Clinical efficacy of alprostan in combination with "Bioptron-II" rays and iruxol-miramistin in the treatment of the diabetic foot complicated by atherosclerosis]

Experience of clinical treatment of 9 patients with diabetes mellitus and diabetic angiopathy using alprostan in combination with rays "Bioptron-II" and iruxol-miramistinum in conditions of polyclinic was summarized. Antidiabetic preparations, mainly insulin, were administered to all patients together with abovementioned treatment. Optimal scheme of treatment constitutes daily slow (no less than 6 h) dropper intravenous infusion of alprostan in 0.1 mg dosage in 150-200 ml isotonic solution of sodium chloride during 15 days. Before and after infusion of alprostan ulcer was locally irradiated using "Bioptron-II" lamp from 5 cm distance during 6 min, bandage with iruxol-miramistinum ointment was applied in ratio 1:1. In 6 patients pain in lower extremities disappeared, ulcers epithelized, in 3--ulcers reduced by 50%.     

The volume and consistency of surgical intervention for the affected several extracranial vessels

The results of the cerebral hemodynamics investigation and of operative treatment of 94 patients with affection of several extracranial vessels were presented. It was established that along with the total arterial lumen narrowing stage increase the pronounced cerebral tissue hypoperfusion occurs. Therefore the reconstruction of several arteries is necessary. In patients with low cerebral perfusional reserve it is expedient to proceed with revascularization in stages.     

Surgeries on major vessels in removal of different tumors

Experience in diagnosis and surgical treatment of 49 patients with tumors of different localization close to their major with main vessels is analyzed. Two variants of tumor - vessel interrelation were seen, patients with iatrogenic vascular lesions were included into a separate group. In 9 patients (group 1) only extravasal compression by the tumor was seen. Most of these tumors were benign. In 15 patients (group 2) reconstructive vascular surgeries were performed because of close interrelation with the tumor or tumor spread into the vessel. Most of these tumors were malignant. Iatrogenic lesions of arteries during surgeries were in 25 patients (group 3). It is demonstrated that duplex sonography permits to diagnose affection of vessels by tumors without invasive procedures. All the patients underwent vascular reconstruction simultaneously with tumor removing. Sceletization of vessels with their decompression was the surgery of choice in benign tumors. In malignant tumors it is recommended to remove the tumor with affected segment of vessel and repair of blood flow. Ligation of vessel may be justified in some cases.     

联合血管切除重建的胰十二指肠切除术疗效分析

目的 探讨联合血管切除重建的胰十二指肠切除术的临床疗效.方法 回顾性分析2007年1月至2011年5月第三军医大学西南医院收治的56例术前诊断为胰腺肿瘤行联合血管切除重建的胰十二指肠切除术患者的临床资料,统计患者围手术期并发症发生率、病死率及术后生存情况.结果 本组患者平均手术时间为473 min(234～853 min),术中平均输血量为781 ml(0～900 ml),其中7例患者未输血;中位住院时间为25.9 d(17～100 d);43例患者进行了人工血管重建.56例患者围手术期并发症发生率为34％ (19/56),病死率为7％(4/56).术后病理诊断:胰头导管腺癌42例,壶腹部癌5例,胆管下端癌3例,十二指肠乳头癌4例,胰头神经内分泌癌1例,胰腺浆液性囊腺瘤1例.随访截至2011年8月,患者1年生存率为57％(32/56),平均生存时间为13.5个月.32例生存患者体质量均不同程度增加,无腹痛.术后3个月内5例患者有轻度腹泻,需要服用止泻药;1例患者术后1个月发现人造血管内血栓形成、中等量腹腔积液,半年后侧支循环形成,腹腔积液消失.结论 对于伴有血管侵犯的胰腺肿瘤患者,应积极行联合血管切除重建的胰十二指肠切除术,能改善胰腺癌晚期患者的生命质量.     

