静脉动脉化治疗血栓闭塞性脉管炎

静脉动脉化治疗血栓闭塞性脉管炎莫经刚王明华朱正练林祖潮血栓闭塞性脉管炎是外科难治性疾病，主要发病部位累及中小动脉，发病年龄２０～４０岁之间，病变的动脉管腔狭窄甚至闭塞，至今尚无理想的手术治疗方法，重者最终难免截肢致残。利用静脉动脉化手术重建肢体血液循...     

复合静脉动脉化治疗血栓闭塞性脉管炎疗效观察

１９９０年～１９９５年５年间，作者在动物实验的基础上，采用股两个平面复合静脉动脉化手术治疗动脉以下三分支血栓闭塞性脉管炎（ＴＡＯ）１５例，经临床观察、随访，证实近期症状改善迅速、确切，远期供血持久，避免了引起肢体肿胀与心功能不全的并发症。作者认为复合静脉动脉化手术具有良好的解剖生理基础，提出静脉动脉化时，动脉应选用无病变波及的主干，静脉不应选用与其伴行的深静脉，而应选用远离病变动脉的中小静脉的原则。     

原位大隐静脉动脉化治疗血栓闭塞性脉管炎七例疗效观察

原位大隐静脉动脉化治疗血栓闭塞性脉管炎七例疗效观察林树良，梅建生我院于１９８９年３月至１９９４年５月应用原位大隐静脉动脉化治疗血栓闭塞性脉管炎７例，经随访效果满意，现报道如下。临床资料一、一般资料本组７例均为男性。年龄最小３０岁，最大的４５岁，平均３...     

血栓闭塞性脉管炎的外科治疗

目的:评估治疗血栓闭塞性脉管炎各种外科手术方法的优缺点和适应证.方法:总结了108例外科治疗病例,其中直接动脉重建12例,大网膜移植术16例,静脉动脉化术18例,交感神经切除术72例,其中联合手术14例.结果:6例随访6月～10年,5例因疗效差而截肢,包括直接大网膜移植1例,局部神经切除术2例和腰交感神经切除2例.动脉重建联合静脉动脉化及腰交感神经切除效果最好.结论:原位大隐静脉旁路术及低位深组静脉动脉化术疗效最优,交感神经切除适合早期病变,大网膜移植术对三期患者也有疗效,联合手术互相补充,相得益彰,值得推广.     

一期大隐静脉动脉化治疗下肢血栓闭塞性脉管炎

目的：通过一期大隐静脉动脉化治疗下肢血栓闭塞性脉管炎。方法：通过利用自体头静脉在患肢大隐静脉与患肢股动脉或髂外动脉之间搭桥，为６６例９１侧下肢血栓闭塞性脉管炎患者实施手术。结果：术后下肢缺血性疼痛消失，皮温皮色恢复正常，足趾及跖部创面愈合，多普勒超声探测及动脉造影提示患足血供良好。结论：本术式不影响静脉血回流，简易、经济，效果良好，使用头静脉搭桥可使本术式应用范围更广。     

下肢血栓闭塞性脉管炎的治疗

目的探讨下肢血栓闭塞性脉管炎(TAO)的治疗。方法自1994年3月至2009年2月期间我院对24例患者的26条有严重慢性缺血表现的下肢,经Doppler超声与DSA、CTA或MRA检查,确诊为下肢TAO。根据影像提示的病变部位与程度不同,分别用以下方式治疗:①19例患者(21条下肢)行静脉动脉化手术治疗;②3例患者(3条下肢)行血管腔内介入治疗;③2例患者(2条下肢)行动脉切开取栓手术。结果 19例患者(21条下肢)静脉动脉化术后随访1～14.5年(平均5.6年),13条患肢症状不同程度好转,可基本正常生活。术前ABI为0.38±0.11,术后6个月为0.79±0.08,差异有统计学意义(P0.05)。手术有效率为61.9%(13/21),截肢率23.8%(5/21)。3例患者(3条下肢)行血管腔内介入治疗,其中1条失败后改行低位深组静脉动脉化手术;2例患者(2条下肢)行动脉切开取栓成功;术后随访1～4年(平均1.8年),均无截肢。结论根据病变部位与程度,选择合适的治疗方法是提高疗效的关键。静脉动脉化手术是治疗下肢TAO的有效方法 。     

下肢血栓闭塞性脉管炎影像学分型及疗效分析

目的初步探讨下肢血栓闭塞性脉管炎的影像学分型及临床意义。方法回顾性分析新疆维吾尔自治区人民医院血管外科2006年1月至2014年1月下肢血栓闭塞性脉管炎84例患者影像及临床资料。结果 84例患者影像资料示下肢血栓闭塞性脉管炎分为髂股型(15例)、股腘型(4例)、膝下型(28例)。54例行血管重建术分别为13例行自体大隐静脉搭桥术、4例行球囊血管扩张联合支架置入术、14例行球囊扩张联合置管溶栓术、23例动脉切开取栓术联合干细胞移植术。围手术期2例行膝上截肢术,3例行膝下截肢术,11例行截趾术。随访时间3~40个月,平均(16±12)个月。总体手术成功率70.4%,术后6个月通畅率50%(24/48),12个月通畅率64.6%(31/48)。结论对于有良好远端流出道的患者,首选自体大隐静脉搭桥术,无良好远端流出道的患者可选择球囊扩张术,疗效尚可。对于慢性患者急性血栓形成的患者动脉切开取栓联合干细胞移植是一种可行、有效的方法。     

