直视下射频消融治疗肝泡状棘球蚴病大鼠模型

目的 探讨直视下射频消融（RFA）治疗大鼠肝泡状棘球蚴病（HAE）的疗效。方法 对30只成功接种泡状棘球蚴病的Wistar雌性大鼠模型分别暴露HAE病灶,开腹直视下穿刺病灶,行单极针穿刺及RFA,计算穿刺及消融成功率。结果 27只穿刺成功（27/30,90.00%）。病理显示19只HAE病灶消融完全,完全消融成功率70.37%（19/27）,病灶呈现凝固性坏死。结论 开腹RFA治疗HAE大鼠技术简单易行,消融后病灶凝固性坏死明显。     

大鼠肝泡状棘球蚴病超声引导下经皮穿刺与开腹造模的比较

目的 比较肝泡状棘球蚴病超声引导下经皮肝穿刺与开腹直视肝内注射肝泡状棘球蚴原头节两种造模方法的优缺点及对后续介入实验研究的影响。方法 将162只Wistar大鼠分成超声引导下经皮穿刺组及开腹接种组,每组81只,用超声引导下经皮肝穿刺和开腹直视下肝内注射肝泡状棘球蚴原头节的方法制备肝泡状棘球蚴病动物模型,以超声筛查动物模型。实验结束后处死动物,对比分析造模情况。结果 超声引导下经皮穿刺组80只成活,其中48只造模成功,肝脏病变阳性率60.00%(48/80),病灶生长部位固定,与周围粘连、侵犯门静脉等脉管系统较轻,3只门静脉插管失败,插管成功率为93.75%(45/48);开腹接种组77只成活,其中33只造模成功,肝脏病变阳性率为42.86%(33/77),病变部位不固定,与周围脏器粘连显著,8只病变侵犯门静脉而插管失败,插管成功率为75.76%(25/33)。超声引导下经皮穿刺组造模肝脏病变阳性率及插管成功率均高于开腹接种组(χ²＝4.617、5.394,P＝0.032、0.020)。结论 肝泡状棘球蚴病介入实验研究采用超声引导下经皮穿刺造模的方法病变阳性率高,造模过程简单,动物痛苦小,死亡率低,适宜后续研究。     

超声在筛检大鼠肝泡状棘球蚴病模型中的应用价值

目的 评价超声在筛检大鼠肝泡状棘球蚴病模型中的应用价值.方法 采用经皮肝脏穿刺注射泡状棘球蚴组织混悬液的方法,制备原发性HAE模型,40只Wistar大鼠接种6个月后行B超检查及开腹探查.结果 B超检查示21只大鼠感染泡状棘球蚴,19只未感染,感染率52.50%.开腹探查证实B超检查21只阳性中1只未感染,19只未感染中1只为阳性.B超检查的灵敏度为95.24%,特异性为94.74%,假阳性率为4.27%,假阴性率5.27%.结论 B超检查诊断大鼠肝泡状棘球蚴感染的灵敏度及特异度均较高,可做为一种无创性筛选大鼠肝泡状棘球蚴感染的方法.     

灰阶超声造影在肝泡状棘球蚴病中的应用

目的 探讨肝泡状棘球蚴病灰阶超声造影的特征性表现.方法 对9例肝泡状棘球蚴病灶在二维超声、彩色多普勒血流显像的基础上进行灰阶超声造影检查,回顾性分析其声像图表现.结果 二维声像图显示9例患者共11个病灶,其中8个病灶呈实质性中高回声,外形极不规则;另3例病灶呈混合型,中央见不规则无回声区.彩色多普勒血流显像示11个病灶内部均无血流信号.超声造影在动脉早期所有病灶周边即出现边框样增强带,并持续至实质期,11个病灶内部在造影期间均未见增强.结论 超声造影可以更好地显示肝泡状棘球蚴病病灶的确切边界,反映周边增殖区微血供状态,为肝泡状棘球蚴病外科手术提供更多的诊断信息.     

兔VX2肝癌模型的肝动脉插管技术改良及DSA表现

目的：探讨对兔VX2肝癌模型肝动脉插管技术的改良，并研究其DSA造影表现。方法：制作36只兔VX2肝癌模型。实验组（26只）采取改良显微外科手术直接行肝动脉插管法行介入治疗，对照组（10只）采用3F微导管经股动脉-肝动脉插管法作对比研究。术前及术后用DSA造影方法进行兔VX2肝癌的影像学观察。结果：实验组的插管成功率为88％（23／26），对照组的插管成功率为40％（4／10）。27只插管成功模型DSA造影示瘤周血管增粗紊乱、大量细小的异常血管．其中24只肿瘤呈均一的或结节样染色。结论：采用显微外科手术改良的肝动脉插管法对兔VX2肝癌模型行介入治疗成功率较高，且可减少实验人员接受的X线辐射，DSA造影可较好评价肿瘤血供情况，是一种较好的实验方法。     

