左下肢浅表静脉多发静脉瘤1例

患者男,30岁;主诉"左下肢有困乏、紧胀感和沉重感15年,加重3个月,来院就诊",无遗传及传染病史.查体:左小腿外后侧皮肤见散在色素沉着,左小腿外后侧浅表静脉明显扩张,其上1/3段可见多发圆形或类圆形囊性肿块,最大者约2.5 cm×3.0 cm×3.3 cm,加压时缩小,立位时明显膨隆,其上覆盖的皮肤温度正常、无搏动感.     

Application of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity

PurposeThe aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy (FS).MethodsA total of 64 patients (35 females, 29 males; mean age, 57 ± 11 years [range, 29–79 years]) with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019. The maximum diameter of the vein branches was >20 mm, which appeared to be cystic dilatation and forms large-scale in the crus or the thigh. All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia. The surgical time, pain/phlebitis, number of incisions, amount of bleeding, recurrence of varicose vein, incidence of surgical site infections (SSIs), satisfaction score, and improvement in clinical symptoms were evaluated respectively with the patients in two groups: Group A, with patients who underwent treatment with the Trivex system, and Group B, patients who underwent treatment by point-form-stripping combined with FS.ResultsAll procedures were performed successfully. The average operative time in Group A was 56 ± 11 min, whereas that of Group B was 90 ± 33 min, which was a significant difference (p < 0.05). Group A patients felt little pain after surgery, whereas in Group B the level of pain peaked on postoperative day 30, mostly due to thrombophlebitis after FS. There was no recurrence of varicose vein was observed in any patient, however, there were some residual effects in Group B, including the amount of bleeding volume, in-hospital stays, pain/phlebitis, and number of incisions (P < 0.05). There were no significant differences with respect to SSIs, improvement in clinical symptoms, and satisfaction scores observed (p>0.05).ConclusionsThis study shows that patients benefited from both treatment options. However, primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy (FS). In summary, the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy (FS) for those who demand a high level of appearance, and especially for young patients, the Trivex system is recommended.     

护理干预及自制硝黄外敷袋治疗下肢静脉曲张合并血栓性浅静脉炎的效果

目的探讨护理干预硝黄药袋外敷对综合治疗下肢静脉曲张并血栓性浅静脉炎患者效果的影响。方法按入院顺序采取随机数字法将接受综合治疗的88例下肢静脉曲张并血栓性浅静脉炎患者,分为干预组和对照组各44例,干预组在硝黄药袋外敷时进行护理干预,对照组仅给予常规外敷。结果对照组患者有10例无效,两组治愈率比较差异有统计学意义（x2=10．36,P〈0．01）结论硝黄药袋外敷时进行护理干预使临床治疗有效率提高,值得推广应用。     

颅脑浅静脉MRV成像研究

目的：探讨正常人颅脑浅静脉MRV表现。方法：对106例正常人进行T1WI、T2WI、T2WI-FLAIR、DWI磁共振检查，并用3D-PC法进行颅脑浅静脉MRV成像。结果：①大脑中浅静脉（SMCV）、Trolard静脉、Labbe静脉的显示率分别为64.6%、52.4%、89.6%。②Labbe静脉的形态表现为单干型144例，双干型38例，多干型10例。③注入上矢状窦段桥静脉支数右侧为3.651±0.964，左侧为3.679±0.932。④右侧大脑半球浅静脉引流优势为Labbe静脉＞Trolard静脉＞SMCV，左侧大脑半球浅静脉引流优势为Labbe静脉＞SMCV＞Trolard静脉。⑤Labbe静脉在大脑半球的引流优势为左侧＞右侧（P＜0.05）。Trolard静脉在大脑半球的引流优势为右侧＞左侧（P＜0.05）。SMCV在大脑半球的引流优势左右两侧基本相当（P＞0.05）。结论：MRV是显示颅脑浅静脉解剖形态的有效方法，对临床诊断和治疗有重要意义。     

股静脉戴戒合腔内电凝术治疗下肢静脉曲张临床研究

目的 观察股静脉戴戒合腔内电凝术治疗下肢静脉曲张的疗效.方法 将271例下肢静脉曲张患者分为研究组(166例)和对照组(105例).研究组行股静脉戴戒合腔内电凝术.对照组行传统的大隐静脉高位结扎剥脱术.比较两组股静脉返流程度、血流峰速度、CEAP临床分类和临床计分以评价疗效.结果 研究组在降低静脉返流程度、增加血流峰速度和减少临床计分等方面均明显优于对照组(P<0.01).结论 股静脉戴戒合腔内电凝术是治疗下肢静脉曲张的理想方法.     

