弹力驱栓治疗四肢外伤性动静脉栓形成

目的：着重讨论弹力驱栓法在四肢外伤性动静脉血栓形成治疗中的作用。方法：通过对28例四肢外伤性动静脉血管血栓形成的治疗。四肢手术驱血的原理,阐述弹力驱栓法在外务后四肢动静脉血栓形成治疗中的重要价值。结果：本组28例因外伤后致四肢动静脉血栓形成,应用弹力驱栓法治疗后,得到随访的23例,均完全康复,无一例因术后血栓形成行第二次手术,成功率100%。结论：弹力驱栓法治疗四肢外伤性动静脉血栓形成,其方法简单,操作方便,安全可靠,效果显,易于掌握。该设想科学合理,实用性强,能普通开展。     

颅内动脉机械取栓装置取栓研究

目的 观察国产颅内动脉机械装置取栓的有效性及安全性.方法 临时阻断颈总动脉血流并注入凝血酶制作60只适合机械取栓的兔急性血管栓塞模型,按随机数字表法分为非治疗组、3h溶栓组、3、6、8、12h取栓组,取栓组应用颅内动脉机械取栓装置取栓,3h溶栓组应用尿激酶溶栓,取、溶栓前后行数字减影血管造影(DSA)观察血管再通,行经颅多普勒(TCD)记录大脑中动脉平均流速(VMCA)变化,行磁共振弥散成像(MR-DWI)描述不同时段取栓表观弥散系数(ADC)的变化.结果 3h取栓、溶栓组的血管再通率分别是80％、20％,差异有统计学意义(P＜0.05),治疗后VMCA的差异有统计学意义(P＜0.05);非治疗组、12 h取栓组ADC值逐渐降低,而3、6、8h取栓组ADC值逐渐上升;栓塞后24 h与非治疗组和12h取栓组比较,3、6、8h取栓组ADC值较高,差异均有统计学意义(P＜0.05).结论 颅内动脉取栓装置取栓有效地提高了闭塞血管的再通率,迅速恢复血流,适当延长了血管内治疗的时间窗.     

门静脉癌栓研究进展

门静脉癌栓（portal vein tumor thrombus，PVTT）是肝癌发展过程中最常见的病理表现之一，文献报道依据尸检和影像学检查，PVTT发生率为20％-70％，而手术切除标本镜检PVTT发生率高达90％。患者一旦出现PVTT，短期内就会引起门静脉高压、肝功能衰竭、腹水，最终导致死亡。门静脉主干及主要分支癌栓患者自然生存时间仅3个月。近年来，有关PVTT的病因及诊断、治疗都有了较深入的研究，但是其明确的形成机制和对机体的侵袭、转移等的机理尚不清楚。临床治疗中肝癌伴PVTT患者的总体疗效还较差。本文对PVTT研究的现状，安全、有效的临床治疗方法做一综述。     

脊髓栓系综合征

脊髓栓系综合症（ＴｅｔｈｅｒｅｄＣｏｒｄＳｙｎｄｒｏｍｅ，ＴＣＳ）是指由于脊髓受到纵向牵拉而引起的神经损害症候群，包括一系列的病理异常，引起不同程度的肢体瘫痪和尿便功能障碍，常有脊髓低位（低于Ｌ１～２间隙）和终丝紧张变粗〔１〕。七十年代以来，随着神经...     

栓体栓道式附着体义齿的修复病例报告

附着体是一种固定-活动联合修复方法,与卡环固位型可摘义齿相比有其明显的优越性,使一些以前修复效果较差甚至无法修复的患者获得了较为理想的修复效果[1].现将笔者几个典型的美容修复病例报告如下.     

