简讯

应北京医科大学临床介入放射学研究所所长杨仁杰教授的邀请,美国宾夕法尼亚大学医院著名介入放射学教授 Constantin Cope 来北京医科大学第三临床学院进行了为期三天的学术交流研讨活动。研讨会(1995年10月29～11月1日)期间,采用 Cope set 器械对2例肝硬化并门脉高压上消化道出血患者进行了 TIPSS术,对1例严重多发性大动脉炎腹主动脉钙化右肾动脉狭窄的患者进行了 PTRA 治疗,并均获成功。Cope 教授作了有关 TIPSS、TCPS(经     

介入栓塞治疗在临床急症动脉性出血中的应用

目的探讨急症动脉性出血行介入栓塞治疗的临床应用价值,提高介入放射学在急症医学中的地位。方法回顾性分析2008年7月~2015年4月急症动脉性出血患者30例,其中上消化道出血12例,肝癌破裂出血4例,脾破裂出血3例,肝脏假性动脉瘤出血3例,肾脏穿刺术后出血2例,肾血管平滑肌脂肪瘤破裂出血1例,盆腔动脉出血5例。术后随访观察栓塞疗效、并发症、住院时间、患者恢复情况等。结果技术成功率96.7%,无严重并发症发生,2例上消化道出血患者首次栓塞后仍有出血,2天或3天后再次行介入栓塞治疗后不再出血,1例肝脏假性动脉瘤行两次栓塞后仍有出血,其余27例均一次栓塞良好。结论临床确诊为动脉性出血或怀疑有动脉性出血,内科药物治疗无效或急症出血药物治疗不佳时均可行血管内介入动脉造影,明确出血动脉后随即行介入栓塞治疗以挽救患者生命,或为临床下一步治疗提供帮助。     

提高介入放射学在急症医学中的地位

介入放射学应用于急症医学有其天然的优势,它创伤小、疗效高、起效迅速,并将诊断和治疗完美结合在一起.应用于急诊医学中的介入技术不仅包括栓塞和取栓等血管内技术,还包括气管支架、椎体成形术等多项非血管介入技术.然而,除心、脑血管疾病和部分外伤性出血疾病外,介入治疗在急症中的应用还远远没有受到重视.进一步发挥介入治疗在急诊中的优势、提高介入放射学在急症医学中的地位势在必行.     

介入栓塞治疗胆道出血五例

胆道出血临床不多见 ,内科保守治疗和传统的外科处理 ,预后均较差 ,死亡率较高。随着介入放射学的发展 ,国内外已有经动脉栓塞治疗胆道出血的报道 ,但总的病例数很少。本文报告 5例外科手术后胆道出血介入栓塞治疗的情况。资料和方法一、临床资料1996年 10月～ 2 0 0 1年 5月 ,     

致命性大出血急救护理专家共识(2019)

介入技术飞速发展改变了传统出血疾病的救治体系,使得很多过去不可控或难治的致命性大出血变得可控、可治。国内"出血中心"建设成立,开启了以介入、急诊等多学科团队协作的出血急救新模式,也对致命性大出血急救护理实践提出了更高的要求。然而,目前我国仍缺乏相关护理规范。为此,中国研究型医院学会出血专业委员会和中国出血中心联盟牵头组织国内相关护理专家,就致命性大出血急救护理达成专家共识,对大出血常见类型、患者紧急护理评估、急救护理要点、效果评价以及出血中心护理急救处置流程等进行了初步论述,旨在为临床相关护理实践提供指导和参考,提高出血救治成功率,促进医疗安全。     

加强介入医师临床思维与能力培养的重要性和紧迫性

根据介入放射学的发展历史较短,但速度较快,治疗疾病病种繁多且逐渐复杂,与其他相关临床学科关系密切,各地介入放射学发展水平不平衡的现状及中国介入放射学从业医师队伍的特点,阐明介入放射学医师临床思维与能力培养的重要性和紧迫性,并提出关于加强介入放射学医师临床思维能力培养的几点建议.最后系统介绍临床工作中应遵守的疾病诊疗程序,强调做好患者围手术期管理和随访.加强介入放射学从业医师的临床思维能力培养,才能使介入放射学在夹缝中求生存,求发展,并成为一门让患者和其他同行们认可的临床学科.     

全身麻醉在神经介入手术中的应用进展

近10年来,随着各种介入放射学诊断与治疗技术的发展,越来越多的复杂介入手术逐渐开展起来,并应用于各种患者,对患者配合度的要求也越来越高,因此麻醉也被越来越多地应用到介入操作和患者处理之中,向麻醉医师提出了更多挑战.本文对全身麻醉在神经介入放射学领域的研究进展、临床应用、操作步骤、与清醒镇静的比较及并发症等做一综述.     

介入放射学在急诊医学中的应用

介入放射学的发展使一些急重症病例得以快速有效的处理。本文总结我院１９８６年以来将介入放射学用于急重病例的临床观察结果，并对有关问题进行讨论。资料与方法一、一般资料４２例患者，男３７例，女５例，年龄１３～６１岁，平均４２岁。其中大咯血６例，外伤性肾破裂...     

