目的:探讨高频超声在血管球瘤诊断中的价值.方法:回顾性收集并分析15例血管球瘤的超声特点、临床表现等资料,并与45例神经鞘瘤、14例血管平滑肌瘤相比较.结果:血管球瘤、血管平滑肌瘤以及神经鞘瘤在性别、年龄、分布、长径、前后径及痛疼方面差异均有统计学意义(P<0.05～P<0.01).与其他2种疾病相比,血管球瘤临床特点为好发于年轻女性,病灶较小,主要分布于指趾,常伴有特征性疼痛.在超声下回声均匀程度以及超声多普勒血流信号方面3种疾病差异均无统计学意义(P>0.05).结论:血管球瘤具有较特征的临床与超声表现,高频超声可作为首选的检查方法.
Objective:Cerebral infarction is frequently seen in haemodialytic patients,we investigated the characteristics pe- ripheral artery atherosclerosis and cerebral infarction,in order to explorate association between them.Methods:In 42 patients with end-stage renal disease who underwent haemodialysis therapy(HD group) and 42 age-matched healthy (control group), color Doppler ultrasonography was performed to check the atherosclerotic plaque of paries posterior of carotid and femoral ar- teries and Gofman's index,CT for cerebral infarction.Results:Compared with control group,the patients in HD group showed thicker atheroscierotic plaque of paries posterior of carotid and femoral arteries (1.52±0.49 mm vs 0.88±0.26mm,P＜0. 001;1.37±0.48mm vs 0.86±0.33mm,P＜0.05,respectively),higher Gofman's index (4.00±3.03 vs 0.43±0.96,P＜0. 001;1.45±1.91 vs 0.24±0.86,P＜0.05,respectively),higher positive rate of C-reactive protein (33.3% vs 0%,P＜0. 001);higher incidence of cerebral infarction (28.6% vs 0%,P＜0.001).Atherosclerotic plaques of carotid and femoral arteries demonstrate mixed echogenicity.Conclusion:Atherosclerosis is a common complication,and significant carotid artery stenosis or ulcerations releasing microemboli to the brain are responsible for many occlusive cerebrovascular diseases.Color Doppler ultra- sonography may be used for detection of atherosclerosis in hemodialytic patients,and providing evidence for working out thera- peutic schedule.
动静脉内瘘是慢性肾衰竭维持性血液透析患者赖以生存的"生命线".内瘘对透析效果和患者长期生存有重要影响.目前国内外采用的内瘘手术方法大多是上肢前臂腕纹上桡动脉头静脉吻合术,实践中该术式时有因增加回心血量,诱发充血性心力衰竭.本文采用鼻咽窝桡动脉远心端与头静脉近心端端端吻合能有效地控制吻合口血流量,既不诱导高输出性心力衰竭,又不增加远期内瘘并发症,且能满足常规血液透析的血流量要求.现将研究结果报道如下.
目的探讨维持性血液透析患者的最佳内瘘手术方式.方法153例慢性肾功能衰竭患者随机分为两组,鼻咽窝组78例,于手背鼻咽窝处0.6～1 cm切口,应用9个零无损伤尼龙线行桡动脉远端头静脉近端端端吻合8～12针.前臂组75例,于左前臂腕纹上3 cm纵形切口2～5 cm,用9个零无损伤尼龙线间断作桡动脉头静脉两近心端端端吻合.手术1年后,应用彩色多普勒超声检查测定吻合口血流量;记录透析血流量;以及1年间充血性心衰发生率与内瘘并发症.结果78例鼻咽窝组内瘘吻合口血流量与透析血流量均较理想,无并发症发生.结论手背鼻咽窝处应用9个零无损伤尼龙线行桡动脉远端头静脉近端端端吻合建立血透通路为最佳选择.既不诱导高输出性心力衰竭,又不增加远期内瘘并发症,且能满足常规血透的血流量要求.
