上肢创伤骨折术前彩色多普勒超声筛查深静脉血栓的意义

目的:探讨上肢创伤骨折术前行血管彩色多普勒超声(color Doppler flow imaging,CDFI)筛查上肢深静脉血栓的意义。方法:回顾性分析2009年1月至2011年12月因创伤致上肢桡尺以上骨折入院拟行切开复位术的1200例患者,男833例,女367例;年龄20～87岁,平均(41.94±15.41)岁。所有患者入院时伤肢肿胀、疼痛,入院后立即对伤肢行夹板外固定等治疗。伤肢肿胀好转后3～10d,拟行骨折复位术前1d,行CDFI检查患者上肢静脉血管,了解上肢深静脉血栓发生情况,分析血栓发生与性别、年龄及骨折部位的关系,并对深静脉血栓患者是否合并糖尿病、高血压、高血脂进行回顾性分析。结果:1200例上肢创伤骨折患者术前经CDFI检查,证实并发DVT9例,血栓发生率为0.75%。血栓发生率女性高于男性(P<0.01);30岁以上年龄组有发生血栓的风险;肱骨段以上骨折患者血栓发生率远高于桡尺骨折;9例血栓患者1例合并高血压、高血脂,1例合并糖尿病,7例无高血压、高血脂及糖尿病。结论:上肢创伤骨折有发生深静脉血栓风险,对上肢创伤骨折患者在有条件的医院术前均应行CDFI筛查上肢DVT,对维护医疗安全、降低医疗纠纷及保障患者生命安全有重要意义。     

高频超声检查在上肢神经损伤中的临床应用

目的 探讨高频超声检查在上肢神经损伤中的应用价值.方法 对31例临床确诊为上肢单根神经损伤患者,根据超声检查分成保守治疗组和手术治疗组.手术组(19例)均行神经探查修复术,并以术中探查结果为准计算术前超声的诊断符合率;保守治疗组(12例)和手术组术后均予口服营养神经药物治疗,定期随访超声检查.结果 保守治疗组早期超声图像表现:神经走行弯曲,但神经外膜清晰可见,局部水肿.手术组术前超声图像表现:神经回声带连续性部分中断或完全中断,损伤区为无回声或低回声结构,神经近端直径增粗.手术组与超声诊断完全符合15例,符合率为78.9%;保守治疗组中10例神经功能恢复良好,2例保守治疗无效而行手术治疗.结论 高频超声检查对上肢周围神经损伤有很好的临床应用价值,并对临床治疗和随访有指导意义.     

彩色多普勒超声评价PICC上肢静脉血栓

目的:探讨彩色多普勒超声检查在评价经外周置人中心静脉导管( PICC)患者发生上肢静脉血栓中的应用价值.方法:对2010年2月-2012年1月期间留置PICC并出现上肢症状的89例患者进行上肢静脉彩色多普勒超声检查,分析声像图特点.结果:89例留置PICC患者中56例(62.9％)的导管位于右上肢,33例(37.1％)位于左上肢.10例(11.2％)患者发生导管相关性上肢静脉血栓,6例位于右侧,4例位于左侧.其中男性7例,恶性血液病3例,肺部恶性肿瘤2例,腹部恶性肿瘤1例,重症肺炎1例;女性3例,均为乳腺肿瘤患者.结论:彩色多普勒超声能方便、快捷、无创地评价留置PICC患者上肢静脉血栓的发生,值得推广.     

三维增强磁共振血管造影在主动脉缩窄诊治中的应用

目的评价三维增强磁共振血管造影（3D CE-MRA）在主动脉缩窄诊治中的临床价值。方法21例主动脉缩窄病人用屏气超快速三维梯度回波序列行3D CE-MRA检查，工作站上三维重建。6例同期行心血管数字减影血管造影（DSA）检查。所有病例均经手术证实。结果21例中单纯主动脉缩窄6例，伴其他心血管畸形或病变15例。3D CE-MRA所显示的主动脉缩窄部位、程度及长度与手术所见一致，并能准确显示心外大血管病变，也易于进行手术前后评价。结论3D CE-MRA能无创、准确诊断主动脉缩窄。对主动脉缩窄整体全貌及侧支血管的显示，有助于临床手术方案的制定。对主动脉缩窄心外大血管病变的诊断可基本取代心血管DSA检查，可作为主动脉缩窄的首选检查方法之一。     

