无水乙醇肝段栓塞联合TACE治疗小肝癌20例

目的:探讨无水乙醇肝段栓塞联合TACE治疗小肝癌的可行性及临床疗效,以改进小肝癌介入栓塞治疗方法,减少并发症。方法:将5F RH导管作为导引导管,利用同轴导管技术将微导管超选入肿瘤动脉,对20例小肝癌患者行肝段性化疗栓塞术。结果:全组共19(95%)例患者获得瘤体内完全充填性栓塞,全组病灶直径缩小50%以上14例(70%),缩小25%以上3例(15%)。全组随访12~36个月(平均29个月),18例存活,所有患者治疗后肝功能损害轻微,未发生严重并发症。结论:本治疗方法操作简单、方便、超选择成功率高、疗效好、副反应少,可以明显提高存活率,具有十分重要的临床应用价值。     

微导管肝段动脉化疗栓塞术治疗原发性肝癌89例临床观察

[目的]评价微导管肝段动脉化疗栓塞术治疗肝癌的疗效.[方法]应用微导管对89例原发性肝癌患者行肝段动脉化疗栓塞术.[结果]全组89例共行化疗栓塞134次,术后血清AFP下降〉50 %者71例（79.7%）,肿瘤缩小〉50%者18例（20.2%）,肿瘤缩小在25%～50%者48例（53.9 %） 23例患者肿瘤体积无明显变化.术后肝功能损害轻微,无严重并发症.[结论]微导管操作简单、方便,超选择成功率高,术后并发症少,在肝动脉化疗栓塞治疗原发性肝癌中有较高的应用价值.     

微导管超选择插管介入治疗小肝癌的疗效

目的:探讨微导管超选择插管在小肝癌介入治疗的临床应用价值。方法:35例诊断明确的小肝癌患者常规RH导管选择性造影后应用微导管超选择肝段或亚肝段"嵌入"肿瘤血管插管进行栓塞化疗。即时观察碘油病灶内碘油沉积情况,术后1周行肝功能检查了解肝功能损伤情况。随访3个月,观察其疗效。结果:微导管插管技术成功率为100%。术后病灶内碘油沉积完全,肝功能检查显示轻度损伤。1个月后CT复查10例(28.6%)肿瘤体积缩小>50%,18例(51.4%)肿瘤体积缩小25%～50%,7例(20.0%)肿瘤体积缩小不明显。结论:微导管超选择"嵌入"肿瘤血管进行栓塞化疗小肝癌,具有治疗效果好,节省药量且利用率高,最大限度保护肝功能等优点。     

肝动脉灌注化疗栓塞(TACE)和肝动脉节段性化疗栓塞(TASCE)治疗原发性肝癌的疗效评价和与术后肝硬化发生的相关性

肝动脉灌注化疗栓塞(TACE)虽是临床治疗原发性肝癌的首选方法之一,但可引起肝癌患者肝功能损害,肝纤维化血清学指标升高。而肝动脉节段性化疗栓塞(TASCE)是在TACE基础上,将导管超选择性插至左或右以下的段支行化疗栓塞。它所涉及的范围相当于肿瘤所在的肝段,对肿瘤其他部位影响     

介绍一种自制乳化碘油的方法

40%碘化油注射液,常作为一种栓塞剂应用于介入放射学领域,在临床上主要用于肿瘤如肝癌患者的栓塞治疗.在栓塞肝癌时,为了避免栓塞剂损害正常肝组织,医生多采用3F的微导管作超选择插管后,再将栓塞剂注入瘤体内.     

微导管超选择插管在肝癌介入治疗中的应用

目的　评价微导管超选择肝动脉插管治疗原发性肝癌的疗效、副作用和应用价值。方法　超选择和非超选择插管组各 40例 ,前者以微导管“嵌入”肿瘤血管 ,后者以“低压流控法”进行栓塞化疗。比较两组疗效、副作用并作应用价值分析。结果　微导管超选择插管组与非超选择插管组相比 ,疗效更佳 ,副作用更轻 ,且应用价值更加合理。结论　微导管超选择插管介入治疗肝癌疗效好 ,副反应轻 ,应用合理     