累及重要血管的腹膜后肿瘤切除术

目的总结合并重要血管切除重建的腹膜后肿瘤切除经验。方法对16例累及重要血管的腹膜后肿瘤患者均采用合并重要血管切除重建的肿瘤切除术。血管重建方式：人工血管移植16例次，下腔静脉部分切除及修补3例次；其中动静脉联合重建6例次，合并其它脏器切除重建5例次。结果无手术死亡。随访14例，随访期3~71个月，平均30个月。随访期间死亡5例，其中12个月内死亡3例， 64个月内死亡1例，71个月死亡1例；随访期无血管阻塞。结论合并重要血管切除重建的腹膜后肿瘤切除术对累及重要血管的腹膜后肿瘤是安全有效的。     

小血管吻合术后发生血管危象原因的分析及防治

为探讨小血管吻合术后发生血管危象的原因、诊断及防治，分析１９８５年８月～１９９７年１２月３１４例小血管吻合术后发生血管危象的病例，其中发生组织坏死及部分坏死１５２例，占４８．４％。发生危象后保守治疗１４４例，坏死１０４例；手术探查１７０例，坏死４８例。随访８６例，随访时间为６周～７年。结果发现，发生危象后又建立正常血循环者，术后组织恢复与未发生危象者无明显差别；而发生危象后血循环不佳，靠建立侧支血循环成活者，术后多出现伤口愈合不良，肿胀时间长，组织有不同程度萎缩及感觉恢复较差等。认为，血管吻合技术及术后防血管痉挛处理，对预防小血管术后发生血管危象十分重要；保守治疗效果不佳时应及时行手术探查     

Chronic arterial insufficiency of lower extremities and pelvis: the ways of its treatment optimization

Results of application of preparation alprostan in 30 patients with chronic arterial insufficiency of lower extremities of III-IV stages were presented. Changes of regional blood flow and microcirculation of lower extremities under the influence of alprostan were studied. Positive result of treatment was achieved in more then 73% of patients.     

Causes of unsatisfactory outcome in patients with diabetes mellitus complicated by necrotic inflammation of the foot]

Retrospective analysis of the conservative and surgical treatment results of 222 patients with diabetes mellitus, complicated by necrotic-inflammatory affection of foot, was performed for the 1991-1996 period. In 25.2% of observations the extremity amputation was done on the hip level, 13 (5.8%) of patients died. The unsatisfactory result causes were the reoperation performance on foot in a critical ischemia zone, the decrease of the first operation volume, nonadequate correction of metabolic, haemorheologic disturbances, antibacterial therapy.     

Surgical treatment of patients with critical lower limb ischemia due to affection of arteries of the femoral-popliteal-tibial segment

Experience of surgical treatment of 325 patients with critical lower limb ischemia due to affection of infrainguinal vessels are analyzed. Comparative analysis of efficacy of direct, indirect and combined revascularizations was carried out, quality of life of patients in long-term period after surgery was evaluated.     

Crural or pedal artery revascularisation for limb salvage: is it justified?

With the ageing of population, the incidence of limb-threatening ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and infragenicular vessels. Fortunately, recent advances in vascular surgery made arterial reconstruction of crural and pedal vessels possible. Should crural or pedal bypass surgery be offered to these frail, polyvascular patients, or is primary amputation a preferable treatment option in case of advanced limb-threatening ischemia? In order to answer this controversial question, the author analysed recent literature data on the feasibility and durability of infrapopliteal bypasses. The quality of life was also considered as an outcome measure. Finally, the cost-effectiveness of both treatment modalities (limb-saving distal bypass versus primary amputation) was assessed.     

股部血管损伤伴软组织严重挫伤的治疗

目的 总结近年我院对12例股部血管损伤合并软组织严重挫伤保肢与截肢的指征、手术主合并症的治疗。方法 采用血管重建、坏死组织清除、骨折的处理、术后积极治疗代谢性肌肾综合征及小腿骨间膜室综合征等综合治疗方法。结果 除1例死亡,截肢2例,1例小腿肌力下降外,其余均恢复正常。结论 通过血管重建及积极处理合并症可保留肢体,恢复功能。     

