腹腔镜下左髂总动脉-股动脉人工血管旁路移植治疗髂外动脉闭塞症一例

目的总结腹腔镜下人工血管旁路移植治疗髂外动脉闭塞症的手术技巧和临床效果。方法 2011年12月,收治1例57岁髂外动脉硬化闭塞症男性患者。患者双下肢间歇性跛行;下肢动脉造影示左髂外动脉闭塞,右髂总动脉狭窄;心电图示窦性心律,完全性右束支传导阻滞,ST段改变;踝肱指数(ankle brachial index,ABI):左侧0.59,右侧0.54。于全麻下行腹腔镜下左髂总动脉-股动脉人工血管旁路移植术。结果术后人工血管通畅,吻合口无漏血,患者跛行症状明显改善。术后1周左侧ABI增加至1.09;术后1个月血管造影显示血管通畅。结论腹腔镜下主-髂动脉重建既保留开腹动脉旁路移植效果好的特点,又具有腔内支架成形创伤小、术后恢复快的优点。     

轻型血友病髂肌血肿2例报告

我院收治 2例血友病髂肌血肿患者 ,复习有关文献 ,报告如下 :例 1,男 ,2 4岁 ,某部学员。患者双杠训练后出现右腹股沟区肿痛 10ｄ入院。查体 :右下肢跛行 ,右髋屈曲挛缩 ,伸展受限 ,右腹股沟区触及 8ｃｍ× 8ｃｍ包块 ,右小腿内侧浅感觉迟钝 ,右股四头肌肌力Ⅱ级 ,ＣＴ示右侧髂肌肿胀 ,内有边界清楚的类圆形低密度影 (图 1)。化验 :凝血酶原时间、凝血酶原活动度、凝血酶原时间国际标准化比值 (ＰＴＩＮＲ)均正常。入院后手术治疗 ,术中见右侧髂肌隆起 ,髂肌内有 8ｃｍ× 8ｃｍ× 6ｃｍ类圆形包块 ,有包膜 ,肿物内为暗红色出血及血凝块 ,局…     

带髂内分支支架的腔内隔绝术治疗腹主动脉瘤伴双髂动脉瘤

目的探讨带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤治疗中的应用。方法回顾性分析2011年6月～2012年6月我院收治的10例腹主动脉瘤合并双髂动脉瘤患者的临床资料。患者均于术前行CT血管造影(CTA)检查,腹主动脉瘤均为肾下型;髂动脉瘤仅累及髂总动脉8例,累及髂内动脉开口处2例。手术先置入带髂内分支的髂动脉带膜支架,再置入腹主动脉瘤的分叉型带膜支架。结果患者均一次手术成功,无死亡。9例患者获得随访,随访时间3～6个月,患者腹部搏动性肿块均消失,均未出现臀部、骶尾部坏死,无明显性功能障碍,1例出现臀部的轻度间歇性跛行。8例术后3个月行腹主、双髂动脉彩超检查,未见明显内瘘,移植的髂内分支支架血流通畅。3例术后6个月行腹主、双髂动脉CTA检查,未见Ⅰ型、Ⅲ型内瘘,髂内分支支架内血流通畅。结论带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤的治疗中是安全、有效的;可以有效地保留一侧髂内动脉,减少或避免因髂内动脉封闭而带来的并发症。     

髂窝脓肿术后坏疽性脓皮病1例

患者男,65岁.于2001年8月1日因"右下腹疼痛2年"当地县医院诊断性穿刺在右髂窝抽出2ml脓血液后诊为右髂窝脓肿.4d后行脓肿切开引流,脓液未作培养,术后甲硝唑、氨苄西林及头孢噻肪钠抗炎疗效不佳,术后第4d出现高热,体温达39℃,换药见切口周围皮肤、组织水肿变黑、血性渗出多,右侧胸壁相继出现一红斑,中央皮肤破溃,即于2001年9月1日转诊我院.既往无溃疡病、结肠炎及药物过敏史.     