节段性栓塞化疗与常规栓塞化疗对肝癌术后复发的肝功能影响的比较

目的研究节段性栓塞化疗与常规栓塞化疗对肝癌术后复发肝功能的影响差异。方法50例肝癌术后复发病例,其中男性47例,女性3例,年龄30-74岁,平均50岁。其中32例行常规栓塞化疗,18例行节段性栓塞化疗。均采用Seldinger技术,分别将导管置于肝固有、肝左或肝右动脉。或超选择性将导管至于亚段靶动脉,分别注入栓塞剂及化疗药物,栓塞剂为进口超液态碘化油,用量为5-15ml,化疗药物选用5-FU1000mg,cDDP60mg,MMC20mg(或THP40mg)行夹心面包栓塞法。结果常规栓塞化疗组治疗后32例TBIL(24/32)、ALT(20/32)明显升高,ALB(13/32)轻度降低。节段性栓塞化疗组,18例患者中仅1例ALT轻度升高。结论肝癌术后复发栓塞化疗,节段性栓塞化疗对肝功能影响较常规栓塞化疗明显降低。     

45例原发性肝癌病人经导管肝动脉化疗栓塞治疗的护理

[目的]总结原发性肝癌病人经导管肝动脉化疗栓塞治疗的护理。[方法]对45例原发性肝癌病人行经导管肝动脉化疗栓塞治疗,同时加强围术期护理。[结果]使病人的生理、心理达到最佳状态,确保介入手术的成功,减少并发症的发生,提高病人生存质量。[结论]加强原发性肝癌病人经导管肝动脉化疗栓塞治疗的护理是手术成功的保证。     

肝癌经股动脉植入式导管药盒系统的灌注和栓塞化疗

目的：探讨介入放射学方法留置导管药盒治疗肝癌的治疗方法和结果。方法：采用Seldinger技术，经股葫脉穿刺将导管插入肝动脉，然后与植入式药盒连接并埋置于皮下，对27例原发性和转移性肝癌患者经导管药盒系统进行了多次动脉灌注及栓塞化疗，灌注抗癌药物为ADM和5-FU，栓塞采用MMC-碘油乳剂。结果；有26例病人导管超选择置入肝左、右动脉、肝固有动脉或肝总动脉，1例导管留置在腹腔动脉。患者术后平均生存期11．4个月，本组无严重并发症。结论：植入式导管药盒系统，为晚期肝癌患者的动脉灌注和栓塞化疗提供了一个永久和方便的治疗途径。     

双介入治疗中晚期肝癌的临床效果观察

目的探讨双介入治疗中晚期肝癌的临床效果。方法选择2005年1月至2009年12月原发性肝癌90例随机分成观察组和对照组各45例。对照组采用Seldinger技术实施单纯肝动脉化疗栓塞,观察组在肝动脉化疗栓塞后将导管选择性置入脾动脉进行灌注,行间接门静脉化疗。结果观察组疗效好于对照组、甲胎蛋白(AFP)下降明显、生存期长(P<0.05);两组不良反应发生率无显著差异(P>0.05),无出血、肿瘤破裂及肝功能衰竭等严重并发症。结论肝动脉化疗栓塞与门静脉化疗合用治疗中晚期肝癌可弥补单纯肝动脉化疗栓塞治疗中的不足,对防治肿瘤复发和转移、提高患者长期生存率有重要意义,需要应严格选择治疗病例。     

Balloon-occluded arterial stump pressure before balloon-occluded transarterial chemoembolization

Objective To evaluate balloon-occluded arterial stump pressure (BOASP), which is responsible for effective balloon-occluded transarterial chemoembolization (B-TACE), at each hepatic arterial level before B-TACE using a 1.8-French tip microballoon catheter for unresectable hepatocellular carcinoma (HCC). Material and methods The BOASP at various embolization portions was retrospectively investigated. “Selective” and “non-targeted” BOASP was defined as the BOASP at the subsegmental or segmental artery and the lobar artery, respectively. Results The measurement of the BOASP was carried out in 87 arteries in 47 patients. BOASP?>?64?mmHg was revealed in the caudate lobe artery (A1) and the left medial segmental (A4), right anterior superior segmental (A8), anterior segmental, right and left hepatic arteries. Significant difference was noted in the incidence of BOASP above 64?mmHg between “non-targeted” and “selective” BOASP (p?=?0.01). “Non-targeted” BOASP was significantly greater than “selective” BOASP (p?=?0.0147). In addition, the BOASP in A1, 4, 8 and the anterior segmental arteries were significantly greater than in the other subsegmental and segmental arteries (p?=?0.0007). Conclusion “Non-targeted” B-TACE should be avoided to perform effective B-TACE and “selective” B-TACE at A1, 4, 8 and the anterior segmental arteries may become less effective than at the other segmental or subsegmental arteries.     

