不同口径的自体静脉移植修复小动力脉缺损的实验研究

实验以３８只家兔的股动脉作为受区血管，造成缺损后植入不同口径的自体静脉，术后２周内进行血流量、通畅率、血栓成率和扫描电镜检查。结果表明，静脉口径比受区动脉口径小约２０％时移植效果较好。     

真皮下血管网皮片移植血运重建的实验研究

本文探讨:(1)真皮下血管网在皮片移植后不同时间的演变(活体观察法);(2)血管网植皮与全厚植皮血运重建的对比中,真皮下血管网的作用(微动脉灌注法)。证实真皮下血管网主要在植皮后1周内对皮片的成活发挥作用,即通过受皮区向皮片长入毛细血管而沟通,于术后3天使血管网充盈血液;第5～7天皮片与受皮区的毛细血管干及微动脉的互相吻接,明显地促进了皮片的血运重建,1周以后新的真皮下血管网开始出现,而皮片内原来的真皮下血管网被选择性地部分保留下来。血管是否保留取决于附近受皮区有无近似口径的干血管供吻接。另外,由受皮区向皮片长入的毛细血管,部分口径增粗,成为干血管。     

第二肝门重建术治疗肝静脉阻塞型Budd-Chiari综合征

目的 分析和评价第二肝门重建术治疗肝静脉阻塞型布-加综合征(Buddi-Chiari syndrom,BCS)的可行性和中远期疗效.资料与方法 自1999年1月至2008年12月收治的肝静脉阻塞型或肝静脉阻塞伴下腔静脉阻塞的BCS患者,单独应用副肝静脉成形术或分别联合肝静脉成形术、下腔静脉成形术的方法治疗的27例患者,在副肝静脉成形术和肝静脉成形术前后经导管测定副肝静脉、肝静脉压力,观察围手术期并发症,并观察术后6、12、24、36个月受干预血管的通畅率.结果 27例中26例成功,副肝静脉成形术成功率达96%,术中3例出现心慌、胸闷症状,急性肺栓塞1例,均经保守治疗痊愈.26例随访,术后6、12、24及36个月受干预血管的初始再通率分别为96.2%、88.5%、76.9%及73.1%.结论 第二肝门重建术是治疗肝静脉阻塞型BCS行之有效的方法,在肝静脉阻塞型BCS介入治疗中应灵活运用.     

足外侧皮瓣的解剖研究与临床应用

1983年7月我院采用足外侧皮瓣,临床应用8例均获成功。通过124例尸体解剖学研究,证明此皮瓣的供血动脉多数来自腓动脉,少数来自胫后动脉,自外踝后方走向足外侧缘,此动脉称为跟外侧动脉。该皮瓣定为足外侧皮瓣,由小隐静脉引流,腓肠神经支配。供应皮肤范围,其后界可达外踝上方至跟腱的联线,前界可达第5跖骨底或第5趾根部,外侧可达足外侧缘,内侧占足背皮肤的外1/3。此皮瓣的优点是:(1)血管蒂长度在6cm以上,可较自由地与受区血管吻合;(2)解剖恒定,血管蒂口径在2mm以上,适于与受区血管吻合;(3)皮瓣有恒定的神经支配,且与血管同方向进入皮瓣,神经皮支易于从主干(腓肠神经)分出;(4)皮瓣颜色好,厚度适中,较致密,耐压抗磨;(5)供区隐蔽,供皮后不引起功能障碍,是一个较理想的新供皮区。     

