肢体创伤性动脉病变的介入诊断与治疗

目的 评价介入放射方法诊断治疗肢体创伤性动脉病变的效果。方法 8例肢体动脉创伤伴有远端肢体缺血改变，其中2例伴大出血，伤者接受了选择性患肢动脉造影检查；7例随后进行了动脉病变的血管腔内介入治疗。治疗方法包括动脉分支或主干栓塞、动脉内溶栓和血管内支架置放。结果 血管造影精确显示了动脉破裂、假性动脉瘤、血栓形成或动脉内膜损伤等病变性质。3例假性动脉瘤、3例动脉血栓病变综合应用介入治疗方法取代外科手术获得满意疗效。1例溶栓后证实动脉破裂和1例造影证实动静脉瘘后转手术治疗。结论 介入放射与外科方法相结合能明显提高肢体动脉创伤的诊断治疗水平，有效挽救伤者肢体和生命。     

Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Soft tissue sarcomas (STS) tend to recur locally. In a series of 140 patients operated on during the past two decades with STS of the extremities and trunk, prognostic factors influencing local recurrence were determined. Statistical significance was evaluated for the quality of surgical resection (P<0.001), regional positive lymph nodes (P=0.03), and adjuvant radiotherapy (P=0.01) [for resection without wide margins (R1) and low-grade (G3) tumors]. In 1988, the surgical procedure was standardized. After 1987, local recurrence decreased significantly (P < 0.001). In subfascial tumors, local recurrence occurred far less in cases of compartmental resection than with wide excision. These data indicate that the course of patients with STS can be beneficially influenced by optimal therapy. Resection with wide margins in all three dimensions is the aim of sarcoma surgery. Postoperative radiation therapy is indicated in the case of R1 resection.

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Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Zusammenfassung Weichteilsarkome neigen zur Ausbildung von Lokalrezidiven. In einer Studie von 140 Patienten der letzten 20 Jahre mit Sarkomen an Extremitäten und Rumpf wurde untersucht, welche Faktoren das Auftreten von Lokalrezidiven beeinflussen. Statistische Signifikanz ergab sick fur die Qualität der chirurgischen Re sektion (R) (p<0,001), den regionalen Lymphknotenstatus (p=0,03) sowie eine adjuvante Strahlentherapie (p=0,01) [bei marginal resezierten (RI), niedrig differenzierten (G3) Tumoren]. 1988 wurde das chirurgische Vorgehen standardisiert. In der Zeit danach traten signifikant weniger Rezidive auf als davor (p < 0,001). Bei subfaszialer Lage traten Rezidive nach Kompartmentresektion wesentlich seltener auf als nach weiter Resektion. Der Krankheitsverlauf von Weichteilsarkomen ist also durchaus therapeutisch beeinflußbar. Ein dreidimensional weiter Sicherheitsabstand ist das entscheidende Therapieziel, eine Bestrahlung in R1-Situationen indiziert.

     

负压对缺血肢体血流动力学影响的实验研究

目的：观察负压对肢体动脉闭塞犬患肢血流动力学的影响。方法：犬15只，随机分治疗组10只和对照组5只。两组均采用切断犬后肢股动脉分支、动脉腔内置入螺旋状金属丝的方法，制作肢体缺血模型。在模型制作后2wk，治疗组行患肢负压治疗10d，对照组不做负压治疗。两组均于模型前、模型后2wk及治疗结束后，用彩色多普勒观察患肢股动脉血流动力学指标：收缩期最大流速(Vmax)、平均流速(Vmean)、阻力指数(R1)、搏动指数(P1)的变化。结果：治疗组在治疗后患肢股动脉Vmax、Vmean显著增加(P＜0．001)，RI、PI显著降低(P＜0.01)；对照组各指标无明显变化(P＞0．05)。结论：负压对缺血肢体血流动力学表现为流速增加，阻力下降。     

Solitary skeletal hemangioma of the extremities

Objective. To report the clinicopathologic features of solitary skeletal hemangioma of the extremities and to review previous cases in the English language medical literature. Patients. In addition to five of our own cases, 34 literature cases with substantial and 75 with partial clinicopathologic information were found. Results. Our patients, three men and two women, ranged in age from 37 to 83 years (mean 65.6 years). The lesion was an incidental radiologic finding in two patients, while three were symptomatic. In no case was a correct preoperative radiologic diagnosis made, a malignant process being considered as a possibility in all. The hemangiomas were medullary; two involved a metacarpal, two the fibula, and one the humerus. In contrast, previously reported patients were younger (mean age 32 years), predominantly female (60%), and symptomatic in over 90% of cases. The lesion is rare in those younger than age 10 years or older than age 60 years. As in our patients, the long bones are most frequently involved (75%), with the diaphysis or metadiaphysis, as in four of our patients, the most common locations. Although 20% of cases occur in the hands or feet, metacarpal involvement is rare. Medullary origin, as in all of our cases, is most frequent, but 45% of cases are either periosteal (33%) or intracortical (12%). In the literature, cavernous hemangioma is the most frequent type. Three of our hemangiomas were cavernous, one capillary, and one venous, the latter being rarely reported in extremity bones. Conclusions. Due to the diversity of radiologic patterns produced by skeletal hemangioma, a correct preoperative diagnosis is rarely made. Almost all patients do well, even those with less than complete removal of the lesion; local recurrence is rare. All of our patients were well following either therapeutic or simple diagnostic procedures. Due to the destructive nature of some biopsy procedures, the histologic diagnosis of hemangioma may at times also be problematic. Received: 7 February 2000 Revision requested: 31 March 2000 Revision received: 25 May 2000 Accepted: 26 May 2000     

Outcomes of upper extremity interventions for chronic critical ischemia

Background

Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management.

