支架联合125I粒子条植入术治疗上腔静脉综合征

目的 观察支架联合¹²⁵I粒子条植入术治疗上腔静脉综合征(SVCS)的短期效果。方法 回顾性分析40例SVCS,其中23例接受上腔静脉支架植入术(支架组)、17例接受支架联合¹²⁵I粒子条植入术(联合组);比较组间技术成功率、临床成功率、并发症发生率、支架通畅率,以及患者肿瘤无进展生存期(PFS)和总生存期(OS)的差异。结果 2组技术成功率均为100%;联合组与支架组临床成功率(94.12% vs. 91.30%)、并发症发生率(17.65% vs. 8.70%),术后1个月支架通畅率(100% vs. 91.30%)、2个月支架通畅率(100% vs. 82.61%),以及患者中位PFS(4.12个月vs. 3.83个月)和中位OS(22.44个月vs. 20.36个月)差异均无统计学意义(P均>0.05)。术后4个月联合组支架通畅率高于支架组(100% vs. 78.26%,P<0.05)。结论 支架联合¹²⁵I粒子条植入术治疗SVCS短期效果确切。     

125I粒子敷贴式鼻饲营养管用于食管癌恶性梗阻

目的 观察自制¹²⁵I粒子敷贴式鼻饲营养管用于治疗食管癌恶性梗阻的可行性和安全性。方法 对14例经病理证实的食管癌并伴Ⅲ~Ⅳ级吞咽困难高龄患者行DSA引导下¹²⁵I粒子敷贴式鼻饲营养管置入术,使¹²⁵I粒子完全覆盖肿瘤段上下各2 cm行近距离放射治疗;观察技术成功率、临床治疗成功率、手术时间、肿瘤吸收剂量[D90（90%肿瘤体积所接受的剂量）]、有无核素脱落、术后并发症及肿瘤控制情况,并比较术前与术后6~8周Karnofsky评分及Neuhaus吞咽困难分级差异。结果 对所有患者均成功置入¹²⁵I粒子敷贴式鼻饲营养管,技术成功率100%（14/14）;手术时间（27.37±4.82）min。临床治疗成功率85.71%（12/14）,D90为（52.19±6.64）Gy。9例（9/14,64.29%）患者诉治疗期间胸骨后间断性疼痛,可耐受。未发生核素脱落及其他并发症,肿瘤局部控制率为92.86%（13/14）。术后6~8周Karnofsky评分（t=-2.75,P=0.01）及Neuhaus分级（Z=9.72,P<0.01）均较术前明显改善。结论 ¹²⁵I粒子敷贴式鼻饲营养管制作及置入简单、便捷,可同时实现近距离放射治疗和胃肠营养。     

对比TACE联合125I粒子与联合仑伐替尼治疗肝细胞癌伴门静脉癌栓的有效性及安全性

目的 对比TACE联合¹²⁵I粒子植入或仑伐替尼治疗肝细胞癌(HCC)伴门静脉癌栓(PVTT)的有效性及安全性。方法 回顾性分析52例HCC伴Ⅱ/Ⅲ型PVTT患者,分为TACE联合¹²⁵I粒子组(A组,n=27)及TACE联合仑伐替尼组(B组,n=25);比较2组客观缓解率(ORR)、总生存期(OS)及不良反应率。结果A组ORR、中位OS、Ⅱ型PVTT中位OS及Ⅲ型PVTT中位OS分别为70.37%(19/27)、13.6个月、14.1个月及13.2个月;B组分别为32.00%(8/25)、11.3个月、12.3个月及10.4个月;A组上述指标均优于B组(P均<0.05)。A组不良反应发生率为48.15%(13/27),均未见严重并发症;B组不良反应发生率为88.00%(22/25),5例(5/25,20.00%)出现严重药物毒性反应。结论 TACE联合¹²⁵I粒子治疗HCC伴PVTT的有效性及安全性均优于TACE联合仑伐替尼。     

