白细胞激活及炎症反应在慢性静脉功能不全中的作用

目的 探讨白细胞激活及炎症反应在慢性静脉功能不全中的作用。方法 查阅国内、外相关文献并进行综述。结果 白细胞激活及炎症反应参与静脉壁和瓣膜重塑，导致静脉瓣膜功能不全及静脉曲张的形成。结论 白细胞激活及由此引起的炎症反应在慢性静脉功能不全的发生、发展中起重要作用。     

Risk Stratification for Recurrent Venous Thromboembolism in Unprovoked Venous Thromboembolism Patients

Unprovoked venous thromboembolism (VTE) patients are at much higher risk of a recurrent VTE event than provoked VTE patients. Oral anticoagulation therapy (OAT) after a first unprovoked VTE has proved to effectively reduce the risk of recurrence during therapy however this benefit is lost after discontinuing OAT. A minimum of 6 to 12 months of OAT is recommended for first unprovoked VTE patients to prevent recurrence. However, there is evidence indicating that some patients are at ongoing high risk of recurrent VTE after discontinuation of therapy and that these patients may need indefinite anticoagulation to effectively prevent recurrences. Several risk factors for recurrent VTE have been identified that may be helpful to physicians when deciding whether OAT should be continued or discontinued in unprovoked VTE patients after initial therapy. The present article reviews risk factors for recurrent VTE including D-Dimer levels after discontinuation of OAT, elevated levels of Factor VIII, residual venous obstruction, post-throm-botic syndrome, male gender, and older age. Research is also underway to determine the predictive ability of these known VTE recurrence risk factors, combinations of these risk factors and their interrelationships as well as to actively search for additional potential predictors.     

小型猪静脉增流DIEP皮瓣的血流动力学研究

目的 研究静脉增流对小型猪腹壁下动脉穿支(DIEP)皮瓣成活面积的影响及其血流动力学特点。方法 选取24头小型猪,在其腹部形成模拟增流DIEP皮瓣和传统DIEP皮瓣,并进行相应指标测量。包括皮瓣的血流灌注,静脉血管的压力,以及静脉血气分析。血流动力学测量后,所有腹部皮瓣原位缝合,随机选取12只形成静脉增流的DIEP皮瓣(实验组),其余12只为传统的DIEP皮瓣(对照组)。术后7 d进行活检,测量皮瓣的成活面积。结果 在静脉增流模式下,各血流动力学指标均较无增流情况下明显改善。对照组皮瓣成活率为(82.1±7.6)%,实验组为(99.4士1.2)%,差异显著。结论静脉增流技术可显著改善DIEP皮瓣灌注并增加皮瓣成活面积。就大面积皮瓣而言,静脉增流技术是改善静脉淤血和增大皮瓣成活面积的可靠方式。     

Non-saphenofemoral Venous Reflux in the Groinin Patients with Varicose Veins

OBJECTIVES: To investigate the incidence, clinical significance, anatomical variation and physiology of non-saphenofemoral venous reflux (non-SF reflux) in the groin. DESIGN: Prospective study. MATERIALS: A total of 1072 vascular diagnostic workups in 680 patients with possible venous diseases to the legs were included. METHODS: Duplex scanning and air plethysmography. RESULTS: A total of 1022 legs had venous diseases. Of these, 101 (9.9%) had non-SF reflux in the groin. Such reflux occurred in recurrent varicose veins (RVV) in 16.3%, in primary varicose veins (PVV) in 6.1% and in deep venous thrombosis (DVT) in 8.0%. Two patterns of reflux were distinguished: epigastric reflux from lower abdominal wall veins (71 legs) and pudendal reflux from perineal and/or gluteal veins (30 legs). Pudendal reflux was almost exclusive to women and did not occur with DVT. If there was only non-SF reflux at the groin the venous filling indices (VFI) were close to normal (1.7+/-1.0 ml/s for RVV, 1.9+/-1.2 for PVV, 1.7+/-1.0 for DVT) and no active ulcers were observed. However, if non-SF reflux was associated with saphenofemoral or other reflux the VFIs (3.3+/-2.3 ml/s for RVV, 3.8+/-1.5 ml/s for PVV) were abnormal (p <0.05) and ulcers occurred in 11/32. CONCLUSION: Non-SF reflux in the groin is common. Such reflux may be missed at initial surgery and lead to recurrence of varicose veins. However, the venous physiological disturbance of such reflux is mild and it is not associated with ulcers unless combined with reflux at other sites in the leg.     

