介入法取胃内异物

在临床工作中经常见到胃内异物．多采取内镜或外科手术取出,介入法取异物未见文献报道．近半年来笔者遇到胃内金属异物5例．经内镜下试取均失败,患者亦均拒绝接受手术．后采用介入法将5例共7件金属异物全部成功取出．且末引起任何并发症,疗效满意．现报告如下．     

透视下套管法钳取深部软组织内金属异物

目的 探讨深部软组织内金属异物透视下套管法钳取术的可行性和安全性。方法 23例69颗金属异物深部软组织内存留患者。异物长度为0．2－3．0cm,宽度为0．1－0．5cm,离体表最矩距离为2－5cm,存留时间7－120d。采用钳夹式椎间盘摘除器套装,透视下用定位针将外套管引入到异物处,并送入髓钳夹住异物取出体外。结果 23例患者69颗异物均1次成功取出。手术时间为8－15min,X线暴射时间为1－4min。未发现并发症。结论 透视下套管法钳取术,是取出深部软组织内金属异物的1种新的简便、安全可行的方法。     

吞服金属异物24例手术治疗体会

1998年4月20日、5月15日,我院收治二批吞服金属异物病人24例,均经手术治疗,术后无并发症,痊愈出院。1　临床资料1.1　一般情况　本组男16例,女8例;年龄19～34岁,平均23岁。皆因毒瘾所致的变态心理和企图逃避强制戒毒或劳动而吞金属异物。吞最多者为5件。异物存留时间:15d1例,3d6例,2d14例,1d3例。存留部位:食管中段1例,胃6例,十二指肠3例,空回肠11例,结肠3例。异物类型:钢板(皮鞋底板)、发夹、8号铁丝、门扣、螺丝钉,最大为15cm×2.5cm×0.2cm,最小为3cm×0.3cm×0.2cm,平均10cm×2cm×0.2cm。1.2　手术情况　均手术治疗,21例为第1次手术,2…     

胃十二指肠恶性梗阻金属内支架治疗的方法探讨

目的 探讨金属内支架治疗不能手术的胃十二指肠恶性梗阻的方法和疗效.方法 回顾分析9例胰头癌和6例胃癌所致胃十二指肠梗阻患者行金属内支架置入术的资料,分析内支架置人治疗中的操作要点以及影响术后疗效的因素.结果 ①患者术中体位因人而异,因时而异;②经导管注入空气撑开胃腔有利于插管操作;③采用7F指引导管可减少与超硬导丝之间的相对摩擦力;④医生通常在全视野近距离透视下操作,所受辐射剂量较大;⑤插入超长超硬导丝过程中,根据张力将导管导丝联合后撤可减少导丝盘曲;⑥调整超长超硬导丝走向与胃腔形态相符合有利于插入释放器;⑦影响术后疗效的主要因素为病变位置特点、患者饮食习惯及疾病发展转归,患者的死亡原因主要为转移和全身衰竭.结论 关注手术操作的细节和要点是成功实施金属内支架治疗胃十二指肠恶性梗阻的关键,肿瘤的发展转归是影响疗效的决定因素.     

X线电视监视下钳取女性膀胱内异物

本文搜集3家医院1988-1998年11例膀胱内各种不同类型的异物，均在X线电视导引下经尿道顺利取出，未发生任何并发症。现着重介绍膀胱内异物取出方法和注意事项。1材料与方法1.1一般资料11例全部为女性，年龄16-56岁，平均30岁。发病因素为两类：一类是因好奇（性自慰）不慎将异物经尿道插入膀胱，7例；另一类是泌尿外科手术中留置输尿管支架管，4例。1．2膀胱内异物的种类体温计3例，金属发铗3例，金属外壳微型圆珠笔1例，输尿管支架管4例。1．3治疗方法和注意事项X线片上如异物表面有钙盐沉着结石形成者为本治疗方法的禁忌证。术前患者排尿…     

颞下窝金属异物的治疗经验

１９６９～１９８９年间，共收治１０例颞下窝金属异物患者，介绍如下。临床资料本组共１０例，男７例，女３例。年龄５～４２岁，平均２１岁。枪伤９例，其中汽枪４例，小口径步枪３例，猎枪２例；手榴弹伤１例。伤道经换药愈合后，用长注射针头插入颞下窝，经Ｘ线照片确...     