小肠出血的介入放射学治疗

位于小肠的消化道出血较其他部位为少,约占全部急性消化道出血的5%,但在表现为急性便血症状的病人中可达25%～30%。由于消化道内镜和钡剂检查对小肠出血的检测均有一定限度,要明确小肠出血的部位常较困难,手术检查对于明确出血部位的作用亦有限,且对急性出血的手术深查常有很高的死亡率,故血管造影检查在明确小肠出血的部位及进行介入放射学治疗方面具有相当重要的作用。虽然近年来通过血管造影检查而进行介入放射学治疗有了相当的发展,但对下消化道出血,尤其是小肠出血的介入放射学治疗的报导仍相对少见,本文主要述及介入放射学在小肠出血治疗中的     

肾动脉栓塞治疗肾脏疾病47例报告

随着介入放射学的发展，血管栓塞术已被广泛，成为临床治疗和辅助治疗的一种有效方法。我院自１９８３年５月￣１９９６年１２月对４７例肾肿瘤，肾外伤出血，肾脓肿进行肾动脉栓塞治疗，取得满意效果。     

Hemorrhage with pelvic fractures: efficacy of transcatheter embolization.

To determine the effectiveness of angiography in identifying bleeding sites and controlling the massive and often fatal hemorrhage accompanying pelvic fractures, the hospital course and outcome of 28 patients who underwent angiography after pelvic trauma were reviewed. In 20 patients, active bleeding was demonstrated. Transcatheter occlusions of bleeding arteries were performed in 18 of these, with angiographic ontrol of hemorrhage in 18 and clinical control in 17. Two patients with active bleeding were not embolized because of subsequent surgical intervention in one and technical angiographic difficulties in the other. Blood transfusion requirements averaged 32.1 units in the 48 hr or less before occlusion and 5.2 units during 48 hr after occlusion. Of the 18 patients who underwent arterial embolization, nine died, seven of associated injuries, one of extrapelvic hemorrhage, and one of hypotension. Nine patients survived to be discharged. These results confirm that transcatheter occlusion of bleeding vessels in the pelvis reduces hemorrhage and facilitates the management of patients with pelvic trauma.     

Primary pontine hemorrhage: Clinico-computed tomographic correlations

A series of 10 patients with primary pontine hemorrhage with CT confirmation is reported. All patients were hypertensive. Seven patients had classical pontine hematoma syndrome characterized by decreasing levels of consciousness, quadriparesis, and eventual demise. The three other patients had atypical or partial clinical features of pontine hemorrhage and good prognosis.

The pontine hemorrhage can be divided into 4 groups from the viewpoint of location of the hematomas. There are bilateral tegmentobasis (massive) type, hemipontine type, localized tegmentum type, and localized basis type. There was no evidence of ventricular extension in all 10 cases.

All patients suffering the massive type had classical pontine hematoma syndrome and fatal outcome, the other three remaining types had atypical or partial clinical features for pontine hemorrhage and survived.

It is concluded that CT is highly reliable method for the diagnosis and location of primary pontine hemorrhage.     

Prognostic factors in intraparenchymatous hematoma with ventricular hemorrhage

Summary Intraventricular hemorrhage following intraparenchymatous hematoma is thought to be a frequent and often fatal event. Computerized tomography has proved to be valuable for its diagnosis. Hospital records of seventy-eight patients with intraparenchymatous hematoma and intraventricular hemorrhage diagnosed by computerized tomography were retrospectively reviewed to evaluate initial clinical features and CT findings in order to assess potential prognostic factors.     

Komplikation bei der Operation eines invertierten Papilloms

Inverted papilloma is a primary benign neoplasm of the parananasal sinus. Complete surgical removal is the therapy of choice due to local destruction and the risk of malignant transformation. Internal carotid artery trauma is a rare complication of paranasal sinus surgery. A case of a fatal arterial hemorrhage during endoscopic sinus surgery in a 77-year-old woman which resulted in a subdural hemorrhage is presented and discussed.     

The abdominal compartment syndrome: CT findings.

OBJECTIVE: The abdominal compartment syndrome is a potentially fatal condition resulting from pathologic elevation of intraabdominal pressure. We evaluated preoperative abdominal CT scans of four patients with proven abdominal compartment syndrome to identify signs of increased intraabdominal pressure. CONCLUSION: CT findings common to all four patients included tense infiltration of the retroperitoneum out of proportion to peritoneal disease, extrinsic compression of the inferior vena cava by retroperitoneal hemorrhage or exudate, and massive abdominal distention with an increased ratio of anteroposterior-to-transverse abdominal diameter (positive round belly sign; ratio > .80; p < .001). Direct renal compression or displacement, bowel wall thickening with enhancement, and bilateral inguinal herniation were each present in two of the four patients. Radiologists should be aware of this life-threatening syndrome. In the appropriate clinical setting, CT findings of increased intraabdominal pressure should be swiftly communicated to other physicians involved in treating the patient because the abdominal compartment syndrome requires emergent surgical decompression.     