Venous angiomas of the posterior fossa should be considered as anomalous venous drainage

Venous angioma of the posterior fossa has been described, and the existing literature has been reviewed. The patient presented had a venous angioma located in the pons, and both cerebellar hemispheres and was drained by an enlarged and anatomically anomalous vein within the fourth ventricle. The patient had a "cough headache" and later had signs of cerebellar involvement. A surgical attempt at collapsing the anomalous vein resulted in death in the immediate postoperative period due to venous infarction of the brain stem and cerebellum. Emphasis has been given to the following: 1. "Cough Headache" can be a presenting feature for venous angiomas of the posterior fossa. 2. Venous angiomas of the posterior fossa are developmental anatomic anomalies with enlargement of certain venous structures as a result of inadequate alternative venous drainage. 3. The enlarged vein, which is the pathognomonic feature of venous angiomas, serves a vital function in drainage of blood from structures in the posterior fossa as the usual drainage pathways are inadequate or absent. 4. Operative intervention aimed at resection or collapse of such large veins, which has been successful in treatment of venous angiomas of the frontal lobe, can be disastrous in the treatment of those lesions occurring in the posterior fossa.     

Primary Axillary Venous Aneurysm: Report of a Case

We report a case of nontraumatic, spontaneous venous aneurysm of the left axillary vein. This case may represent only the second such case ever reported in the English-language medical literature. Venous aneurysms are often associated with trauma, arteriovenous fistula, or other venous abnormal hemodynamic conditions, but true primary venous aneurysms are very rare. Surgical excision was uncomplicated and performed easily.     

腹腔镜胆囊切除术后静脉血栓12例分析

目的探讨腹腔镜胆囊切除术(laparoscoptc cholecystectomy, LC),术后静脉血栓发生的原因和预防. 方法回顾性分析我院2002年1月～2004年6月258例LC术后12例静脉血栓的临床资料. 结果手术时间17～58 min,平均38 min.术中出血量15～100 ml,平均45 ml.11例浅静脉血栓治疗6～8 d后红肿热痛等症状消失,复查彩色多普勒血栓消失,予华法林抗凝治疗,随访6～12个月,未见复发.股深静脉合并肺栓塞1例,抗凝治疗4个月,随访6个月,未见复发. 结论 LC术后静脉血栓的发生与病人高危因素、CO2气腹、麻醉等因素密切相关,在围手术期应积极采取措施加以预防.     

双功彩超定量评判下肢静脉瓣膜的倒流

目的:确定双功彩超检测下肢静脉瓣膜倒流严重程度的参数。方法:对40例准备行股浅静脉第一对瓣膜重建的病人,术前应用双功彩超检测股浅静脉第一对瓣膜的倒流指数,将检测结果与术中探查的静脉瓣膜倒流程度相比较。结果:双功彩超探测的静脉倒流指数与术中探查的静脉倒流严重程度呈上相关(r=0.8747,P=0.000),静脉倒流指数可以区分轻中度与重度静脉倒流(P=0.000)。结论:双功彩超探测静脉倒流指数可定量地用来评价静脉倒流的严重程度。     

Surgical Management of Long-Term Central Venous Access in Uraemic Patients

Over a 5-year period, 1980–1985, 39 patients from a dialysispopulation of over 400 treated at this centre experienced majordifficulties in achieving adequate access for dialysis by conventionaltechniques (i.e. arteriovenous fistula or CAPD). This studyhas evaluated the long-term results of a new approach to circulatoryaccess, central venous catheterisation (CVC) for so called "highrisk" patients. CVC consists of inserting a single-lumen CAPD-typesilastic catheter into the right atrium via an external or internaljugular vein. Forty-seven catheters have been inserted into39 uraemic patients. All patients had failed on, or were unsuitablefor, conventional access to haemodialysis or CAPD. Ten patients(26%) had previous failed renal transplants. The median durationof catheter use was 7 months (range 1–60 months) and atotal of 6500 high-performance dialyses have been performedusing this technique. No patient has died of catheter-relatedproblems. The catheters were easily managed by nurses and welltolerated by the patients. The incidence of complications amongpatients was low: displacement (1), catheter thrombosis (2),skin exit-site infections (5), septicaemia (2). Central venouscatheterisation is a method of providing safe and reliable long-termvascular access which is immediately usable by high-risk patientswho have either failed on or are unsuitable for conventionalcirculatory access.     

