股动脉医源性抽剥伤行大隐静脉重建1例术后护理

大隐静脉曲张高位结扎抽剥术是普通外科的常规手术 ,将股动脉误作大隐静脉行高位结扎抽剥者实属罕见。我科于 2 0 0 1年 11月收治 1例 ,采用对侧大隐静脉重建股动脉获得成功 ,保全了肢体 ,现将护理体会报告如下。1　临床资料患者 ,男性 ,5 7岁。入院前 12h因“右侧大隐静脉曲张     

大隐静脉解剖变异1例

作者见到1例大隐静脉解剖变异,报告如下。 患者男性,44岁。因双侧大隐静脉曲张行大隐静脉高位结扎加剥脱术,术中见左侧大隐静脉自股中部分为直径相似的3支上行。主干穿筛筋膜入股浅静脉,另2支以不同高度各与主干成10～15°角     

大隐静脉与股静脉交汇点解剖变异1例报道

我们在行右下肢单纯性大隐静脉高位结扎＋分段抽剥术时,发现大隐静脉与股静脉交会点变异,特报道如下。     

大隐静脉射频消融术与大隐静脉高位结扎剥脱术治疗静脉曲张的疗效对比

目的比较大隐静脉射频消融术和大隐静脉高位结扎剥脱术治疗静脉曲张的临床疗效。方法回顾性分析2018年9月至2019年5月江苏省中医院收治的70例(93条患肢)下肢大隐静脉曲张患者的临床资料,将行大隐静脉射频消融术和高位结扎剥脱术治疗的患者分别设为观察组和对照组,每组35例(对照组43条患肢,观察组50条患肢)。对比分析2组患者手术时间、恢复时间、切口数量、术后VAS疼痛评分等手术相关情况,比较2组患者手术前后CEAP分级、临床疗效、术后并发症、术后生活质量和满意度评分。结果与对照组相比,观察组所需手术时间、术后首次下床时间、住院时间及恢复时间较短,术中出血量、切口数量较少,术后VAS疼痛评分较低;2组患者CEAP分级构成在术后均比术前显著降低;观察组患者术后并发症总发生率显著低于对照组;观察组患者术后生活质量总评分及各项评分均显著高于对照组;观察组患者对治疗方法的整体评价高于对照组,以上差异均具有统计学意义(P<0.05)。结论大隐静脉射频消融术与大隐静脉高位结扎剥脱术疗效相当,但射频消融术有操作简单、创伤小、恢复快、并发症少且美观等优势,同时可减轻患者痛苦,显著改善术后生活质量,提高患者满意度。     

次高位大隐静脉结扎联合属支电凝术与传统静脉曲张手术的对比研究

目的：探讨次高位大隐静脉结扎联合自制套管针电凝术治疗大隐静脉曲张的优越性。方法将单下肢大隐静脉曲张患者81例分成改良组(28例)和传统组(53例),分别接受传统手术即大隐静脉高位结扎剥脱术和次高位大隐静脉结扎联合自制简易套管针电凝术,观察疗效。结果改良组的手术时间、出血量、切口数量、切口总长度均小于传统组;术后生活质量评分(CIVIQ)高于传统组,<0.05。结论次高位大隐静脉结扎联合自制简易套管针电凝术即剥除了大隐静脉主干,同时彻底治疗了属支静脉,简便易操作,创伤小恢复快,更加美观,体现了外科的微创发展方向。     

大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢深静脉瓣膜功能不全的临床疗效

目的探讨大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢深静脉瓣膜功能不全(DVVI)的临床疗效。方法回顾性分析2016年1月至2017年10月蚌埠医学院附属阜阳医院收治的457例下肢DVVI患者的临床资料,根据手术方式的不同分为观察组(236例)和对照组(221例)。观察组患者行大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗,对照组患者仅行大隐静脉高位结扎剥脱术治疗。通过彩色多普勒超声检查分析患者术后2周、2年的静脉管径值、平均血流速度及Valsalva试验下血液反流持续时间,利用单因素和多因素Logistic回归分析DVVI患者术后复发的危险因素。结果术后2周观察组患者静脉管径值和反流持续时间均短于对照组,平均血流速度则高于对照组,差异有统计学意义(P 0. 05);术后2年观察组患者平均血流速度高于对照组,而静脉管径值和反流持续时间短于对照组,差异有统计学意义(P 0. 05)。观察组复发率为6. 36%,低于对照组的15. 84%,差异有统计学意义(P 0. 05)。经单因素分析,复发与患者年龄、术前CEAP分级、穿戴TED弹力袜时间、阿司匹林肠溶片依从性、GSV属支残留和股浅静脉带戒术有关(P 0. 05)。多因素Logistic回归分析显示,年龄≥50岁(OR=5. 953)和GSV属支残留(OR=12. 167)是术后复发的独立危险因素(P 0. 05),而股浅静脉带戒术是术后复发的独立保护因素(OR=0. 728,P 0. 05)。结论大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢DVVI的疗效显著,在改善患者血流动力学方面更具优势,复发率更低。     

