用犬三种股静脉移植方法修复股动脉对比研究

目的 比较三组移植方法的效果,旨在推广应用于临床。方法 分三组,Ａ组１０只犬,２０根股血管,１０根肱血管,股（肱）静脉外套螺纹人造血管;Ｂ组１０只犬,２０根股血管,股静脉外套平滑人造血管,Ｃ组１０只犬,２０根股血管,股静没有外套人造血管。结果 术后１８０ｄ进行检查。血管造影,Ａ组２８根血管通畅,Ｂ组２０根血管通畅,Ｃ组６根血管明显狭窄,其余未见血管显影。光学显微镜检查,Ｂ组管壁增殖增厚最少,其次是     

小口径生物血管材料静脉移植实验研究

静脉系统血管移植后易形成血栓，导致移植血管栓塞．目前是临床上尚未解决的难题之一。本研究采用小口径生物血管材料——经新型环氧固定剂处理的猪主动脉血管行犬下腔静脉血管移植，着重观察其通畅性，并进行病理学检查。     

犬三种股静脉移植后微细结构改变的对比研究

目的 探讨三种股静脉移植修复动脉后的增殖微细结构改变，为临床应用研究打下基础。方法 对3组实验犬的3种股静脉移植修复动脉进行光镜和透射电镜下观察血管内膜、中膜、外膜的增殖情况。结果 股静脉外套人造血管后的内、中、外膜增殖多于股静脉外套改进人造血管组；用股静脉修复股动脉缺损组内膜、中层和外膜增殖最重，有的导致血管栓塞。结论 股静脉外套改进人造血管后的股静脉内膜、中层的外膜增殖最少，是中、小动脉缺损修复的可行方法。     

用犬股静脉移植修复股动脉缺损后动态增殖研究

目的以杂种家犬为实验对象，用手术的方法建立股静脉替代股动脉的实验模型，探讨股静脉移植修复动脉缺损后的微细结构增殖性改变及其随时问改变的变化程度，找寻静脉替代动脉后的增殖规律。方法股静脉倒置移植修复动脉缺损，术后30～180d分6个时间段行血管造影观察通畅率并分别切取移植静脉，肉眼和光镜观察自体静脉移植后的内膜、中膜增殖情况。结果血管造影显示移植静脉管腔变细，管壁增厚，都有不同程度的僵硬变厚，弹性减低，光镜下管腔面内皮细胞层随时间延长由扁平状逐渐变为柱状，中膜平滑肌层数增多。结论自体静脉移植人动脉环境后时间越长，移植血管管壁就越厚，管腔就越狭窄，闭塞的几率增加。术后60d为移植静脉管壁增殖的开始时期。     

手背静脉的应用解剖

有关手背静脉的研究较少，我们用成人上肢标本９０侧，在手术显微镜下对内径大于０．３ｍｍ的手背静脉进行了细致的解剖学观测。     

足趾移植血管解剖的变异及其处理方法探讨

自１９６６年杨东岳等首创第２足趾移植再造拇指获得成功以来，已广泛应用于各种拇、手指缺损的再造，但足背动脉缺如及第１跖背动脉的解剖变异仍是导致手术停止或失败的重要因素，因此对以上动脉缺如或解剖变异的处理进行了深入细致的研究，找到了一些行之有效的处理方法...     

股前外侧并联穿支皮瓣的应用解剖与血管造影研究

目的 通过尸体解剖及CT血管造影,为股前外侧并联穿支皮瓣的设计与临床应用提供解剖学基础.方法 ①应用解剖:2具防腐尸体解剖旋股外侧血管分支及穿支,测量并记录穿支部位.②CT血管造影:对20例患者进行了64排螺旋CT血管造影检查,测量穿支数量、分出点位置、管径、走行、类型、起源、长度、皮肤穿出点位置、相邻穿支分出点间距、相邻穿支穿出点间距.结果 ①尸体应用解剖:2具标本(4侧)共解剖出9根皮肤穿支.其中,7根起源于旋股外侧动脉降支;2根肌间隙穿支,7根肌肉穿支;9根穿支平均管径(0.65±0.19)mm;平均血管蒂长(16.59±5.98)cm;平均相邻穿支间距离(5.66±1.73)cm.②CT血管造影:20例患者(40侧)检出100根穿支,平均每侧(2.50±1.06)根穿支;98根穿支起源旋股外侧动脉降支;36根为肌间隙穿支,64根为肌肉穿支;平均穿支直径为(0.65±0.32)mm;平均穿支长度为(42.52±19.35)mm;平均相邻穿支分出点距离(43.66±28.44)mm;平均相邻穿支穿出点距离(49.52±25.01)mm.结论 通过尸体应用解剖及CT血管造影对旋股外侧动脉穿支血管的测量,为股前外侧并联穿支皮瓣的设计与临床应用提供了解剖学基础.     

