EXPERIENCE ON SURGICAL MANAGEMENT OF RUPTURE OF ABDOMINAL AORTIC ANEURYSM

Objective. To describe our surgical experience on rupture of abdominal aortic aneurysm .Methods. Two cases of ruptured aortic aneurysms with severe complication were analyzed. Aorta reconstruction procedures were performed using bifurcated e-PTFE grafts during emergency operation. Diagnosis, preoperadve resuscitation, emergency surgical intervention, and postoperative complications of these patients were summarized and discussed.Results. Rupture of aortic aneurysm in both patients presented as a huge retroperitoneum haematoma by computed tomography scan. They were successfully saved by prompt body fluid compensation, emergency procedure, intraoperative resuscitation, and postoperative intensive care.Conclusions. Correct diagnosis, prompt surgical management, immediate intraoperative proximal aorta clamping during procedure, and effective management of postoperative complications were the key points to successful treatment of ruptured aortic aneurysm.     

腹主动脉瘤合并消化系统恶性肿瘤的外科治疗

目的 探讨腹主动脉瘤腔内隔绝术在腹主动脉瘤合并消化系统恶性肿瘤患者治疗中的可行性。方法 回顾性分析2014年1月至2019年12月在北京协和医院接受治疗的28例腹主动脉瘤合并消化系统恶性肿瘤患者的临床资料及随访结果。结果 28例患者中,合并结直肠癌21例,胃癌6例,肝癌1例。所有患者均采取分期手术治疗,其中21例选择先行腹主动脉瘤腔内隔绝术,2期行肿瘤手术。所有患者术后恢复良好,无围手术期死亡,无动脉瘤破裂、肠缺血、肠瘘等并发症。出院后随访过程中1例患者出现支架内血栓形成,1例存在Ⅱ型内漏,无腹主动脉瘤相关性死亡。结论 腹主动脉瘤腔内隔绝术由于微创、不改变腹腔内解剖结构等特点,缩短了分期手术时间间隔,降低了消化系统肿瘤手术难度,是治疗方案中值得推荐的方法。     

一例鲁宾斯坦-泰比综合征患者的临床及基因分析并文献复习

鲁宾斯坦-泰比综合征（RSTS）是一种临床上罕见的常染色体显性遗传病,患者常表现出精神发育迟滞、宽拇指、钩形鼻等特征。RSTS可导致多器官发育不全,也可导致多系统（内分泌系统、消化系统、泌尿系统等）发育不全,甚至可累及皮肤（如毛母细胞瘤、多毛症等）。近年研究发现RSTS可增加患者患癌风险,但该病罕见,目前国内外相关报道较少,虽部分患者可通过临床特征及基因检测确诊,但仍有不少患者无法确诊,因此需进一步明确该病的病因和发病机制。本文报道了桂林医学院附属医院收治的1例疑似RSTS患者,通过对其进行临床特征分析和基因检测,发现患者有一个CREBBP基因突变：c.3832G>A（p.Glu1278Lys）,未发现患者父母该基因突变,表明该基因突变为新发突变,患者诊断为RSTS明确。RSTS十分罕见,确诊困难,通过本例患者的报道,可以提供该病更多的临床特征,有助于对该病基因型-表型相关性的研究,能够给未来诊治RSTS提供更多参考。     

双J管在体外冲击波碎石联合物理振动排石治疗肾下盏结石中的应用

目的:探讨留置双J管后行体外冲击波碎石(ESWL)联合物理振动排石(EPVL)治疗肾下盏结石的疗效。方法:入组65例单纯肾下盏结石患者,其中将留置双J管后行ESWL联合EPVL治疗的32例患者作为试验组,同期未留置双J管行ESWL联合EPVL治疗的33例患者作为对照组。比较两组患者基本资料、当日见石率、2周结石排净率及治疗过程中相关并发症等情况。结果:试验组当日见石率、2周结石排净率明显高于对照组,差异有统计学意义(P<0.05)。治疗过程中试验组肉眼血尿发生率明显高于对照组,而肾绞痛发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:留置双J管后行ESWL联合EPVL治疗直径相对较大的肾下盏结石,能有效增加结石排净率,缩短结石排净时间,降低患者肾绞痛发生率,减轻患者痛苦。     

