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急诊介入栓塞联合腹腔灌洗治疗肝癌破裂出血28例 总被引:1,自引:0,他引:1
目的:评价急诊介入栓塞联合腹腔灌洗治疗原发性肝癌破裂出血的疗效、意义。方法:回顾性分析28例不能手术切除的原发性肝癌破裂出血患者的病例资料,采用Seldinger技术穿刺,使用明胶海绵、碘化油对所有肝癌破裂出血患者行肝动脉栓塞化疗,同时行腹腔灌洗。结果:26例原发性肝癌出血得到完全控制,血性腹膜炎症状均很快缓解。2例于介入栓塞后24-48h再出血,行急诊手术止血后存活。结论:急诊肝动脉介入栓塞联合腹腔灌洗治疗不能手术切除的原发性肝癌破裂出血疗效确切,创伤小,抢救手段安全、可靠。 相似文献
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目的:探讨急诊肝动脉栓塞治疗原发性肝癌破裂出血的方法、临床效果、意义。方法:回顾性分析14例原发性肝癌破裂出血患者的病例资料,其中巨块型肝癌10例、结节型3例、小肝癌1例。所有患者均行急诊肝动脉超选择插管,采用弹簧圈、明胶海绵及碘化油等栓塞出血动脉。结果:14例原发性肝癌出血得到完全控制,患者术后生存期均在5个月以上,其中1例半年后死亡,5例随访24个月均存活。结论:急诊肝动脉栓塞治疗原发性肝癌破裂出血疗效肯定,创伤小,是安全、可靠的抢救手段。 相似文献
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目的 探讨剖宫产术后子宫切口憩室反复阴道出血的介入诊疗作用.方法 回顾我院1例剖宫产术后子宫切口憩室反复出血的盆腔动脉DSA表现及栓塞治疗,并结合文献复习该病发病原因、影像学表现及治疗方法.结果 患者因阴道反复出血前后共经历3次盆腔动脉DSA造影及栓塞治疗,短期止血效果肯定.DSA表现为子宫动脉、阴部内动脉参与供血,供血动脉均增粗、扭曲,右侧子宫弓状动脉增粗,左侧子宫末梢动脉可见对比剂外溢征象,未见明显肿瘤染色或动静脉瘘征象.最后经宫腔镜证实子宫切口瘢痕内多发小憩室形成,其内可见积血.后经开腹手术切除子宫切口瘢痕组织,随访1年未见出血复发.结论 子宫切口憩室DSA造影表现不具特征性,介入栓塞治疗协同2期外科根治术疗效肯定. 相似文献
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自发性肝癌破裂出血的急诊动脉栓塞治疗 总被引:6,自引:3,他引:3
目的评价自发性肝癌破裂出血急诊动脉导管栓塞(TAE)治疗的疗效。方法回顾性分析1997年9月-2005年9月的16例自发性肝癌破裂出血急诊TAE治疗过程。16例患者中6例伴有低血容量性休克。结果16例患者急诊TAE治疗均止血成功,成功率100%。从肿瘤破裂出血引起失血性休克或发现血性腹水到TAE治疗结束时间为1.5~5h,平均3.6h,其中3例为1.5h。TAE止血治疗后每例患者进行了2~6次动脉导管化疗栓塞(TACE),平均3.7次,结合CT导引肿瘤内无水乙醇注射(CT-PEI)5~9次/例,平均6.8次/例;3例未再进行介入及外科治疗;1例TAE术后3d进行了肝移植手术。平均生存时间为14.3个月。结论急诊栓塞是治疗自发性肝癌破裂出血安全有效的手段。在TAE止血后对肿瘤进行TACE联合CT-PEI治疗取得了良好的效果。 相似文献
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目的:探讨原发性肝癌微波治疗后的DSA表现及临床意义。方法:本组共12例原发性肝癌,均为单发病灶,肿瘤直径3.0~6.5cm(平均4.4cm),经皮肝穿刺微波治疗术后1~3个月内行肝总动脉及可疑区域供血动脉超选择性血管造影,同时对残留及复发灶进行栓塞治疗。结果:术后造影表现为微波治疗的肿瘤区多为无血管区,呈圆形或类圆形无染色或低密度染色区;治疗边缘区可见以下几种征象:肉芽形成(7例)、出血(3例)、边缘残留或复发(7例)和无异常造影征象(2例)。肝内异位复发灶(7例)造影表现同其原发肿瘤常见造影表现。本组12例造影发现原位边缘复发和/或肝内异位复发灶8例并全部完成栓塞治疗。结论:微波治疗区域的边缘征象的发现和鉴别是判断局部残留及复发的关键,DSA在疗效的观察及进一步综合治疗中有较高的临床价值。 相似文献
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目的探讨介入诊疗对急性出血的诊断与治疗价值。
方法对67例急性出血的患者采用介入治疗,行选择性及超选择性动脉造影和血管内栓塞术,其中上消化道出血28例,下消化道出血12例,子宫出血17例,肝肾出血5例,急性咯血1例,术后急性腹腔内出血4例。
结果67例患者经一次选择性动脉造影获得明确诊断66例,诊断阳性率98.51%(66/67)。选择性动脉造影显示对比剂外溢出血直接征象37例,直接征象阳性率55.22%(37/67)。发现假性动脉瘤13例,肿瘤供血动脉及肿瘤染色21例,子宫瘢痕染色及孕囊染色12例,血管结构不良出血1例。诊断明确后均成功止血。1例消化道出血患者,介入栓塞治疗4天后复发出血,经第二次选择性动脉造影及介入栓塞侧支供血后成功止血。一次性栓塞治疗成功率98.51%(66/67)。
结论选择性动脉造影及血管内栓塞术对急性出血可明确出血部位,而且可迅速有效止血,是一种安全易行、迅速有效的诊断与治疗手段。 相似文献
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The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and
neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications
which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation
intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal
cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor
stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can
be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography,
are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant. 相似文献
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This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread. 相似文献
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Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease. 相似文献
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Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium. 相似文献