综合保温措施在晚期肝泡状棘球蚴病自体肝移植围术期的应用

目的：探讨综合保温措施在晚期肝泡状棘球蚴病自体肝移植围术期的应用效果,为提高手术成功率提供理论依据。方法选取18例晚期肝泡状棘球蚴病行自体肝移植术的患者,采用适度提高室温、身体包裹、输液加温、湿敷料加温、冲洗液加温与铺置保温毯的综合保温措施,通过监测肛温、鼻咽温、心率、血压、pH值,验证此法是否有效。结果在新肝再灌注5 min时,患者鼻咽温、肛温分别为：(35.78±0.69),(35.97±0.65)℃,pH值为(7.29±0.08),均显著下降;心率加快为(100.58±5.47)次/min,差异有统计学意义(P<0.01)。在无肝期后30 min和新肝再灌注5 min时,收缩压分别为(82.21±10.45),(83.59±12.71)mmHg,均显著下降,差异有统计学意义(P<0.01);以上指标均在新肝再灌注30 min后恢复正常。结论在晚期肝泡状棘球蚴病自体肝移植围术期,综合保温措施的应用能有效地预防术中低体温的发生。     

猪冠状动脉微栓塞致心肌梗死模型的建立

目的 以聚乙烯醇(PVA)为栓塞剂, 采用经皮微导管介入方法建立可长期存活的猪冠状动脉微栓塞(CME)致心肌梗死模型。方法 对16只西藏小型猪经股动脉选择性插管, 于左前降支动脉第一对角支开口处远端缓慢注入不同浓度100 μm PVA, 于术后第3天、第60天行640层容积CT心肌灌注成像;动物处死后对心肌组织行TTC染色和病理学观察。结果 9只动物造模成功并长期存活, 其PVA浓度为0.001 ml/ml, 注射总量10 ml;CT心肌灌注成像示左心室心尖前壁、侧壁及间隔壁灌注缺损, 主要位于心内膜下, 部分累及心外膜下心肌;心脏TTC染色和病理示微血管栓塞区域心肌梗死。结论 以PVA颗粒为栓子, 采用经皮微导管介入方法建立猪CME致心肌梗死模型成功率高、存活时间长, 为临床研究CME致心肌梗死的理想动物模型。     

实时超声造影诊断肝泡状棘球蚴病

目的 评价实时CEUS诊断肝泡状棘球蚴病(HAE)的价值。方法 38例疑似HAE患者(共55个病灶)接受二维超声和CEUS检查,分析其强化形态、强化模式,并与病理结果对照。结果 经手术病理证实,HAE者32例,共45个病灶,CEUS符合率为96.42%(53/55)。二维超声表现为"脑回征"或"熔岩洞样"改变、"岛屿状"改变、不规则肿块;CEUS三期均未见强化,呈"黑洞征"。结论 相对于二维超声,CEUS可准确反映HAE病灶内部组织成分,对HAE诊断与鉴别诊断有重要价值。     

应用四维CT灌注技术分析肝切除术后大鼠残肝微循环血流动力学变化

目的 应用四维CT灌注（4D-CTP）技术研究不同比例肝切除（PH）术后大鼠残肝微循环血流动力学变化。方法 将144只SD大鼠随机分入假手术（sham）组及50%、60%、70%、80% PH组,每组24只,余24只做补充实验。术后1 h、1、3和7天,sham组和手术组各取6只大鼠行4D-CTP检查,计算肝动脉灌注量（HAP）、门静脉灌注量（PVP）、总肝灌注量（TLP）和肝动脉灌注指数（HPI）,之后取肝脏行病理学检查。结果 共21只大鼠符合小肝综合征（SFSS）表现,70% PH组1只,80% PH组20只。各PH组PVP、TLP均于术后1 h达峰值,术后1天下降,术后3、7天趋于稳定;50%、60% PH组HAP、HPI术后1 h、1天降低,3天和7天略增高;70%、80% PH组HAP术后1 h最高,术后1、3、7天逐渐下降,HPI于术后1 h显著降低,术后1天进一步轻度降低,术后3、7天稍增高。术后1 h,80% PH组PVP、TLP高于50%、60% PH组和sham组（P均<0.05）,HPI低于sham组（P<0.05）;术后1天,80% PH组PVP、TLP高于sham组（P均<0.05）,HPI低于sham组（P<0.05）;术后3、7天各组PVP、TLP、HPI、HAP 差异均无统计学意义（P均>0.05）。结论 应用4D-CTP技术可定量分析大鼠PH术后残肝血流动力学变化,有效区分肝动脉、门静脉血流灌注异常。     