急腹症患者行急诊腹腔镜检查与治疗的临床分析(附364例报告)

目的:探讨急腹症患者行急诊腹腔镜检查与治疗的可行性及应用价值。方法:回顾性分析我院2001年1月至2003年6月收治的364例急腹症患者行急诊腹腔镜检查与手术治疗的临床资料。结果:所有患者入院后早期(6h内)急诊行腹腔镜检查。根据探查所见决定手术方式。其中腹腔镜手术302例,中转手术62例。结论:急腹症患者,各项生命体征平稳能够耐受气腹是急诊腹腔镜探查的适应证,特别对于入院诊断不明确的患者,具有早期诊治,减轻痛苦,缩短住院时间,降低住院费用的优点。     

肠系膜上动脉压迫综合征腹腔镜手术十例

我院于2006年10月至2010年9月行腹腔镜手术治疗肠系膜上动脉压迫综合征患者10例,现报道如下. 资料与方法 1.一般资料:本组10例中男5例,女5例,年龄20～57岁,中位年龄30.5岁.病程10 d至6年(中位时间16个月).多数患者反复发作,缓慢进行性加重.症状包括:餐后恶心、呕吐7例,腹胀、腹痛3例,患者均表现为进行性消瘦,体重下降3～20 kg(中位数10 kg).辅助检查:10例患者均行钡餐造影检查(图1),同时行CT血管造影检查5例、腹部CT检查1例、彩超检查4例,均明确诊断.10例患者全因保守治疗后症状无缓解而行腹腔镜手术治疗.     

上肢动脉闭塞性疾病的外科治疗

目的 总结上肢动脉闭塞性疾病的外科治疗方法及其治疗效果.方法 2000年1月至2011年1月,对7例上肢动脉闭塞性疾病患者术前进行数字减影血管造影(DSA)检查,根据血管病变部位、范围、侧支形成情况,采用腋及上臂部人工血管移植手术3例,自体大隐静脉移植重建肘动脉4例.结果 7例患者经6个月的随诊,移植血管通畅,手部血运改善,其中2例手部慢性溃疡病变自行愈合.结论 针对腋-上臂部肱动脉狭窄性闭塞,采用人工血管移植修复;针对肘动脉及腕部桡动脉闭塞,采用自体静脉移植术均可获得满意效果.术前DSA检查对确认病变部位选择手术方式起重要作用.     

先天性心脏病患儿造影增强磁共振血管成像检查的护理配合

目的探讨对先天性心脏大血管疾病患儿施行造影增强磁共振血管成像(CE-MRA)检查的护理方法。方法对30例先天性心脏大血管疾病患儿进行CE-MRA检查,患儿经镇静制动后,手动静脉注射对比剂0.4mmol/kg,注射后5～10s开始进行造影增强的磁共振血管成像扫描。结果检出法洛四联症12例,主-肺动脉间隔缺损3例,动脉导管未闭8例,先天性主动脉弓缩窄畸形2例,先天性主动脉弓缩窄畸形伴动脉导管未闭5例。图像质量优28例,良2例。结论 CE-MRA检查可获得精确的影像资料。检查前采用6%水合氯醛保留灌肠镇静制动,正确选择血管建立静脉通道,准确掌握推注造影剂和扫描延迟时间,可保证检查的顺利完成,为临床诊断提供优质的影像图像。     

背阔肌皮岛移位重建肩外展功能一例

患者因外伤后2个月左上肢不能外展及上举入院。检查:三角肌萎缩,肩外展功能完全丧失。诊断为腋神经损伤。于1988年8月10日行带血管神经蒂背阔肌皮岛移位代三角肌术。术中将萎缩的三     

头静脉原位转流治疗腋杖致腋肱动脉闭塞一例

患者女,58岁.因“右上肢冷痛1d,加重伴麻木4h”于2010年3月5日入院.既往因小儿麻痹症致右下肢行走障碍,使用双侧腋杖40余年.查体:心率86次/min,律齐,左上肢血压120/63 mm Hg(1 mmHg=0.133 kPa);右上肢血压未测出,右侧尺、桡动脉搏动消失,皮温较对侧低,肌力Ⅳ级.彩超提示:右侧腋肱动脉闭塞.右上肢CT 血管成像(CTA)提示:右腋肱动脉节段性闭塞(图1).术前诊断:右侧腋肱动脉急性栓塞.急诊行右肱动脉切开取栓术.     

