目的 总结布-加综合征患者发生血小板减少症的危险因素.方法 120例布-加综合征患者,根据是否发生血小板减少症分为血小板减少症组48例、无血小板减少组72例.收集两组患者的性别、年龄、病程、解剖分型等一般资料,白蛋白、胆红素、肌酐、凝血酶原时间(PT)、国际标准化比值(INR)、血红蛋白含量等血细胞学指标.采用Logistic回归分析法分析布-加综合征患者发生血小板减少症的危险因素.结果 血小板减少症组年龄、病程、解剖分型、胆红素水平等与无血小板减少组相比,P均<0.05.年龄、病程、胆红素水平是布-加综合征患者发生血小板减少症的影响因素.结论 布-加综合征患者可能发生血小板减少症,年龄大、病程长、高胆红素水平是布-加综合征患者发生血小板减少症的危险因素.

目的 探讨布-加综合征(BCS)人工血管转术后流吻合口狭窄再处理情况.方法 收集2016—2020年火箭军特色医学中心收治的9例BCS患者的临床资料,根据治疗方法的不同将其分为介入组(n=6)和手术组(n=3).介入组中5例行单纯经皮血管腔内成型术(PTA),1例溶栓后行PTA球囊扩张肠系膜吻合口.手术组开腹行肠系膜吻合口增生内膜剥脱血管重建.观察比较两组患者的术后腹围、血浆白蛋白、门静脉压力变化情况.结果 两组患者门静脉压力、腹围、白蛋白比较,差异均无统计学意义(P>0.05).术后随访,介入组患者肝功能好转4例,手术组患者肝功能好转2例.结论 BCS人工血管转流远期吻合口狭窄较为常见,在充分评估吻合口及分流道情况下选择合适的治疗方式,介入球囊扩张和开放手术吻合口重建远期效果无明显差异.

马松瘤也称血管内内皮乳头状增生、血管内血管瘤病、马松氏假性血管肉瘤等,是临床上一种较为少见的血管内反应性增生病变,最早由Ewing在1922年报道,但其名称来源于Masson报道的一例关于感染性痔的病例[1].本病无特异性临床表现,临床诊断较为困难,无特征性检查,虽然超声检查能提示血管腔内实性回声、丰富血流信号、呈"火球样"改变,但明确诊断仍需病理检查.本病虽然为良性肿瘤,但随着瘤体增大,血管腔内局部炎症反应刺激导致继发血栓的风险较高,所以要积极手术治疗.

破裂性静脉瘤是一种临床少见的静脉血管疾病,该病在瘤体较小、压力较低时通常无特异性临床表现,诊断较为困难,容易漏诊和误诊[1-2].超声探查有特征性频谱,即"双流征",在静脉瘤体缺口处形成反向、双期血流,但最终明确诊断仍需病理检查.破裂性静脉瘤虽为良性病变,但是随着瘤体增大,可能出现破溃或继发血栓形成,尤其是颈部的破裂性静脉瘤压迫气道或血栓脱落进入肺循环引起肺栓塞,所以要积极手术治疗.本文探讨了1例颈部破裂性静瘤的诊疗过程,现报道如下.

患者女,88岁,突发上腹绞痛伴呕吐6天、加重2天;既往糖尿病15年、心房颤动6年,脑出血后4年.查体:上腹轻压痛,肠鸣音1次/分.实验室检查:白细胞(white blood cell,WBC)18.6×109/L,钾(K+)3.30 mmol/L,甘油三脂(triglyceride,TG)0.91 mmol/L.腹部 CT 血管造影(CT angiography,CTA)见肠系膜上动脉(superior mesenteric artery,SMA)内充盈缺损(图 1A).综合临床诊断:急性SMA栓塞(SMA embolism,SMAE),心房颤动,2型糖尿病,低钾血症.于全麻下经右股动脉行腹主动脉造影,SMA仅根部显影(图1B),诊断为血栓栓塞SMA;经右股动脉引入 Rotarex 6F 导管(Straub Medical AG,Switzerland)至SMA,启动Straub机械血栓切除系统切除血栓及斑块,复查造影显示SMA全程显影(图1C、1D).

