小儿肱骨髁上骨折伴迟发性肱动脉血栓形成1例

<正>肱骨髁上骨折约占儿童骨折的12%,约3%～12%合并血管损伤,特别是肱动脉损伤。急性肱动脉血栓形成已屡见不鲜~([1]),但迟发性动脉血栓形成鲜有报道,本院诊治1例肱骨髁上骨折患儿,采用闭合复位克氏针固定术治疗~([2]),术后7 d出现肱动脉血栓形成,报道如下。     

经导管髂内动脉栓塞术治疗腰椎后路手术延迟性髂血管分支破裂1例报道

正腰椎后路手术引起的椎体前方腹膜后动脉血管损伤十分罕见,致死率高,即使是早期发现,如果没有足够的经验和及时有效的处理措施,也是非常凶险的并发症。我院近期成功救治了1例腰椎后路减压融合术并发髂内动脉分支损伤的患者,现总结报道如下。     

机器人辅助腹腔镜宫颈癌根治术后并发左髂外动脉假性动脉瘤1例报告

正近年来,能量器械在使用过程中带来的损伤甚至因此导致死亡的病例并未引起足够重视,据美国FDA统计,1994～2013年手术患者中由于能量器械使用造成的损伤多达3553例,致死178例~([1])。假性动脉瘤多见于血管损伤后期,瘤壁为纤维性组织,并不包含正常血管壁的3层组织(内膜、中膜及外膜)~([2])。髂外动脉等深部动脉的假性血管瘤多由医源性原因造成。我院2018年7月收治1例机器     

腰椎融合术后邻近节段退变的研究

正腰椎退行性疾病是引起腰痛和下肢神经症状的主要原因,对于保守治疗无效者,腰椎融合已经成为重要的手术治疗方案~([1-3])。但随着腰椎融合术的广泛应用,术后邻近节段退变(Adjacent segment degeneration,ASD)引起了学者们的关注~([4])。近期相关文献报道~([5]),在腰椎融合术后5年的影像学ASD发生率为36%～84%,症状学ASD发生率为5.2%～16. 5%,部分患者需二次手术治疗~([6])。故怎样降低和避免ASD的发生,成为临床医师及学者们亟待解决的问题。     

腹股沟疝修补术中动脉损伤

修补腹股沟疝的 Bassini,Halsted 式手术中,缝线穿过腹股沟韧带时,恰好途径髂外动脉及其分支的表面;McVay 术式的缝线穿过耻骨梳韧带及浅层的腹横筋膜、股鞘时,都接近大血管,因此在疝修补手术过程中损伤大血管是有可能的。作者总结了24例疝手术中动脉损伤的经验。在讨论中作者指出,病人年龄范围为1.5～79岁,但约半数病例年龄在30～50岁。有2例患者的动脉病变对促成动脉损伤有关,其中1例为动脉瘤,另1例为广泛动脉硬化。     

强直性脊柱炎合并骨折的特点及手术治疗研究进展

<正>强直性脊柱炎(AS)是一种累及人体中轴骨的慢性炎症性疾病,常由于骶髂关节炎、肌腱炎、脊柱附着点炎症及韧带骨化等原因导致背部疼痛~([1]),常伴有严重的骨质疏松,早期即可发现~([2]),晚期伴有严重的后凸畸形,常表现为颈椎、腰椎前凸减小甚至变为后凸及胸腰段后凸~([3])。AS患者多存在脊柱骨性强直、椎体骨质疏松及脆性增加,因此,无外力或轻微的外力作用即可发生脊柱骨折,且容易并发严重的脊髓损伤~([4]);病史较长的患者,常形成僵     

腰椎后路椎间盘摘除术并发腹侧大血管损伤1例报道

腹部血管损伤是后路椎间盘摘除手术的一个严重并发症,最早在1945年由Linton和White报道[1]。其发生率较低,有报道为0.016%[2],一旦出现会导致大失血、循环衰竭而威及生命,死亡率高达50%[3],因此尽早诊断和治疗十分关键。我院2000年11月～2010年10月收治的1200余例腰椎后路椎间盘摘除手术患者中有1例出现腹部大血管损伤,报告如下。     

支架取栓术治疗大脑中动脉M2段闭塞的临床效果

正对急性脑梗死患者,早期开通血管与预后密切相关~([1])。超早期使用重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)进行溶栓是目前急性脑梗死最有效的治疗方法之一,但闭塞大血管再通率仅为13%～18%~([2])。2015年美国心脏协会(American Heart Association,AHA)/美国卒中协会(American Stroke Association,ASA)发布的《急性缺血性卒中治疗指南》~([3])推荐,对发病6h内的颈内动脉或近端大脑中动脉闭塞患者可行血管内支     

