Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
ObjectiveTo explore the value of potaried technique with Trivex system in treatment for venous skin ulcer with deep venous thrombosis sequelae (DVTS) of lower limbs. MethodsTotal 166 patients with venous skin ulcer with DVTS of lower limbs were included in this study. The patients of operation group (94 patients involving 94 legs) were treated by using potaried technique with Trivex system. The patients of nonoperation group (72 patients involving 72 legs) were treated by using nonoperative method. The clinical indexes of skin infection rate, skin necrosis rate, shrinkage rate of wound area, skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were used to assess the clinical curative effect between two groups on 5, 20, 120 and 360 d after operation or treatment, respectively. ResultsThere were no skin infection and skin necrosis in two groups on 5 d after operation or treatment. The rate of shrinkage of wound area and skin depigmentation of patients in operation group were significantly higher than those in nonoperation group on 20 d after operation or treatment 〔(95.8±2.138)% vs. (68.7±3.125)%，P=0.048; (87.6±1.263)% vs. (12.3±1.324)%， P=0.018〕. The rate of the ulcer healing of patients in operation group was significantly higher than that in nonoperation group on 120 d after operation or treatment (97.9%vs. 8.3%， P=0.014). The rate of the ulcer recurrence of patients in operation group was significantly lower than that in nonoperation group on 360 d after operation or treatment (5.3% vs. 97.2%， P=0.015). ConclusionThe potaried technique with Trivex system can be used as one of the surgical treatment methods for venous skin ulcer with DVTS of lower limbs.
目的 总结急性动脉栓塞致肌病肾病代谢综合征(myonephropathic-metabolic syndrome,MNMS)的诊治经验。方法 回顾性分析2005年1月至2006年3月由急性动脉栓塞导致的11例MNMS的临床资料。结果 5例存活(保肢4例）； 2例死于高钾血症引起的心搏骤停，4例死于以急性肾功能衰竭为首发的多器官功能不全综合征。结论 急性动脉栓塞一旦确诊，尽早手术。MNMS是急性动脉栓塞的常见、严重并发症，急性动脉栓塞时尽快重建血流、骨筋膜室综合征尽早行筋膜室切开术及坏疽肢体尽早截肢是预防和治疗MNMS的关键。
Objective To investigate the efficiency and safety of autologous peripheral blood stem cell transplantation （ABSCT） in treatment for thromboangiitis obliterans. Methods Fifty patients （62 affected limbs） with thromboangiitis obliterans were treated by ABSCT. A series of subjective indexes including improvement of pain and cold sensation and objective indexes including intermittent claudication distance， ankle brachial index （ABI）， skin temperature， and improvement of foot skin ulcer were evaluated. Results Due to necrosis in middle and lower part of leg， 4 of 50 patients （4 lower limbs） were taken extremity amputation on 3 weeks after ABSCT， 46 patients kept their legs successfully. On 1 month after ABSCT， the legs pain and cold sensation of 46 patients （58 affected limbs） vanished， and the score of feet pain and cold sensation after ABSCT were better than those before ABSCT （P＜0.05）. The intermittent claudication distance， skin temperature， and ABI of 46 patients with kepting their legs on 3 months after ABSCT significantly increased as compared with before ABSCT 〔intermittent claudication distance：（80.38±45.53） m versus （330.56±142.31） m；skin temperature：（26.50±0.46） ℃ versus （31.49±0.45） ℃；ABI：0.41±0.02 versus 0.71±0.05〕， the differences were statistically significant（P＜0.05）. Six months after ABSCT， different degree neonatal lateral vessels were found in 58 affected limbs of 46 patients by lower extremity arteriography. The complications were not found in all the patients by laboratory or CT detection， such as malignant tumors， retinal hyperplasia， aneurysm and so on. After ABSCT， 40 patients were followed up for 9 to 36 months （mean 22.5months）， the symptom had improved. Due to leg pain aggravated after 6 months， score of pain feelings was 4 in 6 patients and with toe ulcers， who had ABSCT again. Eighteen months after transplantation， the patients had only debilitation of lower extremity. The pain feeling was improved （score of pain feeling was 1）. The toe ulcer was healed and no angiosclerotic myasthenia happened. Conclusions ABSCT is a simple， safe， and effective method， especially in treatment for patients with severe lower limb ischemia who is no arterial reconstruction is feasible. It could improve the quality of life of patients and might be avoided amputation of lower extremity or foot.
