彩色多普勒超声检查对静脉吸毒致下肢静脉炎及淋巴水肿的诊断价值

目的：探讨彩色多普勒超声检查对静脉吸毒致下肢静脉炎及淋巴水肿的诊断价值。方法：对18例静脉吸毒患者下肢静脉、皮下组织、腹股沟淋巴结进行彩色多普勒超声检查。结果：18例静脉吸毒患者彩色多普勒超声检查声像图表现为下肢静脉管壁弥漫性增厚,回声增强,内壁粗糙,彩色多普勒血流显像（CDFI）显示静脉血流束不同程度变窄,血流颜色暗淡,探头加压管腔不被压瘪,乏氏试验未见明显反向血流。其中右侧股总静脉血栓形成1例。8例患者双侧胫前及足背水肿处超声声像图显示皮下组织增厚,回声增强,内见长条状无回声管腔,呈网格样改变,管腔内未探及血流信号,伴双侧腹股沟多发肿大淋巴结。结论：下肢静脉注射吸毒患者易致下肢静脉炎,可继发血栓形成及淋巴水肿。彩色多普勒超声检查对于诊断静脉吸毒致下肢静脉炎及淋巴水肿具有无创、快捷、准确的优势,对辅助临床诊断及随诊复查具有重要价值。     

彩超对肿瘤患者经外周静脉穿刺中心静脉置管后血栓性静脉炎的诊断价值

目的探讨彩超检查在肿瘤患者经外周静脉穿刺中心静脉置管(PICC)后发生静脉血栓诊断中的临床价值。方法回顾性分析36例肿瘤患者PICC后急性血栓形成的声像图表现和治疗后的超声表现。结果36例血栓形成中,29例于留置针处静脉管壁上发生局部血栓性静脉炎(静脉附壁血栓),7例发生完全型静脉血栓形成,与未置管肿瘤患者发生血栓比较,PICC患者血栓性静脉炎发生概率增高。结论肿瘤患者PICC后可诱发血栓性静脉炎,超声检查对肿瘤患者静脉血栓的诊断是一项非创伤性、高敏感性、可重复性、有价值的检查方法,对配合肿瘤患者治疗期间的预防血栓、快速诊断血栓、指导临床静脉置管等有重要的临床应用价值。     

彩色多普勒超声在高流量性阴茎异常勃起诊断中的应用

目的 探讨彩色多普勒超声在高流量性阴茎异常勃起诊断中的价值。方法 回顾性分析经超声检查的6例高流量性阴茎异常勃起患者声像图表现。结果 不明原因原发性高流量性阴茎异常勃起2例，外伤后阴茎异常勃起4例，均表现为一侧阴茎深动脉血流收缩期峰值流速（PSV）增高，PSV〉25cm／s，外伤患者一侧阴茎海绵体内同时可见深动脉-海绵体漏，海绵体窦状隙亦不同程度增宽。结论 高流量性阴茎异常勃起具有特征性的声像图表现，彩色多普勒超声在该病的诊断中有重要价值。     

卵巢黄体血肿与畸胎瘤超声声像图的对比研究

目的：探讨卵巢黄体血肿与畸胎瘤的超声声像图特征,提高超声对二者的鉴别诊断能力。方法：回顾性分析58例黄体血肿患者和51例畸胎瘤患者的超声声像图的表现,比较二者二维声像图及彩色多普勒血流方面特征。结果：卵巢黄体血肿和畸胎瘤囊内含高回声区二者之间的比较,差异无统计学意义（P〉0．05）;黄体血肿典型声像图表现：囊内网格状回声及周边环状血流信号,与畸胎瘤鉴别差异有统计学意义（P〈0．05）;畸胎瘤典型声像图表现：囊内团状高回声后方伴声影,与黄体血肿鉴别差异有统计学意义（P〈0．05）。结论：超声对卵巢黄体血肿与畸胎瘤有很好的诊断价值。     

