腔内修复术治疗Stanford B型主动脉夹层:单中心长期疗效分析

目的探讨胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层的长期疗效。方法回顾性搜集300例行TEVAR治疗的Stanford B型主动脉夹层患者的临床及影像学资料,分析患者短期(在院/术后30天)及长期死亡率、并发症发生率及主动脉重塑情况。结果技术成功率100%。左锁骨下动脉完全覆盖29例,烟囱支架重建左锁骨下动脉11例,烟囱支架重建左颈总动脉7例。患者在院/术后30天死亡率0.7%(2/300),并发症发生率14%(42/300)。中位随访时间35个月(6~126个月)。1、3、5年累积全因死亡率分别为2.0%、6.7%、12.8%,主动脉夹层相关死亡率分别为1.7%、4.5%、8.4%;晚期并发症发生率14.7%(44/300),胸主动脉段假腔完全血栓化率83.7%(251/300)。结论应用覆膜血管内支架行TEVAR是治疗Stanford B型夹层安全有效的方法,长期疗效令人满意。     

56例主动脉夹层动脉瘤的外科治疗

本文报道了56例主动脉夹层动脉瘤外科治疗的经验,重点讨论了本病的病因、外科治疗的基本方法和手术方法。     

Necrosis of aorta, myocardium and brain in rabbits following orthostatic shock: main aortic involvement

A microscopical examination of aorta, myocardium and brain of 10 New Zealand White male rabbits submitted to orthostatic shock was performed. In addition six normal animals were used as controls. Seven animals were sacrificed 24 hours following shock by perfusion fixation and three animals three and half to seven hours thereafter. Necrotic changes were present and severe in aortic media, mild in myocardium and minimal in brain neurons. The great difference of involvement of these organs may be related to less vascularization of aortic media as compared with myocardium and brain, and presence of autoregulatory mechanisms of circulation during shock in myocardium and brain. Severe degenerative alterations of aortic media often leading to tissue necrosis due to shock is of importance for the pathogenesis of dissecting aneurysms and experimental atherosclerosis.     

Management of fulminant dissecting cellulitis of the scalp in the pediatric population: Case report and literature review

A case of fulminant dissecting cellulitis of the scalp in a fifteen-year-old African American male is reported. The presentation was refractory to standard medical treatment such that treatment required radical subgaleal excision of the entire hair-bearing scalp. Reconstruction was in the form of split-thickness skin grafting at the level of the pericranium following several days of vacuum-assisted closure dressing to promote an acceptable wound bed for skin grafting and to ensure appropriate clearance of infection. Numerous nonsurgical modalities have been described for the treatment of dissecting cellulitis of the scalp, with surgical intervention reserved for patients refractory to medical treatment. The present paper reports a fulminant form of the disease in an atypical age of presentation, adolescence. The pathophysiology, etiology, natural history, complications and treatment options for dissecting cellulitis of the scalp are reviewed, and the authors suggest this method of treatment to be efficacious for severe presentations refractory to medical therapy.     

椎动脉夹层动脉瘤的影像诊断与血管内治疗

目的总结椎动脉夹层动脉瘤的影像学诊断和血管内治疗经验。方法回顾性分析18例椎动脉夹层动脉瘤的磁共振成像和血管造影影像学特点和血管内治疗经过。结果影像特点为MR内膜瓣与壁间血肿,DSA珠线征,双腔征等。12例支架治疗中4例单纯支架后造影复查不显影,8例支架联合弹簧圈栓塞7例造影复查不显影;6例载瘤动脉闭塞4例造影复查不显影,全部病人临床随访症状消失。15例DSA复查随访,夹层动脉瘤不显影,无复发。结论DSA及MR检查对椎动脉夹层动脉瘤具有诊断价值;血管内治疗如支架技术（单纯置入或联合弹簧圈栓塞）以及载瘤动脉闭塞是椎动脉夹层动脉瘤安全、有效的选择。     

主动脉夹层急症诊断的研究进展

目前许多检查方法对主动脉夹层都难以确诊,延误了治疗时机,原因与主动脉夹层的表现多样及各种检查的特异性和敏感性不同有关。如何急诊诊断主动脉夹层,为其开发更加特异和敏感的检查提供帮助,使患者得到及时、有效的救治,就此笔者综述了主动脉夹层的分型及诊断方法。     

Outlook of Non Operated Type B Aortic Dissection with Special Reference to the Incidence of Degenerative Abdominal Aortic Aneurysm (AAA). One Center Study

Objectives: to determine the value of pharmacological treatment of type B aortic dissection (B AD) in face of new forms of treatment.

Design: this is a retrospective study of the period from 1990 to 2000. Files of 81 patients have been reviewed and completed by questionnaires.

Results: Two B AD died after admission without any treatment, 10 were operated on with 7 discharged alive (group I); 69 received hypotensive agents and ß-blockers, 65 were discharged alive (group II). Late mortality of the group I is 3/7, not related with B AD. Late mortality after mean follow-up of 56.8 months is 27/65 with 4/27 related to B AD (4 ruptures, 2 operated on). Non fatal secondary surgery amounts 5 in 4 patients. Total B AD aortic events comprise 8/65 patients. Type A AD were operated on successfully (8: 4 before B AD, and 4 after B AD). Degenerative abdominal aortic aneurysms were present, operated (9) or not (3), in the history of patients and 3 more appear subsequently. At 10 years, actuarial survival is 40% ±18.

Conclusion: in non-complicated cases of B AD, medical treatment is a reasonable choice, provided that a strict follow-up of the thoracic abdominal aorta is performed.     

彩色多普勒超声对动脉瘤诊断的进一步研究

目的 探讨彩色多普勒超声对动脉瘤的诊断、鉴别诊断价值及治疗价值。方法 使用彩色多普勒超声观察不同类型动脉瘤的二维及彩色多普勒表现36例，包括真性动脉瘤15例，腹主动脉夹层动脉瘤5例，假性动脉瘤16例。使用彩色多普勒超声观察不同类型动脉瘤的二维及彩色多普勒表现，协助临床对假性动脉瘤行超声引导下压迫治疗。结果 1．经超声诊断的动脉瘤与血管造影、CT、核磁或临床手术对比诊断符合率在80％以上；2．真性动脉瘤彩超示血管内径局限性扩张，夹层动脉瘤可见主动脉撕裂内膜的破口及分隔形成的双腔样结构，真腔内血流特征性频谱为收缩期先前向，后逆向，舒张期前向；假性动脉瘤破口处血流呈“往复征”，往复征频谱的探测点有助于确定加压治疗的体外压迫点；3．交替使用低频、高频探头观测动脉瘤二维及频谱能提高诊断符合率及敏感度。结论 彩色多普勒超声对动脉瘤能无创、敏感地得到诊断，有较高的特异性，并可协助临床治疗，具有重要价值。     

小切口股腘动脉搭桥术治疗老年下肢动脉闭塞症

本文报告１９９３年１月～１９９４年１２月采用小切口新方法作股动脉搭桥术治疗股动脉粥样硬化闭塞症共１１例。采用自制顶端带孔的大隐静脉回套器，仅作１～２ｃｍ的小切口数个，可取得搭桥所需长度的大隐静脉。１１例手术取得较好疗效：全组切中１０例获一期愈合，１例结痂延迟愈合。经１月～２年６月随访，术后９例间歇性跛行消失，２例间歇性跛行仍同术前。术前患肢踝／肱指数平均为０．４５，术后踝／肱指数平均为０．７９，提高０．３４，证实下肢动脉血流明显改善。