侵及重要血管的原发性腹膜后肿瘤的手术治疗

目的:探讨侵及重要血管的原发性腹膜后肿瘤的外科治疗方法。方法:对48例患者行肿瘤完全切除28例,不完全切除20例。行血管重建30例,未行血管重建18例。结果:本组48例中40例获随访6～90个月,主要血管重建与未重建患者的1、3、5年生存率分别为91.67%、66.67%、41.67%和68.75%、25.00%、6.25%。结论:侵及重要血管的腹膜后肿瘤已不是手术禁忌,用不同方法处理受累血管,争取彻底切除肿瘤,是减少术后复发、提高长期存活率的有效方法。     

高压电烧伤合并肢体血管损伤治疗10年回顾性分析

背景与目的 高压电烧伤虽然发生率很低，但是潜在的肌肉、神经和血管受损比火焰灼伤更加隐匿，危及肢体的缺血和迟发破裂出血会导致肢体功能丧失、致残甚至致死。高压电烧伤后的肢体血管损伤尚无明确的发生率，也没有诊疗指南的推荐，各个中心的治疗方案也不尽相同。北京积水潭医院作为全国烧伤抢救中心，每年要收治大量的烧伤患者，其中高压电烧伤合并血管损伤的患者屡见不鲜。本文总结了近10年来北京积水潭医院收治的高压电烧伤合并血管损伤的患者诊治方案，试图从中分析出此类患者与创伤性动脉损伤患者的差异，归纳出此类患者的诊疗特点，为今后的临床工作提供有力的证据支持。方法 回顾本中心2010年1月—2020年1月收治的由于高压电烧伤导致肢体血管损伤的患者94例，患者的血管修复方式包括直接局部修补、自体血管重建和人工血管重建。分析术后血管血栓形成、迟发破裂出血、感染、截肢等术后并发症的发生比例，对比数据间的差异。结果 94例患者中，男83例，女11例；平均年龄（30.4±20.1）岁。7例来院时肢体毁损严重，行截肢术。87例完成血管修复，29例行局部修补术，53例采用自体血管重建，5例采用人工血管材料重建，技术成功率100%。局部修补患者术后2周内血栓形成3例，假性动脉瘤2例，均再次手术行自体血管重建。自体血管重建患者中，术后2周内血栓形成7例，切开取栓后血运改善，发生迟发破裂出血4例，切开止血再次重建1例，腔内介入置入覆膜支架3例，术后感染或软组织严重坏死截肢3例。人工血管材料重建患者中，术后2周内血栓形成1例，切开取栓后恢复血运，发生迟发破裂大出血1例，腔内介入置入覆膜支架。75例患者获随访3~6个月，血管通畅率89.3%（67/75）。结论 高压电烧伤后的血管损伤远超肉眼可见的损伤范围，不同于一般创伤导致的相关损伤；血管重建前应充分评估损伤血管及周围组织条件，在充分清创的前提下自体血管和人工血管均可成为良好的重建材料；高压电烧伤导致的血管损伤会随时间推移而进展，应该警惕血栓形成和迟发破裂出血，一旦发生迟发破裂需再次切开止血重建或腔内介入治疗，这样才能保全患肢。     

Kidney clamp,perfuse, re‐implant: a useful technique for graft salvage after vascular complications during kidney transplantation

Although intra‐operative vascular complications during renal transplantation are rare, injuries associated with prolonged ischemia may lead to graft threatening early and late complications. This series describes a novel technique for intra‐operative repair of vascular complications in five patients over a three‐yr period. The method consists of rapid graft nephrectomy and re‐preservation of the graft with cold University of Wisconsin solution, which allows for controlled/precise back table repair of the vascular injury without incurring prolonged warm ischemia time. In three cases, the donor renal vein (2) and donor renal artery (1) were damaged and required back table reconstruction. In two cases, the recipient iliac artery needed reconstruction. Three of the five cases used deceased donor iliac vessels from another donor for reconstruction. Two patients required postoperative dialysis for delayed graft function for three to nine d (average six d) and two patients had slow graft function. All grafts were functioning at 17 months (mean) after transplant, with a median serum of 1.61 mg/dL (0.74–3.69). This series demonstrates the effectiveness of kidney clamp, perfuse, resuscitate as an effective intra‐operative technique to salvage grafts after vascular injury. Although the grafts may suffer from delayed or slow graft function, excellent long‐term function is attainable.     