超声造影评价大鼠肝纤维化分期与肾血流灌注的相关性

目的 分析CEUS技术评价大鼠肝纤维化分期与肾血流灌注的相关性。方法 健康雄性Wistor大鼠50只,随机选取44只,经硫代乙酰胺诱导为肝纤维化模型(肝纤维化组),6只作为对照组。于造模后第4、8、12周分别选取12只肝纤维化组大鼠及2只对照组大鼠行CEUS检查。比较各期(S0~S4)肝纤维化大鼠肾血流灌注情况及时间-强度曲线检测指标变化,并进行统计学分析。结果 与其他各期和对照组比较,S4期大鼠肾皮质血流时间-强度曲线峰值强度减低、达峰时间延长、曲线下面积减小(P均<0.05)。峰值强度、曲线下面积与肝纤维化分期呈负相关(P均<0.01);达峰时间与肝纤维化分期呈正相关(P<0.01)。结论 CEUS结合时间-强度曲线可定量分析不同程度肝纤维化大鼠肾血流灌注情况。肾皮质CEUS参数变化与大鼠肝纤维化分期密切相关。     

经皮支气管动脉/体动脉植入药物输注系统灌注化疗治疗中晚期肺癌初步探讨

目的：研究经皮支气管动脉／体动脉植入药物输注系统（DIS）灌注化疗治疗中晚期肺癌。方法：Seldinger＇s技术经右侧股动脉进路选择性肺癌供血体动脉造影后行超选择性插管并留置植入导管,连接植于右髂窝皮下囊的药盒组成DIS,经DIS进行灌注化疗。结果：3例晚期肺癌,分别采用4F-C2／Yashim超滑导管-ImplantofixⅡ／Soph-A-Port成功行左锁骨下动脉、右叶支气管动脉植入DIS,多次灌注化疗。结论：支气管动脉或供血体动脉植入DIS进行灌注化疗,是一种值得进一步研究应用的肺癌介入治疗方法。     

Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation

BACKGROUNDEarly hepatic artery thrombosis (E-HAT) is a serious complication after liver transplantation (LT), which often results in graft failure and can lead to patient deaths. Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy. Due to the advances in interventional techniques and thrombolytics, endovascular treatments are increasingly being selected by more and more centers. This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIMTo evaluate the feasibility and reasonability of intra-arterial thrombolysis for E-HAT after deceased donor LT.METHODSA total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016. Four patients were diagnosed with E-HAT. All of these patients underwent intra-arterial thrombolysis with alteplase as the first choice therapy after LT. The method of arterial anastomosis and details of the diagnosis and treatment of E-HAT were collated. The long-term prognosis of E-HAT patients was also recorded. The median follow-up period was 26 mo (range: 23 to 30 mo).RESULTSThe incidence of E-HAT was 2.7% (4/147). E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed. The patients were given temporary thrombolytics (mainly alteplase) via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump. Alteplase dose was adjusted according to activated clotting time. The recanalization rate of intra-arterial thrombolysis in our study was 100% (4/4) and no thrombolysis-related mortality was observed. During the follow-up period, patient survival rate was 75% (3/4), and biliary complications were present in 50% of patients (2/4).CONCLUSIONIntra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT. Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.     

儿童肝包虫病的CT特点

目的 探讨儿童肝包虫病的CT表现。方法 回顾性分析27例经病理和/或血清学证实的肝包虫病患儿的临床和CT资料。结果 27例肝包虫病中,肝囊型包虫病26例,肝泡型包虫病1例;单纯肝包虫病10例,合并其他器官包虫病17例;肝内单发包虫18例,多发包虫9例。共发现囊型病灶47个,其中单囊型囊肿占51.06%（24/47）,内囊塌陷型囊肿占42.55%（20/47）,钙化型囊肿占4.26%（2/47）,多子囊型囊肿占2.13%（1/47）,未见实变型囊肿;泡型病灶1个。74.47%（35/47）的囊肿直径>5 cm。结论 CT可定性诊断儿童肝包虫病,是可靠的检查方法。     

超选择性子宫动脉造影的临床应用研究

目的探讨超选择性子宫动脉造影的技术特点,了解子宫动脉形态特征,提高介入治疗的成功率. 方法 158例患者,年龄19～53岁,其中子宫肌瘤患者119例,宫外孕14例,盆腔恶性肿瘤15例,子宫大出血10例.造影导管选用Cobra、headhunter、MP、RUC导管等. 结果两侧316支子宫动脉形态、直径、分布基本对称,196支起自臀下阴部动脉干,占62%;98支起自髂内动脉主干,占31%;13支起自臀上动脉,占4%;9支起点分辨不清.子宫动脉起始处管径比中间段细,与起始动脉之间的夹角变化大.171支子宫动脉与起始动脉的夹角≤60°,约占54%;136支夹角在60°和90°之间,约占43%;9支夹角≥90°,约占3%. 结论 45°斜位造影可帮助我们了解子宫动脉详细的分布情况,顺利完成操作;4.0～5.0F导管可完成超选择性子宫动脉造影的需要;决定插管成功的因素是认清子宫动脉起始的角度.     

