早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张

目的探讨早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张的疗效。方法回顾性分析我院2008年10月～2011年5月32例大隐静脉曲张并发急性血栓性浅静脉炎的临床资料。发病2周内行小切口大隐静脉高位结扎剥脱术。结果全部患者术后局部红肿疼痛于3天内消退，切口全部甲级愈合，住院时间10～16d，平均12．6d。全部患者随访5～32个月，平均13．6月，其中11例〉12个月，未见复发。结论早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张是安全的，术后疗效满意。     

射频闭合与传统剥脱术治疗下肢静脉曲张的对照研究

目的评价射频闭合(radiofrequency endovenous obliteration,RFO)的疗效。方法 56例(56条肢体)大隐静脉曲张患者随机分为两组,每组28例。RFO组利用射频能量使大隐静脉全程闭合,静脉剥脱组用传统方法高位结扎剥脱大隐静脉。两组病例小腿散在的曲张浅静脉均采用点式剥脱处理。比较两组病例的切口数、术后疼痛、平均住院日和短期疗效等情况。结果 RFO组平均切口少、术肢疼痛轻、无皮下血肿,术后平均住院日(2．50±1．00)d。静脉剥脱组的术后平均住院日(4．14±0．85)d。结论 RFO闭合大隐静脉具有创伤小、恢复快、腿部少留瘢痕等优点,是一种可部分替代传统大隐静脉高位结扎剥脱术的有效方法。     

高位结扎联合点式与传统剥脱术应用于大隐静脉曲张患者的临床对比

目的 探讨高位结扎联合点式与传统剥脱术应用于大隐静脉曲张患者的临床效果.方法 80例研究对象均选自北京市通州区西集卫生院2018年9月至2021年7月收治的大隐静脉曲张患者,随机数字表法将其分为对照组和观察组,每组各40例.对照组患者予以大隐静脉高位结扎联合传统剥脱术治疗,观察组患者予以大隐静脉高位结扎联合点式剥脱术治...     

原发性大隐静脉曲张高位结扎并剥脱术治疗的护理

目的 探讨大隐静脉高位结扎并剥脱术的护理要点.方法 60例原发性大隐静脉曲张患者,采用改良大隐静脉高位结扎并剥脱术,并给予系统的术前、术后护理.结果 60例患者刀口均一期愈合.本组1例发生深静脉血栓形成,经卧床休息抬高患肢,肝素抗凝治疗痊愈,随访1 a无复发.结论 大隐静脉高位结扎并剥脱术的治疗配合系统的手术前后护理,...     

大隐静脉高位结扎并浅静脉电凝术治疗大隐静脉曲张的临床研究

目的：对比研究大隐静脉高位结扎并浅静脉电凝术治疗大隐静脉曲张的疗效。方法：研究组：采用大隐静脉高位结扎并浅静脉电凝术30例；对照组：采用传统手术方法（高位结扎加迂曲静脉剥脱术）30例。比较两组手术时间、术中出血量、术中开始下床活动时间、住宅天数等指标。结果：研究组与对照组术中出血、下床时间、拆线时间、住院天数、手术时间均有显性差异（P＜0．01，P＜0．05）。结论：大隐静脉高位结扎并浅静脉电凝术的临床综合疗效明显优于传统手术方法（高位结扎加迂曲静脉剥脱术），值得临床推广。     

