布-加氏综合征的治疗进展

布-加氏综合征(Budd-Chiari Syndrome)是由于肝静脉或邻近的下腔静脉阻塞而产生的一系列临床综合征。随着血管外科的发展，对这种疾病的认识有了进一步提高。由于其病理类型的不同，对于该病征的治疗方法亦较多，约有30余种。本综合近年国内献，对目前常用的布-加氏综合征的治疗方法作一评述。     

布-加氏综合征根治性术式的探讨

目的：统计布-加氏综合征直视下根治术的45例资料，并探讨三种根治性手术的优缺点及适应症。方法：隔膜切除或病变的下腔静脉段切开、心包片扩大成形17例；闭塞或狭窄的下腔静脉段切除、人工血管原位移植24例；肝静脉流出道成形6例。同时行肝静脉至右心房的下腔静脉人口处人工血管间置移植4例。结果：因术后并发症死亡2例；复发4例．均为心包片扩大成形术后的病人。结论：心包片成形术适用于隔膜型，人工血管原位移植适用于短段闭塞或狭窄型．肝静脉流出道成形可用于长段下腔静脉闭塞型。     

5例布-加氏综合征彩色多普勒超声诊断分析

目的探索彩色多普勒超声对肝静脉阻塞型布-加氏综合征的诊断价值。方法应用彩色多普勒超声观察5例肝静脉阻塞型布-加氏综合征的彩色多普勒超声的声像图特点。结果下腔静脉型3例,肝静脉型2例。结论彩色多普勒超声可较准确地判定血管狭窄及阻塞的部位和类型。     

5例布-加氏综合征彩色多普勒超声诊断分析

目的 探索彩色多普勒超声对肝静脉阻塞型布-加氏综合征的诊断价值.方法 应用彩色多普勒超声观察5例肝静脉阻塞型布-加氏综合征的彩色多普勒超声的声像图特点.结果 下腔静脉型3例,肝静脉型2例.结论 彩色多普勒超声可较准确地判定血管狭窄及阻塞的部位和类型.     

下腔静脉闭塞段切除人工血管原位移植治疗布-加氏综合征18例报道

自1994年以来,采用下腔静脉闭塞或狭窄段切除人工血管原位移植治疗布-加氏综合征18例。手术适宜于短段闭塞型、伴有明显狭窄的隔膜型或局限性狭窄型而采用经皮球囊扩张失败或以往采用隔膜切除、心包片成形术而术后复发者。经本治疗术后3～36个月随访,所有病例疗效满意,无一例复发。     

冠状动脉内支架植入术和Abciximab应用在对急性心肌梗死患者行首次血管成形术后保持冠状动脉通畅和改善临床预后中的协同效应

研究对象和方法　该项研究共纳入了自 1995年 8月至1998年 12月期间的在症状发作后 12小时内行首次 PTCA术的 6 5 0名急性心肌梗死 (AMI)的住院患者 ,依输助治疗方案的不同 ,共分为 4组 :第 1组 ,单纯行 PTCA术 (n=2 2 0 ) ;第 2组 ,PTCA术加冠状动脉内支架植入术 (n=12 8) ;第 3组 ,PTCA术加 Abcixim ab(血小板糖蛋白 IIb/ IIIa受体拮抗剂 )治疗 (n=10 4) ;第 4组 ,PTCA术加冠状动脉内支架植入术并 Abcixim ab治疗 (n=198) ,所有患者的临床特征、病情严重程度、 AMI发作时总的缺血时间无均相近 ,而第 3组和第 4组患者术前经…     

肝右静脉与下腔静脉位置对布-加综合征产生机制的影响

目的探讨不同肝右静脉与下腔静脉夹角变化对布-加综合征患者下腔静脉隔膜发生机制的影响。方法运用Mimics软件对临床磁共振成像血管造影下腔静脉和主要肝静脉图像进行三维实体模型重建,测得正常模型下腔静脉与肝右静脉夹角为56°。在保持模型基本结构不变基础上,分别构建肝右静脉与下腔静脉夹角为30°和120°的模型,并数值模拟计算3个模型的壁面剪切力、壁面压强、速度分布。结果 3个模型壁面压强、壁面剪切力差异显著。与正常人56°模型相比,30°模型有较高的壁面压强和较低的血液流速,120°模型有较低的壁面剪切力和血液流速,并伴随有涡流的出现,这些血流动力学因素的改变更易于血栓的形成。56°模型血管内血流流速最快。结论对下腔静脉与肝右静脉血液流场的数值模拟有助于了解布-加综合征的发病机制,提高下腔静脉阻塞隔膜形成风险的预测,为治疗提供理论依据。     

