介入联合手术治疗门静脉血栓形成7例

目的 评价介入联合手术治疗门静脉血栓形成的疗效。方法 对7例术前确诊为门静脉血栓形成者行开腹经肠系膜上静脉的门静脉内手术取栓、局部溶栓和门静脉狭窄/闭塞段球囊扩张、内支架置入术。2例因小肠坏死、1例因肠腔明显狭窄而同时行部分小肠切除术。结果 7例均治疗成功。术前腹痛、腹胀及消化道症状消失,腹水基本消失。随访3～24个月,平均16个月,均健在,无消化道出血。多普勒超声复查显示门静脉血流通畅。结论 介入联合手术是治疗门静脉血栓形成的安全、有效方法。     

Low molecular weight heparin improves healing of chronic venous ulcers especially in the elderly

Venous ulcers are common, especially in the elderly, accounting for more than 50% of all lower extremity ulcers with important socioeconomic problems. Improving extracellular matrix functioning, by heparin administration, seems to be a way to support wound healing. A total of 284 patients with venous ulcers were recruited in a 4‐year period. All patients were subjected to the most appropriate treatment after considering their preference (compression therapy followed or not by vein surgery). Patients were randomised into two groups of 142 persons in each (group A and group B as cases and controls, respectively). Patients of group A, in addition to the basic treatment as described earlier, received administration of nadroparin 2850 IU/0.3 ml through subcutaneous injection once a day for 12 months, whereas group B patients received basic treatment alone. Healing was assessed by means of direct ulcer tracing with computerised planimetry. Group A showed a healing rate of 83·80% at 12 months, whereas that of group B was 60·56%. Results by age group surprisingly showed that the group of older patients took the most advantage from long‐term treatment with low molecular weight heparin; this group also had lowest recurrence rate.     

38例完全性肺静脉异位引流的外科治疗

目的：总结３８例完全性肺静脉异位引流的外科治疗经验。资料和方法：３８例中男１７例,妇女１例。年龄２个月￣２２岁,３岁以内婴幼儿１２例。体重４．５￣３６．０ｋｇ。心上型２０例、心内型１５例、混合型３例。全组均在中度低温体外循环下将完全性异位引流的肺静脉直接或通过房间隔缺损隔入左房。结果：手术死亡３例（７．９％）,其中２例术后严重心律失常、１例多次缝合止血致吻合口狭小。术后并发心律失常１２例、呼吸道感     

低温停循环第二肝门成型根治肝静脉阻塞型布加综合征初探

目的 总结在深低温全身麻醉、体外循环辅助下，第二肝门成型根治肝静脉阻塞型布加综合征的临床治疗体会。方法 回顾16例初步应用本项手术的临床资料，经胸部正中切口，切开胸骨，在不打开胸膜腔和腹膜腔的情况下，仅行心包、下腔静脉切开，显出第二肝门病变和下腔静脉病变，在暂时停循环状态下进行局部病灶切除和第二肝门血管重建。结果 手术中恢复肝静脉回流后即见肝脏明显缩小，膈肌表面代偿静脉支瘪缩；随访6个月至7年，无1例死亡或并发症发生，无1例复发，均获得临床治愈。结论 深低温停循环状态下、第二肝门血管成型是一种理想的根治肝静脉阻塞型布加综合征的手术方法，安全、有效、创伤小、恢复快、符合解剖和生理需要。     

Revascularization of the gastroepiploic artery in pancreas transplant.

Thrombosis accounted for 52.0% of all transplant failures in one recent large series and is felt to result from devascularization of the pancreas during organ procurement. A technique to revascularize the pancreas is described. The operative notes and angiograms of 110 consecutive pancreas transplants were reviewed. Eight pancreata were found deprived of blood supply to the head and the neck of the pancreas on indigocarmine-renograffin table angiograms. During back table reconstruction a distal branch of the superior mesenteric artery (SMA) was dissected and anastomosed end to end to the gastroepiploic artery using 8-0 monofilament suture. Repeated table angiogram showed excellent blood supply to the head of the pancreas, the duodenum and the body and tail of the pancreas. The pancreas transplantation proceeded with iliac artery graft inflow, portal venous outflow and enteric drainage. Simultaneous quadruple therapy with thymoglobulin, CNI, MMF and a 4-day course of steroids was used. All patients became insulin independent and euglycemic. No duodenal leak was observed in the entire series. In summary, 1-ligation of the gastroduodenal artery (GDA) is not a safe procedure, especially when arterial blood supply from the inferior pancreaticoduodenal artery is poor or inexistent, 2-table angiogram helps delineate the high risk hypo-perfused pancreas, 3-preservation of the right gastroepiploic artery and the branches of the SMA allows an easy revascularization of the pancreatic graft.     

门静脉血栓的综合治疗

目的：探讨门静脉血栓的临床诊断及综合治疗。方法：45例中非手术治疗27例,介入溶栓10例,手术8例。结果：3例治愈,42例好转。结论：提高对本病的认识,及时辅以必要的辅助检查,是早期诊断的关键 选择个性化的治疗方案,是综合治疗成功的关键。     

环形缝合控制骶前静脉丛出血临床观察(附10例报告)

目的总结环形缝合法对骶前静脉丛出血的止血效果。方法采用环形缝合处理骶前出血10例,其中复发性直肠癌行Miles手术6例,行Hartmann术3例;子宫平滑肌肉瘤术后复发行部分乙状结肠加直肠切除术1例。结果10例均止血满意,缝合完成后未再出血,痊愈出院。结论环形缝合能安全地控制骶前出血,适用于能明视出血点的无休克病人。     

低中心静脉压应用于肝叶切除33例术中出血量观察

目的研究低中心静脉压下行肝叶切除对减少术中出血的影响。方法64例肝叶切除手术随机分两组：对照组（C组）31例,实验组（L组）33例。L组肝叶切除时维持中心静脉压在2～5cmH：0,肝叶切除后恢复正常水平;C组中心静脉压维持正常水平。观察两组病人术中输液量、尿量、失血量。结果L组术中出血量、输血量、尿量均低于对照组（P〈0．05）。结论低中心静脉压技术可减少肝叶切除术中出血量、输血量。     

腹腔镜术后下肢深静脉血栓形成的探讨(附2例报告)

目的:探讨腹腔镜术后下肢深静脉血栓(DVT)形成的发病危险因素以及防治方法。方法:分析2例腹腔镜胆囊切除术(LC)术后DVT的临床资料。结果:2例患者经过溶栓、抗凝、祛聚及对症支持等治疗后病情均完全缓解,深静脉再通,无1例发生肺栓塞。结论:由CO2气腹引起的下肢血流动力学、机体凝血纤溶改变及内皮细胞损伤是腹腔镜手术区别于开腹手术后DVT形成的重要原因。