超声诊断急性阑尾炎40例

目的探讨经腹超声诊断急性阑尾炎的临床价值。方法对40例急性阑尾炎患者的超声表现、手术结果及病理资料进行对照分析。结果超声诊断的40例急性阑尾炎经手术、病理证实39例，符合率为97．5％。急性阑尾炎的声像图表现为：①在盲肠部探及肿胀的低回声阑尾，阑尾壁增厚，管壁呈强弱强三层回声结构，腔内多有积液（87．1％），有时可见强回声团块（粪石）。②阑尾周围肠间隙可探及少量游离液性暗区（46．1％）。③急性坏疽性阑尾炎，阑尾管壁不规则性增厚，管壁三层回声结构可见或消失，并发穿孔时周围探及较多的积液。结论超声可对急性阑尾炎作出较准确的诊断，并可提示是否为急性坏疽性阑尾炎。     

甲状腺结节环状钙化的声像图特征及诊断价值分析

目的分析甲状腺结节环状钙化的超声特征及其对结节良、恶性诊断的价值。方法回顾性分析78例甲状腺结节伴环状钙化的术前超声检查结果和术后病理结果。结果甲状腺结节边缘环状钙化声像图中,恶性结节中钙化环不连续的发生率66．04％（35／53）高于良性结节33．96％（18／53）（X^2=4．718,P=0．030,OR=2．917,95％CI：1．093～7．783）;恶性结节中钙化环发生增厚改变（厚度≥0．5mm）的发生率87．50％（28／32）高于良性结节12．50％（4／32）（X^2=19．752,P=0．000,OR=11．941,95％CI：3．573～39．910）;恶性结节的钙化结节内部低回声的比例75．76％（25／33）高于良性结节24．24％（8／33）（X^2=17．28,P=0．000,OR=9．986,95％CI：2．936～33．352）。结节大小、内部囊性改变与否在良、恶性结节中差异无统计学意义（p〉0．05）。结论甲状腺结节环状钙化的不连续性、增厚改变及内部低回声的超声声像特征有助于诊断甲状腺癌。     

异位妊娠96例分析

目的总结异位妊娠超声像图表现及特点,提高超声对异位妊娠的诊断符合率。方法分析96例经手术证实的异位妊娠患者经腹或经阴道超声声像图表现,总结声像图特点,并分析误诊原因。结果96例异住妊娠患者输卵管壶腹部妊娠71例,超声诊断符合率为91．5％（65／71）;宫角妊娠12例,超声诊断符合率为83.3％（10／12）;问质部妊娠4例,诊断符合率为75％（3／4）;子宫瘢痕妊娠4例,诊断符合率为100％（4／4）;宫颈妊娠3例,诊断符合率为66．7％（2／3）;宫内外复合妊娠及残角妊娠各1例均误诊。结论超声是异位妊娠的首选检查方法,经阴道超声与腹部超声结合应用,可提高异位妊娠的检测率。     

超声诊断下肢静脉曲张并发血栓性浅静脉炎的分析

目的探讨下肢静脉曲张并发血栓性浅静脉炎的声像图表现。方法使用彩色多普勒超声诊断仪对45例临床有下肢肿胀或局部肿胀伴疼痛、浅静脉隆起及皮肤色素沉着、湿疹的患者进行检查。结果下肢静脉曲张合并血栓性浅静脉炎的患者,血管内径均有增宽,管腔内回声增强或减低,血流呈湍流表现,频谱形态失常以及瓦氏试验可见返流频谱,根据返流时间判定瓣膜功能不全的程度。结论对下肢静脉曲张并发血栓性浅静脉炎有着特有的声像图,其诊断具有重要的临床价值。     

原发性输卵管癌20例临床分析

目的 探讨原发性输卵管癌的临床表现及其诊断。方法 回顾性分析江西省妇幼保健院1991～2002年间手术治疗的20例原发性输卵管癌患者的临床表现、超声检查结果和血清CAl25水平，与手术病理结果进行比较，基本手术方式为全子宫、双附件、部分大网膜切除＋盆腔淋巴结清扫术。结果 患者平均患病年龄为57．45岁，70％发生于绝经后，90％有阴道出血，80％有阴道排液，80％同时有阴道出血和阴道排液。超声检查94．1％（16／17）可探及盆腔肿块，彩色多谱勒血流显像检查92．3％（12／13）可探及丰富血流信号，肿块内平均血流阻力指数（RI）为0．5，范围0．44～O．56。血清CAl25水平测定78．6％（11／14）高于35mlU／ml。结论 原发性输卵管癌主要表现为阴道出血、排液，超声声像图可探及盆腔肿块，肿块内可探及低阻力的丰富血流，血清CAl25可明显增高。上述表现有助于临床原发性输卵管癌的诊断。     

