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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。     

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.     

血管外科基础研究和新技术发展方向的探索与思考

在几代医学工作者的努力下,我国血管外科事业在过去的几十年中已经取得了较大的发展,但比较其他许多相对成熟的学科而言,依然是一门新兴的学科.随着我国国情状况的进展,经济建设的快速发展,全球化和城市化的演变,人口老龄化的进程和饮食结构的变化,涉及血管外科范围的疾病谱较前也有了很大的不同.血管外科的发展需要深入的基础研究和新技术的应用研究,来反思我们所面临的问题和机遇.在此,需要我们对血管外科基础研究和新技术领域方面的进展与发展方向作出进一步的探索与思考.     

抑癌基因PTEN在结肠直肠癌中表达的研究

目的：探讨PTEN蛋白在结肠直肠癌组织中的表达及其临床意义。方法：应用免疫组织化学技术检测1998年1月至1999年8月间于我院收治的122例结肠直肠癌组织标本中frrEN蛋白的表达。结果：在122例结肠直肠癌组织标本中有39例为阴性表达，正常结肠直肠黏膜组织、腺瘤组织均为阳性表达（P〈0．01）。无论阳性面积抑或强阳性面积，PTEN蛋白表达与结肠直肠癌病人的性别、年龄无显著相关性（P〉0．05）；而与结肠直肠癌周径、淋巴结转移、远处转移、肿瘤分化程度和Dukes分期存在显著相关（P〈0．01）。肿瘤分化各组两两比较显示，在阳性面积中除高分化与中分化腺癌、在强阳性面积中除低分化与未分化腺癌（P〉0．05）外，其余各组间统计学检验均存在显著性差异（P〈0．01）。Dukes分期各期两两比较，无论是阳性面积还是强阳性面积，除B期与C期（P〉0．05）外，其余各组间统计学检验均存在显著性差异（P〈0．01）。结论：PTEN抑癌基因的蛋白表达低下或丢失与结肠直肠的癌变有关，可能是结肠直肠的癌变过程中一种较晚发生的事件，是进展期结肠直肠癌的一种信号。     

体育锻炼治疗下肢动脉闭塞症的现况和评价

下肢动脉闭塞症是常见的血管疾病,多由动脉粥样硬化和血栓闭塞性脉管炎引起,病变的早期临床表现主要为间歇性跛行,随着病情的进展继而出现静息痛和肢端坏疽等严重的症状。轻者影响患者的生活和工作,重者需截肢而致残,甚至危及生命。综合文献资料,在60岁以下的人群中,周围动脉闭塞性病变的患病率在3％以下;而在75岁以上的人群中,则剧增为20％以上。     

静脉血栓栓塞症的诊断现状

静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓形成(deep vein thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE)。PTE是肺栓塞的一种类型,定义为来自静脉系统或右心的血栓阻塞肺动脉或其分支所导致,以肺循环和呼吸功能障碍为主要临床和病理特征的     

Angiosome概念在重症肢体缺血中的应用进展

重症肢体缺血(critical limb ischemia,CLI)指周围动脉血管疾病(peripheral arterial disease,PAD)中最具严重症状者,出现静息痛、肢端溃疡、坏疽等,病程至少持续2~4周[1],主要病理变化是多节段、多平面大小腿动脉的粥样硬化闭塞,病变程度相当于Rutherford 4~6级或FontaineⅢ~Ⅳ期[2]。对于CLI,无论是行旁路转流术或是腔内血管成形     

重症下肢缺血的诊治现状与进展

重症肢体缺血(critical limb ischemia,CLI)是肢体动脉硬化闭塞症(arteriosclerosis obliterans,ASO)的极端严重状态,是指动脉硬化闭塞所引起的肢体静息痛、溃疡或坏疽,下肢的发生率远高于上肢。在未接受动脉重建的下肢CLI病人中,1年截肢率为25%,死亡率高达30%[1-2]。尽管临床上有许     

手术后腹壁哆裂和切口疝(文献综述)

近50年来,虽然对机体组织修复的生物学过程,有了许多新的认识,但腹腔手术后,因腹壁愈合不良而哆裂的发生率,并无改变。腹壁哆裂和巨大切口疝(Giant Ventral Heinia:GVH)对病人构成重大威胁。前者的发生率为1～3％,死亡率为9.4～43.8％;后者的发生率为0.5～10％,手术修补术后复发率3～33％,造成很高的病残率。本文     

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.