氩氦冷冻消融在肺癌多学科综合治疗中的研究进展

肺癌是世界上发病率最高的恶性肿瘤之一,外科手术为首选治疗方式。近年来许多新兴微创技术治疗肺癌取得了良好效果。氩氦冷冻消融术因具有损伤小、恢复快、安全性高、并发症少等优点,已取得医患双方认可。冷冻消融适用于不能手术切除的早期肺癌及减少晚期肺癌负荷。肿瘤是一种全身性疾病,因此冷冻消融联合其他治疗方法将是未来肺癌治疗发展方向,从而改善患者临床症状,提高生活质量,延长生存时间,达到最佳治疗效果。该文就冷冻消融治疗及与其他方法综合治疗肺癌研究现状和进展作一综述。     

Therapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation

Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when 'conventional therapies' fail in the intubated patient with status asthmaticus.     

Assessment of changes in 1-second forced expiratory volume in bronchial provocation testing

The question of whether functional residual capacity (FRC) falls in infants during active sleep has been clouded by studies using different subject groups and techniques for measurements of lung volume and determination of sleep state. Twenty healthy full-term infants within the first week of life participated in the present study. Neurophysiological and behavioral criteria were used to define sleep state, and measurements of FRC were made using a specially constructed closed-circuit helium dilution system. Regularity of respiration was recorded using magnetometers on the chest and a modified respirator monitor. Results showed that no significant changes in FRC occurred, related either to sleep state or to regularity of respiration. In addition, we failed to detect any differences in FRC between the sexes. Pediatr Pilmonol. 1989; 7:71–77 .     

Effective pulmonary blood flow in children with acute asthma attack requiring hospitalization

In children with acute obstructive lung disease gas exchange is affected by ventilation-perfusion mismatch and the degree of bronchoconstriction. Standard lung function measurements do not reflect the impairment in gas exchange. Alternatively, the effective pulmonary blood flow (EPBF), that is, the proportion of the cardiac output that is supplying well-ventilated lung units, can give accurate and noninvasive estimates of ventilation-perfusion mismatch. We measured EPBF with the argon freon ?22 rebreathing technique in children with acute severe asthma to assess their response to nebulized salbutamol and to determine whether induced changes in the EPBF could be predicted from baseline measurements. Twenty-four children admitted with an acute asthma attack had spirometry and triplicate EPBF measurements before and after nebulized salbutamol. Eighteen patients had repeated tests 50 days later when fully recovered; 4 patients were taking methylxanthines on at least one occasion. The mean forced expiratory volume in 1 sec (FEV₁) rose from 55% of predicted to 66% after salbutamol and to 83% with recovery. The mean coefficients of variation for EPBF measurements on the three test occasions were 11.3%, 8.2%, and 9%. Except in children on methylxanthines, the EPBF values were reduced during the acute asthma attack (median, 2.53 L/min/m²; range, 1.99–3.60 L/min/m²) compared with paired values obtained after recovery (median, 2.89 L/min/m²; range, 2.2Eb4.04 L/min/m²) (P = 0.009). Salbutamol caused a highly significant increase in EPBF from 2.88 L/min/m² (range, 1.86–3.80) before treatment to 3.34 L/min/m² (range, 2.264.65) immediately afterwards (P = 0.0003). The spirometric indices did not relate to the changes in the EPBF values. However, when the effective stroke volume index was calculated in 11 patients, the changes induced by nebulized salbutamol had a significant inverse relation with the pretreatment FEV, (P = 0.61; P = 0.02). In conclusion, the argon freon-22 rebreathing technique can be used successfully and reproducibly to measure EPBF in children with an acute asthma attack. Except in children taking methylxanthines, EPBF during the acute attack is reduced and rises significantly after salbutamol. EPBF values after recovery were significantly higher than the presalbutamol values during the attack. Spirometric indices do not relate to the EPBF changes but are inversely related to the effective stroke volume changes. Pediatr Pulmonol. 1994; 17:370–377. © 1994 Wiley-Liss, Inc.     

