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Development and Current Status of Vascular Surgery in China

我國血管外科在布加綜合征的研究和治療、血管腔內技術、人工血管內皮化、干細胞移植治療肢體缺血等方面均達到國際水平［1，2］。現就我國血管外科的進展和特點分述如下。......

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.

Surgical Management of Suprarenal Aortic Occlusion with Takayasu’s Arteritis

目的 探討大動脈炎所致腎動脈上腹主動脈閉塞的手術治療方法。方法 回顧性分析1例腎動脈上腹主動脈閉塞行腹主動脈-雙股動脈人工血管搭橋手術治療的患者的臨床資料,并進行文獻復習。結果 術后患者頭痛明顯好轉，血壓由術前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,雙下肢踝肱指數由0.50升至1.19。術后2周復查CTA示人工血管通暢，術后3個月復查彩超示人工血管通暢，血壓在(140～150)/(80～95) mm Hg間波動，雙眼視力1.0左右，已恢復正常生活。結論 大動脈炎所致腎動脈上腹主動脈閉塞常會影響多個重要臟器的供血，病變復雜，手術時機及方法的正確選擇及長期抗炎治療可以提高患者的治療效果。

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.

兒童巨大頸內動脈瘤切除并直接重建的手術治療（附1例報道）

1例股靜脈至無名靜脈金屬異物的外科治療

　　患者，男，39歲。3年前因大面積燒傷在外院治療，2年后經X線拍片見一金屬導絲從右股靜脈直到無名靜脈（圖1）,遂切開右股靜脈欲取出導絲，但見部分導絲已與靜脈內膜黏合，無法取出，手術失敗; 后再次經對側股靜脈入徑，用抓捕器從無名靜脈將導絲套住并向下行套至第二腰椎水平處即無法下行，考慮腰二椎體以下導絲已與下腔靜脈黏合,再將抓捕器進入右股靜脈也無法抓捕導絲，手術再次失敗（圖2）。后收治于第二炮兵總醫院，決定采用導管套切分離摘取法，經術前準備后于全麻下行第3次手術。手術沿右股部原切口進入，瘢痕密集，分離困難。逐步顯露出右股總及股深淺靜脈并分別過帶控制，沿右股總靜脈觸及硬條索樣物，向下延及股淺靜脈。切開右股總靜脈，見導絲與股靜脈后壁完全貼合，被光滑內膜覆蓋（圖3）。切開后壁內膜顯露導絲，小心地將其自股淺靜脈抽出，檢查導絲完整，試牽引并不會被拉伸或折斷（圖4）。用6 F椎動脈造影管沿導絲插入，導絲由導管壁上的預開孔處引出并固定，此后小心地沿金屬異物推進導管，至進入約5 cm處即無法前進； 換用10 F SteerEase輸送導管以同法推進（圖5），此過程中不斷轉動并前后移動導管，前進十分困難，操作達40 min后導管進入約30 cm至超過腰二水平，小心將導絲和導管向下同時牽引，將異物完整取出（圖6）。患者術后恢復順利，滿意出院。擬服抗凝藥3～6個月。　　討論　　靜脈內金屬異物多是外傷或醫源性所致，臨床罕見，治療困難。本例長條金屬異物位于無名靜脈和股靜脈之間。以往手術和介入治療未能成功的原因在于導絲在體內時間過長，已與血管融合一體。本例于第二炮兵總醫院成功治療的關鍵在于將導絲從血管融合體中游離出來。避免盲目暴力拉扯,否則會出現導致患者生命危險的大出血。宜選擇直型且韌性好的導管，便于導管旋轉進入且不會損傷周圍靜脈管壁。術中證實導絲無明顯腐蝕表現，所以沿導絲同軸緩慢向上推進導管穿破下腔靜脈的可能性不大。我們將導絲游離端穿入套管后從預先自制的側壁孔引出，在固定導絲的前提下采用推進管鞘的方法　（圖5）完成手術（應用杠桿原理）， 這是我們在手術室而不是在導管室施行治療的根本原因，如有條件在透視下緩慢插入導管會更安全。但是必須指出的是，如果在股部切口發現導絲游離端已經被腐蝕且很易折斷時，我們則會中止該治療方案，因為筆者曾手術取出留置體內的自無名靜脈到肝內留存11年的塑料套管，極易折斷，最終是分為數段后全部取出。若本例導絲隨著置入時間的延長，亦達到此程度，顯然不宜采用上述方法。本例手術成功的關鍵在于術前充分準備、可行的方案及術中精細的操作。在取出異物后，可能的大范圍靜脈內膜損傷，因而防止術后附壁血栓形成和肺栓塞至為重要，因而需予抗凝治療。

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　研究胃癌細胞SGC-7901培養上清液及轉化生長因子-β1（TGF-β1）是否可促進人類腹膜間皮細胞表達βig-h3蛋白。方法　培養胃癌細胞SGC-7901，取第3天培養液上清與DMEM培養液的混合液 （1∶4）以及0、1.0、10.0和50.0ng/ml的 TGF-β1分別刺激人類腹膜間皮細胞HMrSV50、3、6、12及24h，ELISA方法檢測上清液中βig-h3蛋白濃度，Western blot法檢測細胞內βig-h3蛋白濃度。結果　對照組有基礎量的βig-h3蛋白表達； 胃癌細胞SGC-7901培養上清液及TGF-β1均可明顯增加HMrSV5細胞上清液及細胞內的βig-h3蛋白濃度（P＜0.05），且TGF-β1的刺激作用呈時間及濃度依賴性。結論　胃癌細胞SGC-7901培養上清液及TGF-β1可明顯刺激HMrSV5細胞表達和分泌βig-h3蛋白。