头颈部静脉畸形的经皮硬化治疗

目的 探讨经皮穿刺酒精硬化技术在头颈部静脉畸形治疗中的安全性和价值。方法 9例头颈部静脉畸形患者，均采用经皮穿刺酒精硬化治疗。结果 9例患者共接受治疗16次，初次治疗的技术成功率为100％。7例患者术后症状明显改善，随访2～12个月，未见病变复发。结论 经皮穿刺酒精硬化技术是治疗头颈部静脉畸形的有效方法。     

静脉畸形及其泡沫硬化治疗研究进展

静脉畸形是一种胚胎血管在发生过程中结构异常引起的疾病,目前主流的治疗手段是硬化剂注射和手术切除。弥漫型的静脉畸形病变范围广,手术治疗常因为不能完全切除而导致复发。在泡沫硬化治疗中,硬化剂可广泛充盈于病灶而起到治疗作用,而且不留手术疤痕,操作简单,并发症较少。本文综述静脉畸形泡沫硬化治疗研究进展。     

临床护理解剖学(3)

颈内静脉穿刺插管术颈内静脉穿刺插管术是选择在颈内静脉下段进行穿刺,并插管进行高能营养疗法,或作中心静脉压测定。当头皮与肢体血管塌陷或硬化而难以穿刺成功时,选择该静脉是可取的。     

老年病人静脉穿刺逆行方法探讨

逆行静脉穿刺即离心式静脉穿刺，在静脉穿刺时采用与常规静脉穿刺相反的方向进针而实施的操作方法。老年病人由于静脉管壁增厚变硬、管腔狭窄、血管弹性降低、脆性增加、皮下脂肪少、血管易滚动、不易固定、容易刺破等原因，静脉穿刺成功率相对较低，特别是对于慢性病、肿瘤、消耗性疾病病人，长期的静脉输液使静脉硬化、闭塞。为了提高静脉穿刺成功率，本文尝试了逆行静脉穿刺方法，对穿刺成功率进行观察，现报道如下。     

介绍3种提高静脉穿刺成功率的方法

有些患者的血管已经硬化，或较细小，很难进行静脉穿刺。我们总结出3种能够改善血管穿刺条件，提高静脉穿刺成功率的方法。现报告如下。     

超声引导下外周静脉穿刺的临床应用

外周静脉穿刺是临床治疗中常见的护理操作之一。在临床工作中,外周静脉穿刺失败率高达20％［1］。肥胖、水肿、慢性疾病、低血容量、药物、血管畸形［2］、长期卧床、儿童患者［3］容易造成穿刺失败。如何提高外周静脉穿刺的成功率,长期以来一直是护理工作者研究的课题。近年来,越来越多的护理工作者将超声技术应用于外周静脉穿刺中。超声对组织和血流有较高的分辨率,可以清晰显示血管及其周围组织情况,有助于血管定位或者引导穿刺。超声引导下外周静脉穿刺可以提高穿刺的成功率［4］。本文就超声引导下外周静脉穿刺方面的相关研究进行综述。     

经内镜聚桂醇硬化治疗结肠血管畸形观察

目的 探讨内镜下聚桂醇注射液硬化治疗结肠血管畸形的疗效.方法 对经内镜检查确诊的10例结肠血管畸形患者予内镜下1％聚桂醇注射液多点注射硬化治疗.结果 首次硬化治疗后10例血管畸形患者均无复发性出血,2次治疗后有效率达100％.结论 内镜下1％聚桂醇注射液硬化治疗结肠血管畸形是安全、有效的,尤其适用高龄不能耐受手术者,并可进行反复治疗.     

体位改良应对PICC置管困难20例

经外周穿刺中心静脉（PICC）置管是经贵要静脉、肘正中静脉或头静脉穿刺，经腋静脉到达上腔静脉或锁骨下静脉，是深静脉置管的一种方法，起到了外周血管穿刺，中央静脉治疗的效果。临床PICC置管传统采用平卧位，但遇到血管塌陷、血管痉挛、血管扭曲畸形等情况常常会导致插入受阻，甚至置管失败。受阻的原因大多为穿刺针无法准确进入血管或导管置人头臂静脉与锁骨下静脉成角处送管困难,     

