Portal hypertension due to portal venous thrombosis： Etiology, clinical outcomes

The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting clinical pictures. There are controversial issues in nomenclature, management (including anticoagulation problems), follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients.     

Surgical Intervention for Hepatocellular Carcinoma with Bile Buct Thrombi

Objective: To summarize the experience of surgical intervention for hepatocellular carcinoma(HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis. Methods: From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.Results: The operative procedures included hepatectomy with removel of BDT (n=7), hepatectomy com-bined with extrahepatic bile duct resection (n=4), thrombectomy through choledochotomy (n=3), piggy back orthotopic liver transplantation (n=1). The 1-and 3-year survival rates were 73.3% and 40%, respec-tively. Two patients survived over 5 years. Conclusion: Surgical intervention was effective for patients with HCC and BDT. Operation for recurrent lesion can prolong survival period. Liver transplantation is a new treatment worthy of further investigation.     

10例肺动脉内膜剥脱术的观察和护理

目的肺动脉内膜剥脱术是慢性肺血栓栓塞症治疗的一种有效手段.方法通过对10例行肺动脉内膜剥脱术患者的术前、术后观察和护理进行总结.结果其护理与一般的心脏直视手术护理有相似之处,但其术后辅助呼吸、呼吸道的管理有别于普通的心脏直视术后护理.结论术后积极抗凝预防再次栓塞是术后成功的关键.     

颅内静脉血栓形成2例报告并文献复习

对 2例颅内静脉血栓形成病例结合文献分析总结 ,结果认为该病临床恢复较快而彻底 ,影像学上缺血性病灶消失完全 ,不留软化灶 ,病情变化与影像学变化可不同步 ,临床恢复可早于血管再通是本病的临床特征之一。 CT、 MRI等检查对诊断本病很关键。脱水降颅压、抗凝、溶栓是其基本治疗原则。     

长筒靴型间断气压治疗仪预防ICU患者DVT的临床研究

目的:探讨长筒靴型间断气压治疗仪的间歇充气加压治疗(IPC)对ICU患者下肢深静脉血栓症(DVT)的预防作用.方法:将92例ICU重症患者随机分配到实验组和对照组,对照组采取常规康复治疗,实验组从患者入ICU当日开始给予IPC预防DVT,以7d为观察期,比较观察期内两组患者DVT发生率、双侧大腿周径、双侧大隐静脉流速.结果:在观察期内,两组患者DVT的发生率比较差异有统计学意义(P＜0.05);治疗前后两组患者下肢周径,对照组治疗前后比较差异无统计学意义(P＞0.05),但实验组治疗前后比较差异有统计学意义(P＜0.05),治疗后实验组和对照组比较差异有统计学意义(P＜0.05);两组患者下肢静脉血流速度比较,对照组治疗前后比较差异无统计学意义(P＞0.05),实验组治疗前后比较差异有统计学意义(P＜0.05),治疗后实验组和对照组比较差异有统计学意义(P＜0.05),提示IPC可预防DVT的发生.结论:IPC是预防重症患者发生DVT的一种安全有效的措施.     

抗心磷脂抗体与眼部相关疾病

抗心磷脂抗体属于自身抗体之一,其与血栓形成、血小板减少及自然流产有关。近年来国外学者从不同角度做了大量研究,表明血栓性疾病与抗心磷脂抗体相关。为此笔者复习了近年相关文献,就抗心磷脂抗体阳性患者的流行病学、免疫学发病机制、临床表现、眼部特征、诊断依据、鉴别诊断、预防与治疗等问题进行综述。     

