Conventional operation and laser therapy in the treatment of varicose veins

Objective： To evaluate the effectiveness of endovenous laser therapy and conventional therapy on the varicose of great saphenous vein. Methods ： Thirty-two patients received endovenous laser therapy and 32 patients were operated by conventional therapy （high ligation and stripping）. The observation results of great saphenous vein（GSV） were recorded by clinical evaluation and duplex ultrasound examination. And the operating time, intraoperative blood loss, time to become moveable, duration of hospitalization and degree of feeling pain were compared between the two groups. Results： Compared with conventional therapy, laser therapy had good curative effect with less complications and no scars and no pains. There were significant differences between the two groups （P〈0. 01）. Conclusion： Laser therapy for varicose of great saphenous vein is better than the conventional therapy. It deserves to be widely used in clinical treatment.     

Vascular surgery

Assessment of risk factors for acute lower-limb deep venous thrombosis;Endovenous laser treatment, radiofrequency endovenous occlusion and conventional stripping combined with transilluminated powered phlebectomy for lower extremity varicose vein;Endovenous radiofrequency ablation in combination with TriVex for treatment of chronic venous in-sufficiency of the lower extremity;Transcatheter thrombolysis via the small saphenous vein for acute lower limb deep venous thrombosis;Interventional therapy for left iliac vein stenosis or occlusion     

髂静脉受压综合征的腔内治疗

Background  Iliac vein compression syndrome (IVCS), the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS. 

Methods  Between January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.

Results  The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.

Conclusions  Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

     

Clinical application of hepatic venous occlusion for hepatectomy

Background Most liver resections require clamping of the hepatic pedicle （Pringle maneuver） to avoid excessive blood loss. But Pringle maneuver can not control backflow bleeding of hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from the injuries of the hepatic veins. Although total hepatic vascular exclusion can prevent bleeding of the hepatic veins effectively, it also may result in systemic hemodynamic disturbance because of the inferior vena cava being clamped. Hepatic venous occlusion, a new technique, can control the inflow and outflow of the liver without clamping the vena cava. Methods A total of 71 cases of liver tumors underwent resection with occlusion of more than one of the main hepatic veins. All tumors involved the second porta hepatis and at least one main hepatic vein. Ligation or occlusion with serreflnes, tourniquets and auricular clamps were used in hepatic venous occlusion. Results Of the 71 patients, ligation of the hepatic veins was used in 28 cases, occlusion with a tourniquet in 26, and occlusion with a serrefine in 17. Right hepatic veins were occluded in 38 cases, both right and middle hepatic veins in 2, the common trunk of the left and middle hepatic veins in 24, branches of the left and middle hepatic veins in 2, and all three hepatic veins in 5. Thirty-five cases underwent hemihepatic vascular occlusion, 4 alternate hemihepatic vascular occlusion, 23 portal triad clamping plus selective hepatic vein occlusion, and 9 portal triad clamping plus total hepatic vein occlusion. The third porta hepatis was isolated in 26 cases. The amount of intraoperative blood loss averaged （540±2.83） （range 100 to 1000） ml in the group of total hemihepatic vascular occlusion and in the group of alternate hemihepatic vascular occlusion, （620±317） （range 200-6000） ml in the group of portal triad clamping plus selective or total hepatic vein occlusion. All tumors were completely removed. Conclusions Hepatic venous occlusion     

Oral administration and external application of Chinese drugs combined with micro-invasive operation for the treatment of varicose ulcers in the lower extremities

Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremities(ecthyma).Methods:A total of 152 patients(163 limbs) suffering from varicose ulcers on the lower limbs were assigned to two groups according to the patients' willingness.The 102 cases(109 limbs) in the treatment group underwent the method of endovenous microwave closure of communicating vei...     

The Surgical Treatments for the Long Saphenous Varicose Vein

Objective To summarize the experiences of the surgical treatments for the long saphenous varicose vein. Methods 545 cases （667 legs） were treated with smaller incisions and stripping of the long saphenous vein. Results 500 cases （91.7%） were followed-up on an average of 3.7 years. The result shows that this technique could decrease the operative injures and the complications. The recurrent rate is very low （1.2%）. Conclusion This easy and reasonable operative technique is worth recommending due to their ideal effects.     

EVALUATION OF SAPHENOUS STRIPPING OPERATION IN THE TREATMENT OF VARICOSITY OF LOWER EXTREMITY

The causes of failure of saphenous stripping in 145 patients with a total of 177 limbs and 200 operations are analysed. In most cases saphenous varicosity is secondary to incompetence of the deep venous system.Varicosity of the lower extremity is a common clinical feature of different diseases. Its real etiology should be determined through venography in order that appropriate operation could be instituted. Stripping of the saphenous vein and ligation of the communicating veins is indicated only in simple saphenous varicosity, but may be used as an adjunctive procedure to reconstructive operations of the deep venous trunks.     