剪切波弹性成像对静脉畸形硬化治疗后疗效评估的应用研究

目的 应用超声剪切波弹性成像技术(SWE)获取静脉畸形硬化治疗前后的杨氏模量值变化,探讨其在评估静脉畸形硬化治疗后的临床疗效。方法 选取经临床确诊且行MRI、常规超声检查的门诊或住院静脉畸形患者30例为研究对象,所有研究对象在硬化治疗前、治疗后1周、治疗后1月均行常规超声及SWE检查记录相关参数值,讨论SWE在静脉畸形硬化治疗后疗效评估中的临床应用价值。结果 ①与常规超声相比较,SWE对静脉畸形血管硬化治疗后评价灵敏度更高。②SWE反应出静脉畸形硬化治疗后1月病灶的硬度变大,与周围组织的硬度比值变大,治疗前后对比有差异,有统计学意义(P＜0.05)。结论 SWE能有效评估静脉畸形硬化治疗后的临床疗效,具有一定的临床应用价值,且操作简便,易于实施,建议采用。     

影响静脉穿刺成功的因素及对策

静脉穿刺是最基本的护理操作技术之一,在临床护理中占有非常重要的位置。影响静脉穿刺成功的因素包括护士技术操作方法和心理素质,以及病人环境因素。现阐述如下。1影响静脉穿刺成功的因素1.1主观因素1.1.1技术操作①血管选择不当:选择了近关节处静脉或明显硬化的血管;②穿刺深     

Laser disintegration of cyanoacrylate clot with successful endoscopic removal of sclerotherapy needle from gastric varix

Intravariceal cyanoacrylate injection is a highly effective and safe procedure for the treatment of bleeding gastric varices. Nevertheless, some cases of severe cyanoacrylate-specific complications due to embolization have been described. Technical difficulties, including risk of sclerotherapy needle clogging, and cyanoacrylate sticking to the tip and the accessory channel of the endoscope, have been mentioned in other reports. We report a case in which a sclerotherapy needle that remained stuck in gastric valves after bucrylate injection was successfully removed by laser disintegration of the cyanoacrylate clot.     

盆腔淋巴囊肿超声引导下不同介入治疗方法疗效分析

目的探讨超声引导下不同介入治疗方式对有症状性盆腔淋巴囊肿的疗效。 方法分析2014年6月至2020年6月解放军总医院收治的36例盆腔恶性肿瘤术后出现有症状性淋巴囊肿患者的超声引导下介入治疗情况,按照治疗方式不同分为单纯穿刺抽液组、无水乙醇硬化组和置管引流组,采用χ²检验比较3种治疗方式的疗效差异。 结果单纯穿刺抽液组患者11例,治愈率为36%（4/11）,对于合并感染的较小淋巴囊肿（＜5 cm）,单纯抽液+抗生素冲洗有效,1例淋巴囊肿直径＞10 cm者效果为无效;无水乙醇硬化组患者13例,治愈率为62%（8/13）,2例淋巴囊肿直径＞10 cm者效果为无效;置管引流组患者12例,治愈率为83%（10/12）,淋巴囊肿直径＞10 cm的病例均为治愈和好转。置管引流组治疗效果优于无水乙醇硬化组,无水乙醇硬化组治疗效果优于单纯穿刺抽液组,3组间差异具有统计学意义（χ²=12.91,P=0.012）。36例患者均治疗成功,无术后并发症发生。 结论超声引导下介入治疗淋巴囊肿安全有效。超声引导下置管引流治疗效果最佳,尤其是对较大囊肿;无水乙醇腔内硬化治疗治愈率较高;单纯抽液治疗疗效较差,而伴有感染的淋巴囊肿穿刺抽液并抗生素冲洗留置疗效良好。     

Sonographic follow-up of ethanolamine oleate sclerotherapy for hydrocele

Sclerotherapy has gained increasing popularity during the last few years as a treatment for hydrocele. Little is known of the natural course of intrascrotal changes, however, nor of their timetable after therapy. In the present trial scrotal ultrasonography was performed before the sclerotherapy and during the follow-up examination in the case of 70 symptomatic consecutive outpatients ranging in age from 19 to 85 years (mean, 58 years) with 71 hydroceles treated by ethanolamine oleate sclerotherapy. Posttreatment sonographic findings typically included heterogeneously echogenic extratesticular masses, cystic areas with peritesticular hyperechoic lines, and a thickened scrotal wall. All the lesions showed improvement. Sonography proved to be useful for differentiating hydroceles from spermatoceles and for evaluating the need for a renewed treatment during follow-up. Ethanolamine oleate was effective as a sclerosant, as 86% of cases were cured or significantly improved. Complications were mild and uncommon, and no intratesticular or epididymal changes were observed. Ethanolamine oleate sclerotherapy can be recommended as a treatment of choice for hydrocele.     

