背景与目的:腔静脉滤器置入是预防下肢深静脉血栓形成患者发生肺栓塞最直接和最有效的手段,已被临床广泛应用.可转换型滤器用于预防肺栓塞的时限更加灵活,转换操作更加简单,但其临床应用的资料尚不足,因此,本研究通过单中心回顾性分析,综合评估可转换型腔静脉滤器的临床应用特点.方法:回顾性分析本中心行DSA引导下置入可转换型腔静脉滤器的52例患者资料.测量不同个体的下腔静脉直径,髂静脉分叉与低侧肾静脉开口距离,滤器释放时前跳距离,滤器释放后长度与宽度等指标,进一步明确置入安全距离.并收集滤器转换时间及转换术中情况,探讨复杂病例转换技巧.结果:经测量,52例患者的髂静脉分叉与低侧肾静脉开口距离为(116.4±13.2)mm,远大于滤器释放后的平均长度(54.6±1.3)mm;滤器释放后的滤器平均宽度为(22.9±3.0)mm,略大于释放前下腔静脉平均直径(20.8±3.4)mm;19例(36.5％)发生滤器释放后的前跳,平均前跳距离为(6.5±1.8)mm.释放后,滤器均无明显倾斜.在拟行转换的48例患者中,42例(87.5％)一次性成功解锁,平均耗时(4.5±0.8)min;其中39例(81.3％)回收钩取出后,滤器未打开或未完全打开,均经猪尾导管搅拌后完全打开.在41例超期转换病例中(＞2个月),37例患者(90.2％)一次性转换成功,其中4例患者(8.5％)有回收钩贴壁,经导丝成袢技术联合鹅颈抓捕技术辅助下成功转换.结论:可转换型腔静脉滤器是一种安全有效、容易转换的滤器选择.在置入过程中应考虑前跳可能.在超过推荐转换时限的患者,一次性转换成功率仍然较高.

目的 探讨可转换型滤器的置入和转换技术以及管理经验.方法 回顾性分析2018年1-12月期间笔者所在医院肝脏外科中心/血管外科收治的115例有随访资料的可转换型滤器置入病例的临床资料.结果 115例下肢深静脉血栓患者中男74例,女41例;年龄22～87岁、中位年龄54岁.可转换型滤器置入技术成功率为100％,无手术相关并发症.置入后随访4～ 455 d、中位随访时间90 d,有9例复发下肢深静脉血栓(7.8％),其发生时间为转换型滤器置入后16～104 d、中位复发时间42 d,其余均未发生任何不良事件.23例(20.0％)接受滤器转换手术,其中1例转换失败,22例成功转换,技术成功率为95.7％ (22/23).转换手术时间22.8～51.4min、中位时间27.4 min.转换手术距置入手术时间为4～455 d、中位时间为159 d.22例成功转换患者中,20例使用辅助技术,辅助技术使用率为90.9％.转换后随访30～180 d、中位随访时间90 d,随访中未发生任何不良事件.结论 可转换型滤器置入和转换手术安全性高,滤器转换技术成功率高,长期留置体内仍有机会转换成功,可作为临床滤器使用时的重要选项.

目的:比较不同血流抑制反转时间(BSP-TI)条件下,非对比增强空间标记多反转脉冲序列(SLEEK)MR血管成像诊断肺栓塞(PE)的准确度并评价图像质量.方法:61例(男38例,女23例)CT肺动脉血管成像(CTPA)诊断为肺栓塞的患者,于CTPA检查后48h内行非对比增强SLEEK MRA检查.比较不同BSP TI的SLEEK MRA图像质量,并以CTPA作为参考标准,计算并比较不同BSP-TI的SLEEK MRA诊断肺栓塞的准确度.结果:BSP-TI为900 ms时SLEEK MRA图像质量最佳,不同BSP-TI(BSP-TI=500、700、900、1100、1300和1500 ms)诊断肺栓塞的准确度分别为62.3％、89.3％、90.4％、84.6％、77.0％、69.3％;但当存在肺膨胀不全或肺部炎症时,BSP TI为1300及1500 ms时有助于显示该区域的肺动脉及栓子.结论:BSP-TI为900 ms时大多数患者的SLEEK MRA图像质量最佳,诊断肺栓塞的准确度最高,但当存在肺膨胀不全或肺部炎症时,调高BSP-TI有助于该区域肺动脉及肺栓塞的显示.

