经颈静脉肝内门体分流术联合部分脾动脉栓塞术对肝硬化脾功能亢进患者肝功能和外周血细胞的中远期影响

【摘要】 目的 探讨经颈静脉肝内门体分流术（TIPS）联合部分脾动脉栓塞术（PSE）对肝硬化伴脾功能亢进（脾亢）患者肝功能和外周血细胞的中远期影响。 方法 回顾性分析2014年1月至2018年9月昆明医科大学第一附属医院收治的92例肝硬化脾亢患者完整临床资料。根据治疗方案不同,分为TIPS联合PSE组（A组,n=47）和单纯TIPS组（B组,n=45）。比较两组术后1周,1、6、12个月外周血细胞变化、不良反应及肝功能变化。结果 两组手术均获成功。两组患者术后各时段均有不同程度肝损伤,术后1周A组肝功能损伤较B组严重（P＜0.05）;术后1个月两组患者肝功能指标差异无统计学意义（P＞0.05）;术后6、12个月A组Child-Pugh评分基本恢复至术前水平（P＞0.05）,低于B组（t=2.925,P=0.044;t=3.102,P=0.017）;A组术后各时段白细胞、血小板计数与术前及B组相比,差异均有统计学意义（P＜0.05）,但术后12个月较其余各时段呈下降趋势。两组患者术后均无严重不良反应和难以控制的并发症。结论 TIPS联合PSE术治疗肝功能储备尚可的肝硬化脾亢患者有助于提升外周血象,改善术后中远期肝功能,且术后不良反应较轻,并发症可控。     

部分脾动脉栓塞术治疗肝硬化性脾功能亢进的临床评价

目的探讨部分脾动脉栓塞术(PSE)对治疗肝硬化性脾功能亢进的疗效及临床价值。方法对20例肝硬化性脾功能亢进患者进行了PSE;观察术前术后外周血象的变化、腹水消退及并发症发生情况。结果 20例患者术后外周血象较术前明显改善。8例有腹水者,腹水消失6例,腹水减少2例。术后并发症主要有左上腹疼痛(15例)、发热(10例)、左侧胸水(3例)。结论 PSE对治疗肝硬化性脾功能亢进症有明显疗效和重要的临床价值。选择合适的病人和严格的操作技术能避免严重并发症的发生。     

部分脾栓塞术治疗肝硬化门脉高压症肝、脾血流动力学远期变化

目的 观察肝硬化并发门脉高压症和脾功能亢进(脾亢)患者行部分脾栓塞(PSE)后肝、脾血流动力学的远期变化.方法 对1 720例肝硬化并发门静脉高压症和脾亢患者行PSE,观察其1～5年病死率,分析其死亡原因,对生存期达5年以上且资料完整的600例患者观察术前及术后肝、脾血流动力学及血象、脾脏大小、并发症等变化.结果 PSE后不同时期血流动力学具有明显变化,消化道出血次数和量明显减少;白细胞及血小板较术前明显上升;术后2个月脾脏开始逐渐缩小,3个月后明显缩小.差异有统计学意义(P<0.01).结论 PSE可明显改善肝、脾血流动力学,降低门脉压力,改善脾亢症状,减少消化道出血机会,延长生存期,改善生活质量,远期疗效显著且稳定,是一种创伤小、并发症少、安全、有效的技术.     

PVA颗粒作为栓塞材料在部分性脾栓塞术中的应用评价

目的　评价PVA颗粒作为栓塞材料在部分性脾栓塞术 (PSE)治疗肝硬化脾功能亢进 (脾亢 )中的疗效及并发症。方法　 5 0例肝硬化脾亢行PSE患者 ,依据PSE术所采用的栓塞材料不同分为2组 :A组 2 6例 ,栓塞材料为明胶海绵颗粒 ;B组 2 4例 ,栓塞材料为 30 0～ 70 0 μm的PVA颗粒。随访观察两组外周血白细胞、血小板和红细胞计数变化及术后反应。选取术后 1年资料完整的 4 1例进行分析 ,其中A组 2 2例 ,B组 19例。结果　两组术后 1年内白细胞和血小板计数均较术前明显升高 (P <0 .0 0 1)。虽然B组术后白细胞和血小板计数较A组升高较多 ,但两组的疗效差异无显著性 (P >0 .0 5 )。两组术后红细胞计数一直无明显变化 (P >0 .0 5 )。B组疼痛的程度重、持续时间长 ,而A组发热的发生率高。较严重并发症的发生率两组无明显差异。结论　PVA颗粒可作为PSE术的栓塞材料 ,栓塞程度控制在 5 0 %～ 70 %可有效治疗脾亢、减轻术后反应。     