经导管动脉栓塞治疗医源性肝动脉损伤

目的:探讨医源性肝动脉损伤(Iatrogenic hepatic arterial injuries,IHAI)数字减影血管造影(Digital subtraction angiography,DSA)表现及介入栓塞治疗的疗效。方法:本组23例IHAI患者,先行选择性动脉造影,明确出血部位及性质,然后超选择性动脉栓塞,栓塞材料选择弹簧圈、微弹簧圈、明胶海绵。结果:DSA显示假性动脉瘤14例,对比剂外溢5例,肝动脉胆管瘘3例,肝动脉门静脉瘘1例。栓塞技术成功率100%(23/23),临床成功率87.0%(20/23),2例二次栓塞成功止血,1例二次栓塞后仍间断出血。术后1月内3例分别死于感染性休克、多器官衰竭及突发呼吸心跳骤停,8例于术后3~14月死于多器官衰竭或恶性肿瘤进展,余12例随访1~26月未再出现大出血。术后3 d血红蛋白明显升高(P<0.05),肝功能较术前升高,但统计学无显著差异(P>0.05),术后30 d血红蛋白及肝功能基本恢复到正常范围,未出现其它严重并发症。结论:经导管动脉栓塞术可作为IHAI首选治疗方法。     

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

ObjectiveThis study aimed to introduce and evaluate a new embolization technique for the right gastric artery (RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy (HAIC).MethodsFrom January 2013 to January 2017, 159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 86 of these patients (56 men; aged 28–88 years; mean: 60.6 ​± ​12.0 years), in whom the RGA was obvious on arteriography, embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC. In the first phase (first three years), antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients. In the second phase (next two years), embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery (LGA) in 31 patients. The success rates and the incidence of acute gastroduodenal mucosal toxicity (AGMT) in these two groups were compared.ResultsThe total success rate of the RGA embolization was 70.9%. The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization, which was significantly higher than that of antegrade embolization alone (63.6%) performed in 55 patients (p ​= ​0.047). No complications related to embolization of RGA were documented. The incidence of AGMT was 29.1% (16/55) in patients in the first phase, which was significantly higher than that in the patients in the second phase (9.7%, 3/31) (p ​= ​0.037).ConclusionA combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.     

256层螺旋CT血管成像术前评价肾癌肾动脉解剖及肿瘤供血动脉

目的 采用256层MSCTA观察肾癌患者肾动脉解剖及肿瘤供血动脉情况,为肾癌患者术前评估提供影像学信息。方法 回顾性分析56例经手术后病理确诊的肾癌患者(肾癌组)及300例非肾癌患者(对照组)肾动脉CTA资料,采用VR及MPR技术重建肾动脉图像,观察肿瘤供血动脉形态改变、肿瘤与肾动脉空间解剖关系及肿瘤肾外迷走供血动脉情况;比较肾癌组及对照组肾动脉解剖及变异差异。结果 肾癌组肿瘤位于左肾者31例、位于右肾者24例、双肾癌1例,肿瘤最大径(5.86±2.48)cm;肾动脉主干及分支、肾盂、肾静脉呈各种受压、受侵改变;患侧肾动脉直径分别为左侧(7.14±0.72)mm、右侧(7.04±0.70)mm,较对照组 明显增粗(P<0.05);共发现肿瘤肾外迷走供血动脉27支,分别来自脾动脉、肠系膜下动脉、膈下动脉、肾包膜动脉、肝动脉、腰动脉及肠系膜上动脉。肾癌组肾动脉变异率与对照组比较差异无统计学意义     

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

BACKGROUNDIleal hemorrhagic infarction after carotid artery stenting (CAS) is a fatal complication. The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner. We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS. CASE SUMMARYA 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment. On the first day after surgery, the patient had abdominal distension and abdominal pain. Abdominal enhanced computed tomography revealed intestinal obstruction, severe stenosis of the superior mesenteric artery, and poor distal angiography. An exploratory laparotomy was performed, and pathological examination showed hemorrhagic ileal infarction. It was subsequently found that the patient had intestinal flatulence. With the guidance of an ultrasound scan, the patient underwent abdominal puncture, drainage, and catheterization. After 58 d of treatment, the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points, and a Modified Rankin Scale score of 1 point. At the 6-mo follow-up, the patient had an excellent functional outcome without stroke or mesenteric ischemia. Furthermore, computed tomography angiography showed that the carotid stent was patent.CONCLUSIONIleal hemorrhagic infarction is a fatal complication after CAS, usually caused by mesenteric artery embolism. Thus, more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS, and the complications should be identified and treated as early as possible.