球囊血管成形术治疗主动脉狭窄

经皮穿刺球囊导管血管腔内成形术，在国外已广泛应用。１９８９年以来我们用此成形术治疗主动脉狭窄４例，３例成功。随访３～８个月，狭窄无复发，近期疗效比较满意。球囊血管成形术效果好且成功率高，操作简便安全可重复使用，是心血管病非手术治疗的新技术之一。     

血管重建术后再狭窄的防治现状

目的 了解血管重建术后再狭窄的各种防治手段。方法 对有关国内、外血管重建术后再狭窄防治方法的文献进行综述。结果 血管再狭窄的防治手段包括基因治疗、药物治疗、血管外支架和物理治疗等。基因治疗的方法包括转染能抑制血管平滑肌细胞增殖的基因和利用反义核酸技术或RNA干扰技术使能促进血管平滑肌细胞增殖的基因失活。结论 各种防治方法各有优、缺点，有些还存在争议。随着分子生物学技术的发展，基因治疗将会成为防治血管再狭窄的最有效手段。     

血管内支架成形术治疗基底动脉狭窄

目的 探讨血管内支架成形术治疗基底动脉狭窄的近期疗效。方法 20例症状性基底动脉狭窄应用球囊膨胀支架行血管内成形术治疗。结果 12例基底动脉恢复正常管径，8例狭窄程度减小80％以上，无手术相关并发症。无短暂性脑缺血发作(Transient ischemic sttack，TIA)或卒中再发作。脑血管造影随访13例，均无血管再狭窄。结论 血管内支架成形术治疗基底动脉狭窄的近期疗效令人满意。     

经皮穿剌血管盛开术治疗移植肾动脉狭窄

为了观察血管成形术在移植肾动脉狭窄的治疗作用。我们将１８例移植肾动脉狭窄并高血压的患者进行了血管成形术治疗。疗效以临床随访、血管造影和超声迫踪为评价。结果１８例患者手术均成功，成形术后，所有患者均治愈。认为血管成形术是移植肾动脉狭窄所致长期高血压和肾功能减退的有效的和首选的治疗方法。     

预防颈动脉成形术后再狭窄的实验研究进展

颅外颈动脉硬化闭塞性疾病是多种缺血性脑血管病的重要危险因素,目前临床上应用的颈动脉内膜切除术（CEA）、血管成形支架置入术（CAS）等方法近期虽可获得理想的血液再灌注,但各种血管成形术后3～6个月内高达25％～50％的再狭窄率,严重影响了临床效果,且没有有效的防治方法。因此,近年来有关抑制颈动脉成形术后血管再狭窄的基因、药物和放射等方面的试验研究日渐增多。     

血管内支架成形术治疗颅外颈动脉狭窄

目的　评价颅外颈动脉狭窄支架成形术的安全性及近期疗效。　方法　 2 0 0 0年 10月～ 2 0 0 2年 12月共收治颈动脉狭窄 16 4例 ,其中颅外分叉部颈内动脉狭窄 14 6例 ,单纯颅外段颈内动脉狭窄 13例 ,单纯颈总动脉狭窄 5例 ,采用自膨胀支架进行血管成形治疗。　结果　 16 4例支架植入均获得成功 ,血管狭窄程度从治疗前 (78 8± 13 6 ) %降低到 (10 2± 7 5 ) % ,围手术期无死亡及大卒中发生 ,1例出现短暂性脑缺血发作 (Transientischemicattack ,TIA) (0 6 % ) ,1例出现小卒中 (0 6 % )。14 5例获得随访 ,时间 3月～ 30月 (平均 8 9月 ) ,随访期间无TIA及卒中发生 ,无死亡。术后 6月数字减影脑血管造影随访 4 5例 ,再狭窄 1例 (2 2 % ) ,但无临床症状。　结论　血管内支架成形术是治疗颈动脉狭窄安全而有效的方法 ,短中期结果令人满意。     

血管内支架成形术治疗颅外段颈动脉狭窄

目的:分析总结血管内支架治疗颅外段颈动脉狭窄的方法和并发症的预防.方法2001年10月至2008年6月共271例(300侧)颅外段颈动脉狭窄患者接受血管内支架成形术治疗,术前口服氯吡格雷75 ms/d,肠溶阿司匹林100～200 mg/d,辛伐他丁40 mg/晚,共5～10 d.应用肝素持续静脉滴注(50 mg/d)共2 d.术后继续抗血小板、降脂治疗.结果:271例患者(300侧)手术均获成功,颈动脉狭窄和脑缺血症状得到明显改善.术后1周内并发症7例,1例死亡.226例患者3～24个月行超声或数字减影血管造影,5例发生再狭窄;其中45例患者超声随访超过36个月,无再狭窄病例;所有病例随访期间无脑缺血相关症状发生.结论:血管内支架治疗颈动脉狭窄是安全有效的,正确的围手术期的处理以及娴熟的操作技巧是手术成功的关键.     