短期内反复内镜治疗难治性食管静脉曲张破裂大出血

目的：探讨食管静脉曲张破裂大出血急诊硬化治疗术后仍持续出血的再次内镜下处理。方法：52例食管静脉曲张破裂大出血首次硬化术后仍出血不止或于1周内再次大出血患者,插入二腔一囊管后牵拉,再次进行硬化或（和）组织黏合剂黏堵治疗。结果：再次硬化治疗41例,黏堵加硬化治疗11例,无效转外科手术1例,死亡2例。急诊止血率为94.2%。发生较重并发症7例。结论：内镜下反复硬化或（和）黏堵治疗是控制难治性食管静脉曲张破裂大出血的首选抢救措施。     

内镜硬化联合组织胶治疗危重食管胃底静脉曲张的配合及护理

目的内镜硬化联合组织胶治疗危重食管胃底静脉曲张的配合及护理。方法对115例危重食管静脉曲张破裂大出血患者分别进行内镜下注射硬化剂,组织黏合剂与内镜下组织黏合剂与硬化剂联合注射治疗的配合及护理进行回顾性总结。结果3种方法的急诊止血率分别为81．5％、95.8％、100％;术后发热率分别为73.8％、87．5％、76．9％;胸痛发生率分别为84．6％、70．8％、76．9％;静脉曲张消失率分别为64．5％、31．3％、90％。结论硬化剂与组织黏合剂联合治疗效果优于其他方法,治疗过程中全程护理具有重要的地位,做好内镜下硬化、组织胶治疗的前期准备、配合及病情观察护理,可更好地提高疗效。     

体表血管瘤和脉管畸形的综合治疗临床观察

目的 观察综合治疗体表血管瘤及脉管畸形的临床疗效.方法 2008年1月-2010年9月,收治体表血管瘤和脉管畸形患者共205例.手术治疗156例,其中单纯手术治疗103例,合并介入治疗9例,硬化剂治疗44例;非于术治疗49例,其中介入治疗1例,硬化剂治疗38例,介入合并硬化剂治疗10例.术后随访6个月～3年.结果 15...     

Strategies and challenges in treatment of varicose veins and venous insufficiency

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.     

血管内支架移植物置入术治疗StanfordB型主动脉夹层

目的评价血管内支架移植物置入术治疗Stanford B型主动脉夹层的安全性和有效性.方法10名主动脉夹层患者,均在全麻下进行移植物置入术治疗,4例置入TALENT内支架移植物,6例置入国产内支架移植物.结果2例未能有效封堵动脉破裂口,其中1例治疗后12 h因动脉破裂死亡.1例移植物部分遮盖左锁骨下动脉,但无上肢进行性缺血加重,余7例动脉夹层及假腔均较好封堵.术后1周,9例行CTA检查,除1例夹层未得到封堵外,其余8例内支架移植物均无移位,假腔均缩小,真腔均扩大.随访8例(2～38个月),均无症状再发.结论内支架移植物置入术可有效治疗Stanford B型主动脉夹层;严格选择适应证可提高治疗的安全性和有效性.     

Endovascular carotid reconstruction in palliative head and neck cancer patients with threatened carotid blowout presents a beneficial supportive care measure

ABSTRACT Carotid blowout is a devastating complication in patients with head and neck malignancy. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. Recently, endovascular therapy has been proposed for head and neck surgical patients. Preliminary reports showed a better outcome with less morbidity and mortality compared to the previous treatment modalities. The use of such techniques in cases of impending or acute carotid blowout syndrome has been previously described to be beneficial for palliative head and neck cancer patients as well. We introduce a case of a head and neck cancer patient receiving palliative care, presenting with threatened carotid blowout, who was managed with endovascular placement of a covered stent under elective conditions in order to prevent an inevitable carotid rupture. In the present case endovascular carotid stenting allowed preservation of the vessel, prevented the dramatic situation of carotid rupture, and facilitated a rapid hospital discharge without any neurologic or stenting sequelae.     

硬化剂注射治疗胃Dieulafoy病

目的：评价硬化剂注射对胃内Dieulafoy病的治疗效果。方法：对16例胃内Dieulafoy病引起上消化道出血的患者进行内镜下硬化剂注射治疗。并对临床及治疗效果进行分析。结果：15例患者经注射后上血成功。一次注射止血成功者13例（81．2％）。再次注射上血成功者2例,（13．3％）。由于活动出血未能控制而需手术治疗者1例。随访1年,无一例再发生出血。结论胃Dieulafoy病引起的出血可以成功地采用内镜下注射硬化剂止血,该方法简单且疗效良好,临床上值得首先选用。