跨中线颅中窝穿通性脑损伤并颅内巨大金属异物救治成功一例

跨中线颅中窝穿通性脑损伤并颅内巨大金属异物救治成功一例周修玉张之营孟令军孙德州张华患者男，３６岁，电气焊工人，因爆炸伤昏迷呕吐５小时于１９９６年９月１１日１５点３０分入院．患者在气焊工作中，所焊油桶爆炸，爆飞的焊枪自鼻翼左侧插入颅内，伤后即昏迷．查体...     

七例十二指肠金属异物手术治疗体会

胃肠道异物是较常见的临床急症之一 ,而嵌于十二指肠的金属异物则很少见。我院从 1980年至 1999年共收治 7例嵌顿在十二指肠降部和水平部之间金属异物的患者 ,并行十二指肠切开取异物术 ,现总结如下 :临床资料　本组男 6例 ,女 1例。年龄 2 0～ 41岁 ,平均 2 6岁。异物在体内停留最长时间 95ｄ ,最短时间 35ｄ。 7例病人均为有意吞服金属异物 ,其中吞服长 15ｃｍ ,宽 1.5ｃｍ ,厚 0 .3ｃｍ的直硬金属异物 5例 ;长 14～ 15ｃｍ ,直径0 .5ｃｍ金属棒和铁钉各 1例。全部病人均有上腹部不适或持续性隐痛。腹部平片均显示腹部金属异物。稀钡剂检…     

自制异物钩及异物勺经胃镜取异物12例

我院１９９２年６月～１９９８年１月共收治胃异物患者１２例,采用自制异物钩及异物勺,经胃镜取异物获得成功,现报告如下。１　临床资料　本组患者１２例,男８例,女４例,年龄１７～３４岁,均为服异物自杀者。所有患者均于服异物后３ｈ内就诊,并行Ｘ线或胃镜检查确诊,其中食道内异物３例,胃内异物９例。异物种类有钥匙、戒指、折叠剪、钉子、木螺丝、瓷块。２　制作和使用方法　取直径约１－０ｍｍ的铁丝４０ｃｍ及纱布１块,分别制成大小不等的异物钩及异物勺（见图１）。异物钩由铁丝直接弯曲而成,呈鱼钩状,长约２－０～３－０…     

上消化道异物137例成因与胃镜下治疗分析

<正>上消化道异物10%～20%可在内镜下取出,0.4%～14%需手术治疗。异物若存留超过24 h,并发症的危险将大为增加,因此内镜介入治疗不应延迟。2004—2011年我们对发病在24 h内的137例上消化道异物进行了急诊胃镜下治疗,现将体会报告如下。1资料与方法1.1一般资料本组137例患者中男73例,女64例,年龄16～79岁,平均(55.4±3.6)岁,其中11～40岁31例,     

介入性再通术治疗输卵管阻塞性不孕症的临床应用

目的 :研究介入性再通术治疗输卵管阻塞性不孕症的临床疗效和综合治疗技术。方法 :将同轴导管沿着特制角部定位导丝插入子宫角部 ,输卵管插管成功后 ,对阻塞段行导丝再通或高压推注法再通。在介入性再通术基础上结合中医活血化瘀法辅助治疗。结果 :再通率为 90 %。介入结合中医药组 66例 ,2 9例受孕 ,受孕率为 43 .9% ;单纯介入组42例 ,16例受孕 ,受孕率为 3 8.1% ,两组受孕率比较 ,P <0 .0 1,综合治疗组受孕率高于后者。对 10 8例患者利用特制钩形角部定位导丝行介入再通 ,插管成功率为 10 0 %。伞端再通成功率为 60 %。结论 :介入再通结合中医活血化瘀法综合治疗输卵管阻塞性不孕症 ,明显提高了临床疗效。     

Intravascular foreign bodies: loop-snare retrieval system with a three-lumen catheter.

