感染性假性动脉瘤血管处理方式的选择

目的探讨对于注射吸毒导致的感染性假性动脉瘤血管手术方式的选择。方法对我院2005年8月~2008年2月收治的17例注射吸毒导致的假性动脉瘤患者进行总结。全部患者均行手术治疗,血管处理的方法有：8例行人工血管旁路转流,4例自体大隐静脉原位转流,1例动脉修补,4例股动脉结扎。结果17例中有1例死亡。1例术后并发动脉吻合口瘘,再次手术修复吻合口成功。术后随访15例：人工血管阻塞2例,其中有1例出现下肢缺血症状。动脉结扎的病例有1例手术后2月出现下肢坏死而截肢。至少6例在术后出现毒品复吸。结论注射吸毒所致的感染性假性动脉瘤的血管处理须依据多种因素综合判断而定,总体疗效满意。     

Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent “chocking” of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV. Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor’s right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1), left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure. Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.     

解剖外旁路治疗注射毒品所致股动脉感染性假性动脉瘤

目的总结解剖外旁路治疗注射毒品所致股动脉感染性假性动脉瘤的外科治疗经验。方法回顾性分析我院2000年1月至2009年12月期间31例因注射毒品引起的股动脉感染性假性动脉瘤并接受解剖外旁路手术的患者临床资料,对破口部位、瘤体大小、手术方式以及疗效进行比较。结果 22例行倒置自体大隐静脉解剖外旁路手术,9例行ePTFE人造血管解剖外旁路手术。术后平均随访时间（7.6±5.8）个月,最长15个月。接受自体大隐静脉旁路的病人未出现移植物感染,1年内肢体存活率100%,1年内移植物通畅率86.4%（19/22）,3例因复吸导致移植物阻塞（14.6%）。接受人造血管旁路的病人中,5例在术后1周内出现移植物感染（55.6%）而切除移植物（其中2例随后出现肢体严重缺血而行截肢术）,1年内肢体存活率77.8%,3例术后3个月内移植物阻塞,1例术后1年移植物仍然通畅（通畅率11.1%）。结论倒置自体大隐静脉解剖外旁路手术是治疗注射毒品所致股动脉感染性假性动脉瘤的安全、有效、经济的方法。     

注射吸毒致假性股动脉瘤的救治

目的：了解注射吸毒致假性股动脉瘤的特点及外科治疗的疗效。方法：2000年1月-2008年6月间收治30例假性股动脉瘤破裂患者。手术治疗26例,4例拒绝。瘤体切除、瘤腔清创后,其中,行股动脉直接修补3例,人工血管片修补8例,应用四氟乙烯（ePTFE）人工血管移植10例,股动脉结扎5例。结果：拒绝手术4例患者全部死亡。25例肢体均存活,足背动脉搏动恢复。术后伤口出血再次手术3例,其中截肢1例。随访3个月~4年,股动脉结扎中1例肢体间歇性跛行。结论：彻底清创、血管修补或移植、控制感染是治疗注射吸毒致假性股动脉瘤的有效方法;直接行股动脉结扎在条件困难情况下是可选择的术式。     

小隐静脉用作冠状动脉旁路移植材料

目的尝试应用小隐静脉作为冠状动脉旁路移植材料或旁路移植材料不足时的补充.方法6例患者应用No-touch技术获取小隐静脉7条,作为端侧或者序贯吻合的旁路材料.结果所有小隐静脉旁路长度合适、直径适当、流量满意、患者无相关并发症.结论小隐静脉获取容易,其长度和解剖特点均适合作为2次手术或无合适大隐静脉患者的冠状动脉旁路移植材料.     

血管移植透析内瘘术—附45例(51人次)报告

本文报告４５例（５１人次）血管移植透析内瘘术。采用自体大隐静脉、异体动脉和人造血管（Ｅ－ＰＴＦＥ）材料,移植瘘管的一年透析使用率为８１．５８％,使用３年以上８例,病人带功能移植瘘管总时间最长达７６个月以上。每１００个移植瘘管随访月平均并发症发生率为３．６２,其中血栓形成和回流静脉或流出端吻合口狭窄是移植瘘管的主要失功原因。作者认为异体动脉具有良好的组织相容性、较高的瘘管使用率和血管材料的相对可选择性,是移植血管内瘘的较理想血管材料     