随着中心静脉置管和介入手术的广泛应用,医源性血管内异物的发生率随之升高.自20世纪80年代起,国内已经开始对医源性血管内异物进行治疗[1-2].常见的医源性血管内异物包括各种导管、导丝、完全植入式静脉输液港、经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC )、下腔静脉滤器及各种封堵装置.对于医源性血管内异物的处理,通常首选介入手术取出,可以采取局部血管切开或腹腔镜辅助;在上述方法不能解决的情况下也可以采用开放手术进行治疗[1-4].本文对4例医源性血管内异物取出患者的病历资料进行分析,并结合相关文献对医源性血管内异物患者的临床特征、诊治过程进行探讨,以期能够为医源性血管内异物的临床诊治提供可供参考的处理策略,现报道如下.

目的 超选择肾动脉弹簧圈栓塞术治疗经皮肾镜碎石取石术(PCNL)后严重出血的疗效.方法 收集2017年1月至2020年12月河北燕达医院收治的PCNL后严重出血行超选择肾动脉弹簧圈栓塞术治疗39例患者临床资料.统计PCNL后患者肾动脉出血情况;术后不良反应(恶心、呕吐、发热、腰痛);栓塞术成功率和术后肾功能情况.结果 肾动脉上支出血率17.95％、中支出血率51.28％、下支出血率30.77％;迟发性出血率53.85％、持续性出血率46.15％;输血率58.97％.39例患者的栓塞成功率94.87％;术后不良反应中,恶心发生率17.95％,呕吐发生率12.82％,发热发生率25.64％,腰疼发生率43.59％.术后的肾小球滤过率高于术前,血清尿素氮和血清肌酐低于术前,差异有统计学意义(P<0.05).结论 PCNL术后严重出血患者应尽快行数字减影血管造影(DSA)明确诊断后进行栓塞治疗,DSA和超选择肾动脉弹簧圈栓塞术可作为PCNL大出血首选的检查及治疗方法,超选择肾动脉弹簧圈栓塞术是安全有效的治疗方式,值得推广.

文章对1例以指端青紫为首发表现的抗磷脂抗体综合征患者诊治过程进行介绍.

患者男,76岁,因“左上肢突发疼痛伴皮温低2天”住院;高血压30年,口服药物控制良好.查体:心尖搏动位于右第5肋间锁骨中线内0.5 cm,心率82次/分,律不齐,第1心音不等,各瓣膜区未闻及病理杂音;左锁骨中线第5～7肋间、右腋中线第9～11肋间叩诊浊音;左手指尖略发绀,皮温低,左肱、尺、桡动脉搏动(-).超声:左肱动脉远端血流中断;心脏位于右胸腔,左心房增大.心电图:I、aVL和V1～V6导联QRS波群主波向下、T波倒置,V1～V6导联R波渐降低,律不齐.胸部增强CT(图1A、1B):心脏位于右胸腔,房室反位,主动脉在脊柱右侧,肝脏位于左上腹,十二指肠球部位于肝下,胃位于右上腹.综合诊断:完全性内脏逆位(situsinversus totalis,SIT),镜面右位心,心房纤颤(简称房颤),急性左肱动脉栓塞.遂于DSA引导下行左肱动脉切开取栓术,术中造影示肱动脉远端血流中断(图1C),将0.014in导丝插入桡动脉,沿导丝置入3F Fogarty双腔取栓导管(Edwards),取出长约5 cm暗红色血栓.复查造影示肱、桡动脉通畅(图1D).术后桡动脉搏动有力,予利伐沙班10 mg(2次/天),2周后行左心耳封堵术以防再栓塞,术后左上肢血供恢复良好.

病例资料患者,男,50岁,因“确诊布加综合征10年,腹壁静脉曲张进行性加重,间断腹胀、下肢酸胀半年,消化道出血6d”入院.患者于10年前明确“布加综合征”诊断,先后行“下腔静脉球囊扩张术”7次.每次治疗后下肢肿胀及酸胀感均减轻,但持续半年至1年不等后,肿胀再次出现.本次主要因下肢酸胀明显,活动后肿胀加重入院.

