超声引导下瘤内注射平阳霉素治疗肝血管瘤

目的：观察超声引导下瘤内注射平阳霉素治疗肝血管瘤的临床疗效及安全性。方法：对35例肝血管瘤患者,在超声引导下经皮肝穿刺向瘤体内注入硬化剂（含平阳霉素8mg、生理盐水5mL与地塞米松5mg）,术后3个月复查肝脏B超,观察患者治疗前后肝血管瘤的变化及不良反应。结果：本组35例,CR12例,PR22例,NC1例。有20例术后3个月肿瘤缩小超过80%,肝区闷胀不适及腹部包块消失。结论：超声引导下瘤内注射平阳霉素硬化治疗肝血管瘤是一种简便、安全、有效的方法。     

超声介入穿刺注射聚桂醇治疗肝囊肿疗效分析

目的 探讨在超声引导下注射聚桂醇硬化剂治疗肝囊肿的临床应用价值及远期疗效.方法 110例术前经B超和CT检查确诊为单纯性囊肿的患者,在超声导向下应用一次性PTC针抽净囊液,并注射聚桂醇硬化剂治疗.术后分别于3个月及6个月、12个月、24个月后复查B超并进行对比.结果 术后3个月囊肿体积较术前有所缩小,术后6个月后囊肿体积较术前明显缩小甚至消失,术后24个月与术后6个月囊肿体积无明显差异.结论 超声引导下经皮肝囊肿聚桂醇硬化治疗有较高临床应用价值.     

超声引导下聚桂醇硬化治疗腹腔脏器囊肿患者的护理

目的总结超声引导下聚桂醇硬化治疗腹腔脏器囊肿的护理方法。方法对97例腹腔脏器囊肿患者采用超声引导下聚桂醇硬化治疗,治疗前做好患者准备及物品准备,加强治疗中的护理配合,治疗后密切观察患者病情变化及并发症的护理。结果所有囊肿一次性穿刺硬化治疗成功,无一例发生严重并发症;术后6个月超声复查,103个囊肿消失,11个囊肿缩小2/3以上,治疗有效率100%。结论对聚桂醇硬化治疗的腹腔脏器囊肿患者实行全方位的护理,可保障治疗效果。     

Nursing care of patients having abdominal cysts treated with lauromacrogol sclerosing therapy under ultrosonography

目的 总结超声引导下聚桂醇硬化治疗腹腔脏器囊肿的护理方法.方法 对97例腹腔脏器囊肿患者采用超声引导下聚桂醇硬化治疗,治疗前做好患者准备及物品准备,加强治疗中的护理配合,治疗后密切观察患者病情变化及并发症的护理.结果 所有囊肿一次性穿刺硬化治疗成功,无一例发生严重并发症;术后6个月超声复查,103个囊肿消失,11个囊肿缩小2/3以上,治疗有效率100％.结论 对聚桂醇硬化治疗的腹腔脏器囊肿患者实行全方位的护理,可保障治疗效果.     

聚桂醇注射治疗龟头静脉畸形15例临床分析

目的：评价经皮病损内注射聚桂醇治疗龟头静脉畸形的疗效及安全性。方法2011年1月至2013年5月,共治疗龟头部静脉畸形15例。采用硬膜外麻醉下经皮瘤体内注射聚桂醇硬化治疗,每次聚桂醇注射液0.5～2.0 mL局部注射,治疗间隔1个月,治疗1～4次。结果所有患者治疗部位均出现暂时性红斑和水肿,仅1例发生局部溃破,2例患者术后出现轻度疼痛,无出血、感染病例。随访1～3年,所有患者龟头静脉畸形病灶完全清除,未见复发,无色素改变、畸形和勃起功能障碍。结论经皮瘤体内注射聚桂醇硬化治疗龟头静脉畸形疗效确切、简便易行,且术后出血和感染发生率低,不影响阴茎外观和功能,建议作为龟头静脉畸形的首选治疗方法。     

CT引导经皮穿刺聚桂醇注射治疗肾囊肿

目的探讨CT引导经皮穿刺聚桂醇注射治疗肾囊肿的疗效。方法选取2011-05—2016-03间黄河中心医院收治的36例单纯性肾囊肿患者,均在CT引导下实施经皮穿刺聚桂醇注射治疗。回顾性分析患者的临床资料。结果 36例均一次穿刺成功,抽出囊液40~140 m L。注射聚桂醇后无全身及局部不适。术后3个月复查CT,7例囊肿直径4 cm,给予二次穿刺硬化治疗。术后6个月复查,18例囊肿消失,16例囊肿直径缩小至1~3 cm,1例囊肿直径仍为5 cm,1例心源性猝死未能随访。结论 CT引导下经皮穿刺聚桂醇注射治疗肾囊肿,疗效肯定,无不良反应,是一种有效的微创治疗方法,尤其适合身体条件差、麻醉风险大、不能耐受手术的患者。     