大隐静脉传统剥脱术与激光治疗大隐静脉曲张的临床对比分析

目的：比较大隐静脉曲张的传统剥脱术和激光治疗术的治疗效果。方法大隐静脉曲张患者(双侧)36例随机分为两组,每组18例,一组行大隐静脉传统剥脱手术,另一组行大隐静脉高位结扎联合激光腔内闭合术。比较两组术中术后出血量、切口长度、术后住院时间和术后并发症发生率。结果激光治疗组的术中术后出血量、切口长度、术后住院时间较传统静脉剥脱组显著减少(P<0.05)。但两组患者的术后并发症的发生率差异无显著意义(P>0.05)。结论大隐静脉高位结扎联合激光腔内闭合术治疗大隐静脉曲张是一种安全有效的微创手术方法。     

高位加分段结扎治疗大隐静脉曲张

高位加分段结扎治疗大隐静脉曲张高位加分段结扎大隐静脉曲张术，是将大隐静脉及汇集支分别结扎切断，阻断了股静脉内的血液倒流；分段结扎将静脉腔分隔成数段，使血流阻隔，令其静脉血通过交通支汇入深静脉，使大隐静脉废用萎缩。山东临沂矿务局中心医院用该法治疗１６例...     

血管移植修复掌浅弓缺损的研究进展

目的 探讨不同部位血管移植修复掌浅弓血管缺损的研究进展。方法 以“vascular system injuries” “superficial palmar arch” “vascular grafting” “vein grafts” “arterial graft”和“血管系统损伤”“掌浅弓”“血管移植术”“静脉移植”“动脉移植”作为关键词,限定语言种类为英文和中文,在PubMed、中国知网和万方数据库检索2016年12月之前发表的有关掌浅弓缺损后应用血管移植修复的相关文献,进行归纳总结。结果 临床上对于严重外伤所致的掌浅弓缺损,主要采用浅静脉移植和小动脉移植两种方式进行重建。不同的修复方式具有不同的优缺点:足部静脉移植多采用端侧吻合的方式,可提供足够多的吻合口,但手术操作难度较大;Y型静脉移植多将移植血管串联桥接,优点是远端可提供多个吻合端口,但手术繁复,桥接后的血管远近端口径与受区血管口径相差较大;前臂静脉网移植可以解决供受区血管不匹配难题,但血管网解剖不恒定,增加了手术切取难度;手背静脉弓形态、口径与掌浅弓相近,手术切取及吻合操作均较容易,而瓣膜阻挡及手背瘢痕明显是其缺点;足背浅静脉弓移植修复掌浅弓缺损,可以解决供受区远、近端血管口径不匹配、数目不等难题,但瓣膜阻挡血流一直是困扰着临床的难题;小动脉移植修复掌浅弓缺损,临床效果可靠,缺点是对供区肌肉血供有一定影响。结论 应用血管移植可以重建缺损掌浅弓的连续性,恢复远端手指血液供应;不同部位血管移植修复缺损掌浅弓的手术方式及手术繁易程度存在差异,并均有一定缺陷;临床上寻找一种新的、适宜的血管供区,是血管移植重建掌浅弓缺损的研究方向。     

预防大隐静脉术中股静脉损伤的应用解剖

目的 :探讨大隐静脉术中可能造成股静脉损伤的解剖学因素 ,并提出相应的预防措施。方法 :对 5 2条患肢和 40条下肢标本的隐静脉裂孔及大隐静脉根部的局部解剖结构进行观察与测量。结果 :隐静脉裂孔形态以卵圆形和盾形者为主 ,其纵径 (40 .0± 12 .0 )mm ,横径 (2 8.0± 9.0 )mm ,大隐静脉根部属支以 3或 4支为多见。结论 :根据隐静脉裂孔特点及属支解剖情况 ,作者认为 :①切口要足够大 ;②正确识别解剖层次 ;③掌握正确的高位结扎部位。是防止术中股静脉损伤的关键。     

Histochemical studies on the autonomic innervation of the femoral artery and vein

Summary The innervation of the femoral artery and vein in the dog was studied using: a) glyoxylic acid fluorescence (for the histochemical localization of adrenergic nerve fibers); b) acetylcholinesterase (for the histochemical localization of cholinergic nerve fibers).—Andrenergic nerve fibers and related terminals in both vessels are confined to the adventitial-medial transitional zone and the outer layers of the media. Acetylcholinesterase containing nerve fibers are localized in the adventitial-medial transitional zone of the femoral artery. These findings may indicate the presence of a cholinergic vosodilatator system in the control of the circulation in the femoral artery.     

