Objective To observe the revascularization process of transplanted nerve after transplantation of long nerve and accompanying peri pheral vessels, to investigate its relationship with nerve regeneration. Methods The mediannerve defect models of the left forelimb (3 cm in length) were made in 60 New Zealand rabbits (aged 6-8 months, weighing 2.0-2.5 kg, and male or female), which were randomly divided into 2 groups (n=30). In situ anastomosis of the median nerves was performed in the control group; in situ anastomosis of the median nerves was made in parallel to the surrounding elbow veins, the transplanted epineurium and the adventitia were sutured with nerve anastomosis l ine in the experimental group. After operation, the gross observation, electrophysiological testing, and histopathology observation was performed at 1, 2, 4, 8, and 12 weeks, and transmission electron microscope at 12 weeks to observe the revascularization of nerve grafts, nerve fiber regeneration, and functional recovery. Results In the experimental group, revascularization was observed at 1 week after operation, and the degree of revascularization was significantly higher than that in the control group at 2, 4, 8, and 12 weeks. At 8 and 12 weeks, the nerve fiber regeneration speed, quality, and quantity in the experimental group were better than those in the control group. At 2, 4, 8, and 12 weeks, the nerve conduction velocities were (10.32 ± 0.94), (13.14 ± 1.22), (22.68 ± 1.16), and (24.09 ± 1.27) m/ s respectively in the experimental group, and were (9.18 ± 1.07), (11.12 ± 1.03), (19.81 ± 1.37), and (20.67 ± 1.19) m/s in the control group, showing significant difference at 12 weeks after operation (t=3.167, P=0.001). At 12 weeks in the experimental group, the myel in sheath had similar size, less sheath plate delamination, normal Schwann cells and rich organelles, in which normal microfilaments, microtubules and axonal mitochondria were observed; axonal mitochondria had clear crestfilm and no swelling and vacuolization, and the neurofibrils basically became normal. The myelinated nerve fibers area, myelin thickness, and axon diameter were (5.93 ± 0.94) mm2, (0.72 ± 0.12) μm, and (3.12 ± 0.12) μm respectively in the experimental group, and were (5.28 ± 0.72) mm2, (0.65 ± 0.09) μm, and (2.98 ± 0.16) μm respectively in the control group, all showing significant differences (t=3.736, P=0.002; t=3.271, P=0.002; t=4.533, P=0.001). Conclusion The transplanted nerves in parallel to large blood vessels can promote angiogenesis of the transplanted nerve, and accelerate the regeneration and functional recovery of the nerves.
目的 探讨食管癌术后酒精戒断综合征的原因及有效预防治疗措施。 方法 2000年1月－2011年10月共行食管癌手术935例，术后发生酒精戒断综合征16例，患者均为男性，年龄41～67岁，平均54岁。饮酒史16～47年，平均27.8年；每日饮白酒量为250～1 000 g，酒精含量162～590 g，平均321.5 g。所有患者均符合中国精神疾病分类与诊断标准第3版（CCMD-3）酒精戒断综合征诊断标准。在食管癌常规术后治疗的基础上，根据患者谵妄、烦躁、精神失常、昏迷等不同情况应用维生素B族、纳络酮、氟哌啶醇、氯丙嗪、安定、促进脑细胞代谢及补充能量等综合治疗，必要时予以镇静后气管插管呼吸机辅助呼吸。 结果 患者经治疗后戒断症状均完全消失，治疗时间2～10 d，平均5.3 d。13例获随访，随访时间4～18个月，均完全戒酒，其中1例术后8个月死于急性心肌梗死；余12例均恢复良好，且未出现酒精戒断症状。 结论 经合理有效的围手术期处理，食管癌术后酒精戒断综合征发生率可明显降低，详细询问病史，术前术后积极预防并及时给予有效的治疗是治愈的关键。
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.