聚桂醇泡沫硬化治疗下肢静脉曲张562例分析

目的探讨无超声引导下聚桂醇泡沫硬化治疗下肢静脉曲张的临床效果。方法 2009年10月～2011年4月对562例下肢曲张静脉穿刺进行聚桂醇泡沫硬化注射治疗,硬化剂泡沫使用20 ml注射器抽取10 ml空气注入含10 ml聚桂醇的安瓿瓶反复抽吸形成,再将10 ml含泡沫硬化剂的注射器与6号头皮针相连,硬化治疗下肢静脉曲张562例共613条患肢。结果 1周后复查曲张静脉触诊均变成硬条索状,未有触及软的曲张静脉,3个月后患者未诉有明显曲张静为治愈,1个疗程聚桂醇泡沫硬化治疗后治愈率98.2%（602/613）,2个疗程治疗后治愈率100%。并发症发生率12.3%（69/562）,其中干咳为主要并发症,占10.1%（57/562）。结论无超声引导聚桂醇泡沫硬化治疗下肢静脉曲张操作简单、有效、微创、安全。     

聚桂醇硬化剂治疗婴幼儿皮肤血管瘤的临床疗效

目的 临床观察聚桂醇注射液局部瘤体内注射治疗婴幼儿皮肤血管瘤的疗效.方法 对30例血管瘤患儿局部瘤体内注射硬化剂——聚桂醇注射液,定期观察和记录血管瘤大小、质地、颜色的变化,并随时处理治疗过程中出现的不良反应.根据瘤体消退情况确定治疗次数.治疗结束后6个月,按4级评分法对疗效进行评价.结果 30例患儿均完成治疗全程,其中达到I级疗效者2例(6.7％),Ⅱ级疗效者4例(13.3％),Ⅲ级疗效者5例(16.7％),Ⅳ级疗效者19例(63.3％).瘤体直径越小,硬化剂注射治疗的次数越少,且治疗效果越好.早期积极给予聚桂醇硬化剂治疗的效果较好.所有患儿随访6个月均未复发,也未出现严重的不良反应.结论 聚桂醇硬化疗法是一种安全、有效地治疗婴幼儿血管瘤的方法.     

超声引导下泡沫硬化治疗四肢血管瘤

目的探讨超声引导下注射泡沫硬化剂治疗四肢血管瘤的疗效。方法收集经超声确诊的四肢血管瘤患者30例,于超声引导下向血管瘤腔内注射聚桂醇泡沫硬化剂,随访8个月,观察治疗后血管瘤体积变化和临床症状改善情况,评价疗效,观察治疗相关并发症。结果对13例进行1次治疗、12例进行2次治疗、3例进行3次治疗、2例进行4次治疗;血管瘤体积缩小≥60%19例、缩小30%~59%7例、缩小1%~29%2例、无明显变化2例,临床症状消失14例、明显好转11例,症状无明显变化5例;25例治疗有效,有效率为83.33%(25/30)。所有患者均未发生严重并发症。结论超声引导下聚桂醇泡沫硬化剂治疗四肢血管瘤费用低廉、安全、有效,值得临床推广与应用。     

超声引导下聚多卡醇泡沫硬化剂治疗大隐静脉曲张的早期临床疗效分析

目的:探讨聚多卡醇泡沫硬化剂治疗大隐静脉曲张的临床效果及大隐静脉主干硬化治疗的有效方法。方法:对35例大隐静脉曲张患者在超声引导下行泡沫硬化剂注射治疗,大隐静脉主干内注射3%聚多卡醇泡沫硬化剂,曲张静脉属支内注射1%聚多卡醇泡沫硬化剂。观察术后临床疗效及并发症发生情况。结果:35例患者均成功行超声引导下行泡沫硬化剂注射治疗,随访6个月以上,大隐静脉主干治疗段硬化闭塞良好,未见血流信号;术后6个月静脉临床症状严重程度评分VCSS评分较术前明显下降[(1.0+0.4)分vs.(4.2+1.5)分](P0.01);其中2例患者出现术中不良反应,3例患者需要行二次曲张静脉属支泡沫硬化剂注射治疗,所有患者均未发生深静脉血栓及肺栓塞等严重并发症。结论:超声引导下聚多卡醇泡沫硬化剂治疗大隐静脉曲张,具有创伤小、无严重并发症,可重复进行,近期随访效果良好等优点。     

