血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎病人血清中红细胞免疫调节因子的研究

为了探讨血栓闭塞性脉管炎病人血清中红细胞免疫调节因子对红细胞免疫功能的影响，测定了３０例ＴＡＯ病人红细胞免疫附促进因子花环率和红细胞免疫粘附抑制因子花环率。结果表显示：ＴＡＯ组ＲＦＥＲＲ明显降低，ＲＦＩＲＲ明显为高，与对照组比较有显著差异。     

一期大隐静脉动脉化治疗下肢血栓闭塞性脉管炎

目的：通过一期大隐静脉动脉化治疗下肢血栓闭塞性脉管炎。方法：通过利用自体头静脉在患肢大隐静脉与患肢股动脉或髂外动脉之间搭桥，为６６例９１侧下肢血栓闭塞性脉管炎患者实施手术。结果：术后下肢缺血性疼痛消失，皮温皮色恢复正常，足趾及跖部创面愈合，多普勒超声探测及动脉造影提示患足血供良好。结论：本术式不影响静脉血回流，简易、经济，效果良好，使用头静脉搭桥可使本术式应用范围更广。     

Involvement of the coronary artery in a patient with thromboangiitis obliterans. A case report

 We report a case of coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and a saphenous vein graft in a 36-year-old man with Buerger's disease. He was hospitalized in the coronary intensive care unit with a diagnosis of acute myocardial infarction. His coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) and right coronary artery. Left ventricular dysfunction was detected by ventriculography. The patient had undergone bilateral sympathectomy of the lumbar branches for distal arterial occlusions due to thromboangiitis obliterans 12 years previously. Under cardiopulmonary bypass and aortic cross-clamping, we performed endarterectomy and a complex bypass procedure to LAD. Aorta-right coronary artery bypass was also applied. A histopathological study of an endarterectomy specimen showed characteristic features of thromboangiitis obliterans. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day. Received: November 19, 2001 / Accepted: February 16, 2002     

基于数据挖掘的中医药治疗血栓闭塞性脉管炎的用药规律研究

目的:基于中医传承辅助平台挖掘中国知网数据库(CNKI)中以中医药治疗血栓闭塞性脉管炎的组方用药规律,为中医药治疗血栓闭塞性脉管炎提供临床参考。方法:检索CNKI 数据库中近30 年有关中医药治疗血栓闭塞性脉管炎的文献,筛选出符合条件的治疗血栓闭塞性脉管炎的中药方剂,利用中医传承辅助平台(V2.5)集成的数据分析方法,挖掘中医药治疗血栓闭塞性脉管炎的用药规律。结果:共筛选出410 篇文献,符合条件处方600 首,涉及233 味中药。处方中药物出现频次≥ 60 的药物得到33 个,演化得到核心组合28 个,新处方14 个;药物主归肝、心、脾经,性味分别以温、寒、平和苦、辛、甘为主。结论:治疗血栓闭塞性脉管炎的药物立足于“血瘀”病机,以活血化瘀为主要治则,辅以清热、补虚、温通、息风止痉、止痛、托毒生肌、燥湿、通络等药物,在临床应用中灵活辨证施治。     

血栓闭塞性脉管炎合并动脉硬化闭塞导致下肢缺血的手术治疗

目的 探讨下肢血栓闭塞性脉管炎(thmmboangiitis obliterans,TAO)合并动脉硬化闭塞症(arteriosclerosis obliterans,ASO)手术治疗效果.方法 回顾性分析2007年治疗的TAO合并ASO 6例患者的资料.2例行腹主动脉切开取栓+内膜剥脱+腹主动脉-股深动脉人工血管旁路移植-胭动脉人工血管-小腿动脉自体大隐静脉旁路移植术,1例行腹主动脉切开取栓+内膜剥脱+腹主动脉-右股深动脉人工血管旁路移植-膝下胭动脉人工血管旁路移植术;1例行左髂总动脉-左股深动脉人工血管旁路移植一胫前动脉自体大隐静脉原位移植术,1例行左侧人工血管切开取栓+左股深动脉成形-膝下腘动脉人工血管旁路移植术,1例行右股总动脉-左股总动脉人工血管旁路移植-胫后动脉自体大隐静脉旁路移植术.结果 5例患者术后恢复顺利,1例于术后当天出现股动脉-腘动脉人工血管和远段的大隐静脉桥血栓形成,立即再次手术行人工血管和大隐静脉切开取栓术,并同时行胫后动静脉吻合.6例患者均痊愈出院,无死亡病例.5例患者的下肢远端静息痛完全缓解,1例部分缓解.足部溃疡的2例创面明显缩小,无感染发生.所有患者得到随访,平均随访为6.5个月,3例足部溃疡愈合.1例术后3个月出现左股部切口感染,最终行膝上截肢处理,残端一期愈合.其他5例患者的移植血管通畅,症状缓解.结论 对TAO合并ASO患者如果手术治疗方式恰当,可以取得比较好的疗效.     