A foreign body retrieval system composed of a three-lumen catheter, a guide wire, and a wire loop nearly perpendicular to the axis of the catheter was used to retrieve catheter fragments located in the inferior vena cava in two patients and in the superior vena cava in one patient. Fragments were looped within 1 minute of catheterization and were retrieved without complication. Catheter fragments placed in the pulmonary artery of one dog were also successfully retrieved.     

气管支架置入术治疗重症气道狭窄的疗效与经验

目的总结气管支架置入术治疗重症气道狭窄的疗效和经验。方法各种原因引起的气管和主支气管狭窄患者13例。术前常规行高千伏胸部X线摄片和CT检查以了解气道狭窄的部位、形态和范围。狭窄段位于气管10例、右侧主支气管1例、左主支气管2例。在透视下将多功能导管配合超滑导丝经过声门进入气管,随后更换金属加强导丝并随导管越过狭窄段,将导丝留置于狭窄段远端,撤除导管,将装有支架的置入器沿导丝送至狭窄段,释放支架。结果全部支架均成功置入,技术成功率100%。术后所有患者呼吸困难症状明显改善,恶性肿瘤患者平均存活时间为6.2个月,1例良性气管狭窄患者随访5年仍无再狭窄。结论气管支架置入术是治疗重症气道狭窄的有效方法。     

Use of a newly designed multifunctional coil catheter for stent placement in the upper gastrointestinal tract

PURPOSE: To evaluate the usefulness of a newly designed multifunctional coil catheter for stent placement in patients with upper gastrointestinal tract strictures. MATERIALS AND METHODS: Constructed in our research laboratory, the coil catheter was used in 202 consecutive patients with malignant (n = 191) or corrosive (n = 11) upper gastrointestinal tract strictures. The coil catheter was made of a stainless-steel coil (1.3-mm inner diameter, 1.8-mm outer diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the coil catheter was evaluated based on whether the coil catheter could pass the stricture over a guide wire and whether measurement of the stricture length was possible while the guide wire was in place. RESULTS: The passage of the coil catheter over a guide wire beyond the stricture was technically successful and well tolerated in 199 of 202 patients (99%). Negotiation of a guide wire or a coil catheter through the stricture of the stomach (n = 2) or duodenum (n = 1) under fluoroscopic guidance failed in three patients. In two of these three patients, it was possible to negotiate a guide wire and a coil catheter under combined endoscopic and fluoroscopic guidance; it was not possible in the third. There were no procedure-related complications. CONCLUSION: The newly designed multifunctional coil catheter is useful in stent placement in patients with upper gastrointestinal tract strictures.     

Superelastic guide-wire snare for removal of foreign bodies from the urinary tract.

A superelastic guide wire was used (after failure of other methods) as a loop snare to retrieve a foreign body from the ureter in three patients. In vitro comparison of the expansion capability of the superelastic guide wire and that of the standard retrieval wire showed that the superelastic wire forms larger loops within an elastic space. Also, because of less frictional resistance and its ability to be formed into stiffer loops, the superelastic wire resists kinking and is easier to manipulate than the standard wire.     

42例介入治疗髂动脉和股动脉闭塞性病变的临床疗效观察

目的 探讨介入治疗对于髂、股动脉闭塞性病变的临床疗效.方法 回顾性分析42例髂动脉和(或)股动脉闭塞患者的临床资料.42例患者分别采用经导管溶栓、导丝开通、经皮血管腔内成形术(PTA)、支架置入术等方法进行介入治疗,随访2年,对介入治疗前后Rutherford评分进行双尾法配对Wilcoxon检验,踝肱指数(ABI)进行双尾法配对t检验.结果 治疗中,首次开通成功率97.6%(41/42),2次开通成功率100%(42/42).溶栓治疗26例,机械开通31例,PTA 33例,支架置人31例(60枚).术中未出现血管破裂、穿孔等严重并发症.术后所有患者下肢缺血症状明显减轻或消失.Rutherford评分由治疗前中位数4.0分降至治疗后中位数1.0分,差异具有统计学意义(Z=-5.887,P<0.01);踝肱指数由治疗前0.34±0.14增加至0.65±0.10,差异也具有统计学意义(t=25.924,P<0.01).术后1年初次开通率92.8%(39/42),2次开通率100.0%(42/42);术后2年初次开通率71.4%(30/42),2次开通率97.6%(41/42).结论 介入治疗髂、股动脉闭塞性病变,创伤小、疗效好,具有良好的临床应用价值.     

