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微创胸膜腔置管注入尿激酶治疗结核性胸腔积液

【摘要】 目的 探讨微创胸膜腔置入中心静脉导管(简称导管)注入尿激酶治疗结核性包裹性胸腔积液(简称积液)的临床价值。方法 2008年6月-2009年8月在正规抗结核治疗基础上,选取确诊积液患者72例,按数字随机法分为治疗组和对照组,治疗组36例经超声引导导管置入胸膜腔并注入生理盐水50 mL加尿激酶10万 U,对照组36例多次穿刺抽液,比较两组疗效及积液引流量、胸膜厚度、积液吸收时间等。结果 治疗组28例显效,5例好转,3例无效;对照组10例显效,13例好转,13例无效,两组疗效差异具有统计学意义(Plt;0.05)。治疗组与对照组平均积液引流量分别为1 421 mL和756 mL,胸膜厚度分别为(1.9±0.4) mm和(3.7±1.2) mm,积液吸收时间分别为(13.3±1.2)d和(17.3±1.6)d,两组间比较差异均有统计学意义(Plt;0.05)。结论 超声引导导管置入胸膜腔并注入尿激酶治疗结核性包裹性胸腔积液疗效显著,可增加引流量,减轻胸膜肥厚,改善肺功能,减少穿刺机会。

动静脉内瘘异常重构的手术干预一例

CLINICAL APPLICATION OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT SHUNT TO PORTAL HYPERTENSION

We had performed transjugular intrahepatic portosystemic stent shunt (TIPSS) in one hundred and three patients with advanced liver cirrhosis and portal hypertension from July,1993 to January, 1995. TIPSS was carried out successfully in ninty-eight out of 103 cases and the technical success rate was 95.2%. Acute variceal bleeding was immediatly controlled and portal pressure reduced by an average of 1.36±0.02 kPa after TIPSS. The disappearance of gastric cornoary and esophageal varices, the shrinkage of spleen and the reduction of ascite were observed . Three patients died of acute liver failure and one died of variceal redbleeding within 30 days of treatment. Mild encephalohthy was obserbed in 10 cases with TIPSS. At follow-up of 1～22 months, variceal rebleeding and ascite were observed in 6 patients and stenosis of shunt was evident is 12.5% of cases by the subsequent doppler sonography. According to this result, TIPSS is an effective method for the treatment of portal hypertension.

Endoscopic Modified by the ThreeCavity Tube 2 Capsule Combined Sclerotherapy of Esophageal Varices Bleeding Clinical Efficacy (Clinical Analysis of 14 Cases)

目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。

视网膜中央静脉阻塞合并睫状视网膜动脉阻塞一例

Isolation and Identification of Primary Human Umbilical Vein Endothelial Cells

【摘要】 目的 通过比较两种原代人脐静脉内皮细胞的分离培养方法并对细胞特异性抗原进行鉴定,探索提高原代内皮细胞体外培养存活率及纯化率的方法。 方法 采用一次性无菌注射器向人脐静脉灌注消化液,消化液的浓度和消化时间分别025%(质量体积比)胰蛋白酶,10 min和01%(质量体积比)胶原酶Ⅱ,15 min。通过在倒置显微镜下观察细胞的形态特点和用免疫荧光染色的方法对细胞进行鉴定,比较两种消化方法的优劣。 结果 01%胶原酶Ⅱ,15 min的消化方法较025%胰蛋白酶,10 min对原代人脐静脉内皮细胞有更好的分离效果,活细胞数量多且细胞纯度较高。免疫荧光染色结果表明细胞内有Ⅷ因子相关抗原表达。结论 胶原酶Ⅱ可以有效分离脐静脉内皮细胞,最佳消化条件是01%胶原酶Ⅱ,37℃,15 min。【Abstract】 Objective To explore the optimal method for primary culture of human umbilical vein endothelial cells (HUVECs). Methods HUVECs were prepared from human umbilical cords by 01% collagenase Ⅱ digestion for 15 minutes and 025 trypsinase digestion for 10 minutes,respectively. HUVECs were observed under inverted microscope and identified by immunofluorescence.The two methods of digestion were compared. Results More HUVECs were harvested through the method of 01% collagenase Ⅱ for 15 minutes,which expressed Ⅷ related antigen. Conclusion The method of 0.1% collagenase Ⅱ digestion for 15 minutes is a better choice to isolate HUVECs.