半导体激光治疗下肢静脉曲张35例报告

目的:探讨静脉腔内激光(endo venous laser treatment,EVLT)治疗下肢静脉曲张的疗效。方法:在静脉加局麻下采用半导体激光治疗下肢静脉曲张患者35例,随访3～16个月观察疗效。结果:术后全部患者曲张静脉消失,下肢酸胀沉重感明显改善,平均住院时间为4.2天。结论:半导体激光治疗下肢静脉曲张具有安全、有效、创伤小、恢复快等特点,效果满意。     

In vitro experimental study on the treatment of superficial venous insufficiency with high-intensity focused ultrasound

A major cause of superficial venous insufficiency is valvular dysfunction in the great saphenous vein. Dilation of the annulus inhibits valve closure preventing reflux in the vein. This study suggests curing dilation by shrinking the collagen fibers in the vein wall using high-intensity focused ultrasound. An in vitro feasibility study was carried out on 20 segments of human saphenous vein. A spherical probe was used to create two 9-mm-long exposure regions on the vein wall in each segment. The focal point of the sound field was moved mechanically along the vein. Different combinations of in situ acoustic intensity and sound source speeds were tested. A contraction index, which expresses the retraction of the vein after ultrasound exposure, was measured between 7 (+/-1) and 24 (+/-8)%. Histologic analysis verified the absence of vein rupture, vein perforation and tissue carbonisation after ultrasound exposure.     

医护人员下肢静脉曲张患病率断面调查研究

目的：调查我市医护人员下肢静脉曲张的发生、防护和治疗情况,为进一步干预和提高防护水平提供依据。方法：采用自设问卷进行凋查,被调查人员按CEAP分级方法自评,调查我市一、二、三级医院的医护人员150人。结采：被调查的医护人员150人中,下肢静脉曲张31人,患病率20．67％。其中单纯下肢静脉曲张17人,下肢静脉功能不全14人。全组医护人员采取弹力袜防护者11人,占7．33％。不同教育程度间比较尤明显差异（P=0．133,Fisher确切概率）,同样在不同级别医院比较也．无统计学差异（P=0．943）。采取治疗者8人,占25．81％,不同教育程度及不同级别医院间比较无统计学差异。经多因素条件Logistic回归分析结果显示,站立工作每13大于8h、遗传因素、护理工种可能足下肢静脉曲张的危险因素。结论：医护人员下肢静脉曲张发生几牢较高,防护和治疗均处于较低水平,需要采取合理的措施来改善目前状况。     

超声引导下泡沫硬化剂硬化交通支静脉在治疗复发型下肢静脉曲张中的应用价值

目的 探讨超声引导下泡沫硬化剂硬化交通支静脉在治疗复发型下肢静脉曲张患者中的应用价值。方法 对31例复发型下肢静脉曲张患者采用超声引导下注射泡沫硬化剂硬化交通支静脉治疗,作为观察组,回顾33例复发型下肢静脉曲张患者常规实施交通支静脉结扎+分段剥脱术的临床治疗资料作为对照组,对比两组患者手术时间,住院天数,术后并发症,治疗效果等方面情况。结果 观察组在手术时间,住院天数,术中出血,术后并发症等方面少于对照组,差异有统计学意义(P<0.05),治愈率与对照组比较,差异无统计学意义。结论 超声引导下泡沫硬化剂硬化交通支静脉在治疗复发型下肢静脉曲张疗效显著,并且具有手术时间短、术后并发症少等优势。     

Endothelial mediated enhancement of noradrenaline induced vasoconstriction in normal and varicose veins

Summary. The role of the endothelium to influence smooth muscle contraction in normal and varicose veins was investigated in vitro using saphenous vein preparations obtained at vascular surgery. Paired control and endothelium-denuded rings were tested simultaneously and contracted with noradrenaline (10^-9-10^-4 M). Identical experiments were also performed on sheep femoral veins and arteries. Noradrenaline induced maximal tension was 30% lower in varicose compared to normal veins. In normal veins removal of endothelium significantly reduced the maximal response to noradrenaline by 40% whereas in varicose veins no significant reduction could be seen. In the sheep femoral vein removal of the endothelium also resulted in decrease of noradrenaline-induced contraction. It can be concluded that in the human saphenous vein the endothelium has a contraction facilitating effect in response to stimulation with noradrenaline. In varicose veins the endothelial-mediated enhancement of noradrenaline-induced vasoconstriction is reduced probably because of endothelial damage. This observation may be of importance in the pathogenesis of varicose veins.     