全动脉化非体外循环冠状动脉搭桥术的临床应用

目的探讨全动脉化非体外循环冠状动脉旁路移植术(冠脉搭桥术)的手术技术、安全性和近中期手术效果。方法 2004年3月～2012年4月接受全动脉化非体外循环冠脉搭桥术(包括微创冠脉搭桥)患者35例,人均搭桥2.7支(1～4支)。其中常规开胸非体外循环冠脉搭桥30例,胸腔镜辅助下微创冠脉搭桥5例。同期行体外循环下全动脉化冠脉搭桥8例,同期行一根乳内动脉和静脉做常规非体外循环冠脉搭桥248例,比较不同手术方式的死亡率、并发症、桥血管数目和近中期疗效等。结果全动脉化非体外循环冠脉搭桥术后仅1例患者因胸骨感染死亡,34例症状明显改善顺利出院,随访效果均良好,无心绞痛发作,心功能明显改善。结论全动脉化非体外循环冠状动脉旁路移植术临床效果较好,并发症及死亡率较体外循环下搭桥少,总的风险更低,但因患者病变、病情及各种因素,本术仍不能完全取代冠状动旁路移植术。     

Surgical rescue and restoration of renal function in an anuric renal failure patient: a case report

We present a case of anuric renal failure in a forty-nine year old woman secondary to bilateral renal artery occlusion that responded favorably to surgical revascularization. The patient presented with a three day history of diminished to absent urine output. The patient's BUN and creatinine were 52 mg/dL and 9.3 mg/dL, respectively. The patient remained anuric and required hemodialysis. Chronic atherosclerotic occlusion of both renal arteries with reconstitution of the renal arteries via collateral support was seen on angiography. Twenty-six days after presentation, the patient had aortorenal artery bypass using a saphenous vein graft. Postoperatively the patient had excellent diuresis with the creatinine improving to a nadir of 1.5 mg/dL. This case is a demonstration that the kidneys can remain viable with subacute renal artery occlusion in the presence of adequate collateral blood flow. Surgical or transcatheter renal revascularization should be considered in appropriate patients.     

假性动脉瘤的临床研究(附30例临床报告)

目的:对假性动脉瘤临床病例的回顾性分析和总结,以期提高假性动脉瘤的诊断和治疗水平.方法:对2003～2006年收治的30临床病例的诊断和治疗过程进行回顾性分析和总结.结果:病因以毒品注射致伤及医源性损伤为主,损伤部位以股动脉多见,30例临床病例均手术治疗,动脉结扎及瘤体清除术9例,单纯动脉修补术3例,瘤体清除及动脉修补术15例,瘤体清除及人工血管或自体大隐静脉旁路搭桥术3例,术后患者均全愈出院.结论:假性动脉瘤正确诊断和及时治疗其预后良好.     

下肢动脉搭桥术后人工血管闭塞的治疗

目的 探讨下肢动脉搭桥术后人工血管闭塞的治疗方法及疗效.方法 回顾性分析自2004年10月至2009年10月治疗的下肢动脉搭桥术后人工血管闭塞53例临床资料,共计104例次闭塞,10例末次闭塞保守治疗,其余94例次手术治疗:单纯人工血管取栓术26例次,再次搭桥或延长搭桥术23例次,人工血管取栓并球囊扩张术18例次,截肢术14例次,人工血管取栓术并股动脉或腘动脉内膜剥脱术10例次,2例人工血管闭塞并感染取出后保守治疗,自体干细胞移植1例次.结果 77例次血运重建手术,49例次术后人工血管再次闭塞(63.6%).6例失访;47例患者平均随访(29.8±17.1)个月,其中10例死亡(21.3%),12例人工血管闭塞后截肢(25.5%),25例患者保肢(53.2%),其中18例患者人工血管通畅(38.3%),7例闭塞保守治疗(14.9%).生存分析显示本组3年生存率77.4%,保肢率64.7%,累积通畅率45.7%,重建术式对通畅时间的影响无统计学意义.结论 下肢动脉人工血管搭桥术后闭塞血运重建术后再闭塞率及截肢率较高,应根据具体情况选择恰当治疗方式.     

