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目的 探讨单侧髂静脉闭塞的外科治疗。方法 1987年8月至1999年12月，采用Palma-Dale手术治疗髂静脉闭塞症23例。结果 17例获得长期随访，平均随访56个月。10例术后患肢肿胀、疼痛明显改善，静脉性跛行消失。5例溃疡复发，其中2例经植皮和游离背阔肌皮瓣移植后溃疡愈合。结论 Palma-Dale手术宜慎重且合理地选择病例。Palma-Dale手术应在患肢闭塞段远侧深静脉主干瓣膜和肌肉泵功能尚未被破坏之前施行；在主干静脉瓣膜已被破坏时，宜考虑同时行瓣膜重建术。     

股浅静脉闭塞症手术治疗的初步评价

目的：评价股浅静脉闭塞症的手术治疗。方法：1988年3月－2000年12月，采用原位大隐静脉－Guo静脉转流（Husni's）手术治疗股浅静脉闭塞症共8例。结果：6例（6／8）获得长期随访，平均随访74个月。2例转流静脉通畅，临床症状明显好转或基本消失；4例闭塞、肿胀加重但未出现溃疡等严重并发症。结论：Husni's手术宜慎重且合理地选择病人。Husni's手术宜选择病程较短、患肢腓肠股泵功能尚未严重受损的病例；压力辅助治疗是十分重要的。     

下肢动脉硬化闭塞症外科治疗的评估

下肢动脉硬化闭塞症（ａｒｔｅｒｉｏｓｃｌｅｒｏｓｉｓ　ｏｂｌｉｔｅｒａｎｓ,ＡＳＯ）是老年人慢性下肢缺血最常见原因,治疗不及时或不妥当可致截肢。外科手术治疗的目的是改善肢体缺血症状及挽救肢体,主要术式为动脉内膜剥脱术、血管旁路移植术、血管腔内治疗和复合式手术４类,每种术式都有其适应证和优缺点。动脉内膜剥脱术　　动脉内膜剥脱术（ｅｎｄａｒｔｅｒｅｃｔｏｍｙ）是充分解剖病变血管后,以内膜剥离子在内膜下方全周游离整个病变段,完整切除内膜,同时将远端内膜固定以防夹层形成及管腔堵塞。此术式在动脉代用品问…     

杂交手术治疗多节段下肢动脉闭塞1例

<正>下肢动脉硬化闭塞症(arteriosclerosis,ASO)由动脉粥样硬化病变引起,近年来随着生活水平的提高及人口老龄化的发展,患病率逐年升高,60岁以上人群患病率在8.3%~18.8%[1]。由于对本病认识不足,就诊时多为下肢多节段广泛病变。为挽救患肢,目前治疗主要以传统血管重建手术或血管腔内介入治疗为主,但两者各具优缺点。杂交手术(hybrid operation)将传统外科手术与血管腔内治疗     

下肢动脉硬化闭塞症的外科治疗问题

肢体慢性缺血主要由动脉硬化闭塞(anerial sclerosis occlusion，ASO)症引起，本文着重就其手术方式、外科治疗中需要把握的问题及有关治疗进展方面的问题做一简要评述。     

下肢动脉硬化闭塞症的外科治疗

下肢动脉硬化闭塞症(lowerextremityatheroscleroticocclu sivedisease,LEAOD)是血管外科常见病,是导致慢性下肢缺血的主要原因,其发病率随年龄增大而增加,Criqui统计65岁以上的男性约10%患有LEAOD,而75岁以上则有20%的发病率[1];北美60岁以上的高血压患者中有近25%患有慢性下肢缺血[2]。LEAOD是全身动脉硬化的局部表现。在我们的一组158例严重多节段动脉硬化闭塞症患者中,50%以上合并有心脑血管疾病,25%以上合并有糖尿病。严重的合并症是导致临床治疗效果欠佳和死亡率高的主要原因之一。因此,在下肢缺血的治疗中,不仅要注重肢体血管…     

动脉闭塞性疾病的外科治疗——自体大隐静脉旁路术治疗下肢动脉硬化性闭塞症

下肢动脉硬化性闭塞症是血管外科的常见病，目前在治疗上多采用血管移植旁路术进行动脉重建。自体大隐静脉是较常用的旁路材料，主要用于腹股沟以远的动脉重建。由于其取材上的独特优势，在人造材料研制日新月异的今天，仍占有重要地位，并已成为评价其他材料疗效的标准。最早的自体静脉移植试验是由Gluck在1894年报告的，但     

