目的 總結超選擇性腎動脈栓塞治療經皮腎鏡取石術后嚴重出血的臨床經驗。 方法 回顧分析2009年10月－2012年11月行經皮腎鏡取石術后發生嚴重出血的6例（2.74%）患者的臨床資料和對其進行超選擇性腎動脈栓塞術的血管造影表現和栓塞療效。 結果 患者平均年齡67歲，經皮腎鏡取石術后急性出血1例，遲發出血5例，均有體外沖擊波碎石史或糖尿病、高血壓病史。腎動脈造影顯示損傷動脈為腎后下段動脈、腎下段動脈分支，表現為假性動脈瘤5例，動靜脈瘺1例。使用彈簧圈或聚乙烯醇顆粒超選擇性栓塞，栓塞后出血無一例復發。隨訪6個月，5例腎功能未見下降，1例受損。 結論 經皮腎鏡術后嚴重出血與術中動脈損傷有關，采用超選擇性腎動脈栓塞術能夠達到迅速止血、盡可能保全患腎功能、有效挽救生命的診療效果。
Objective To evaluate the cl inical results of allogeneic bone graft for interbody fusion in cervical tuberculosis. Methods Between January 2000 and January 2008, 30 cases of cervical tuberculosis were treated with allogeneic (group A, n=15) or autologous (group B, n=15) il iac crest bone graft combined with anterior fixation after radical debridement. In group A, there were 8 males and 7 females with an average age of 38 years; the disease duration was 6 to 14 months; the preoperative kyphosis Cobb angle was (8.6 ± 11.3)°; the preoperative Japanese Orthopaedic Association (JOA) score was 13.0 ± 3.1 for neurological function; and the length of bone graft was 32 mm on average. In group B, there were 9males and 6 females with an average age of 42 years; the disease duration was 4 to 17 months; the preoperative kyphosis Cobb angle was (4.9 ± 7.4)°; the preoperative JOA score 12.3 ± 4.2; and the length of bone graft was 34 mm on average. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time and bleeding volume in group A were significantly less than those in group B (P lt; 0.05). Wound effusion were found in 2 cases of group A, and the other incisions healed by first intention. No infection occurred in group B. In group A, 13 cases were followed up 12-48 months; in group B, 14 cases were followed up 13-46 months. The time of bone graft heal ing in group A [(7.6 ± 2.1) months] was significantly longer than that in group B [(4.2 ± 1.1) months] (t=2.773, P=0.005). The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation (P lt; 0.05), but no significant difference was found between 2 groups at different time after operation (P gt; 0.05). There was no significant difference in JOA score at 6 months after operation between group A (14.1 ± 2.6) and group B (14.3 ± 2.4) (t=1.655, P=0.162). The improvement rate for neural function were 83.7% in group A and 87.8% in group B, showing no significant difference (χ2=3.150, P=0.071). There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up. Five cases had chronic pain at il iac donor sites in group B. According to Bridwell et al. evaluation standard, the bone fusion was satisfactory in 11 cases (84.6%) and unsatisfactory in 2 cases (15.4%) in group A, and was satisfactory for all in 14 cases (100%) in group B. The satisfactory rate of bone fusion showed no significant difference between 2 groups (χ2=2.680, P=0.115).Conclusion Allogeneic bone grafting has a good cl inical result for spinal fusion in cervical tuberculosis surgery, which can treat tuberculosis bone defect effectively.
ObjectiveTo study a new method for establishing the rat model of incomplete adhesive intestinal obstruction. MethodsThe serosal stripping method was adopted, the general health condition changes of rats were observed on day 3, 5, and 7 after modeling, meanwhile the weight was measured, the superior mesenteric artery flow velocity and small intestine wall thickness were observed via the color Doppler ultrasound and orthostatic X ray. The level of D-lactate acid in the blood plasma, and the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in the intestine tissue were tested. The pathological changes of the intestine tissue were observed. ResultsCompared with the normal group (no treatment was done), the general health conditions of rats were worse, the weight significantly decreased (Plt;0.01), the superior mesenteric artery blood flow velocity significantly increased and small intestinal wall was thickened (Plt;0.05, Plt;0.01), airfluid level or a great deal of seroperitoneum and pneumatosis flat appeared via orthostatic abdominal X-ray, the level of D-lactic acid in the blood plasma and the content of MDA in the intestine tissue significantly increased on day 5 after modeling (Plt;0.05, Plt;0.01), the activity of SOD in the intestine tissue significantly decreased on day 7 after modeling in the model group (Plt;0.05). The pathological changes consistented with adhesive intestinal obstruction via pathological observation. On the 7th day, the rat model of incomplete adhesive intestinal obstruction was successfully built . ConclusionThe rat model of incomplete adhesive intestinal obstruction is completed by serosal stripping method.