目的探讨肝外型门静脉高压症的外科治疗经验。方法1993年1月至1999年12月，我科收治肝外型门静脉高压症42例，男19例，女23例，年龄8~58岁，平均24.6岁，经B超、动脉造影、脾静脉造影和术中探查，诊断为门静脉血栓形成34例，内脏动静脉瘘5例，终末支门静脉纤维化2例，肝动脉瘤压迫门静脉1例。根据病变不同，分别给予肠腔分流、脾肾分流、经导管溶栓及栓塞或动静脉瘘切除等治疗。结果术后2例死亡，并发肝脓肿1例，肠坏死1例，其余患者均获满意疗效。有31例随访5个月~6年无复发。结论肝外型门静脉高压症只要选择好合理的治疗方法，可获满意疗效，且远期效果良好。
From Oct. 1993 to Dec. 1995, nineteen refractory cases with varicosis and chronic ulcer of lower limb were treated. The average age of these patients was sixty-eight, the disease history was more than 20 years. The size of the ulcer of the leg ranged from the minimum of 10 cm x 8 cm to the maximum of 30 cm x 15 cm. All of them had once received saphenectomy and split skin graft without ulcer healing before they were admitted in our department. Both venography and ultrasonography showed superficial venous valve incompetence. The following comprehensive treatment was adopted. Firstly, myoplasty around popliteal vein was done. Secondly, phlebexairesis and phleborrhaphy were done for the variciform veins through minor incision. Then through debridement of the ulcer was performed. Delayed split skin graft was exerted one week later. The result showed that all the cases were successful: the ulcer was healed and there was no recurrence of varicosis.
Objective To investigate the effectiveness of repairing hallux metatarsophalangeal skin and soft tissue defect with medial flap with double blood supply system in elderly patients. Methods Between June 2011 and March 2012, 9 cases (9 toes) of skin and soft tissue defect at hallux metatarsophalangeal joint were treated with medial flap with double blood supply system. There were 7 males and 2 females, aged 60-70 years (mean, 65.4 years). Injury included crush injury in 5 cases, traffic accident injury in 4 cases. The interval of injury and operation ranged from 3 hours to 5 days (mean, 35 hours). The patients had bone or tendon exposure with pollution of wounds. The size of defects ranged from 2.0 cm × 1.5 cm to 2.5 cm × 2.0 cm. The size of flaps ranged from 2.0 cm × 1.7 cm to 3.0 cm × 2.2 cm. Medial dorsal nerves were anastomosed with toe nerves to recover flap sensation. The donor site was repaired with skin grafting. Results All 9 flaps and skin grafting survived completely, and primary healing of wounds were obtained. Nine patients were followed up 6-8 months (mean, 7 months). The colour, texture, and contour of the flaps were good. The two-point discrimination of the flaps was 12-16 mm (mean, 14 mm) at last follow-up. The patients could walk normally. No scar contracture formed at donor site. No wear occurred. Conclusion The medial flap with double blood supply system can be used to repair hallux metatarsophalangeal skin and soft tissue defect in elderly patients because the flap can be easily obtained, has good blood supply, and has no injury to the main artery and nerve.