8-24F鞘管血管缝合器的临床应用及并发症防治

目的:评价血管缝合器在较大血管鞘血管介入手术中的应用,以及相关并发症的处理.方法:回顾性分析110例血管介入手术(8F-24F鞘管)应用血管缝合器后的临床效果以及其并发症的发生情况和相应的预防和处理对策.结果:110例患者经股动脉穿刺后应用血管缝合器止血,其中8F-12F鞘管90例,应用血管缝合器91把,并发症发生率95.6%;12F以上鞘管20例,包括主动脉夹层、胸、腹主动脉瘤(双股动脉穿刺6例),应用血管缝合器52把,并发症发生率95%.结论:在充分评估患者血管条件及熟练操作后,应用血管缝合器,对于8F-24F各种血管鞘术后的血管缝合止血是安全、有效的备选手段,可以缩短患者的卧床时间,在某些情况下可以替代传统的动脉切开术,进一步缩短住院时间.     

静脉血栓栓塞疾病诊疗之再认识

深静脉血栓形成(deep venous thrombosis,DVT)与肺血栓栓塞症(pulmonary embolism,PE)合称为静脉血栓栓塞疾病(venous thromboembolism,VTE),是危害人类健康的常见血管疾病.VTE的预防和治疗进展一直是临床医师广泛关注的热点课题[1],本文就此做一介绍.     

间断喷射导管溶栓治疗近期发生或恶化的下肢缺血

Background  The recent onset or deterioration of lower extremity ischemia is highly associated with intravascular thrombus. Treatment of these thrombotic occlusions is challenging. Pulse-spray catheter directed thrombolysis (PS-CDT) refers to the technique of intermittent forcefully injecting the thrombolytic agent into the thrombus to fragment it and increase the surface area available for enzymatic action. This study was designed to evaluate the efficacy and safety of PS-CDT in patients with recent onset or deterioration of lower extremity ischemia.

Methods  From August 2008 to March 2009, 44 patients with acute or chronic lower extremity ischemia were recruited in this prospective study, which included 37 men and 7 women ranging from 15 to 83 years old (mean age (51.1±17.4) years). PS-CDT through a multi-side-hole thrombolytic catheter by using urokinase was conducted in all patients. The progression of thrombolysis was assessed and graded by angiography. Adjunctive therapies were used to correct underlying lesions. The follow-up period was 12 months.

Results  In the 44 patients, the average total dose of urokinase for each patient was (2 120 000±1 100 000) IU (median 2 000 000 IU), with a median duration of lysis of 48 hours. The rate of initial technical success was 97.7%. The rate of clinically successful lysis was 81.8%. Early (≤30 days) and late (from 30 days to 12 months) amputation rates were both 4.5% (2/44). The overall amputation rate was 9.1% (4/44). No mortality was recorded during thrombolysis and follow-up period (12 months). No major bleeding or allergic reaction was seen during thrombolytic therapy. 11.4% had symptoms of distal embolization. The primary patency rate for the arteries that were clinically successfully thrombolyzed as compared with those that failed to lysis was 83.3% vs. 57.1%, respectively, at 1 year.

Conclusions  PS-CDT, combined with adjunctive therapies, is associated with good safety and efficacy in recent-onset or deterioration of lower extremity ischemia. Successful thrombolysis may be accompanied by better outcomes.