经皮穿刺氩氦刀冷冻治疗肝癌56例临床分析

目的　探讨氩氦刀冷冻治疗肝脏恶性肿瘤的临床意义。方法　 2 0 0 1年 7月～ 2 0 0 2年6月 5 6例肝脏恶性肿瘤在B型超声引导下行经皮穿刺氩氦刀冷冻治疗。术后患者定期复查血清肿瘤标记物、B型超声检查及CT或MRI。结果　患者肝功能ChildA级 5 0例 ,ChildB级 5例 ,ChildC级 1例。原发性肝癌 4 6例 ,转移性肝癌 10例。小肝癌 (直径≤ 5cm)甲胎蛋白阳性者治疗后转阴占80 % ,甲胎蛋白阴性者治疗后CT或MRI复查病灶完全坏死达 6 1.5 %。转移性肝癌治疗后瘤标降至正常或CT、MRI提示病灶完全坏死者占 6 0 %。结论　氩氦刀冷冻治疗肝脏恶性肿瘤是一种微创、安全、疗效可靠的新方法。对于不适宜行手术治疗的肝脏恶性肿瘤患者是一种有效的微创外科治疗方法。     

Arterial response to excimer and argon laser irradiation in the atherosclerotic swine

Injury associated with laser-induced tissue ablation may be reduced by using pulsed energy delivery at low repetition rates, as opposed to using continuous wave energy delivery. This study was designed to examine the similarities and differences between these two systems as regards the healing process, and to examine whether one is superior to the other. In order to test this postulate, the healing response of normal and atherosclerotic aorta were examined after exposure in vivo to argon and excimer (XeCl 308 nm) laser radiation in hypercholesterolemic swine. Swine were fed hyperlipidemic diets for eight months following balloon denudation of the descending aorta. Following general anaesthetic, the descending aorta was isolated and laser burns were made on both normal and atherosclerotic intima using a continuous wave argon laser delivered through a 50 diameter quartz fibre, and a XeCl excimer laser carried through a 1 mm diameter fibre. Energy levels of 3 to 5 J were applied with the argon laser. The pulse duration for the excimer laser was 30 ns and craters were produced using 10 to 60 pulses at a repetition rate of 20 Hz and an energy density of 2 J cm^–2.Forty-eight hours after laser application, craters created by both lasers were filled with thrombus material. Argon burns were surrounded by thermal and acoustic injury which was not seen with excimer burns. Three weeks after laser application all crater surfaces were reconstituted. Unlike the excimer burns, argon craters demonstrated necrosis well beyond the crater margins and were characterized by multinucleate giant-cell reaction surrounding char debris. By nine weeks both excimer and argon laser burns were covered by fibrous tissue but could be distinguished by the fact that char debris and subjacent tissue injury arose with the argon burns.The results suggest that both lasers can be used to remove focal atherosclerotic plaque from arteries without inducing excessive thrombogenicity. Rapid healing is observed with both; however, damage to surrounding tissue is significantly greater with a continuous energy delivery laser as opposed to pulsed energy delivery.Work supported in part by: Heart and Stroke Foundation of Ontario, Grant-in-Aid No. 5-17     

Scanning electron microscopy of microarterial anastomoses with the argon laser

A carotid end-to-end anastomosis was performed in 50 Wistar rats (mean weight 260 g) by means of a Coherent 900 argon laser. Laser pulses (average 19) of 300 mW power and 5 s exposure time were used, the beam being focused to form a spot of 150 m diameter. From day 0 to day 210, 13 specimens underwent scanning electron microscope examination. The results show that the laser impact produces a wall injury of 100 m in width with some coagulative necrosis of the media and adventitia. The line of anastomosis became re-endothelialized within four days, at which time collagen fusion was observed in the subendothelial layers. The longitudinal arrangement of the endothelial cells was restored by day 10. In the long term, a thick collagenous meshwork maintained the strength of the media, while normal endothelium covered the anastomosis. Complications such as disruption and aneurysm formation were attributed to technical problems.