Sudden cardiovascular collapse caused by carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass grafting

Endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） has gained increasing acceptance as a less invasive alternative to conventional open vein harvesting. With this procedure, carbon dioxide （CO2） is insufflated to create a subcutaneous tunnel to facilitate the harvest of the great saphenous vein. The technique seems to be safe because there are no adverse hemodynamic consequences or systemic CO2 absorption during EVH. We report a case of massive right heart gas embolism which occurred during a routine EVH performance of the saphenous vein. Techniques for early diagnosis of this rare but life-threatening complications, transesophageal echocardiography （TEE） is a sensitive tool in detecting CO2 embolism [except end-tided CO2 （ETCO2）] and pulmonary arterial pressure （PAP） monitoring. The rapid recovery of CO2 embolism in the patient who underwent EVH with CO2 insufflation and CABG surgery was due to immediate and accurate diagnosis and prompt treatment.     

A clinical study on diabetic retinopathy.

A clinical research on the diabetic retinopathy(DR) is reported. In the 662 cases of diabetes mellitus examined, the prevalence of DR was 51.3%, of which 7.6% were preproliferative and 7% proliferative. The study showed that when the disease progressed to the preproliferative and proliferative DR, laser photocoagulation could be the best treatment of choice, and panretinal photocoagulation was also quite effective in the treatment of pregnant patients with proliferative diabetic retinopathy.

     

Effects of Shehuang Paste(麝黄膏) on hemodynamics, endotoxin, nitric oxide and endothelin-1 in patients with refractory cirrhotic ascites

Objective： To explore the influence of Shehuang Paste （麝黄膏, SHP） to the hemodynamics, endotoxin, nitric oxide （NO）, and endothelin-1 （ET-1） in patients with refractory cirrhotic ascites. Methods： Fifty-nine cases of refractory cirrhotic ascites were randomly assigned to two groups, 32 cases in the treatment group and 27 cases in the control group. The basic treatment was the same for both groups, including liver protecting medicines, diuretics and supportive drugs, but SHP navel sticking was applied for the treatment group additionally once a day. A course of one month of treatment was applied and the general efficacy on ascites was observed by the end of the therapeutic course. Before and after the treatment, examinations by limulus lysate chromogenic test was conducted to measure plasma endotoxin content; colorimetry to measure plasma content of NO indirectly, radioimmunoassay to measure plasma ET-1 content; and color Doppler ultrasonography to measure the blood flow of portal vein and splenic vein. The relationship between the blood flow of portal vein and splenic vein and endotoxin, NO and ET-1 in the treatment group was analyzed as well. Results： The total effective rate on ascites was 84.4% in the treatment group, and 48. 1% in the control group, with significant difference shown between them （P〈0.01）. In the treatment group the blood flow of portal vein and splenic vein, contents of endotoxin, NO and ET-1 all got significantly reduced after treatment （ P〈0.05 or P〈0.01）; while these indexes in the control group were not significantly changed （P〉0.05）. Moreover, it was found that in the treatment group, the blood flow of portal vein and splenic vein had a positive correlation to the levels of NO, ET-1, and endotoxin, either before or after treatment. Conclusion： Application of SHP navel sticking could clearly reduce the blood flow of portal vein and splenic vein, and lower the content of endotoxin, NO and ET-1. The blood flow of portal vein and splenic vein in the treatment group showed a positive correlation with the contents of endotoxin, NO and ET-1.     

腔内激光治疗原发性下肢大隐静脉曲张32例

目的探讨腔内激光治疗原发性下肢大隐静脉曲张的疗效。方法对32例(36条肢体)大隐静脉曲张患者采用腔内激光治疗,观察临床效果。结果本组所有病例的下肢曲张浅静脉手术后闭、消失。术后2例发生下肢轻度皮肤灼伤,3例有大腿皮肤瘀斑。结论腔内激光是一种安全、简便、有效的大隐静脉曲张的治疗方法。     

大隐静脉曲张针孔高位结扎加腔内激光治疗

目的 研究大隐静脉针孔高位结扎加大隐静脉曲张腔内激光治疗的方法,总结该疗法的临床疗效.方法 大隐静脉曲张患者133例,其中单纯大隐静脉曲张102例,同时伴有轻度股浅静脉反流31例.内踝部Seldinger法穿刺大隐静脉,通过导丝置入5F造影导管,将光纤通过导管送入大隐静脉内,行血管腔内激凝闭.膝关节上激光功率15~18W,每0.5~1cm血管内脉冲持续时间1s,间隔1s.膝关节下功率12W,每0.5~1cm血管内照射1s,间隔1s.结果 7例有轻度皮肤灼伤,无其他并发症.随访5~36个月,平均18个月,局部皮肤营养障碍性病变明显减轻,浅静脉曲张消失,下肢酸胀感减轻或消失.结论 大隐静脉曲张腔内激光治疗创伤小,恢复快,疗效好.     