下肢动脉硬化闭塞症的外科治疗

目的:探讨外科治疗下肢动脉硬化闭塞症的临床经验。方法:从1995年7月～2002年7月共对292例(313条肢体)动脉硬化闭塞症病人进行外科治疗,其中20条患肢施行解剖外血管重建术,38条患肢施行了腔内外科治疗或合并开放性血管重建手术,255条患肢施行了开放性手术重建下肢血供。结果:手术成功者患肢的踝肱指数与术前比较显著增加(P<0.01),症状得到明显改善。平均随访时间3.1年(0.5～7年),解剖外重建组移植血管一期通畅率为56%,腔内外科组通畅率为78%,开放性手术组通畅率为72%。结论:病人的全身情况、动脉病变的范围和程度是选择下肢动脉硬化闭塞症外科治疗方法的主要依据,为取得较好的长期通畅率和临床效果需要重视围手术期处理和术后随访。     

主髂动脉闭塞症外科治疗11例体会

主髂动脉闭塞症是血管外科常见的动脉闭塞性疾病,病变部位以主髂动脉分叉及双侧髂总动脉多见,外科手术目的主要是重建下肢血液循环.本文就我们近两年主髂动脉闭塞症手术治疗病例资料进行分析.     

静脉动脉化治疗下肢动脉闭塞症

静脉动脉化为将动脉血流引入静脉 ,利用静脉途径逆向灌注远端组织 ,使静脉起到动脉的作用。目前主要用于治疗下肢动脉广泛性闭塞 ,也有用于颅脑、肝脏、阴茎、皮瓣及下肢缩短畸形的报告。一、沿革　利用静脉重建缺血组织的营养已有百年 ,其进程可分为三个阶段。1.动静脉直接灌注　 190 2年Ｓａｔｒｕｓｔｅｇｕｌ首先用股动静脉直接吻合治疗足趾缺血 ,术后均发生严重肢体肿胀 ,大部肢体坏死。现公认 ,该法不可取。2 .动静脉瘘　 1965年Ｒｏｏｔ用月国静脉作动静脉瘘实验 ,并临床应用 6例 ,尚有一定疗效。但术后仅部分血液在逐步克服瓣膜阻力…     

Palma—Dale手术治疗髂静脉闭塞症

目的:探讨单侧髂静脉闭塞的外科治疗.方法:1986～1998年,采用Palma-Dale手术治疗单侧髂静脉闭塞症患者共10例.结果:7例(7/10)获得长期随访,平均随访85个月.术后患肢肿胀、胀痛明显改善,静脉性跛行消失.3例溃疡复发(3/5),其中2例经植皮和游离背阔肌皮瓣移植后溃疡愈合.结论:Palma-Dale手术宜慎重且合理地选择病例.Palma-Dale手术应在患肢闭塞段远侧深静脉主干瓣膜和肌肉泵功能尚未被破坏之前施行;在主干静脉瓣膜已被破坏时,宜考虑同时作瓣膜重建术.     

髂静脉闭塞支架置入治疗要点精析

髂静脉闭塞发生率较高,临床多为隐匿性病变。非血栓性髂静脉闭塞是下肢慢性静脉疾病的重要原因,常见有静脉血栓后综合征和非血栓性髂静脉压迫综合征2种。支架置入是髂静脉闭塞的主要治疗手段之一,应严格把握支架置入指征。支架直径合理选择和精准定位是保证髂静脉支架高通畅率的关键技术要点。血管腔内超声对辅助髂静脉闭塞诊断和髂静脉支架置入有重要意义。髂静脉支架置入术后需定期接受超声随访,术后药物治疗方案目前仍有争议。新型髂静脉专用支架的研发及应用有望进一步提高髂静脉支架置入的临床效果。     

左髂总静脉狭窄与急性下肢深静脉血栓形成

目的探讨左髂总静脉狭窄程度与深静脉血栓形成的关系。方法对１９９１年９月～１９９７年３月的６３例急性髂股静脉血栓（ＤＶＴ）病例的一般资料、血栓形成诱因、手术方法及结果进行了回顾性分析。结果左髂总静脉直径较正常狭窄≥４７．１％时血栓形成的病例数骤然增加。结论左髂总静脉直径狭窄接近一半时，随时可能发生血栓形成，但因侧支代偿而不发病。一旦血栓形成的诱因出现，将可引起血栓发生。因而，遇有血栓形成的诱因时，应行多普勒超声检查。     

Cross-Femoral Venous By-Pass (Palma’s Procedure) to Relieve Venous Hypertension Due to Retroperitoneal Leiomyosarcoma: A Case Report

Retroperitoneal leiomyosarcoma arising in, or involving, the inferior vena cava or the iliac vein are infrequent tumours. They are usually treated by “en-block” surgery. Venous reconstruction is usually not needed, since collateral circulation can adequately offset the main vessel flow. However, in rare cases, collateral circulation may be insufficient. The authors report a case of leiomyosarcoma infiltrating the left iliac vein. One week after radical resection surgery, the patient developed left leg compartmental syndrome due to venous hypertension.

The patient was successfully treated by thrombectomy of the left femoral vein and cross-femoral venous bypass (Palma’s Procedure) by means of an 8 mm diameter polytetrafluoroethylene (PTFE) prosthesis. To improve the flow inside the graft, an arterio-venous fistula (AVF) was performed. The choice of a prosthetic conduit, its diameter, and the AVF are discussed.     

主肝静脉急性阻断后引流肝段保留价值的研究

目的观察主肝静脉阻断后保留肝段的病理形态学变化。方法７８只大鼠随机分为对照组、肝段静脉结扎组、左主肝静脉缩窄组与结扎组,动态观测受累肝叶的病理学,肝脏微循环与血流动力学变化。结果主肝静脉结扎后２４小时即发生肝细胞坏死,门静脉血内毒素与ＴＸＢ２／６－Ｋｅ－ｔｏ－ＰＧＦ１α明显升高,主肝静脉缩窄组受累肝叶边缘大量肝静脉与门静脉侧支形成,门静脉血内毒素与ＴＸＢ２／６－Ｋｅｔｏ－ＰＧＦ１α也发生不同程度升高,两组均明显高于肝段静脉结扎组与对照组。结论正常肝组织不能耐受主肝静脉急性阻断,无肝静脉引流的肝组织不但完全丧失功能,而且引起内毒素血症与肝脏微循环障碍,主肝静脉结扎应同时将引流肝段切除。     

Successful surgical repair of an ilio-iliac arteriovenous fistula associated with a ruptured common iliac artery aneurysm

IntroductionWe describe the case of an 86-year-old man with an ilio-iliac arteriovenous fistula (AVF) resulting from a ruptured aneurysm. This condition rarely occurs, has a high mortality rate, and was successfully treated via surgery.Presentation of caseThe patient presented with a temporary loss of consciousness and left leg edema. A pulsatile abdominal mass with vascular murmur and thrill was detected. Enhanced computed tomography showed abdominal aortic and iliac aneurysms with left common iliac vein occlusion, and the left external iliac vein was easily seen through the AVF. We directly sutured the AVF and performed aneurysmectomy and prosthetic graft replacement. During surgery, placement of occlusive balloon catheters through the AVF minimized intraoperative bleeding. The patient recovered uneventfully, and swelling of the left leg was immediately reduced after surgery.DiscussionAlthough rare, AVFs can be life-threatening, and urgent treatment and intensive care are occasionally needed. Surgical management of AVF requires a definitive preoperative diagnosis and control of venous bleeding during surgery. Fulfilling these major requirements can potentially reduce morbidity and mortality in patients with AVFs. Interestingly, there was no sign of high-output heart failure throughout the treatment course due to compression of the aneurysm and consequent blood flow failure to the left iliac vein.ConclusionUsing the balloon occlusion technique, we were able to minimize blood loss during open repair. Use of multiple imaging modalities facilitates correct preoperative diagnosis and consequently improves surgical outcome.     

Effects of portal vein occlusion on myocardial contractility

We studied canine left ventricular contractile performance following 15min of portal vein occlusion by analyzing the end-systolic pressure diameter relationship (ESPDR) which many investigators have reported as being independent of changes in preload and afterload but sensitive to changes in ventricular contractility. Portal vein occlusion for 15min decreased the mean arterial pressure, left ventricular peak systolic pressure, and cardiac index, while the release of the occlusion gradually increased these values, although it did not restore them to the control values. The systemic vascular resistance index increased during portal vein occlusion and returned to the control values after release. Left ventricular end diastolic diameter decreased during portal clamping and returned to the control values after release. ESPDR and percent shortening were not significantly changed during or after portal clamping. These rersults indicate that the decrease in blood pressure during portal vein occlusion was not due to a reduction in myocardial contractility but rather was due to a reduction in preload.(Oka T, Ohwada T, Mizuguchi T, et al.: Effects of portal vein occlusion on myocardial contractility. J Anesth 5: 344–351, 1991)     

Femoropopliteal in situ saphenous vein bypass: Technical aspects and factors determining patency

The results and the factors influencing long-term patency rates in two technical variations of femoropopliteal «in situ» saphenous vein bypass procedures were evaluated retrospectively. Technique I (n=33) consisted of a limited approach to the saphenous vein, destruction of the valves with a Cartier stripper and no tributary ligation. Technique II (n=55) included complete exposure of the saphenous vein valvular destruction using Hall’s stripper and ligation of all tributaries. Early thrombosis was observed in 21% and 3.6% of cases in techniques I and II, respectively. The frequency of local complications was identical in both techniques (18%). Overall actuarial primary patency at 4 years was 70%. Secondary patency (including patency following reoperations for graft failure) was 88 % overall, 78.5% in technique I and 95% in technique II (p<0.05). The site of the distal anastomosis significantly influenced the four year cumulative patency rate (upper popliteal ?100%, lower popliteal ?93.6%, tibioperoneal vessels ?70.5%, p<0,05), whereas the number of patent leg vessels, the clinical stage of disease and the site of the proximal anastomosis (common femoral or superficial fernoral artery) did not. Results obtained with the in situ saphenous vein bypass using technique II were better than with technique I. Close follow-up and preventive reoperations clearly enhanced patency rates. The site of distal anastomosis significantly affected long-term results.