下肢慢性缺血合并急性血栓形成的外科治疗

目的 探讨治疗下肢慢性缺血合并急性血栓形成的最佳外科治疗手段.方法 回顾性分析2000年1月～2010年10月我科收治的26例下肢慢性缺血合并急性血栓形成患者的临床资料,比较单纯采用股动脉切开导管取栓术组(10例)与股-腘动脉切开取栓联合动脉重建手术组(16例)的疗效.结果随访时间1～114个月,单纯股动脉切开术组中的...     

Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer

BACKGROUND: The purpose of this study was to determine the feasibility and efficacy of hyperfractionated accelerated radiotherapy (HFRCB) combined with simultaneous chemotherapy with weekly cisplatin (CDDP) in locally advanced inoperable head and neck cancer. METHODS: From August 1999 to December 2002, 37 patients (median age, 59 years) with Union Internationale Contre le Cancer stage III (n = 2) and stage IV (n = 35) squamous cell cancer of the oropharynx and hypopharynx were treated in a prospective phase I/II trial. Concomitant boost radiotherapy (1.8 Gy, days 1-38 and 1.5 Gy boost, days 22-38, twice daily with at least a 6-hour interval; total dose 69.9 Gy) and simultaneous cisplatin, 40 mg/m2 weekly, were given. RESULTS: The median treatment duration was 42 days (range, 38-46 days). Toxicity was manageable, with neutropenia grade III/IV and thrombocytopenia grade IV in seven and one patients, and mucositis grade III/ IV in 27 and five patients, respectively. Chemotherapy was restricted to four weekly applications in 29 patients mainly because of mucosal toxicity with a median dose intensity of 160 mg/m2 (0-200) of cisplatin in 5.5 weeks. With a median follow-up of 28 months for living patients, the 2-year overall survival rate was 67%. The median overall and relapse-free survival times were 36 and 31 months, respectively. CONCLUSION: HFRCB in combination with weekly cisplatin achieves a high rate of locoregional control and survival. Four weekly cycles of 40 mg/m2 cisplatin seem to be the dose limit for most patients.     

The effectiveness of G. A. Ilizarov's method in treating patients with III- and IV-stage chronic ischemia of the lower extremities

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.     

Regional vasotropic and hepatotropic therapy in the complex treatment of postoperative purulent peritonitis

In 8 patients, operated for postoperative spreaded purulent peritonitis, umbilical vein was catheterized, postoperatively angiographic investigation was performed, leaving catheter in tr. coeliacus or a. mesenterica superior, through which regionary hemodilution, using drop infusion of 20 mcg of alprostan during 3-4 days. Additionally, to all the patients intraportal hemodilution with hepatoprotector thiotriazoline infusion was performed. Application of the treatment measures complex proposed had assisted an early restoration of splanchnic microcirculation, significant lowering of endogenic intoxication severity, rapid restoration of hepatic functional activity, reduction of systemic inflammatory answer expression.     

血流重建术及动脉结扎术治疗慢性感染性股部动脉假性动脉瘤的疗效比较

目的探讨毒品注射所致的慢性感染性股部动脉假性动脉瘤（CIFA）的合理外科治疗方法。方法对我院血管外科2007年7月至2010年6月收治的44例CIFA患者按住院号单双号分组,单号为第一组（20例）行主干动脉血流重建术,双号为第二组（24例）行主干动脉结扎术。结果第一组14例（70％）术后无任何并发症。6例（30％）术后出现严重感染．取出移植物后行二期血流重建术;第二组20例（83．3％）术后无任何并发症,4例（16．7％）出现间歇性跛行因而行二期血流重建术。所有患者行一期或二期手术后均康复出院,无一例患者行截肢术。两组最终手术成功率差异无统计学意义（P〉0．05）,但第二组一期手术成功率显著高于第一组（P〈0．05）,第二组出现严重并发症并行二期血流重建的病例显著低于第一组（P〈0．05）。随访5个月至3年,所有患者均未出现间歇性跛行等缺血性症状及患肢缺血性坏死等严重并发症。结论主干动脉结扎术是CIFA的合理手术方式,必要时可行二期血流重建术。