经导管动脉注射玻璃酸酶联合尿激酶溶栓治疗眼动脉栓塞兔模型

目的 观察经导管动脉注射玻璃酸酶联合尿激酶溶栓治疗兔眼动脉栓塞的价值。方法 将27只健康新西兰大白兔随机分A、B、C 3组,每组9只,以微导管超选择至兔眼动脉,注射透明质酸,建立兔眼动脉栓塞模型;建模30 min后,经超选择性动脉插管,分别对A、B及C组兔眼动脉注射尿激酶、玻璃酸酶及玻璃酸酶联合尿激酶,并行眼动脉造影观察各组溶栓情况,观察玻璃酸酶联合尿激酶溶栓治疗兔眼动脉栓塞的价值。结果 建立兔眼动脉栓塞模型耗时12~57 min,平均（23.04±10.05） min。溶栓后10 min,A、B及C组兔眼动脉开通率分别为11.11%（1/9）、22.22%（2/9）及44.44%（4/9）;溶栓30 min后各组开通率分别为11.11%（1/9）、22.22%（2/9）及55.56%（5/9）,组间两两比较差异均无统计学意义（P均>0.05）,但B及C组眼动脉未能开通的兔眼球周围血运较溶栓前明显改善。结论 经导管注射玻璃酸酶联合尿激酶溶栓可用于治疗兔眼动脉栓塞。     

Triaxial transarterial embolization for lower gastrointestinal bleeding: A retrospective case series

Objective: Superselective transcatheter arterial embolization (TAE) is important for lower gastrointestinal (GI) bleeding. A new 1.9-Fr. no-taper microcatheter has recently become available and can be inserted into a 2.7-Fr. microcatheter. We assessed the applicability of this new triple co-axial (triaxial) system to TAE for lower GI bleeding. Material and methods: Five patients with lower GI bleeding underwent TAE with the triaxial system. The approach was via the femoral artery with a 4-Fr. sheath in all cases. The 4-Fr. catheter and triaxial system were inserted into the artery in which extravasation had occurred. Coil embolization was performed with 0.010-inch coils. We evaluated technical success rate, clinical success rate and complications. Results: All five cases of bleeding occurred at the ascending colon, and were caused by diverticulosis in four cases, and an injury to the artery during polypectomy in one case. The 1.9-Fr. no-taper microcatheter could be inserted into the site of extravasation, the vasa recta, in all procedures and TAE was performed successfully. The disappearance of extravasation was confirmed in all cases following TAE. No patients exhibited any signs of recurrent bleeding or complication. Conclusion: The triaxial system appears to be effective and useful in superselective TAE for lower GI bleeding.     

亚秒级螺旋CT肺动脉造影检测段与亚段肺动脉

目的评价亚秒级螺旋CT血管造影检测段与亚段肺动脉的能力及分析不同观察者间评阅图像的变异程度.方法对20名非胸肺和肺动脉疾病临床患者螺旋CT肺动脉造影(CT pulmonary angiography;CTPA)进行回顾性研究,共分析400个段动脉和800个亚段肺动脉.由两名具有不同临床经验的放射医师分别阅读图像,测量主肺动脉强化程度,记录显示清晰的段与亚段肺动脉,评价其显示情况,分析不同医师所得结果之间的相关性.结果97.5%的肺段动脉和77.5%亚段肺动脉显示清晰,观察者间一致性好(K=0.68).主肺动脉平均CT值为278±30Hu.结论亚秒级螺旋CTPA能清晰显示段与亚段肺动脉,可用于外周型肺动脉栓塞的诊断.     

钆塞酸二钠增强MRI评估全肝及各肝段肝功能

目的 评价采用乳腺CEUS预测模型诊断乳腺恶性病灶的观察者一致性。方法 收集多中心共953例接受超声和CEUS检查的乳腺单发结节患者。本课题组由初始组（各医院1名低年资医师）、检查者组（各医院1~2名具有2年以上CEUS检查经验的医师）、研究组（四川省医学科学院四川省人民医院2名高年资医师）及交叉盲读组（各医院1~2名副主任医师或主任医师）构成。首先由初始组及检查者组根据乳腺影像报告和数据系统（BI-RADS）对病灶进行分类,其次由交叉盲读组和研究组采用乳腺CEUS预测模型再次进行BI-RADS分类。以病理结果为金标准,计算4组诊断乳腺恶性病灶的效能;分析观察者间诊断乳腺恶性病灶的一致性。结果 953例中,病理证实良性病灶451例（451/953,47.32%）,恶性病灶435例（435/953,45.65%）,癌前病变67例（67/953,7.03%）。初始组、检查者组、研究组及交叉盲读组诊断乳腺恶性病灶的准确率分别为71.67%（683/953）、74.92%（714/953）、80.17%（764/953）及83.42%（795/953）。初始组与检查者组诊断乳腺恶性病灶的一致性较好（Kappa=0.82,P<0.001）,与研究组及交叉盲读组的一致性中等（Kappa=0.56、0.41,P均<0.001）;检查者组与研究组、交叉盲读组的一致性均为中等（Kappa=0.68、0.51,P均<0.001）;研究组与交叉盲读组的一致性中等（Kappa=0.74,P<0.001）。结论 不同观察者采用乳腺CEUS预测模型诊断乳腺恶性病灶的一致性一般。     