血管内支架成形材料在脑供血动脉狭窄治疗中的应用

目的：总结近年来血管内支架成形材料在脑供血动脉狭窄治疗中的应用情况。 方法：由作者应用计算机检索维普数据库中与血管内支架置入治疗脑供血动脉狭窄有关的文章,检索时限2000-01/2010-10。检索关键词：血管内支架成形术;脑供血动脉狭窄;缺血性脑卒中;并发症。纳入标准：血管内支架置入治疗脑供血动脉狭窄的文章。排除标准：重复研究或较陈旧文献。 结果：金属内支架进入临床治疗后取得了令人瞩目的效果,但具有一定的致血栓形成性、永久性存留体内、再狭窄仍较高、金属表面难以附载药物等缺点。针对以上不足,近些年对支架材料、构形设计、制作工艺等均作了不少改进,更引人注目的是20世纪80年代末和90年代初覆膜支架的出现和生物学支架概念的提出,使血管内支架又进入了一个新的阶段。 结论：随着血管内技术的发展,脑保护装置下血管内支架置入已成为治疗颅内外动脉狭窄的主要方法之一,支架技术的安全性和有效性已显著提高,但仍存在如血栓形成、脑出血、再狭窄以及过度灌注等问题。     

血管内支架植入术治疗左肾静脉压迫综合征的疗效

目的 观察血管内支架植入术治疗左肾静脉压迫综合征的临床疗效.方法 2002年6月至2011年7月本院本科采用血管内支架植入术治疗6例左肾静脉压迫综合征患者.患者术前、后进行了尿常规分析等实验室检查、彩色多普勒超声检查和(或)计算机断层扫描(CT)检查.结果 6例患者都成功植入了自膨式支架.术前和术后左肾静脉受压狭窄段的直径分别为(1.88±0.95)mm、(5.24±0.61) mm,差异有统计学意义(P＜0.05).术中左肾静脉测压为(11.00±4.34) mm Hg(1 mm Hg=0.133kPa),植入支架后为(6.00±2.55) mmHg,差异有统计学意义(P＜0.05).患者术后2～6个月肉眼或镜下观察血尿消失,尿液常规分析结果正常.术后随访6～60个月,肉眼或镜下观察患者血尿无复发;彩色多普勒超声或CT检查显示支架血流通畅,无再狭窄或血栓形成;2例左精索静脉曲张的患者完全缓解.结论 血管内支架植入术治疗左肾静脉压迫综合征有满意的临床疗效.     

Prognostic Usefulness of Metabolic Syndrome Compared with Diabetes in Korean Patients with Critical Lower Limb Ischemia Treated with Percutaneous Transluminal Angioplasty

Purpose

Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients.

Materials and Methods

We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66±14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes.

Results

The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038).

Conclusion

As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.     

An Autopsy Case of Cholesterol Embolism Following Percutaneous Transluminal Coronary Angioplasty and Aortography

A 67-year old woman with a 6-year history of angina pectoris underwent percutaneous transluminal coronary angioplasty. Just after manipulation of the guiding catheter during a second attempt at angioplasty and aortography, the patient developed intestinal obstruction with peritonitis. Laparotomy was performed, and surgical specimens taken during surgery revealed necrosis and perforation of the small intestine. Microscopical examination proved that this was the result of multiple fresh cholesterol emboli in the arteries. Postoperatively, renal failure and sepsis developed, and the patient died 13 days after surgery. Autopsy revealed multiple cholesterol emboli in arteries of the intestine, spleen, pancreas, liver and kidneys. This case demonstrates that cholesterol embolism can be a serious complication of percutaneous transluminal coronary angioplasty. Acta Pathol. Jpn. 32: 203∼206, 1989.     