下肢静脉曲张术后并发静脉血栓的有效护理干预

目的:分析对下肢静脉曲张术后并发静脉血栓患者的有效护理干预措施。方法:以2019年6月~2019年6月我院收治的42例下肢静脉曲张患者为研究对象,随机分为两组,各21例,对照组常规护理,实验组实施有效护理干预,对比护理效果。结果:对照组下肢静脉曲张术后患者的并发深静脉血栓发生率高于实验组患者,差异具备统计学价值;实验组下肢静脉曲张术后患者的护理满意度高于对照组患者,差异显著且具备统计学意义。结论:下肢静脉曲张术后实施有效护理干预可降低并发静脉血栓发生率,同时提升患者护理满意度,有效改善患者预后,促进患者康复,也有利于维护良好的护患关系,因此应在临床实践中对有效护理干预进行推广与普及。     

Experience of Interstitial Permanent I125 Brachytherapy for Extremity Soft Tissue Sarcomas

AimsSoft tissue sarcomas are uncommon, but relatively aggressive tumours. Although surgical resection remains the primary therapeutic modality for all localised tumours, brachytherapy combined with function-preserving excision is a popular treatment for extremity soft tissue sarcomas. The objective of this study was to evaluate the effect of interstitial permanent brachytherapy using I¹²⁵ seeds in patients undergoing the combined modality in the management of soft tissue sarcomas at our institution.Materials and methodsBetween January 2007 and January 2012, 110 adult patients aged 18–86 years (median = 44 years) with extremity soft tissue sarcomas and who underwent interstitial permanent brachytherapy as part of the local treatment were included in this study. Treatment included wide local excision of the tumour and brachytherapy using a permanent I¹²⁵ implantation. Complications were assessed in terms of wound complication and peripheral nerve damage.ResultsAfter a median follow-up of 43.7 months, the local control, disease-free survival and overall survival for the entire cohort studied were 74, 54 and 77%, respectively. The actual rates of wound complications requiring reoperation and nerve damage were 4.5 and 1.8%, respectively.ConclusionsWe conclude that interstitial permanent brachytherapy with I¹²⁵ after function-preserving surgery results in a satisfactory outcome in patients with extremity soft tissue sarcomas and the complication rate is low.     

Extraskeletal Ewing sarcoma attached to the ulnar nerve: A case report

IntroductionExtraskeletal Ewing sarcoma (EES) of the extremity is uncommon, and only a small number of reported cases have been devoted to the upper-extremity.Presentation of caseA 65-year-old woman presented with a recurrent EES, a highly malignant tumor, involving the ulnar nerve at the right elbow region which was initially suspected as a benign soft tissue tumor, schwannoma, thus marginal excision had been performed. Due to its malignant behaviour, we treated the recurrent lesion with wide excision and reconstruction combined with chemotherapy. Histological evaluation revealed a monotonous small round cells appearance.DiscussionEES of the extremity involving the ulnar nerve is fairly uncommon. The tumor was often smaller in the adult than in the child population which was consistent with the present case, thus may mimic a benign tumor. Because of the overlapping histopathological features of EES with other tumors, other investigations such as immunohistochemistry and cytogenetic studies must be performed to allow definitive diagnosis. The result of our study was negative for the EWSR1-FLI-1 and CIC-DUX4 fusion gene, however, other less frequent translocations could be found in this case which does not exclude the diagnosis of Ewing sarcoma family.ConclusionFew cases of EES involving the ulnar nerve have been previously reported. The correct diagnosis of EES involving the ulnar nerve has become particularly important in order to enable the initiation of comprehensive management that have the potential to reduce disease progression and the avoidance of improper and potentially harmful surgical therapy.     

四肢软组织静脉畸形的比较影像学诊断

目的比较用于四肢软组织静脉畸形的各影像学检查方法的临床价值。方法收集2009年2月-2014年2月于我院就诊的27例四肢软组织静脉畸形患者,所有患者均行X线平片、超声、CT、MRI及血管造影检查,并对各检查结果进行统计描述,比较各检查的优缺点。结果四肢软组织静脉超声检查可表现大小不等、分布不均、形状不规则的蜂窝或网状液性暗区,软组织中的畸形静脉多表现为可压缩的低回声,明确病变畸形静脉的形态、大小以及范围,并可用于术中动态观察,但该检查方式的病变界限欠清。而MRI检查能够清楚分辨畸形静脉的部位、大小。定位准确,明确病变血管累及范围,并能明确软组织成分,虽相对较昂贵,但对于静脉畸形的诊断有重要的指导意义。结论 MRI以及超声检查对于畸形血管的诊断以及明确病变范围有重要的临床指导意义,值得临床推广及应用。