副肝静脉的影像解剖学研究

目的:利用肝脏标本并结合活体肝脏的超声与CT图像,对副肝静脉(accessory hepatic veins,AHV)的走行、口径及其与下腔静脉的夹角进行对照研究,为肝移植手术、肝切除术、肝癌的介入治疗以及提高临床影像手段对AHV的显示率,提供解剖学与影像学依据。方法:①随机选用经福尔马林固定的离体无病变肝脏12例,沿下腔静脉(IVC)后壁正中剖开管腔,观察AHV开口情况,并在解剖放大镜下仔细解剖剥离AHV,观察其来源,走向,数量,测量AHV的长轴与IVC长轴的夹角。②随机选健康查体者600人进行超声检查,取剑突下纵切,中上腹部横切,右腋前线纵切,观察AHV的汇入部位、走向、数量、口径及其与下腔静脉轴线的夹角。③随机选80例因胆囊、胰腺或肾脏疾病行CT强化检查,肝脏正常者扫描图像,观察AHV的汇入部位、走向、数量、口径及其与下腔静脉轴线的夹角情况。结果:①12具尸体标本共有AHV 79支,人均6.12±1.13(2~10)支,平均口径0.36±0.11(0.1~1.0)cm;AHV和IVC呈锐角者57支,人均5.21±1.61支,平均口径为0.22±0.14cm,约占总数量的72%;呈直角者22支,人均1.91±0.79支,平均口径为0.42±0.16cm,占总数量的28%。②600例体检者超声检查显示AHV共490支,平均0.78±0.41(0~3)支/例,平均口径0.38±0.19cm。显示的AHV与IVC的夹角多呈直角或近似直角,约88%(431/490),170例显示较粗大的肝右后下静脉,口径0.3~0.81cm,平均0.40±0.19cm。③80例肝强化CT图像,仅24例显示粗大的肝右后下静脉,未见细小尾状叶静脉显示。结论:正常中国人AHV变异较大;在肝右后下静脉显示方面超声与螺旋CT检查相似,在细小AHV显示方面超声检查优于螺旋CT图像。     

经皮经肝肝静脉成形术治疗肝静脉阻塞型Budd-Chiari综合征

目的探讨和评价经皮肝穿刺入路肝静脉腔内成形(percutaneous transhepatic recanalization and angioplasty of hepatic vein,PTRAHV)治疗肝静脉型Budd-Chiari综合征(BCS)的可行性和中远期疗效。方法自1996年9月至2006年10月收治单纯肝静脉阻塞型及肝静脉阻塞伴有下腔静脉阻塞型BCS患者101例,在PTRAHV前后经导管测定患者肝静脉压力,观察围手术期并发症,并分别于术前、术后6个月彩超测量门静脉内径、平均流速和血流方向等,计算对比血流量,随访观察受干预血管的通畅率。结果技术成功率91.1%(92/101)。术中急性肝静脉血栓形成3例,术后发生肝穿刺道出血2例,肝包膜下血肿1例,肺栓塞1例,均经保守治疗痊愈,未发生致死性并发症。随访74例,术后6个月门静脉平均流速和血流量参数均高于术前(P<0.05);术后6个月、1年和2年的受干预血管的初始再通率分别为83.8%(62/74)、78.4%(58/74)和76.5%(39/51),其辅助再通率分别为94.6%(70/74)、91.9%(68/74)和84.3%(43/51)。结论采用PTRAHV技术治疗膜性或节段性肝静脉型BCS操作简单、安全、有效,其中远期效果令人满意。     

上腔静脉梗阻外科治疗(附5例报告)

本文通过应用大隐静脉、人造血管与经戊二醛处理后的新生儿脐带静脉,分别为5例上腔静脉梗阻进行6例次转流术或上腔静脉重建术,认为脐带静脉具有取材容易,处理简单,血管口径一致,无静脉瓣,缝合较易等优点;大隐静脉适用于不开胸者,为减轻症状治疗首选材料;人造血管不宜代上腔静脉。上腔静脉梗阻手术治疗指征是,当梗阻发生在奇静脉或其以上,侧枝循环少,左右无名静脉通畅,病人有不能耐受的脑部和呼吸道症状,估计能够耐受开胸手术。     

盘式封堵器封堵老年心房颤动患者大口径左心耳的安全性和有效性

目的 评价盘式封堵器应用于老年心房颤动（房颤）患者大口径左心耳的安全性和有效性。方法 回顾性分析2018年5月至2021年6月在上海周浦医院接受LAmbre盘式封堵器封堵术治疗的老年房颤患者临床资料。78例左心耳开口直径≥31 mm患者为大口径组,140例左心耳开口直径<31 mm患者为非大口径组。比较两组患者临床一般资料、术中参数、抗栓治疗方案及随访12(10,22)个月结果。结果 大口径组女性占42.3%,年龄（75.8±9.1）岁,≥80岁患者比例为43.6%。大口径组盘式封堵器密封盘直径范围为32～40 mm,术后封堵器周边漏发生率显著高于非大口径组（P<0.05）;器械相关血栓（DRT）发生率为13.3%(8/60),高于非大口径组4.2%(4/96)(P<0.05)。两组术后发生脑梗死、短暂性脑缺血发作、脑出血及死亡差异无统计学意义（均P>0.05）。结论 老年大口径左心耳房颤患者接受盘式封堵器封堵治疗安全有效,术后封堵器周边漏及DRT发生率增加,但不影响临床预后。     