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Résumé Anastomoses micro-artérielles au laser argon: étude en microscopie électronique à balayage. Les auteurs réalisent au laser Argon (Coherent 900) une anastomose carotidienne terminoterminale sur une série de 50 rats Wistar de poids moyen de 260 g. Les impacts laser (en moyenne 19) sont de 300 mW de puissance et d'une durée de 5 s chacun, avec un point de focalisation de 150 m de diamètre. On réalise sur 13 spécimens un examen en microscopie électronique à balayage. L'impact laser induit sur la paroi artérielle une lésion de 100 m de large avec une légère nécrose de coagulation de la media et de l'adventice. La ligne de suture est re-endothélialisée dès le quatrième jour, alors qu'une fusion du collagène est observée dans les couches sousendothéliales. L'arrangement longitudinal des cellules endothéliales est retrouvé dés le dixième jour. A long terme, un réseau collagénique serré assure la résistance de la media et un endothélium normal recouvre la ligne de soudure. Les complications tel que lâchage ou anéurysmes doivent être attribuées aux inconvénients techniques du début de l'expérimentation.

     

Role of anterior retinal cryoablation in the management of neovascular glaucoma

In a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360° ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.Abbreviations ARC Anterior retinal cryoablation - NVG Neovascular glaucoma - NVI Neovascularization of the iris     

氩激光治疗视网膜静脉阻塞新生血管的临床研究

为探讨、分析氩激光治疗视网膜阻塞新生血管的疗效。氩激光治疗视网膜静脉塞新生血管５５例,中央静脉塞行全视网膜光凝。分支静脉阻塞区域播散性光凝,光斑２００－５００μｍ,时间０．１－０．２ｓ,能量０．１２－０．４ｗ,Ⅱ级光斑,蓝绿色光波,黄斑格栅光凝光斑１００μｍ,时间０．１ｓ,能量视病情而定,以Ⅰ级反应为度,绿色光波。结果：５５例中４４例有效,新生儿血管消嫁总有效率８０％,无效１１例（其中视盘有新生血     

Auswirkungen von Argon-Gasembolien während eines PneumoperitoneumsRID="*"ID="*"Die Studie wurde zum Teil gefördert von der DFG (Bo 1329/8–1)

Zusammenfassung. In einer experimentellen Studie wurde bei 10 Schweinen mit einem mittleren K?rpergewicht von 18,9 (15–24) kg eine intraven?se CO₂- oder Argon-Embolie mit 10, 20 und 30 ml Gas durchgeführt. Das invasive Monitoring zeigte bei der Gasembolie mit Argon im Gegensatz zur Gasembolie mit CO₂ einen st?rkeren Anstieg des pulmonal arteriellen Drucks (p < 0,001), einen st?rkeren Abfall des endexspiratorischen CO₂ (p < 0,01), des Herzminutenvolumens (p < 0,01) und des mittleren arteriellen Drucks (p < 0,01). In der Argon-Gruppe (n = 5) starben zwei Tiere nach 20 bzw. 30 ml Bolusgabe. Ein weiteres Tier konnte nach Gabe von 30 ml Bolus erfolgreich reanimiert werden. In der CO₂-Gruppe (n = 5) starb weder eines der Tiere noch war eine Reanimation erforderlich. Wenig l?sliche Gase wie Argon sollten in Situationen mit erh?htem Risiko einer Gasembolie nicht angewendet werden. ID=" Dr. T. Junghans Klinik f&uuml;r Allgemein-, Visceral-, Gef&auml;&szlig;- und Thoraxchirurgie Universit&auml;tsklinikum Medizinische Fakult&auml;t der Humboldt-Universit&auml;t Campus Charit&eacute; Mitte Schumannstra&szlig;e 20/21 D-10117 Berlin