脾动脉门静脉吻合联合完全门体分流对犬门脉高压症的治疗观察

目的为评估门静脉脾动脉化对门脉高压症的治疗效果,对丝线栓塞性门脉高压模型犬进行脾动脉门静脉吻合联合完全门体分流(PACS术),并观察治疗效果。方法对门脉高压犬采用脾切除、门静脉(入肝段)-脾动脉吻合、门静脉(远肝段)-腔静脉吻合。测定入肝门脉、入下腔门脉血流、压力;门静脉、肠系膜上静脉的内径、最大血流速度、血流方向;观察手术前后肝功能变化,肝脏蛋白质合成变化。结果术后向肝门脉流量(PVF)上升至原来的180%,向肝门静脉压(PVP)上升至原来的196%,门静脉入下腔门脉血流量增至原先的130%,而压力降至原来的45.5%,均具有极为显著的统计学差异(P<0.01)。术后3周末肝功能指标和蛋白合成与术前比较,改变不明显,无统计学差异。结论PACS手术成功率较高,术后死亡率低,可同时提高入肝血流和降低侧支压力,是一种值得尝试和进一步研究的新手术方法。     

肝硬化合并食道静脉曲张破裂出血危险因素的研究

本研究目的在于探索导致肝硬化食道静脉出血的各种危险因素。病例来源于我院1983～1985年收治的部分门脉性肝硬化合并食道静脉曲张患者共100例,按其是否伴有食道静脉曲张出血分为出血组和非出血组各50例,对导致出血的各种危险因素进行了回顾性调查。最后本文提出了引起静脉曲张出血的始发危险因素是门脉高压的程度;门静脉游离压>3.49Kpo,或B超探测门静脉(总干)直径>1.9cm,脾静脉(脾门处)>1.3cm。促发因素;男性,年龄>40岁,合并肺部感染,脾功能亢进(血色素<70g/L,白细胞计数<5×10~9/L,血小板<60×10~9/L)。具备上述始发危险因素二项和促发危险因素二项以上的食道静脉曲张患者,提示出血高度可能性。建议用B型超声探测门静脉、脾静脉和肠系膜上静脉直径作为判断门静脉压的一种手段,可使肝硬化患者避免导管检测或食道镜检查带来的危险和不便。     

肝硬化大鼠原位肝移植血流动力学改变

目的 研究肝硬化大鼠异体原位肝移植术后血流动力学改变.方法 雄性健康SD大鼠50只,采用腹腔及皮下注射四氯化碳(CCl_4),同时饮用乙醇溶液诱导10周,制备肝硬化大鼠模型;按KAMADA二袖套法(门静脉和肝下下腔静脉)对肝硬化大鼠原位肝移植;观察肝移植前后门静脉血流动力学的变化.结果 制备肝硬化大鼠模型36只;进行肝移植手术26次,术后成活并进行门静脉血流动力学指标检测12只.经统计学方法检验,肝移植术后门静脉压较术前明显降低[(1.60±0.10)kPa vs. (1.70±0.25)kPa,P<0.05];门静脉血流量明显增加[(7.55±1.02)mL/min vs. (6.15±0.88)mL/min,P<0.05];门静脉阻力明显降低[(11.84×10~(-2)±2.51×10~(-2))kPa/(mL·min) vs. (16.29×10~(-2)±2.40×10~(-2))kPa/(mL·min),P<0.05].结论 异体肝移植术可改善肝硬化大鼠血流动力学指标.     

尼群地平对肝硬化鼠门脉压力及肝硬化患者肝血流动力学的影响

用GOULD－4600型多导生理记录仪测定了尼群地平（NTP）对20例肝硬化鼠门脉压力的影响及用核多功能仪测定了NTP对63例肝硬化患者肝血流的即刻及慢性作用。结果表明：NTP可使肝硬化鼠门脉压力下降13.0％。NTP即刻及慢性作用均可降低肝硬化病人门脉血流，对全身循环影响小，不影响肝脏的有效灌注及肝、肾功能。提示：NTP可望成为一种预防肝硬化食道曲张静脉破裂出血的有效药物。     

TIPS对肝血流动力学影响及并发症的观察

研究了经颈静脉肝内门体分流术（TIPS）对肝血流的影响和并发症的观察。对21例肝硬化门脉高压症患者实施TIPS治疗，采用超声多普勒检测门静脉主干血流速度、支架内血流速度，及核多功能仪检测肝总血流。结果表明，TIPS技术成功率85．7％，肝内分流道建立后，门静脉压力下降，门静脉流速增加，肝总血流减少不明显；一过性肝性脑病、支架狭窄，除与建立的分流道部位不同有关外，与血流动力学紊乱也有关系。     