Objective To investigate the clinical efficacy of superior mesenteric artery(SMA) catheter thrombolysis in the early treatment of acute superior mesenteric venous thrombosis (ASMVT).Methods Six cases of ASMVT treated with SMA catheter thrombolysis were reviewed.The diagnosis,treatment and prognosis of the patients were analyzed.Results In 6 patients,except for 1 cases undergoing laparotomy for intestinal resection,the remaining treatments were successful with no obvious complications.The blood circulation rate of the mesenteric vein in the interventional treatment reached 60.0％,and the abdominal symptoms disappeared.The patients were followed up for half a year to 2 years,and 1 cases relapsed.Conclusion Interventional therapy has the advantages of less trauma,simple operation and less complications.For patients without necrosis of the ASMVT,early intervention with adequate anticoagulation may improve patient outcomes considerably.

Budd-Chiari syndrome (BCS) is a rare hepatic disease caused by occlusion of the hepatic venous outflow at any level from the small hepatic veins to the atriocava junction. BCS could have serious consequences if not treated promptly. The appropriate therapeutic strategy can be offered to change the natural course of the disease. The present case reports a young man with BCS who successfully received the hybrid treatment combined with endovascular intervention and mesocaval shunt by step. The 11-year follow-up showed that the patient was free of clinical symptoms, and computed tomography and ultrasonography confirmed the patency of the stent and shunt. Although BCS therapy methods are well established, the patient often needs to be treated repeatedly because of the high risk of recurrence. Step therapeutic strategy to alleviate portal and inferior vena cava hypertension of BCS patients are respected. The combination of endovascular intervention and mesocaval shunt was effective in our patient, and both stent and shunt have satisfactory long-term patency.

Background: The long-term efficacy of mesoatrial shunt (MAS) for Budd-Chiari syndrome (BCS) is not well studied. The purpose of our study was to investigate the long-term outcome and efficacy of MAS for BCS. Methods: We retrospectively evaluated 11 patients who underwent MAS for BCS from April 1986 to November 1995. Records of patients' clinical presentations, laboratorial investigation, Doppler duplex ultrasonography, radiologic image, and treatment outcomes were all retrieved and analyzed. Results: Follow-up intervals ranged from 1 year and 2 months to 30 years and 2 months (mean, 17 years and 8 months). Portal pressure decreased significantly from 35.72 +/- 3.52 cm H2O to 27.86 +/- 5.83 cm H2O post-MAS (P = 0.001). The 5-year, 10-year, and 20-year patency were 72.7%, 54.5%, 36.4%, respectively; 63.3% of patients had survived for more than 10 years and 45.5% for more than 20 years. A male has been alive with patent shunt for 28 years and 1 month. Conclusions: The MAS with enforced rings is an effective therapeutic modality for BCS with cautious perioperative management.

目的 探讨导管直接溶栓(catheter directed thrombolysis,CDT)对下肢急性深静脉血栓形成(acutedeep venous thrombosis,ADVT)的治疗效果.方法 回顾性分析笔者所在医院2014年1月至2015年10月期间收治的46例下肢ADVT患者治疗前后的患侧膝上15 cm周径、患侧膝下15 cm周径及通畅改善度评分,分析CDT对下肢ADVT的治疗效果.结果 所有患者均成功置管,其中5例经健侧“翻山”逆行置管,40例在超声引导下经患侧腘静脉顺行置管,1例经患侧股静脉置管.46例患者均成功置管溶栓,溶栓时间3～12d、(4.7±1.8)d.治疗过程中8例出现不同情况并发症,经对症处理、停药及拔管后均缓解,无死亡.同组内与治疗前比较,全人群、22～45岁组及46～74岁组治疗后患侧的膝上15 cm周径(P=0.028,P=0.017,P=0.031)、膝下15 cm周径(P=0.035,P=0.038,P=0.047)及患侧通畅度评分均较低(P=0.023,P=0.028,P=0.031);同组内与健侧比较,全人群、22～45岁组及46～74岁组治疗后患侧膝上15 cm周径(P=0.073,P=0.387,P=0.358)和膝下15 cm周径(P=0.416,P=0.625,P=0.253)的差异均无统计学意义.治疗后经超声检查提示血管完全再通15例(32.6％),部分再通28例(60.9％),管腔未通3例(6.5％),总有效率为93.5％ (43/46).出院后有43例患者获访,随访时间1～ 24个月,中位数为18个月.随访期间,活动后患肢肿胀、皮肤颜色明显加深5例,患肢酸胀明显19例,部分再通者中深静脉血栓形成(DVT)复发9例,发生血栓形成后综合征(PTS) 11例.结论 CDT是治疗下肢ADVT最为直接和有效的方法.

