透视下套管法钳取深部软组织内金属异物

目的 探讨深部软组织内金属异物透视下套管法钳取术的可行性和安全性。方法 23例69颗金属异物深部软组织内存留患者。异物长度为0．2－3．0cm,宽度为0．1－0．5cm,离体表最矩距离为2－5cm,存留时间7－120d。采用钳夹式椎间盘摘除器套装,透视下用定位针将外套管引入到异物处,并送入髓钳夹住异物取出体外。结果 23例患者69颗异物均1次成功取出。手术时间为8－15min,X线暴射时间为1－4min。未发现并发症。结论 透视下套管法钳取术,是取出深部软组织内金属异物的1种新的简便、安全可行的方法。     

软组织内金属异物C臂下单针定位特制钳取出术

目的探讨软组织内金属异物C臂下单针定位特制钳取术的可行性、微创性和安全性。方法诊治38例137颗金属异物软组织内存留患者,异物长度为0.2～3.5 cm,宽度为0.1～1.0 cm,离体表距离为0.5～6.5 cm,存留时间1 h～10年。采用C臂透视下单针定位引入特制异物钳到异物处,夹住异物取出体外。结果 38例患者134颗异物均1次成功取出。手术时间为5～35 min,X线照射时间为0.5～4 min。未发生并发症。结论 C臂下单针定位特制钳取出术,是取出软组织内金属异物的1种简便、安全、微创,值得推广的方法。     

X线电视监视下钳取女性膀胱内异物

本文搜集3家医院1988-1998年11例膀胱内各种不同类型的异物，均在X线电视导引下经尿道顺利取出，未发生任何并发症。现着重介绍膀胱内异物取出方法和注意事项。1材料与方法1.1一般资料11例全部为女性，年龄16-56岁，平均30岁。发病因素为两类：一类是因好奇（性自慰）不慎将异物经尿道插入膀胱，7例；另一类是泌尿外科手术中留置输尿管支架管，4例。1．2膀胱内异物的种类体温计3例，金属发铗3例，金属外壳微型圆珠笔1例，输尿管支架管4例。1．3治疗方法和注意事项X线片上如异物表面有钙盐沉着结石形成者为本治疗方法的禁忌证。术前患者排尿…     

不透X线异物的术前定位

不透X线的再物如果嵌入软组织中,在行手术取出前,用X线照像或标记导引,对于最少剥离和损伤正常组织而确保成功地取出异物是有用的。一种理想的定位方法应有一个准确的标记,这个标记能保持固定,直到手术取出后为止。采用改良的针头——钩形金属丝方法可满足这些要求。     

X线透视异物定位法

透视下手术摘取金属异物不仅麻烦费事,让医患双方接受过多的辐射,还造成广泛的手术损伤[1]。在X线透视形成的平面图像上确定异物的空间位置,有相当的难度。为解决这一难题,本人设计了一种空间定位方法,在实践中取得了很好的效果,介绍如下。原理(见图1)两条交叉于一点(金属异物)     

经纤支镜钳取气管、支气管异物的护理

总结经纤支镜钳取气管、支气管异物患者35例的护理体会。认为术前针对性的心理护理、细致的病情观察、术中密切配合,是成功取出异物的关键。做好术后并发症及特殊症状的护理,是手术成功的重要环节。     

气管、支气管可透X线异物的X线诊断

本文收集我院近年来经手术证实的42例气管、支气管可透X线异物的X线诊断情况进行回顾性分析,旨在提高对本病的诊断水平.     

利用金属网X线平片法进行软组织内金属异物三维定位

软组织内金属异物存留是很常见的临床问题。治疗中常常存在定位不准、手术时间长、手术失败等问题。过去术前常采用Ｘ线平片定位 ,甚至要在透视下进行手术。此种定位方法误差率高 ,病人及医师受Ｘ线伤害较多。 1979年以来 ,笔者设计了利用金属网Ｘ线平片法进行软组织内金属异物的三维定位方法 ,取得了满意效果。现报告如下。定　位　方　法定位前先照异物部位Ｘ线正侧位片。根据Ｘ线片 ,选择金属异物与皮肤之间没有重要结构侧作为金属网定位侧。选择一块大小合适的金属网 ,网格面积为 0 .2 5～ 1.0ｃｍ2 。将金属网固定于皮肤上 ,摄Ｘ线片。…     