肝癌合并门静脉癌栓或肝静脉癌栓的处理

肝细胞肝癌(简称肝癌)易于侵犯肝内的血管结构，尤其是门静脉，根据尸检及影像学检查，约20％～70％的肝细胞肝癌(HCC)伴有门静脉癌栓(PVTT)。相对PVTT而言，肝静脉癌栓(HVTR）较少见，但一些晚期肝癌也能看到癌栓侵入肝静脉、下腔静脉甚至右心房。门静脉癌栓及肝静脉癌栓的     

肝细胞癌并胆管癌栓

肝细胞癌是最常见的恶性肿瘤之一。肝癌的外科治疗在其综合治疗中占重要地位。关于肝细胞癌血管的侵犯 ,尤其是侵犯门静脉形成血管栓子已有较多报道。文献记载肝细胞癌患者约34%～ 4 0 %有门静脉癌栓 (ｐｖｔｔ) [1、2 ] 。胆管癌栓的出现率低 ,约 1.6 %～3% [3、4] ,报道文献很少。但因胆管癌栓而出现黄疸、被认为病程较晚的肝细胞癌患者 ,若经积极处理 ,仍可获得较好的预后。现对肝细胞癌并胆管癌栓病例综述如下。一、肝细胞癌并胆管癌栓的诊断根据胆管癌栓所在部位 ,患者的临床表现不一。有的病例会出现梗阻性黄疸的表现 ,而有的患者则无…     

脊髓栓系综合征研究进展

脊髓栓系综合征（tethered cord syndrome,TCS）是由于各种先天性或后天性因素压迫,牵拉脊髓,造成脊髓圆锥张力异常增加,圆锥低位而引起的一系列临床症状和体征,主要包括疼痛,大小便失禁,双下肢运动感觉障碍,     

儿童脊髓栓系综合征

脊髓栓系综合征 (英文名称较多 :Tetheredspinalcordsyndrom ,Tetheredcordsyndrom ,Tetheredconus ,Filumter minalesyndrom ,Cordtractionsyndrom ) ,为先天性或后天获得性脊柱、椎管、脊髓异常 ,终丝变异、变短、增粗、紧张而使脊髓圆锥受到牵拉 ,处于低位 ,而出现一系列神经功能障碍征候群。 2 0世纪 5 0年代前 ,仅有少量有关脊髓栓系综合征的报道出现在神经系统病变相关的杂志上。 5 0年代后 ,矫形外科医师在治疗青少年先天性、特发性脊柱侧弯和脊柱结核引起脊柱畸形并发截瘫手术时 ,发现了脊髓栓系综合征问题 ,从此引起了矫形外科界…     

伴静脉瘤栓的肾癌患者瘤栓水平对预后的意义

作者回顾性研究了1 970年7月至2 0 0 0年7月间,进行了外科手术的1 5 3例患者就瘤栓在肾静脉和下腔静脉中不同水平对癌特异性生存率的影响。研究主要集中在两个方面:腔静脉瘤栓水平是否影响患者的长期生存率;1 997年TNM分期中肾静脉和下腔静脉中有瘤栓同属T3b,这两者的长期生存率是否存在差异。平均随访6 0个月(1 2～2 2个月) ,其中肾静脉瘤栓组4 6例,下腔静脉瘤栓V1组(瘤栓位于膈以下) 6 8例,V2组(瘤栓位于膈以上,心房以下) 1 7例,V3组(瘤栓突入心房) 2 2例。性别、年龄,肾周浸润程度,Fuhrman分级,发生转移的比例和肿瘤大小各组间无统计…     

下肢深静脉血栓手术取栓与介入取栓疗效的比较研究

目的比较手术取栓与介入取栓对下肢深静脉血栓形成(deep vein thrombosis,DVT)的近、远期疗效。方法回顾分析2000年3月~2008年8月167例混合型和中心型DVT的临床资料,其中手术取栓87例,介入取栓80例,术后均局部应用尿激酶溶栓、肝素抗凝治疗,后期应用华法林抗凝6~12个月。结果治疗后介入组双大腿及小腿周径差中位数分别为0.8cm(-3.0~6.0cm)和0.7cm(0.0~5.5cm),手术组分别为1.6cm(0.0~8.0cm)和1.1cm(0.0~4.5cm)(Z=-3.932,P=0.000;Z=-3.313,P=0.001)。介入组住院时间(7.7±4.9)d,显著短于手术组(14.7±6.5)d(t=7.806,P=0.000)。介入组腹膜后血肿、肺部感染、伤口感染、淋巴漏等总的并发症发生率为8.8%(7/80),显著低于手术组35.6%(31/87)(χ2=17.135,P=0.000)。131例随访(47.3±28.3)月,2组大、小腿周径差,主观症状评分,色素沉着,静脉曲张,间歇跛行发生率等方面均无显著差异(P0.05)。结论手术取栓与介入取栓相比,远期疗效相当,但介入取栓对于混合型和中心型DVT的治疗时间窗宽,近期疗效更佳,且住院时间短,并发症少。     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