Venipuncture-induced causalgia: anatomic relations of upper extremity superficial veins and nerves, and clinical considerations

BACKGROUND: In 1994, 11 patients with injury to upper extremity cutaneous nerves after routine venipuncture were reported. All developed causalgia (Complex Regional Pain Syndrome, Type 2). Nerve injury appeared secondary to direct trauma via "inappropriate" needle or bolused material entry into the plane of the nerves beneath the veins, or nerves overlying the veins. However, in 3 of 13 additional patients, the venipunctures were properly performed and atraumatic. STUDY DESIGN AND METHODS: To explore the anatomic relationships of superficial veins and cutaneous nerves with regard to the role of direct nerve trauma during venipuncture in the development of causalgia, the 14 upper extremities of seven randomly chosen cadavers were dissected at three common venipuncture sites. In addition, the clinical features of all 24 patients are presented. RESULTS: Major branches of cutaneous nerves were superficial to and overlay veins in six extremities. In multiple instances, nerves and veins were intertwined, requiring detailed dissection to separate them. In the classic situation, nerves were immediately as deep as veins, often with no fascial separation. CONCLUSIONS: Anatomical relationships between upper extremity superficial veins and cutaneous nerves are so intimate that needle-nerve contact during venipuncture is common. Because venipuncture-induced nerve injuries are rare, factors other than direct nerve contact appear necessary for the chronic pain syndrome to occur.     

Effect of lumbar elevation on dilatation of the central veins in normal subjects

Background

Increasing the size of the central veins is required to increase the success rate of central line placement and decrease complication risk. Right-sided approach for the central veins, Valsalva maneuver, and Trendelenburg position have been recommended, but these may not be available for some cases. This study aimed to determine a more convenient patient position that can result in the largest central vein diameter.

超声评估下肢浅静脉手术后深静脉瓣膜功能变化

目的 应用超声评估下肢浅静脉手术改善深静脉瓣膜功能的程度及其影响因素.方法 60例住院治疗的下肢原发性深静脉瓣膜功能不全的患者(70条患肢),术前经彩色多普勒超声检查深静脉血流动力学指标,术后6个月对患者进行超声随访,比较手术前后深静脉瓣膜功能的改善程度.结果 下肢浅静脉手术后深静脉瓣膜功能的总体改善率为65.7%,股浅静脉和腘静脉的瓣膜功能亦均得到了改善,且二者在改善程度上没有差异.激光腔内闭合术与大隐静脉高位结扎剥脱术对深静脉反流的改善程度无差异.结论 超声检查可用于下肢浅静脉手术改善深静脉瓣膜功能的评估.     

超声新技术在浅表器官中的应用

超声新技术的应用不仅可提高超声诊断的准确性,弥补常规超声的不足,同时为介入性超声精确定位和疗效评估提供了新的方法;而且可为临床科研和教学提供新的方向和领域。超微血流成像和新型剪切波弹性成像技术在乳腺、甲状腺、淋巴结等浅表器官的应用成为目前研究的热点。     

循证护理对神经外科围手术期患者预防下肢深静脉血栓形成的影响

目的 探讨循证护理干预对神经外科围手术期患者预防下肢深静脉血栓形成的影响研究.方法 将109例神经外科围手术期患者随机分为观察组55例,对照组54例.观察组实施针对下肢深静脉血栓形成的诱发因素给予循证护理干预,对照组给予手术前后的常规护理指导.比较两组患者术后下肢深静脉血栓形成发生率、危险因素、复发率及术后健康状况等.结果 下肢深静脉血栓形成的发生率、危险因素、复发率观察组明显低于对照组(P<0.05),术后健康状况明显优于对照组(P<0.05).结论 循证护理干预对神经外科围手术期患者预后有良好的促进作用,有效降低下肢深静脉血栓形成的复发,是一种行之有效的护理方法.     