X线监视下经尿道植入支架治疗高龄前列腺增生症

目的评价植入网状记忆合金支架治疗高龄前列腺增生症尿道狭窄的临床效果和可行性。方法47例患者,年龄72~93岁,平均78.3岁,排尿困难7~21年。1%利多卡因尿道黏膜麻醉,DSA引导下经尿道将支架放置在前列腺尿道最狭窄处。结果47例患者均一次治疗成功(100%),其中43例支架植入后立即自行排尿,排尿通畅。本组无1例出现尿道再狭窄和结石等情况,排尿通畅率100%。结论记忆合金网状支架治疗前列腺增生引起的排尿困难临床疗效显著,值得临床推广应用。     

透视下采用导管导向技术取支气管异物

呼吸道异物多发生于儿童,因患病突然,症状较重,对如何取出异物,常常是临床医师碰到的棘手问题,特别是不具备作胸外科手术的基层医院.笔者在多年的工作中遇到3例支气管异物的患者,采用透视下导管导向技术,均成功取出支气管内的异物,现将有关方法及体会总结报告如下.     

软组织内异物279例取出体会

目的探讨软组织内异物的治疗。方法对1982年5月～2003年10月我院外科收治的279例软组织内异物的诊断治疗进行回顾性分析。结果金属性异物的诊断手段为体检及X线摄片,总确诊率为100％(170／170),取出率97．65％(166／170);非金属异物的诊断方法为体检、X线摄片以及超声检查,确诊率为91．7％(100／109),取出率为93．58％(102／109)。结论对软组织异物的治疗应重视术前准备,准确定位才能确保手术损伤小,提高手术成功率。     

经皮穿刺胃造瘘和胃空肠造瘘术

目的 探讨透视引导下经皮穿刺胃造瘘术（PG）和胃空肠造瘘术（PGJ）的可行性和安全性。方法 23例吞咽困难的患者。上段食管癌10例,中段食管癌1例,咽部癌6例,球麻痹2例,脑转移瘤4例。采用美国Cook公司生产的Marx-cope PGJ套装。先经鼻饲管经鼻或经口途径置入导管后注入气体800～1000ml,至胃腔明显扩张。然后在透视引导下采用Seldinger技术将PG饲管置入胃腔内,或将PGJ饲管经胃腔、十二指肠置入空肠内。术后严密观察腹部症状和体征。随访饲管使用情况。结果 23例患者均成功完成PG术,技术成功率为100％。其中将饲管置入空肠内13例,均成功。术后出现上腹部疼痛1例,造瘘口周围感染1例,经处理后均痊愈。1例于术后第2天,因胃内容物反流出现窒息死亡。随访期间经饲管给予顺利。恶性肿瘤患者18例死亡,另3例仍在随访中,中位生存期为6．5个月。球麻痹患者1例更换新的PG饲管,另1例失访。结论 透视引导下PG和PGJ术,成功率高,并发症少,是建立长期胃肠内营养的良好途径。     

经皮透视引导下胃造瘘和胃空肠造瘘术的临床应用

目的 评估经皮透视引导下胃造瘘和胃空肠造瘘术的临床应用,探讨影像导引下置管的技术操作及其适应证、禁忌证和并发症.方法 回顾性分析2002年5月 - 2010年6月在我院实施透视引导下胃造瘘和胃空肠造瘘术的40例患者的临床资料.采用Seldinger技术造痿,成功置入饲养管.分析手术指征,操作过程,技术成功率,手术相关并...     

