【摘要】 目的 了解人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病的临床疗效。 方法 对2002年1月-2010年12月因造血干细胞移植并发重症肝静脉闭塞病的6例患者，利用人工肝支持系统，选用血浆置换程序进行血浆置换。 结果 6例患者经血浆置换治疗后，胆红素均明显下降，3例最终恢复，2例因肝功能再次恶化死亡，1例死于严重混合性感染。 结论 人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病是一种新的尝试，是有效和可靠的。【Abstract】 Objective To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation. Methods Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system. Results After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections. Conclusion Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.
Objective To investigate the effect of one stage arterialization of posterior tibial vein in treatment of peripheral arterial extensive occlusive disease. Methods Forty-six cases (56 limbs) of patients with peripheral arterial extensive occlusive disease were treated with one stage arterialization of posterior tibial vein. Results The symptom of pain disappeared right after one stage arterialization of posterior tibial vein in all patients . Skin temperature went up. The long-term results were satisfactory during the period of 3 months to 7 years follow-up, except two limbs were amputated and two limbs were reoperated with pedicle omental transplantation. Conclusion The technique of one stage arterialization of posterior tibial vein has advantages of one-stage procedure, various indications, little influence to venous return and rapid relief of ischemic symptoms.
Toinvestigatenewgraftmaterialsforreconstructionofarterialcirculationforlowerlimbsarterialischemia,authorstreated18patientswith24ischemiclowerlimbswithbypassofsmallsaphenousveininsitufromMay,1992toMay,1997whowerefollowedupforonetofiveyears.Theshorttermresultshowedthatischemicsymptomswereimprovedsignificantlyin88.8%oflimbs.Goodorexcellentrateofthelongtermresultreached83.3%.Thepatencyrateofthegraftbythelifetableanalysisin1,3and5yearswas95.8%,79.6%and70.0%respectively.Weconcludethatusingsmallsaphenousveinasthegraftmaterialtoreconstructthecirculationoftheischemiclegisagoodoperationforlongsegmentofarteriosclerosisobliterans(ASO)andthromboangiitisobliterans(TAO)withtheocclusionofthreebranchesinferiortopoplitealartery.Ithastheadvantagesofnolimittolength,unnecessarilypredamagingvalvesandligatingbranchesinfullcourseconsequentlytoavoidreversionanddistortion.
15 patients suffering thromboangiitis obliterans with the occlusion of three branches below popliteal artery were treated by the operation of vein-arterification compounded femoral and popliteal planes at this hospital from 1990 to 1995. It is proved by clinical observation and correspondence with 15 patients that the symptoms ammeliated quickly and surely at the near future and forward blood supply lasted so as to avoid the complications of limb edema and heart failure. So the authors consider that the composite vein-arterification has a good anatomical and physical basis and suits to sufferers with the occlusion below popliteal vessels caused by different reasons, the principle of vein-arterification is to select the trunk artery of no pathological changes and not the collateral deep vein, but should select small-median superficial vein far away from pathological artery.
FromApril1990toDecember1996,15patientswithaortoiliofemoralorfemoralatheroscleroticocclusivediseaseweretreatedwithaortoprofundabypassgrafting:5patientswereperformedwithprofundoplasty;2patientsweretreatedwithprofundapoplitealarterybypass.Theexcellentresultsofthe19patientswereconfirmedafterameanfollowupperiodof24.5months.Twopatientshadimprovementafteroperation.Amputationwasperformedinonelimbafter6monthsofoperationbecauseofsevereinflammation.Theauthorsconsideredthattheprofundafemoralarteryplaysanimportantroleinaortofemoralarteryreconstruction.Itisagoodinfloworoutflowprovidingarterialbloodtoseverelyischemiclegswithocclusionofaortoiliosuperficial,iliosuperficialorsuperficialfemoralarteries.
Objective To investigate the surgical therapy for chronic total occlusion (CTO) of coronary artery with offpump coronary artery bypass grafting (OPCAB). Methods From Aug. 1999 to Oct. 2007, 696 patients with 853 totally occluded coronary arteries (127 coronary arteries lack of opacification while the other 726 arteries with reverse flow showed by coronary angiography) underwent OPCAB. A total of 2 231 grafts were constructed including 136 placed to coronary endarterectomy (CE) targets and 28 arterialized middle cardiac veins. Blood flow was detected during operation in 26 coronary arteries with no opacification in preoperative angiography, while no blood flow was detected in 63 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 15 cases because of a poor hemodynamics and 6 of which were assisted with intraaortic balloon pump(IABP). Results All patients survived the operation. 6 died in hospital because of low cardiac output (2 cases), renal failure (2 cases), perioperative cardiac infarction (1 case) or cerebrovascular accident (1 case). Stress ulceration occurred in one case, mediastinal infection occurred in another case after operation. Both were treated medically and recovered. 692 patients were followed up and the rate of flup was 99.42%(685/686)， with 4 withdrawal. Freedom from cardiac angina was 99.85%(685/686) and cardiac functional grading (NYHA) was Ⅰ-Ⅱ. Conclusion OPCAB can be well performed in patients with chronic total occlusion of coronary arteries. The ralue of coronary angiography for evaluating totally occluded coronary artery is limited, and endoscope or intravascular ultrasound techniques may be helpful.
