Objective: To investigate clinical and imaging parameters to predict blood loss and cranial nerve injury (CNI) following carotid body paraganglioma (CBP) resection. Methods: A retrospective examination of clinical and imaging data was conducted on 63 patients who underwent CBP resection at Xiangya Hospital of Central South University from January 2016 to December 2022, including 23 males and 40 females, aged 26-87 years old. Three imaging parameters including tumor volume, the angle of contact with the internal carotid artery (ICA), and the distance to the base of skull (DTBOS) were gauged using the IMEDPACS software on CTA and MR imaging. The predictive efficacies of age, gender, Shamblin classification, and three imaging parameters for blood loss and CNI following surgery were analysed. Logistic composite parameter models were constructed and their predictive validity was assessed. Results: Multivariate logistic regression analysis underscored that only tumor volume (OR=1.381,95%CI:1.167-1.507,P=0.001) showed significant statistical correlations with blood loss following surgery. Area under curve (AUC) values of 0.910 for receiver operating characteristic (ROC) curves showed a sensitivity of 1.000 and a specificity of 0.694. Tumor volume (OR=1.126,95%CI:1.030-1.231, P=0.002) and DTBOS (OR=0.225,95%CI:0.081-0.630,P=0.005) were significantly associated with postoperative CNI. The analysis of logistic composite model showed AUC values for tumor volume, DTBOS and combination of the two parameters were 0.858, 0.788, and 0.872, respectively. The model for combination of tumor volume and DTBOS also proved superior in predicting postoperative CNI (Z=3.106, P<0.001), with a sensitivity of 0.833 and a specificity of 0.769. Conclusions: Tumor volume and DTBOS emerged as effective predictors for blood loss and/or CNI in patients with CBP resection. Moreover, the logistic composite parameter model outclassed single-parameter models in terms of their predictive clinical value.

背景与目的:有关医院获得性肺血栓栓塞症(HA-PTE)的流行病学数据大多来自单一病种的调查研究,对于全院范围内HA-PTE的调查研究尚少.因此,本研究对全院范围内HA-PTE患者流行病学及临床特征等进行分析,以期为HA-PTE防治与管理提供参考依据.方法:收集中南大学湘雅医院2018年1月1日—12月31日确诊HA-PTE患者(病例组)的临床资料和实验室检验数据,并根据性别、年龄、入院Caprini血栓风险评分等级、是否接受外科手术及手术等级,按1:1匹配同期非HA-PTE患者作为对照组.分析HA-PTE患者的发病率、病死率、相关临床病理因素、危险因素及有价值的预测指标等.结果:2018年度122 942例住院患者中确诊新发HA-PTE患者68例(0.55‰),无HA-PTE相关死亡病例.42.65％(29/68)的HA-PTE患者同时合并有深静脉血栓形成.HA-PTE患者主要分布在神经内科(14/68,20.59％)、普通外科(11/68,16.18％)和呼吸内科(8/68,11.76％).单因素分析结果显示,病例组呼吸系统疾病、肺部感染及入住ICU的比例高于较对照组(OR=4.60,95％CI=1.75～12.10,P=0.002;OR=2.38,95％CI=1.04～5.43,P=0.040;OR=11.00,95％CI=1.42～85.20,P=0.022),总住院时长与住院总费用高于对照组(OR=1.11,95％CI=1.05～1.18,P＜0.005;OR=1.01,95％CI=1.00～1.03,P=0.005),纤维蛋白原降解产物(FDP)水平高于对照组(OR=1.11,95％CI=1.03～1.20,P=0.004).多因素分析结果显示,呼吸系统疾病(校正 OR=3.58,95％CI=1.32～9.71,P=0.012)和入住 ICU(校正 OR=11.38,95％CI=1.38～93.54,P=0.024)是 HA-PTE 的独立危险因素.结论:患有呼吸系统疾病和入住过ICU的患者为HA-PTE的高危人群,神经内科、普通外科和呼吸内科是HA-PTE的高危科室,HA-PTE会导致患者的住院时长和医疗费用显著增高.FDP水平对于HA-PTE可能有一定的预测价值.

Objective: To investigate the emergency management process of ruptured abdominal aortic aneurysm (RAAA), and analyze the perioperative mortality factors of different surgical methods. Methods: The emergency data and hospitalization data of 91 patients with ruptured abdominal aortic aneurysm in Xiangya Hospital of Central South University from June 2010 to June 2019 were retrospectively analyzed.Twelve of the patients died preoperatively due to excessive blood loss, and the remaining 79 patients were hospitalized for open surgery (OSR) or endovascular repair (EVAR).The differences in age, time to hospital arrival, emergency preparation time, first creatinine value, emergency infusion volume, preoperative drop in blood pressure, preoperative use of vasoactive drugs and iliac artery involvement were compared between preoperative death group (n=12) and preoperative survival group (n=79), OSR group (n=50) and EVAR group (n=29), postoperative death group (n=23) and postoperative survival group (n=56). Results: Seventy-nine patients received open surgery or endovascular repair, and 23 died after operation. Age, time to hospital arrival, first creatinine value and emergency infusion volume were (77±11) years, (18±5)h, (469±150) μmol/L, (4 140±1 743) ml in the preoperative death group and (70±10) years, (12±8) h, (228±174) μmol/L, (1 358±1 211) ml in the preoperative survival group, respectively, and the differences were statistically significant (all P<0.05). There were no significant differences in preoperative data, intraoperative treatment and postoperative perioperative mortality between the open surgery group and the endovascular repair group (all P>0.05). The intraoperative blood loss, operation time and aortic occlusion rate in the endovascular repair group were 100 (50, 175) ml, (3.2±0.9) h, 13.8%, respectively, which were better than that in the open surgery group 1700 (600, 3425) ml, (5.2±1.1) h, 100%. The differences were statistically significant (all P<0.05). Age, emergency preparation time, first creatinine value, emergency infusion volume, blood pressure decline rate and vasoactive drug utilization rate in the death group were (77±8) years, (4.1±1.7) h, (456±172) μmol/L, (2 024±1 687) ml, 100%, 100%, respectively, and (68±10) years, (2.7±2.2) h, (135±26) μmol/L, (1 085±825) ml, 21.4%, 12.5% in the survival group, respectively. The differences were statistically significant (all P<0.05). Conclusions: Age, emergency preparation time, first creatinine value, emergency infusion volume, decreased blood pressure and use of vasoactive drugs are all associated with perioperative death in patients with ruptured abdominal aortic aneurysm. EVAR surgery is a better choice if conditions exist.

背景与目的:Ⅱ型内漏是腹主动脉瘤腔内修复术(EVAR)术后相对常见的并发症,然而目前对其是否需要手术干预及干预时机方面尚无统一的认识.因此,本研究探讨EVAR术后Ⅱ型内漏的手术方法,及其临床效果与安全性,以期为临床提供给参考.方法:回顾中南大学湘雅医院血管外科2016年1月-2020年12月期间行EVAR手术治疗的腹主动脉瘤患者临床与随访资料,分析EVAR术后发生Ⅱ型内漏的发生率,以及其中行二次手术干预的患者的疗效、并发症及随访情况.结果:期间共282例行EVAR患者,术后随访1～54个月,平均17.9个月.随访过程中,发现单纯Ⅱ型内漏68例(24.1％),其中31例患者(45.6％)Ⅱ型内漏自愈;25例患者(36.8％)瘤体直径无明显增大;12例患者(17.6％)瘤体直径增加＞10 mm或表现有相应的临床症状行二次干预.二次干预患者中,10例行经皮动脉栓塞术,其中8例患者行责任动脉栓塞者随诊12个月无内漏复发,瘤体直径缩小;2例栓塞后术后随访24个月Ⅱ型内漏仍存在,但瘤体直径无继续增大;2例行开放手术,其中1例术后出现急性心肌梗死,行急诊PCI,术后顺利恢复出院,另1例术中大出血,住院时间延长至16d.2例开放手术患者术后随访6个月以上,情况良好,内漏完全消失.结论:大部分EVAR术后Ⅱ型内漏患者预后较好,而对于随访中瘤体直径增长较快及有临床症状者,栓塞责任血管可获得不错的临床效果;开放手术创伤相对较大,严重并发症发生率较高,选择需慎重.

新型冠状病毒肺炎(COVID-19)疫情正处于暴发和相持相交替的关键阶段.糖尿病足病(以下简称糖尿病足)是常见的严重糖尿病慢性并发症,诊治难度大且常需要多学科协作,在COVID-19疫情背景下,糖尿病足诊治面临着新的严峻形势.糖尿病足患者比一般人群更容易患COVID-19,而对于合并糖尿病足的COVID-19患者在糖尿病足处理和COVID-19处理上都更为困难.此外,COVID-19疫情期间糖尿病足诊疗的医疗资源相对减少,而多数糖尿病足患者需要长期门诊随访,部分患者需要限期手术或急诊手术.医护人员需要依据新形势对糖尿病足患者采取新的诊疗流程和措施.本文结合武汉等地多家医院的一线COVID-19和糖尿病足患者诊治经验,参考相关诊疗方案和专家共识,对COVID-19疫情下糖尿病足的多学科诊疗策略进行归纳总结.