放射性肝损伤的动物实验研究

目的 探讨放射性肝损伤的生化指标、CT影像及病理学特点.方法 20只新西兰白兔随机分为4组:对照组,半肝放疗10、15和20 Gy组,放疗后3个月内监测肝功能、凝血功能,放疗后第3个月观察肝脏CT影像及病理变化特点.结果 20 Gy组死亡3只,余组无死亡;10和15 Gy组谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)于放疗后1个月起明显升高,碱性磷酸酶(ALP)放疗后下降,纤维蛋白原(FbgC)、凝血酶时间(TT)于放疗后1周升高显著,2周恢复至正常;CT增强扫描动脉期无强化,静脉期全肝广泛强化,肝内静脉显影不清,延迟期造影剂消退快;病理表现为随放疗剂量加大,肝静脉闭塞征、肝纤维化和胆管损伤表现越明显,同一放疗后肝脏照射区损伤较非照射区略重.结论 半肝放疗20 Gy死亡率明显增高,10和15 Gy后可引起肝功能改变及凝血功能一过性改变;CT表现为增强扫描显示强化减弱,肝静脉显影不清;随放疗剂量加大放射性肝纤维化、肝静脉闭塞征等表现加重.     

反装甲武器对坦克内绵羊杀伤效应试验研究

目的了解不同口径及不同弹种反坦克武器对坦克内绵羊致伤特点。方法用4种武器、5种弹药在100m距离向坦克前甲板射击;另用反坦克地雷,在坦克履带下引爆,同时测试坦克内冲击波超压、有害气体及温度,试验后检查动物伤情。结果坦克内的68只动物中,44只受到了不同程度的弹片伤、冲击伤、复合伤,其伤处总数为492处,大口径、中口径2种弹致伤率达100％;舱室内有害气体(主要是CO)严重超标;坦克舱室内温度增高幅度不大。结论反装甲武器侵彻坦克后,致绵羊受伤率极高、伤情复杂、伤势严重,死亡率高,加之舱室类兵器机动性强,内部空间小等特点,给救治带来困难。     

Venous thrombosis related to peripherally inserted central catheters

PURPOSE: To determine factors that may lead to venous thrombosis in patients with peripherally inserted central catheters (PICC). MATERIALS AND METHODS: The medical records of 678 patients with 813 PICCs during 1997 were cross-referenced with all patients receiving venous duplex examinations (1,631) during the same time period. Multiple factors were examined in the patients with catheter-related thrombosis, including diagnosis, solution infused, catheter tip position, vein accessed, and catheter diameter. RESULTS: Nurses placed 269 PICCs with 12 venous thromboses, for a rate of 4.5%. Radiologists placed 544 PICCs with 20 venous thromboses, for a rate of 3.7%. There was no significant difference in these rates. The overall thrombosis rate was 3.9%. After multivariate analysis, only catheter diameter remained significant. There were no thromboses in catheters 3 F or smaller. The thrombosis rate was 1% for 4-F catheters, 6.6% for 5-F catheters, and 9.8% for 6-F catheters. CONCLUSIONS: Thrombosis rate associated with PICCs was low (3.9%). The smallest acceptable catheter diameter should be used to decrease the incidence of venous thrombosis.     

彩色多普勒超声表现与原发性下肢深静脉瓣膜功能不全辨证分型的相关性

目的:探讨彩色多普勒超声表现与原发性下肢深静脉瓣膜功能不全中医辨证分型的相关性。方法:对550例(608条)原发性下肢深静脉瓣膜功能不全患者按中医辨证分为2组:脾虚湿阻证组和湿热下注证组,分别行彩色多普勒超声检查,观察2组静脉管径、流速、返流的时间、返流速度。结果:脾虚湿阻证组的静脉管径、静脉流速均在正常范围,返流时间多小于2s,返流速度多小于30cm/s,病变多累及1组瓣膜;湿热下注证组表现为静脉管径增宽、静脉流速在正常范围、返流时间多大于4s,返流速度多大于30cm/s,病变多累及2组以上瓣膜。结论:彩色多普勒超声表现与原发性下肢深静脉瓣膜功能不全中医辨证分型有较高的相关性。     

Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

OBJECTIVE: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. METHODS: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. RESULTS: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. CONCLUSIONS: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.     

