目的 探討顯微手術治療破裂大腦中動脈動脈瘤（MCAA）的適應證、術前評估及手術技巧。 方法 回顧性分析2008年1月－2011年1月經翼點入路行顯微外科手術治療的65例破裂MCAA患者的臨床資料。其中男40例，女25例；年齡22～78歲，平均46.8歲。術前Hunt-Hess分級：Ⅰ級15例，Ⅱ級25例，Ⅲ級13例，Ⅳ級10例，Ⅴ級2例。動脈瘤直徑＜5 mm 10個，5～15 mm 36個，15～25 mm 15個，＞25 mm 4個，平均7.8 mm。其中56例動脈瘤位于大腦中動脈分叉部，5例位于大腦中動脈的M1段，4例位于分叉后M2段。 結果 手術夾閉動脈瘤60例，余5例行動脈瘤夾閉加包裹術。患者術后獲隨訪3～36個月，平均16個月，均無動脈瘤復發或再出血發生。按格拉斯哥預后評分（GOS）結果評定：恢復良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 結論 充分的術前評估，合適的手術入路選擇，以及手術技巧的靈活應用是顯微外科手術成功治療破裂MCAA的保證。
Objective
To explore the effectiveness of the transforming growth factor-β1(TGF-β1) and tumor necrosis factor-α(TNF-α) inducing human bronchial epithelial(HBE) cells to optimize epithelia-mesenchymal transformation(EMT) model.
Methods
Blank control, TGF-β1 10 ng/ml, TNF-α 10 ng/ml, TGF-β1 10 ng/ml+TNF-α 10 ng/ml induced human epithelial cells for 24 hours. Then the change of morphological alteration were observed by applying CCK8, cells migration assay and Western blot technique.
Results
When TGF-β1 plus TNF-α induced human epithelial cells for 24 hours, most of HBE cells traits changed including morphological alteration from cobblestone to fusiform, connection between cells vanishing, intercellular space broadening. In the experiments of checking cell migration capacity by the vitro scratch test, the group spacing was 420.06±10.38 μm in the blank control group, 499.86±34.00 μm in the TGF-β1 10 ng/ml group, 514.93±10.56 μm in the TNF-α 10 ng/ml group, 569.68±33.58 μm in the TGF-β1 10 ng/ml+TNF-α10 ng/ml group. TGF-β1 cooperated with TNF-α led to scratch spacing narrowing significantly. Western blot analysis showed that expression of E-cadherin and Vimentin varied significantly in the TGF-β1+TNF-α group.
Conclusion
Inducing human bronchial epithelial cell by TGF-β1 cooperated with TNF-α optimizes EMT model.