骨盆前环后环骨折与骨盆动脉损伤的相关性研究

目的探讨骨盆骨折X线表现与骨盆动脉损伤的关系及诊断、治疗方法。方法自1999年1月~2003年10月,收治55例骨盆骨折合并血管损伤,入院时均处于休克状态,收缩压小于90mmHg,脉率大于120次/min。输血量400~10800ml,平均2886ml。入院后常规摄骨盆后前位、出口位及入口位X线片,经输血和抗休克治疗后,血压不升或升后又下降,排除其他部位出血后即行髂动脉造影,并行动脉栓塞。患者ISS评分平均39±16。根据X线表现分为后环骨折21例,前环骨折12例,髋臼骨折6例,混合骨折16例。结果55例髂内动脉造影患者,50例为髂内动脉及其分支损伤出血,行血管栓塞,4例髂外动脉损伤,3例血栓形成,1例破裂;1例髂总动脉血栓形成。3例死亡,成功率94.55%。损伤最多的血管是臀上动脉(32.56%),其次是骶外侧动脉及髂腰动脉。后环骨盆骨折损伤血管64支,主要臀上动脉、骶外侧动脉及髂腰动脉,前环骨折损伤血管17支,主要为闭孔动脉。混合骨折平均输血3876ml±1068ml。结论根据骨盆骨折X线表现可预测血管损伤类型,后环骨折容易引起臀上动脉、骶外侧动脉及髂腰动脉损伤,前环骨折易损伤闭孔动脉,其中最易损伤的是臀上动脉。髂内动脉造影及动脉栓塞是较好的诊断及治疗方法。     

孤立性髂动脉瘤的临床诊治现状

1一般概述髂动脉扩张性病变直径至少较正常动脉扩大50%即可谓髂动脉瘤,髂总动脉扩张性病变直径大于1.5cm即可称髂总动脉瘤[1]。临床上所见的髂动脉瘤大多数是延续于腹主动脉瘤,位于髂动脉部位包括髂总、髂外和髂内动脉的动脉瘤,而不伴有腹主动脉瘤,称为孤立性髂动脉瘤(isolated iliac artery aneurysm,IIAA),临床罕见。IIAA的发病率为0.1%～1.9%[2]。根据尸检报告,IIAA患病率是0.008%～0.03%[3,4]。有报道IIAA     

Treatment of a case of primary osteosarcoma of the left heart: a case report

Intracavitary sarcoma of the heart is rare. We report a case of primary osteosarcoma of the left atrium and ventricle that was managed with surgical resection and chemotherapy, attaining more than 1-year survival.     

Hepatic endometrioma: a case report and review of the literature: report of a case

Hepatic endometriosis has an extremely rare occurrence characterized by the presence of ectopic endometrium in the liver. A diagnosis of hepatic endometriosis is established after surgery. A 51-year-old multiparous female was referred to our unit for investigation of a liver tumor. The patient reported a 6-month history of epigastric pain and vomiting. She had undergone conservative hysterectomy for uterine leiomyomas several years earlier. The results of liver function tests and the levels of tumor markers (CA 19.9, CEA, CA125, αFP) were normal. Radiological imaging (USS, CT and MRI) suggested the presence of liver cystadenoma, liver cystadenocarcinoma or cystic metastasis of the liver in the left liver lobe extending to the diaphragm with left hepatic vein compression. Laparotomy was performed. The intraoperative frozen sections suggested a diagnosis of endometriosis. Anatomical resection was performed, including left lobectomy with diaphragm resection. The final histology confirmed the presence of hepatic endometrioma without malignant transformation. Fourteen cases of hepatic endometrioma have been described in the medical literature. We herein report the 15th case. Making a preoperative diagnosis of hepatic endometriosis is very difficult, despite conducting a complete investigation, in the absence of clinical and radiological characteristics. The diagnosis is made according to a histological examination of the whole surgical sample.     

Epidermoid of the third ventricle--report of a case

A rare case of epidermoid of the third ventricle was experienced. The patient was a fifteen years old boy, who had been hospitalized four years earlier due to acute hydrocephalus. The ventriculography at that time revealed a large cystic tumor containing heterogeneous mass filling the entire third ventricle, which seemed to be a dermoid or epidermoid. Ventricular drainage and ventriculo-peritoneal shunt were performed and he was discharged one month later without any complaint. On February 10th 1983, he was re-admitted with severe headache, nausea and showing markedly increased intracranial pressure and right hemianopsia. Computerized tomography scans demonstrated a large round low density mass in the entire third ventricle extending into the prepontine cistern. Radical operation was performed by the anterior transcallosal approach. After dissecting the interhemispheric fissure, a longitudinal incision about 15 mm long was made in the anterior part of the corpus callosum and the tumor was removed. Mild diabetes insipidus and subdural effusion appeared postoperatively. The patient was discharged on April 7th with right hemianopsia and returned to school. The anterior transcallosal approach seemed to be a good operative procedure in such large third ventricle tumor cases since it allowed excellent exposure of the third ventricle and minimized postoperative neurological deficits.     

Microscopic carcinoma of the breast--report of a case

Microscopic cancer is extremely rare even among "occult breast cancers". We treated a 70 year old woman with complaints of serosanguineous nipple discharge which yielded cytologically Class V cancer cells. Microdochectomy was performed and intraductal carcinoma was verified histologically in serially cut sections. Following a simple mastectomy, she has been well with no evidence of recurrence or metastasis, at this time.