超顺磁性氧化铁标记大鼠骨髓基质细胞经门静脉移植MRI活体示踪的研究

目的观察1．5T场强MRI联合动物专用线圈是否可以活体示踪经门静脉移植的纳米级超顺磁性氧化铁颗粒标记的骨髓基质细胞（bone marrow stromal cells BMSCs），为介人性门静脉骨髓基质细胞移植治疗终末期肝脏疾病的研究提供进一步的依据。方法供体大鼠5只，梯度密度离心分离BMSCs，纳米级超顺磁性氧化铁颗粒和脂质体转染BMSCs，体外经普鲁士蓝染色和HE染色确定细胞标记率。受体大鼠15只，分为5组，分别为对照组和纳米级超顺磁性氧化铁颗粒标记的骨髓基质细胞经门静脉移植人正常大鼠肝脏后2h、3d、7d及2周组。1．5T场强MRI联合动物专用线圈行T1W、T2W和T2＊序列扫描，观察肝脏信号改变情况，与对照组比较，并且与组织切片对照。结果纳米级超顺磁性氧化铁颗粒和脂质体转染BMSCs，细胞标记率〉95％。经门静脉移植人正常大鼠肝脏后，T2＊序列扫描显示经标记的BMSCs在肝内显示弥漫性的结节性低信号影，移植后2h到2周均可见到细胞在受体肝脏内存在，组织学切片显示信号缺失部位与铁颗粒标记细胞相一致。结论纳米级超顺磁性铁氧体颗粒标记的大鼠BMSCs经门静脉移植后可以通过1、5T场强行MRI活体示踪，为临床干细胞移植的应用提供可行的示踪方法。     

脾大部切除加断流术治疗小儿门静脉高压症(附16例临床分析)

目的探讨脾大部切除加断流术治疗小儿门静脉高压症的临床疗效。方法对16例确诊为门静脉高压症的患儿行脾大部切除加断流术。随访患儿恢复情况。结果16例患儿手术顺利,恢复良好,无死亡病例。无再发消化道出血、脾功能亢进表现,无脾切除术后凶险感染出现。结论保留脾脏的脾大部切除加断流术是治疗小儿门静脉高压症一种较好的手术方法。     

肛直肠抑制反射时门静脉血中P物质变化

目的探讨肛直肠抑制反射（RAIR）时门静脉血中P物质（SP）的变化规律及外源性内脏神经对其变化的影响。方法将实验大白鼠分为7组，其中6组先按去与不去直肠肛管外源性内脏神经支配而分为不去神经和去神经两大组，每组中又按Foley导管上气囊置入直肠腔中的位置分为2、4、6cm组；同时再设1个对照组，将Foley导管置入直肠腔中，但不注水扩张球囊。检测并比较在直肠腔内刺激后，各组门静脉血中的SP值及变化情况。结果去神经组中2、4cm组与不去神经组之间及对照组之间，门静脉血中SP值变化比较，P〉0．05，差异无统计学意义。不去神经组中的6cm组与对照组及去神经组中2cm和4cm组之间SP值比较，P〈0．01，差异有统计学意义；去神经组和不去神经组中的6cm组之间SP值比较，P〈0．01，差异有统计学意义。结论直肠腔内上部的刺激不引出RAIR可能与该部位的刺激使内括约肌兴奋性递质（SP）的释放有关；外源性内脏神经对RAIR中门静脉血的SP变化有调控作用。     

表达谱基因芯片筛选体外循环前后心肌细胞因子的变化

Objestive Systemic inflarmmation may be triggered by injury, hypothermia, ischemia-reperfusion and the contact of the blood with foreign body during cardiopulmonary bypass (CPB). To determine the application values of gene chip technique in the clinical practice and the study of cardiovascular stagery, as well as to provide clues to the study of inflammatory responess during CPB, microarry for gene expression profiles was used to identify the differences in the gene expression of myocardium between pre-and post- CPB. Methods Six adult patients who underwent CPB from March to May in 2003 were involved. Samples of right atrium were col- lected before and at immediate end of CPB. BD AtlasTM cDNA Expression Arrays was used to identify the differences in the gene ex- pression of cytokines. The results were compared with that of semi-quantative RT-PCR. Resellts The mean age of 6 patients (5 males and 1 female) was (32.67± 11.72) years. The baseline heart function was gradeⅡin 3 cases and grade Ⅲ in 3 other cases. The baseline left ventricular ejection fraction(LVEF)was (58.17±7.91)%. The mere duration was (91.67±43.88) minutes for CPB and was (58.67±43.46) minutes for aorta blocking. The minimum nasopharynx/rectal temperture was (29.37±1.90)℃/ (32.15±1.52)℃. Gene expression profiles of cytokines in the myocardium pre- and post-CPB were analysed successfully. The ex- pression of IL-6, IFN-γ,Wnt5a, TNFRSF1B, a member of tumor necrosis factor receptor superfamily, PIGF and MFNG in the myo- cardium were unpregulated after CPB. Conclusion Microarray technique is applicable in the study of cytokines changes dying CPB. cDNA microarray identified pleliminarily the differences in the gene expression between pre- and post-CPB. These genes may be in- valved in inflammation and other psthophysiological responses incuced by CPB. The myocardiym is probably one of the major sources of cytokines during CPB. Further study may be helpful in understanding the llngthe development of inflammation during CPB, and eventually, reducing the post-operative complications.     

中西医结合治疗Leriche综合征78例

目的:总结中西医结合治疗Leriche综合征的方案.方法:回顾性总结Leriche综合征的临床治疗78例,均行人工血管主股或主髂动脉转流手术,术后静脉应用低分子右旋糖酐、复方丹参注射液和维脑路通.结果:手术结束后均能触及股动脉和动脉搏动,手术后7 d,患肢缺血症状均得到改善.手术后3月,患肢缺血症状消失,64例阳痿现象得到改善.彩色超声血管吻合口及人工血管内均未见血栓.结论:人工血管主股动脉转流或主髂动脉转流是治疗Leriche综合征较好的手术方案,围手术期合理应用扩血管、祛聚、活血化瘀药物,同时及时处理伴发疾病是提高临床治愈率和提高远期疗效的关键.     

肝硬化门静脉高压症患者心脏泵功能减退

心脏血流动力学参数足反映人体生命信息和心脏泵功能的重要指标.同前,尢创性血流动力学检测已广泛应用于心力衰竭、休克等危重症患者的病情监测、治疗方案的确定等,以便使患者得到科学、有效的治疗[1-2].     

脾切除、贲门周围血管离断术治疗门静脉高压症并上消化道出血

回顾性分析32例用脾切除、贲门周围血管离断术治疗肝炎肝硬化引起的门静脉高压症所致食管胃底曲张静脉破裂出血的临床资料。结果示，急症止血率100%，术后并发症死亡率为3.1%，术后痊愈率96.9％。提示本方法的疗效是确切的，且易在基层推广。     

多指多平面压砸性离断再植的处理

2002年2月-2005年8月，我院采用浅静脉移植桥接、动静脉转流或动脉移植等方法对多指多段压砸性离断进行再植，取得了良好的效果。