两种介入途径治疗急性、亚急性门静脉及肠系膜上静脉血栓的临床疗效分析

目的：评价介入技术治疗急性和亚急性门静脉（portal vein,PV）及肠系膜上静脉（superior mesenterie vein, SMV）血栓形成的临床疗效。方法：对28例治疗急性和亚急性（发病一周至一月）的PV及SMV血栓患者进行介入治疗。按介入治疗途径不同分为下述两组：选择经颈静脉穿刺门静脉（transjugular intrahepatic portosystemic shunt , TIPS途径）置管溶栓（19例）和经皮穿肝内门脉（percutaneous transhepatic）置管溶栓治疗（9例）。结果：所有患者随访一周至三个月,其中治疗成功24例,临床症状明显改善,无严重并发症。经TIPS途径治疗的患者组中,16例随访显示大部分血栓被清除,门静脉系统有血流通过,临床症状缓解。3例SMV及PV恢复部分血流,但临床症状无明显改善。经皮穿肝内门脉直接置管溶栓治疗组中,6例患者的PV及SMV内血栓大部分清除,血流基本改善,2例患者PV及SMV血流部分好转,临床症状无明显改善,严重并发症1例（术后两天死于腹腔出血）。结论：经TIPS途径介入技术和经皮穿肝内门脉直接置管溶栓治疗是治疗急性和亚急性PV及SMV血栓形成的有效方法,前者的疗效及安全性均好于后者。     

对比分析多种介入途径治疗门静脉系统血栓的临床疗效

目的:对比分析多种介入途径治疗门静脉系统血栓的临床疗效。方法:收集从2001年1月至2009年3月经我科治疗的37例门静脉系统(包括门静脉、肠系膜上、下静脉及脾静脉)血栓形成患者,根据介入治疗途径的不同分为三组:A组(13例)行经TIPS途径门静脉行碎栓溶栓及置管溶栓术;B组(19例)行直接经皮穿肝门静脉碎栓和或置管溶栓术;C组(5例)行经肠系膜上动脉置管溶栓治疗。所有的患者术后定期随访1-12个月,复查CT或彩超了解门静脉系统的血流变化及临床症状恢复情况。结果:A组:经治疗出院时11例(85%)患者门静脉完全再通,;1例(8%)门静脉血流部分再通,1例(8%)术后第二天因出血死亡。术后随访1、3、6、12月门静脉通畅率分别为:85%,77%,77%,62%;所有患者的临床症状均明显缓解。B组:经治疗出院时7例(37%)门静脉完全再通,9例(47%)部分再通,3例(16%)因出血中止溶栓;随访1、3、6月、12月门静脉通畅率分别为:32%,26%,16%,16%。C组:经治疗出院时5例(100%)患者门静脉均未再通,通畅率为0%,术后随访1-3个月内4例患者临床症状得到部分缓解。结论:经TIPS途径治疗后门静脉的再通率及临床症状改善均好于直接经皮穿肝及经肠系膜上动脉途径。经肠系膜上动脉置管溶栓法无法使已有侧支形成的门静脉主干复通,仅能一定程度缓解患者的临床症状。     

对比分析多种介入途径治疗门静脉系统血栓的临床疗效

目的：对比分析多种介入途径治疗门静脉系统血栓的临床疗效。方法：收集从2001年1月至2009年3月经我科治疗的37例门静脉系统（包括门静脉、肠系膜上、下静脉及脾静脉）血栓形成患者,根据介入治疗途径的不同分为三组：A组（13例）行经TIPS途径门静脉行碎栓溶栓及置管溶栓术;B组（19例）行直接经皮穿肝门静脉碎栓和或置管溶栓术;C组（5例）行经肠系膜上动脉置管溶栓治疗。所有的患者术后定期随访1—12个月,复查CT或彩超了解门静脉系统的血流变化及临床症状恢复情况。结果：A组：经治疗出院时11例（85％）患者门静脉完全再通,;1例（8％）门静脉血流部分再通,1例（8％）术后第二天因出血死亡。术后随访1、3、6、12月门静脉通畅率分别为：85％,77％,77％,62％;所有患者的临床症状均明显缓解。B组：经治疗出院时7例（37％）门静脉完全再通,9例（47％）部分再通,3例（16％）因出血中止溶栓;随访1、3、6月、12月门静脉通畅率分别为：32％,26％,16％,16％。C组：经治疗出院时5例（100％）患者门静脉均未再通,通畅率为0％,术后随访1-3个月内4例患者I临床症状得到部分缓解。结论：经TIPS途径治疗后门静脉的再通率及临床症状改善均好于直接经皮穿肝及经肠系膜上动脉途径。经肠系膜上动脉置管溶栓法无法使已有侧支形成的门静脉主干复通,仅能一定程度缓解患者的临床症状。     