下肢原发性静脉返流性疾病的外科治疗进展

目的：探讨下肢原发性静脉返流性疾病的外科治疗效果。方法：对国外有关下肢静脉返流性疾病外科治疗方面的文献进行综述。结果：下肢慢性静脉功能不全常常累及下肢多个静脉系统，对下肢浅静脉、深静脉和交通静脉三个系统同时进行治疗，才能取得更好的临床疗效。结论：对各个下肢静脉系统进行综合性治疗，将成为今后外科治疗下肢慢性静脉疾病的方向。     

腹腔镜术后下肢静脉血栓形成分析

目的：探讨腹腔镜术后下肢静脉血栓发生的原因和预防措施。方法：回顾分析2000年5月至2006年5月2 000余例各种腹腔镜术后出现的26例下肢静脉血栓患者的临床资料。结果：手术时间20-200min,15例下肢浅静脉血栓治疗5-7d后症状消失,复查彩色多普勒血栓消失,随访3-12个月无复发。11例髂—股及股深静脉、血栓,经抗凝治疗14-21d症状消失,随访12个月无复发。结论：腹腔镜术后下肢静脉血栓的发生与患者高危因素、CO2气腹、体位等密切相关,在围手术期应积极采取措施予以预防。     

Novel Fenestration Designs for Controlled Venous Flow Shunting in Failing Fontans With Systemic Venous Hypertension

The Fontan procedure is employed as the final‐stage palliation in single‐ventricle congenital heart patients and results in diversion of venous blood directly to the pulmonary arteries. Fontan patients have been known to suffer from postoperative systemic venous hypertension, which in turn is associated with pleural effusions and protein losing enteropathy, leading to a decreased duration and quality of life. Despite the ongoing debate on its benefits, a circular fenestration hole (typically 4 mm) establishing a venous shunt to the common atrium is traditionally employed to relieve venous pressure in the Fontan conduit and improve early postoperative Fontan hemodynamics. However, these improvements come at the cost of reduced oxygen saturation due to excessive right‐to‐left shunting if the fenestration is permanent. The ideal “selective” fenestration would therefore limit or eliminate shunt flow at tolerable systemic venous pressures and allow increased flow at high pressures. The objective of this study is to introduce new fenestration designs that exhibit these desirable pressure‐flow characteristics. Novel plus‐shaped and S‐shaped fenestration designs with leaflets are introduced as alternatives to the traditional circular fenestration, each having identical effective orifice areas at the fully open states. In vitro steady leakage flow tests were performed for physiological flow‐driving pressures in order to obtain pressure‐drop versus flow‐rate characteristics. In addition, the leaflet opening kinematics of the plus‐shaped fenestration was investigated computationally using finite element simulation. Fluid‐structure interaction analysis was performed to determine leaflet displacements and pressure‐flow characteristics at low pressures. Further, a lumped parameter model of the single‐ventricle circuit was created to simulate pulsatile flow conditions For the plus‐shaped fenestration, the flow rate was found to increase nonlinearly with increased driving systemic venous pressures at high physiological‐pressure drops which did not cause the leaflets to fully open, and linearly for low driving pressures. These results indicate that leaflets of the plus‐shaped fenestration design activated passively after a critical systemic venous pressure threshold. This feature is ideal for minimizing undesirable excessive venous shunting. A large variability in shunting flow rate may be obtained by changing the shape, thickness, size, and material of the fenestration to suit requirements of the patient, which can further limit shunt flow in a controlled manner.     

静脉动脉化治疗广泛性下肢动脉闭塞症

目的:探讨静脉动脉化手术对广泛性下肢动脉闭塞症的疗效.方法:对有慢性缺血表现的20条下肢行Doppler超声与DSA或MRA检查,确诊为广泛性下肢动脉闭塞症.然后用分期或一期静脉动脉化手术对所有患肢进行治疗.结果:术后近期3条截肢.17条患肢随访6～51个月,其中2条患肢深静脉血栓形成,15条患肢疗效理想,症状消失.术后Doppler超声与MRA复查可见动脉血向缺血肢体灌注.结论:静脉动脉化治疗广泛性下肢动脉闭塞症疗效良好,为治疗该病开辟了一条新途径.