咯血患者支气管动脉改变及其MSCT:回顾与展望

咯血是肺部疾病的常见症状,急性发作的大咯血往往对患者的生命造成威胁。支气管动脉的破裂是咯血最常见的病因。利用MSCT及支气管动脉CTA对支气管动脉进行研究,可帮助临床制定治疗方案、评价治疗效果。本文对咯血相关的肺部疾病的支气管动脉影像学改变进行综述,重点探讨MSCT在支气管动脉研究中的意义及进展。     

肺栓塞合并支气管动脉-肺动脉瘘导致咯血的介入治疗

目的:通过肺动脉、支气管动脉造影分析慢性肺动脉栓塞后咯血的原因,并探讨对其介入治疗的安全性和有效性。材料和方法:CT和导管法肺动脉造影证实的慢性肺栓塞13例,其中伴咯血7例(男性1例,女性6例)。对咯血者进行支气管动脉造影后行支气管动脉栓塞治疗。结果:7例肺栓塞伴咯血者的支气管动脉造影均发现支气管动脉-肺动脉瘘,行支气管动脉栓塞术后咯血消失,短期随访生活质量明显改善。结论:支气管动脉-肺动脉瘘是慢性肺动脉栓塞后咯血的主要原因,行支气管动脉栓塞治疗可有效地控制咯血,并且对肺的血供无明显不良影响。     

选择性肺动脉造影及CT血管造影诊断肺动脉假性动脉瘤并文献复习

绝大多数咯血患者出血来源于支气管动脉,少部分来源于非支气管体循环动脉侧支.支气管动脉和非支气管体循环动脉栓塞(以下统称支气管动脉栓塞)是一种治疗大咯血公认有效的治疗方法.一般认为,支气管动脉栓塞后咯血仍不能控制者应考虑肺动脉源性咯血的可能,文献报道其发生率约为5%～10%,最常见的原因为肺动脉假性动脉瘤[1].     

支气管动脉-肺动脉瘘致大咯血的介入治疗

目的 观察支气管动脉-肺动脉瘘的血管造影表现,评价介入治疗支气管动脉-肺动脉瘘致咯血的重要性、安全性以及疗效.方法 2007年1月-2008年1月我院共收治大咯血患者39例,其中12例存在支气管动脉-肺动脉瘘,均行支气管动脉栓塞术(BAE)治疗,分析支气管动脉-肺动脉瘘致咯血的表现、病理解剖学特点,评价BAE治疗支气管动脉-肺动脉瘘的安全性和疗效.结果 本组12例支气管动脉-肺动脉瘘致咯血患者,均用明胶海绵颗粒行BAE治疗,术后止血率为100%,无明显并发症出现,平均随访13.5个月(6～18个月),患者均未发生再次咯血.结论 支气管动脉-肺动脉瘘是咯血的病理解剖结构,BAE是治疗和预防此类咯血的有效措施.     

支气管动脉栓塞治疗肺大咯血

目的　探讨支气管动脉栓塞治疗大咯血的方法及疗效。方法　对 36例大咯血或长期反复咯血的病人用明胶海绵颗粒栓塞支气管动脉。 36例病人中 ,单侧 31例 ,双侧 5例。肺癌 1 7例 ,支气管扩张 8例 ,肺结核 1 1例。先行支气管动脉造影 ,确定出血血管后 ,用明胶海绵颗粒栓塞 ,直到支气管动脉闭塞为止。结果　即刻止血 31例 ,出血完全控制。 5例咯血明显减少 ,内科治疗后咯血完全停止。随访 3月～ 5年 ,再出血 2例。结论　支气管动脉栓塞是治疗大咯血的有效方法 ,效果确切 ,止血迅速     

支气管动脉栓塞治疗急性大咯血

目的：通过对支气管动脉栓塞治疗急性大咯血的分析,探讨支气管动脉栓塞治疗大咯血的效果及影响因素。方法：21例病人,共栓塞出血动脉34支,其中右支气管动脉18支,左支气管动脉13支,肋间动脉3支：栓塞材料为明胶海绵颗粒。结果：栓塞后,19例病人出血明显减少;2例术后第2天又有大咯血,治疗失败。治疗有效率90．5％（19／21）。结论：支气管动脉栓塞术是急性大咯血的安全、简便、有效的治疗手段。     

超选择性支气管动脉栓塞治疗大咯血的临床评价

目的探讨支气管动脉栓塞治疗大咯血的临床应用价值。方法对42例大咯血患者的支气管动脉造影和支气管动脉栓塞治疗进行回顾性总结评价。结果42例患者中介入栓塞治疗后显效35例(83.3%),有效7例(16.7%)。结论支气管动脉栓塞是治疗急性大咯血的有效方法,而超选择性插管栓塞治疗更安全有效,可作为临床首选的治疗方法。     

支气管动脉栓塞治疗大咯血

目的：研究支气管动脉栓塞治疗大咯血的临床疗效。方法：对29例大咯血患者行选择性支气管动脉造影后,对病变动脉用消毒明胶海绵颗粒进行栓塞止血。结果：29例患者均一次栓塞成功,大多数患者能及时止血,个别患者3～5 d内咯血渐止。结论：支气管动脉栓塞治疗大咯血,损伤小,止血效果显著,是一种安全,有效的治疗方法。     

支气管动脉CTA在大咯血介入栓塞治疗中的应用

目的探讨支气管动脉CTA在大咯血介入栓塞治疗中应用的策略及临床效果。方法80例大咯血的患者在介入栓塞治疗前行支气管动脉CT血管造影（CTA）检查,在介入手术中寻找所有的出血动脉,并逐一进行栓塞治疗。68例患者栓塞治疗1周后复查支气管动脉CTA检查。对支气管动脉CTA在大咯血介入栓塞治疗中的应用效果进行回顾性总结评价。结果80例大咯血的患者在介入栓塞治疗前行支气管动脉CTA检查,共找到107支病变的出血动脉,介入手术中共找到118支出血动脉并成功栓塞治疗。术前支气管动脉CTA检查诊断的准确率为90．68％（107/118）。68例患者栓塞后治疗支气管动脉CTA检查显示所有已栓塞的支气管动脉栓塞效果良好。结论介入栓塞治疗前支气管动脉CTA检查可以为支气管动脉栓塞治疗中寻找出血动脉提供准确的定位作用。栓塞治疗后行支气管动脉CTA检查有利于对栓塞疗效的准确判定。     

医用明胶海绵栓塞支气管动脉治疗大咯血 （52例病人长期随访观察）

目的评价明胶海绵栓塞支气管动脉对大咯血病人的疗效。方法利用明胶海绵栓塞52例大咯血或顽固性咯血病人的支气管动脉,其中45例栓塞单支支气管动脉,3例栓塞同侧两支支气管动脉,4例行双侧支气管动脉栓塞。52例病人,其中肺结核38例,支气管扩张9例,肺癌4例。支气管动静脉畸形出血1例。结果经3个月～9年的随访,47例栓塞后咯血完全控制,4例仍有间断性痰中带血,但出血量明显减少,出血间隔时间延长。1例支气管动静脉畸形栓塞后出血停止,但48h后发生急性大咯血窒息死亡。结论明胶海绵栓塞支气管动脉是治疗大咯血和顽固性咯血的有效手段。     

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 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     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

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.