目前,新型冠状病毒肺炎(简称:新冠肺炎,WHO命名为COVID-19)疫情对我同人民的生命健康造成了巨大的威胁.在新冠肺炎疫情下,如何应对血管外科门诊患者;如何应对血管外科的危急重症患者;如何安全的实施血.管外科手术;如何做好血管外科患者的术后管理和随访,这些都对血管外科医师提出了新的挑战.结合最新的文献报道和笔者所在医院的防控经验,本文对以上问题作出思考并提出个人建议,希望能起到抛砖引玉之作用,能够引发血管外科医师对新冠肺炎疫情下如何实施血管外科诊疗进行思考,以期更好地为临床服务.

背景与目的:脾动脉瘤(SAA)是一类少见、具有潜在致命破裂风险的内脏动脉瘤疾病.SAA的传统手术方式为开腹切除动脉瘤及脾脏.近年来,随着介入技术和材料的发展,SAA的腔内治疗越来越普及.相比于开放手术,腔内治疗具有微创、简便、术后快速康复的优势.本文探讨SAA腔内治疗的有效性和安全性.方法:回顾性分析2012年1月-2019年12月在中南大学湘雅医院血管外科治疗的30例SAA患者资料,并介绍了我科治疗SAA的3种介入手术方式.结果:患者30例均行腹部CTA明确SAA诊断,其中近脾门型17例,中间型9例,远脾门型4例;囊状动脉瘤19例,梭形动脉瘤11例.30例均采取腔内治疗方法,其中21例行SAA栓塞术,6例行脾动脉支架置入术,3例行脾动脉裸支架置入+栓塞术.患者术后平均住院时间4d,平均住院费用5万元,术后发生腹痛、呕吐、发热等症状10例,症状均在3d以内缓解,无后遗症发生.发生穿刺点出血1例,保守治疗好转后出院.住院期间无急性脾梗死发生,没有发生需再次手术的并发症.22例患者术后随访3～6个月,CT复查示动脉瘤完全血栓化,未见造影剂进入;出现无症状局灶性脾梗死5例.结论:介入腔内手术可在保留脾脏的情况下治疗SAA,治疗效果确切,且创伤小,术后恢复快,并发症发生概率低,住院时间短,费用相比开放手术无明显增加.腔内治疗可作为绝大部分SAA的首选治疗,具体手术方式需根据术前CTA显示的SAA形态及位置来决定.

目的:比较腹主动脉暂时阻断(TAL)与腹主动脉球囊阻断(LABO)在凶险性前置胎盘合并胎盘植入剖宫产手术中的预防出血的优劣.方法:回顾2016年1月-2018年7月在湖南省妇幼保健院住院分娩的84例凶险性前置胎盘合并胎盘植入患者资料,其中48例采用开放TAL止血,36例采用LABO止血.比较两组患者术前情况、手术相关指标、手术后及新生儿情况等各项参数.结果:两组患者的年龄、孕产次、分娩间隔时间、分娩孕周、术前胎盘超声评分差异均无统计学意义(均P＞0.05);两组患者剖宫产手术时间、术中出血量、输浓缩红细胞量、子宫切除率差异均无统计学意义(均P＞0.05);两组患者在新生儿Apgar评分、新生儿体质量、术后住院时间差异均无统计学意义(均P＞0.05),TAL组剖宫产术后血管并发症发生率明显低于LABO组、住院费用明显少于LABO组(19.4％vs.0;40 278元vs.29 100元,均P＜0.05).结论:在凶险性前置胎盘合并胎盘植入剖宫产手术中,TAL与LABO止血效果及子宫切除率相似,但前者更安全、经济,并发症少,值得推广.

Currently, platinum-based chemotherapy, EGFR-TKIs, antiangiogenic therapy and immunotherapy are applied to treat advanced non-small cell lung cancer. Selection of single or combination therapy and sequence of drugs become the focus of clinical treat-ment of advanced non-small cell lung cancer. In recent years, many prospective or retrospective studies have reported the efficacy of single platinum chemotherapy, or platinum-combined therapy for advanced non-small cell lung cancer. Various research results brought new challenges to some extent for clinicians to choose drug regimen. In this paper, the related research results over the world were reviewed for clinical and research reference.