125I粒子植入术联合支气管动脉化疗栓塞治疗纵隔型肺癌和/或肿瘤纵隔淋巴结转移

目的 观察¹²⁵I粒子植入术联合经支气管动脉化疗栓塞(BACE)治疗纵隔型肺癌和/或肿瘤纵隔淋巴结转移的价值。方法 回顾性分析20例接受¹²⁵I粒子植入术联合BACE治疗的纵隔型肺癌和/或肿瘤纵隔淋巴结转移患者,观察术后肿瘤疗效反应、患者生存情况及生活质量等,评价联合治疗疗效。 结果 粒子植入术后患者均出现轻度不良反应,1例发生中度不良反应,未见重度不良反应。术后随访8~49个月,术后1个月卡诺夫斯基绩效状态量表(KPS)评分显著提高(P=0.019);术后6个月5例肿瘤完全缓解、9例部分缓解,4例疾病稳定,2例疾病进展,客观反应率为70.00%,局部控制率为90.00%;患者中位无进展生存期10.5个月,中位总生存期为20.5个月,总生存率45.00%。结论 ¹²⁵I粒子植入术联合BACE用于纵隔型肺癌和/或肿瘤纵隔淋巴结转移疗效和安全性均较好。     

TACE联合放射性125I粒子植入治疗不宜消融肝癌的安全性及有效性分析

目的 评价TACE联合¹²⁵I粒子植入治疗不宜消融肝癌的疗效。方法 将82例不宜消融的肝癌患者分为2组：联合组40例,予TACE联合¹²⁵I粒子植入治疗;对照组42例,予单纯TACE治疗。比较2组治疗后肝功能、血常规、血清甲胎蛋白（AFP）、并发症、客观有效率及远期生存率。结果 联合组¹²⁵I粒子植入术前、术后剂量学差异均无统计学意义（P均>0.05）。联合组术后3、6个月客观有效率[85.00%（34/40）、67.50%（27/40）]明显高于对照组[61.90%（26/42）、45.24%（19/42）;P均<0.05]。联合组患者中位生存时间为25.7个月,对照组为10.7个月;联合组1、2、3年累积生存率分别为77.50%、54.30%、23.30%,对照组为45.20%、32.60%、13.60%。联合组术后3个月及6个月血清AFP水平明显低于对照组（P均<0.05）。联合组治疗后1个月肝功能及血常规与术前差异均无统计学意义（P均>0.05）。结论 TACE联合¹²⁵I治疗不宜消融肝癌安全、有效。     

125I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞预防肝细胞癌合并门静脉主干癌栓患者上消化道再出血

目的 观察¹²⁵I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞（PTVE）预防肝细胞癌（HCC）合并门静脉主干癌栓（MPVTT）患者上消化道再出血的效果。方法 回顾性分析16例接受¹²⁵I粒子条-门静脉支架植入联合PTVE治疗的原发性HCC伴MPVTT患者,统计治疗后随访期间上消化道再出血、支架通畅性和生存时间。结果 16例均成功接受¹²⁵I粒子条-门静脉支架植入联合PTVE,未见严重治疗相关不良事件。随访15~1 620天,中位随访时间207天;期间10例发生上消化道再出血（其中4例死亡）,中位再出血时间为185天,治疗后1、3、6及12个月累积无上消化道再出血率分别为87.50%、68.18%、53.03%及26.51%;5例门静脉支架闭塞,11例支架均通畅,中位支架通畅时间为252天,治疗后1、3、6及12个月累积支架通畅率分别为100%、93.33%、84.00%及31.50%。共14例死亡,中位生存时间为210天,治疗后1、3、6及12个月累积总体生存率分别为93.75%、74.04%、60.58%及13.46%。结论 ¹²⁵I粒子条-门静脉支架联合PTVE对预防HCC伴MPVTT患者上消化道再出血有一定效果。     