     

颈动脉内膜切除术中应用鱼精蛋白中和肝素的临床观察

目的 评价颈动脉内膜切除术中应用鱼精蛋白中和肝素对术中止血时间、术后引流量及相关并发症的影响.方法 收集2012年1至12月于北京协和医院行颈动脉内膜切除术治疗的125例次颈动脉狭窄患者的病例资料,进行回顾性队列研究.根据术中是否使用鱼精蛋白,将患者分为鱼精蛋白组和非鱼精蛋白组.分析和比较两组的病例资料、术中止血时间、术后伤口引流量及相关并发症.结果 125例次颈动脉内膜切除术中鱼精蛋白组共75例次,非鱼精蛋白组共50例次.鱼精蛋白组术后第1天伤口引流量少于非鱼精蛋白组,分别为(14±13)ml和(19±12)ml,P=0.038;鱼精蛋白组术后总引流量平均值小于非鱼精蛋白组,分别为(20±17)ml和(26±15)ml,P=0.035;鱼精蛋白组术中止血时间较非鱼精蛋白组缩短,分别为(30±11)min和(36±11) min,P=0.030.125例次手术无一例因手术死亡,其中1例(0.8％)发生切口血肿,急诊行血肿清除后恢复良好,1例(0.8％)患者发生术后脑卒中加重,经内科保守治疗后好转.结论 颈动脉内膜切除术中选择性使用鱼精蛋白,对缩短术中止血时间、减少术后伤口引流量有积极作用,且不增加缺血性脑卒中的风险.     

bcl-2及cyclinD1 mRNA在膀胱移行细胞癌中的表达

目的 检测bcl-2及cyclinD1 mRNA在膀胱移行细胞癌中的表达.方法 应用逆转录聚合酶链反应(RT-PCR)的方法检测40例膀胱移行细胞癌组织和10例正常膀胱组织中bcl-2、cyclinD1 mRNA的表达情况.结果 40例膀胱移行细胞癌组织中bcl-2、cyclinD1 mRNA的表达分别为0.650±0.018、0.660±0.022,与其在正常膀胱组织中的表达0.250±0.035、0.320±0.028相比,差异均有统计学意义(P＜0.05).Bcl-2 mRNA在临床分期Tα～T2a中的表达(0.720±0.011)显著高于T2b～T4(0.59±0.017),P＜0.05;cyclinD1 mRNA在Tα～T2a的表达量(0.590±0.021)显著低于T2b～T4(0.750±0.021),P＜0.05.相关分析示相关系数为r=-0.34,P=0.031.结论 bcl-2、cyclinD1 mRNA在膀胱移行细胞癌中过度表达与肿瘤的发生、发展密切相关;可用于膀胱移行细胞癌的诊断和评价预后;在膀胱移行细胞癌的发展及评价预后中,bcl-2、cyclinD1 mRNA呈现出负相关趋势. Abstract： Objective To investigate the expression and clinical significance of bcl-2 and cyclinD1 mRNA in bladder transitional cell carcinoma(TCCB). Methods The expression of bcl-2 and cyclinD1 mRNA were detected by RT-PCR in 40 patients with TCCB and 10 normal bladder tissues. Results The expressional level of bcl-2 and cyclinD1 mRNA in 40 TCCB tissues(0.650±0.018,0.660±0.022) were significantly higher than that level in normal tissues(0.250±0.035,0.320±0.028) (P<0.05). The expression of bcl-2 mRNA in the TCCB tissues of clinical stage Tα-T2a was higher than the expression in stage T2b-T4(P<0.05). But cyclinD1 mRNA in the TCCB tissues of clinical stage T2b-T4 was higher than the expression in stage Tα-T2a(P<0.05),and cyclinD1 mRNA and bcl-2 had correlation(P<0.05). Conclusions RT-PCR assay is reliable and sensitive for detecting bcl-2 and cyclinD1 mRNA in carcinoma specimens from TCCB. The high expression of bcl-2 and cyclinD1 mRNA were correlated to the malignancy.     

颈动脉内膜剥脱术后过度灌注综合征

脑过度灌注综合症（cerebral hyperperfusion syndrome,CHS）是颈动脉内膜剥脱（carotidendarterectomy,CEA）术后罕见而严重的并发症。若治疗不及时,可能导致严重颅内水肿、脑出血甚至死亡。本文就CHS相关方面的最新知识作一总结,包括定义、病理生理基础、危险因素、辅助检查及治疗等,从而引起广大临床医生关注,避免CEA术后这一严重并发症的发生。