中心静脉导管(Central venous catheter,CVC)可以连续监测血流动力学状态,药物治疗,输送肠外营养和血液透析等[1-2],但在置管过程中或置管之后可能会出现各种并发症;导丝留置体内就是其中之一,可能导致心律失常,血管损伤,血栓形成,感染,心脏穿孔和心包填塞等[3-4].本文就一例CVC导丝留置患者体内超过10个月的案例进行报道,对其可能的原因进行分析,并提出对应的预防措施.

根据循证医学的基本原则,美国血管外科学会(SVS)在系统性回顾的基础上,于2018年1月发布了腹主动脉瘤(AAA)治疗指南,针对AAA的诊断评估、治疗方式、麻醉及围术期处理、术后管理及随访、经济效益学分析5个方面做了重点阐述,并给出111条具体的推荐建议,并按GRADE法给出了推荐强度及证据级别.笔者对该指南中涉及的新观点或推荐意见、以及与临床诊疗过程中的密切相关点作一解读,以期读者更好的理解该指南.

欧洲心脏病学会(ESC)与欧洲血管外科学会于2017年发布了新版的《ESC外周动脉疾病诊治指南》.与2011版指南相比,更新了14条推荐建议,新增了16条推荐建议.其中对于外周动脉疾病的抗栓治疗,亦给出了详细的推荐意见以及循证医学证据.本文根据指南更新的循证医学证据,结合临床实际问题,重点对指南给出外周动脉疾病抗栓药物治疗推荐意见进行解读,以期医务工作者能更好的理解和遵循指南.

Adipose derived stem cells (ADSCs) are adult mesenchymal stem cells with self-renewal,vitality and multilineage differentiation potential,and growth and proliferation ability.These properties make ADSCs to have great potential in tissue regeneration and the repair of diseased organs.In recent years,studies have shown that ADSCs is closely related to the occurrence,development and treatment of tumors.The progress of adipose derived stem cells in the treatment of malignant tumors is reviewed in this article.

Objective To compare the clinical efficacy of extra vascular occlusion of low abdominal aorta and low abdominal aorta balloon occlusion in the treatment of placenta previa with placenta previa.Methods From January 2014 to July 2017,68 implantable placenta previa patients were divided into two groups,elective cesarean section of extra vascular occlusion of low abdominal aorta in 34 cases(group A)and cesarean section on the lower abdominal aorta balloon occlusion in 34 cases(group B),and observation of pregnant women was compared between surgery of two groups. Results Operation time,complications of vascular injury and thrombosis,fetal radiation exposure in group A were significantly lower than that of group B(P<0.05);two groups of patients with sensory dysfunction incidence,cesarean operation time,intraoperative blood loss,blood transfusion rate,the uterus resection rate,hospitalization time had no statistically significant difference postoperatively(P > 0.05). Conclusion Two kinds of operation can safely and effectively reduce the bleeding during the treatment of placenta previa. While group A surgery operation time is short,without intraoperative and postoperative bleeding of the puncture site,without pelvic and lower extremity arterial thrombosis,without X-ray exposure,more safety of the womb and can be popularized in clinic.

目的 探索中国人群腹主动脉瘤(AAA)与下肢动脉硬化闭塞症(PAD)两种疾病危险因素的区别与联系.方法 采用1:1个体匹配的病例对照研究设计选择2010年1月至2017年12月就诊于湘雅医院血管外科的AAA或PAD患者,每1例AAA患者匹配与其性别、年龄相符合的PAD患者.收集研究对象的一般人口学资料、既往病史和行为因素,使用标准化方法获取血清学检测结果.结果 共550例研究对象275个配对组.两组在合并的高血压、高血脂、冠心病及脑梗患病率上差异无统计学意义(P>0.05),但AAA组中合并糖尿病的比例明显低于PAD组,差异有统计学意义(P<0.01);两组吸烟史和饮酒史差异无统计学意义(P>0.05);在血清学检测上,两组间血清胆固醇和低密度脂蛋白胆固醇水平差异有统计学意义(P<0.05),而尿素、肌酐、尿酸、葡萄糖、甘油三酯、高密度脂蛋白胆固醇及血红蛋白水平差异无统计学意义(P>0.05).结论 AAA和PAD具有大多数相同的危险因素,但在糖尿病病史、血清胆固醇和低密度脂蛋白胆固醇水平上存在差异;糖尿病可能是AAA的一个保护性因素.

