目的總結急性腸系膜上動脈缺血性疾病的外科治療經驗。 方法對黃石市中心醫院2002年1月至2013年6月期間收治的41例急性腸系膜上動脈缺血性疾病患者的臨床資料進行回顧性分析。 結果41例急性腸系膜上動脈缺血性疾病患者中，行手術治療40例（術中死亡2例），行介入溶栓治療1例。術后出現短腸綜合征9例，死亡19例。出院后27例患者獲訪，隨訪時間為1周～2年（平均隨訪時間為1.4年）。隨訪期間，因家屬放棄治療而于家中死亡7例，轉院后于他院死亡4例，3例未愈或復發，13例痊愈（1例行介入溶栓治療）。 結論急性腸系膜上動脈缺血性疾病的不同進展階段其臨床特征有所差異，術前CT血管造影（CTA）檢查的意義重大。早期診斷、早期治療、根據病情不同階段選擇合適的治療方案（手術、介入治療、藥物治療等）是降低死亡率的關鍵。
The way of intravenous drug abuse is to puncture the peripheral blood vessels and inject the drug directly into the blood. Therefore, this method has an impact on the peripheral artery and venous system of the users, and can cause a variety of peripheral vascular diseases, such as phlebitis, deep vein thrombosis, chronic venous insufficiency, phlebangioma, atherosclerosis, acute arterial ischemia, pseudoaneurysm, etc. However, due to the particularity of drug abusers, the vascular complications caused by intravenous drug abuse have not attracted enough attention. This paper reviewed the types and pathogenesis of peripheral vascular diseases caused by intravenous drug abuse, so as to improve the clinical understanding of peripheral vascular diseases caused by intravenous drug abuse, improve the prognosis of patients, reduce occupational exposure of medical staff, and play a certain role in social warning.
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.
ObjectiveThis study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis.MethodsThe clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system. Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy wasanalyzed.ResultsEighteen (90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was (4.2±1.4) d and (1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were (35.80±12.30) ×104 U and (45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheter-directed thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after surgery, and 2 patients had lower extremity ulcer caused by lower extremity ischemia symptoms. During the follow-up period, no lower limb necrosis, amputation, and death occurred in the remaining patients.ConclusionsThe AngioJet mechanical thrombectomy system is safe and effective. Combined with the use of catheter-directed thrombolysis and stent implantation, the AngioJet mechanical thrombectomy could lead to quick recovery of the perfusion of the lower extremity and improve the limb salvage rates, exhibiting excellent clinical value.
ObjectiveTo summarize diagnostic strategies of unilateral lower limb swelling. MethodThe clinical data of 357 patients hospitalized with unilateral lower limb swelling from March 2013 to October 2014 in our department were analyzed retrospectively. ResultsThree hundred and seven (86.0%) patients were admitted to hospital within 2 weeks since the symptom onset (acute swelling), the most common cause (281 cases) was lower extremity deep vein thrombosis (DVT), other causes included infection (11 cases), hematoma (7 cases), lymphatic obstruction (4 cases), iliac vein compression syndrome (2 cases), pelvic tumor compression (1 case), arteriovenous fistula (1 case). Etiology for chronic swelling contained lower extremity DVT (33 cases), arteriovenous fistula (5 cases), lymphatic obstruction (5 cases), Klippel-Trenaunay syndrome (3 cases), pelvic tumor compression (3 cases), iliac vein compression syndrome (1 case). Up to 60.5% (26/43) lower limb swelling which were not due to DVT had histories of misdiagnosis as DVT. Nine cases of lymphatic obstruction were secondary to malignant tumor itself or the sequel of treatment. Three hundred and thirty-eight (94.6%) patients were received lower limb doppler ultrasound, while 308 patients (91.9%) were diagnosed. Fifty-nine patients needed further CT venography (CTV) or CT angiography (CTA), 10 patients were received radionuclide lymphoscintigraphy to be diagnosed. ConclusionsAlthough DVT is the main cause of unilateral lower limb swelling, the lower limb swelling which is not due to DVT is frequently misdiagnosed and belatedly treated. Considering the complexity and reciprocal overlapping for the etiology of lower limbs swelling, developing a appropriate diagnosis strategy is important. Apart from history taking and physical examination, color doppler ultrasound for the lower limb is suggested to be the preferred imaging examination mean. Pelvic cavity screening for occupancy lesions and iliac vein should be evaluated synchronously if possible. For cases which can't be diagnosed by ultrasound, CTV, CTA, or radionuclide lymphoscintigraphy could be important supplement to assist the diagnosis.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.
ObjectiveTo summarize the pathogenesis, epidemiology, and risk factors of portal vein thrombosis after splenectomy, and combined with the latest advances in clinical prevention, diagnosis, and treatment of portal vein thrombosis after splenectomy, so as to provide some references for clinical prevention and treatment in the future.MethodLiteratures on portal vein thrombosis after splenectomy were collected and reviewed.ResultsThe incidence of portal vein thrombosis after splenectomy was high and its occurrence was the result of multiple factors. It was mainly related to the change of splenic venous blood flow mechanics after splenectomy. In terms of diagnosis, enhanced CT scan was the first choice. Currently, there was no consensus on treatment options, which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-molecular-weight heparin may reduce the risk of portal vein thrombosis.ConclusionThe concept of tertiary prevention of portal vein thrombosis after splenectomy should be established, and individualized treatment should be adopted in combination with the patient’s condition.
Objective To review the relationshi p between heritable hypercoagulable state (HHCS) and avascular necrosis of femoral head (ANFH). Methods The latest original articles about the relationshi p between HHCS and ANFH were extensively reviewed. Results Several genetic mutations which could cause HHCS, such as thrombophilic factor V G1691A gene, thrombophilic factor II G20210A gene, 5, 10-methylenetetrahydrofolate reductase C677T gene, plasminogen activator inhibitor 1 4G/5G, and tissue factor pathway inhibitor gene, may be genetic risks of ANFH. Conclusion HHCS may be a genetic cause of ANFH. Further studies are needed to confirm the relationship between HHCS and Chinese ANFH.
ObjectiveTo explore the features of images by CT,MRI,and MRV for early cranial venous sinus thrombosis (CVST) to provide the diagnostic evidence for choosing an optimal imaging examination. MethodsThe clinical data (imaging features of CT,MRI,and MRV) of 46 patients with CVST diagnosed between January 2009 and January 2013 were retrospectively analyzed. ResultsBrain CT showed the direct signs of CVST in 15 cases (32.6%),and indirect signs of CVST in 8(17.4%).MRI showed the signs of CVST in 17 cases (68.0%);the diagnostic positive rate of MR venography (MRV) combined with MRI was 87.5%,84.6% of which was in line with that of digital subtraction angiography. ConclusionCT can be used as screening tool for those highly suspect CVST cases.MRI combined with MRV show great diagnostic value for CVST.