高位结扎并点式微创剥脱术治疗原发性下肢静脉曲张

目的探讨高位结扎并点式微创剥脱术治疗原发性下肢静脉曲张的临床效果。方法 2006年10月～2009年6月,对原发性大、小隐静脉曲张236例,术前应用彩色多普勒超声进行CEAP分类诊断,定位标记病变曲张浅静脉及贯通静脉走行,在静脉麻醉联合局部浸润麻醉下行高位结扎剥脱术,局部做1～3mm小切口,用静脉钩取出局部曲张血管或结扎功能不全的贯通静脉。结果 236例术后切口均正常愈合,曲张静脉全部消失,186例下肢浮肿术后1个月消退,40例术后3个月内皮肤色素沉着消退,10例下肢皮肤溃疡于2个半月全部愈合。无深静脉血栓及肺动脉栓塞等严重并发症,209例随访0.5～3年,平均12个月,无复发。结论术前彩色多普勒标记定位大、小隐静脉高位结扎并点式微创剥脱术治疗效果良好,具有损伤小、恢复快、治疗彻底、术后皮肤美观等优点。     

大隐静脉曲张激光闭合术时高位结扎与未高位结扎的近期复发率对比研究

目的 研究大隐静脉激光闭合术时高位结扎与未高位结扎对近期复发率的影响,明确大隐静脉激光闭合术时是否有必要附加大隐静脉高位结扎术。方法 将2004年3月至2006年3月接受大隐静脉激光闭合术的215例患者随机分为两组,A组：大隐静脉高位结扎加激光闭合术,B组：单纯大隐静脉激光闭合术,比较其术后复发率及并发症的区别。结果 随访6～29个月,1例失访,无深静脉血栓及肺栓塞发生。A组复发4例,复发率3.8%,B组复发9例,复发率8.3%,两组复发病例病因均为原发性深静脉瓣膜功能不全,单纯大隐静脉曲张术后无复发。经统计学分析,两组复发率无统计学意义（P〉0.05）。结论 没有证据表明行大隐静脉激光闭合术时首先行高位结扎更有优势,未高位结扎并不增加深静脉血栓形成及肺栓塞的发生机会。     

改良大隐静脉腔内闭合联合点状剥脱术治疗下肢浅静脉曲张的疗效观察

目的对比改良大隐静脉腔内闭合联合点状剥脱术与大隐静脉高位结扎加硬化剂注射术治疗下肢静脉曲张的临床疗效。方法回顾性分析2009年5月至2011年5月本院行改良大隐静脉腔内闭合联合点状剥脱术患者568例(676条患肢)和接受大隐静脉高位结扎加硬化剂注射术的患者487例(585条患肢),两组随访比较并发症及术后复发情况。结果两组患者静脉曲张均得到治愈。对照组出现皮下硬结57例,皮下瘀斑70例,血管血栓性浅静脉炎75例;改良组出现皮下硬结40例,皮下瘀斑55例,血管血栓性浅静脉炎60例。总体复发率两组间无统计学差异,但改良组大隐静脉主干复发率明显低于对照组。结论改良大隐静脉腔内闭合联合点状剥脱术对大隐静脉主干和大的分支行彻底剥脱临床效果佳,手术相对微创,大隐静脉主干复发率低,值得推广。     

大隐静脉剥脱术术式改进

大隐静脉剥离术,传统的方法是先作高位结扎,剥离器自上而下插入静脉进行剥脱。大多病例只能插至小腿中段,因此往往需要分数段进行,手术时间较长,多个切口,术后常有小腿局部麻木长久不愈。在进行高位结扎时偶有发生股静脉损伤的严重并发症。     

改进高位结扎剥脱术治疗单纯性大隐静脉曲张体会

目的总结单纯性大隐静脉曲张的治疗经验。方法回顾性分析我院2007年3月至2009年11月期间采用改进高位结扎及剥脱术治疗单纯性大隐静脉曲张65例患者的临床资料。结果本组患者手术时间45~127 min,平均54 min。住院时间5~8 d,平均6.8 d。所有切口均甲级愈合,肿胀不适、沉重感等症状消失,切口皮下无出血、瘀血、血肿,无皮肤麻木等并发症发生。术后随访2~33个月,平均26.9个月,无一例发生深静脉血栓形成,均按期拆线,效果良好,无复发。结论改进高位结扎剥脱术治疗单纯性大隐静脉曲张疗效确切。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.