超声引导下平阳霉素瘤体内注射与DSA引导下平阳霉素肝动脉栓塞治疗肝血管瘤对比分析

目的 对比分析超声引导下平阳霉素(PYM)瘤体内注射与DSA引导下PYM肝动脉栓塞治疗肝血管瘤的临床应用价值。方法 收集50例肝血管瘤患者,对其中26例(超声组)行超声引导下PYM瘤体内注射治疗,24例(栓塞组)行DSA引导下PYM肝动脉栓塞治疗,对比两种治疗方法的治疗时间、费用、术后疗效及并发症情况。结果 对50例患者均顺利完成治疗。超声组治疗时间[(10.54±3.33)min]及治疗费用[(2250.00±244.15)元]均明显低于栓塞组[(55.56±15.56)min及(12 555.56±2069.03)元],差异均有统计学意义(P=0.033、0.012)。超声组术后发热[15.38%(4/26)]及肝功能异常发生率[19.23%(5/26)]均低于栓塞组[70.83%(17/24),50.00%(12/24)],差异有统计学意义(P均<0.05);两组间术后肝区疼痛发生率[61.54%(16/26) vs 54.17%(13/24)]差异无统计学意义(P=0.775)。共59个肝血管瘤中,超声组31个,栓塞组28个。术后12个月,超声组及栓塞组治疗总有效率均为100%(31/31,28/28)。超声组瘤体平均缩小率[(93.10±6.85)%]明显高于栓塞组[(68.81±4.23)%],差异有统计学意义(P=0.004)。结论 两种治疗方法效果均可靠,但超声引导下PYM瘤体内注射治疗肝血管瘤在治疗时间、费用、术后并发症及瘤体缩小率方面更具优势。     

脑血管畸形栓塞治疗中造影技术探讨

目的;通过对几种类型AVM造影技术的总结,分析AVM的诊断及栓塞过程中选择性造影和微量造影应注意的技术问题。方法：人为地将AVM分成两种类型,即高流低阻型（A）和高流高阻型（B）根据不同的类型,设定不同的造影条件。栓塞过程中微量造影时,根据微导管的类型及微导管位于畸形团内的深度,设定微量造影条件。结果：当微导管位于畸形团内时,压力应相应减低至120－150PSI,当微导管在供血动脉行经较长时,应重复造影,以获得较为清晰的图像。结论：良好的造影条件能提供重要的影像信息,特别是微量造影,有时可能出现全和无的信息反差。     

Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note

Objective

Many techniques have been use for retrieval of an entrapped microcatheter during Onyx (eV3 Neurovascular) embolization of brain arteriovenous malformations (BAVMs). We report our technique that we term “pull-push-pull” that can be utilized as first management in retrieving the microcatheter.

Method

We analyzed a total of 37 patients that underwent BAVM embolization with either Onyx 18 or 34 at our institution. Standard embolization techniques were utilized with the use of Marathon (eV3 Neurovascular) microcatheter. When difficulty in retrieving the microcatheter arose, we used the “pull-push-pull” technique. The technique comprises the eV3 protocol of retraction. In addition, the microcatheter is stretched causing the Onyx cast to stretch in its inner core, creating a more thorough cohesive property amongst the Onyx mixture. Then the microcatheter is pushed back and to its point of embolization origin. Afterwards, retraction of the microcatheter is enabled as it can be easily dislodged from the cast. Multiple attempts can be repeated as needed.

Result and discussion

We had three patients that had difficulty with removal of microcatheter (8.1%). Utilization of the “pull-push-pull” technique was used on two of those patients. No neurological complication was observed with our technique. We believe the cohesive property of Onyx solution helps in the retrieval of the catheter by our method and technique.

Conclusion

We believe the “pull-push-pull” can be utilized and be an additional technique before attempting other catheter retrieval techniques in Onyx BAVM embolization.