下肢静脉血栓的超声诊断和鉴别诊断

目的探讨彩色多普勒超声在下肢静脉血栓诊断和鉴别诊断中的作用。方法回顾性分析50例下肢肿胀患者的声像图特征。结果下肢静脉血栓38例（76％），其他疾病12例（24％）。结论彩色多普勒超声在诊断和鉴别诊断下肢静脉血栓及其他疾病导致的下肢肿胀有重要临床价值。     

超声引导泡沫硬化治疗静脉曲张术后 复发溃疡的疗效分析

目的 探讨超声引导泡沫硬化（UGFS）治疗下肢静脉曲张术后复发溃疡的临床疗效。方法 选 取2014 年6 月-2015 年12 月河北医科大学第一医院收治的行UGFS 治疗下肢静脉曲张术后复发溃疡的患 者45 例,对患者临床资料进行回顾性分析,观察不同组别患者泡沫硬化剂的用量及溃疡愈合时间的差别。 结果 3 种术式患者术后复发年限比较无差异（P >0.05）。浅静脉+ 交通静脉治疗组泡沫硬化剂平均用量高 于浅静脉组与交通静脉组（P <0.05）,C5 组与C6 组患肢溃疡愈合时间比较有差异（P <0.05）。3 组不同性别 和肢体溃疡愈合时间比较无差异（P >0.05）。体重指数、年龄与溃疡愈合时间呈正相关（P <0.05）。患者术 后并发症血栓性浅静脉炎最常见,发生率为11.1%。有血栓性浅静脉炎患者泡沫硬化剂平均用量高于无血栓 性浅静脉炎患者（P <0.05）。术后12 个月病变血管完全或部分再通率为20.0%（9/45）。结论 UGFS 治疗下 肢静脉曲张术后复发溃疡具有治愈率高、并发症少等特点,是一种简便、精准、有效的诊疗方法。     

Effectiveness of long term oral anticoagulation treatment in preventing venous thrombosis in hereditary protein S deficiency

In eight of 14 patients who were deficient in protein S and who belonged to two unrelated families thrombosis presented as thrombophlebitis in seven and deep vein thrombosis in six, complicated by pulmonary embolism in four and leg ulcers in two. In four patients superficial thrombophlebitis preceded deep vein thrombosis by one to 11 years. Post-thrombotic varicose veins and venous insufficiency had developed in four patients. In three of those and in a fourth patient symptomatic superficial thrombophlebitis, deep vein thrombosis, and pulmonary embolism did not recur while they were taking oral anticoagulant treatment for six to 12 years. The anticoagulation intensity corresponded to international normalised ratio values of over 2.5. It is concluded that the benefits of anticoagulant treatment for patients with congenital thrombotic disease are great, and thus it is necessary to make an early diagnosis and treat patients at risk of developing thrombosis.     

成人尸体阴茎延长长度的测量及其静脉淋巴管的解剖学观察

目的　为阴茎延长术、阴茎断后再植、阴茎包皮环切、血管性阳痿等术后水肿及其治疗提供解剖学依据,并为阴茎延长手术疗效提供实验室数据。方法　在16例正常成人新鲜尸体标本上按照阴茎延长术手术方法切断阴茎浅悬韧带后测量阴茎延长的长度,并将此长度与身高进行统计学比较。另选40例新鲜阴茎标本行静脉血管铸型及淋巴管间接注射Shiff染色并结合解剖方法,观察其数量、走行、分布特点。结果　切断阴茎浅悬韧带后阴茎延长长度在2～3cm范围,与身高无明显相关。注入龟头及包皮系带的10 %印度墨汁主要通过阴茎背侧及双侧形成的2～4条阴茎浅组淋巴管主干回流,此主干与背浅静脉伴行,腹侧未见淋巴管显色。结论　在静止状态下,阴茎延长术后,阴茎的延长范围为2～3cm ;海绵体注射时尽量选择阴茎侧面近1/ 3血管稀疏区。阴茎延长术后皮下顽固水肿与背浅静脉、背侧及双侧淋巴管损伤有密切关系。     