EXPERIMENTAL STUDY ON THE ROLES OF ENDOGENOUS OUABAIN IN THE DEVELOPMENT OF HYPERTENSION

Endogenous ouabain (EO) ,also named en-dogenous sodium pump inhibitor or endogenousdigitalis- like substance previously,is a kind of hor-mone secreted from adrenal cortex which was dis-covered recently[1～ 4 ] .Sodium,blood volume ex-pander and angiotensin could stimulate EO se-cretion and EO has been proved to have many phys-iological and pathological roles,such as inhibitingNa ,K - ATPase,stimulating cardiac contractili-ty,contracting blood vessel and stimulating sym-pathetic nervous sys…     

肝血流同步双栓治疗中、晚期肝癌的临床研究

我院１９８９年１０月～１９９５年３月对５７例中晚期肝癌患者进行肝血流同步双栓（经腹肝动脉、门静脉双置管同时注入化疗栓塞剂）治疗。结果半年生存率为９４．１％。１年６６．６％，２年３１．３％，３年５．８％。该方法明显优于单纯肝动脉化疗栓塞，安全可靠，操作简单，术后并发症少，是中晚期肝癌综合治疗中较理想的方法。     

断流术加胃减动脉术后胃分泌功能的观察

观察了２３例门脉高压症患者行断流术前后胃液中的基础胃酸分泌量（ＢＡＯ）、最大胃酸分泌量（ＭＡＯ）、高峰胃酸分泌量（ＰＡＯ）及血清胃泌素水平的变化。结果显示：加作胃减动脉术的治疗组（１１例）术后胃液中ＢＡＯ、ＭＡＯ、ＰＡＯ均比术前升高（Ｐ＜０．０５），而行单纯断流术的对照组（１２例）手术前后无明显变化（Ｐ＞０．５）。血清胃泌素水平两组均比术前降低（Ｐ＜０．０５），且改变的程度基本一致（Ｐ＞０．５）。表明：在断流术基础上加作的胃减动脉术不但不引起胃泌酸功能减退，反而可使术前胃泌酸功能的低下状态得以改善；加作的胃减动脉术也不影响血清胃泌素的水平。     

门脉高压犬小肠微循环超微结构的变化

目的　研究门脉高压犬小肠微循环超微结构的改变。方法　行缩窄门静脉主干1/2 加丝线慢性栓塞术建立犬肝前性门脉高压症模型,观察小肠黏膜上皮和黏膜及黏膜下层微循环超微结构的改变。结果　肝前性门脉高压犬小肠黏膜及黏膜下微循环超微结构改变的特征为:血管数量增多,直径增大;微动脉腔小、壁厚,胶原纤维增生、紊乱,内皮细胞受损;微静脉腔大、壁薄,基膜及内皮细胞受损;毛细血管内皮细胞受损,白细胞浸润;肠黏膜上皮细胞、基底膜受损,回肠平滑肌细胞核畸形。结论　门脉高压犬小肠黏膜及黏膜下微循环超微结构出现明显改变。     

EFFECTS OF OUABAIN AND DIGOXIN ON THE GENE EXPRESSION OFSODIUM PUMP α-SUBUNIT ISOFORM IN AORTIC SMOOTH MUSCLE OF RATS

Accumulating evidence indicates that endoge-nous ligands of the digitalis receptor may exist inthe mammalian body, which has recently been de-scribed to be indistinguishable from ouabainL1'2j.Endogenous ouabain (EO) might induce many cy-tobiological changes and play an important role inregulating water and sodium metabolism and vas-cular tone in the body["'J. Many studies haveshowed that EO content in both hypertensive pa-tients and hypertensive animals is much more thanthose of normal subje…     

断流术加胃减动脉术的意义和胃减动脉术式的探讨

设计了丝线胃网膜右动脉枉性栓塞术，用在门脉高压症（PH）断流术中，以进一步减少胃壁动脉的血供、缓解术后胃里局部的静脉高压状态、防止术后门脉高压性胃病（PHG）的发生发展及增加断流的彻底性。以16条PH模型犬为对象，与现存的其它两种术式—胃网膜右动脉主干结扎和胃网膜右动脉主干及其胃支离断（统称为“胃减动脉术”）进行对照研究。结果表明，该方法即可以克服胃网膜右动脉主干结扎的效果不持久，又能避免胃网膜右动脉主干及其胃支离断的胃壁缺血坏死等弊端。有希望成为在PH断流术中进一步减少胃壁动脉血供的理想术式。     