Hepatic mesenchymal hamartoma and infantile hemangioma: a rare association

Background/PurposeThe association between liver infantile hemangioma and mesenchymal hamartoma is rare. This communication reports the clinical, radiologic, and pathologic features of 3 infants with concurrent liver hemangioma and mesenchymal hamartoma.MethodsWe conducted a comprehensive search of the database of our Vascular Anomalies Center over the past 12 years (1999-2010) for the keywords mesenchymal hamartoma, liver, and hemangioma in a large cohort of patients with liver hemangioma. Medical records and imaging studies of multiple modalities were reviewed. The search included infants with histopathologically proven liver hemangioma and mesenchymal hamartoma confirmed by the clinical and imaging findings.ResultsThere were 112 children with the diagnosis of liver hemangioma; 3 of them (0.027%) had concurrent mesenchymal hamartoma. Mesenchymal hamartoma predates the appearance of multifocal liver hemangiomas in 1 patient.ConclusionsThe rare coexistence of liver infantile hemangioma and mesenchymal hamartoma could be a true association.     

CEUS引导射频消融联合瘤体内血液抽吸治疗肝血管瘤的安全性及临床效果

目的探讨CEUS引导射频消融(RFA)联合瘤体内血液抽吸治疗肝血管瘤(HCH)的安全性及临床效果。方法回顾性分析2010年1月—2016年12月接受CEUS引导RFA联合瘤体内血液抽吸治疗的55例HCH患者(共77个病灶)的资料。治疗前均经常规超声及CEUS明确瘤体大小及血供情况,治疗后即刻及治疗后3个月复查常规超声及CEUS,计算术后即刻及术后3个月瘤体容积、瘤体缩小率及治疗后3个月瘤体血供完全消失率,并进行统计学分析。结果平均治疗时间(31.53±15.89)min,平均瘤体内血液抽吸量(135.36±68.13)ml。术中瘤体内血液抽吸量与治疗前瘤体容积呈正相关(r=0.722,P0.05)。55例HCH患者治疗后均未出现相关严重并发症,9例(9/55,16.36%)发生轻微并发症。治疗后即刻及治疗后3个月瘤体容积均较治疗前明显减小(P均0.05),平均瘤体缩小率分别为(48.76±32.58)%及(22.37±35.73)%。治疗后3个月瘤体血供完全消失率为96.10%(74/77)。结论 CEUS引导RFA联合瘤体内血液抽吸治疗HCH是一种安全、有效的方法,有可能成为治疗HCH的首选手段。     

聚桂醇局部注射对不同年龄和部位小儿血管瘤的疗效分析

目的 探讨聚桂醇注射治疗小儿血管瘤的疗效。方法 回顾性分析2014年6月~2019年6月间,在江门市妇幼保健院小儿外科收治的体表血管瘤患儿90例,给予多点注射聚桂醇治疗,采用Achauer疗效评价方法进行评估,记录瘤体面积变化、取得疗效所需的时间及并发症。结果 聚桂醇第一疗程总体有效率95.56%,第二疗程有效率可达100%,其中头面颈部的体表血管瘤起效最快,年龄越小效果越好。四肢的血管瘤并发症最高,达5.56%;肿胀和疼痛是最常见的并发症。结论 聚桂醇局部注射治疗小儿血管瘤取得良好的临床效果,疗程短且并发症发生率低,可广泛应用于小儿体表血管瘤的治疗。     

Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions?

BackgroundPartial hepatectomy for centrally located liver lesions is technically more challenging than that for peripheral lesions. Enucleation of liver hemangiomas is easier and safer than partial hepatectomy. Whether enucleation gives the same surgical outcomes for both centrally and peripherally located hemangiomas is unknown. This study aimed to evaluate the difference in surgical outcomes of enucleation of centrally and peripherally located liver hemangiomas.MethodsThis study used a prospectively maintained database consisting of a consecutive series of patients who underwent enucleation of liver hemangiomas in a tertiary referral center from January 2004 to December 2006. Surgical variables, length of hospital stay, and postsurgical complications were compared between centrally and peripherally located liver hemangiomas.ResultsDuring the study period, 172 patients underwent enucleation of hepatic hemangiomas. The lesions were centrally located in 76 patients (44.2%) and peripherally located in 96 patients (55.8%). The 2 groups were comparable in demographic data and lesion characteristics. There was no hospital mortality. The major complication rates were low in both groups (2.6% vs. 3.1%; P = .848). Enucleation of centrally located liver hemangiomas required significantly longer vascular inflow occlusion time (P <.001), longer operating time (P <.001), and more blood transfusion (P = .001). This group also had a higher volume of blood loss (P = .004) and longer hospital stay (P = .024) than the group with peripherally located liver hemangiomas.ConclusionsEnucleation is a safe surgery for hemangiomas in any part of the liver, although it is technically more demanding for centrally than peripherally located hemangiomas.     