以发热为首发症状的右髂外动脉瘤自发破裂一例

患者男,77岁,因“发热2个月,右下腹肿物6d ,伴右腰部和右下肢放散痛”于2 0 0 3年4月16日入院。经抗结核和抗炎治疗病情无好转。既往糖尿病史7年。查体:体温38 4℃,血压135 / 85mmHg ,体态肥胖,心肺检查未见异常,右下腹扪及12cm×9cm大小质硬肿物,边界不清,移动度差,无压痛,双下肢无水肿,双足背动脉搏动正常。血、尿常规、肝肾功能及凝血像正常,血沉4 4毫米第1小时,纤维结肠镜检查正常。彩色B超示:右下腹实性占位,其内可见动脉血流信号。螺旋CT示:右下腹骶椎前方囊实性肿物,与周围组织及髂总动脉分界不清(图1)。术前诊断:右髂窝腹膜后肿物…     

髂外动脉与股动脉搭桥术治疗移植肾切除术后肾蒂残端大出血一例

患者 ,男性 ,4 8岁。因慢性肾功能衰竭、尿毒症期 ,于1997年 6月 2 7日在我院行同种异体肾移植术。整块法切取供肾 ,供肾动脉两支 ,相距 0 .5cm ,直径分别为 3mm和 4mm ,均起源于腹主动脉 ,故取腹主动脉片与右髂外动脉端侧吻合 ,手术顺利。移植肾血供开放后 1min泌尿 ,术后 2 4h尿量5 10 0ml。术后第 4d开始尿量逐渐减少 ,第 5d恢复血液透析 ,此后尿量 30 0～ 4 0 0ml/d。彩色超声波检查发现 :移植肾体积增大 ,呈球形改变 ,肾内回声不均 ,皮髓质分界不清 ,肾乳头水肿、回声降低。移植肾下极附近可见 8.1cm× 9.1cm低回声不均质影。肾血流充…     

选择髂内或髂外动脉吻合对移植肾的影响

目的 探讨肾移植动脉重建选择髂外或髂内动脉时移植肾血流参数、肾脏功能和血管并发症的差异。方法 135例初次肾移植患者随机分为2组，2组患者平均年龄、HLA错配数目、淋巴细胞毒试验、冷／热缺血时间差异均无统计学意义（P〉0．05），术后免疫抑制剂应用方案相同。应用髂外动脉端侧吻合66例，髂内动脉端端吻合69例。随访3个月，比较2组患者肾脏功能、彩色多普勒肾脏血流参数和血管并发症发生率。结果 髂内动脉、髂外动脉组2组患者术后3个月时肾功能监测指标（Cr：118．41 vs123．68μmol／L），移植肾主肾动脉、段动脉、大叶间动脉血流及阻力指数差异无统计学意义（P〉0．05）。结论 肾移植动脉重建选择髂内外动脉对移植肾功能及血液流变学无明显影响，动脉选择应根据患者具体情况决定。     

肾移植术后股神经病一例

患者 ,女 ,4 5岁 ,因慢性肾小球肾炎尿毒症晚期于 2 0 0 2年 3月 2 5日在我院行尸体肾移植术。右下腹弧行切口 ,腹膜外钝性游离 ,显露右髂窝 ,移植肾静脉、动脉分别与受者髂外静脉、髂内动脉端侧吻合和端端吻合 ,吻合血管时间 2 5min ,开放血流 2min后有尿液流出 ,将移植肾放入右髂窝内。术后移植肾功能恢复顺利。第 4d血肌酐和尿素氮正常。术后第 1d ,患者觉右下肢麻木 ,活动受限 ,体检发现右股前内侧直到膝及小腿前内侧皮肤感觉明显减退 ,屈髋肌群及股四头肌张力明显降低 ,右髋呈外展、外旋位 ,大腿不能曲 ,小腿不能伸直 ,右髋肌群及股四…     

肾移植术后移植肾癌肉瘤1例报告并文献复习

目的：提高对肾移植术后移植肾癌肉瘤的认识及诊疗水平。方法：回顾性分析1例肾移植术后移植肾癌肉瘤患者的临床资料：患者女,73岁,因尿毒症于1996年10月在外院行肾移植术,移植肾置入右髂窝;因移植肾失功能于2001年3月行第二次肾移植术．移植肾置于左侧髂窝。2006年11月出现右侧移植肾区疼痛,伴镜下血尿。B超、CT检查发现右侧移植肾占位性病变而入院。在全麻下行移植。肾探查术．将右侧移植肾完整切除。结果：手术顺利,手术时间3h．出血量150ml,病理检查报告为移植肾癌肉瘤。术后2个月,患者出现排斥反应与肠梗阻,病情急剧恶化,家属放弃治疗。结论：移植肾癌肉瘤恶性程度高,预后极差．早期诊断有助于提高生存率。     