支架血栓症及其中药防治研究

研究表明,血管内介入治疗技术较简单药物治疗效果好,和外科血管搭桥术相比创伤明显减小,已在心脑血管疾病领域得到广泛应用。从经皮冠状动脉腔内成形术、裸金属支架到药物洗脱支架,支架内再狭窄问题已控制在可接受的范围。然而,支架置入术后并发症"支架血栓症"却困扰着药物洗脱支架的发展。抗血栓治疗、选择合适的支架类型和操作技术、开发新型支架和抗血栓药物、注意冠心病二级预防是预防支架内血栓形成的关键。该文主要对支架血栓症的形成原因、机制、防治(抗血小板、抗凝、溶栓)的最新研究进展及中药在其中的潜在应用进行探讨,以期为血管药物洗脱支架血栓症的防治及中医药在其中的应用提供一定的参考。     

An Experimental Study on the Flexibility of Prevention against Thrombosis Following Mechanical Valve Replacement by tPA Gene Transduction

Objectives Use a gene suture immersed recombinant tissue-type plasminogen activator （r-tPA）expression plasmid to transduce myocardia to prevent the thrombosis after mechanical tricuspid valve replacement in pigs. Methods A r-tPA gene plasmid was constructed and conjugated to a novel cationic phosphonolipid and a r-tPA gene suture was made. Eighteen pigs were selected and divided into two groups at randomization. There were 9 pigs in the experimental group and 9 in the control group, all the 18 pigs＇ tricuspids were replaced with mechanical valves. The gene threads were sutured into the right ventricular walls near mechanical valves and an ultrasound was used on the surfaces of the right ventricular walls for the gene transfer in the experimental group. Coagulative function, D-dimer level of the blood and the thrombosis on the surfaces of the valves were observed. Results r-tPA gene plasmid was successfully constructed and r-tPA protein was expressed in the ventricular cells around the gene sutures. D-dimer reached its peak level （ 1.67 ±0. 79） μg · mL^-1 in 1 week after operation in two groups, but it decreased to preoperation level thereafter in control group and kept on the high level and reincreased to a new high level （ 1.89 ± 0.79 ） μg · mL^-1 until the end of the experiment in experimental group. The thromboses around the valves were found in all the control group （100%） but only 1 （ 11.11% ） case in experimental group. There were no changes in prothrombin time pre and post operation in two groups. Conclusions Using gene suture immersed r-tPA expression plasmid to transduce myocardia might be a best substitution for life long anti-coagulation therapy for the patients, who underwent operation.     

推拿为主治疗下肢深静脉血栓症体会

笔者自１９９２年以来，采用憋放按摩疗法，配合中草药熏洗疗法治疗下肢深静脉血栓症３例，获满意疗效，现报道如下。１　一般资料本组资料３例，男２例，女１例；年龄１７～５６岁；周围型２例，混合型１例；左腿１例，右腿２例；病程最长者５个多月，最短者３个多月；其病因及病理：创伤、手术、妊娠、恶性肿瘤，长期卧床导致血液成份改变，血液高凝状态和血流缓慢，引起下肢深静脉血栓形成。２　治疗方法２１　憋放推拿消栓　医者用左手拇指或其余四指，横压在凝固的血栓区上方的深静脉血管上，在患者不感觉很疼的情况下尽量压紧，目的…     

8例经皮经股静脉置放下腔静脉滤器的手术配合

肺动脉栓塞是深静脉血栓形成后的一种严重并发症 ,严重时可以危及生命 ,而 75 %～ 90 %的肺动脉栓塞病例 ,其栓子主要来源于下腔静脉及下肢深静脉血栓 ,经皮经股静脉穿刺安置下腔静脉滤器近年来已被广泛用于阻止栓子上行 ,从而预防和减少肺动脉栓塞的发生。自 2 0 0 1年以来我院ＤＳＡ室成功地放置了 8例下腔静脉滤器。现结合实际操作总结如下。1　临床资料患者男 5例 ,女 3例 ,年龄 43～ 71岁 ,平均 5 8.1岁。 8例病人均经下肢深静脉造影确定为下肢深静脉血栓症。2　手术步骤2 .1　局麻下经皮经健侧股静脉穿刺置动脉鞘。2 .2　用猪尾巴多侧…