全麻下CT引导下经皮穿刺射频消融治疗肝内特殊部位的恶性肿瘤

目的 评价在CT引导下进行经皮穿刺射频消融(RFA)治疗肝内一些特殊部位的恶性肿瘤的可行性及临床价值.方法 18例肝脏恶性肿瘤患者,共有26枚肿瘤,分别位于膈下、肝门部、肝包膜下、下腔静脉旁、胆囊旁以及结肠旁等肝内的特殊部位.所有患者均先行TACE治疗,然后在全麻和CT引导下行经皮穿刺RFA治疗,观察穿刺、布针所费的时间.随访1 ～ 15个月,观察并发症和疗效.结果 所有患者费时为1 ～ 3 min完成穿刺、布针.26枚肿瘤共进行了35次RFA治疗,未出现任何严重并发症.20枚肿瘤完全坏死;6枚部分坏死.结论 本研究的结果表明,在全麻和CT引导下对肝内特殊部位恶性肿瘤进行经皮穿刺RFA治疗是可行的,在降低RFA的操作难度和风险方面具有一定的临床价值.     

超声引导下经皮射频消融治疗中晚期肝癌的临床研究

目的评价B超引导下冷循环射频肿瘤治疗仪射频消融(RFA)治疗中晚期肝癌的临床疗效及并发症。方法采用超声引导下经皮穿刺冷循环RFA治疗中晚期肝癌25例,其中转移性肝癌8例,原发性肝癌17例。每个病灶进行RFA1～2次。其中8例患者术前给予3次TACE治疗。术后通过增强CT扫描评价疗效。结果10个病灶完全坏死,余15个病灶大部分坏死。随访半年,25例患者现全部存活且生存质量明显提高。结论超声引导下经皮穿刺冷循环RFA治疗中晚期肝癌短期效果满意,值得推广。     

CT引导下射频消融术在肝脏恶性肿瘤治疗中的临床应用

目的评价肝动脉化疗栓塞(TACE)联合全麻下CT引导下经皮穿刺射频消融(RFA)治疗肝脏恶性肿瘤的疗效。资料与方法原发性肝癌患者20例,肿瘤切除术后复发6例,肝转移瘤5例,男23例,女8例,年龄40～74岁。所有患者均先行TACE术(1～2次),然后在全麻CT引导下经皮穿刺行RFA治疗,其中2例联合手术行RFA治疗,2例做了2次RFA治疗。随诊2～36个月,观察并发症和疗效。结果 31例患者共进行43次RFA治疗,未出现任何严重并发症。23个肿瘤完全坏死,11个部分坏死。结论 TACE联合全麻下CT引导下RFA治疗肝脏恶性肿瘤是一种有效的微创治疗方法。     

CT导向射频消融术治疗肝脏肿瘤

目的:探讨CT导向下经皮肝穿刺射频消融(radiofrequency,RFA)治疗肝脏肿瘤的安全性和有效性。方法:原发和转移性肝脏肿瘤28例,采用Radoionics中空冷却射频仪在CT引导下将射频电极置于肝肿瘤内,同时置入20G的穿刺针,从穿刺针中注入生理盐水5~10ml后进行治疗。并随访6~36个月,运用螺旋CT三期扫描评价治疗效果。结果:28例肝脏肿瘤,病灶32个,原发者20例,转移者8例,肿瘤最大直径≤3cm为26个,肿瘤直径在3~5cm之间为6个,经过RFA治疗,肿瘤完全坏死为25个,部分坏死占7个。6个月生存率100%,12个月生存率71.4%(20/28),生存36个月1例,部分病例还在随访中,未见其他严重并发症。结论:CT导向下经皮肝穿刺射频消融治疗肝脏肿瘤是一种安全、有效的方法。对于肿瘤直径≤3cm的肝脏肿瘤治疗效果较佳。     