Objective To investigate the therapeutic effect of low molecular weight heparin sodium and dexamethasone so‐dium phosphate on catheter‐related thrombosis.Methods Sixty Japanese big ear white rabbits were divided into four groups (n=15 each):control group ,low molecular weight heparin group ,dexamethasone sodium phosphate group ,low molecular weight heparin combined with dexamethasone group.A central venous catheter was inserted into right jugular vein to induce catheter‐related thrombosis.After the surgery ,control group was treated with normal saline ;molecular weight heparin group and dexam‐ethasone sodium phosphate group were subcutaneously injected with low molecular weight heparin and dexamethasone ,respec‐tively ;low molecular weight heparin combined with dexamethasone group received injection of both.Catheter‐related thrombosis in jugular vein and D‐Dimer concentration in serum were observed 7 days after the surgery.Results Catheter‐related thrombo‐sis model was successfully established in Japanese big ear white rabbits.Compared with control group ,the formation rates of catheter‐related thrombosis in low molecular weight heparin group and low molecular weight heparin combined with dexametha‐sone group were significantly decreased (P<0.01) ,and the levels of D‐dimer were significantly decreased in these groups (P<0.01).Conclusion Low molecular weight heparin may prevent catheter‐related thrombosis efficiently.Anti‐inflammation treat‐ment with glucocorticoid might inhibit catheter‐related thrombosis.

颈部假性动脉瘤（pseudoaneurysm，PSA）发病率非常低，但可能导致无法控制的出血甚至危及生命［1］。传统外科手术对于PSA动脉破裂口的直接修复和血管塑形难度很高，往往需要牺牲载瘤动脉或进行血管架桥手术，死亡率和致残率较高［2］。超声引导下小剂量凝血酶注射术因其简单、经济、便捷、有效、安全已成为外周动脉PSA 治疗的重要手段，临床报道较多［3］。而关于超声造影（contrast-enhanced ultrasonography，CEUS）和彩色多普勒超声（color dopple ultrasonography，CDUS）引导下凝血酶注射治疗颈部PSA 的病例还未见报道。笔者回顾分析了两例在本院诊治的颈部 PSA 患者的相关影像学资料和诊疗经过，旨在探讨 CEUS 及 CDUS 在凝血酶注射治疗颈部 PSA中的应用价值。

脉管炎会造成肢体溃烂、坏死、截肢,在人们眼里是一件非常可怕的事情.在血管外科门诊经常会有患者询问:"医生,我是不是得了脉管炎?"一部分患者是被朋友、邻居提醒来看病的,一部分是自己看了一些报纸、网络文章、广告后来看病,还有一部分是在非专科医师处就诊后诊断为"脉管炎"的.然而,很多患者并没有患脉管炎,只是将其他血管疾病都当成了脉管炎.

目的 探讨丹参注射液联合低分子肝素(LMWH)治疗肠系膜静脉血栓(MVT)的疗效.方法 回顾性分析26例LMWH非手术治疗MVT病例.根据是否联合静脉注射丹参注射液分为A组(非用药组)和B组(用药组),分析两组住院期间病死率、中转手术率和平均住院日.结果 A、B两组住院期间病死率分别为36.4%(4/11)vs 13.3%(2/15),差异无统计学意义(P＞0.05);中转手术率81.8%(9/11)vs 26.7%(4/15),平均住院(15.0±4.1)d vs(11.1±2.9)d,差异均有统计学意义(P＜0.05).结论 丹参注射液联合LMWH应用于非手术治疗MVT对改善中转手术率和缩短住院时间有一定临床价值.