布加综合征有关生化指标的病例对照研究

目的 通过分析布加综合征有关主要生化指标的特点,为了解BCS患者血栓形成的因素提供线索。方法 收集我院2017年2月~2018年1月住院治疗的105例BCS作为病例组,选取同期来本院体检中心体检的同性别、同年龄的105例健康体检者为对照组。采用病例对照研究,对两组WBC、RBC、HGB、MCH、Neu%、Lym%、PLT、TC、TG、HDL-C及LDL-C各指标分别进行男女分层分析。结果 病例组男性患者的WBC、HGB、MCH、Lym%、PLT、TC、TG、HDL-C及LDL-C水平与对照组比较,差异有统计学意义（P＜0.05）;两组男性患者RBC及Neu%比较,差异无统计学意义（P＞0.05）。病例组女性患者的WBC、HGB、MCH、Lym%、PLT、TC、TG、LDL-C水平与对照组比较,差异有统计学意义（P＜0.05）;两组女性患者RBC、Neu%及HDL-C水平比较,差异无统计学意义（P＞0.05）。结论 加强与血栓形成有密切关系的如PLT、TC、TG、HDL-C及LDL-C等指标的基础研究,为BCS的病因研究及有针对性的治疗提供科学依据。     

Primary Leiomyosarcoma of the Inferior Vena Cava with Budd-Chiari Syndrome

A 44 year old Japanese woman with leiomyosarcoma of the inferior vena cava is reported. She presented with Budd Chiari syndrome and died of hepatic failure about 3 months after the onset of symptoms. The tumor arose from the middle segment of the inferior vena cava, occluded the inferior vena cava and projected into the right atrium. A total of 28 cases of Budd-Chiari syndrome due to primary leiomyosarcoma of the inferior vena cava are reviewed.     

Postcardiac Injury Syndrome after Percutaneous Coronary Intervention

The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium. According to previous reports, almost all cases develop after major cardiac surgery or a myocardial infarction. Recently, a few reports have described post cardiac injury syndrome as a complication of endovascular procedures such as percutaneous cardiac intervention. Here we describe an unusual case of post cardiac injury syndrome after a percutaneous coronary intervention.     

无创经皮电刺激仪治疗OSAS的实验研究和临床疗效

研究采用经皮双向电流脉冲刺激舌下颏舌肌作为治疗阻塞性睡眠呼吸暂停综合征(O bstructive sleepapnea syndrom e,O SA S)的一种新方法。采用多导睡眠图同步监测患者,当发生睡眠呼吸暂停时及时给予最佳参数的电刺激,使得以颏舌肌为主的上气道扩张肌促使舌体向前运动,扩大舌咽气道,降低上气道阻力,改善夜间低氧血症,改善睡眠结构。临床疗效结果表明,22名O SA S患者经我们治疗后显效17名,好转2名,无效3名,有效率77.27%。初步证明这是一种的治疗O SA S的新方法。     

低分子量肝素抑制血管成形术后平滑肌细胞增生及再狭窄形成

观察血管成形术后平滑肌细胞增生及再狭窄形成过程，探讨低分子量肝素的抑制作用。     

Low Daily Dose of Antioxidant Probucol Decreases Incidence and Severity of Restenosis after Transluminal Coronary Balloon Angioplasty

Antioxidant probucol in both high (1000 mg) and low (250 mg) daily doses effectively reduced manifestations of oxidative stress in patients with atherosclerosis (assessed by in vivo accumulation of lipoperoxides in atherogenic LDL). When probucol was administered in a dose of 250 mg/day for 7–10 days before transluminal balloon coronary angioplasty and then for 6 months after surgery, the incidence of restenosis decreased to 25% compared to 45% in the control (without probucol therapy). In the group of operated patients receiving probucol (250 mg/day for 6 months) the minimal artery lumen was significantly higher, and the degree of artery occlusion significantly lower than in the control group not treated with probucol.__________Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 139, No. 2, pp. 150–152, February, 2005     

布-加综合征的彩色多普勒超声诊断及与肝硬化的鉴别诊断

目的探讨彩色多普勒超声在诊断布-加综合征及与肝硬化的鉴别诊断中的应用价值。方法32例布-加综合征患者（男性19例,女性13例,平均年龄37岁）和40例门脉性肝硬化患者（男性28例,女性12例,平均年龄48岁）,分别接受二维超声、彩色多普勒超声和频谱多普勒超声检查,并对获得的资料进行回顾性分析。所有患者经血管造影和/或病理、CT证实。结果布-加综合征的典型特征是病变主要累及下腔静脉和肝静脉,病变处管腔闭塞或狭窄,其内血流紊乱,并可出现侧支循环和交通支;肝硬化患者主要表现为肝脏缩小、脾大、门静脉增宽、腹水,血流动力学改变主要以门静脉和肝静脉为主。结论彩色多普勒超声对布-加综合征、肝硬化的诊断及鉴别诊断符合率较高,为诊断布-加综合征和肝硬化提供有效手段,对选择合理治疗方案及评价治疗效果具有指导意义。