目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
ObjectiveTo compare the efficacy of varicose great saphenous vein (GSV) treatment alone versus combined treatment with iliac vein compression (IVC) intervention in improving lower extremity symptoms and prognosis among the patients with varicose GSV complicated by IVC. MethodsBased on inclusion and exclusion criteria, the patients with varicose GSV complicated by IVC treated at the Day Service Center of the First Affiliated Hospital of Chongqing Medical University from May 2022 to January 2025 were retrospectively enrolled. The patients were assigned into two groups according to the treatment strategies: the varicose GSV treatment alone group (control group) and the combined treatment group for varicose GSV and IVC (observation group). The primary endpoints included the closure rate of the GSV trunk, venous clinical severity score (VCSS), and venous insufficiency epidemiological and economic study quality of life/symptom (VEINES-QOL/Sym) questionnaire score at 6 and 12 months postoperatively. The significance level was set at α=0.05. ResultsA total of 264 patients with left lower extremity varicose GSV complicated by IVC were included. The observation group comprised 32 patients, while the remaining 232 patients underwent 1∶3 propensity score-matching, resulting in 96 matched patients in the control group. The baseline characteristics, including gender, age, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). At 12 months postoperatively, the GSV trunk closure rate was 100% in both groups. Within-group comparisons revealed significant improvements in the VCSS and VEINES-QOL/Sym points at 6 and 12 months as compared with preoperative (on admission) values (P<0.05). Between-group comparisons showed that the observation group had greater improvement in the VEINES-QOL/Sym score at 6 months (P=0.028), but no significant difference in the VCSS (P=0.775); At 12 months, the observation group demonstrated significantly better the VCSS (P<0.001) and VEINES-QOL/Sym points (P<0.001) as compared with the control group. ConclusionsFor patients with left lower extremity GSV varicosities complicated by IVC, both treatment strategies significantly improve symptoms. Results of short-term follow-up (6 months) demonstrate early advantages in quality of life improvement with concurrent IVC intervention, while results of 12-month follow-up indicate superior efficacy in both symptom relief and quality of life enhancement. Therefore, concurrent IVC intervention may provide greater clinical benefits for mid- to long-term prognosis for patients with left lower extremity GSV varicosities complicated by IVC.
Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage. Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006. All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography. Results Thirty-nine patients’ deep venous valve function kept well up to now, and there was no significant difference between the two results. Four patients without proximal saphenous vein ligation recurred, and there was reflux in deep venous. Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively. Proximal great saphenous vein ligation is important for successful operation.
ObjectiveTo summarize the research progress of CT related to esophageal varices of cirrhotic patients complicated with portal hypertension.MethodsRelevant CT literatures of esophageal varices of cirrhotic patients complicated with portal hypertension were collected to make an review,then summarized the research status and progress of CT in the diagnosis and evaluation of lower esophageal varices.ResultCT had a good correlation with endoscopic diagnosis of esophageal varices, and CT was of great value in evaluating the presence, degree, and risk of esophageal varicose veins, especially in predicting the risk of esophageal varicose veins, which could be used as an effective modality to assist endoscopic examination to a certain extent.ConclusionsCT is an important examination method for esophageal varices, which has important value in diagnosis and evaluation. In the future, more further researches can be carried out to provide more strong and accurate support for the diagnosis and treatment of esophageal varices.
Objective To evaluate the effectiveness and safety of microsurgical varicocelectomy (MV) compared with Palomo surgery for male varicocele. Methods MEDLINE (1985-October 2008), EMbase (1990-October 2008), China Biology Medicine Literature Disc Database (1979-October 2008), CMCC (1979-October 2008) and CNKI (1990-October 2008) were searched electronically by computer. Addtionally, four relevant journals were searched manually to get randomized controlled clinical trials about the comparison of MV and Palomo in the treatment of varicocele. Two reviewers screened the literature, evaluated the document quality, extracted the data independently, and checked the result together. RevMan software version 4.3.1 developed by the Cochrane Collaborative was used for meta-analysis. Results Seven RCTs reporting data on effectiveness and safety of MV versus palomo surgery were included. Meta-analyses showed that MV was superior to palomo surgery in improving sperm motility [RR= 1.21, 95%CI (1.09, 1.34), P=0.000 5], concentration [RR= 1.35, 95%CI (1.20, 1.51), Plt;0.000 01] and also postoperation natural pregnancy rate [RR= 1.34，95%CI (1.08, 1.66), P=0.008]. While the MV group had a longer operation time in unilateral [WMD= 23.01 min, 95%CI (16.86, 29.16), Plt;0.000 01] or bilateral varicocele [WMD= 34.05 min, 95%CI (4.9, 63.21), P=0.02] than Palomo surgery. The recovery time difference in the two groups was not significant. The incidence of varicocele recurrence was significantly lower in the MV group than in the Palomo group [RR= 0.17, 95%CI (0.10, 0.31), Plt;0.000 01], and the incidence of postoperative hydrocele was also significantly lower in the MV group than in the Palomo group [RR= 0.10, 95%CI (0.05, 0.23), Plt;0.000 01]. The incidences of wound infection, scrotal hematoma and scrotal pain were similar in both groups. Conclusion The evidence shows that MV is superior to Palomo surgery because of the higher sperm improvement rate, higher natural pregnancy rate and lower incidence of recurrence and hydrocele. But the operation time is longer. The long-term effect and overall effectiveness of MV need more high-quality RCTs to confirm.