颈内动脉狭窄83例的血管内支架治疗

目的 探讨颈内动脉狭窄血管内支架治疗的方法。方法 选择颈内动脉狭窄大于85%的患者83例行血管内支架治疗，于围手术期进行抗血小板治疗，并行全脑血管造影及颈部超声检查。手术采用2类支架，分预扩与不预扩两种操作。结果 83例手术操作顺利，无临床并发症，影像学评价完全成功，超声波检查示脑血流恢复正常或好转。56例临床症状消失，27例临床症状不同程度好转。术后随访3～24个月，复查脑血管造影及超声波示支架形态良好，血液通畅，血管无再狭窄。结论 采用正确的围手术期治疗及手术方法对颈内动脉狭窄行血管内支架治疗是安全的，支架的选择与是否预扩尚待商榷。     

血管内支架成形术治疗移植肾动脉狭窄

一、资料和方法肾移植患者3例,男性2例,女性1例。3例均为供肾动脉同受者髂动脉端端吻合。移植时间0.5～9年。临床主要症状为进行性高血压,且用降压药效果不佳;肾功能受损,表现为血尿素氮,肌酐逐渐升高,尿量减少伴双下肢浮肿。3例均采用对侧股动脉穿刺Ｓｅｌｄｉｎｇｅｒ技术行移植肾动脉造影证实移植肾动脉狭窄的部位和程度。然后用4～6ｍｍ球囊导管,直径选择以邻近正常血管直径为标准。在透视下将球囊导管置入狭窄动脉处,反复扩张球囊至球囊壁上切迹消失,再放置内径6ｍｍ的Ｓｔｒｅａｋｅｒ支架(Ｂｏｓｔｏｎ公司,美国),造影复查了解血管成…     

彩色多普勒超声早期预测ASO术后再狭窄风险的临床研究

目的：评价彩色多普勒超声作为术后早期随访方法预测ASO术后再狭窄风险的的有效性。方法：回顾性研究25例采用手术治疗的下肢动脉硬化闭塞症患者：第1组为各类开放性转流术者，术后检查移植物皿管中段血流峰值流速（middle graft，MG），依据测得值进行中远期闭塞危险性划分。将流出道动脉血流量手术前后的变化量与此结果进行相关性研究；第2组为各类腔内治疗术者，术后随访重点为流出道动脉血流量。亦依据测得值进行中远期闭塞危险性划分。再将之与手术结束后数字减影血管造影（digital subtraction angiography，DSA）检查结果评分进行相关性研究。结果：第1组患者，按MG值划分之结果与流出道动脉血流量增长幅度呈负相关；第2组患者，按流出道动脉血流量划分之结果与DSA评分结果亦呈负相关。结论：彩色多普勒超声检查是下肢动脉硬化闭塞症术后早期随访的有效方法。     

血管重建术后再狭窄发生机制的研究新进展

再狭窄是导致血管重建术后闭塞、手术失败的重要原因,明确其发生机制对防治再狭窄及提高血管重建术后长期通畅率具有重要意义.目前再狭窄发生机制的主要观点有弹性回缩、炎症反应、血栓形成、内膜增生和血管壁重塑等,本文就以上几方面进行综述.     

Rotationplasty as a reconstructive operation after tumor resection

Reconstruction in the skeletally immature patient following resection of osteosarcoma about the knee is a challenging problem. Salvaging of the limb with allogeneic or prosthetic replacement results in a shortened limb with functional limitations. Arthrodesis yields a stiff and shortened limb. The so-called growing prosthesis has a high complication rate and is still unproven. However, rotationplasty has been successfully used as a reconstructive technique following resection of these types of tumors in the skeletally immature patient. A limb with normal sensation and proprioceptions, adequate range of motion, and without leg-length discrepancies, functional limitations, or painful neuroma is to be expected. Although a prosthesis must be worn, these patients are active and participate in unrestricted physical activity. Cosmetic acceptance has not been a problem and complications are minimal. Thus, rotationplasty requires only a single operation and results in a highly functional limb.     

Twenty-four hour blood flow in the forefoot after reconstructive vascular surgery.

