静脉

Objective By comparing the applications of catheter insertion via external jugular vein and basilic vein, provide clinic foundation for that external jugular vein is the best choice of peripherally inserted central venous catheter operation.

作者：曾令瑜作者单位：达州市中心医院，四川达州 635000 目的：经过颈外静脉与贵要静脉行中心静脉置管的应用比较，为经外周静脉置入中心静脉导管术首选颈外静脉提供临床依据。

And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%、27.39%、20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54,low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively. Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding.

结果：①术后一过性发热62例(84.9%)，腹痛腹胀48例(65.8%)是介入断流术常见的并发症，未发生严重并发症；②门静脉造影显示胃冠状静脉、胃短静脉和胃后静脉的曲张分流的出现率是100%、65.26%和38.34%；显示食管静脉曲张主要由胃冠状静脉供血，胃静脉曲张主要由胃短静脉和胃后静脉供血；胃冠状静脉大多数为单支，少数为双支，其双支的出现率分别为30.57%；胃冠状静脉开口于门静脉主干的为52.06%，开口于脾静脉主干的为27.39%和开口于门脾静脉交汇处的为20.55%；③发现胃肾分流3例，脾肾分流7例、腹膜后门腔静脉分流2例，以及CTA检查发现脐静脉开放者2例；④73例患者介入断流术前和术后平均自由门静脉压力分别为3.87±1.82kpa和3.64±1.14kpa，前后比较存在显著性差异；11例再次介入手术患者的术前、术后和复发后的自由门静脉压力分别为4.02±0.24kpa、3.82±0.25kpa和3.93±0.23kpa ，前后比较发现首次术前与术后存在显著性差异，首次术前和复发出血术前门静脉压力比较无显著性差异；⑤介入术后复查曲张静脉转归基本消失54例，轻度19例；⑥Spearman相关分析和Logistic多因素回归分析，肝功能分级、静脉曲张程度、门脉血流方向和残存小侧支四个因素对曲张静脉转归有影响；Spearman相关分析和Logistic多因素回归分析门脉高压性胃病和出血量等因素对复发出血时间有影响；⑦COX回归分析，门体分流和曲张静脉转归两个因素对术后生存有影响；⑧术后随访6-70月，1、2、3、4、5年的累计复发出血率和累计生存率分别为17.81%、28.77%、38.36%、43.84%、47.95%和93.15%、91.78%、86.30%、83.56%、80.82%；结论：介入断流术治疗门脉高压食管胃底静脉曲张有独特的优点，可以快速直接控制曲张静脉出血而门静脉压力无显著增高，保证了肝脏灌注；与外科分流术相比适应证广、损伤轻、术后恢复快，不易遗漏曲张静脉；肝功能分级、曲张静脉程度、门脉血流方向和残存侧支血管对食管胃曲张静脉转归有影响；门脉高压性胃病对复发出血时间有影响；门体分流和曲张静脉转归对生存时间有影响。

Methods:Preoperative angiography in all 12 veintype KTS patients showed that deep vein patency, no absent ,no obstruction in both lower extremity. Four of these patients which were simply lower limb extralateral varices were operated by varicotomy and varicosity branches ligation. Eight patients which diffuseexpansion type were applicated blood drive belt and tourniquet method and via high level ligation of great and small saphenous vein with varicose vein removal and ligation of perforating veins.

12例静脉型KTS患者术前均行双下肢静脉造影显示深静脉通畅，无缺如或阻塞，其中4例下肢外侧单纯静脉曲张行曲张静脉剥脱术及分支结扎术，8例静脉弥漫扩张者应用驱血带和止血带的方法行大小隐静脉高位结扎加曲张静脉切除及交通支结扎术。

DSA features included: dilatations of brain venule could be seen and the number of brain veins increased; the circulati...

其DSA影像学主要表现为：全脑小静脉扩张、迂曲、数目明显增多；全脑动静脉循环时间延长；丘纹静脉和大脑内静脉系统显影增粗、扩张，并发生深静脉滞流，呈现出"雪花样"表现；静脉窦内对比剂滞留、显影延迟或残缺不全。结论：DSA全脑血管造影是诊断脑静脉系统血栓的可靠方法。

Results :The deep formal vein,formed by the perforating venous trunk and tributaries of gracilis muscle,converged into the femoral vein 8.6±0.9 cm below the midpoint of inguinal ligament.Its truck was 2.6±0.5 cm long and 6.9±1.1 mm in diameter.In 29 cases,there was 1 valve proximal to the abouchement of the first perforating vein.The deep femoral vein collected the venous blood of the thigh and the knee,the superficial venous blood of the shank.