EXPERIMENTAL STUDY OF INCOMPETENCY OF DEEP VEIN OF LOWER LIMB

OBJECTIVE The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve. METHODS Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons. RESULTS In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted. CONCLUSION It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.

APPLIED ANATOMY OF THE PERFORATING BRANCHES ARTERY AND ITS DISTALLY-BASED FLAP OF SURAL NERVE NUTRIENT VESSELS

Objective To investigate the distribution of the perforating branches artery of distally-based flap of sural nerve nutrient vessels and its clinical application. Methods The origins and distribution of perforating branchesartery of distally-based flap were observed on specimens of 30 adult cadavericlow limbs by perfusing red gelatin to dissect the artery.Among the 36 cases, there were 21 males, 15 females. Their ages ranged from 6 to 66, 35.2 in average. The defect area was 3.5 cm×2.5 cm to 17.0 cm×11.0 cm. The flap taken ranged from 4 cm×3 cm to 18 cm×12 cm. Results The perforating branches artery of distally-based flap had 2 to 5 branches and originated from the heel lateral artery, the terminal perforating branches of peroneal artery(diameters were 0.6±0.2 mm and 0.8±0.2 mm, 1.0±1.3 cm and 2.8±1.0 cm to the level of cusp lateral malleolus cusp).The intermuscular septum perforating branches of peroneal artery had 0 to 3 branches. Their rate of presence was 96.7%,66.7% and 20.0% respectively(the diameters were 0.9±0.3, 1.0±0.2 and 0.8±0.4 mm, andtheir distances to the level of cusp of lateral malleolus were 5.3±2.1, 6.8±2.8 and 7.0±4.0 cm). Those perforating branches included fascia branches, cutaneous branches, nerve and vein nutrient branches. Those nutrient vessels formed longitudinal vessel chain of sural nerve shaft, vessel chain of vein side and vessel network of deep superficial fascia. The distally-based superficial sural artery island flap was used in 18 cases, all flaps survived. Conclusion Distally-based sural nerve, small saphenous vein, and nutrient vessels of fascia skin have the same origin. Rotation point of flap is 3.0 cm to the cusp of lateral malleolus, when the distally-based flap is pedicled with the terminal branch of peroneal artery.Rotation point of flap is close to the cusp of lateral malleolus, when the distally-based flap is pedicled with the heel lateral artery.

Clinical analysis of branch retinal vein occlusion

Objective To investigate the complications of the Branch Retinal Vein Occlusion. Methods Two hundred and seventy-seven cases (277eyes) of branch retinal vein occlusion (BRVO) have been studied retrospectively from 1995 October to 1999 October Results Most cases of BRVO occured after the age over fifty-five. About 81.85% BRVO affected at supiriotemporally and inferiotemporally. The incidence of the complication of BRVO is closely related to the site of obstrution, the larger branch vein occlusion the higher incidence of the nonperfusion area and neovascularization Conclusion The macular edema occured in the early stage of the BRVO, and most non-perfusion areas were observed between six to twelve months. The neocvscularization always observed after one year later from the vein obstruction. So that the patient have to be followed carefully with a long duration. （Chin J Ocul Fundus Dis,2002,18:17-19）

上腔静脉右肺动脉分流术治疗三尖瓣闭锁

目的 总结上腔静脉右肺动脉分流术治疗三尖瓣闭锁(TA)的临床经验。 方法 2004年10月至2008年4月，采用上腔静脉右肺动脉分流术治疗TA 10例，男8例，女2例 ；年龄2～13岁，平均年龄5.6岁；体重10.0～33.5 kg，平均体重16.4 kg。TA合并大动脉错位(右位心)2例，房室间隔缺损3例，永存左上腔静脉1例。均在常温非体外循环下手术，切断上腔静脉，近端缝合，远端与右肺动脉做端侧吻合；1例合并永存左上腔静脉患者行双侧上腔静脉肺动脉吻合术。 结果 全组无死亡患者，术后末梢血氧饱和度由74%±9%上升至92%±5%。所有患者紫绀明显减轻，顺利出院。随访10例，分别随访6~36个月，血氧饱和度86%±3%，活动能力明显改善。 结论 上腔静脉右肺动脉分流术治疗TA效果满意，是比较理想的术式。