褐藻胶微球在部分性脾栓塞术中的应用评价

目的评价褐藻胶微球(AMG)作为栓塞材料在部分性脾栓塞术(PSE)治疗肝硬化脾功能亢进(脾功能亢进)中的疗效及并发症。方法2003—2005年42例肝硬化脾功能亢进行PSE患者,栓塞材料为250~450μmAMG。超选择性脾下极动脉部分性脾栓塞。结果共进行脾栓塞42次,栓塞范围40%~70%。栓塞后有35例出现发热,持续3~15d,38例出现腹痛,其中27例需用强效止痛药。少量胸腔积液6例,保守治疗后消失。未出现脾脓肿等严重并发症。术后24h白细胞和血小板计数开始升高(P<0.05),术后3个月白细胞维持在正常值为38例,血小板维持在正常值为39例。结论AMG可作为PSE术的栓塞材料治疗脾功能亢进,减轻术后反应。     

三丙烯微球在部分性脾栓塞治疗继发性脾功能亢进中的临床应用

目的 评价三丙烯微球在部分性脾动脉栓塞(PSE)治疗肝硬化脾功能亢进(脾亢)中的临床疗效.方法 30例肝硬化合并脾肿大、脾亢患者行PSE,16例使用明胶海绵,14例使用三丙烯微球.栓塞面积一般在40% ～ 80%.术后随访观察患者外周血白细胞、血小板计数变化及不良反应.结果 6个月后28例患者血白细胞、血小板恢复正常,...     

部分脾栓塞术治疗脾功能亢进36例临床分析

目的 讨论部分脾栓塞术（partial splenic embolization,PSE）治疗脾功能亢进的栓塞程度与临床疗效及并发症的关系.方法 对36例脾功能亢进患者行PSE治疗,观察术后并发症及术后3天、7天、1个月、3个月外周血白细胞、红细胞、血小板变化与栓塞程度的关系.结果 成功实施手术的36例患者术后均有不同程度的并发症,术后外周血WBC,RBC,PLT均有不同程度的升高,术前与术后1个月数值比较均有统计学意义（WBCt =2.751,P＜0.05,RBCt=1.960,P＜0.05,PLTt =3.435,P＜0.05）.并发症的程度、血细胞的改善程度与栓塞程度呈正相关.结论 PSE是治疗脾功能亢进安全、有效的方法,栓塞程度与临床疗效及并发症均呈正相关.     

经脾动脉行明胶海绵与碘化油栓塞治疗脾功能亢进的对照研究

目的探讨经脾动脉行明胶海绵和碘化油栓塞治疗肝硬化脾功能亢进(脾亢)的疗效与并发症,为临床治疗肝硬化脾亢栓塞剂的选择提供依据。方法回顾性分析40例肝硬化脾功能亢进患者行经脾动脉明胶海绵栓塞和39例行经脾动脉碘化油栓塞治疗的临床资料,观察两组患者外周血三系细胞改善和并发症以及复发情况。结果两组患者的脾脏体积回缩、血红蛋白、白细胞和血小板计数差异无显著性(P>0.05),但碘化油栓塞组患者6个月后有部分病例出现血小板再次减少,明胶海绵栓塞组术后并发症发生率高于碘化油栓塞组(P<0.05),碘化油栓塞组肝、胃肠道毒性分级均较明胶海绵栓塞组低。结论对高龄、肝功能差、腹水较多、凝血功能严重障碍、肝硬化门脉高压明显的患者可行经脾动脉碘化油栓塞治疗脾亢。     

肝硬化伴脾功能亢进的部分脾栓塞治疗

目的：评价部分性脾栓塞治疗肝硬化所致脾功能亢进(脾亢)的效果和优势。方法：13例肝硬化伴脾亢的患者行经脾动脉大部栓塞术，并比较术前后相关指标，结果：脾栓塞为50％-80％，患者术后白细胞和血4、板计数明显上升，患者术后体力，精力明显改善，免疫功能无损害。结论：部分性脾栓塞是治疗肝硬化伴脾亢的有效方法，安全，损伤小，且能保留脾脏的免疫功能，使肝硬化患者能进一步治疗。     

部分脾栓塞在继发性脾功能亢进中的应用现状

脾功能亢进(脾亢)发生于各种原因的脾淤血,是一种常见病,随着介入放射学的发展,部分脾栓塞术(PSE)在临床上已经广泛应用,其在继发性脾亢中的应用越来越多.有多种栓塞材料可用于PSE,且各有优缺点.由于脾脏血管的解剖特点,栓塞体积大小直接影响PSE治疗效果.评价PSE的疗效,可以根据外周血象、免疫功能、血流动力学指标和肝功能进行观察.由于种种原因,PSE在临床应用过程中存在一些不足,亟待加以完善.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).