肝移植作为终末期肝病唯一有效的治疗手段,具有手术复杂、时间长、创伤大等特点,患者术后恢复面临感染、腹腔出血、排斥反应等诸多挑战,直接影响康复质量。加速术后康复(enhanced recovery after surgery,ERAS)作为一种新型围术期管理策...肝移植作为终末期肝病唯一有效的治疗手段,具有手术复杂、时间长、创伤大等特点,患者术后恢复面临感染、腹腔出血、排斥反应等诸多挑战,直接影响康复质量。加速术后康复(enhanced recovery after surgery,ERAS)作为一种新型围术期管理策略,可有效促进患者术后康复,目前已广泛应用于外科各领域,但目前我国肝移植领域尚缺乏全面、科学的ERAS共识方案。2022年12月,国际肝移植学会发布了首个《肝移植手术加速康复共识建议》,对接受死亡后器官捐献和活体器官捐献的肝移植受者、活体肝移植供者ERAS策略提出建议。本文对该共识要点进行详细解读,以期为我国肝移植患者围术期ERAS实践提供参考。展开更多
Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a val...Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors ofrestenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions （AIOLs）. Methods： Fifty-six patients （82 limbs） who underwent open repair and endovascular treatment （ET） for symptomatic TASC II D AlOEs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results： The mean duration of follow-up was 42.8 ± 23.5 months （ranging from 3 to 90 months）. Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 1 ） limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion： This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AlOEs.展开更多
目的:分析对比腔内技术与主股动脉转流治疗泛大西洋协作组(TASC)C D级主髂动脉病变的长期通畅率结果,为此类患者的手术选择提供依据。方法:回顾性分析安贞医院血管外科,2005年至2008年间,行腔内技术与主股动脉转流治疗TASC C D型主髂动...目的:分析对比腔内技术与主股动脉转流治疗泛大西洋协作组(TASC)C D级主髂动脉病变的长期通畅率结果,为此类患者的手术选择提供依据。方法:回顾性分析安贞医院血管外科,2005年至2008年间,行腔内技术与主股动脉转流治疗TASC C D型主髂动脉病变77例(腔内治疗组35例,主股转流组42例),分析围手术期及远期预后,平均随访时间(59.7±18.7)个月。结果:腔内组5年一期通畅率68.8%,二期通畅率78.1%,总体生存率93.8%,总体保肢率90.6%;主股转流组5年一期通畅率92.1%,二期通畅率94.7%,总体生存率94.7%,总体保肢率97.3%。结论:腔内技术和主-股动脉转流治疗TASC C D型主髂动脉病变均可取得良好的远期疗效,但主-股动脉转流的远期通畅率更好。在无明显手术禁忌的情况下,应优先选择血管转流手术。展开更多
Barany学会前庭疾病国际分类(International Classification of Vestibular Disorders,ICVD)致力于推进前庭症状术语标准化、前庭疾病分类与诊断标准化的雄心壮志。如今,ICVD系列标准陆续发表,受到学界的广泛认同和推广。本文从专家共...Barany学会前庭疾病国际分类(International Classification of Vestibular Disorders,ICVD)致力于推进前庭症状术语标准化、前庭疾病分类与诊断标准化的雄心壮志。如今,ICVD系列标准陆续发表,受到学界的广泛认同和推广。本文从专家共识形成的方法学角度剖析ICVD系列标准的制定过程,分析其亮点,指出其不足之处,明确专家共识制定过程中几个关键问题;最后,提出几点建议,以期为国内专家共识的制订提供借鉴和参考。展开更多
文摘肝移植作为终末期肝病唯一有效的治疗手段,具有手术复杂、时间长、创伤大等特点,患者术后恢复面临感染、腹腔出血、排斥反应等诸多挑战,直接影响康复质量。加速术后康复(enhanced recovery after surgery,ERAS)作为一种新型围术期管理策略,可有效促进患者术后康复,目前已广泛应用于外科各领域,但目前我国肝移植领域尚缺乏全面、科学的ERAS共识方案。2022年12月,国际肝移植学会发布了首个《肝移植手术加速康复共识建议》,对接受死亡后器官捐献和活体器官捐献的肝移植受者、活体肝移植供者ERAS策略提出建议。本文对该共识要点进行详细解读,以期为我国肝移植患者围术期ERAS实践提供参考。
基金We appreciate the guidance and proof-reading of Prof. Miltiadis E Krokidis from Cambridge University Hospital.This study was supported by a grant from National Natural Science Foundation of China （No. 81370420）.
文摘Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors ofrestenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions （AIOLs）. Methods： Fifty-six patients （82 limbs） who underwent open repair and endovascular treatment （ET） for symptomatic TASC II D AlOEs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results： The mean duration of follow-up was 42.8 ± 23.5 months （ranging from 3 to 90 months）. Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 1 ） limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion： This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AlOEs.
文摘目的:分析对比腔内技术与主股动脉转流治疗泛大西洋协作组(TASC)C D级主髂动脉病变的长期通畅率结果,为此类患者的手术选择提供依据。方法:回顾性分析安贞医院血管外科,2005年至2008年间,行腔内技术与主股动脉转流治疗TASC C D型主髂动脉病变77例(腔内治疗组35例,主股转流组42例),分析围手术期及远期预后,平均随访时间(59.7±18.7)个月。结果:腔内组5年一期通畅率68.8%,二期通畅率78.1%,总体生存率93.8%,总体保肢率90.6%;主股转流组5年一期通畅率92.1%,二期通畅率94.7%,总体生存率94.7%,总体保肢率97.3%。结论:腔内技术和主-股动脉转流治疗TASC C D型主髂动脉病变均可取得良好的远期疗效,但主-股动脉转流的远期通畅率更好。在无明显手术禁忌的情况下,应优先选择血管转流手术。
文摘Barany学会前庭疾病国际分类(International Classification of Vestibular Disorders,ICVD)致力于推进前庭症状术语标准化、前庭疾病分类与诊断标准化的雄心壮志。如今,ICVD系列标准陆续发表,受到学界的广泛认同和推广。本文从专家共识形成的方法学角度剖析ICVD系列标准的制定过程,分析其亮点,指出其不足之处,明确专家共识制定过程中几个关键问题;最后,提出几点建议,以期为国内专家共识的制订提供借鉴和参考。
