【摘要】 目的 探讨健康教育路径在下腔静脉滤器（inferior vena cava filter，VCF）置入术患者中的应用效果。 方法 2008年1月－2010年5月，将62例VCF置入术患者随机分为观察组（32例）和对照组（30例），观察组采用健康教育路径进行健康教育，对照组患者采用常规健康教育。 结果 观察组患者的健康教育达标率明显高于对照组（Plt;0.05），焦虑发生率明显低于对照组。 结论 应用健康教育路径对VCF置入术患者实施，能提高患者对健康知识的掌握程度和效果，促进患者早日康复；同时可强化护患沟通，和谐护患关系。【Abstract】 Objective To investigate the effect of health education pathway in patients treated with placement of inferior vena cava filter (VCF). Methods Sixty-two patients treated with placement of inferior VCF from January 2008 to May 2010 were randomly divided into experimental group (n=32) and control group (n=30). Health education pathway and routine general way were adopted respectively to treat patients in the experimental group and the control group. Results Standard-achieving rate of the health education in the experimental group was significantly higher than that in the control group (Plt;0.05), and the incidence of anxiety was also lower in the experimental group. Conclusion Health education pathway for patients treated with placement of inferior VCF can increase the patients’ health care knowledge, lessen patients’ anxiety, and strengthen the nurse-patient communication and harmonious relations.
ObjectiveTo summarize short-term and long-term effects of ex vivo liver resection followed by autotransplantation (Abbreviation: autotransplantation) in treatment of advanced hepatic alveolar echinococcosis (HAE).MethodThe clinical data and follow-up data of 17 patients with advanced HAE who underwent autotransplantation from November 2016 to July 2019 in the Ganzi Tibetan Autonomous Prefecture People’s Hospital were retrospectively analyzed.ResultsThe autotransplantations were performed successfully in the 17 patients with advanced HAE. Ten patients underwent the inferior vena cava (IVC) reconstruction with autologous saphenous veins, 5 patients underwent the artificial revascularization, 1 patient underwent the direct anastomosis of the original IVC, and 1 patient didn’t reconstructed (the retroperitoneal collateral circulation was abundant). The mean liver graft mass was 681.3 g (365–1 350 g) and operation time was 11.5 h (9–16 h). The median anhepatic period was 312 min (175–450 min), blood loss was 2 000 mL(950–4 500 mL), red blood cell suspension transfusion was 6.4 U (1–20 U), and fresh frozen plasma was 1.1 L (0.8–2.0 L). The postoperative hospital stay was 5 to 45 d with an average of 25.6 d. There were 4 patients with the postoperative hepatic enveloping effusion, 1 patient with bile leakage, and 1 patient with bile duct stenosis. All of them were treated and cured, and no death occurred. The follow-up time of 17 patients was 3 to 35 months with an average of 9.5 months, no recurrence of HAE and distant metastasis were observed.ConclusionsIn highlands, autotransplantation in treatment of advanced HAE patients with different IVC reconstruction is satisfactory, but it has a higher risk and is difficult. Choice of intraoperative reconstruction materials, judgment of posterior peritoneal collateral circulation, presence or absence of tension in end-to-end anastomosis of the IVC require precise consideration. At the same time, anticoagulation therapy and complications management are difficult, and it is only suitable for plateau medical center with rich experience.
目的探讨经腘静脉置溶栓导管灌注溶栓治疗急性下肢深静脉血栓形成（DVT）的临床应用价值。方法对28例急性DVT患者（其中2例合并肺动脉栓塞）在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗，并对溶栓效果进行分析。 结果全组患者溶栓后症状明显改善，下肢肿胀消退，肺部症状缓解。溶栓后患、健侧大腿周径差〔(1.72±1.23) cm〕明显小于溶栓前〔(5.47±1.29) cm〕,差异有统计学意义(t=12.14，Plt;0.01)， 患肢大腿消肿率为91.58%; 溶栓后患、健侧小腿周径差〔(1.55±0.77) cm〕也明显小于溶栓前〔(5.04±1.32) cm〕，差异有统计学意义（t=13.81，Plt;0.01)，患肢小腿消肿率为84.92%。溶栓后静脉通畅评分〔(4.34±3.55)分〕明显低于溶栓前〔(15.23±4.64) 分〕，差异有统计学意义(t=6.42，Plt;0.01 )，溶栓后静脉平均通畅率为87.43%。 2例合并肺动脉栓塞患者中，1例栓子完全溶解，1例大部分溶解。 所有患者均无严重并发症。 25例患者获随访，随访1～12个月（平均7.16个月），无一例出现血栓再发。结论经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法。
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. MethodsThe clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. ResultsIn this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. ConclusionsHepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.
