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。
目的 探討附臍靜脈在門靜脈高壓分流術中的應用。方法 對第二炮兵總醫院2009年收治的2例經多次治療后復發的布加綜合征患者利用明顯擴張的附臍靜脈進行門體分流術。結果 術后門靜脈壓力均明顯降低， 2患者分別在術后隨訪7和5個月，療效滿意。結論 對于復雜重癥的門靜脈高壓患者，明顯擴張并壓力增高的附臍靜脈可用于門腔靜脈轉流，術式簡單有效。
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.
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.
目的探討改良的局部加壓包扎法治療腹股溝區切口淋巴瘺的療效。方法2005年12月至2010年11月期間對10例腹股溝區切口淋巴瘺患者采用彈力繃帶持續加壓包扎，同時切口放置閉式引流裝置進行治療。 結果全部患者切口經加壓包扎后淋巴液均明顯減少，經持續加壓包扎3~20 d（平均7.2 d）后獲臨床治愈; 其中1例患者于加壓包扎后第4天出現下肢股淺靜脈血栓，經及時溶栓和抗凝治療后好轉。 本組患者隨訪1~59個月（平均14.7個月），10例患者切口均一期愈合，無下肢淋巴水腫發生。結論彈力繃帶加壓包扎結合切口閉式引流治療腹股溝區切口淋巴瘺療效顯著，該方法簡單、安全，值得臨床推廣應用。
目的 探討Abernethy畸形致下消化道出血的診斷及治療方法。方法 回顧1例Abernethy畸形患者的診治情況，并結合相關文獻進行分析。結果 血管造影確診后經積極術前準備，行剖腹探查、乙狀結腸造瘺術，術后3周開始給予中藥保留灌腸至術后7周，6個月關閉造瘺,3周后繼續輔以中藥保留灌腸4周。患者順利恢復出院，隨訪9個月未再次出血。結論 正確的診斷及合理的治療方案是救治的關鍵。