输卵管妊娠非血管介入治疗的临床研究

目的：评价输久管介入治疗的新方法以及与其他药物治疗的比较。方法：在Ｘ线透视下,选用球茎端导管引导３Ｆ微细导管配０．０４５ｃｍ白金头导丝,经阴道,宫腔插入输久管,对输卵管妊娠的孕囊进行穿刺,并注入氨甲喋呤使孕囊死亡。结果：２５例患插管均一次成功,２２例患治愈,治愈率为８８．００％。     

Noninfectious complications of long-term central venous catheters: radiologic evaluation and management

During a 5-year period, 416 long-term double-lumen central venous catheters were inserted into 288 patients. In these patients, 106 catheter venograms and nine upper extremity venograms were performed. All studies were reviewed retrospectively to determine the nature and prevalence of noninfectious catheter-related complications, to evaluate the efficacy and safety of streptokinase therapy, and to determine if catheter venography should be performed before streptokinase therapy is started. Noninfectious complications occurred in 66 (23%) patients. Complications that resulted in catheter malfunction included deposition of fibrin around the catheter tip (formation of a fibrin sheath) in 44 (57%) instances, a constricting suture in six, abutment of the catheter tip against the venous wall in eight, catheter leak in two, and migration of the catheter completely out of the vein in three. Venous thrombosis developed in 11 patients. Treatment with low doses of streptokinase successfully relieved catheter obstruction due to a fibrin sheath in 27 (87%) of 31 instances. No bleeding complications occurred. Five patients had malpositioned catheters in the azygous, axillary, or internal jugular veins. By use of a deflector wire or snare inserted via the femoral vein, all five were relocated successfully into the superior vena cava. Recognition of noninfectious complications associated with use of long-term catheters is important for institution of appropriate therapy, which in many instances obviates removal of the catheter. Formation of a fibrin sheath in only 57% of cases of catheter malfunction provides an argument for performing catheter venography before streptokinase therapy is started. Low-dose streptokinase therapy for long-term central venous catheters occluded by a fibrin sheath is safe and efficacious.     

节段性狭窄闭塞型布-加综合征的介入治疗

目的:探讨节段性狭窄闭塞型Budd-Chiari综合征(BCS)的介入治疗价值及方法.方法:搜集26例BCS病例资料,其中9例为下腔静脉(IVC)节段性狭窄,17例为IVC节段性闭塞.对单纯IVC狭窄患者行球囊扩张术,对IVC节段性闭塞患者先使用导丝硬头钝性开通或TIPS穿刺针锐性开通,然后行球囊扩张术.如多次球囊扩张...     

经口放置金属支架治疗胃、十二指肠及空肠恶性狭窄67例

目的 探讨经口放置胃肠道内支架的方法,评价金属支架在治疗胃、十二指肠及空肠恶性狭窄中的作用。方法 胃、十二指肠及近端空肠恶性狭窄病例67例。在X线监视下通过递送导管或胃镜经口送入超滑导丝并使之过胃、十二指肠狭窄或阻塞段;经交换导管替换软头特硬导丝后由硬导丝引入附镍钛合金支架之套管式推送器将支架送入狭窄段释放。对完全阻塞使用胃镜仍不能将导丝送入者则经胃镜用微波或热极烧灼形成小通道后再送入导丝引入支架（5例）。结果 67例中有64例经97例次操作,成功地放置了83个支架。支架置于胃体及幽门部18个,胃肠吻合口17个,十二指肠降段和水平段44个,近端空肠4个。另3例经5次操作放置支架未成功。支架置入病例临床症状均获缓解（59例）或明显改善（5例）。术后1个月复查支架通畅率97．5％,有4例共5个支架分别于支架置入后16－61d移位脱落,其中1个经口取出、3个自行经肛门排出、1个滞留于回盲部但均未出现并发症。结论 经口放置金属支架能有效缓解胃、十二指肠及空肠梗阻,为提高晚期肿瘤患者的生活质量、延长其生存时间,提供了姑息性治疗的方法。