超声检查附脐静脉开放腹壁静脉曲张在门静脉高压临床分型的意义

目的应用彩色多普勒超声对门静脉高压附脐静脉开放和腹壁静脉曲张门腔之间侧支循环进行研究,确定门脉高压分型。方法超声检查86例肝硬化门静脉高压、13例布加综合征及6例门静脉主干、脾静脉血栓3组门静脉高压患者的腹壁静脉曲张门腔之间侧支循环吻合情况及血流方向。结果肝硬化门静脉高压组腹壁静脉曲张在脐以上血流流向头端,而脐以下血流流向腹端。布加综合征合并下腔静脉阻塞组,血流均流向上胸端。门静脉主干、脾静脉血栓未见脐静脉开放及腹壁静脉曲张。结论应用彩色多普勒超声判断附脐静脉开放和腹壁静脉曲张门腔之间侧支循环的情况,可明确血管阻塞部位、程度、范围,为肝前、肝内及肝后门静脉高压分型的诊断提供有效依据,对临床制定合理治疗方案具有指导意义。     

经尿道等离子体双极电切治疗浅表膀胱肿瘤29例

目的探讨经尿道等离子体双极电切术治疗浅表膀胱肿瘤（PKRB t）的安全性与有效性。方法应用美国AM-C I公司的经尿道等离子体双极电切系统行浅表膀胱肿瘤切除术29例。患者男22例,女7例,年龄33-72岁,平均54.8岁。多发肿瘤7例,单发肿瘤22例,膀胱侧壁有肿瘤分布者20例。结果经尿道膀胱肿瘤等离子体双极电切术手术时间15-65 m in,平均30 m in。无经尿道电切综合征;18例侧壁肿瘤切除时,5例发生闭孔神经反射,但无膀胱穿孔,所有患者术后随访1-33个月,7例复发,均再行PKRB t。结论PKRB t是一种安全、有效的手术方式。闭孔神经反射是PKRB t常见并发症之一。     

Long-pulsed Nd:YAG 1064 nm in the treatment of leg veins: Check up of results at 6 months in 100 patients

This study assessed at 6 months, subjectively and objectively, the efficacy of a long-pulsed Nd:YAG laser system in clearing leg veins.

A hundred female patients (25–60 y.o., skin types II–IV) with leg vein varicosities were treated with single pulse shots by a long-pulsed 1064 nm Nd:YAG laser, with 3, 5, 7 and 10 mm spot size diameters with related energies at 130, 120, 110 and 100 J/cm², and pulse lengths of 20, 30, 40 and 50 ms, respectively.

One or two treatments were given at 2-month intervals, with post-treatment assessments at 6 months. Patients subjectively assessed the treatment and their results were used to identify a satisfaction index (SI). Objective assessment was based on clinical photography and computer-generated data from a vein clearance detection program.

The overall patient satisfaction rate was 57% and objective assessments based on the clinical photography and computer assessment were 64% and 71%, respectively.

The Nd:YAG 1064 nm long-pulsed laser offered efficient treatment of leg veins irrespective of skin phototypes and results were better on blue and thick vessels. Side effects were minimal and transient.     

高频超声显示浅表神经源性肿瘤相连神经的价值

目的 探讨高频超声对浅表部位神经源性肿瘤连接神经的显示价值,以提高超声对神经源性肿瘤的诊断准确性.方法 对35 例外周神经源性肿瘤进行回顾性分析,探讨连接神经的声像图特点、超声显示率,及其与周围组织的鉴别.结果 35例40个神经源性肿瘤,经病理证实共32个神经鞘瘤,8个神经纤维瘤.其中38个肿瘤显示相连神经,两端均可显示的24个,肿瘤相连神经纵切面表现为中低回声暗带,周边可见线形高回声,接近肿瘤时逐渐膨大,呈三角形.结论 ①高频超声对浅表部位神经源性肿瘤的连接神经有较高的显示率,对鉴别神经源性肿瘤与非神经源性肿瘤有较好的帮助.②掌握神经周围的解剖结构及声像图特征,可以提高连接神经的显示率.③观察肿瘤与神经的连接方式有助于鉴别神经鞘瘤与神经纤维瘤.