目的探讨经腘静脉置溶栓导管灌注溶栓治疗急性下肢深静脉血栓形成（DVT）的临床应用价值。方法对28例急性DVT患者（其中2例合并肺动脉栓塞）在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗，并对溶栓效果进行分析。 结果全组患者溶栓后症状明显改善，下肢肿胀消退，肺部症状缓解。溶栓后患、健侧大腿周径差〔(1.72±1.23) cm〕明显小于溶栓前〔(5.47±1.29) cm〕,差异有统计学意义(t=12.14，Plt;0.01)， 患肢大腿消肿率为91.58%; 溶栓后患、健侧小腿周径差〔(1.55±0.77) cm〕也明显小于溶栓前〔(5.04±1.32) cm〕，差异有统计学意义（t=13.81，Plt;0.01)，患肢小腿消肿率为84.92%。溶栓后静脉通畅评分〔(4.34±3.55)分〕明显低于溶栓前〔(15.23±4.64) 分〕，差异有统计学意义(t=6.42，Plt;0.01 )，溶栓后静脉平均通畅率为87.43%。 2例合并肺动脉栓塞患者中，1例栓子完全溶解，1例大部分溶解。 所有患者均无严重并发症。 25例患者获随访，随访1～12个月（平均7.16个月），无一例出现血栓再发。结论经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法。
Objective To establish and modify a rat model of arterialized small-for-size orthotopic liver transplantation and investigate the histopathologic changes of the grafts after transplantation. Methods Modified two-cuff technique was applied to establish a rat model of 40% small-for-size orthotopic liver transplantation with a modified microvascular “sleeve” anastomosis between the celiac trunk of donors and the stump of right kidney artery of recipients. Seven days survival rate was observed, main indices of liver function, histopathologic changes of the grafts were detected on the 1st, 2nd, 4th and 7th day after transplantation, respectively. Results The successful rate of operation was 93.3%. Seven days survival rate was 60.0%. The mean time of nonhepatic time was (12.0±2.5) min. Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate on the first day and peaked on the second day after operation. Histological findings indicated that hepatic sinusoidal and central vein dilation, monocytes infiltration in partial area were found on the 1st day after operation, more diploid and polyploid hepatocytes could be observed on the 4th day after operation. Conclusion The model is easily available and highly reproducible, and the stability of the model is improved by modifying the technique. The histological changes of the grafts are mainly caused by ischemia-reperfusion injury.
Objective To investigate the significance of hepatic arterial reconstruction on the model of 40% small-for-size orthotopic liver transplantation in rats. Methods Modified two-cuff technique was applied to establish a rat model of 40% orthotopic liver transplantation. A total of 240 Sprague Dawley (SD) rats were randomly divided into 2 groups: reconstructive artery group and non-reconstructive artery group. One week survival rate was observed. Main indexes of liver function, histology and the expression of proliferative cell nuclear antigen (PCNA) of liver graft （by immunohistochemical method） were detected on day 1, 2, 4 and 7 after transplantation, respectively. Results One week survival rates of reconstructive artery group and non-reconstructive artery group were 65.0% (13/20) and 50.0% (10/20) respectively (Pgt;0.05). Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate from day 1 and peaked on day 2 after surgery in two groups. ALT in non-reconstructive artery group on day 2 and 4 were significantly higher than that in reconstructive artery group (P＜0.05). TB in non-reconstructive artery group on day 2 and 7 were significantly higher than that in reconstructive artery group (P＜0.05). Histological findings indicated that more diploid and polyploid hepatocytes and more gently dilation of central veins and hepatic sinusoids could be seen postoperatively in reconstructive artery group. The expression of PCNA of liver graft peaked on day 2 after surgery. The expression of PCNA of reconstructive artery group was higher on day 1 (P＜0.01) and lower on day 7 than that of non-reconstructive artery group after operation (P＜0.05). Conclusions Arterial reconstruction can improve liver function of liver grafts after small-for-size orthotopic liver transplantation, alleviate the histological changes and promote the regeneration of liver grafts quickly.