括约肌外侧切开肛瘘栓填塞——一种改良的肛瘘栓技术

2014年10月,对2例括约肌上型肛瘘患者,术前不进行挂线治疗,在括约肌外侧瘘管转折处切断瘘管,将瘘管分为两部分,分别填塞1枚肛瘘栓并缝合固定,通畅引流。2例全部治愈,术后无并发症,肛门功能良好,外口愈合时间12、13 d,肛缘伤口愈合时间50、45 d。随访8个月,无复发。     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

目的 比较手术取栓与介入取栓治疗急性下肢深静脉血栓形成(DVT)的近、远期疗效.方法 回顾性分析2000年3月至2008年8月136例急性混合型和中心型DVT患者的临床资料.手术取栓组80例,其中男性30例,女性50例;年龄26-81岁,平均(58±14)岁.介入取栓组56例,其中男性25例,女性31例;年龄22～92岁,平均(57±17)岁.术后均局部应用尿激酶溶栓、肝素抗凝治疗,后期应用华法林抗凝6～12个月.结果 介入取栓组治疗后双大腿周径差小于手术取栓组[(0.8±1.3)cm比(1.5±1.7)cm,P=0.002],两组小腿周径差异无统计学意义[(0.7±1.1)cm比(1.0±1.1)cm,P=0.152].介入取栓组的平均住院时间少于手术取栓组[(7±4)d比(15 4-7)d,P=0.000].介入取栓组并发症发生率低于手术取栓组(8.9%比32.5%,P=0.000).108例获随访,随访率为79.4%.平均随访(46±29)个月,两组在大、小腿周径差、症状评分、色素沉着、静脉曲张、间歇性跛行及慢性溃疡的发生率等方面差异均无统计学意义(P>0.05).结论 介入取栓与手术取栓相比,远期疗效相当,近期疗效更佳,且住院时间短,并发症少.     

带栓髓内针治疗股骨干骨折

作者于1979～1982年对47例48个股骨干骨折采用Grosse—Kempf带栓髓内针固定(In terlockingIntramedullary Nailiny)。其中15例横断或小斜面骨折,10例大斜面或螺旋骨折,23例粉粹骨折。为了分类之便,作者将股骨从大粗隆顶点至膝关节分为6段。16例骨折在第6段,7例在第3段;17例在第4段;8例在第5段。仅有24例(占50％)骨折在中1/3。术后完全负重平均30天(7～150天)。除1例术后3个月因其他病死亡之外,全部随访1～4年,平均16个月。除1例延迟到66周才愈合外,其余骨折均在9～40周之内愈合(平均16周)。治疗结果优者30例;良8例;可7例;差2例。     

伴胆管癌栓的肝细胞癌

肝细胞癌 (HCC)常侵犯门静脉和肝静脉 ,而罕有侵犯胆管者 ,在尸解和手术标本中胆管癌栓占 2 %～9% ,其预后差和生存率低 ,多由于切除率低的缘故。作者分析日本 Nagoya大学医学院第一外科于 1980～1999年收治的 132例肝切除术中 ,发现具肉眼胆管癌栓者 17例 (13% ) ,无癌栓者 115例 ,两组患者的年龄无明显差异 (5 8.8± 2 .0岁∶ 6 0 .0± 0 .8岁 ) ,男女比分别为 15∶ 2和 96∶ 19。另 6例仅作姑息性手术 ,如引流术等 ,故实际切率为 74 % (17/ 2 3)。分析结果　 (一 )临床发现　 4例无症状 ,其余有黄疸 10例、腹痛 5例、胃纳不佳 3例、疲…