大隐股浅静脉动脉化治疗晚期血栓闭塞性脉管炎

自１９８７年３月～１９９１年８月共收治晚期血栓闭塞性脉管炎病例１６例，其中８例采用一期大隐静脉动脉化治疗，另８例采用股浅动静脉转流术，二期静脉动脉化，取得良好的效果，报道如下。临床资料本组全部为男性，其中三期一级９例，三期二级５例，三期三级２例，年龄...     

骨髓干细胞移植治疗血栓闭塞性脉管炎5例

目的观察骨髓干细胞移植治疗血栓闭塞性脉管炎(TAO)的疗效。方法采用重组人粒细胞集落刺激因子动员干细胞,采集5例TAO患者自体骨髓干细胞并分离,配成干细胞悬液注射于患肢小腿肌肉。结果治疗6个月后,患肢疼痛、冷感、麻木感症状减轻,平均级别分别下降2.2级、1.4级、2.4级;跛行距离延长,平均下降2.8级;溃疡逐渐愈合,溃疡面积平均下降2.8级;踝肱指数平均升高0.27。患者术后CT血管造影及数字减影血管造影检查可见患肢有新生血管。结论骨髓干细胞移植治疗TAO是一种可行且早期有效的方法。     

Omentum autotransplantation in thromboangiitis obliterans: Report of three cases

Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India of chronic arterial occlusion of the limbs. The current modalities of therapy do not provide adequate relief to a large number of these patients. An omentum autotransplantation to the lower limbs was performed in three patients as a limb salvage procedure. The initial results with up to a year of follow-up are so far encouraging.     

静脉动脉化治疗下肢动脉闭塞症16例报告

应用分期或一期静脉动脉化手术治疗下肢动脉闭塞症。远端无理想流出道１６例、１８条肢体。随访８～４３个月，大部分病人疗效良好。认为术前的动脉造影能显示病变部位与程度，为选择术式提供了依据。一期术式与分期术式相比，有见效快，不需二期手术的优点。还对术式选择与手术并发症进行了探讨     

The effect of bronchiolitis obliterans syndrome on health related quality of life

Bronchiolitis obliterans syndrome (BOS) is the most important factor limiting long-term survival after lung transplantation, and has a substantial impact on patients' daily life in terms of disability and morbidity. Aim of our study was to examine the effects of BOS on health related quality of life (HRQL) in lung transplantation patients. Data on HRQL from 29 patients who developed BOS at least 18 months earlier were studied longitudinally. HRQL measures were: the Nottingham Health Profile (NHP), the State Trait Anxiety Inventory (STAI), the Self-rating Depression Scale (ZUNG), and the Index of Well Being (IWB). Furthermore questions concerning activities of daily life and dyspnea were asked. The majority of the patients were male, and the most common diagnosis was emphysema. After the onset of BOS, significantly more restrictions were reported on the dimensions energy and mobility of the NHP. These restrictions appeared to increase over time. After the onset of BOS, STAI scores remained more or less stable and close to the value of the general population. ZUNG scores were significantly higher after the onset of BOS, and patients experienced a lower level of well being than the general population. The percentage of patients that reported to be able to perform activities of daily life without effort declined dramatically after the onset of BOS. Furthermore, the percentage of patients complaining of dyspnea increased after the onset of BOS. In conclusion, our study showed that HRQL was negatively affected by the onset of BOS. However, in spite of these less favorable long-term results, even patients who develop BOS may at least temporarily benefit from a lung transplantation.     

Clarithromycin for prevention of bronchiolitis obliterans syndrome in lung allograft recipients

Dhillon GS, Valentine VG, Levitt J, Patel P, Gupta MR, Duncan SR, Seoane L, Weill D. Clarithromycin for prevention of bronchiolitis obliterans syndrome in lung allograft recipients.
Clin Transplant 2012: 26: 105–110.
© 2011 John Wiley & Sons A/S. Abstract: Background: Bronchiolitis obliterans syndrome (BOS) is the major limitation to long‐term survival following lung transplantation and strategies to reduce its incidence have remained elusive. Macrolides may stabilize lung function in patients with established BOS. Their role, however, in prevention of BOS remains unexamined. Methods: Survival and BOS‐free survival of 102 lung allograft recipients (LARs), transplanted at a single center between July 1995 and December 2001 who routinely received clarithromycin, were compared with two different control groups. The first control group consisted of 44 LARs from the same center who were transplanted from January 2002 onwards and did not receive clarithromycin. The second control group consisted of a contemporaneous cohort of 5089 recipients, transplanted between 1995 and 2001, reported to the United Network for Organ Sharing database. Results: When compared with the first control group, BOS‐free survival was reduced in LARs receiving clarithromycin. Univariate (hazard ratio [HR] 3.13, p‐value = 0.004) and multivariate (HR 3.49, p‐value = 0.04) analyses showed that routine use of clarithromycin was associated with an increased risk of developing BOS. When compared with the second control group, the five‐yr survival of clarithromycin group was similar (p‐value = 0.24). Conclusions: Routine use of clarithromycin does not delay development of BOS or improve survival.     