Management of infected femoral pseudoaneurysms in intravenous drug abusers: a review of 57 cases

BACKGROUND: The present study was carried out to evaluate the clinical characteristics and surgical methods used for the management of infected femoral pseudoaneurysms secondary to illegal drug injections. METHODS: Fifty seven consecutive patients who presented with infected pseudoaneurysm of the lower limb and were admitted to the emergency department of Sina Hospital during a 5-year period were enrolled in this study. Surgical methods performed consisted of vein angioplasty, simple ligation of femoral artery, and emergent or delayed revascularization. RESULTS: All participating patients were males with a mean age of 36.7 years. Three (5.3%) and two (3.5%) patients underwent primary repair and emergent vascular bypass, respectively; whereas delayed revascularization was performed in only eight (14%) cases. Forty four (77.2%) patients achieved a normal lifestyle without any vascular bypass. Early critical ischemia and late claudication was reported in two (3.5%) and eight (14%) patients, respectively. Other complications such as amputation and mortality were rarely reported. CONCLUSIONS: In our study, simple ligation of the external iliac or femoral artery was the most frequent management method for treating infected femoral pseudoaneurysms. Simple ligation of the external iliac or femoral artery seems to be a safe procedure in drug abusers presenting with infected femoral pseudoaneurysms.     

17β-雌二醇作为扩充液对大隐静脉保护作用的研究

目的本研究从扩充液的角度对比研究17β-雌二醇作为扩充液与其他传统扩张液对大隐静脉内皮细胞的保护作用,探讨其在临床上应用的价值,选择对冠状动脉旁路移植术中对大隐静脉损伤最小的扩充液,并且能最大限度的保护静脉壁血管内皮细胞和血管内膜的完整性,在临床应用上能提高冠状动脉旁路移植术后大隐静脉桥血管的远期通畅率。方法筛选21例行冠状动脉旁路移植术（CABG）的患者,取术前未进行扩充的大隐静脉,留下进行冠状动脉旁路移植剩余的血管分割成3段,每段长约2em为3组,用不同的扩充液扩充每段分割好的大隐静脉,A组1713-雌二醇组（n=21）;B组婴粟碱组（n=21）和c组自体血液肝素混合组（n=21）,比较各组扩充液扩充后血管的损伤情况。结果应用17β-雌二醇作为扩充液扩充后的血管通过光镜、血管免疫组化及电镜结果观察损伤最小,差异有统计学意义（P〈0．05）。结论在临床中选取17β-雌二醇其作为桥血管扩充液应用于冠状动脉旁路移植术中,可更好地保持术后远期的通畅性。     

冠状动脉搭桥术的临床应用进展

冠状动脉搭桥术(ＣＡＢＧ)的常规方式是胸骨正中完全劈开切口,低温、体外循环、心脏停跳,大隐静脉作为血管桥,虽术野显露好,静止无血,吻合方便,但与体外循环和插管有关的并发症比较多,医疗费用高[1～5],冠状动脉粥样硬化性心脏病(ＣＡＤ)的发病呈年轻化的趋势,人类的平均寿命在逐渐延长,而大隐静脉桥的10通畅率仅50%左右[6],二次手术不仅增加患者的痛苦和经济负担,而且风险大。另外病人对生活质量日益重视,一方面对手术的安全性和减轻手术创伤的要求增高,另一方面有慢性肾功能不全、慢性阻塞性肺疾病、脑血管病变等ＣＡＢＧ高危因素,而要求…     

大隐静脉属支的观测及临床意义

目的：：通过观测大隐静脉属支,为临床外科相关手术操作和下肢静脉疾病的临床诊断和治疗提供解剖学资料。方法：对10具成人尸体标本大隐静脉属支进行解剖学观测,测量并统计相关数据。结果：20侧大隐静脉属支,其中14侧正常,6侧大隐静脉近侧端只收纳了腹壁浅静脉、阴部外静脉、股内侧静脉和股外侧静脉4个属支,2条旋髂浅静脉(A 及 B)各自汇入股静脉、股深静脉。旋髂浅静脉(A)走行在腹股沟韧带内下方,穿阔筋膜,于股动脉后方绕过,距两侧髂前上棘连线的垂直距离为(77.20±1.20)mm处汇入股静脉,汇入处外径为(1.84±0.18)mm。旋髂浅静脉(B)穿入阔筋膜,跨过股神经,股深动脉,距两侧髂前上棘连线的垂直距离为(89.64±1.30)mm 处汇入股深静脉,汇入处外径为(2.04±0.12)mm。结论：正确认识大隐静脉属支的异常特点,对于临床大隐静脉曲张高位结扎剥脱术及内科相关疾病诊治等可能具有一定价值和指导意义。     