ObjectiveTo investigate the significance of Fogarty catheter embolectomy combined with multiple minimally invasive techniques for acute limb ischemia. MethodsClinical data of 88 cases(88 limbs) of lower limb ischemia who were treated in our hospital from Feb. 2007 to Jan. 2011 were collected and analyzed. Of the 88 patients, 46 cases were operated by Fogarty catheter embolectomy(embolectomy group), 42 cases were operated by Fogarty catheter embolectomy combined with multiple minimally invasive techniques(combination group). Comparisons of the clinical indexes of ankle-brachial index(ABI), saturation of blood oxygen(SO2) of toes, and temperature of foot skin before and after operation were performed between the 2 groups, as well as the incidence of mortality, complication, and amputation after operation. ResultsCompared with before operation in the same group, the value of ABI, SO2, and temperature of foot skin in the 2 groups were higher(P<0.05), as well as the 3 kinds of indexes were both higher in combination group after operation(P<0.05). The rates of mortality, amputation, myonephropathic metabolic syndrome(MNMS), osteofascial compartment syndrome, and transient renal insufficiency were 13.04%(6/46), 17.39%(8/46), 26.09% (12/46), 26.09%(12/46), and 13.04%(6/46) respectively, the corresponding rates in combination group were 4.76% (2/42), 7.14%(3/42), 14.29%(6/42), 9.52%(4/42), and 9.52%(4/42) respectively, which were all lower in combination group(P<0.05). ConclusionFogarty catheter embolectomy combined with multiple minimally invasive techniques can be one of the surgical treatment methods for acute limb ischemia, which is characterized by minimally invasive surgery and effective treatment.
ObjectiveTo investigate the therapeutic evaluation of catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular in the treatment of lower extremity atherosclerotic occlusive disease (ASO). MethodsClinical data of 64 ASO patients who were treated in our hospital from June 2011 to October 2014 were analyzed retrospectively. These patients were divided into two groups according to the therapies:33 patients were treated by catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular (combination group), and the other 31 patients were only treated by multiple minimally invasive techniques of endovascular (intervention group). Comparison of the clinical indexes was performed between the 2 groups, including vascular patency rate, stent implantation rate, operation time, ankle-brachial index (ABI), saturation of blood oxygen (SO2) of toes, temperature of foot skin, amputation rate, and hospitalization expense. ResultsIn the same group (combination group and intervention group), compared with the time point of before operation, the clinical indexes of the ABI, SO2 of toes, and temperature of foot skin were higher after operation (P<0.05). At the same time point of before or after operation, there were no significant difference between the 2 groups in ABI, SO2 of toes, and temperature of foot skin (P>0.05). The vascular patency rate of combination group was higher than that of intervention group[97.0% (32/33) vs. 83.9% (26/31)], P<0.05. But the stent implantation rate[18.2% (6/33) vs. 64.5% (20/31)], amputation rate[3.0% (1/33) vs. 16.1% (5/31)], operative time[(2.0±0.5) h vs. (4.0±1.1) h], and hospitalization expense of patients who got successful limb salvage[(8 500±1 200) yuan vs. (34 000±2 100) yuan] of combination group were all lower or shorter than those of intervention group (P<0.05). After operation, there were no complication happened in the patients who got successful limb salvage of combination group (n=32) and intervention group (n=26). In postoperative 6 months, the lower extremity arteries in patients who got successful limb salvage of combination group and intervention group were all examined by color ultrasonography, and they were unblocked. The lower extremity arteries of the patients with stent implantation in the 2 groups suffered with no obvious stenosis or occlusion. ConclusionsCatheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular can become one of the surgical treatment methods for ASO, which characterized by minimally invasive operation, effective treatment, and low cost.
The misdiagnosis rate and mortality of mesenteric ischemia are high, but with the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can get timely and effective treatment. This article starts from the epidemiology, vascular anatomy, etiology, clinical manifestations and classification of mesenteric ischemia, and the progress of diagnosis and treatment under the multidisciplinary diagnosis and treatment mode, and details the research progress of mesenteric ischemia at home and abroad. This paper focuses on the significance of multidisciplinary diagnosis and treatment mode in the diagnosis and treatment of mesenteric ischemia, in order to strengthen the treatment consciousness of mesenteric ischemia and explore a more accurate and effective treatment system. The purpose of this study is to provide some reference for avoiding intestinal infarction and improving the survival rate of intestinal tract.
Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups: group A (102 cases)： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B (97 cases)： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group (group C). Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini-invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.