腹腔镜技术在肠道血管畸形急性出血中的应用体会

目的:探讨腹腔镜技术诊治肠道血管畸形急性出血的临床价值。方法:回顾分析为13例保守治疗无效的小肠血管畸形急性出血患者行腹腔镜辅助手术的临床资料。结果:13例患者术前选择性行肠系膜数字减影血管造影(digital sub-traction angiography,DSA)。造影定位下行腹腔镜辅助小肠部分切除吻合术10例,回盲部切除末端回肠造口术1例;术中造影无法明确,内镜协助探查明确出血部位,腹腔镜辅助下行小肠切除吻合1例;导管造影及内镜协助探查均无法明确出血部位,行小肠双口造瘘观察1例。12例痊愈出院,1例死亡。结论:DSA及术中造影是诊断小肠出血并准确定位的有效方法,为外科手术提供了正确的定位。DSA及术中造影准确定位后行腹腔镜辅助手术切除病变肠段安全、有效。     

四肢骨骼肌肌内血管瘤的诊断与治疗

目的：探讨CTA和MRI在四肢骨骼肌肌内血管瘤的诊断和治疗中的价值,以及手术治疗的疗效。方法：2003年4月至2011年2月,采用手术切除或密集环形缝扎方法治疗18例四肢骨骼肌内血管瘤患者。其中男8例,女10例;年龄5～28岁,平均12.5岁;病程1～5年。主要症状为易变性肿物和疼痛,部分有多次破溃出血史。18例行MRI检查,11例同时行CTA检查,证实为骨骼肌内血管瘤。据肿块变化、疼痛、复发3方面情况评价手术效果。结果：18例分布情况：上肢6例,下肢12例。病理分型均为血管畸形,其中毛细血管型畸形13例,静脉型畸形4例,动静脉瘘型畸形1例。18例随访时间为6个月～2年,平均8.8个月。术后显效15例,有效2例,不满意1例。结论：CTA和MRI对四肢骨骼肌内血管瘤诊断符合率高,CTA三维立体解剖成像,对确定最佳的手术入路、保护重要血管以及处理瘤体供应血管有重要的价值。在肌肉侵犯的术前判断及手术方式决策上,MRI较CTA更有价值。     

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目的 分析先天性血管畸形的治疗经验。方法 从1995年7月至2003年5月上海第二医科大学附属第九人民医院共治疗先天性血管畸形204例，其中先天性动静脉瘘58例，海绵状血管瘤72例，静脉畸形骨肥大综合征74例。先天性动静脉瘘采用手术、栓塞和手术联合栓塞等方法进行治疗；海绵状血管瘤采用手术和手术联合Nd：YAG激光治疗；静脉畸形骨肥大综合征采用保守治疗、外侧畸形静脉和曲张静脉切除、受压的深静脉段松解和胭动脉分支结扎等治疗。结果 经过治疗的先天性血管畸形大部分在临床均能取得一定的疗效，部分病人症状复发甚至加重。结论 先天性血管畸形的治疗仍是临床所面临的难题之一，积极的并根据病情所采用的个体化和联合的治疗方法是非常必要的，常可取得一定的临床效果。     