ObjectiveTo investigate the basic operation and treatment experiences of the surgical treatment of Budd-Chiari syndrome (BCS). MethodsClinical data of 1 024 cases of BCS who received surgical treatment in our hospital from April 1994 to December 2013 were collected and analyzed. ResultsThere were 1 024 cases in our study, 116 cases of them underwent surgery, 908 cases of them underwent interventional surgery; 265 cases underwent inferior vena cava (IVC) balloon dilatation, 464 cases underwent IVC balloon dilatation and stenting, 97 cases underwent open surgery of hepatic vein (HV), 52 cases underwent right atrium femoral vein combined membrane rupture balloon dilation stent, 7 cases underwent caval shunt, 20 cases underwent radical surgery, 45 cases underwent IVC-right atrium bypass, 6 cases underwent intestinal cavity-real shunt, 9 cases underwent intestinal cavity-neck combined shunt, 30 cases underwent transjugular intrahepatic portosystemic shunt, 29 cases underwent intestinal-line real shunt. There were 902 cases were followed-up for 1 day-19 years (13 years on average), and the application of many kinds of operation strictly and flexibly brought satisfactory results for cases of BCS. ConclusionsThe diagnosis and classification of BCS will help us to make safe, effective, and appropriate treatment plan. In addition, we must use color Doppler ultrasound to observe the pathological changes of the situation, in this way we can have a clear goal in the treatment process.
ObjectiveTo investigate therapeutic method, curative effect, and prognosis of inferior vena cava (IVC) blocking Budd-Chiari syndrome (BCS) with thrombosis. MethodsClinical data of 128 BCS patients with membranous or short-segment occlusion of IVC as well as IVC thrombosis, who accepted interventional treatment in The Affiliated Hospital of Zhengzhou University from Apr. 2004 to Jun. 2012, were retrospectively analyzed. Comparison of the difference on effect indicators between predilation group and stent filter group was performed. ResultsThereinto, 9 patients with fresh IVC thrombosis were treated with agitation thrombolysis (agitation thrombolysis group), 56 patients were predilated by small balloon (predilation group), for the rest 63 patients, a stent filter was deployed (stent filter group). Besides 1 stent filter fractured during the first removal attempt and had to be extracted surgically in the stent filter group (patients suffered with sent migration), in addition, the surgeries of other patients were technically successful without procedure-related complication. effect indicators were satisfactory in all patients, and there were no statistical differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stay, and incidence of complication (P > 0.05), but the cost of predilation group was lower than that of stent filter group (P < 0.01). All of the 128 patients were followed-up postoperation, and the duration range from 18 to 66 months with an average of 44.2 months. During the follow-up period, reobstruction of the IVC was observed in 13 patients without thrombosis, of which 1 patient in agitation thrombolysis group, 6 patients in predilation group, and 6 patients in stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group (P > 0.05). Patients with recurrence got re-expansion treatment, and no stenosis or thrombogenesis recurred. ConclusionsAgitation thrombolysis for fresh IVC trombosis in the patients with BCS is safe and effective. Predilation and stent filter techniques are all effective in the treatment of BCS with chronic IVC thrombosis, but the former technique seems to be more economic.
ObjectiveTo analyze the causes of lower extremity varicose veins and assess the value of deep vein imaging in diagnosing and treating venous diseases, according to deep vein angiography examination results under digital subtraction angiography. MethodsDuring January 2012 to January 2013, 689 cases of lower limb varicose veins in 394 patients underwent lower extremity deep venous anterograde contrast examination, among which 87 patients also underwent left femoral venous trocar puncture angiography examination and 46 patients underwent femoral vein puncture inferior vena cava angiography examination at the same time. Then the results of imaging data were analyzed. ResultsThe causes of lower limb varicosity, according to its incidence, were as follows:primary deep venous valve incompetence (349 limbs of 184 patients) accounting for 50.7%, simple varicose veins of lower limbs (148 limbs of 95 patients) accounting for 21.5%, left iliac vein compression syndrome (121 limbs of 69 patients) accounting for 17.6%, cloth plus syndrome (54 limbs of 34 patients) accounting for 7.8%, post-thrombotic syndrome (16 limbs of 11 patients) accounting for 2.3%, and Klipple-Trenaunay syndrome (1 patient) accounting for 0.1%. ConclusionVaricose vein of lower limb is a common clinical manifestation of a variety of diseases, and the primary deep venous valve incompetence is the leading cause. Varicose veins of lower limb deep vein angiography is a reliable method for examination of lower extremity venous disease, and a basis for the choice of other treatments as well.