综合微创疗法在下肢静脉曲张治疗中的应用

为使术后肢体更加美观,我院于2003年2月至2006年6月对306例下肢静脉曲张患者采用Tri-Vex静脉切除系统[1]联合经皮浅静脉电凝术及传统大隐静脉高位结扎、剥脱及股浅静脉带戒环缩术进行治疗,取得微创美容治疗的目的,现报告如下.     

微创旋切术治疗大隐静脉曲张

目的探讨大隐静脉微创旋切手术方法、疗效及优点。方法采用美国SmithNephew公司的TriVex系统，对16例患者共19条肢体在大隐静脉高位结扎及剥脱的基础上，应用微创旋术切除下肢曲张的静脉。结果术后静脉曲张消失，溃疡愈合，无明显疤痕。结论下肢静脉微创旋切治疗能够减小创伤，缩短手术时间，具有美容效果。     

静脉腔内激光联合手术治疗下肢静脉曲张

目的初步评价腔内激光联合手术治疗下肢静脉曲张的疗效。方法全组下肢静脉曲张患者28例，共38条下肢。按病因和病情的不同，采用3种手术治疗：（1）临床表现明显的原发性下肢深静脉瓣膜功能不全者4条下肢，作股浅静脉瓣膜包窄＋大隐静脉高位结扎＋EVLT＋SEPS术；（2）轻度原发性深静脉瓣膜功能不全者15条下肢，作大隐静脉高位结扎＋EVLT＋SEPS；（3）单纯性大隐静脉曲张者19条下肢，作大隐静脉高位结扎＋EVLT。结果平均随访11个月，全组患者均无复发；临床症状和体征消退或好转，彩超检查示大隐静脉均全程闭合，无血流信号。结论EVLT具有无创、安全、操作简便和疗效良好的优点，联合手术治疗下肢静脉病变的效果满意。     

全程浅静脉连续缝扎治疗下肢静脉曲张

目的 改革传统术式，减少下肢静脉曲张手术的创伤。方法 通过Brpdie-Tren-delenburg及Perther试验及下肢静脉彩色多普勒超声检查等对确诊为下肢静脉曲张的83例患者、102条患肢进行了大隐静脉次高位结扎和经皮全程浅静脉连续环形缝扎术，而不做大隐静脉主干抽剥及曲张静脉的剥脱，以减少创伤。结果 该术式创伤小，术后恢复快，复发率低。结论 全程浅静脉缝扎是治疗单纯性大隐静脉曲张的一种可靠的微创手术方法，值得推广。     

大隐静脉曲张的诊治

目的：探讨下肢静脉造影对于诊断和治疗大隐静脉曲张的指导意义。观察大隐静脉曲张的治疗方式与疗效的关系。方法：用35%泛影葡胺60～80 mL注入足背静脉进行下肢静脉造影,全面了解该肢体静脉系统情况。治疗采用3种方法,即：（1）大隐静脉高位结扎+分段静脉剥脱+交通支结扎术;（2）高位结扎+曲张静脉经皮缝扎术;（3）高位结扎+局部注射硬化剂。结果：大隐静脉造影的诊断符合率100%,经15年随防对于单纯性大隐静脉曲张3种治疗结果均未复发,疗效无差异（P＞0.05）;大隐静脉曲张伴交通支瓣膜功能不全者,大隐静脉高位结扎+分段静脉剥脱+交通支结扎术的疗效优于其它两种方法（P＜0.05, P＜0.01）。结论：下肢静脉造影对大隐静脉曲张的治疗有指导意义。单纯大隐静脉曲张以高位结扎、经皮缝扎术为首选;大隐静脉曲张伴交通支瓣膜+深静脉瓣膜功能不全者以高位结扎、分段静脉剥脱、交通支结扎为首选方式。     

下肢静脉曲张微创治疗进展

下肢静脉曲张是多种静脉疾病所共有的临床表现,最常见的病因是深静脉瓣膜功能不全（DVI）和大隐静脉（GSV）功能不全.根据不同的病因,手术包括各种深静脉瓣膜重建、交通静脉结扎和曲张浅静脉结扎及抽剥术.对于单纯性浅静脉曲张,传统的手术是高位结扎和抽剥术.近十年,因微创手术的发展,使下肢静脉曲张的治疗取得了明显的进步.     

下肢静脉曲张伴原发性深静脉瓣膜功能不全手术方法的探讨

目的：探讨下肢静脉曲张伴原发性下肢深静脉瓣膜功能不全的治疗方法。方法：回顾性总结1990年11月至2000年6月间治疗的下肢静脉曲张伴有深静脉瓣膜功能不全（3－4）级患者189人，245条肢体。将所有患者随机分为试验组133条肢体和对照组112条肢体，所有患者均行大隐静脉高位结扎剥脱术或大隐静脉高位结扎电凝术，试验组同行行股浅静脉戴戒术。结果：手术成功率100％，随访率为87％，随访时间为6个月至9年2个月，平均4年；两组术后的复发率均为3．3％，症状及体征有极大的改善，疗效比较差异无显著意义（P＞0．05）。结论：下肢静脉曲张伴有原发性下肢深静脉瓣膜功能不全时，单独进行浅静脉的高位结扎剥脱术即能达到满意的结果，并不一定要同时进行深静脉瓣膜的处理。     

钬激光治疗下肢静脉曲张44例初期报告

目的评价应用钬激光治疗下肢浅静脉曲张的初步疗效。方法对44例下肢静脉曲张患者共50条肢体,采用钬激光处理大隐静脉主干,结合大隐静脉高位结扎、曲张分支点式剥脱等治疗。结果所有患者经治疗后,静脉曲张消失,并发症较少。结论腔内钬激光治疗下肢静脉曲张近期疗效明确,同时具有简便、微创、美容等优点。     

小切口大隐静脉剥脱术联合泡沫硬化剂注射治疗下肢浅静脉曲张100例临床分析

我院2008年8月至2010年1月采用小切口行大隐静脉近端高位结扎及主干剥脱术联合泡沫硬化剂注射大隐静脉曲张属支的手术方法治疗100例下肢浅静脉曲张病人,疗效较好。现报告如下。1资料与方法1.1一般资料本组100例共117条下肢浅静脉曲张患     

微波血管腔内微创治疗下肢静脉曲张

目的：比较微波血管腔内微创治疗与传统手术治疗下肢静脉曲张的临床疗效与优缺点。方法：治疗组采用微波血管腔内凝固封闭大隐静脉结合属支曲张静脉穿刺凝固方法。对照组采用传统大隐静脉高位结扎加静脉剥脱手术方法。结果：治疗组在症状改善、患肢美观、手术时间、出血量、住院时间、术后并发症等方面优于对照组。结论：微波血管腔内微创治疗下肢浅静脉曲张，具有微创、患者痛苦小、恢复快、美观、疗效好、并发症少、手术操作简捷等优点。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.