股／腘静脉损伤的手术治疗

目的探讨股／腘静脉损伤的手术治疗方法。方法1998年4月至2007年5月治疗股／胭静脉损伤26例。单纯静脉伤12例，合并股／腘动脉损伤14例，分别采用血管修补术、血管补片修复、端端吻合术、大隐静脉移植及“并管法”大隐静脉移植修复动、静脉。结果23例肢体术后血运恢复。合并股／腘动脉损伤14例中，1例并发肾功能衰竭，3例肢体坏死截肢，4例肢体肌肉部分坏死清创后残留部分功能障碍，单纯股／胭静脉损伤者血管修复后肢体无显著肿胀，血运良好。随访3个月～7年，23例肢体血运良好。结论股／腘静脉损伤修复有助肢体恢复正常血供，优先处理合并动脉损伤，“并管法”大隐静脉移植修复股／腘静脉损伤有一定临床使用价值。     

不同年龄患儿不同体位时股动脉与股静脉的解剖关系

目的 研究不同年龄患儿不同体位时股动脉与股静脉的解剖关系.方法 选取疝气修补术患儿,年龄4个月～7岁,ASA分级Ⅰ或Ⅱ级,按年龄分为婴儿组(≤1岁)、幼儿组(＞1岁,≤3岁)和学龄前儿童组(＞3岁,≤7岁).取下肢伸直位和外展位,在腹股沟韧带处以及其下方2 cm和4 cm处扫描并采集超声图像,测量股动脉与股静脉夹角、股静脉未重叠宽度和股静脉深度.结果 共有65例患儿完成本研究,婴儿组14例,幼儿组22例,学龄前儿童组29组.在腹股沟韧带处91%的患儿股静脉均位于股动脉内侧后方,到腹股沟韧带下方4 cm处,股静脉均位于股动脉的后外侧方.3组下肢外展位时股静脉深度较伸直时减浅,学龄前儿童组下肢外展位时股静脉未重叠宽度增加(P＜0.05);从腹股沟韧带至其下方4 cm处股静脉深度逐渐增加,股静脉未重叠宽度逐步减小,股动脉与股静脉夹角均逐渐增大(P＜0.05),3组各测定指标比较差异无统计学意义(P＞0.05).结论 腹股沟韧带至其下方4 cm处患儿股动脉与股静脉的解剖关系均为股静脉由股动脉内侧后方旋至外侧后方;下肢外展位时可减浅股静脉深度,在学龄前患儿中亦可增加股静脉未重叠宽度,提示患儿尤其是学龄前患儿股静脉穿刺时宜选择外展位.     

背静脉复合体的应用解剖学研究

目的探讨背静脉复合体(dorsal vein complex,DVC)的解剖学形态、分支、走行、回流途径及周围组织关系,以指导膀胱癌、前列腺癌根治性切除手术中对 DVC 的准确处理.方法解剖6具男性成年尸体盆腔标本,记录 DVC、耻骨前列腺韧带、阴茎背深静脉(deep dorsal vein, DDV)及阴部内静脉等组织结构、走行特点.结果6具标本 DVC 分深、浅两层结构,浅层为前列腺浅表静脉,深层为前列腺静脉丛.前列腺浅表静脉在左右耻骨前列腺韧带之间,前列腺前面为单干,在膀胱颈处形成分支;前列腺静脉丛在前列腺筋膜深面局限于两耻骨前列腺韧带之间,平均宽度20．52 mm.DVC 远端与阴部内静脉、DDV 及闭孔静脉存在多种形式的广泛交通,近端则分别进入两侧膀胱前列腺静脉丛,可通过阴部内静脉、闭孔静脉及膀胱前列腺静脉丛回流入髂内静脉.结论 DVC 局限于前列腺前面两耻骨前列腺韧带之间.耻骨前列腺韧带前列腺附着部可作为确定DVC 位置及范围的解剖标志,在耻骨前列腺韧带外侧游离前列腺可有效避免 DVC 损伤.DVC 与阴部内静脉、DDV、膀胱前列腺静脉丛及闭孔静脉存在广泛交通.在前列腺尖部贯穿左右耻骨前列腺韧带外侧缝扎才能将 DVC 主干完全阻断,有效减少出血.     