糖尿病髂动脉硬化患者肾移植术51例报告

目的探讨糖尿病髂动脉硬化患者的肾移植手术特点。方法51例糖尿病合并髂动脉硬化的肾移植受者共行肾移植术54例次。其中肾动脉与髂外动脉直接端侧吻合13例次；切除硬化内膜，肾动脉与髂总／髂外动脉端侧吻合19例次；切除硬化内膜，肾动脉与髂内动脉钛环钉法端端吻合22例次。结果发生移植肾血流灌注不足致移植肾原发性无功能3例次，发生移植肾功能延迟恢复9例次（17．6％），其余42例次移植肾功能恢复良好。围手术期死亡2例（均为心跳骤停）。随访11—70个月，1年人／肾存活率为89．8％／87．8％，3年存活率为84．4％／81．3％。结论糖尿病髂动脉硬化患者移植肾动脉吻合困难，为保证移植肾有充足的血流灌注，应根据患者的不同情况选择吻合血管，并行硬化动脉内膜切除术。合并冠心病的患者肾移植术前应先行心肌再血管化手术。     

髂内动脉在肾移植术后髂外动脉出血中的应用

目的:探讨肾移植术后感染性外动脉移植肾动脉吻合口出血的处理。方法:采用自体髂内动脉片或段修补、串接治疗髂外动脉吻合口大出血。结果:修复后的髂外动脉血流通畅,患侧下肢血供良好。结论:感染性移植肾动脉髂外动脉吻合口出血为肾移植术后严重并发症,单纯缝扎止血常难以奏效,与其他方法比较,自体髂内动脉片或段修补、串接修补缺损的髂外动脉操作简单,效果非常满意。     

肾移植术中采用供肾动脉与髂外动脉吻合的体会

对２７例髂内动脉有严重动脉粥样硬化的肾移植受者实施供肾动脉与受者髂外动脉端侧吻合术，术后除有３例患者因环孢素用量过大使移植肾功能恢复略延迟外，其它２４例患者均于术后４天内肾功能恢复正常，且无一例外科并发症。认为该术式可作为髂内动脉情况异常的一种弥补方法，但不宜作为常规术式。     

带旋髂深血管蒂髂骨瓣移植加折断式加压螺钉内固定治疗成人股骨颈骨折

目的；探讨成人股骨颈骨折的手术治疗方法及疗效。方法：在解剖复位的基础上对96例成人股骨颈骨折植入带旋髂深血管蒂的髂骨瓣，并用3根折断式加压螺钉内固定。结果：96例平均随访2年，骨折愈合91例，愈合率94．8％，髋关节功能按Jacobs等标准评定，优72例，良15例，差9例，总优良率达90．6％。结论：带旋髂深血管蒂髂骨瓣移植加折断式加压螺钉内固定联合治疗成人股骨颈骨折疗效肯定，操作较简单。     

Using bilateral iliac branch devices for endovascular iliac aneurysm repair

Introduction: The endovascular repair of bilateral iliac aneurysms using bilateral Iliac Branch Devices (IBDs) has been infrequently performed and reported. We aim to describe this technique and report on the results of our case series. Methods: Three different device designs are available. The procedural options include a totally transfemoral approach, or a combined transfemoral and brachial approach. Clinical records for patients who have had this procedure were reviewed. Results: The indications for the technique include bilateral common iliac artery aneurysm repair, with or without concomitant abdominal aortic aneurysm repair. Considerations include the timing of main body endovascular aortic aneurysm repair (EVAR) device introduction, the use of a proximal access site and the type of IIA stent‐graft that is used. Between 2007 and 2010, six patients had bilateral IBD implantation. All patients required an EVAR main body device in addition to bilateral IBDs. Eighty‐three per cent were males, mean age was 73 years. Mean follow up was 15 months. Technical success was obtained in 100% of cases. There was one branch occlusion (8.3%). There were no type I endoleaks. One patient had a type II endoleak. Conclusions: Bilateral IBDs can be used safely and with excellent rates of technical success and branch patency in appropriately selected patients.     