超声引导下经皮射频消融治疗肝癌

目的观察超声引导下射频消融术(RFA)治疗肝癌(LC)的效果。方法回顾性分析165例LC,其中52例接受保守治疗(保守治疗组),55例(60个肿瘤)接受手术治疗(手术治疗组),58例(64个肿瘤)接受超声引导下射频消融治疗(RFA组),于治疗前后接受CEUS、CT或PET-CT、肝功能、甲胎蛋白(AFP)、癌胚抗原(CEA)等检查,并定期接受临床随访。结果 RFA组患者住院时间和费用明显低于保守治疗组和手术治疗组(P均<0.05);治疗后3个月有效率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但明显高于保守治疗组(P<0.05);3组患者的肝功能指标、AFP、CEA均较治疗前明显下降(P均<0.05),手术治疗组与RFA组优于保守治疗组(P均<0.05);2年生存率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但均明显高于保守治疗组(P均<0.05)。结论超声引导下射频消融治疗原发及转移性LC有效、安全、费用低,特别适用于不能耐受或者不愿手术且直径<5cm的肿瘤。     

椎体成形术治疗症状性椎体血管瘤:影像学随访评价

目的探讨经皮椎体成形术（PVP）治疗症状性椎体血管瘤及影像学随访评价的临床应用价值。方法回顾性分析接受PVP治疗的24例（共29节椎体）椎体血管瘤患者的资料,对其术前、术后1周及术后1年随访时的x线平片、CT及MR检查结果进行统计学分析。结果24例患者PVP均成功,骨水泥充填良好,未出现严重并发症;术后1周所有病变椎体前、后缘高度比（A／B）为0．83士0．15,术后1年A／B为0．83土0．20（t=-1．984,P〉0．05）。随访未见新发椎体压缩性骨折,血管瘤无复发。结论PVP是一种比较安全且有效的微创治疗椎体血管瘤的方法;影像学检查可用以评价PVP治疗效果。,     

Cryotherapy of subglottic hemangioma

The natural history of the hemangioma is spontaneous regression; therefore, most lesions require no treatment. The large occlusive subglottic hemangioma which presents before the age of 6 months, however, may be life-threatening. Two infants with subglottic hemangiomas with complete upper airway obstruction were treated successfully with cryotherapy, after tracheostomy. In each case the cryoprobe was placed transbronchoscopically on the subglottic hemangioma at -80 degrees C. for 30 to 45 seconds, the freezing interval varying with the age of the patient. One infant is asymptomatic and has had the tracheostomy tube removed. The other infant, after successful cryosurgical treatment, died from an unrelated illness. The histopathology of the larynx 3 1/2 months after cryotherapy of the hemangioma showed tracheal reepithelialization, active regeneration of cartilage with maintenance of luminal diameter, minimal submucosal fibrosis, and minimal residual hemangioma. Cryotherapy for subglottic hemangiomas offers many advantages including hemostasis, controlled local surgical injury, subsequent rapid healing of tissues with minimal fibrosis, and preservation of lumen without stricture. Previous forms of therapy which have been supplanted include radiotherapy, injection of sclerosing substances, systemic steroids, and surgical excision. Carbon dioxide laser is an effective therapeutic modality that we reserve for selected smaller hemangiomatis lesions of the subglottic area.     

聚桂醇局部注射治疗婴儿血管瘤疗效观察

目的:评价聚桂醇局部注射治疗婴儿体表血管瘤的临床疗效。方法:对65例不同部位的婴儿血管瘤注射聚桂醇注射液,通过3～7个月的观察,判断其疗效。结果:65例患儿,其中治愈15例,部分治愈45例,改善5例,有效率92.3%。结论:聚桂醇治疗婴儿血管瘤无需住院,安全、有效、方便,治疗后无明显瘢痕,符合美容要求。     

肝血管瘤栓塞治疗后肝功能及瘤体大小变化

目的探讨平阳霉素碘化油乳剂治疗肝血管瘤的效果及肝功能变化。方法回顾性分析37例肝血管瘤患者共59个病灶[直径平均（4.4±3.1）cm],检测平阳霉素碘化油乳剂栓塞前及栓塞后3、6、9、12、18天肝功能指标丙氨酸氨基转移酶（AAT）、总胆红素（TB）、直接（DB）及间接胆红素（IDB）的变化,以及术后1、6、12个月病灶缩小情况。结果术后3天AAT升高最明显,以后逐渐下降,术后18天所有患者AAT均降至正常范围。术后3天AAT〉100 U/L者中存在靶向外栓塞（灶周血管分支碘化油沉积、邻近肝实质碘化油沉积）者多于无靶向外栓塞者（P〈0.05）。胆红素栓塞前后变化不明显。术后6个月所有瘤灶均缩小或消失,最大径平均减小（2.4±1.6）cm。结论平阳霉素碘化油乳剂栓塞肝血管瘤是安全、有效的方法,术后肝功能下降与靶向外栓塞有关,一般在2周左右恢复正常。