Management of patch infections after carotid endarterectomy and utility of femoral vein interposition bypass graft

ObjectivePatch infection after carotid endarterectomy (CEA) is a rare but devastating complication. A variety of different treatment options are reported; however, there is currently no consensus on how to manage this highly morbid problem. The purpose of this study was to review our experience with management of infectious patch complications after CEA and to highlight utility of femoral vein interposition bypass grafting.MethodsAll CEA patch infection operations at the University of Florida from 2002 to 2017 were reviewed retrospectively. Preoperative history, intraoperative details, and postoperative complications were recorded. Bypass patency was verified with duplex ultrasound imaging (1 month, 6 months, annually). The primary end point was 30-day stroke or death; secondary end points included cranial nerve injury, reintervention, reinfection, and survival. Life tables were used to estimate end points.ResultsTwenty-nine patients (mean age, 70 ± 9 years; male, 76%) were identified. The index CEA occurred at a median of 15 months (interquartile range, 1-55 months) preoperatively (39% <2 months after the index procedure). A variety of patch materials were implicated (Dacron, n = 9; unknown/undocumented, n = 8; bovine pericardium, n = 5; expanded polytetrafluoroethylene, n = 3; unidentified nonbiologic prosthetic, n = 3; saphenous vein, n = 1). Carotid reintervention antecedent to the infected patch presentation occurred in 41% (incision and drainage, n = 10; carotid stent, n = 2; vein patch, n = 1). The most common infecting organisms were Staphylococcus and Streptococcus species (52%; n = 15). The most frequent presentation (46%; n = 13) was pericarotid abscess or phlegmon (pulsatile neck mass or pseudoaneurysm, 28% [n = 8]; carotid-cutaneous fistula, 28% [n = 8]). Reconstruction strategy included femoral vein interposition bypass in 24 patients (83%; nonreversed configuration, 16/24 [67%]), saphenous vein patch in 4 patients (14%), and femoral vein patch in 1 patient (3%). Median postoperative length of stay was 5 days (interquartile range, 4-8 days). Twelve patients (41%) experienced a complication, and the 30-day stroke/death rate was 7% (death, n = 1; stroke, n = 1). The single postoperative death occurred in a patient with history of congestive heart failure who developed a pulseless electrical activity arrest on postoperative day 11 that resulted in multiorgan system failure. Cranial nerve injury occurred in 28% (n = 8; cranial nerves X [3], VII [2], XII [2], and IX [1]), all of which resolved by last follow-up. In follow-up (mean clinical follow-up, 17 ± 14 months; mean survival time, 108 months [95% confidence interval, 81-135 months]), two (7%) complained of limb edema with femoral cutaneous nerve palsy that resolved by 3 months. One interposition bypass occluded at 3 months (asymptomatic); the remaining grafts remained patent with no restenosis, reinfection, or reintervention events. The 1- and 5-year survival was 87% ± 6% and 82% ± 8%, respectively.ConclusionsCEA patch infection can be successfully managed with femoral vein interposition bypass with acceptable postoperative outcomes. Excellent patency can be anticipated with good long-term survival. This strategy can be considered especially in cases with carotid size mismatch or if there is limited availability of alternative biologic conduits.     

带血管蒂髂骨瓣复合骨基质明胶移植治疗股骨颈骨折不愈合

目的探讨带血管蒂髂骨瓣复合骨基质明胶移植治疗青壮年股骨颈骨折不愈合的疗效。方法本组28例股骨颈骨折经手术或非手术治疗6～9个月，骨折仍不愈合者，采用带血管蒂髂骨瓣复合骨基质明胶移植，术后观察骨折愈合，股骨头坏死及关节功能恢复情况。结果28例骨折全部愈合，关节功能按Ja-cobs标准评定，优19例，良7例，差2例。结论青壮年股骨颈骨折不愈合的手术治疗，带血管蒂髂骨瓣复合骨基质明胶(BMG)移植是有效术式，治疗结果体现了该术式具有“活骨移植”及诱导成骨的双重作用，疗效明显。     

Portal vein reconstruction using an internal jugular vein as a graft: Report of a case

We report the case of a 41-year-old man with pancreatic carcinoma invading the portal vein who was successfully treated by portal vein resection combined with pancreatoduodenectomy and reconstruction using an autointernal jugular vein. The internal jugular vein is an ideal graft for portal vein replacement because it has sufficient length, a well-matched diameter, and there is no venous insufficiency after unilateral resection. Nevertheless, this is the first report of portal vein reconstruction using the internal jugular vein as a graft.     