Twelve patients with multiple vavices were found adjacent to the common bile duct during cholecystectomy and exploration of the common blie duct in the presence of stones. Eleven of them were with cirrhosis. The authors recommend that retrograde cholecystecotomy, or partial cholecystestomy with electrical cauterization of the remaining gallbladder mucosa ,or even cholecystostomy be the optimal selection in the presence of a large venous channel in calot’s triangle. Multiple fine-needle puncture of the bile duct can be performed over the vascullar area until bile is aspirated; extracting the choledocholith from a transduodenal sphincterotomy is another selective maneuver; and if bleeding occurs, suturing for hemostasis can be placed on the connective tissue over both sides of the lacerated vessel instead of the wall of varices.
ObjectiveTo identify the core genes involved in the great saphenous varicose veins (GSVVs) through bioinformatics method. MethodsThe transcriptional data of GSVVs and normal great saphenous vein tissues (control tissues) were downloaded from the gene expression omnibus database. The single sample gene set enrichment analysis (ssGSEA) was used to calculate the Hallmark score. The weighted gene co-expression network analysis (WGCNA) combined with machine learning algorithms was used to screen the key genes relevant GSVVs. The protein-protein interaction (PPI) analysis was performed using the String database, and the receiver operating characteristic (ROC) curve was used to reflect the discrimination ability of the target genes for GSVVs. ResultsCompared with the control tissues, there were 548 up-regulated genes and 706 down-regulated genes in the GSVVs tissues, the Hallmark points of KRAS signaling and apical junction were down-regulated, while which of peroxisomes, coagulation, reactive oxygen species pathways, etc. were up-regulated in the GSVVs tissues. A total of 639 differentially expressed genes relevant GSVVs were obtained and 165 interaction relations between proteins encoded by 372 genes, and the top 10 genes with the highest betweeness values, ADAM10, APP, NCBP2, SP1, ASB6, ADCY4, HP, UBE2C, QSOX1, and CXCL1, were located at the center of the interaction relation. And the core genes were mainly related to copper ion homeostasis, neutrophil degranulation G protein coupled receptor signaling, response to oxidative stress, and regulation of amide metabolism processes. The SP1 and QSOX1 were both Hub genes. The expressions of the SP1 and QSOX1 in the GSVVs tissues were significantly up-regulated as compared with the control tissues. The areas under the ROC curves of SP1 and QSOX1 in distinguishing GSVVs tissues from normal tissues were 0.972 and 1.000, respectively. ConclusionsSP1 and QSOX1 are core genes in the occurrence and development of GSVVs. Regulation of SP1 or QSOX1 gene is expected to achieve precise treatment of GSVVs.
目的 探讨应用小切口点状抽剥加高位结扎术治疗下肢浅静脉曲张的疗效。方法 选择我院2006～2010年期间经静脉造影确诊为下肢浅静脉曲张患者146例（共153条患肢），采用小切口点状抽剥小腿部曲张浅静脉（包括小隐静脉及交通静脉结扎），加大隐静脉高位结扎、分段抽剥术式治疗。结果 本组手术顺利，手术时间30～50min （平均38min），住院时间3～5d （平均3.5d）。术后随访121例，随访6个月～3年（平均1.6年），除1例术后复发外，其余疗效满意，无手术并发症发生。结论 小切口点状抽剥加高位结扎术治疗下肢浅静脉曲张具有操作方法简单、手术时间短、创伤痛苦小、术后恢复快、复发率低、术后美观等优点，在基层医院值得推广应用。
Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.