Anatomic study of femoral vein occlusion during simulated hip arthroplasty

Summary An anatomic study was undertaken to establish whether positioning of the leg and surgical approaches for total hip replacement (THR) cause changes in the femoral v. which may contribute to the development of deep vein thrombosis (DVT). The patency of 32 femoral vv. of 18 cadavers was inspected at different levels during simulated THR. Before and after removal of the femoral head through a transgluteal or posterior approach, a wide-angle endoscope was inserted into the femoral v. via the external iliac v. Blood flow was simulated by proximal irrigation with saline through the popliteal v. After removal of the femoral head distinct changes were observed in both approaches. In the transgluteal approach the changes were dependent on the degree of adduction and the body build of the cadaver. Initially, an oval form was seen in a constricted lumen with an increasingly oblique oval deformation and a final facet-like closure, usually at about 5 to 7.5 cm below the inguinal ligament. In total adduction this stenosis occured regardless of build. Using a posterior approach, the necessary internal rotation caused a closure of the vein in 50% of cases. In combination with flexion and adduction there was stenosis in all cadavers regardless of body build. Our results indicate that the duration of the adducted position of the thigh during THR via a transgluteal approach should be minimised, as there is a reduction in blood flow with even minor degrees of adduction. In the posterior approach the stenosis occurs earlier, and is independent of the build of the cadaver.

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Étude anatomique de la sténose de la veine fémorale au cours des arthroplasties totales de hanche

Résumé L'étude anatomique a été réalisée pour établir la relation entre les différentes positions du membre inférieur au cours des arthroplasties totales de hanche et la survenue d'une thrombose veineuse profonde. Cette étude a été réalisée sur 18 cadavres, dont 32 vv. fémorales ont pu être examinées à différents temps de l'arthroplastie totale de hanche, avant et après ablation de la tête fémorale, par voie trans-glutéale ou par voie postérieure. Un endoscope (grand angle) a été introduit dans la v. fémorale par la v. iliaque externe. Le flux sanguin a été simulé par irrigation antérograde avec du sérum salé à travers la v. poplitée. Après l'ablation de la tête fémorale, il a été noté des différences significatives entre la voie d'abord trans-glutéale et la voie d'abord postérieure pour ce qui concerne l'aspect de la lumière de la v. fémorale et le flux sanguin. En ce qui concerne la voie trans-glutéale, ces modifications dépendaient du degré d'adduction et de la corpulence du cadavre. L'aspect de la lumière de la v. fémorale était initialement ovale, puis évoluait progressivement vers la sténose complète qui se situait à peu près entre 5 et 7,5 cm audessous du ligament inguinal. En adduction complète de la cuisse, la sténose se produisait, quelle que soit la corpulence du cadavre. En ce qui concerne la voie d'abord postérieure, la rotation médiale, indispensable à l'accès pour la mise en place de l'élément prothétique fémoral, causait une sténose de la v. fémorale dans 50% des cas. En ce qui concerne la combinaison des mouvements d'adduction et de flexion de la hanche, elle était responsable d'une sténose de la v. fémorale dans tous les cas, et ceci quelle que soit la corpulence du cadavre. Nos résultats indiquent que le durée de la position d'adduction de la cuisse durant l'arthroplastie totale de hanche par voie transglutéale devrait être diminuée car la réduction du flux sanguin dans la v. fémorale survient, même pour des petits degrés d'adduction. Dans la voie d'abord postérieure, la sténose survient plus tôt, elle ne dépend pas de la corpulence du cadavre.