大隐静脉高位结扎联合X线下导管引导泡沫硬化剂治疗大隐静脉曲张体会

目的：观察大隐静脉高位结扎联合X线下导管引导泡沫硬化剂治疗大隐静脉曲张的临床效果。方法选择81例（92条患肢）大隐静脉曲张患者,采用大隐静脉高位结扎联合X线下导管引导注射泡沫硬化剂进行治疗,观察、随访临床效果。结果92条患肢均获得满意效果;随访6～30月,无复发病例。结论大隐静脉高位结扎联合X线下导管引导泡沫硬化剂治疗大隐静脉曲张的方法简单安全、疗效确切、创伤小、符合美容要求,适用于大隐静脉曲张有美容要求及高龄不能耐受传统手术。     

静脉腔内激光治疗大隐静脉曲张的疗效分析

目的观察静脉腔内激光（EVLT）治疗大隐静脉曲张的疗效。方法将68例大隐静脉曲张病人随机分为两组,EVLT组（36例）和传统手术组（32例）。EVI。T组采用EVLT加大隐静脉高位结扎;传统手术组采用大隐静脉高位结扎抽剥,交通支切除结扎。随访3～18个月。观察术后效果、并发症的情况并比较分析。结果两组病例下肢酸胀、乏力明显好转;皮肤色素沉着减轻。EVLT组平均住院时间为4．2d,传统手术组为9．4d,传统手术组并发症明显多于EVLT组。结论EVLT治疗大隐静脉曲张创伤小,并发症少,疗效确切,比传统手术治疗优越。     

腔内激光闭合术联合高位结扎治疗单纯性大隐静脉曲张23例护理体会

目的:总结腔内激光闭合术联合高位结扎治疗单纯性大隐静脉曲张的护理体会.方法:对23例单纯性下肢大隐静脉曲张患者采用腔内激光闭合术结合高位结扎,进行术前、术后护理和健康教育.结果:23例均治愈,无下肢深静脉血栓等并发症发生.结论:腔内激光闭合术联合高位结扎治疗大隐静脉曲张具有操作简便、术后恢复快、手术瘢痕小、住院时间短、不易复发等优越性,做好术前、术后的护理工作是保证手术成功的重要环节.     

大隐静脉高位结扎剥脱联合电凝术治疗大隐静脉曲张

目的探讨大隐静脉高位结扎剥脱联合电凝术治疗大隐静脉曲张的临床应用价值。方法回顾性分析我院2005年1月￣2006年4月间收治的下肢静脉曲张病人98例,其中行大隐静脉高位结扎剥脱联合电凝术61例。结果61例病人术后均恢复良好,术后住院时间均为2d,随访8个月,皮下瘀斑、局部皮肤感觉障碍均消失,无复发病例。结论大隐静脉高位结扎剥脱联合电凝术是治疗大隐静脉曲张的有效手段,达到了微创、美观的要求。     

泡沫硬化剂治疗大隐静脉曲张的疗效分析

目的：探讨泡沫硬化剂治疗大隐静脉曲张的临床效果。方法：选择30例（条）下肢静脉曲张的患者,对其进行大隐静脉高位结扎,小腿曲张静脉内注射1％乙氧硬化醇泡沫硬化剂,观察大隐静脉曲张症状的改善。结果：30例患者（30肢）均成功接受治疗。平均每条患肢应用20ml泡沫硬化剂,无严重并发症发生。术后5例局部存留曲张静脉团块,但超声检查未见血流信号;3例曲张静脉附近出现炎性反应。24条患肢于治疗后2周、3个月后复诊血管超声时大隐静脉主干闭塞。平均随访3个月,24例患者下肢临床症状明显缓解,下肢明显的曲张静脉消失;2条患肢的溃疡于术后2个月愈合。结论：泡沫硬化剂疗法可有效治疗大隐静脉曲张,联合大隐静脉高位结扎可增加治疗的安全性,是治疗大隐静脉曲张的新方法。     

高位结扎联合腔内激光治疗术治疗大隐静脉曲张37例临床分析

[背景]探讨高位结扎联合腔内激光治疗术对大隐静脉曲张的治疗效果.[病例报告]自2008年2月至2008年10月间,采用高位结扎联合腔内激光方法给37例46条患肢进行了大隐静脉曲张治疗术,同时对小腿局部静脉团实施部分切除术或缝扎术.全组患者的手术时间为32~56 min,平均为44min,术后住院时间为6~10 d;无复发病例.31例患者随访2~8个月,平均为6个月,见下肢酸胀感明显缓解或消失,浅静脉曲张消失.术后复查彩色超声波结果示,大隐静脉主干全部出现血栓性闭塞,无血流信号.[讨论]高位结扎结合静脉腔内激光治疗大隐静脉曲张具有手术操作简单,安全,易于掌握,创伤小等优点,是疗效确切的治疗方法.     

