Objective To investigatethe anatomic structure of the compound flap of distally-based saphenous nervegreat saphenous vein nutritional vessels so as to provide anatomic basis for the clinical operation. Methods The origin, branches, anastomosis of nutritional vessels of sural nerve-great saphenous vein, and the relationof blood supply of tibia and soleus muscle were observed on 30 low limb specimens of adult cadaver, which were perfused with red gelatin to dissect from the artery. Results The nutritional vessels of sural nerve-great saphenous vein originated from: the saphenous artery 3-5 branches with a diameter of 0.7±0.4 mm；the cutaneous branches of medial inferior genicular artery, diameter of 0.7±0.2 mm；the intermuscular space perforating branches of posterior tibial artery 2-7 branches with a diameter of 1.0±0.2 mm，the internus halfside of the muscular branches nutrient soleus muscle；the perforating osteoseptocutaneous 1-2 branches with a diameter of 1.3±0.3 mm; the perforating branches of superior malleolus with a diameter of 0.6±0.2 mm; the perforating branches of medial anterior malleolus with a diameter of 0.8±0.3 mm. A vascularnetwork of 3 layers, which included periosteum, deep artery, and fascia nerve and superficial vein, was formed by those branches of deep artery, fascia branches, periosteum branches, and nerve-vein nutrition branches. Conclusion The nutritional vessels of saphenous nerve-great saphenous vein has the same origin as muscles, bones, and cutaneous nutritional vessels. It provides anatomic basis for the compound flap of distally-based saphenous nerve nutritional vessels.
目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
This study was to observe the result in patients suffering from severe ischemia of legs with arterialization of the great saphenous vein. Eighty nine patients suffering from the disease were treated by bridging the autogenous cephalic vein or Gore-Tex artificial vessel between the great saphenous vein and the femoral or external iliac arteries. The results showed that the blood supply of the affected legs was increased immediately after operation. The ulcers of the toes and the plantar areas were healed gradually and the pain relieved. It was concluded that this method did not interfere with the reflux of the venous blood in the diseased limbs. This method was simple, safe and effective for treating severe ischemia of the lower limbs.
ObjectiveTo explore the feasibility of radiofrequency ablation of great saphenous varicose veins in ambulatory surgery.MethodsPatients who underwent radiofrequency ablation of great saphenous varicose veins between May 2018 and June 2019 in General Hospital of Northen Theater Command were prospectively selected. According to their choices of treatment modes, patients were divided into two groups, day surgery group and routine inpatient group. The preoperative waiting time, length of hospital stay, and hospitalization expenses of the two groups were compared. The postoperative pain, tenderness, and complications were followed up on the first day (the next day after operation), the third day, and the fourteenth day after operation, and the time of return to normal life and work and patients’ satisfaction in two groups were recorded.ResultsA total of 95 patients were enrolled, including 52 in the day surgery group and 43 in the routine inpatient group. There was no significantly difference in age, gender, heart rate, mean arterial pressure, or operation time between the two groups (P>0.05). Compared with the routine inpatient group, the day surgery group had shorter preoperative waiting time, shorter length of hospital stay, and lower hospitalization expenses (P<0.05). In the day surgery group, the time of return to normal life and the time of return to work were shorter and patients’ satisfaction was significantly higher than those in the routine inpatient group (P<0.05). There was no significant difference in pain, tenderness, or paresthesia scores between the two groups after surgery according to the follow-up assessment (P>0.05); the pain, tenderness, and paresthesia scores on the first day and the third day were significantly different from those on the fourteenth day after surgery, indicating that the longer the postoperative time of the two groups, the less pain, tenderness, and paresthesia scores were.ConclusionRadiofrequency ablation of great saphenous varicose veins in ambulatory surgery has a short hospital stay, low medical cost, high patient satisfaction, and can ensure the safety of treatment at the same time, which is worthy of clinical promotion
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。
目的 研究地佐辛＋咪达唑仑在大隐静脉射频闭合术中的镇静作用，并观察其对生命体征的影响以及不良反应的发生情况。方法 选取60例行大隐静脉射频闭合术患者，根据麻醉方式分为芬太尼＋咪达唑仑组和地佐辛＋咪达唑仑组２组，每组30例。分别监测心率（HR）、动脉血氧饱和度（SpO2）、平均动脉压（MAP），记录用药后5min和30min的镇静评分、生命体征以及术中不良反应的发生情况。结果 给药后5min和30min的镇静效果评分芬太尼＋咪达唑仑组分别为（2.95±0.14）分和（4.09±0.05）分，地佐辛＋咪达唑仑组分别为（3.16±0.09）分和（4.08±0.08）分，2组比较差异无统计学意义（P＞0.05）。2组给药后5min和30min的HR、SpO2及MAP比较差异均无统计学意义（P＞0.05）；与给药前（0min）比较，差异也无统计学意义（P＞0.05）。2组患者镇静良好，无躁动，均无一例发生呼吸抑制，仅芬太尼＋咪达唑仑组有4例发生呛咳。结论 芬太尼和地佐辛联合咪达唑仑用于大隐静脉射频消融手术患者，镇静效果良好，对生命体征影响小，但地佐辛组无呛咳，不良反应发生率更低。
ObjectiveTo summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. MethodWe retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. ResultFour patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusioncarefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.
Abstract： Objective To investigate the extracellular matrix （ECM） gene expression profile of saphenous vein （SV） in end-stage renal disease （ESRD） patients undergoing coronary artery bypass grafting （CABG）. Methods Sixty-eight patients who were diagnosed as coronary artery disease by coronary angiography and admitted to Department of Cardiovascular Surgery，Zhongshan Hospital of Fudan University from July 2004 to December 2010 were enrolled in this study. According to whether or not they had preoperative ESRD history，all the 68 patients were divided into 2 groups，the ESRD group with 30 ESRD patients who needed maintenance hemodialysis，and the control group with 38 patients without preoperative renal disease. Preoperative clinical data of all the patients were collected in detail. SV samples were obtained at the time of CABG. Microarray，immunohistochemistry and Western blotting were used to investigate the expression profile of ECM genes of SV in ESRD patients undergoing CABG. Results There was no statistical difference in preoperative clinical variables between the 2 groups except the variables which were directly related to their kidney disease （P＞0.05）. There were 16 genes that were up-regulated at least 3-fold and 3 genes that were down-regulated at least 3-fold in the ECM gene expression profile of SV in the ESRD group patients before CABG. The expressions of matrix metalloproteinases-2 （MMP-2） and matrix metalloproteinases-9 （MMP-9） of the ESRD group were significantly higher than those of the control group （2.60±0.50 vs. 0.70±0.16，1.80±0.40 vs. 0.60±0.15，P＜0.01）. The expressions of tissue inhibitor of metalloproteinase-2 （TIMP-2） and tissue inhibitor of metalloproteinase-3 （TIMP-3） of the ESRD group were significantly lower than those of the control group （0.60±0.19 vs. 2.20±0.30，0.90±0.28 vs. 2.40±0.70，P＜ 0.05）. Conclusion A variety of ESRD-related risk factors of cardiovascular diseases may severely influence on the balance of ECM gene expression of SV before CABG，and the resulting imbalance is a risk factor to aggravate SV graft disease after CABG.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.