PTVE 与TIPS治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血 的疗效比较

目的:研究经皮胃底曲张静脉栓塞术(PTVE)和经颈静脉肝内门体分流术(TIPS)治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血的临床疗效,为临床治疗提供依据。方法:选取2001年4月到2015年4月我院肝硬化门静脉高压合并食管胃底静脉曲张破裂患者169例,根据手术方式分为PTVE组(行PTVE治疗)141例和TIPS组(行TIPS治疗)28例,比较两组术前、术后门静脉压力,术前、术后3个月、6个月以及1年两组Child-Pugh评分、白蛋白以及直接胆红素,并比较两组再出血和肝性脑病发生率。结果:TIPS组术后门静脉压力较术前显著降低,比较差异具有统计学意义(P0.05),术后PTVE组及TIPS组组间比较差异具有统计学意义(P0.05);两组术前和术后各时间直接胆红素无统计学意义(P0.05);PTVE组术后1年白蛋白水平显著升高,与术前和TIPS组比较差异具有统计学意义(P0.05),TIPS组术后白蛋白有所升高,但各时间比较差异无统计学意义(P0.05),PTVE组术后各时间Child-Pugh评分较术前明显改善,比较差异具有统计学意义(P0.05),TIPS组术后3个月和术后6个月Child-Pugh评分较术前明显改善,比较差异具有统计学意义(P0.05);两组术后再出血发生率比较无统计学意义(P0.05),PTVE组肝性脑病发生率显著低于TIPS组,比较差异具有统计学意义(P0.05)。结论:PTVE和TIPS治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血效果相当,TIPS能显著降低门静脉压,PTVE能降低肝性脑病的发生率,改善患者Child-Pugh评分。     

PICC置管后致静脉血栓的护理

目的总结分析经外周静脉置入中心静脉导管(PICC)后并发静脉血栓的情况、治疗方法及转归,并制定针对性的护理干预措施。方法选择我院放疗科一病区2012年1月~2015年6月收治的150例鼻咽癌患者为研究对象,患者均因治疗需要行PICC置管,并在循证基础上给予针对性护理干预。结果 9例患者置管后发生静脉血栓,发生率为6.00%;溶栓治疗后9例患者症状均明显缓解,无栓子脱落导致脑栓塞和肺栓塞病例。结论做好PICC置管后上肢静脉血栓的预防性护理和上肢静脉血栓形成后的护理,杜绝或减少静脉血栓的发生原因,从而降低静脉血栓的发生率。同时及早发现上肢静脉血栓形成,并及时采取恰当的处理措施,可减轻患者的痛苦及经济负担,延长PICC留置时间。     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。     

超声引导下经皮经肝胆囊置管治疗老年化脓性胆囊炎伴胆囊积液的应用价值

目的：探讨超声引导下经皮经肝胆囊置管引流治疗化脓性胆囊炎伴胆囊积液的应用价值。方法：老年患者不能耐受手术或不愿手术治疗,胆囊颈部结石嵌顿引起的化脓性胆囊炎伴胆囊积液患者86例,在超声引导下,8F猪尾巴导管经皮经肝进行胆囊穿刺置管治疗。治疗后用超声进行随访观察,结合临床症状判断疗效。结果：在超声引导下,86例化脓性胆囊炎伴胆囊积液患者均成功进行胆囊穿刺置管引流冲洗治疗,患者症状明显改善,经治疗临床症状消失后出院,择期拔管。结论：超声引导下经皮经肝胆囊置管微创治疗是不能手术或不愿接受手术的化脓性胆囊炎伴胆囊积液患者的一种有效治疗方法。     

超声引导下经皮经肝胆囊置管治疗老年化脓性胆囊炎伴胆囊积液

目的:探讨超声引导下经皮经肝胆囊置管引流治疗化脓性胆囊炎伴胆囊积液的应用价值。方法:老年患者不能耐受手术或不愿手术治疗,胆囊颈部结石嵌顿引起的化脓性胆囊炎伴胆囊积液患者86例,在超声引导下,8F猪尾巴导管经皮经肝进行胆囊穿刺置管治疗。治疗后用超声进行随访观察,结合临床症状判断疗效。结果:在超声引导下,86例化脓性胆囊炎伴胆囊积液患者均成功进行胆囊穿刺置管引流冲洗治疗,患者症状明显改善,经治疗临床症状消失后出院,择期拔管。结论:超声引导下经皮经肝胆囊置管微创治疗是不能手术或不愿接受手术的化脓性胆囊炎伴胆囊积液患者的一种有效治疗方法。     