股浅静脉瓣膜外修复成形术后血流动力学动态变化74例分析

目的检测股浅静脉瓣膜外修复成形术后血流动力学动态变化 ,以分析其治疗下肢深静脉瓣膜功能不全的疗效。方法回顾性分析原发性下肢深静脉瓣膜功能不全 74例 ( 96条肢体 )的资料 ,利用流速剖面图彩超和空气体积描记仪分别于术前、术后 1、3个月及 1年进行血流动力学指标检测并进行统计学分析。结果全组术后静脉返流量、灌注指数、静脉功能不全评分指标于术后 1、3个月、1年均较术前显著降低 (P <0 0 1)。而射血分数、剩余容积分数均值于术后 3个月、1年较术前明显改善 (P <0 0 1)。溃疡愈合率达 78 8% ( 2 6 /33) ,术后 93 6 %的肢体各种症状体征消失和明显缓解。结论股浅静脉瓣膜外修复成形术可显著改善血流动力学状况 ,对治疗原发性下肢深静脉瓣膜功能不全及静脉性溃疡有确切疗效     

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目的研究下肢深静脉瓣膜外成形术的临床应用价值。方法自2001年1月至2002年10月，四川省人民医院选择经静脉造影或彩色多普勒检查确诊为原发性下肢静脉瓣膜功能不全的37条患肢行静脉瓣膜外成形术。结果31条患肢随访6个月至2年，疗效良好者30条，轻度肿胀1条。经彩色多普勒检查，均无返流。结论深静脉瓣膜外成形术方法简便，不需阻断、切开深静脉，只要操作正确，术后并发症少，是治疗原发性下肢深静脉瓣膜功能不全的首选术式。     

Bile duct replacement using an autologous femoral vein graft: an experimental study. Preliminary results

The repair of common bile duct injuries is a complex procedure with a significant rate of postoperative morbidity and mortality. The aim of this study was to demonstrate the usefulness of the autologous vein graft in replacement of the bile duct. Twelve male Sprague-Dawley rats weighing 350 +- 550 g were used in the study and were divided at random into two groups: the control group (60) and the experimental group in which a 3-mm segment of the bile duct was resected and the biliary tract was replaced by a segment of vein aided by stent (G1). Both groups were subdivided into pairs of rats to study at 30, 60, and 120 days. All of the animals underwent radioisotope cholangiography, a repeat laparotomy, and blood tests for further pathologic study. The clinical evaluation and biochemical nuclear medicine and pathologic studies showed no evidence of cholestasis. The histologic study of the graft showed replacement of the endothelium by biliary-appearing epithelium. The use of an autologous vein graft with a supporting stent proves to be a feasible and alternative procedure for bile duct reconstruction. Further experimental studies should be carried out to validate these findings so they can be implemented in clinical cases.     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

目的 通过兔股动脉、静脉预构轴型扩张皮瓣的微循环血流晕动态变化、光镜下结构的改变及其成活面积,为预构轴型扩张皮瓣的临床应用提供依据.方法 选择新西兰白兔40只,随机分为4组:预构轴型扩张皮瓣组、预构轴型不扩张皮瓣组、单纯预构轴型皮瓣组及无蒂游离皮瓣组,每组4只,前2组股动脉、静脉移位后,预构轴型扩张皮瓣组、预构轴型不扩张皮瓣组分别在肉膜深面置入容量为50 ml长方形皮肤软组织扩张器,预构轴型扩张皮瓣组7 d后开始注水;无蒂游离皮瓣组为对照组,未采取预构及扩张处理.定期对4组皮肤进行微循环血流量检测,并取样进行光镜观察.预构术后52 d,前3组形成以预构股动静脉血管束为蒂的岛状皮瓣,游离皮瓣组则形成无蒂游离皮瓣后均原位缝合,观察其成活面积.结果 预构轴型扩张皮瓣组较其他组微循环血流量增加,成活面积大[(97.54±2.73)%],光镜下改变显著(P<0.05).结论 扩张术能促进预构轴型皮瓣的血管化进程,明显增大预构轴型皮瓣成活面积,增加其移植的安全性.     

Application of cryopreserved vein grafts as a conduit between the coronary vein and liver graft to reconstruct portal flow in adult living liver transplantation

Abstract:  Adult-to-adult living donor liver transplantation is an alternative to donation from a deceased individual, and can help relieve the shortage of liver donations available for adult patients in Asian countries. When transplant candidates have thrombosis and deterioration of the portal vein, living donor liver transplantation is relatively contraindicated because portal veins in the grafts are short and vein grafts may not be available to reconstruct the portal vein. From June 2003 to May 2007, 82 adult living donor liver transplantations were performed at Chang-Gung Memorial Hospital. Three patients had portal vein thrombosis and marked fibrosis of the portal vein and cryopreserved vein grafts were used to reconstruct portal flow from the engorged coronary vein to the graft portal vein. All vein grafts are patent and all patients have normal liver function at 21–36 months after transplantation. When cryopreserved vein grafts are available, adult living donor liver transplantation can be successfully performed in patients with marked deterioration of the portal vein. The short distance from the engorged coronary vein to the graft portal vein may decrease the incidence of re-thrombosis of the venous conduit.