经颈静脉肝内门体分流术治疗肝硬化门脉高压症对机体液递物质的影响及疗效

目的探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化门脉高压症对机体液递物质的影响及其临床疗效评价。方法肝硬化门脉高压症患者40例,分为TIPS组和内科组,每组20例。另选健康成人20例,作为正常对照组。应用放免法及生化分析法测定各组各时段血清一氧化氮(NO)、白细胞介素-6(IL-6)及血浆丙二醛(MDA)的水平,观察临床表现及肝功能的变化。结果TIPS术后所有患者出血停止,一般状况改善明显,TIPS术后1 d血清丙氨酸氨基转移酶(ALT)较术前升高,且差异有显著性(P<0.01),术后7 d有所降低,与术前相比无显著性差异。两治疗组40例患者血清NOI、L-6及血浆MDA水平治疗前后均高于健康正常人(P<0.01)。TIPS组术后NO水平与内科组治疗一周后相比明显升高(P<0.01)。TIPS组术后NO水平较术前明显升高(P<0.01)。结论TIPS治疗肝硬化门静脉高压症近期疗效显著,术后肝功能无明显损害;术后血清NO水平升高,其机制可能与TIPS引起门脉及全身血流动力学变化有关;MDA无明显变化,表明肝脏总的血流灌注减少不明显。     

核多功能仪首次通过法测定门静脉肝动脉血流的价值及临床意义

本研究以核多功能仪首次通过法为手段,以门静脉和肝动脉血流百分数、门静脉和肝动脉斜率为肝血流灌注指标,对25例正常人、125例各种慢性肝病患者作了测定。正常人结果与文献报道基本一致;各种肝病的结果与各自的病理变化相吻合;重复检测两次结果无差异。提示本测定方法稳定,结果可靠,具重复性,并有非创伤、简便、快速、价廉之优点;对了解肝病时肝脏的器质性变化及其程度有较大的参考价值,并有助于各种肝病的诊断和鉴别诊断。     

In situ absorption and metabolism of stilbene glycoside in rat

Stilbene glycoside (TSG) has been shown to have many beneficial properties. It is therefore essential to understand the absorption and metabolism of TSG in detail. We determined the recovery of TSG and its metabolites (TSG sulfate/glucuronides) in rat gastric contents, gastric mucosa, portal vein plasma, celiac arterial plasma, bile, and urine after administration of 15mg of TSG in 0.5mL physiological saline or incubation for 20min in situ in the stomach of rats. Within 20min, (64.0±9.8)% of the administered TSG disappeared from the stomach; later, TSG was recovered in both free and conjugated forms in plasma and bile, but not in urine. On the other hand, only free TSG was detected in the gastric contents and mucosa; it was also detected in the portal vein plasma as (48.1±3.5)% of the total TSG (all forms of TSG). However, the proportion of free TSG in the celiac arterial plasma and bile decreased to 4%-10%. In addition, the proportion of free TSG to total TSG in the liver microsome incubation mixture after TSG was incubated in liver microsome at 37℃ for 30min was very low [(10.6 ± 2.6)%]. These results indicate that TSG could be quickly absorbed from the rat stomach, conjugated in liver and excreted in bile. Such novel information would be helpful for the use of TSG as a beneficial natural product which may improve its proposed efficacy in preventing chronic diseases.     

Nitroglycerin reduces augmentation index and central blood pressure independent of effects on cardiac preload

Objective To determine whether reduction In central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-lead or is due to arterial dilation. Methods We compared effects of NTG with these of lower body negative pressure (LBNP). Hemodyunmic measurements were made at rest, during LBNP (10, 20 and 30 mmHg, each for 15 min) and after NTG (10, 30 and 100μg/min, each dose for 15 min) in ten healthy volunteers. Cardiac pre-lead, stroke volume and cardiac output were assessed by echacardiography. Central pressure an mnentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30μg/min) reduced pre-lead (as measured by the peak velocity of the S wave in the superior vena eava) to a similar degree [by (26. 8 ± 3.8) % and (23.9 ± 3. 4) %, respectively]. Compared to LBNP, NTG reduced systemic vascular resistance [by (32. 9 ± 7.5) %, p< 0. 01], decreased peripheral and central pressure augmentation [by (20. 8 ± 3. 4)% units and (12. 9±2. 9)% units, respectively, each P< 0. 01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.     

