目的 探讨四肢动脉损伤的诊断和治疗方法。方法 回顾分析我院1996年1月至2006年7月共诊治的23例四肢动脉损伤患者的临床资料。分别采用直接动脉修补、动脉结扎、端端吻合、自体大隐静脉移植及人工血管吻合。术中取栓6例,合并静脉损伤修复8例。结果 截肢3例（13.0%）。获得随访12例，随访时间3个月~5年，11例多普勒超声证实损伤血管血流通畅，下肢肌肉挛缩1例； 下肢血供不足1例。结论 早期诊断是提高肢体存活率和避免假性动脉瘤发生的关键。手术方式的合理选择、Fogarty导管常规取栓和早期筋膜切开可提高治愈率。
随着外科技术和围手术期治疗水平日益提高，腹主动脉瘤择期手术治疗死亡率已控制在5%以内［1，2］，但破裂腹主动脉瘤（ruptured abdominal aortic aneurysm,RAAA）的死亡率一直在40%～70%，如果包括尚未到达医院的RAAA患者，死亡率可达80%～90%，RAAA被美国列为第13位死亡原因［2~4］。目前，及时准确的诊断和快速有效的外科治疗仍是降低RAAA死亡率的关键。......
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
bjective To study the effectiveness of subfascial endoscopic communicating branch vein ablation in treating communicating branch vein insufficiency.MethodsFiftyseven cases of primary lower extremity vein valve insufficiency complicated by communicating vein insufficiency diagnosed by venography and color duplex were treated with subfascial endoscopic communicating branch vein ablation, and their information was analyzed retrospectively.ResultsSwelling was observed in leg of 7 cases after operation, and disappeared within one week spontaneously. Incision infection occurred in 2 cases and skin ambustion happened in 2 cases. Superficial vein varicosis disappeared in all case, skin pigmentatin declined significantly and ulcers healed in 2-3 weeks.Conclusion Subfascial endoscopic communicating branch vein ablation is an excellent choice in treating communicating branch vein insufficiency.
目的交流腹主动脉瘤的诊断和外科治疗方法。方法对1991年2月至2002年7月我院外科治疗的30例肾下型腹主动脉瘤的临床资料进行回顾性分析。结果数字减影血管造影术诊断1例，MRI诊断2例，其余27例均经CT确诊。该30例中，腹主动脉瘤破裂6例，行急诊手术，死亡2例（死亡率33.3%）； 24例未破裂者中， 22例行腹主动脉瘤切除和原位人造血管移植术，术后死亡2例（死亡率9.1%），另2例行腹主动脉瘤腔内人造血管移植术。结论及早术前诊断，恰当地选择手术时机、手术方式及正确的围手术期处理是提高手术成功率，减少术后并发症和死亡率的关键。
Abstract： Arginine vasopressin （AVP） is closely related to the pathogenesis of a variety of cardiovascular diseases and kidney diseases. Currently it is often used for the treatment of severe peripheral vasodilatory shock， and particularly beneficial for patients with refractory catecholamine-resistant vasodilatory shock. For some patients who do not have adequate AVP level in plasma after cardiovascular surgery， external low-dose AVP infusion is helpful to decrease the heart rate, and the dosage and duration of catecholamine use. Early initiation of low-dose AVP infusion may be beneficial for postoperative patients’ hemodynamic recovery without adverse complications. More randomized control trials are needed to provide evidence for rational usage， dosage and duration of AVP administration.
In recent years，West China Hospital of Sichuan University actively participated in medical assistance and rescue in Wenchuan，Yushu and Lushan earthquakes. However，professional roles of cardiovascular surgeons in medical assistance and rescue in earthquakes remain unclear because of the particularity of cardiovascular surgery, which often affects the assembly of medical assistance and rescue teams. Thus，we need to explore the necessity for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake. In this article，medical rescue work of cardiovascular surgeons within 72 hours after 2008 “5•12” Wenchuan earthquake and 2013 “4•20” Lushan earthquake is analyzed and compared to identify professional roles of cardiovascular surgeons in medical rescue within 72 hours after earthquake. It is necessary for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake.