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小血管端側鑲嵌縫合法的實驗研究與臨床應用

在６０只Ｗｉｓｔｅｒ大白鼠股動脈分支血管模型上，設計與主于血管順血流方向４５°和９０°角端側鑲嵌縫合法吻會的實驗研究，與傳統吻合法作為對照。術后９周內分別做解剖血管，測定血管外徑和血流量，動脈造影，組織學檢查等。結果證明，實驗組術后１～９周內通暢率高于對照組。實驗組無吻合口狹窄，其內膜光滑，增生輕，愈合良好。對照組有１／５的動物吻合口嚴重狹窄。半數以上的內膜高度增生，通血不良。經臨床初步應用，證明此法有明顯優點。

Diagnosis and Treatment of Lesions of Major Artery in Limbs

目的　 探討四肢動脈損傷的診斷和治療方法。方法　回顧分析我院1996年1月至2006年7月共診治的23例四肢動脈損傷患者的臨床資料。分別采用直接動脈修補、動脈結扎、端端吻合、自體大隱靜脈移植及人工血管吻合。術中取栓6例,合并靜脈損傷修復8例。結果　截肢3例（13.0%）。獲得隨訪12例，隨訪時間3個月~5年，11例多普勒超聲證實損傷血管血流通暢，下肢肌肉攣縮1例； 下肢血供不足1例。結論　早期診斷是提高肢體存活率和避免假性動脈瘤發生的關鍵。手術方式的合理選擇、Fogarty導管常規取栓和早期筋膜切開可提高治愈率。

Subfascial Endoscopic Communicating Branch Vein Ablation in Treating Communicating Branch Vein Insufficiency (Report of 57 Cases)

bjective To study the effectiveness of subfascial endoscopic communicating branch vein ablation in treating communicating branch vein insufficiency.MethodsFiftyseven cases of primary lower extremity vein valve insufficiency complicated by communicating vein insufficiency diagnosed by venography and color duplex were treated with subfascial endoscopic communicating branch vein ablation, and their information was analyzed retrospectively.ResultsSwelling was observed in leg of 7 cases after operation, and disappeared within one week spontaneously. Incision infection occurred in 2 cases and skin ambustion happened in 2 cases. Superficial vein varicosis disappeared in all case, skin pigmentatin declined significantly and ulcers healed in 2-3 weeks.Conclusion Subfascial endoscopic communicating branch vein ablation is an excellent choice in treating communicating branch vein insufficiency.

我國胸心血管外科發展現狀與趨勢——中華醫學會第13次全國胸心血管外科學術會議熱點解讀

Evidence- and guideline-based perspectives on evolution of endovascular therapy for lower extremity peripheral artery disease: A critical analysis of the 2024 ESVS clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication

Peripheral artery disease (PAD) of the lower extremities, which poses a major challenge in the field of global public health, has seen a rising trend in its incidence and disability rate year by year. With the continuous innovation of new diagnostic techniques, imaging evaluation methods, and treatment strategies, profound changes have taken place in the diagnosis and treatment paradigm in this field. Based on the “European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication” issued by the European Society for Vascular Surgery in 2024, we systematically reviewed the relevant international guidelines in recent years and conducted horizontal comparisons. Combining with the latest clinical research evidence, we conducted an in-depth analysis from the perspective of evidence-based medicine on the strategic evolution, technical key point updates, and clinical evidence levels of endovascular treatment for lower extremity PAD. The aim is to provide an evidence-based medical basis for clinical decision-making.

Diagnosis and Surgical Management of Ruptured Abdominal Aortic Aneurysm

隨著外科技術和圍手術期治療水平日益提高，腹主動脈瘤擇期手術治療死亡率已控制在5%以內［1，2］，但破裂腹主動脈瘤（ruptured abdominal aortic aneurysm,RAAA）的死亡率一直在40%～70%，如果包括尚未到達醫院的RAAA患者，死亡率可達80%～90%，RAAA被美國列為第13位死亡原因［2~4］。目前，及時準確的診斷和快速有效的外科治療仍是降低RAAA死亡率的關鍵。......

The Necessity for Cardiovascular Surgeons to Join Medical Rescue Team within 72 Hours after Earthquake

In recent years，West China Hospital of Sichuan University actively participated in medical assistance and rescue in Wenchuan，Yushu and Lushan earthquakes. However，professional roles of cardiovascular surgeons in medical assistance and rescue in earthquakes remain unclear because of the particularity of cardiovascular surgery, which often affects the assembly of medical assistance and rescue teams. Thus，we need to explore the necessity for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake. In this article，medical rescue work of cardiovascular surgeons within 72 hours after 2008 “5?12” Wenchuan earthquake and 2013 “4?20” Lushan earthquake is analyzed and compared to identify professional roles of cardiovascular surgeons in medical rescue within 72 hours after earthquake. It is necessary for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake.

Guidelines on patient blood management for adult cardiovascular surgery under cardiopulmonary bypass

Working Group on Extracorporeal Life Support, National Center for Cardiovascular Quality Improvement developed guidelines on patient blood management for adult cardiovascular surgery under cardiopulmonary bypass, aiming to standardize patient blood management in adult cardiovascular surgery under cardiopulmonary bypass, reduce blood resource consumption, and improve patients outcomes. Forty-eight domestic experts participated in the development of the guidelines. Based on prior investigation and the PICO (patient, intervention, control, outcome) principles, thirteen clinical questions from four aspects were selected, including priming and fluid management during cardiopulmonary bypass, anticoagulation and monitoring during cardiopulmonary bypass, peri-cardiopulmonary bypass blood product infusion, and autologous blood infusion. Systemic reviews to the thirteen questions were performed through literature search. Recommendations were drafted using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. After five rounds of experts discussions between 2023 and 2024, 19 recommendations were finally formed.

3-D打印技術在血管外科的應用

Advances in Basic Research and Clinical Study in Vascular Surgery