Complex thoracic aortic diseases are of diverse forms,for which endovascular therapy may convert the untreatable conditions into treatable ones mainly by means of prolonging the proximal landing zone.The specific measures include chimney stent technique,hybrid surgery,in-situ fenestration and pre-fenestration technologies,and also include the selection of the appropriate aortic stent and the branched stent technology which will be used in clinical settings in the near future.The choice of various methods is mainly based on the location and characteristics of the lesion and the patient's economic conditions,and the experience of the surgeon also should be considered.

目的:比较顺行与逆行内翻抽剥治疗大隐静脉曲张的临床效果.方法:回顾分析511例行内翻抽剥加点式抽剥治疗静脉曲张患者的临床资料,其中234例行从内踝附近开始至隐股交界处方向的顺行抽剥(顺行组),277例行从隐股交界处开始至内踝附近方向的逆行抽剥(逆行组),比较两组患者的相关临床指标.结果:两组患者术前资料具有可比性.两组的手术时间、术中出血量、切口个数、术后住院时间、总并发症发生率、术后下肢酸胀情况及术后溃疡愈合时间方面,差异均无统计学意义(均P＞0.05),但顺行组隐神经损伤率及术后静脉曲张复发率明显低于逆行组(P＜0.05).结论:顺行抽剥治疗大隐静脉曲张在减少隐神经损伤和远期疗效方面优于逆行抽剥.

Objective:To investigate the treatment method for type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair (EVAR).Methods:The clinical data of 3 patients with relatively severe type Ⅱ endoleak after EVAR treated in the Department of Vascular Surgery of Xiangya Hospital from 2011 to 2016 were retrospectively analyzed.Of the patients,one case with a continuous enlargement of the aneurysmal sac after hybrid operation (reconstruction of the visceral vessels plus EVAR) for thoracoabdominal aortic aneurysm,a retrograde endoleak from the celiac axis was found by CTA examination;the other two cases had a retrograde endoleak from inferior mesenteric artery after EVAR for abdominal aortic aneurysm.Results:The patient with retrograde endoleak from the celiac axis was treated with Interlock detachable coil embolization,and the other two patients were treated with conventional coil embolization.Embolization was successfully performed and the endoleak disappeared in the 3 patients.Conclusion:Embolization using different approaches is an effective method for type Ⅱ endoleak after EVAR.

美国胸科医师学会（American College of Chest Physicians，ACCP）一直致力于制定和发布深静脉血栓形成（deep vein thrombosis thrombosis， DVT）和肺栓塞（pulmonary embolism， PE），统称为静脉血栓栓塞症（venous thromboembolism， VTE）的治疗指南。目前该指南已成为国际上公认的最权威的血栓栓塞性疾病治疗指南。2016年1月，ACCP在《CHEST》杂志发表了第十版的 VTE 治疗指南（antithrombotic therapy for VTE disease， AT－10）［1］，相对上一版治疗指南（AT－9），更新了12条推荐意见，新增了3条推荐意见［2］。通过共计30条推荐意见，重点介绍了VTE治疗领域的新进展和存在的争议。本文根据指南更新的循证医学证据，结合临床中的实际问题，对指南给出的推荐意见作一解读，以期临床工作者更好地理解和遵循指南。

Objective:To evaluate the effcacy of using unibody bifurcated stent gratfs in endovascular aneurysm repair. Methods:hTe clinical data of 15 patients with abdominal aortic aneurysm, 5 patients with iliac aortic aneurysm and 5 patients with abdominal aortic or iliac aortic dissection undergoing endovascular aneurysm repair with unibody bifurcated stent gratfs (Shanghai MicroPort Medical Co., Ltd.) were retrospectively analysed. Results:hTe surgical success rate was 100%(25/25) with an overage operative time of 42.4 min. No type I or type III endoleak occurred, iliac thrombosis occurred in one case atfer operation and on death occurred during perioperative period. Follow-up was conducted for 3 to 16 months and no type II endoleak was noted during review visits. Conclusion:Endovascular aneurysm repair using unibody bifurcated stent graft is a preferable choice of the treatment options for abdominal aortic aneurysm or dissecting aneurysm. However, the long term results still need to be veriifed.