经皮导管接触溶栓腔内治疗与标准抗凝治疗用于急性下肢深静脉血栓的临床效果比较

目的:分析和比较经皮导管接触溶栓腔内治疗与单纯标准抗凝治疗急性下肢深静脉血栓形成的临床效果的安全性。方法:回顾性分析93例中央型(髂股静脉)和混合型(全下肢深静脉)深静脉血栓患者临床资料,根据治疗方法的不同分为导管溶栓治疗组(试验组)65例、单纯抗凝治疗组(对照组)28例,比较两组患者治疗后患肢消肿率、下肢深静脉血栓的溶栓率及并发症的发生率。结果:治疗后,试验组患者患肢大腿消肿率[(83.03±4.53)%]显著高于对照组[(50.42±7.41)%](P0.05);患肢小腿消肿率[(76.48±8.24)%]亦显著高于对照组(54.95±8.14)%(P0.05)。试验组患者下肢深静脉血栓溶栓有效率为92.31%(60/65),显著高于对照组[14.29%(4/28)](P0.05)。随访半年后,试验组患者下肢血管的通畅率为90.67%(57/65),PTS率为7.69%(5/65);而对照组患者下肢血管的通畅率为21.42%(6/28),PTS率为14.28%(4/28)。试验组血管通畅率明显高于对照组(P0.05),而PTS发生率明显低于对照组(P0.05)。两组患者并发症发生率比较差异无明显统计学意义(P0.05)。结论:经皮导管接触溶栓腔内治疗急性中央型和混合型下肢深静脉血栓的短期疗效优于单纯抗凝治疗,且两种方法的安全性相当。     

超声引导下经皮穿刺引流对重症急性胰腺炎的精准治疗

目的:评价超声引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)的安全性及临床疗效。方法:回顾性分析2011年1月-2015年12月在超声引导下经皮穿刺置管引流的273例SAP患者的临床资料,比较患者引流前后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平的变化。结果:273例患者中,131例患者仅经过PCD术后治愈出院;103例患者行超声引导下PCD术后全身症状得到明显改善,后期再采用经腹膜后内镜下清创术治愈出院,39例患者无好转,中转为开腹手术,PCD术的成功率为100%。103例经内镜下清创的患者中2例死亡,39例无好转的开腹手术患者中13例死亡。患者引流后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均较引流前显著降低,差异有统计学意义(P0.05)。结论:采用超声引导下的经皮穿刺置管引流治疗SAP具有定位准确、创伤小的有点,可使部分患者免于手术,或者为后续治疗创造有利条件,临床疗效显著。     

Comparison between mechanical properties of human saphenous vein and umbilical vein

ABSTRACT: BACKGROUND: As a main cause of mortality in developed countries, Coronary Artery Disease (CAD) is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG) is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary. METHODS: Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress--strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels. RESULTS: Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein's stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation. CONCLUSION: Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels' stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as rat aortic vessels. As blood vessel's stiffness is directly related to elastin and mainly collagen content, results showed the lower amount of these two contents in umbilical vein regarding Saphenous vein.     

Leaf dissymmetry and vein growth field

The growth of the vein system of the leaf ofTropaeolum peltophorum was studied (i) at the vein level (analysis of the growth kinetics and of the growth field of the 7 primary veins) and (ii) at the limb level (comparison of the growth of the veins).The vein growth kinetics depend on the position of the vein on the leaf: there is a proximal/distal gradient and a bilateral gradient of the growth parameters (=variation of the temporal organization of the kinetics). The growth field of the veins (=local growth pattern) is also dependent on time and on vein position.Specific correspondences exist between singular points of the global growth curves (V _max, _min), the variations of the growth field and the vein position. The spatio-temporal organization of the vein system growth is then characterized by positional variations of kinetic order which show the existence of areal morphogenetic dissymmetry.     

Serum HPL level in maternal vein, umbilical cord artery and vein in term and preterm birth

The serum HPL level in maternal vein and the cord vein and artery in term (n = 34) and preterm (n = 74) birth was tested to classify the hormonal changes and the correlation between the maternal and fetal HPL values. It was found that between the 28th and the 40th weeks of gestation the maternal level tended to increase while in the cord vein and artery it decreased significantly in negative correlation with the weeks of pregnancy. The maternal serum HPL level was significantly higher than that of the cord vein and artery. Between the 28th and 40th week the value in the cord artery divided by the value in the cord vein multiplied by 100 tended to decrease. While the HPL concentration in maternal serum did not correlate with its level in the cord vein and artery the levels in the cord vein and artery were significantly correlated. The characteristic and independent change in the fetal serum HPL concentration raised the possibility of a change in the transport function of the placenta and of an autonomous fetal HPL metabolism.     

Infection and cancer: the common vein

The role of infectious agents in the development of cancer is well documented. The pathogenesis of various human neoplasms ranging from non-Hodgkin lymphoma (NHL) to cervical carcinoma frequently involves a chronic, most often viral, infection. At the same time, there is compelling evidence that certain acute infections result in the inhibition of neoplastic growth. The basis for this phenomenon is often thought to be concomitant anti-tumor immunity. Yet, experimental data supporting this hypothesis are scarce, and other non-immune anti-tumor factors could be involved. For instance, since virtually all aggressive tumors outstrip their blood supply, development of new vessels, or angiogenesis, is a limiting factor during neoplastic growth. In this review, we will discuss recent studies that implicate anti-angiogenesis in infection-mediated tumor suppression and suggest that this mechanism could also complement cytotoxic immunity arising from the use of cancer vaccines.