Total Arterial Revascularisation in Left Ventricular Dysfunction

Despite the excellent results achievable withcoronary artery bypass operations using a singlein-ternal mammary artery(I MA)graft to the left an-terior descending coronary artery(LAD)and addi-tional saphenous vein grafts,the long-term paten-cy of vein grafts in the coronary artery circulationhas beenless than that of arterial grafts.Choosingthe conduit with the highest early and long-termpatency for all of the diseased coronary arteries isone way to i mprove outcomes of coronary arterybypass …     

活体右半肝移植静脉流出道重建技术的改进

目的 探讨在不包含肝中静脉(middle hepatic vein,MHV)的成人间活体右半肝移植(living donor liver transplantation,LDLT)流出道的重建模式.方法 对我院肝移植中心47例不含MHV成人间活体右半肝移植,其受体流出道重建的临床资料进行回顾性分析.移植肝右肝静脉(RHV)与受体下腔静脉的吻合口成形为"三角形";右肝下静脉(IRHV)与下腔静脉直接吻合,MHV粗大属支即肝Ⅴ段(V5)、Ⅷ段(V8)静脉用大隐静脉搭桥后,分别开口与下腔静脉垂直式吻合.结果 本组供体术后无严重并发症和死亡.受体47例发生并发症9例,其中肝静脉狭窄1例,小肝综合征1例,肝动脉栓塞1例,肠肠吻合口出血1例,胆漏2例,隔下脓肿1例,肺部感染2例.死亡3例,死因为小肝综合征1例,多器官功能衰竭 2例.47有31例重建V5、V8和(或)右肝下静脉,其流出道重建率65.96%(31/47),其中重建1支静脉为36.17%(17/47),重建2只静脉为21.28%(10/47),重建3只静脉为8.51%(4/47).所有病例术后随访2～48月,CT和超声检查1例肝静脉狭窄,4例在7～25d发现血栓,但侧枝循环已建立.结论 采用"多口垂直式吻合" 的方式重建流出道,可保证移植肝的有效静脉回流,预防小肝综合征,减少供体的手术风险.     

Dramatic vascular course of Behcet's disease

Vascular involvement in Behcet's disease is rare approximately 14% venous and 1.6% arterial, serious and recurrent. We report a case of Behcet's disease with deep venous thrombosis and right iliac pseudoaneurysm which was repaired with polytetrafluoroethylene PTFE graft. The patient received warfarin, aspirin, clopidogrel, immunosuppressive and corticosteroids. Two months later the patient developed manifestations of superior vena cava thrombosis and the graft was blocked. Three months later, ischemia of the right foot deteriorated and left femoral artery to right femoral artery crossover PTFE graft was performed.     

Surgical management of large and giant intracavernous and paraclinoid aneurysms

Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.
Methods The pterional approach was routinely used. The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression. Paraclinoid aneurysms were directly clipped, intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft. Intraoperative electroencephalogram （EEG） and somatosensory evoked potential （SSEP） monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries. Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels. Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms. Postoperative digital subtraction angiography （DSA） was performed in 33 of the 36 patients.
Results Thirty-two paraclinoid aneurysms were directly clipped, 1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascularization. Except for two patients who died in the early postoperative stage, 34 patients＇ follow-up was 6-65 months （mean 10 months） and a Glasgow Outcome Scale score of 4 to 5 at discharge. At the 6-month follow-up examination, Rankin Outcome Scale scores were 0 to 2 in 32 patients. EEG and SSEP monitoring changed in six patients. Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected. Three posterior wall aneurysms were clipped.
Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms. The temporary parent vessel occlusion, retrograde su     

注射毒品致感染性假性股动脉瘤破裂19例外科治疗

目的 探讨注射毒品致感染性假性股动脉瘤破裂的外科治疗方法.方法 回顾分析19例注射毒品致感染性假性股动脉瘤破裂患者的临床资料,术前应用彩超或下肢血管造影诊断;8例采用人工血管行旁路髂外动脉和股浅动脉端端吻合术,11例行单纯瘤体两端股动脉结扎术.结果 全部病例手术成功,无继发肢体坏死;血管移植者术后复查彩色多普勒超声显示移植血管通畅.结论 瘤体切除+人工血管移植仍是治疗注射毒品所致假性股动脉瘤的理想方案;但在无条件行血管移植时,瘤体切除+股动脉结扎术是治疗的有效方法之一;不提倡行破裂瘤体修补术.