人工血管移植动静脉瘘术后超声检测价值

目的 探讨彩色多普勒超声对人工血管移植动静脉瘘及其并发症的检测价值.方法 对18例人工血管移植动静脉瘘术后4～6周的患者,应用彩色多普勒超声测量动脉侧吻合口和移植人工血管动脉端内径、峰值流速和血流量,同时对上肢出现不适症状患者进行超声检测.结果 术后4～6周彩色多普勒超声显示吻合口和移植人工血管血流充盈良好,动脉侧吻合口内径、峰值流速和血流量分别为(3.61±0.68)mm、(298.56±93.42)cm/s、(583.62±216.77) ml/min;人工血管动脉端内径、峰值流速和血流量分别为(4.47±0.61)mm、(219.37±68.42)cm/s、(325.23±117.12)ml/min.7例患者手术侧上肢出现不适症状,超声检查发现1例血清肿;3例移植血管血栓;1例假性动脉瘤;2例单纯性皮下组织水肿.结论 超声对人工血管移植动静脉瘘术后人工血管及其并发症的检测有重要的临床应用价值.     

Composite hemangioendothelioma: report of 5 cases including one with associated Maffucci syndrome

Composite hemangioendothelioma (HE) is a low-grade malignant vascular tumor showing varying combinations of benign, low-grade malignant, and malignant vascular components. The predominant histologic components are histologically identical to epithelioid HE and retiform HE. To our knowledge, there have been only 12 cases of composite HE reported in the English literature and its nature and biologic behavior remains unknown. In this study, the clinicopathologic and immunohistochemical features of 5 cases of composite HE including a case with associated Maffucci syndrome are described. The patients were 4 females and 1 male with a median age of 43.4 years (range, 22 to 75 y). All tumors occurred in the dermis and/or subcutis. The tumors arose in the foot or lower leg in 3 patients, in the jaw in 1 patient, and as multiple tumors in the left upper extremity in 1 patient. Two patients had congenital tumors, in the lower thigh and foot, and upper extremity, respectively. The lesions were usually of several years duration. The size of individual tumors ranged from 1.5 to 30 cm. The tumors were composed of a complex admixture of histologic components resembling various vascular lesions. The predominant components, present in all cases, resembled retiform HE and epithelioid HE. Angiosarcomalike areas were observed in 3 cases. Lymphangiomalike areas were found in 2 cases. Areas of spindle cell hemangioma, cavernous hemangioma, or arteriovenous malformation were identified in 1 case each. The 2 congenital cases, which exhibited multiple lesions, had angiosarcomalike components and an angiomatosislike growth pattern. One patient each was associated with Kasabach-Merritt or Maffucci syndrome. Immunohistochemically, all tumors showed expression of at least 2 endothelial markers (CD31, CD34, and/or factor VIII-related antigen). Of 4 cases with follow up (median duration, 8.6 y), 1 tumor recurred locally. To date, none of the patients have developed metastases. There was no difference of biologic behavior among cases with various combinations of histology in this study and previously reported cases. We conclude that composite HE should continue to be regarded as a low-grade malignant vascular tumor (HE), with significant potential for local recurrence, but little if any potential for distant metastasis.     

Surgical treatment for congenital arteriovenous malformation: 10 years' experience.

OBJECTIVES: We report our 10 years experience of the surgical treatment of congenital arteriovenous malformation (AVM). METHODS: We retrospectively reviewed the medical records of 145 patients with AVM who visited Samsung Medical Center in Korea from 1994 to 2003. Among the 145 patients, 21 patients were operated on. Preoperative embolo/sclerotherapy was done in 20 out of the 21 patients. RESULTS: The surgically treated AVMs were 13 cases of head and neck lesions, four cases of upper extremity lesions, one case each of back lesion, uterus lesion, lower extremity lesion and multiple site lesions. There were 10 patients with the extratruncular infiltrating type, nine patients with the extratruncular limited type, one patient with a truncular superficial AV fistula and one patient with a mixed type. Fourteen cases were operated on for cosmetic reasons and since they had localized lesions, and five cases were operated on for tissue necrosis. Fourteen cases were cured by a single operation, yet seven cases needed several sessions of operation to cure the AVM or to promote wound healing after surgery. CONCLUSION: The surgical treatment of AVM is a challenging issue for vascular surgeons. To minimise the complications related to surgery, a multidisciplinary team approach should be considered.     