β-IRRADIATION WITH A LIQUID~(188)Re-FILLED BALLOON PREVENTS NEOINTIMAL PROLIFERATION IN THE CAROTID OF RABBIT

Ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｎｇｉｏｐｌａｓｔｙ(ＰＴＣＡ )ｉｓｏｎｅｏｆｔｈｅｍｏｓｔｃｕｒｒｅｎｔｔｈｅｒａｐｉｅｓｆｏｒｃｏｒｏｎａｒｙａｒｔｅｒｙｄｉｓｅａｓｅ ,ｂｕｔｉｔｒｅｍａｉｎｓｌｉｍｉｔｅｄｂｙａ30 %ｔｏ 6 0 %ｒｅｓｔｅｎｏｓｉｓｒａｔｅ .Ｉｎｔｒａｖａｓｃｕｌａｒｂｒａｃｈｙｔｈｅｒａｐｙ (ＩＶＢ)ｉｓａｎｅｆｆｅｃｔｉｖｅｍｅｔｈｏｄｔｏｉｎｈｉｂｉｔｃｏｒｏｎａｒｙｒｅｓｔｅｎｏｓｉｓａｆｔｅｒＰＴＣＡ .Ａｎｅｗｃｏｎｃｅｐｔｏｆｐｒｅ…     

胎儿肝脏的整修

胎儿肝脏的整修是辅助性胎肝移植的重要环节之一，它直接关系到植入肝脏的质量和移植效果。为取得临床前的胎肝整修经验，对２０例脑死亡胎儿的肝脏采用原位灌注，腹腔多器官联合切取后在冰水盆内整修。结果表明肝动脉解剖游离复杂费时，应注意有无肝动脉解剖变异存在。胎肝门静脉血供的建立，选择脐静脉为宜，但应结扎脐静脉导管。肝静脉流出道可选择肝上或肝下下腔静脉。胆道重建用胎儿胆囊作吻合。     

脾大脾脏巨噬细胞在门脉高压症脾亢发生中的作用

目的　探讨脾大、脾脏巨噬细胞 (MΦ)在门脉高压症 (PHT)脾亢发生中的作用。方法　采用免疫组化和透射电镜等方法 ,对比观察PHT脾脏MΦ 内ACP含量 ,MΦ 超微结构及MΦ 吞噬破坏血细胞数量的变化。并对PHT患者的脾指数、MΦ 内ACP含量及外周血细胞计数三者之间作相关分析。结果　同正常脾脏相比 ,PHT脾脏MΦ 内ACP含量增多 ,MΦ 表面伪足增多、增长 ,胞内溶酶体数量增多 ,MΦ 吞噬破坏红细胞、血小板的数量明显增多。PHT患者的脾指数和MΦ 内ACP含量与外周血细胞计数成反比 ,脾指数和MΦ 内ACP含量成正比。结论　脾大、脾脏MΦ 在PHT脾亢的发生中起着重要作用。     

肝脏B型超声断面解剖初步研究

<正> B型超声在临床已广泛应用,搞清肝脏B型超声常用声束方向的各种方位断面解剖,对肝病超声诊断颇有参考价值。肝脏B型超声断面解剖国内已有报导,但例数均较少,而且肝脏大小、形态以及内部管道系统个体差异较大,尚需积累大量资料,进行观察和研究,从而得出一个较有普遍性规律,更好地应用于临床,这就是本文研究的目的。     

胃贲门附近静脉的应用解剖

用60具尸体对胃贲门附近的静脉做了研究,主要结果如下:一、胃左静脉分三型:以Ⅰ型(2支)多见,55例(91.66%);有33例(55.60%)位于脊柱左侧;汇入脾静泳者36例(60.00%);终末口径平均3.81毫米。二、贲门食管支分二型,Ⅰ型(1支)者55例(93.22%),汇入胃左静脉弓形郎者55例(87.30%)。三、胃右静脉汇入门静脉者49例(89.09%)。四、胃后静脉分二型,Ⅰ型(1支)者45例(90.00%),有41例(74.55%)汇入脾静脉中1/3段。五、胃短静脉具有2—6支,有44例(73.33%)为3支和4支型。