SMART stent for salvage of hemodialysis access grafts

PURPOSE: To evaluate the SMART stent for treating angioplasty-resistant hemodialysis access venous stenoses. MATERIALS AND METHODS: A retrospective study of 64 patients with polytetrafluoroethylene grafts who were treated with the SMART stent at 69 locations in the venous outflow tract was undertaken. Stents were used for elastic recoil after percutaneous transluminal angioplasty, venous rupture, or recurrent stenosis less than 3 months after angioplasty. When angiographic follow-up was available, the degree of in-stent restenosis was measured. Primary patency was determined, and, when applicable, compared with that of previous angioplasty treatments of the same lesion. RESULTS: The SMART stent was placed in 15 central veins and 54 peripheral veins, with a 98% technical success rate and a 97% clinical success rate. The mean primary access patency times were 14.9 months and 8.9 months in patients who received central and peripheral stents, respectively. In 19 patients whose central or peripheral venous stenoses were previously treated with angioplasty, the mean primary access patency was increased from 2.5 months to 10.6 months after placement of the SMART stent (P = .0003). Angiography in 29 patients after an average of 348 days showed 55% mean in-stent stenosis. The only stent-related complication occurred in a patient who had venous dissection associated with the edge of a SMART stent placed at the elbow. CONCLUSION: The SMART stent is safe and effective for treating dialysis access venous stenoses that are resistant to standard angioplasty.     

Complication rate of venous access procedures performed by a radiology practitioner assistant compared with interventional radiology physicians and supervised trainees

PURPOSE: To compare venous access complication rates associated with procedures performed by radiology practitioner assistants (RPAs) versus interventional radiology (IR) faculty members, IR fellows, and radiology residents. MATERIALS AND METHODS: A retrospective review of venous access procedures in the IR department for 12 consecutive months at a single university hospital was performed. Procedural primary operators included 12 radiology residents, two IR fellows, four IR faculty members, and one board-certified RPA with 2 years of university training. Data examined included immediate and short-term complications separated into major and overall categories. RESULTS: A total of 2093 venous access procedures were performed. The RPA performed 670 procedures (temporary central venous catheter placement, n = 274; peripherally inserted central catheter, n = 67; venous access catheter change, n = 99; venous port placement, n = 126; tunneled central venous catheter placement, n = 39; catheter check, n = 32; and venous explant, n = 43). Similar procedure ratios were noted with faculty members, fellows, and residents. Procedures by the RPA had a major complication rate of 0.29% and an overall complication rate of 0.89%. Four IR faculty members performed 291 procedures, with no major complications and an overall complication rate of 1.71%. Two IR fellows performed 562 procedures, with a major complication rate of 0.35% and an overall complication rate of 1.06%. Twelve residents performed 570 procedures, with a major complication rate of 0.52% (range, 0%-2.46%) and an overall complication rate of 1.39% (range, 0%-3.70%). No significant difference was found among groups (P = .7). CONCLUSION: A properly trained and monitored RPA can safely perform selected venous access procedures with complication rates equal to those of IR faculty members, fellows, and residents.     

锁骨下静脉输液港的并发症及临床处理

目的：探讨锁骨下静脉输液港的并发症,分析临床处理方法及疗效。方法：回顾性分析150例行锁骨下静脉输液港置入术的患者病例资料,记录并发症的发生及临床处理方法及疗效。结果：147例患者完成锁骨下静脉输液港系统置入术,操作成功率为98%;操作时间为25-60 min,平均43 min;3例手术失败,其中1例气胸,2例穿刺锁骨下动脉;近期并发症的发生率为6.67%;远期并发症发生率为14%。结论：锁骨下静脉输液港置入术操作简单、使用安全,临床操作及护理程序的提高有利于减少并发症的发生。     

