介入医学的技术史对研究生创新思维的启迪作用

doi:10.3877/cma.j.issn.2095-5782.2023.03.015

在专业型硕士研究生教学中，缺乏有效的启迪创新思维的资料和方法是亟待解决的问题。文章在分析专业型硕士研究生创新思维不足的成因的基础上，梳理了介入栓塞术的历史，并将其应用于研究生创新思维的启发教学，取得了较好效果。这说明介入医学的技术史是一座具有启迪创新思维的宝库，值得进一步发掘。

关键词: 介入医学, 创新思维, 技术史, 研究生教育

The inspiration of innovative thinking is ignored in the professional postgraduate education. Lack of efficient materials and methods is the chief cause for this problem. We revise the history of interventional embolization, and apply it to the inspiring of innovative thinking for postgraduate students. Well effect has been achieved. This shows that the technical history of interventional medicine is a treasure and worth further exploration to inspire innovative thinking in the professional postgraduate education.

Key words: Interventional medicine, Innovative thinking, History of technology, Postgraduate education

表1 部分介入栓塞术的早期报道

年份	杂志	疾病	论文类型	病例数	描述
1960	J Am Med Assoc	颅内动静脉畸形	个案报道	1	用甲基丙烯酸甲酯（颅骨修补材料）制成小球（直径2.5、3.0、4.0、4.2 mm），经颈动脉直接引入，靠血流冲刷至供血动脉近端^[4]
1967	J Neurosurg	经动脉海绵窦瘘	个案报道	2	采用颈动脉切开的方式，用自体肌肉块直接栓塞颈内动脉^[6]
1968	Radiology	脊髓动静脉畸形	个案报道	1	采用导管技术，用自体肌肉块栓塞供血动脉^[8]
1972	Radiology	急性胃肠道出血	个案报道	1	肝衰、凝血异常、胃出血的患者，胃网膜动脉灌注肾上腺素无效后，采用自体血凝块栓塞，达到了止血效果。13天后患者因基础病死亡，尸检显示胃肠道和胰腺无缺血征象^[9]
1972	N Engl J Med	骨盆骨折	个案报道	3	自体血凝块栓塞髂内动脉。其中2例成功，1例栓塞后血压得以维持，后因肾衰和DIC死亡，尸检未见盆腔出血源^[10]
1973	Radiology	肾出血	个案报道	1	用自体血凝块超选择栓塞肾活检导致的动静脉瘘，出血停止^[11]
1974	Radiology	鼻出血	个案报道	2	用明胶海绵颗粒栓塞靶血管，分别随访3个月和3周，无复发。已认识到：导管要尽可能接近出血部位，周围型栓塞不容易形成侧支而复发^[12]
1976	J Am Med Assoc	咯血	个案报道	5	用明胶海绵颗粒栓塞支气管动脉。其中4例成功，1例因右支气管动脉与脊髓前动脉有吻合，改行外科手术^[13]
1973	Br J Urol	肾腺癌	论著	20	用自体肌肉组织块栓塞肾动脉。病灶明显缩小，部分病例栓塞后行外科手术，术中出血减少。部分有转移的患者进展减缓，作者推测与激活免疫有关^[16]
1977	Lancet	类癌肝转移	个案报道	2	受肝动脉结扎的启发，用明胶海绵栓塞肝动脉，达到缓解症状的目的^[20]
1979	Br Med J	原发性肝癌	个案报道	2	单纯明胶海绵栓塞。作者认为先栓塞，肿瘤缩小后再静脉化疗^[21]

表1 部分介入栓塞术的早期报道

年份	杂志	疾病	论文类型	病例数	描述
1960	J Am Med Assoc	颅内动静脉畸形	个案报道	1	用甲基丙烯酸甲酯（颅骨修补材料）制成小球（直径2.5、3.0、4.0、4.2 mm），经颈动脉直接引入，靠血流冲刷至供血动脉近端^[4]
1967	J Neurosurg	经动脉海绵窦瘘	个案报道	2	采用颈动脉切开的方式，用自体肌肉块直接栓塞颈内动脉^[6]
1968	Radiology	脊髓动静脉畸形	个案报道	1	采用导管技术，用自体肌肉块栓塞供血动脉^[8]
1972	Radiology	急性胃肠道出血	个案报道	1	肝衰、凝血异常、胃出血的患者，胃网膜动脉灌注肾上腺素无效后，采用自体血凝块栓塞，达到了止血效果。13天后患者因基础病死亡，尸检显示胃肠道和胰腺无缺血征象^[9]
1972	N Engl J Med	骨盆骨折	个案报道	3	自体血凝块栓塞髂内动脉。其中2例成功，1例栓塞后血压得以维持，后因肾衰和DIC死亡，尸检未见盆腔出血源^[10]
1973	Radiology	肾出血	个案报道	1	用自体血凝块超选择栓塞肾活检导致的动静脉瘘，出血停止^[11]
1974	Radiology	鼻出血	个案报道	2	用明胶海绵颗粒栓塞靶血管，分别随访3个月和3周，无复发。已认识到：导管要尽可能接近出血部位，周围型栓塞不容易形成侧支而复发^[12]
1976	J Am Med Assoc	咯血	个案报道	5	用明胶海绵颗粒栓塞支气管动脉。其中4例成功，1例因右支气管动脉与脊髓前动脉有吻合，改行外科手术^[13]
1973	Br J Urol	肾腺癌	论著	20	用自体肌肉组织块栓塞肾动脉。病灶明显缩小，部分病例栓塞后行外科手术，术中出血减少。部分有转移的患者进展减缓，作者推测与激活免疫有关^[16]
1977	Lancet	类癌肝转移	个案报道	2	受肝动脉结扎的启发，用明胶海绵栓塞肝动脉，达到缓解症状的目的^[20]
1979	Br Med J	原发性肝癌	个案报道	2	单纯明胶海绵栓塞。作者认为先栓塞，肿瘤缩小后再静脉化疗^[21]

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The innovation inspiring effect of interventional technical history for graduate students

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The innovation inspiring effect of interventional technical history for graduate students