【Abstract】 Objective To analyze the influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis. Methods Between January 2009 and December 2010, 59 patients (67 limbs) with chronic limb ischemia associated with acute thrombosis were treated. According to whether the no-reflow phenomenon occurred or not, the patients were divided into no-reflow group (19 patients, 21 limbs) and reflow group (40 patients, 46 limbs). Logistic regression was used to analyze the roles of ischemia time, ischemia extent, smoking, hypertension, cardiovascular and cerebrovascular disease, diabetes, surgical procedure, platelet count, fibrinogen (FBG), prostaglandin I2 (PGI2), and thromboxane A2 (TXA2) on no-reflow phenomenon after reperfusion. Results The results of the logistic regression analysis indicated that ischemia time (OR=7.196; 95%CI: 1.679-27.960), ischemia extent (OR=5.116; 95%CI: 1.399-109.338), smoking (OR=6.893; 95%CI: 3.704-2 291.003), diabetes (OR=3.864; 95%CI: 1.009-421.702), PGI2 (OR=7.985; 95%CI: 1.001-1.043), and TXA2 (OR=7.643; 95%CI: 1.011-1.065) were the high risk factors of no-reflow phenomenon. The levels of TXA2 and FBG in no-reflow group were significantly increased and the level of PGI2 was decreased, showing significant differences when compared with the reflow group (P lt; 0.05). However, no significant difference was found in the platelet count between 2 groups (P gt; 0.05). Conclusion Ischemia extent and ischemia time are the main influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis, and the patients combined with smoking or diabetes are high risk population of the no-reflow phenomenon. Postoperative patients with no-reflow phenomenon are at a hypercoagulable state in vivo, in which prostacyclin plays an important role.
Objective To investigate the efficacy of autologous bone marrow mononuclear cells transplantation in treating lower l imb thromboangiitis obl iterans (TAO). Methods From January 2005 to November 2008, 25 patients (27 l imbs) with lower l imb TAO were treated. There were 24 males (26 l imbs) and 1 female (1 l imb), aging 16-44 years (33 years on average). Fifteen left l imbs and 12 right l imbs were involved. The median duration of disease was 2 years (from 3 months to9 years). Intermittent claudication was observed in 5 cases (5 l imbs), 16 patients (17 l imbs) had symptom of rest pain, 4 patients (5 l imbs) suffered ulcer on the distal l imbs. The results of visual analogue scale (VAS), maximum walking distance (MWD), ankle/brachial index (ABI), and transcutaneous oxygen pressure (TcPO2) before operation were (7.16 ± 1.12) points, (0.098 ± 0.043) km, 0.20 ± 0.09, and (11.78 ± 3.46) mm Hg (1 mm Hg=0.133 kPa), respectively. A total of 300 mL bone-marrow blood was extracted from the il iac bone. And then the mononuclear cells were isolated from the bone-marrow blood. All patients received cell transplantation only one time. The amount of transplantation bone marrow mononuclear cells was (1.82-29.46) × 109 (mean 13.33 × 109). Results All patients were followed up for 1 years. After 4 weeks of implantation, the results of VAS, MWD, ABI, and TcPO2 were (2.39 ± 0.51) points, (0.783 ± 0.176) km, 0.28 ± 0.16, (21.33 ± 6.57) mm Hg, respectively, showing significant difference compared with preoperative results (P lt; 0.05). The VAS, MWD, ABI, and TcPO2 increased to (2.44 ± 0.67) points, (1.199 ± 0.304) km, 0.37 ± 0.09, (27.90 ± 5.23) mm Hg after 1 year of implantation, showing significant differences compared with preoperative results (P lt; 0.05). One ulcer healed well and the improvement was obtained in other 3 cases after 4 weeks of implantation (80%). Four ulcers healed well after 1 year of implantation (80%). After 1 year of implantation, angiography revealed 37.04% affected limbs had a satisfactory neovascularization. The angiographic levels were grade 0 in 5 cases, grade 1 in 12 cases, grade 2 in 4 cases, and grade 3 in 6 cases. Conclusion Autologous bone marrow mononuclear cells transplantation could be a simple, safe, effective method to treat TAO.