内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

原发性下肢深静脉瓣膜功能不全股静脉形态学研究近况

下肢静脉病是外科的常见病和多发病 ,其中原发性深静脉瓣膜功能不全占有很高的比例[1～ 3 ] ,约 5 3 .0 2 %～ 69% ,其主要的病理特征是 ,在致病因素作用下静脉瓣膜失去单向开放的基本功能 ,静脉扩张、高压 ,久之出现浅静脉曲张、肿胀、皮炎及皮肤营养障碍 ,甚至溃疡形成 ,严重影响患者的生活质量和劳动能力。因此 ,下肢静脉疾病的预防与治疗日益受到重视。本文试就原发性下肢深静脉瓣膜功能不全的形态学研究近况综述如下。一、原发性下肢深静脉瓣膜功能不全的病因及临床表现原发性深静脉瓣膜功能不全是Ｋｉｓｔ ｎｅｒ[4] 在 1980年提出的…     

急性动脉栓塞的治疗

我们报道急性动脉栓塞２３例。死亡３例、截肢５例，共６条肢体。表明，动脉栓塞的原因以心源以心源性血栓为多数，其中冠心病所致急性动脉栓塞的比例逐渐增高。急性动脉栓塞的及早诊治至关重要，病程超过４８小时者，截肢率高达５０％，Ｇｕｏ动脉分叉以下的急性动脉栓塞，可经保守治疗，不强调手术取栓，Ｆｏｇａｒｔｙ导管取栓手术成功率为１００％，取栓后向远端动脉注入尿激酶，有助于提高手术成功率，合并有肺，脑动脉梗塞者，     

传统激光闭合术与硬化剂注射致隐神经损伤比较

目的:探讨在下肢静脉慢性功能不全的患者当中使用激光闭合术和硬化剂注射两种治疗方式导致机体产生隐神经损伤的影响。方法:回顾性分析采用传统激光闭合术治疗的下肢静脉慢性功能不全患者100例(传统激光闭合术组)和采用硬化剂注射治疗的下肢静脉慢性功能不全患者100例(硬化剂注射组),统计2组下肢隐神经损伤的发生时间、治疗周期以及发生部位。结果:随访1年,传统激光闭合术组隐神经损伤的发生率26%高于硬化剂注射组的10%,隐神经损伤出现时间(1.56±1.63)d早于硬化剂注射组的(14.54±2.61)d,隐神经损伤治愈的周期(97.84±12.18)d长于硬化剂注射组的(24.63±16.56)d,传统激光闭合术组隐神经各部位发生损伤的患者人数更多,2组差异均有统计学意义(P0.05)。结论:在运用传统激光闭合术治疗下肢静脉慢性功能不全的患者随访中应在隐神经损伤的防治中给予更多的关注。     

国产盐酸替罗非班治疗冠状动脉支架植入后急性血栓形成1例

我院2006年8月16日在行急诊冠状动脉支架植入术后发生急性支架内血栓并发症1例,经静脉用国产血小板受体拮抗剂盐酸替罗非班(商品名:欣维宁)治疗,取得良好的疗效。现报道如下。患者,男,68岁,因突发心前区憋闷3小时入院。心电图提示急性下壁、正后壁、右室心肌梗死行急诊经皮选择性冠状动脉造影术(CAG) 经皮冠状动脉介入(PCI)手术,患者急诊冠状动脉造影前均给予嚼服阿司匹林300mg及氯吡格雷300mg口服,冠状动脉造影前给普通肝素3000U,取右侧桡动脉穿刺造影,造影显示右冠状动脉第一转折处完全闭塞,左冠状动脉前降支近端85%狭窄。即给予普通肝…