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严重创伤后腹腔间隙综合征行腹腔扩容术1例报道

目的总结腹腔扩容术（IAVI）治疗创伤后腹腔间隙综合征（ACS）的效果及其关键技术。 方法回顾性分析2011年5月笔者所在医院收治的1例严重创伤后ACS患者的临床资料。 结果该例患者先行IAVI，手术时间为80 min，术中出血50 mL，手术顺利。术后监测膀胱压（1次/4 h），于IAVI后14 d行腹壁创面植皮以形成计划性腹疝。该例患者术后无出血、感染等并发症发生，恢复顺利，于术后20 d出院。于出院后9个月再行改良双侧腹直肌推徙术治疗巨大计划性腹疝。行改良双侧腹直肌推徙术后该患者获访24个月，随访期间腹壁疝无复发，未见其他不适。 结论IAVI能够有效防治ACS，提高严重创伤患者的生存率。

负压封闭技术治疗骨筋膜室综合征

Role of Cytoskeleton Structure in The Transformation of Endocytosis Pathways of Vascular Endothelial Cadherin after Lipopolysaccharide Treatment

ObjectiveTo explore the effects of cytoskeleton depolymerizing agent and stabilizer on the clathrin/caveolae-mediated endocytosis, the expression of membrane vascular endothelial cadherin (VE-cad), and the vascular permeability by the transformation of cytoskeleton structure after lipopolysaccharide (LPS) treatment. MethodsCRL-2922 cells were used in the experiments. Indexes were tested at corresponding time point according to name of group, but in blank control group indexes could be tested at any time point. CRL-2922 cells were divided into blank control group, LPS-1 h group, and LPS-4 h group to observe cytoskeleton structure; CRL-2922 cells were divided into LPS-1 h group, Cyt D+LPS-1 h group, LPS-4 h group, and Jasp+LPS-4 h group to determine the expression of membrane VE-cad, and to determine the expression of its co-immunoprecipitation with clathrin and caveolin-1 (Cav1); besides, CRL-2922 cells were divided into blank control group, LPS-1 h group, Cyt D+LPS-1 h group, LPS-4 h group, and Jasp+LPS-4 h group to detect the cumulative infiltration rate. Results①The cytoskeleton showed a dynamic change after LPS treat-ment, the F-actin polymerized and stress fibers formed at 1 hour after LPS treatment, but depolymerized at 4 hours after LPS treatment. ②Compared with LPS-1 h group, the level of co-immunoprecipitation of VE-cad with clathrin in Cyt D+ LPS-1 h group decreased (P<0.05), the level of co-immunoprecipitation of VE-cad with Cav1 increased (P<0.05), and expression level of VE-cad in plasma membrane decreased (P<0.05); compared with LPS-4 h group, there was no significant difference in the level of co-immunoprecipitation of VE-cad with clathrin of Jasp+LPS-4 h group (P>0.05), but the level of co-immunoprecipitation of VE-cad with Cav1 decreased in Jasp+LPS-4 h group (P<0.05), and expression level of VE-cad in plasma membrane increased (P<0.05). ③Compared with blank control group, the cumulative infiltration rates of LPS-1 h group and LPS-4 h group were both higher (P<0.05); compared with LPS-1 h group, the cumulative infiltration rate of Cyt D+LPS-1 h group was higher (P<0.05); compared with LPS-4 h group, the cumulative infiltration rate of Jasp+LPS-4 h group was lower (P<0.05). ConclusionActin cytoskeleton shifts from polymerization to depoly-merization after LPS treatment, the structural change of actin cytoskeleton is an important reason for the transformation of VE-cad endocytosis pathway from clathrin-mediated to caveolae-mediated after LPS treatment.