超声联合腔内治疗动静脉阻塞性疾病并发症原因分析与防治

目的 分析采用超声消融联合Fogarty导管取栓治疗周围血管栓塞性疾病的并发症及其防治措施。方法 周围血管栓塞性疾病309例，其中周围动脉栓塞性疾病110例；周围动脉栓塞性疾病199例。均采用超声消融联合Fogarty导管取栓治疗。结果 各种主要并发症总发生率为17．8％，周围动脉栓塞组并发症发生率为20例，发生率为18．18％，截肢率为19．09％；周围静脉栓塞组并发症发生率为17．59％，两组间并发症发生率比较无统计学意义（P〉0．05）。结论 采用超声消融联合Fogarty导管取栓治疗周围栓塞性疾病．动脉栓塞性疾病组与静脉栓塞性疾病组并发症发生率没有差异，动脉组截肢率高源于血管病变性质。     

螺旋CT双期扫描对小肝癌的诊断价值

目的评价螺旋CT扫描的动脉期、静脉期以及双期联合应用对小肝癌的诊断价值。方法对27例小肝癌行螺旋CT双期增强扫描,增强动脉期于造影剂注射后25～30s开始扫描,静脉期于65～70s开始扫描,造影剂注射速率为2.5～3.0ml/s,用量70～85ml。结果27例小肝癌共发现34个结节病灶。平扫、动脉期、静脉期、动静脉双期的检出率分别为70%、91%、79%、94%,经统计学分析,动脉期和动静脉双期的检出率较平扫和静脉期高（Ρ＜0.05）,动脉期和动静脉双期间、平扫和静脉期间比较均无统计学意义（Ρ＞0.05）。65%（22/34）的小肝癌动脉期呈均匀高密度,与同期肝组织比较,CT值平均增加25.9±14.4HU;23%（8/34）呈不均匀高密度。79%静脉期呈低密度,与同期肝组织比较,CT值平均减少18.7±8.9HU;21%（7/34）为等密度。双期扫描的定性准确率为97%（31/32）。结论螺旋CT动、静脉双期扫描对小肝癌诊断有很高的敏感性和特异性。     

脑CT灌注成像对比剂注射速率与剂量实验研究

目的探讨多层螺旋CT脑灌注成像合适的注射速率及剂量。方法实验采用配伍组设计。处理因素为对比剂注射速率,分别为3、4、5、6、8 m l/s;配伍因素为对比剂注射剂量,分别为0.5、0.75、1、1.25、1.5 m l/kg。25只比格犬随机入组进行灌注成像扫描。所得图像经后处理,测量上矢状窦内对比剂至峰值时间及升高CT值。结果注射速率对上矢状窦至峰值时间有显著性影响。其中5、6 m l/s组上矢状窦至峰值时间与8 m l/s组相比较,无统计学显著性差异;3、4 m l/s组与8 m l/s组相比较,上矢状窦至峰值时间延长。注射剂量对上矢状窦峰时升高CT值有显著性影响。其中1.5、1.25 m l/kg组上矢状窦峰时升高CT值与1 m l/kg组相比较,无统计学显著性差异;0.5、0.75 m l/kg组与1 m l/kg组相比较,上矢状窦峰时升高CT值降低。结论注射速率低至5m l/s或注射剂量低至1 m l/kg时,脑CT灌注成像亦可获得满意效果。     

直接经皮冠脉介入和静脉溶栓治疗急性心肌梗死的比较

目的　探讨直接经皮冠脉介入 (PCI)和静脉溶栓治疗急性心肌梗死 (AMI)的临床疗效。方法　采用不同时期连续 13个月收治AMI患者 ,静脉溶栓组 5 7例 ,直接PCI组 75例。比较两组的再灌注率 ,以及两组住院和随诊期间心脏事件发生的情况。结果　静脉溶栓组再灌注率为 5 7.9% ,直接PCI组为 96 %。超声心动图LVEF值静脉溶栓组和直接PCI组分别为 0 .5 9± 0 .12和 0 .6 3± 0 .10。两组在住院期间的心脏事件的发生率无显著差异 ,而随访期间的心脏事件的发生率有显著差异 :直接PCI和静脉溶栓的不稳定心绞痛发生率分别为 9.3%和 38.6 % ;非致死性心功能衰竭 4 .0 %和 14 .0 % ;病死率 0 %和 7.0 % ;复合终点事件 9.3%和 5 0 .9%。结论　直接PCI能更快、更满意地开通梗死相关血管 ,抢救濒临死亡的心肌 ,改善心功能 ,降低病死率 ,优于静脉溶栓治疗。