目的:探讨肠系膜上动脉综合征（SMAS）所致胃食管反流（GER）性咳喘的诊治方法。方法:回顾性分析6例SMAS致GER性咳喘患者的临床资料。结果:患者的临床表现主要为上腹间断性胀痛、反酸、烧心、咳嗽、哮喘等,上消化道造影示十二指肠水平段受压。2例行保守治疗,4例行手术治疗。随访1.5~84个月,3例术后症状改善明显,1例术后并发胃瘫,予胃动力药物治疗后缓解;2例保守治疗,症状得到有效控制,但需长期服质子泵抑制剂及胃动力药物。结论:SMAS致GER性咳喘的诊治需兼顾SMAS和GER,手术与保守治疗相结合可获满意疗效。

Studies on three-dimensional tissue engineered graft (3DTEG) have attracted great interest among researchers as they present a means to meet the pressing clinical demand for tissue engineering scaffolds. To explore the feasibility of 3DTEG, high porosity poly-ε-caprolactone (PCL) was obtained via the co-electrospinning of polyethylene glycol and PCL, and used to construct small-diameter poly-ε-caprolactone–lysine (PCL–LYS–H) scaffolds, whereby heparin was anchored to the scaffold surface by lysine groups. A variety of small-diameter 3DTEG models were constructed with different PCL layers and the mechanical properties of the resulting constructs were evaluated in order to select the best model for 3DTEGs. Bone marrow mononuclear cells were induced and differentiated to endothelial cells (ECs) and smooth muscle cells (SMCs). A 3DTEG (labeled ‘10-4 %’) was successfully produced by the dynamic co-culture of ECs on the PCL–LYS–H scaffolds and SMCs on PCL. The fluorescently labeled cells on the 3DTEG were subsequently observed by laser confocal microscopy, which showed that the ECs and SMCs were embedded in the 3DTEG. Nitric oxide and endothelial nitric oxide synthase assays showed that the ECs behaved normally in the 3DTEG. This study consequently provides a new thread to produce small-diameter tissue engineered grafts, with excellent mechanical properties, that are perfusable to vasculature and functional cells.

双腔静脉阻塞(bicaval obstruction,BO)是上腔静脉综合征(superior vena cava syndrome,SVCS)合并下腔静脉综合征(inferior vena cava syndrome,IVCS)引起的疾病,临床罕见,治疗困难.笔者采用人工血管转流术治疗1例双腔静脉阻塞病人,随访28年,效果良好.报告如下.

Gastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world’s population. The minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage refractory GERD. However, long-term benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study was therefore conducted to evaluate the outcome of patients with refractory GERD 5 years after the Stretta procedure.

OBJECTIVE:This study aimed to evaluate the efficacy of antireflux treatment on gastroesophageal reflux (GER)-related cough syncope.METHODS:The method used was a retrospective review of the outcomes of antireflux treatment with proton pump inhibitor (PPI), Stretta radiofrequency (SRF), or laparoscopic fundoplication (LF) of 8 patients with chronic cough and cough syncope that was clinically evaluated to be GER related over a period of 2 to 5 years.RESULTS:In the 8 selected cases, the typical GER symptoms disappeared in 7 cases and were significantly eased in 1 case. The chronic cough diminished to mild and occasional occurrence in 6 cases and was completely relieved in 2 cases. Meanwhile, the cough syncope disappeared in all cases. Seven of the patients resumed physical and social functions after the antireflux treatments, except for 1 person, who had a stroke due to other causes.CONCLUSION:For chronic cough and cough syncope of unknown cause, the GER assessment could be valuable. In treating well-selected GER-related chronic cough and cough syncope, PPI, SRF, and LF can be considered. Moreover, satisfactory restoration of physical and social functions could be achieved after effective antireflux therapy.