环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动的临床研究

目的 探讨环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动(PAF,简称房颤)的临床效果与安全性.方法 选择23例PAF患者,应用Ensite3000 Navx系统和Lasso电极指导下行环肺静脉电隔离及左房顶部线、峡部线消融.消融终点为:在消融过程中房颤终止,且肺静脉电位消失,或房颤不终止,但肺静脉电位消失;若在窦律下消融,肺静脉电位消失;左心房顶部及峡部线达到完全阻滞.结果 23例PAF患者均顺利完成手术,手术时间234～297 min,平均(277±41)min,X线暴光时间29～55 min,19例患者术中出现房颤,其中14例在消融过程中房颤终止且达到肺静脉电隔离,另外5例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.左心房顶部线全部达到完全阻滞,峡部线有2例未能达到完全阻滞.随访期间发现3个月后有86.9%的患者房颤消失或明显减少.结论 环肺静脉电隔离联合左心房线性消融治疗PAF 安全、可靠. Abstract： Objective To study the clinical efficacy and safety of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation(PAF) combined with left atrial linear lesion. Methods Twenty-three PAF patients were performed circumferential pulmonary vein isolation combined linear lesion of left atrial isthmus and loof with Ensite 3000 Navx and Lasso electrodes guiding. Radiofrequency end point, atrial fibrillation stopped and pulmonary vein potentials(PVPs) disappeared, or atrial fibrillation did not stop, but PVPs disappeared. PVPs disappeared if atrial fibrillation was ablated during sinus rhythm. Left atrium loof and isthmus line were complete block.Results Twenty-three PAF patients were performed ablation, operation times were from 234 to 297 minutes, X ray time was from 29 to 55 minutes, 19 atrial fibrillations occurred during operation, of which 14 atrial fibrillations stopped with pulmonary vein isolation and linear lesion, the other 5 atrial fibrillations didn't stop, but which pulmonary veins were isolated. Tour patients were performed pulmonary vein isolation during sinus rhythm. All roof lines were completely block, and 2 left atrial isthmus lines were not completely block. 86.9% patients' atrial fibrillation disappeared or decreased significantly.Conclusions It is safe and efficient to treat PAF with circumferential pulmonary vein isolation combined with left atrial linear lesion.     

冠状窦阻塞对心肌细胞的影响

目的 探讨冠状窦阻塞对心肌细胞的影响.方法 健康家犬14只,随机分为实验组7只和对照组7只.开胸,应用无损伤滑线从心外膜在最接近冠状窦口处结扎阻塞冠状窦,阻塞2 h后对心脏标本进行组织学电镜及光镜观察;于阻塞后1 h和2 h时分别取静脉血检测心肌肌钙蛋白I(cTnI)含量.对照组不对冠状窦进行结扎.结果 电镜可见肌原纤维间水肿,部分肌原纤维溶解,肌纤维膜破损,线粒体水肿,核周空泡水肿.组织学光镜可见心肌细胞萎缩,间质血管充血、出血,心肌间质水肿;心肌肌钙蛋白I在实验组和对照组阻塞前和阻塞后1 h、2 h未见明显变化(P均＞0.05).结论 冠状窦阻塞损伤心肌细胞,导致心肌细胞萎缩;对心脏结构造成显著影响. Abstract： Objective To investigate the effect of coronary vein sinus occlusion to cardiomyocytes. Methods Fourteen healthy dogs grouped into the experiment and the contrast randomly, each group had 7 dogs. All dogs received chest open operation. Scatheless slide wire was used to ligate coronary vein sinus at where nearest the orifce of coronary vein sinus from epicardium. Cardiac histology was investigated from electron macroscope and optical macroscope at the end of the experiment 2hours after the ligation. To test the vein blood cTnI concentration after 1 hour and 2 hours ligation. In the contrast group, coronary vein sinus was not ligated. Results In the experiment group, myofibril interstitiual edema, part of myofibril dissolved, myolemma of myocardial disrepaired, mitochondre edema and edemaarround nucleolus were observed from electron macroscope. Atrophy of myocardium,hyperemia and hemorrhage in interstistial vascular and myocardial interstitiual edema were observed from optical macroscope;cTnI did not have significent changes between it before ligation and 1 hour after ligation and 2 hours after ligation( all P ＞ 0.05 ) both in the experiment group and in the contrast group. Conclusions Coronary vein sinus occlusion damaged cardiomyocytes,lead to atrophy of cardiomyocytes and finally result to significent effect to cardiac configuration.