Alveolar neutrophilia is a predictor for the bronchiolitis obliterans syndrome,and increases with degree of severity

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is a common complication of lung transplantation (LT), associated with a tremendous mortality and morbidity. Recent innovative research has focused on bronchoalveolar lavage (BAL) analysis, assuming that neutrophilia might be a marker of chronic rejection. PATIENTS AND METHODS: To address this issue, we retrospectively analyzed 258 sequential BAL from 44 lung transplant recipients, having survived for more than 3 months after surgery. RESULTS: At the end of the follow-up, 22, 7, 7 and 8 patients had BOS stage 0, 1, 2 and 3, respectively. The total cell count and neutrophilia increased with BOS severity (P < 0.01). BOS occuring before and after the 12th month of LT were associated with early and more delayed increases of BAL neutrophils, respectively. Finally, the various kinetic profiles of neutrophil progression were identified, allowing for an earlier identification of BOS stages 2 and 3, by 3 and 6 months, respectively. Conversely, neutrophilia associated to BOS stage 1 remained low, and could not be distinguished from that of stage 0. CONCLUSIONS: These results support the possible role of neutrophils in BOS pathogenesis, and may be of interest for an earlier detection and management of chronic rejection.     

呼气相薄层CT诊断异基因造血干细胞移植术后气体潴留及预测闭塞性细支气管炎综合征

目的探讨造血干细胞移植术后闭塞性细支气管炎综合征(BOS)最佳呼气相薄层CT气体潴留评估方法。方法采用三层五分法及视觉评估法两种阅片方法回顾性分析29例造血干细胞移植术后BOS患者呼气相薄层CT表现,对比呼气相薄层CT气体潴留影像学评分对于气体潴留的诊断价值和视觉评估法、三层五分法及肺功能检查(PFTs)3种方法对于BOS的早期预测价值。结果 PTTs分级:17例BOS0,7例BOS-p,2例BOS1,1例BOS2,2例BOS3,PFTs预测BOS发生的敏感度为41.38%(12/29)。三层五分法ROC曲线下面积(0.566)大于视觉评估法(0.485)。三层五分法评估的敏感度为25.00%(3/12),特异度为82.35%(14/17),阳性预测值(PPV)为50.00%(3/6),阴性预测值(NPV)为60.87%(14/23),预测BOS的敏感度为55.17%(16/29);视觉评估法敏感度为41.67%(5/12),特异度为58.82%(10/17),PPV为41.67%(5/12),NPV为58.82%(10/17),预测BOS的敏感度为79.31%(22/29)。结论对于诊断气体潴留,三层五分法的价值大于视觉评估法;对早期预测BOS,视觉评估法的预测价值最高,三层五分法次之,PFTs最小。     

距骨骨折治疗方法的选择及疗效分析

目的：探讨距骨骨折治疗方法的选择并分析其疗效。方法：1998年10月至2009年10月,共治疗距骨骨折患者44例,其中38例获得随访,男28例,女10例;年龄19-65岁,平均33．5岁。采用石膏外固定10例、切开复位内固定22例、I期Blair胫-距-跟融合术6例。按Matti—Weber分型：I型3例,Ⅱ型15例,Ⅲ型16例,Ⅳ型4例。采用Hawkins评定标准通过疼痛、关节活动度、有无跛行等方面进行疗效评估。结果：38例患者的平均随访时间为4．8年（1～11年）。按Hawkins标准,石膏外固定10例中,优4例,良2例,可3例,差1例。切开复位内固定22例中,优2例,良6例。可6例,差8例。其中结果为差的8例,术后3～5年,均实行了Ⅱ期关节融合术,1例术后患肢短缩3em,跛行,患者拒绝进一步治疗,评价为差,余7例效果均为可。I期Blair胫-距-跟融合术6例中,良1例,可4例,差1例。随访期内发现距骨缺血性坏死12例,创伤性关节炎13例。结论：距骨骨折并发症多见且预后欠佳。骨折损伤程度与预后相关。距骨骨折移位小于2mm宜石膏外固定;手法复位后骨折移位大于2mm应切开复位内固定;骨折合并距骨体全脱位或者关节面不能修复的粉碎骨折宜采用Blair胫-距-跟融合术。     

A technique for vascular reconstruction of pancreaticoduodenal allograft. A literature review and case report

In most cases, whole pancreaticoduodenal allograft vessels can be reconstructed using a segment of donor common iliac artery bifurcation. An alternative way to bridge the splenic artery and the superior mesenteric artery (SMA) is to use a short segment of distal SMA as an interposition graft, as described herein.