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3-D打印技术在血管外科的应用

腹腔镜下左髂总动脉- 股动脉人工血管旁路移植治疗髂外动脉闭塞症一例

目的 总结腹腔镜下人工血管旁路移植治疗髂外动脉闭塞症的手术技巧和临床效果。 方法 2011年12 月，收治1 例57 岁髂外动脉硬化闭塞症男性患者。患者双下肢间歇性跛行；下肢动脉造影示左髂外动脉闭塞，右髂总动脉狭窄；心电图示窦性心律，完全性右束支传导阻滞，ST 段改变；踝肱指数（ankle brachial index，ABI）：左侧0.59，右侧0.54。于全麻下行腹腔镜下左髂总动脉- 股动脉人工血管旁路移植术。 结果 术后人工血管通畅，吻合口无漏血，患者跛行症状明显改善。术后1 周左侧ABI 增加至1.09；术后1 个月血管造影显示血管通畅。 结论 腹腔镜下主- 髂动脉重建既保留开腹动脉旁路移植效果好的特点，又具有腔内支架成形创伤小、术后恢复快的优点。

PRELIMINARY STUDY ON POROUS SCAFFOLD PREPARED WITH DECELLULARIZED ARTERY

Objective To investigate the feasibil ity of preparing the porous extracellular matrix (ECM) by use of some chemicals and enzymes to decellularize the porcine carotid artery. Methods The porcine carotid artery was procured, and warm ischemia time was less than 30 minunts. The porcine carotid artery was decellularized with 1% sodium dodecyl sulfate (SDS) for 60 hours to prepare common ECM; then common ECM was treated with 0.25% trypsin (for 6 hours) and 0.3 U/ mL collagenase (for 24 hours) to prepare porous ECM. The common ECM and porous ECM were stained with HE,Masson’s trichrome, and Orcein to evaluate the histological features. Then the mechanical property, cytotoxicity, and pore size of ECMs were determined. After 4 weeks of subcutaneous implantation in dogs, the histological examination was used for the study. Results Histological observation confirmed that 2 kinds of ECMs were decellularized completely and more porous structure was observed in porous ECM. Scanning electron microscope showed the pores in porous ECM were greater and the length of shorter axis in porous ECM ranged from 5 to 30 μm, the length of longer axis from 40 to 100 μm. The porosity of porous ECM (99.25%) was greater than that of common ECM (91.50%). The burst pressure of porous ECM decreased when compared with common ECM, showing significant difference [(0.154 3 ± 0.012 7) MPa vs [0.305 2 ± 0.015 7) MPa, P lt; 0.05]. There was no significant difference in suture retention strength between 2 kinds of ECMs (P gt; 0.05). The cytotoxicity test showed no obvious cytotoxicity in 2 kinds of ECMs. In vivo implantation test showed that the deeper host cells infiltration and more neo-microvessels in porous ECM were observed than in common ECM. Conclusion SDS and some enzymes can be used to prepare porous ECM as the scaffold for tissue engineered blood vessels.

Surgery Therapy of Thrombosis Accompanied with Nephrotic Syndrome：Report of 4 Cases and Literature Review

目的　探讨肾病综合征并发血栓形成的外科治疗特点。方法　从笔者所在单位收治的肾病综合征并发血栓形成的患者中选取4例血栓形成部位罕见、治疗难度大的病例，对其临床资料进行分析。结果　1例在下肢深静脉血栓形成基础上发生下腔静脉血栓形成；1例腹主动脉急性血栓形成伴下肢动脉栓塞导致下肢坏疽行高位截肢；1例股动脉支架内反复血栓形成导致下肢坏疽行高位截肢；1例人工血管及下肢动脉支架内短时间内血栓形成，经干细胞移植后下肢缺血得到缓解。结论　在血栓形成的诊治过程中提高对肾病综合征的认识，针对肾病综合征患者高凝状态在围手术期进行预防性抗凝治疗，以及充分认识肾病综合征并发血栓形成抗凝治疗的特殊性，可能会降低肾病综合征患者血栓形成的发生率，提高肾病综合征并发血栓形成的外科治疗水平。