经皮肝穿刺酒精消融术中的X线导向与X线联合B超导向的对比研究

目的探讨在经皮肝穿酒精消融术（PEI）中单纯使用x线导向与x线联合B超导向技术（简称联合导向组）的临床使用价值,比较两者导向手段的优缺点。方法选取40例肝脏恶性肿瘤的患者随机分为两组：其中单纯X线组20例;联合导向组20例。均进行经皮肝穿酒精消融术,术后第1天均行cT平扫了解病灶的消融药物分布情况。结果单纯x线组中目标病灶穿刺命中率低且病灶消融药物分布欠均匀,非目标区域出现消融药物概率低：联合导向组中目标病灶穿刺命中率高且病灶消融药物分布均匀,非目标区域出现消融药物概率也低。结论经皮肝穿酒精消融介入治疗术中联合导向的优势明显优于单纯X线导向,建议有条件的单位尽量使用联合导向。     

CT导向下周围型肺癌射频消融治疗的临床分析

目的 探讨CT导向下射频消融（RFA）治疗周围型肺癌的价值。方法 43例周围型肺癌进行了CT导向下射频消融治疗。术前常规CT导向下经皮穿刺活检获取病理学诊断，鳞癌15例，腺癌19例，腺鳞癌4例，大细胞癌3例，未分化癌2例。全部瘤体直径均〈8cm，其中32个病灶直径〈5cm。结果 全部病例手术顺利，术中并发少量气胸者3例，液气胸1例，大量气胸行闭式引流者1例。术后分别在3和6个月CT复查，显示43个病灶中40个体积均有不同程度的进行性缩小，肿瘤内部均出现大片不规则低密度区；3例患者病灶体积无变化，边缘有环状强化，提示肿瘤复发。结论 CT导向下经皮穿刺RFA治疗周围型肺癌是安全有效的微创技术，值得推广应用。     

CT引导下肝肿瘤射频消融治疗的并发症分析

目的 分析CT引导下肝肿瘤射频消融(RFA)治疗的并发症及处理.方法 252例肝肿瘤患者,其中原发性肝癌234例,肝转移癌11例,肝血管瘤7例.所有患者先行肝动脉栓塞术(TAE),然后在CT引导下行RFA治疗.肿瘤共计385个,直径为O.5～16 cm.行RFA 424例次,共计735个位点.绪果13例次(13/424,3.06%)出现并发症,分别为肝被膜下出血6例次,其中1例肝血管瘤患者出现失血性休克,急诊行肝动脉栓塞后出血控制,余患者经内科止血治疗后好转;气胸5例次,其中1例气胸量为90%,经胸腔闭式引流后吸收,余为少量气胸,自行吸收;胆汁瘤1例,经皮肝穿胆汁瘤引流后消失;无症状胆管分支扩张1例,未予特殊处理,自行好转.未出现死亡病例.结论 CT引导肝肿瘤RFA治疗是安全的,常见并发症为肝被膜下出血和气胸,经治疗后可痊愈.     

肝肿瘤CT引导经皮射频消融术后胆道并发症防治

目的 分析肝肿瘤CT引导经皮射频消融(RFA)术后胆道并发症的防治.方法 1 136例肝肿瘤患者共行RFA 1 944例次.其中35例次(35/1 944,1.80%)出现胆道并发症,观察胆道并发症类型及治疗方法.结果 35例次胆道并发症中无症状胆管分支扩张12例,未予特殊治疗.梗阻性黄疸2例,均行经皮肝穿胆道引流术(...     

经皮射频消融治疗肝脏肿瘤

目的：探讨经皮射频消融术(RFA)治疗肝脏肿瘤的临床应用价值。方法：14例经穿刺活检病理证实的肝脏肿瘤患者(原发性肿瘤10例，转移性肝癌1例，肝腺瘤1例，肝血管瘤2例)均行在13超或CT引导下的RFA治疗。所有患者的肝内病灶最大径均≤5cm。同时所有患者均在RFA治疗前，治疗后(1周，1月，3月，6月)行CTA或MRI，及免疫指标来评价疗效。结果：所有肝脏恶性肿瘤患者(11例)，术后的影像学上均可见原病灶局部坏死，气化,1周至六月的复查9例患者未见肿瘤复发征象，2例可见原病灶内及周围有复发征象；同时，AFP、CEA等免疫指标均明显下降。肝脏良性肿瘤的患者，术后在影像学上亦均表现局部坏死，气化，同时复查的增强扫描均未再发现病灶区有明显的强化，结论：经皮射频消融术在肝脏肿瘤的治疗中占有重要的位置，是安全有效的一种方法。     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

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.     

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     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

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.     

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.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].