125I粒子植入联合化学治疗干预晚期结直肠癌肝转移瘤效果

目的 观察¹²⁵I粒子植入联合化学治疗（简称化疗）对晚期结直肠癌肝转移瘤的治疗效果及安全性。方法 对27例晚期结直肠癌肝转移瘤（60个病灶）患者的肝转移瘤病灶行放射性¹²⁵I粒子植入,术后行二线化疗,观察治疗效果、不良反应及预后。结果 60个病灶均顺利植入粒子,剂量分布均匀,共植入粒子1 995枚,平均每个病灶植入粒子（33.41±24.79）枚。术后不良反应轻,予对症处理后均恢复。术后1周肝功能与术前相比无明显差异。以奥沙利铂联合方案化疗6例,伊立替康联合方案21例。化疗3、6个周期后肝转移瘤病灶直径及癌胚抗原（CEA）水平均较术前显著降低（P均<0.001）。中位无进展生存期为8.1个月,中位总生存期为14.6个月。结论 ¹²⁵I粒子植入联合化疗对晚期结直肠癌肝转移瘤安全性好,近期疗效佳。     

125I粒子抑制裸鼠T24移形细胞癌效果

目的 观察不同活度¹²⁵I粒子抑制裸鼠T24移形细胞癌的效果。方法 将40只接种T24人移形细胞癌株荷瘤裸鼠均分为高、中、低活度组和对照组,每组10只,分别于肿瘤中心植入1枚活度0.9 mCi（33.3 MBq）、0.6 mCi（22.2 MBq）、0.3 mCi（11.1 MBq）和0 mCi（粒子不含核素）的¹²⁵I粒子。检测并对比各组植入10、20天后90%肿瘤组织吸收剂量（D₉₀）、抑瘤率（IR）、HE染色放射治疗反应分级（RRG）、凋亡指数及B淋巴细胞瘤-2（Bcl-2）蛋白表达。结果 ¹²⁵I粒子植入后10、20天,各组D₉₀及IR均逐渐降低（P均<0.05）,¹²⁵I粒子周围5 mm以内肿瘤组织均见明显坏死,粒子活度越高、时间越长,坏死范围越大;同期各组凋亡指数均逐渐降低,Bcl-2蛋白表达逐渐增加（P均<0.05）。结论 ¹²⁵I粒子能明显抑制裸鼠T24移形细胞癌生长,促进肿瘤细胞凋亡是其作用机制之一。     

对比直接抽吸一次性取栓与支架取栓治疗急性大脑中动脉闭塞的辐射剂量

目的 对比观察直接抽吸一次性取栓（ADAPT）与常规支架取栓治疗急性大脑中动脉闭塞的辐射剂量。方法 回顾性分析54例大脑中动脉闭塞患者,按照不同介入治疗方法分为ADAPT组（n=29）和支架组（常规支架取栓,n=25）;比较2组术中透视时间、空气比释动能（AK）、剂量面积乘积（DAP）、摄影序列数和摄影帧数以及上述指标之间的相关性。结果 ADAPT组透视时间、AK、DAP、摄影序列数和摄影帧数均低于支架组（P均<0.05）。ADAPT组25例（25/29,86.21%）、支架组13例（13/25,52.00%）AK值<1.0 Gy,ADAPT组中AK值<1.0 Gy者占比高于支架组（P<0.01）;ADAPT组22例（22/29,75.86%）、支架组11例（11/25,44.00%）DAP值<100 Gy·cm²,ADAPT组中DAP<100 Gy·cm²者占比高于支架组（P=0.01）。透视时间与DAP（r=0.60,P<0.01）、AK（r=0.69,P<0.01）均呈正相关,DAP与AK呈正相关（r=0.81,P<0.01）。结论 ADAPT治疗急性大脑中动脉闭塞的辐射剂量低于常规支架取栓。     

腹腔镜超声用于复杂肝胆管结石病腹腔镜术

目的 观察腹腔镜超声(LUS)用于复杂肝胆管结石病腹腔镜术中的价值。方法 回顾性分析43例接受腹腔镜手术治疗的复杂肝胆管结石病患者,根据术中是否应用LUS将其分为LUS组(n=18)和未应用LVS(non LVS, NLVS)组(n=25),对比组间一般资料、术中及术后相关情况。结果 组间患者性别、既往史、合并症,以及具体术式、中转开腹、手术时间及术中失血量差异均无统计学意义(P均＞0.05)。LUS组术后胆道残石率为44.44%(8/18),NLUS组为80.00%(20/25),组间差异有统计学意义(P＜0.05)。术中应用LUS是术后胆道残石率较低的独立影响因素[OR=0.20,95%CI(0.05,0.77),P＜0.05]。结论 在复杂肝胆管结石病腹腔镜术中应用LUS可降低术后胆道残石率。     