手部静脉的应用解剖学研究

目的 通过对手部静脉进行解剖学研究，为临床断指再植、静脉动脉化及静脉间吻合治疗手部撕脱伤提供依据。方法 在手术显微镜下观察10例手静脉的分布情况及2例手铸型标本静脉的分支分布规律。结果 手掌部的深静脉较细小，浅静脉走行分散，无明显伴行动脉，管径细小，分布规律性差。手背静脉粗大，分布恒定，手部静脉有静脉弓和静脉网两种类型。结论 指背静脉是断指再植中的主要吻合静脉，指掌侧浅静脉也有吻合价值。通过吻合手掌部浅静脉，可提高手掌部皮肤撕脱伤的术后成活率。     

无创血管检查诊断下肢深静脉血栓形成的价值

目的比较多普勒血管检查和彩色多普勒超声（彩超）检查在诊断下肢深静脉血栓形成（DVT）中的价值。方法对146例DVT患者共178侧下肢分别进行深静脉的多普勒血管检查及彩超检查,并以彩超作为诊断标准对结果进行比较。结果彩超对于诊断DVT具有很高的准确性,多普勒血管检查对股、胭静脉病变的阳性诊断率为97．9％（142／145）,对下腔静脉、髂静脉、胫前、胫后和腓静脉以及腓肠肌静脉丛血栓的诊断价值低于彩超检查。结论在诊断DVT时,彩超因具有优于多普勒血管检查的优势,可作为诊断的主要手段,多普勒血管检查可以作为初筛的检查方法。静脉造影不应作为诊断DVT的常规检查方法。     

大隐静脉高位结扎并腔内激光闭合术治疗下肢浅静脉曲张

[摘要] 目的 评价应用大隐静脉高位结扎并腔内激光闭合术治疗下肢浅静脉曲张的临床疗效。方法 对110例（共146条肢体）下肢浅静脉曲张患者采用大隐静脉高位结扎+属支离断并腔内激光闭合术,若合并有静脉石或血栓性浅静脉炎的部位,则手术切除曲张的静脉团;术后随访疗效,包括观察分析术后的近期和远期并发症。结果 随访95例131条肢体,平均随访（10±5）个月;绝大部分患者取得了满意的临床疗效,曲张静脉团块消失,患肢酸胀不适感消失,满意率达96.9%;部分患者在术后一段时间内存在并发症,如患肢肿胀,皮肤灼伤,有压痛的条索或硬结,皮下淋巴感染,皮肤麻木,给予对症处理后症状均得到缓解;1条肢体并发深静脉血栓;另有3条肢体曲张静脉局部复发。结论 大隐静脉高位结扎+属支离断并腔内激光闭合术治疗下肢浅静脉曲张疗效可靠。对合并有静脉石或血栓性浅静脉炎的部位,应手术切除曲张的静脉团;激光治疗规范化操作能有效减少并发症。     

吻合指掌侧浅静脉的断指再植

目的：总结吻合指掌侧浅静脉断指再植的手术方法及临床效果。方法：采取吻合指背静脉 指掌浅静脉、吻合指掌侧浅静脉重建静脉回流；采用指掌侧浅静脉动脉化法解决动脉缺损。结果：临床应用52例64指，其中重建静脉回流48例60指，静脉动脉化4例4指，成活62指，成活率96．9％。结论：吻合指掌侧浅静脉可作为吻合指背静脉的补充，又可完全替代指背静脉，是重建再植指静脉回流的有效手段；指掌侧浅静脉动脉化法可解决动脉缺损问题。     

大脑浅静脉吻合静脉的显微解剖及临床应用

目的探讨大脑浅静脉吻合静脉的显微解剖及其临床应用。方法15具（30侧）经血管内灌注染料的成人尸头经开颅取出整个大脑,在手术显微镜下观察测量大脑浅静脉吻合静脉形态。结果Trolard静脉和Labbe静脉是大脑浅静脉的主要吻合静脉,它们都与大脑中浅静脉相联系。但并不是所有的大脑半球吻合静脉都发达。Trolard静脉左侧半球缺如4例,右侧半球缺如9例。Labbe静脉左侧半球缺如4例,右侧半球缺如3例。结论在神经外科手术中,熟练掌握吻合静脉的显微解剖对判断术中静脉损伤所引起的术后并发症非常重要,静脉能保留的应尽可能保留。     

Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism--case report and review of the literature

Since its introduction laparoscopic surgery has been used for many indications, e.g., cholecystolithiasis, hernia, appendicitis, fundoplication, benign large bowel disease and gynaecological disorders. It has been considered as safe and efficient procedure for most patients with only few contraindications, mostly heart-lung disease. When the initial enthusiasm has been replaced by a more critical observation, more complications of laparoscopy or laparoscopic surgery were not only discovered but also reported. In laparoscopic hernia repair there is a tendency for severe complications when compared to open surgery. There is a controversy on possible side-effects of laparoscopic surgery, e.g., thrombosis, and the increased necessity of prophylaxis for thromboembolic events. Recently a growing number of reports on thromboembolic complications in association with laparoscopic surgery were published. Thrombosis may be caused by detrimental effects of pneumoperitoneum on venous flow (increased abdominal pressure and negative Trendelenburg position) and activation of the haemostatic system. Further risk factors may contribute to the risk to develop venous thrombosis. It is well accepted that varicose veins are associated with an increased risk for the thrombosis. However, the association of varicose veins with complications of laparoscopic surgery is unclear. The possible impact of thrombotic complications makes an analysis of the association of varicose veins or a history of deep vein thrombosis on the development of thrombosis after laparoscopic surgery mandatory. Although this is the first report on ascending thrombophlebitis and thrombosis of the sapheno-femoral junction after laparoscopic surgery, the incidence of deep vein thrombosis or superficial thrombophlebitis after laparoscopic surgery or laparoscopy may be much higher according to the pathophysiological changes during and after these procedures. In many patients venous thrombosis may not be recognized or it appears when the patient is already discharged. CONCLUSION: Laparoscopy and laparoscopic procedures may have an increased risk for the development of thrombosis due to increased abdominal pressure and negative Trendelenburg position. Patients with varicose veins and a history of thromboembolism may aggravate laparoscopy associated risks for the development of thromboembolic complications. Superficial thrombophlebitis in the thigh is not a benign disease entity and may lead to deep vein thrombosis (DVT) and pulmonary embolism (PE). Urgent surgical treatment (high ligation) may be warranted together with low-molecular weight heparin (LMWH) and compressions therapy. Patients with varicose veins and a history of venous thrombosis may not be suitable candidates for laparoscopic surgery. Family practitioners may be confronted with this complication more often since patients are discharged earlier from hospital after laparoscopic interventions due to legislative regulations.     

Dorsal penile nerves and primary premature ejaculation

Background Based on our clinical experience, the number of dorsal penile nerves in patients with primary premature ejaculation （PPE） is not consistent with the average number （2 branches）. In this study, we evaluated the number and distribution of dorsal penile nerves among healthy Chinese adults and patients with PPE. Methods The dorsal nerve of the penis, the deep dorsal vein of the penis, and the dorsal artery of the penis between the deep fascia of the penis and the albuginea penis were carefully educed, observed, and counted in 38 adult autopsy specimens. The number and distribution of the dorsal penile nerve in 128 surgical patients with PPE were determined. Results The numbers of dorsal penile nerves of the 38 cases were as follows： 7 branches in 1 case; 6 branches in 1 case; 5 branches in 6 cases; 4 branches in 9 cases; 3 branches in 14 cases; and 2 branches in 7 cases. Most of the dorsal nerves were parallel to each other and in the dorsum of the penis. In only 8 cases, the branches were connected by some communicating branches. In 4 cases, 1 or 2 thin dorsal nerves continued their pathway over the ventral aspect of the penis. The average number of branches of the dorsal penile nerve in patients with PPE was 7.16. Conclusions Based on the study of 38 cases, the average number of dorsal penile nerves was 3.55 branches and that of patients with PPE was greater. These preliminary results suggest that the excessive dorsal penile nerves may have an impact on PPE via increased sensitivity and provide topographic data for the possible treatment of PPE.