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。
Objective To explore the clinical presentation and diagnosis and treatment of prehepatic portal hypertension （PPH） and discuss its surgical strategies. Methods Forty-six cases of PPH treated in the 2nd Artillery General Hospital and Peking Union Medical College Hospital from January 2000 to May 2009 were analyzed retrospectively, including 2 cases of Abernethy abnormality. All patients were evaluated by indirect portal vein angiography, CT angiography and (or) portal duplex system Doppler ultrasonography before treament. Surgical strategies included: 23 cases with meso-caval shunt, 8 cases with splenectomy and spleno-renal vein shunt, 1 case with porta-caval shunt, 2 cases with paraumbilical vein-jugular vein shunt, 3 cases with portal azygous disconnection, 1 cases with splenectomy and portal azygous disconnection, 1 case with sigmoidostomy and closed the fistula of sigmoid six months later, 1 case with resection of part of small intestine due to acute extensive thrombosis of portal vein system, 4 cases with selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy, 2 cases remained no-surgical option and underwent conservative treatment. Results Forty-four patients were followed-up from 2 months to 5 years， average of 23.4 months, one patient without surgical treatment was lost. Satisfactory outcomes were obtained in 34 patients with various shunts, which expressed as a release of hypersplenism and gastrointestinal hemorrhage. Two cases were treated with meso-caval shunt because of rehemorrhage in month 13 and 24 and one died in month 8 after disconnection, one died on day 40 after thrombolytic therapy due to putrescence of intestines, one who remained no-surgical option underwent hemorrhage 4 months later, and then went well by conservative treatment. Conclusion The key of treatment of PPH is to reduce the pressure of hepatic portal vein. Surgical managements of shunt and selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy are safe and effective, but individual treatment strategy should be performed.
目的探讨改良的局部加压包扎法治疗腹股沟区切口淋巴瘘的疗效。方法2005年12月至2010年11月期间对10例腹股沟区切口淋巴瘘患者采用弹力绷带持续加压包扎，同时切口放置闭式引流装置进行治疗。 结果全部患者切口经加压包扎后淋巴液均明显减少，经持续加压包扎3~20 d（平均7.2 d）后获临床治愈; 其中1例患者于加压包扎后第4天出现下肢股浅静脉血栓，经及时溶栓和抗凝治疗后好转。 本组患者随访1~59个月（平均14.7个月），10例患者切口均一期愈合，无下肢淋巴水肿发生。结论弹力绷带加压包扎结合切口闭式引流治疗腹股沟区切口淋巴瘘疗效显著，该方法简单、安全，值得临床推广应用。
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.
目的 探讨Abernethy畸形致下消化道出血的诊断及治疗方法。方法 回顾1例Abernethy畸形患者的诊治情况，并结合相关文献进行分析。结果 血管造影确诊后经积极术前准备，行剖腹探查、乙状结肠造瘘术，术后3周开始给予中药保留灌肠至术后7周，6个月关闭造瘘,3周后继续辅以中药保留灌肠4周。患者顺利恢复出院，随访9个月未再次出血。结论 正确的诊断及合理的治疗方案是救治的关键。
目的 探讨肝外型门静脉高压分流术人工血管闭塞后血流重建的诊治方法。方法 对2006年3月至2010年12月期间笔者收治的102例肝外型门静脉高压患者进行了开放手术治疗，其中3例是再次手术患者并对已严重狭窄或闭塞的人工血管进行了血流重建。结果 3例患者人工血管均得以血流重建，分别随访了32、17及30个月，患者均已恢复正常生活。结论 合适的病例选择、合理的手术方案以及术中和术后规范的抗凝治疗是保证门静脉高压分流术后人工血管长期通畅的重要因素。