Arteriovenous malformation of the mandible: embolization and direct injection therapy

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that can be potentially fatal as a result of massive hemorrhage. Traditional treatment involved extensive surgical resection of the mandible. With the advent of improved endovascular techniques, interventional radiology is now the best method to control active hemorrhage and ultimately cure these lesions. The authors describe three cases of successfully treated mandibular AVM by percutaneous and/or endovascular techniques.     

Transvenous embolization of direct carotid cavernous fistulas

Of 165 cases of direct carotid cavernous fistula, 14 (8.5%) were treated from a transvenous approach. Twelve of these were treated through the inferior petrosal sinus and one through the superior ophthalmic vein. In one patient, both approaches were used. The embolic agents were as follows: five patients had balloons only, four patients had minicoils alone, three patients had coils and liquid adhesives, one had balloons and coils, and one had balloons and liquid adhesives. Among the patients who were treated from a transvenous approach, three had an occluded carotid artery caused by trauma, nine failed transarterial balloon attempts, and one had a prior trapping procedure. In the remaining patient, who had Ehlers-Danlos syndrome, a transarterial approach was judged to be too dangerous. This patient suffered a fatal pontine hemorrhage after subtotal transvenous occlusion of the carotid cavernous fistula with diversion of flow into cortical veins. Another complication occurred when the inferior petrosal sinus was perforated during catheterization, causing a small subarachnoid hemorrhage. The tear was immediately closed with minicoils, and surgical exposure and embolization resulted in complete cure. Of the remaining 12 patients treated, 11 were completely cured and one showed angiographic and clinical improvement. Transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic carotid cavernous fistulas; however, transvenous embolization is an alternative when the arterial route fails.     

Carotid intraplaque hemorrhage: MRI findings

Intraplaque hemorrhage is one of the complications of atherosclerotic plaques. It causes clinical manifestations of ischemia without hemodynamically significant stenosis. MRI has a high capacity for the study of the tissular components of atheromatous plaques and is an efficacious diagnostic method in cases of intraplaque hemorrhage. Symptomatic patients with unstable (complicated) plaques, regardless of the degree of stenosis present, might benefit from surgical treatment (endarterectomy). In these cases, the diagnostic value of a noninvasive technique like MRI is fundamental. We present three cases of intraplaque hemorrhage with clinical manifestations of ischemia studied with MRI.     

消化道大出血外科术前介入治疗的策略和临床价值

目的 探讨消化道大出血外科术前进行介入治疗的临床价值,比较垂体后叶素灌注治疗和栓塞治疗2种介入方法的疗效和复发率.方法 1998年6月至2009年4月间,31例消化道大出血患者在我院接受手术治疗并于术前行介入治疗,根据患者造影情况,分别采用经动脉灌注垂体后叶素和经导管栓塞治疗.评价介入治疗的临床疗效和对手术的影响,比较2种不同介入治疗方法的止血率和复发率.计数资料采用Fisher精确概率法,统计软件使用SPSS11.0.结果 31例患者顺利完成介入治疗,垂体后叶素灌注组和栓塞组的术后止血率分别为69.2%(9/13)、94.4%(17/18),复发率分别为4/9、23.7%(4/17).31例患者介入治疗术后均顺利完成外科手术,其中择期手术20例,未出现手术和介入治疗相关严重并发症和死亡患者.结论 术前介入治疗能为消化道大出血患者提供的手术机会,使部分急症手术变为择期手术,从而降低了手术风险,值得临床推广.     

942例颅内动脉瘤患者血管内治疗围术期出血并发症分析及防治

目的：分析942例颅内动脉瘤患者行血管内治疗的围术期出血并发症发生情况，并探讨其处理措施。 方法：收集2011年1月至2019年4月复旦大学附属华山医院收治的942例颅内动脉瘤患者（1 055个动脉瘤），分析围术期出血并发症发生原因，探讨围术期用药方案，总结防治措施。 结果：本组942例患者发生出血性并发症共12例（1.27%），其中术中出血9例、术后出血3例。9例术中出血无一例致死致残，其中因弹簧圈损伤瘤腔致动脉瘤破裂6例，微导管损伤瘤腔致动脉瘤破裂2例，微导丝损伤远端小分支导致出血1例。9例患者均预后良好，出院前mRS评分较入院时未增加。术后出血3例均死亡，其中2例蛛网膜下腔出血可能与瘤腔栓塞不全或术后肝素化有关，1例基底节区血肿可能与术后血压一过性增高有关。 结论：术前不常规应用抗血小板聚集药物及肝素化可降低术中出血导致的致死率，及时识别并处理后多数患者预后良好。术后出血发生率低，但预后差，病死率高。术前充分评估危险因素，术中致密填塞瘤腔，术后慎用抗凝治疗，可改善出血患者的预后。