Nuclear magnetic resonance imaging: its diagnostic value in patients with congenital vascular malformations of the limbs

Congenital vascular malformations (CVMs) of the limb include simple and cavernous hemangiomas, microarteriovenous and macroarteriovenous fistulas, venous angiomas, and mixed CVMs. In differentiating these lesions, Doppler waveform analysis, labeled microsphere studies, arteriography, closed-space phlebography, and contrast-enhanced CT scans have all been advocated, but each has significant limitations. This article evaluates the ability of magnetic resonance imaging (MRI) in characterizing CVMs. Limb CVMs were evaluated by MRI in eight patients: four in the upper and four in the lower extremity. Before MRI, seven of the patients had arteriography, five had phlebography, and five had Doppler waveform analysis. MRI showed a highly cellular network with little arteriovenous flow in five patients. In four of these, arteriography and phlebography confirmed the presence of a predominantly venous or microfistulous anomaly. In the other three patients, MRI demonstrated high-flow arterial and venous channels and were confirmed by arteriography to have macrofistulous arteriovenous malformations. In all eight patients, MRI revealed the anatomic location and the longitudinal and transverse extent of the vascular malformation as well as their relationships with contiguous muscle groups, bones, and vessels. We conclude that CVMs of the limbs can be characterized accurately with MRI, with the anatomic extent, degree of cellularity, and flow characteristics readily gauged. Because MRI provides the same basic information supplied by angiography and the noninvasive laboratory and assesses anatomic extent and cellularity, it serves well as the primary diagnostic test for suspected CVMs, particularly in infants and children in whom competitive tests pose additional limitations.     

Intraventricular cavernous hemangioma: report of three cases and review of the literature

The clinical and radiographic presentations of 3 patients with intraventricular cavernous hemangioma are described. The accumulated total of 19 cases from the literature are compared to determine whether there is a common clinical and radiographic presentation for this benign intraventricular lesion. The differential diagnosis of intraventricular cavernous hemangioma includes intraventricular meningioma, choroid plexus papilloma, arteriovenous malformation, low grade astrocytoma, and ependymoma.     

肝切除术治疗肝血管瘤72例临床分析

目的：探讨肝血管瘤的诊断、手术指征及外科治疗效果。 方法：回顾性分析2005年8月至2010年8月经手术证实的71例肝海绵状血管瘤和1例毛细血管瘤的临床资料。 结果：右半肝切除13例,左半肝切除5例,左外叶切除16例,尾叶切除8例,肝中央叶段切除14例,肝段切除10例,联合肝段切除6例,预防性胆总管切开、T管外引流3例。术中第一肝门阻断49例,阻断时间8~42 min,平均（19.2±10.5）min;全肝血流阻断18例,阻断时间10~40 min,平均（18.6±11.2）min。所有手术病例过程顺利,切除标本直径5~22 cm,无手术死亡。术后并发症：胸腔积液11例,肺部感染1例,切口感染1例。69例随访5个月至6年,无复发。 结论：严格把握手术指征的前提下,应用肝切除术治疗肝血管瘤是安全有效的。     

葡萄糖转运蛋白-1在血管瘤和血管畸形中的表达及其意义

目的检测葡萄糖转运蛋白-1(glucose transporter-1,Glut1)在血管瘤和血管畸形组织中的表达并探讨其意义。方法各阶段婴幼儿血管瘤标本52例、海绵状静脉畸形25例、动静脉畸形9例、毛细血管畸形2例、正常皮肤软组织5例。应用En Vision法免疫组化染色检测Glut1在上述标本中的表达。结果增生早期,较多血管瘤内皮细胞表达Glut1;增生中期,绝大部分微血管内皮细胞和散在分布的内皮细胞表达Glut1;增生晚期,Glut1表达迅速减弱;消退期血管瘤微血管内皮细胞不表达Glut1。所有海绵状静脉畸形、动静脉畸形、毛细血管畸形、正常皮肤软组织中的小动静脉和微血管均不表达Glut1。结论Glut1是血管瘤内皮细胞发展过程中的一种表型,而不是其固有特征,Glut1表达是血管瘤内皮细胞适应代谢需要而产生的。