     

纳米载体在大鼠深静脉急性血栓治疗中的实验研究

目的 探索新型溶栓方式——使用纳米级载体辅助组织性纤溶酶原激活剂（t-PA）进行溶栓,并与t-PA治疗比较溶栓效率。方法 30只SD大鼠分成3组,每组10只,分别为生理盐水组（生理盐水0.1 mL）、单纯溶栓药物组（t-PA 0.1 mL）和载药纳米载体组（载有t-PA的载体）。采用麻醉动物、手术切开、三氯化铁浸润建立大鼠股静脉急性血栓模型,在氯化铁处理20 min后从远端静脉注射药物,治疗时间均为4 h,每间隔1 h使用激光散斑血流成像系统监测股静脉血流状态。绘制每组样本相对血流量变化曲线,并进行统计学分析。结果 生理盐水组、单纯溶栓药物组、载药纳米载体组的血流灌注恢复率分别为-7.80%、21.36%、60.82%,差异具有统计学意义（P=0.016）,载药纳米载体组中样本治疗后血流量恢复明显升高。结论 与传统溶栓药物治疗t-PA组相比,载药载体组溶栓效率更高,该载体可在血栓治疗中有良好应用前景。     

Force-velocity relations of the portal vein of hyperthyroid rats

Summary The effect of thyroxine on the elementary process of contraction of vascular smooth muscle was tested in 38 hyperthyroid and in 38 control rats. Hyperthyroidism was induced by i.p. injections of triiodthyronine or 1-thyroxine for 2 weeks. By means of afterloaded isotonic contractions of the tetanized portal vein force velocity relations were calculated. There was a slight increase in both the extrapolated velocity of shortening at zero load [from 0.93±0.04 ML/s (control rats) to 1.03±0.04 ML/s (hyperthyroid rats;P<0.05)], and the peak force generation (from 14.8±0.4 mN to 16.1±0.4 mN;P<0.005). The maximum of mechanical power development at a distinct extent of afterload was augmented from 1.35±0.06 W/ML to 1.68±0.06 W/ML (P<0.0005). The influence of thyroxine on the elementary process of contraction in vascular smooth muscle is discussed in connection with the much stronger effect of hyperthyroidism on cardiac muscle contraction.A preliminary report of these results was given at the 48th Meeting of the Deutsche Physiologische Gesellschaft, Regensburg [Pflügers Arch.368, R25 (1977)]     

头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路PICC置管术的影响

目的　探讨头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路上肢外周静脉穿刺中心静脉置管（peripherally inserted central catheters，PICC）操作的影响。 方法　解剖38具（76侧）捐献者遗体，测量和分析上肢外展0 °和90 °时男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角。 结果　头静脉汇入腋静脉或锁骨下静脉的前外侧壁，汇入处管径平均为（7.27±2.94）mm，95%可信区间为6.51~8.03 mm，夹角有锐角、直角和钝角3种类型。上肢外展0 °时，夹角平均为（47.14±27.02）°，95%可信区间为40.97°~63.32°；上肢外展90°时，夹角平均为（63.88±24.26）°，大于上肢外展0°时夹角，95%可信区间为53.96°~65.64°。上肢外展0°时，男、女夹角无明显差异，而上肢外展90°时男性夹角大于女性夹角。上肢外展0°和90°时，左、右侧夹角均无明显差异。 结论　经头静脉入路PICC术时，男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角不影响导管通过，但有少部分人夹角接近或大于90°，尤其男性上肢外展90°可能增加导管通过夹角的难度，操作中需加以注意。     

Role of endothelium in the response of the vein wall to magnesium withdrawal

Complete absence of magnesium has a two-fold effect on the arterial tone: direct smooth muscle contraction and relaxation via endothelium-derived relaxing factor (EDRF) release. In the present study performed on a systemic vein we investigated (1) which of these effects dominates following reduction of magnesium concentration from 1.2 mM to 0.8 and 0.4 mM and (2) whether the vessel segments asymmetrically respond when the magnesium concentration is reduced on either the intra- or extraluminal side. The effects of reducing magnesium concentration on both the isometric tension of isolated ring preparations and the diameter of isolated, perfused and superfused feline femoral veins were investigated. In nor-adrenaline-precontracted rings, rapid decreases in the extracellular magnesium concentration from 1.2 mM to 0.8 and 0.4 mM caused relaxation, whereas total omission of magnesium returned the tone to the level of the initial tone induced by noradrenaline. Both in the presence of haemoglobin (5×10^–6M), and in vessels without endothelium, lowering the magnesium concentration caused a dose-dependent elevation of the noradrenaline-induced tone. In perfused and superfused noradrenaline-contracted vein segments, each reduction of extraluminal magnesium concentration caused contraction of the vessels, regardless of whether the endothelium was intact or not. A decrease in intraluminal magnesium concentration did not alter the diameter of the vessel when the endothelium was intact, but caused contraction when the endothelium was disrupted. The results of the present study demonstrate that both the reduction of magnesium concentration or its complete absence cause an EDRF-mediated relaxation and a directly mediated smooth muscle contraction in the femoral vein of the cat. Within the physiological range of extracellular magnesium concentrations, however, the EDRF-mediated relaxation seems to dominate.