目的探討肝癌手術切除后的序貫綜合治療,以達到有效防治腫瘤復發的目的。方法從我科收治的肝癌患者中挑選3例手術治療后進行序貫綜合治療并取得良好效果病例，對其臨床資料進行分析，從中獲取有關肝癌術后治療的經驗。結果3例肝癌患者在我科手術后接受了積極的預防復發措施，雖最終均出現復發，但對待復發的腫瘤均采取積極的應對措施，獲得了長期生存。結論對于肝癌手術切除后的患者進行積極的序貫性綜合治療有較好的臨床意義，鼓勵對術后復發病例進行積極序貫綜合治療。
OBJECTIVE This paper is aimed to observe the long-term result of reconstruction of wrist joint by replacing distal end of radius with vascularized fibular head in patient of giant tumor. METHODS From July 1978 to November 1993, 12 cases of giant tumor of distal end of radius were treated by this procedure and followed up for 6 months to 15 years, and the movement range of wrist, grip strength, and pain were evaluated. RESULTS The painful wrist released in 11 cases, only one case still existed mild pain and felt discomfortable. The average range of movement of wrist joint was 34.05 degree in volar flexion, 52.80 degree in dorsal extension, 26.25 degree in ulnar deviation, and 19.75 degree in radial deviation, and average grip strength was 44.6 kg. Compared with the contralateral side, there were accounted for 46.2%, 72.7%, 76.1%, 80.6%, and 76.7% respectively. CONCLUSION Replacement of distal end of radius with fibular head to reconstruct wrist joint can restore function of carpal joint, which is proved to be a safe and effective method.
In order to observe the histological changes of the autogenous perichondrium graft from rib in the repair of injured articular cartilage of the condylar process of mandible, 50 rabbits were used, in which 15 were served as control. The articular cartilage with its subchondral bone were resected and an autogenous graft of costal perichondrium was sutured onto the raw surface of the condylar process, and in the controls, only the articular portion of the condylar process was resected without the application of autogenous costal perichondrium graft. The morphological changes of the newly formed cartilage during the process of its development were investigated by hiostological and autoradiog aphic techniques. The result revealed that 10 days after operation, the graft had increased in thickness and was richly populated form the proliferation of mesenchyme-like cells. Twenty to thirty days later, the chondrocytes were matured and the newly formed cartilage had covered the bony surface of mandibular condyle. At 60 days, the newly formed cartilagenous joint surface became glossy, and the morphology and arrangement of cells tended to be regular simulating the morphology of normal articular cartilage. From the experiment, it could be concluded that (1) The autogenous perichondrium graft placed on the condylar surface of mandible could form new articular cartilage which was similar in tissue morphology to the normal condylar cartilage. (2) The process of development of newly formed cartilage was similar to that of the normal cartilage. (3) The motion and loading on the joint could promote the formation of new cartilage and undergo biological reformation, gradually resulting in normal joint morphology. On this basis, the clinical application of autogenous perichondrium graft to repair injured cartilage of the condylar process of the mandible was feasible.
OBJECTIVE: To investigate an effective technique of temporary ectopic implantation for amputated extremity under complex condition. METHODS: Two cases of amputated foot, which could not be implanted primarily, were treated with temporary ectopic implantation. The other leg of patient was chosen as recipient site. The posterotibial artery and saphenous vein were chosen as recipient vessels. When the general condition and the proximal condition of the amputated part were suitable, the ectopic implanted feet were transferred to their anatomic positions. RESULTS: All the feet survived after the replantation. The injured limbs recovered their normal length and sensation. The patients could walk after 4-6 months. CONCLUSION: Temporary ectopic implantation is an ideal technique for the salvage of amputated limb and organ under special condition. Severed foot and lower segment of the leg under complex condition were the best indication for the temporary ectopic implantation.
Objective To investigate the value of monitoring cytokines in serum after human doublehand allotransplantation. Methods We detected solube interleukin-2 receptor(sIL-2R), interleukin-2(IL-2) and interleukin-6(IL-6) levels of the serum in the patient who were performed doublehand transplantation with immunosupressive from September 2000 to November 2000, and in15 healthy volunteers by using enzyme linked immunosorbent assays. Results TheIL-2 and IL-6 levels decreased quickly during inducing period （P＜0.05）, and then increased gradually. While the sIL-2R level increased. The IL-2 level was lower（P＜0.05）, the IL-6 and sIL-2R levels were slightly higher when compared with those before transplantation. There was significant difference in the IL-2level between the patient and healthy volunteers both before and after transplantation, in the IL6 level between the patient and healthy volunteers during inducing period.Conclusion IL-2, IL-6 and sIL-2R levels of serum may be useful in diagnosis of rejection, prevention of opportunistic infection, tumor and graft versus host disease.
Objective To establish a scaffold model from heterogeneoussmall blood vessels. Methods Caudal arteries from 34 Wistar rats( average length 12.08±1.69 cm) were made into acellular blood vessel scaffolds. Some scaffoldswere observed by electron microscope, and others were transplanted to the cut ends of ear central arteries of male Japanese big ear white rabbits. Results Average external diameter was 0.74±0.08 mm in proximal, and 0.55±0.08 mm in distal end of rat caudal arteries. The small blood vessel scaffolds had shin wall whichwas white and soft, composed of fibrous tissues without cells. On the intima surface the fibrous tissues were arrayed densely in a grid-like pattern. After transplantation, the blood flow was reserved, and kept flowing freely in 24 hours. The pulsation of the transplanted artery was accessible and no blood leakage wasfound.Conclusion The natural scaffolds are composed of fibrous tissues, and can sustain the artery pulse pressure for 24 hours. It is better to suture the blood vessels by sleeve anastomosis.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.
Some Chinese traditional medicines were found to inhibit rejection of graft. The antirejection effects of chuanxiong, LCH and HXI in thyroid allografts of rabbits were studied for selecting an immune depressor from Chinese traditional medicine with efficient and less sideeffect. The rabbits were divided into 5 groups in the study, with 7 in each group. Group I: The control group, no drug was used. Group II: dexamethason 0.25mg/kg/day, intramuscularly. Group III: chuanxiong water solution, 5g/kg/day, orally. Group Ⅳ： LCH water solution, 10g/kg/day, orally. Group Ⅴ： HXI water solution, 6g/kg/day, orally. The medication was given for 28 days. The grafted thyroids were removed for histopathological examination on the 28th day postoperatively and were scored and classified. The rejection and the survival of grafts were scored and classfied according to the La Rosa and Warrens criterion. The histopathological findings were as following: in Group I, follicles were badly damaged with much lymphocytes infiltration and fibrosis; in Gracup Ⅱ， two rabbits died, the other three showed damaged of the thyroid tissue and much lymphocytes infiltration; in group Ⅲ and Ⅴ, three cases showed damage of thyroid tissue, however, better revascularization was evident in Group Ⅲ; in Group Ⅳ, there was one case with much lymphocytes infiltration. It seemed that the degree of damage of grafts in the experimental groups was better than that in the control group, and had less lymphocytes infiltration, especially in Group Ⅳ. It was suggested that chuanxiong, LCH, HXI and dexamethason could protect the grafted thyroid, but the sideeffect of dexamethason was more than the other three. The antirejection of LCH was the best of the three. It was worth doing more research. HXI.