Objective To investigate the possibility of using Lipo-PGE1 to treat acute mesenteric vein thrombosis(MVT)in a rabbit model.Methods Thirty rabbits were equally divided into three groups.Rabbit MVT models were established in group A and group B.In group A,the rabbits were treated with parnaparin+Lipo-PGE1,and those in group B only with parnaparin.The rabbits in group C(control group of no-MVT-model)were treated with parnaparin.The D-dimer levels from the peripheral vein were measured at five time points:before surgery,1 h after MVT,and 2,4,6 h after the treatment,named T1-T5 respectively.The pathologic changes in mucosa of small intestine were observed at the end of the experiment and the scores according to the Chiu-Park Scale were calculated.At the same time the MVT-thrombolysis Scale and the index of hydrated quality of the small intestine were calculated too.Results At the time points of T3 to T5,there was significant difference in the D-dimer levels among groups A,B,C(P<0.01).At T3 to T5,the D-dimer levels in group A were(247.5±10.5),(259.1±9.6) and(273.6±11.9) ng/mL separately,which were higher than in group B[(231.9±14.1),(228.7±12.4),(224.6±12.6) ng/mL separately].At the end of the experiment,the scores of Chiu-Park Scale in groups A and group B were(2.00±1.15) and(4.50±1.08) respectively(P<0.01).The scores of the MVT-thrombolysis Scale in groups A and B were(2.70±1.25) and(4.40±0.97) respectively(P<0.01).The indexes of hydrated quality of the small intestine in groups A,B,C were(73.52±2.40),(83.90±2.06) and(70.98±1.93) respectively(P<0.01).The pathologic changes in group A were milder than in group B.Conclusion In the rabbit MVT models,Lipo-PGE1 could enhance the thrombolysis activity,alleviate the pathologic lesions of the suffered small intestine and accelerate thrombolysis of MVT.

Objective To investigate the effect of sarpogrelate, a specific 5-HT2A receptor blocker,on fibrosis past acute rejection of abdominal aortic allotransplantation in rats. Methods The rat models of abdominal aortic transplantation were divided into three groups: allograft control group (Wistar→ SD), isograft control group ( SD→ SD) and sarpogrelate-treated group (Wistar→ SD).Sarpogrelate-treated group received intragastric administration of sarpogrelate every day. The pathologic and immunohistochemical findings of the transplant aorta were observed at 14th and 60th day after transplantation. Results At 14th day, visible acute rejection could be observed in allograft control group,but not in isograft control group. At 60th day, vascular intimal index of sarpogrelatetreated group was significantly lower than that in allograft control group[( 16. 71 ± 3. 94)％ versus (62. 41 ± 6. 54)％ ,P＜0. 05). The expression of PCNA and α-SMA in sarpogrelate-treated group wasalso significantly lower than that in allograft control group[(7. 37 ± 4. 61)％ versus (22. 43 ±3.40)％,(8.21 ± 3. 11)％ versus. (23.70 ± 2.78)％, P＜0.05, respectively). Conclusion The expression of PCNA and α-SMA of the transplant aorta could be suppressed by sarpogrelate, and sarpogrelate could relieve the fibrosis past acute rejection of aortic allograft.

Objective To investigate the therapeutic efficacy of pasting method to deal with the point-like-incision of varicosity.Methods We conducted a prospective randomized trial in 100 patients with simple varicose of great saphenous vein received point-like striping operation,50 patients per group,using 3M IVT fixing sticking to paste versus normal silk to suture the point-like incision respectively.Results There was no significant difference between the pasting group and the suturing group(P>0.05),the scar degree and patients' satisfaction in pasting group were better(P<0.05),time of dealing with single incision was obviously shortened(P<0.01).Conclusion The pasting method to deal with point-like striping incision has a reliable therapeutic effect and applied conveniently.It is worth generalization.

目的探讨纤溶酶联合低分子肝素治疗高龄患者急性下肢深静脉血栓的疗效和安全性。方法回顾性分析70例高龄(≥70岁)急性下肢深静脉血栓患者临床资料。治疗组37例,采取纤溶酶联合低分子肝素方案;对照组33例,采用低分子肝素治疗。比较其疗效和安全性。结果两组静脉完全再通率分别为10.8%(4/37)、0(0/33),部分再通率为59.5%(22/37)、42.4%(14/33),有显著性差异(P<0.05)。治疗组下肢水肿改善率优于对照组,有显著性差异(P<0.05)。两组均无明显凝血功能紊乱和严重出血并发症。结论纤溶酶联合低分子肝素治疗高龄急性下肢深静脉血栓患者疗效高于单独应用低分子肝素,两者安全性相似。