Midterm result of custom-made iliac branch device for common iliac aneurysm with and without abdominal aortic aneurysm

Open in a separate window OBJECTIVESAlthough commercial iliac branch devices offer a new and valid endovascular approach to treating iliac aneurysm and effectively preserve antegrade flow of the internal iliac artery, their use may not be suited for all types of challenging anatomy, especially isolated common iliac artery aneurysm. Our custom-made iliac bifurcation device has a unique design and excludes both combined and isolated iliac branch aneurysm. This study validated the efficacy and safety of the custom device by comparing clinical outcomes between groups receiving commercial and custom devices.METHODSData of consecutive patients receiving iliac bifurcation device implantation for iliac aneurysm with or without concomitant endovascular repair for abdominal aortic aneurysm from January 2010 to May 2019 were reviewed.RESULTSIliac bifurcation device implantation with or without concomitant abdominal aortic aneurysm stent grafting was completed in 46 patients (commercial, n = 35; custom, n = 11). No significant differences were observed regarding postoperative complications, occlusion or endoleak. Comparisons of primary (80.8% vs 85.7%, P = 0.88) and secondary (86.5% vs 85.7%, P = 0.85) patency and freedom from reintervention (88.2% vs 100%, P = 0.33), all-cause mortality (78.6% vs 100%, P = 0.25) and aneurysm-related mortality (100% vs 100%, P = 1.00) also indicated no differences at a 5-year surveillance point. Furthermore, the iliac aneurysms of the groups displayed similar shrinkage 1 year after procedures.CONCLUSIONSFor iliac aneurysm, the novel custom-made iliac bifurcation device is an adaptable design not inferior to commercial devices with regard to postoperative complications, bridge occlusion, endoleak and short-term aneurysm remodelling. It provides an alternative for treatment, particularly when certain anatomic challenges are present.Clinical trial registration2018-07-050BC, 2017-01-023ACF.     

A hard object in the right iliac fossa

An unusual case of a Harrington rod migrating out of the abdominal cavity.     

Isolated dissecting aneurysm of the common iliac artery: Report of a case

Isolated dissecting aneurysms of the peripheral arteries which are not accompanied by a dissecting aneurysm of the aorta are rarely observed. We report herein the unusual case of a 54-year-old man in whom an isolated common iliac aneurysm was found to be caused by isolated dissecting aneurysms of the left common iliac artery.     

Arterial supply of the deep circumflex iliac artery (DCIA) flap

The main constituents of the deep circumflex iliac artery (DCIA) flap are a rim of iliac crest and an overlying paddle of skin. Taylor et al. believed that both constituents were adequately supplied by the DCIA, but in some of our recent DCIA flaps, the bone has survived while the skin has undergone necrosis. We believe that this is because the skin is supplied mainly by the superficial circumflex iliac artery (SCIA). To test this hypothesis, three DCIA flaps, with both the DCIA and SCIA, were raised from three unembalmed cadavers. The DCIA pedicle was injected with a mass of black latex, while the SCIA was injected with a mass of green latex. The flaps were rendered transparent using the Spalteholz method. In each flap, black latex filled vessels close to the rim of bone. Green latex filled vessels in the skin paddle. No black latex was seen in the skin paddle, nor was green latex seen in the bone segment. There was no apparent anastomosis between the two systems. The DCIA mainly supplies the bone and the SCIA the skin, but the DCIA is not always adequate to supply both. When raising a flap of bone and skin from the iliac crest region, surgeons should consider raising both the deep and superficial circumflex arteries.     

带旋髂深血管的游离髂骨瓣移植修复胫骨骨不连

目的：探讨应用带旋髂深血管的游离髂骨瓣移植修复胫骨骨不连的临床疗效。方法2003-2013年对30例胫骨骨不连患者,治疗组15例应用带旋髂深动静脉的髂骨瓣或髂骨皮瓣移植修复,对照组15例采用单纯髂骨移植。结果长期随访发现,治疗组的髂骨瓣均成活,胫骨骨不连骨性愈合时间最早6个月;对照组移植骨再生时间最早9个月,骨髓腔再通时间最早1年。结论采用显微外科技术吻合带旋髂深血管的游离髂骨瓣修复胫骨骨不连,对比单纯髂骨移植,愈合时间明显缩短,疗效可靠。