Totally implanted venous access device removal in interventional radiology

PURPOSE: To demonstrate that totally implanted venous access device (TIVAD) removal in the out-patient interventional radiology (IR) recovery room is safe and effective. MATERIALS AND METHODS: Fifty-seven TIVADs were removed in 56 patients using a standard cut-down technique. Forty-one devices (72%) in 40 patients without signs of pocket infection were closed with primary intention with sub-cuticular absorbable or simple non-absorbable sutures, depending on operator preference. All patients were followed up to assess for bleeding or infection. Sixteen devices (28%) in 16 patients with suspected pocket infection were allowed to heal by secondary intention. These patients were managed with antibiotics and dressing changes until healing was complete. Catheter tips were sent for culture and sensitivity. RESULTS: TIVADs were removed intact in all 57 cases. There were no cases of air embolism, uncontrolled hemorrhage, retained foreign body or catheter fragmentation. No bleeding or infectious complications were noted in those patients who were allowed to heal with primary intention. Wound closure was accomplished in all patients who were allowed to heal with primary or secondary intention. CONCLUSION: TIVAD removal in an out-patient recovery room by an interventional radiology team is safe and feasible, providing a possible alternative venue for this procedure.     

Percutaneous removal of intravascular foreign bodies

Catheter and guidewire fragments left remaining in the cardiovascular system induce a high incidence of morbidity. Percutaneous removal of these fragments was attempted in 13 patients, with complete success in 10, partial success in two, and the fragment was extraluminal in one patient. Technique of foreign body removal and problems encountered are discussed.     

CT引导下经皮穿刺肝脓肿的介入治疗

目的 探讨CT引导下穿刺抽吸、冲洗治疗肝脓肿的方法和价值。方法 在CT引导下经皮穿刺对35例肝脓肿进行抽吸及冲洗治疗，冲洗液采用庆大霉素与甲硝唑混合溶液。结果 本组35例肝脓肿中多房脓肿8例、单房脓肿27例；其中8例脓肿腔内见有气体。经过一次抽吸冲洗治愈者25例，二次治愈者4例，三次治愈者6例。抽吸冲洗出脓汁的量在35mL-760mL。绝大部分病人治疗后于当日体温恢复正常。5例未住院，其余30例病人住院时间平均6．5d。结论 CT引导下经皮穿刺治疗肝脓肿是一项操作简便安全、非常有效的治疗方法，这种方法具有定位准确、损伤小、适应性广泛、便于广泛推广的突出特点。     

Percutaneous radiologic gastrostomy with a simplified gastropexy technique under ultrasonographic and fluoroscopic guidance: experience in 154 patients

Purpose: To evaluate the effectiveness and safety of percutaneous radiologic gastrostomy (PRG) under ultrasonographic (US) and fluoroscopic guidance using a simplified gastropexy technique.

Material and Methods: One hundred and fifty-four (154) patients (mean age 73, range 22-93 years) were referred for PRG. Indication for PRG was neurologic disease, head/neck cancer, and other disease in 73%, 15%, and 12%, respectively. Initially, the stomach was filled with 300-500 cm³ of tap water via a nasogastric tube. The fluid-filled stomach was punctured under US guidance. A guidewire and a single T-fastener were introduced. Under fluoroscopic guidance, the tract was dilated over the guidewire until a 16F dilator with a peel-away sheath could be introduced. During dilatation, the external suture string to the T-fastener was held tight to fixate the gastric wall. A 14F balloon-retained gastrostomy tube was introduced and inflated. The T-fastener was then released, and the gastrostomy tube was retracted gently to affix the gastric wall to the abdominal wall (tube gastropexy). Technical success was assured by aspiration of gastric fluid and fluoroscopically by injection of a water-soluble contrast medium.

Results: The primary technical success rate was 98%. At 30-day follow-up, 3.2% had major complications and 14% minor complications. Three patients (1.9%) died of complications related to the procedure. Thirteen cases (8%) of simple tube displacement without other complications occurred.

Conclusion: PRG guided by US and fluoroscopy is a relatively safe technique with a high success rate, provided the stomach can be properly distended with fluid. However, tube gastropexy alone does not seem to protect against early dislodgement.     

Percutaneous extraction of two deeply lodged foreign bodies

Interventional radiologists have long been familiar with percutaneous removal of intravascular foreign bodies. Catheter fragments and other foreign bodies can, however, also lie within extravascular soft tissues and should be amenable to extraction by similar techniques. We successfully removed fractured catheter fragments embedded in the soft tissues of 2 patients. In both cases, percutaneous needle puncture under radiologic guidance was used to gain directed access. Technical considerations of this method and its potential application are discussed.