Local blood flow in the forefoot (SBF) was measured continuously during 24 hours by 133xenon clearance technique in 10 patients prior to and at least 1 year after successful reconstructive vascular surgery for severe arterial insufficiency (mean: 18 months, range: 12-36). A group of 10 patients with normal peripheral circulation served as a control group. In spite of a considerable increase of the ankle/arm systolic blood pressure index--preoperative: 0.30 +/- 0.12, postoperative: 0.78 +/- 0.28 (mean +/- 1 SD)--the SBF decreased by 50% (p less than 0.001) following reconstructive vascular surgery during day activities. During sleep, however, SBF increased by 80% (p less than 0.001). The relative changes in SBF from day to night at the postoperative examination did not differ from that of the control group, i.e., the normal 24-hour blood flow pattern had been obtained. These changes in SBF are explained by the reappearance of peripheral vasoregulatory mechanisms. Postreconstructive hyperemia was evaluated by the same technique. The changes in SBF following surgery in the positions supine, awake and supine, asleep were found to be insignificant (0.80 less than p less than 0.90). It is concluded that the long-term postreconstructive hyperemia merely is a reflection of the normal 24-hour blood flow pattern.     

内皮祖细胞与血管介入治疗后再狭窄

介入治疗后再狭窄是影响经皮腔内血管成形术治疗疗效的主要原因,也是近年来研究的热点及难点之一.内皮祖细胞是一类能增生并分化成血管内皮细胞的前体细胞,参与体内内皮损伤后的修复和血管再生,有望在血管介入治疗后再狭窄的防治中起重要的作用,本文对内皮祖细胞的研究概况及其近年来在防治介入治疗后再狭窄的研究进展进行综述.     

完全保留残端自体腱重建后交叉韧带对本体感觉恢复的影响

目的观察完全保留残端自体腱重建后交叉韧带(PCL)术后本体感觉恢复状况,探讨完全保留与非保留残端重建PCL对本体感觉恢复的影响。方法对40例PCL损伤的患者中20例行不保留残端自体腘绳肌单束重建术(非保留残端组),20例行完全保留残端自体腘绳肌单束重建术(完全保留残端组)。通过IKDC评分、Lysholm评分及CPM机等速测试膝关节本体感觉,评估两组患者术后本体感觉恢复状况。结果 40例均获随访,时间6~24(15.6±4.945)个月。两组患者术后6、12个月膝关节IKDC评分及Lysholm评分均较术前明显改善(P0.05);两组间比较差异无统计学意义(P0.05)。术后6个月,在3个不同的膝关节复位角度下,非保留残端组患侧膝关节与健侧比较差异有统计学意义(P0.05);完全保留残端组患侧膝关节与健侧比较差异无统计学意义(P0.05);两组间患侧膝关节比较差异有统计学意义(P0.05)。术后12个月,在3个不同的膝关节复位角度下,两组患侧膝关节与健侧比较差异均无统计学意义(P0.05)。两组之间患侧膝关节比较差异无统计学意义(P0.05)。结论完全保留残端重建PCL能够可靠地恢复膝关节的本体感觉,且早期恢复效果优于非保留残端重建PCL。     

Microvascular circulatory changes in the lower extremities after reconstructive vascular surgery for intermittent claudication

We have studied the circulatory changes in the lower extremities after reconstructive vascular surgery in ten patients with intermittent claudication. The following examinations were carried out 3 days before, 3 days, and 28 days after the operation: measurement of ankle systolic blood pressure, calf plethysmography, resting calf muscle blood flow and resting subcutaneous foot blood flow. The vasoconstrictor response (veno-arteriolar reflex) was also assessed. On the night before the operation and on the 28th night after aorto-bifemoral bypass surgery, subcutaneous adipose tissue blood flow in the forefoot was measured during sleep. The ankle systolic blood pressure and the ankle index rose significantly. The former increased from 57 +/- 16.4 mmHg to 93 +/- 24.0 mmHg (mean +/- S.E.M.) and was still elevated on the 28th postoperative day. The total limb blood flow, the muscle blood flow and the blood flow in the subcutaneous tissue of the forefoot during daytime were unchanged. In contrast, the blood flow in the forefoot during sleep increased significantly from 3.5 +/- 1.63 ml x (min x 100 g)-1 to 5.2 +/- 2.14 ml x (min x 100 g)-1 (mean +/- S.E.M.) on the 28th night. The vasoconstrictor response was potentiated, and increased from 27% before the operation to 45% on the third postoperative day. This change was maintained 28 days postoperatively. In conclusion the increase in arterial blood pressure was only reflected in the vasoconstrictor response which had returned to normal by the third postoperative day and nocturnal blood flow in the subcutaneous adipose tissue which did likewise.