Colon Ischemia Associated with Buerger's Disease: Case Report and Review of the Literature

Buerger''s disease, or thromboangiitis obliterans, is a nonatherosclerotic inflammatory disease affecting the small- and medium-sized arteries and veins of the extremities (arms, hands, legs, and feet). It is most common in the Orient, Southeast Asia, India, and the Middle East, and usually affects men aged between 20 and 40 years, although it is becoming more common in women. It is well established that most such patients smoke heavily and experience an improvement in symptoms following smoking cessation. Mesenteric involvement in Buerger''s disease is extremely rare; however, we describe herein two cases of colon ischemia in patients who were previously diagnosed with lower-extremity Buerger''s disease. In one case, the patient developed colonic obstruction, and surgical resection was performed. Histopathologic findings were compatible with the chronic stage of Buerger''s disease. In the other case, angiography revealed abrupt occlusion of the inferior mesenteric artery with numerous collateral vessels, just like the corkscrew appearance found in the extremities. If patients with established Buerger''s disease of the extremities complain of gastrointestinal symptoms, early interventional diagnosis should be performed to prevent intestinal obstruction and gangrene.     

Vascular reconstruction in Buerger's disease: is it feasible?

Purpose: Thromboangiitis obliterans (Buerger's disease) is a clinical syndrome characterized by segmental occlusions of the distal vessels. Although a cessation of using nicotine products usually helps, nevertheless a surgical revascularization may be needed in cases of stage III and IV limbs. Because of the distal and segmental nature of the disease, these procedures are rarely feasible. This article focuses on the feasibility of performing a vascular reconstruction in thromboangiitis obliterans. Methods: Thirty-six of 94 patients (38.3%) who were followed by the Peripheral Vascular Unit of Istanbul Medical Faculty were selected for revascularization and 27 of 36 (81%) patients underwent revascularization procedures. Results: During a 36-month follow-up, the patency rates at the 12th, 24th, and 36th months were 59.2%, 48%, and 33.3%, respectively. The limb salvage rate was 92.5%. Conclusions: Since patients affected by Buerger's disease consist a group of young population who are still in their productive stages, every effort should be taken to obtain a limb salvage in the ischemic period. Although the patency rates do not seem promising, the limb salvation rate was quite satisfactory. Received: October 29, 2001 / Accepted: July 2, 2002 Reprint requests to: Ş. Dilege     

Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

Purpose Buerger's disease is a peripheral arterial occlusive disease (PAOD), which occurs mainly in young male smokers. It is common in Asia, the Middle East, and Eastern European countries, but rare in North America and Western European countries. We investigated the changes in the prevalence and recurrence of Buerger's disease at a referral hospital in northern Thailand. Methods We conducted a retrospective study of patients with Buerger's disease admitted to Chiang Mai University Hospital between January 1988 and December 2002. Buerger's disease was diagnosed according to Shionoya's clinical criteria. Results We evaluated 78 patients with Buerger's disease, with a collective total of 108 admissions. Forty-one patients were admitted for initial treatment, and 37 patients had a history of treatment and were admitted for worsening of Buerger's disease. Between 1988 and 1995, 23 patients were admitted with newly diagnosed Buerger's disease, 52 were admitted because of Buerger's disease exacerbation, and 372 were admitted for a PAOD; whereas between 1996 and 2002, the respective numbers were 18, 15, and 632 (2.9 ± 1.9/year vs 2.6 ± 1.3/year, P = 0.25; 6.5 ± 1.1/year vs 2.1 ± 1.1/year, P = 0.001; 54.1 ± 6.7/year vs 81.6 ± 5.2/year, P < 0.0001). Of the 78 patients with Buerger's disease, 76 were men and 2 were women, with a mean age at onset of 34.1 ± 5 years. The predominant symptom on admission was burning pain in the feet and hands in 75%, digital gangrene in 74%, and a digital ulcer in 43.5%. Conclusions The incidence of recurrence of Buerger's disease seems to be decreasing in our institution, whereas the incidence of this disease and its recurrence both seem to be decreasing in Western countries and Japan.