结果：股深静脉由穿静脉主干及股薄肌支汇合而成，汇入股静脉处位于腹股沟韧带中点下8.6±0.9 cm，主干长2.6±0.5 cm，外径6.9±1.1 mm，29侧各有一个瓣膜位于第一穿静脉汇入处近侧，股深静脉通过其属支收集大腿外侧、后侧、内侧深部及浅静脉回流，并收集膝部深、浅静脉及小腿浅静脉回流。

Of the top of the superior aortic recess extended to the level of the aortic arch from which the branchiocephalic trunk arises. At the level of the aortic arch, 100%of the lymph nodes of superior vena cava were located among the aortic arch, superior vena cava and trachea. At the level of azygos vein, 100%of the lymph nodes of azygos vein and the superior aortic recess were located among the superior vena cava, arch of azygos vein, trachea and concavity of aortic arch.

主动脉弓和奇静脉弓在同一横平面占20.00%±7.30%，40.00%±8.94%的奇静脉弓在主动脉弓凹面平面；②80.00%±7.30%的主动脉上隐窝上界位于主动脉弓右前端头臂干起始处；③在主动脉弓平面，腔静脉后淋巴结位于主动脉弓、上腔静脉和气管之间，出现率为100%；④在奇静脉弓平面，奇静脉弓淋巴结和主动脉上隐窝位于上腔静脉、奇静脉弓、气管和主动脉凹面所围成的气管前间隙内。

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 splenic artery thrombolytic infusion therapy, 2 cases remained no-surgical option and underwent conservative treatment.

行肠系膜上静脉-下腔静脉分流术23例；脾切除、脾静脉-肾静脉分流术8例；门静脉-下腔静脉分流术1例；附脐静脉-颈内静脉分流术2例；门奇静脉断流术3例；脾切除、门奇静脉断流术1例；乙状结肠暂时性造瘘，6个月后闭瘘1例；大部分小肠切除术1例；经股动脉插管溶栓4例；未行手术2例，仅给予护肝及对症治疗。

Methods 36 limbs of recurrent LEVI in 35 cases were enrolled in this study , superficial femoral vein、perforating vein incompetence were all applied with B ultrasound examination and intravenous antegrade angiography of deep vein of inferior member before operation ,8 limbs in 7 cases among them were only operated on superficial vein and the main great saphenous vein was remained ; 28 cases in which main great saphenous vein was drawn out were divided into 2 groups, in group B , operation on superficial vein and external valvuloplasty of superficial femoral vein valve were applied ; in group C ,operation on superficial vein and external valvuloplasty of superficial femoral vein valve combined with subfascial endoscopic perforator vein surgerywere applied.

35例36条肢体复发性LEVI，术前全部行股浅静脉、交通静脉B超及下肢深静脉顺行造影检查，其中7例8条肢体原大隐静脉主干未抽剥仅行浅静脉手术；28例大隐静脉主干已抽剥者随机分为B组和C组，各14例，B组行浅静脉手术+股浅静脉带戒术，C组行浅静脉手术+股浅静脉带戒术联合SEPS。

Result:In 20 cases,there were 18 patients detected VM by MRA.8 patients were found typical sign "caput meduse" and 6 patients were only found the delated draining vein.4 patients showed delated draining vein with medulla vein.12 cases of VM were discovered supratentorial and 6 were undertentorial.

结果：20例静脉畸形磁共振血管造影18例发现异常静脉血管，其中8例具有典型的&水母头&样形态，4例显示扩张的引流静脉和稀少的髓静脉。6例静脉畸形MRA仅显示扩张的引流静脉。12例静脉畸形位于幕上，6例位于幕下。

The procedure performed included 23 crossover saphenous vein bypasses 5 in situ saphenopopliteal bypasses 4 interventional therapies of iliac venous occlusion 2 muscular flap constructions on the popliteal vein 38 varicose vein strippings partly with the ligature of communicating venous and ulceration skingraftings 22 endovenous laser treatments of varicosis partly with ulceration skingraftings 17 simple ulceration skingraftings and 3 free flaps transfer for ulceration.

全组105例患者，共114条患肢，其中23条行大隐静脉交叉转流术， 5条行原位大隐静脉-腘静脉转流术， 4条行髂静脉介入治疗， 2条行腘静脉外肌袢形成术， 38条行曲张浅静脉剥脱术，部分联合交通静脉结扎和溃疡清创植皮术， 22条行曲张浅静脉腔内激光术，部分联合溃疡清创植皮术， 17条行单纯溃疡清创植皮术， 3条行溃疡清创联合游离皮瓣移植术。

The absorption and distribution of chromium were studied in ryeusing nutrient culture technique and pot experiment.

采用不同浓度K2CrO4(0，0.4，0.8和1.2 mmol/L)的Hoagland营养液处理黑麦幼苗，测定铬在黑麦体内的亚细胞分布、铬化学形态及不同部位的积累。

By analyzing theory foundation of mathematical morphology in the digital image processing, researching morphology arithmetic of the binary Image, discussing two basic forms for the least structure element: dilation and erosion.

通过分析数学形态学在图像中的理论基础，研究二值图像的形态分析算法，探讨最小结构元素的两种基本形态：膨胀和腐蚀；分析了数学形态学复杂算法的基本原理，把数学形态学的部分并行处理理念引入到家实际应用中。