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Development and Current Status of Vascular Surgery in China

我国血管外科在布加综合征的研究和治疗、血管腔内技术、人工血管内皮化、干细胞移植治疗肢体缺血等方面均达到国际水平［1，2］。现就我国血管外科的进展和特点分述如下。......

Discussion of Treatment for Deep Venous Thrombosis

Enhance The Treated Effect of Budd-Chiari Syndrome

Clinical and Pathologic Factors Analysis of Postoperative Local Recurrence of Rectal Cancer

Objective　To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods　The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results　There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions　There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.

Research Development of The Relationship Between Hiatal Hernia and Respiratory Symptoms

ObjectiveTo introduce the hiatal hernia (HH) and to summarize the research development of relationship between HH and respiratory symptoms. MethodsLiteratures in recent years which about relationship between HH and respiratory symptoms at home and abroad were collected and reviewed. ResultsGastroesophageal reflux disease (GERD), which always be caused by laryngeal airway and other esophageal symptoms, was a common illness and easily be misdiagnosed. One common symptom of the GERD was the HH. For those patients with reflux-associated esophageal symptoms, many of them suffered from HH. The treatment results showed that the endoscopic surgery could relieve the reflux symptom and effectively control the respiratory symptoms. ConclusionsThe HH can increase the risk of respiratory symptoms; an active treatment on the HH can relieve the respiratory symptoms, which is caused by the reflux symptom.

Clinical Features and Prognosis of Multiple Primary Colorectal Cancer

Objective　To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）. Methods　Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed. Results　Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively. Conclusions　Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.

Culture Supernatants of Human Gastric Cancer Cell and Transforming Growth Factor-β1 Stimulate The Expression of βig-h3 Protein in Human Peritoneal Mesothelial Cell

目的　研究胃癌细胞SGC-7901培养上清液及转化生长因子-β1（TGF-β1）是否可促进人类腹膜间皮细胞表达βig-h3蛋白。方法　培养胃癌细胞SGC-7901，取第3天培养液上清与DMEM培养液的混合液 （1∶4）以及0、1.0、10.0和50.0ng/ml的 TGF-β1分别刺激人类腹膜间皮细胞HMrSV50、3、6、12及24h，ELISA方法检测上清液中βig-h3蛋白浓度，Western blot法检测细胞内βig-h3蛋白浓度。结果　对照组有基础量的βig-h3蛋白表达； 胃癌细胞SGC-7901培养上清液及TGF-β1均可明显增加HMrSV5细胞上清液及细胞内的βig-h3蛋白浓度（P＜0.05），且TGF-β1的刺激作用呈时间及浓度依赖性。结论　胃癌细胞SGC-7901培养上清液及TGF-β1可明显刺激HMrSV5细胞表达和分泌βig-h3蛋白。

Surgical Management of Suprarenal Aortic Occlusion with Takayasu’s Arteritis

目的 探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法。方法 回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习。结果 术后患者头痛明显好转，血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19。术后2周复查CTA示人工血管通畅，术后3个月复查彩超示人工血管通畅，血压在(140～150)/(80～95) mm Hg间波动，双眼视力1.0左右，已恢复正常生活。结论 大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血，病变复杂，手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果。

儿童巨大颈内动脉瘤切除并直接重建的手术治疗（附1例报道）

1例股静脉至无名静脉金属异物的外科治疗

　　患者，男，39岁。3年前因大面积烧伤在外院治疗，2年后经X线拍片见一金属导丝从右股静脉直到无名静脉（图1）,遂切开右股静脉欲取出导丝，但见部分导丝已与静脉内膜黏合，无法取出，手术失败; 后再次经对侧股静脉入径，用抓捕器从无名静脉将导丝套住并向下行套至第二腰椎水平处即无法下行，考虑腰二椎体以下导丝已与下腔静脉黏合,再将抓捕器进入右股静脉也无法抓捕导丝，手术再次失败（图2）。后收治于第二炮兵总医院，决定采用导管套切分离摘取法，经术前准备后于全麻下行第3次手术。手术沿右股部原切口进入，瘢痕密集，分离困难。逐步显露出右股总及股深浅静脉并分别过带控制，沿右股总静脉触及硬条索样物，向下延及股浅静脉。切开右股总静脉，见导丝与股静脉后壁完全贴合，被光滑内膜覆盖（图3）。切开后壁内膜显露导丝，小心地将其自股浅静脉抽出，检查导丝完整，试牵引并不会被拉伸或折断（图4）。用6 F椎动脉造影管沿导丝插入，导丝由导管壁上的预开孔处引出并固定，此后小心地沿金属异物推进导管，至进入约5 cm处即无法前进； 换用10 F SteerEase输送导管以同法推进（图5），此过程中不断转动并前后移动导管，前进十分困难，操作达40 min后导管进入约30 cm至超过腰二水平，小心将导丝和导管向下同时牵引，将异物完整取出（图6）。患者术后恢复顺利，满意出院。拟服抗凝药3～6个月。　　讨论　　静脉内金属异物多是外伤或医源性所致，临床罕见，治疗困难。本例长条金属异物位于无名静脉和股静脉之间。以往手术和介入治疗未能成功的原因在于导丝在体内时间过长，已与血管融合一体。本例于第二炮兵总医院成功治疗的关键在于将导丝从血管融合体中游离出来。避免盲目暴力拉扯,否则会出现导致患者生命危险的大出血。宜选择直型且韧性好的导管，便于导管旋转进入且不会损伤周围静脉管壁。术中证实导丝无明显腐蚀表现，所以沿导丝同轴缓慢向上推进导管穿破下腔静脉的可能性不大。我们将导丝游离端穿入套管后从预先自制的侧壁孔引出，在固定导丝的前提下采用推进管鞘的方法　（图5）完成手术（应用杠杆原理）， 这是我们在手术室而不是在导管室施行治疗的根本原因，如有条件在透视下缓慢插入导管会更安全。但是必须指出的是，如果在股部切口发现导丝游离端已经被腐蚀且很易折断时，我们则会中止该治疗方案，因为笔者曾手术取出留置体内的自无名静脉到肝内留存11年的塑料套管，极易折断，最终是分为数段后全部取出。若本例导丝随着置入时间的延长，亦达到此程度，显然不宜采用上述方法。本例手术成功的关键在于术前充分准备、可行的方案及术中精细的操作。在取出异物后，可能的大范围静脉内膜损伤，因而防止术后附壁血栓形成和肺栓塞至为重要，因而需予抗凝治疗。