目的评价纤溶酶治疗下肢深静脉血栓的疗效和安全性。方法回顾性分析我院下肢深静脉血栓病例,尿激酶组91例和纤溶酶组74例。结果尿激酶组静脉完全通畅率和部分通畅率分别是27.5%、46.2%,纤溶酶组分别为17.6%、62.2%,两组比较差异无统计学意义(P>0.05)。纤溶酶组未出现严重凝血功能异常,两组凝血异常率比较有统计学意义(P<0.05)。结论纤溶酶和尿激酶常规剂量经静脉一次给药治疗下肢深静脉血栓具有相似疗效,纤溶酶出血并发症风险较低,安全性较高。

Objective To explore the hemostasis technique by continuance finger-pressing in the operation of iatrogenic femoral artery pseudoaneurysms (IFAP). Methods retrospective analyzing 25 IFAP cases that undergone selective surgery treatment. Results All the 25 patients were performed femoral artery angiorrhaphy, and there were 4 cases suffered complications. The hemostasis technique group which with 10-minute continuance finger-pressing, were compared with controlled group, has lower parameters in operation time, hemorrhage volume, length of incision, and length of stay after operation(P<0.05). Conclusion The method of hemostasis technique with 10-minute continuance finger-pressing is recommended in IFAP operation. If it comes to the pinches, the method that using double-suture traction under disrupt to hemostasis can be assisted.

病人:男性,61岁.因腹痛、腹胀伴晕厥发作14 h入院.腹痛为突发性上腹部绞痛,迅速发展为全腹持续性胀痛.入院前3 h晕厥1次.有高血压病史10年,无外伤史.

患者,男,35岁.主诉"发现左侧腹股沟肿块5月余".初起发现左侧腹股沟无痛性包块,豌豆样大小.近2个月来包块迅速增大,一般情况好.查体:左腹股沟区约6 cm×5 cm肿块,位置浅表,质硬,活动度差,边界欠清晰,左侧大腿稍增粗,浅静脉扩张明显.外院细胞学检查示"软组织梭形细胞肿瘤".MRI示左侧腹股沟区肿块,股动静脉受推移,部分包绕,部分层面可见瘤栓.

Objective To explore the efficacy and safety of radiofrequency ablation (RFA) in the treatment of liver cancer.Methods 216 cases of liver cancer underwent RFA. After treatment, the main symptoms were observed. Meanwhile, hepatic function examination, alpha fetoprotein (AFP), enhanced CT scans and color ultrasonography were performed. 185 cases were followed up for 12 months.Results AFP level was decreased in 85 % patients with abnormal AFP level before RFA. Blood signals around the tumors were reduced or disappeared in 76 % patients After RFA. All lesions showed complete or partial liquefaction necrosis. Lesions were not enhanced on the CT scan images at 1-6 months after RFA in 56 % patients. The one-year survive rate of the patients after RFA was 84 %.Conclusion RFA is a safe and effective technique for the treatment of liver cancer.

病人:男性,55岁.主诉"发现左侧腹部搏动性包块2周…,无腹痛、腹胀、下肢疼痛等.既往合并冠心病、高血压、双侧多囊肾.体检触及左侧中下腹部8cm× 5 cm搏动性包块,无压痛.多排CT三维成像诊断:左侧髂总动脉瘤,双侧下肢动脉硬化闭塞症.行左侧髂总动脉瘤切除,左侧髂总动脉-髂外动脉人造血管移植.

患者,男,50岁.主诉"发作性上腹痛4 d,加重伴血压下降2 h”.2000年11月5日起,患者劳累后发作左上腹、脐周阵发性隐痛,夜间为甚.外院对症处理好转.8日下午加重,伴恶心、呕吐,来我院急诊留观.9日上午突发上腹部剧痛,以仰卧位为著,左侧卧位稍轻,伴轻度腰痛,血压下降.既往有高血压病史,无其他特殊病史.查体:BP 120/80mmHg,急性失血病容,自主左侧卧位,腹部平坦,无肌紧张,上腹部压痛阳性,反跳痛阴性,未触及包块.腹腔穿刺抽出少量不凝血(约0.5 rnl),B超示腹部积液,脾脏未见异常.诊断腹腔内出血,失血性休克.急诊剖腹探查,见腹腔内、肝下间隙、小网膜囊内大量凝血块及部分积血,约3000 Inl.横结肠系膜巨大血肿,结肠中动脉远端瘤样变,搏动性出血.肝、脾、胰腺、空肠、回肠、升降结肠、乙状结肠等其肠系膜未见异常.行动脉瘤切除,横结肠缺血肠段切除一期吻合.