earliest atrial activation site. Results The earliest atrial activation site, which represented the atrial insertion of the APs, was separated from the tricuspid annulus by an average of 9 ～ 20 ( 13.6 ± 3.4 ) mm, and the local activation time was 18 ～ 80(31.5±16.3) ms earlier than that of the corresponding annular point. The target electrogram demonstrated AP potential in fourteen patients and ventriculoatrial fusion in the rest three. Accessory pathway was blocked in one case during moving the catheter and RF ablation delivery on the areas. One patient exhibited an AP with wide branching on the atrial side during mapping. RF ablation with an irrigated catheter successfully interrupted AP conduction in remaining 16 patients without complications. After a mean follow-up of 3 ～ 41 (18.6±12.7) months, there were no recurrences of ventricular preexcitation or episodes of tachycardia. Conclusion RFW APs refractory to conventional catheter ablation might be due to unique anatomic AP features such as more epicardial course at the annulus level with atrial insertion distance from the tricuspid annulus. Electroanatomic mapping is helpful to accurately localize the atrial insertion sites of these APs and facilitates catheter ablation.     

用门控心肌显像评价重组腺病毒-肝细胞生长因子治疗缺血性心脏病

目的 探讨99Tcm-甲氧基异丁基异腈(MIBI)静息门控心肌灌注显像(G-MPI)评价重组腺病毒-肝细胞生长因子(Ad-HGF)心肌内直接注射对缺血性心脏病早期治疗的价值.方法 18例冠心病患者根据随机分组表分为小、中、大剂量Ad-HGF治疗组,分别接受5×108,1.5×109,5×109空斑形成单位(PFU)/点(均分10点注射)的Ad-HGF心肌内直接注射.所有患者于治疗前后分别行静息G-MPI,以评价心功能和注射部位心肌血流灌注的变化.采用Stata 7.0软件进行统计学处理.结果 (1)与治疗前相比,小剂量组中有3例、中剂量组中有5例、大剂量组中有6例患者于Ad-HGF注射区域出现心肌血流灌注的改善,改善情况与注射剂量有量-效关系(X2=4.34, P＜0.05).(2)18例患者治疗前静息左心室射血分数(LVEF)、左心室舒张末期容积(EDV)和收缩末期容积(ESV)分别为(50.1±6.4)%,(137.7±33.2)和(70.2±22.4)ml;治疗后分别为(58.7±5.6)%,(123.7±32.7)和(51.9±14.9)ml.LVEF治疗后较治疗前有增加(t=6.1, P＜0.01),EDV和ESV则明显降低(t值分别为5.9,6.4,P均＜0.01).(3)低、中、高剂量Ad-HGF治疗组治疗前LVEF为(50.3±4.9)%,(52.0±5.4)%和(47.8±8.8)%,治疗后LVEF为(54.7±4.1)%,(58.8±3.9)%和(62.5±6.3)%.治疗前后LVEF的差值分别为(4.3±1.2)%,(6.8±5.7)%和(8.6±5.9)%,各组治疗后LVEF均增加:其中高剂量组的增加幅度明显高于中、低剂量组(t=3.3, P＜0.05; t=4.3, P＜0.01),中、低剂量组之间差异无统计学意义(t=1.1, P＞0.05).治疗前后LVEF的变化幅度与注射Ad-HGF剂量有量-效关系(Spearman相关系数为0.67, P＜0.01).结论 G-MPI可用于评价Ad-HGF心肌内直接注射治疗缺血性心脏病早期疗效.     

原发性肝癌自发性破裂出血36例

原发性肝癌自发性破裂出血是肝癌的严重并发症，病死率极高，其发生率为10．2％-14．5％。自1982年1月-2003年12月我科共收治原发性肝癌自发性破裂出血患者36例，并进行手术治疗，现报道如下。     

β射线局部照射预防自体移植静脉内膜增生的实验研究

目的：研究放射性同位素局部照射对自体移植静脉段内膜增生反应的影响及其可能机理。方法：建立40只大鼠自体静脉移植模型，随机分成对照组（单纯自体静脉移植组），8，18，36Gy组（按不同32P内膜照射剂量），每组10只，2周后取材固定，行HE染色，Verhoeff弹力纤维染色，增殖细胞核抗原（PCNA）免疫组化测定（SP法），计算机图像分析仪测量移植血管内膜厚度。结果：移植静脉段的内膜平均厚度：对照组与8Gy组差异无显著性（P＞0．05），但高于18，36，Gy组（P＜0．05），18Gy组与36Gy组间差异无显著性（P＞0．05），PCNA阳性片示，18，36Gy组VSMC增殖较对照组受到明显抑制（P＜0．01），两组差异无显著性（P＞0．05），8Gy组较对照组差异无显著性（P＞0．05），结论：适当剂量β射线局部照射可以抑制自体移植静脉的内膜增生及平滑肌细胞（SMC）的增殖，减少再狭窄的发生。     

食道癌术后膈疝误诊结肠癌误治1例

食道癌术后膈疝误诊结肠癌误治１例沈阳医学院附属中心医院普外一科（ｌ１００２４）曾克，吴凤欣，范德荣患者，女，６７岁，两年前因食道癌在外院行食道癌切除，食道胃吻合术。１９９４年ｌｌ月２０日突然不明原因的出现阵发性腹痛，伴腹胀，不排气，不排便。１９９５年...