Digital implantation

The digital implant is an excellent alternative to arthroplasty or fusion procedures, provided that all preoperative criteria are met. It appears to yield the best result with the fewest complications when inserted in a second or third toe at the proximal interphalangeal joint in a rectus foot type.     

Permanent pacemaker implantation after transapical transcatheter aortic valve implantation

The aim of the study was to determine the incidence of permanent pacemaker implantation (PPMI) in a cohort of 358 patients undergoing transapical aortic valve implantation (TAVI) using a balloon-expandable prosthesis between April 2008 and March 2011. After excluding patients who had had a previous PPMI (n=36; 10%), the study group consisted of 322 patients. These were divided into two groups: patients who required PPMI (PPM group) and patients who did not require it (non-PPM group). Preoperative, perioperative and one-year follow-up data were collected prospectively. Twenty (6.2%) patients required PPMI. Previous implantation of an aortic prosthesis (P=non-significant), previous coronary artery bypass grafting (P=0.05) and coronary artery disease (P<0.005) were more common in the non-PPM group. On logistic regression, only patient age seemed to be correlated to PPMI (P=0.05, odds ratio 1.08; CI 0.9-1.1). There was no difference in survival rate between the groups after 30?days (PPM group 95%, non-PPM group 93.6%). Similarly, the survival rate did not differ after one year (PPM group 84%, non-PPM group 80.9%; P=0.3). The PPMI rate after transapical TAVI using a balloon-expandable prosthesis is thus low, and has no impact on early and follow-up mortality.     

Penile prosthesis implantation

The development of effective systemic therapy for the treatment of erectile dysfunction has resulted in a significant increase in the number of men presenting for treatment. Not all men with erectile dysfunction will respond to systemic therapy; those who fail may be candidates for penile prosthesis implantation if second and third lines of treatment also fail or are rejected by the patient and his partner. Penile prosthesis implantation continues to play a role in the treatment of erectile dysfunction. There is a potential for the number of penile prosthesis implantation procedures to actually increase. The ideal penile prosthesis is a three-piece inflatable device that permits good penile flaccidity and increases in size and becomes rigid with inflation.     

Autologous chondrocyte implantation

Rationale for the treatment of cartilage damage in younger patients depends on a thorough understanding of the predisposing factors for the chondrosis and the stage of disease. Implantation with autologous cultured chondrocytes allows for resurfacing of larger defect areas with reproducibly good/excellent results in 90% of patients with isolated lesions of the femoral condyle. Patellar lesions also may be successfully treated (approximately 75% improved) but strict attention must be given to correction of malalignment. Results in patients with tibial and salvage lesions are encouraging; however, these results should be viewed with caution due to the small number of patients with 2-year follow-up. Autologous chondrocyte implantation involves an open technique with the inherent disadvantages of adhesions and a more prolonged recovery. However, these disadvantages must be weighed against the procedure's ability to produce a hyaline-type tissue with greater durability than fibrocartilage repairs produced by traditional marrow-stimulation techniques. We recommended matching the treatment procedure to patient expectations and lesion/demographic characteristics. Based on the available literature. algorithms have been published that recommend autologous chondrocyte implantation be reserved as first-line treatment for high-demand patients with large lesions (>2 cm2) and as revision therapy in patients with lesions of all sizes, regardless of patient demand, who have failed alternative marrow stimulation techniques.     

Temporary ectopic implantation

Temporary ectopic implantation is a technique designed for extremity salvage in cases of devascularization or amputation of an essentially intact part in conjunction with extensive segmental proximal injury. A case of a traumatic midforearm amputation that survived by ectopic implantation in the abdominal wall, with subsequent replantation eleven weeks later, is presented.