超声引导穿刺在经皮肾镜治疗上尿路结石中的临床应用

目的:探讨超声引导在建立经皮肾镜取石术工作通道中的应用价值。方法:应用超声引导穿刺对102例,106侧肾及输尿管上段结石患者建立经皮肾镜工作通道,行经皮肾镜取石术。结果:106侧均穿刺成功建立皮肾通道。选择11肋间为穿刺点80侧,选择12肋下为穿刺点26侧。无胸膜损伤、腹腔脏器损伤等操作并发症。总结石取尽率为83.3%。结论:超声引导穿刺可以为经皮肾镜取石术提供实时、安全、准确的工作通道,对经皮肾镜取石术具有重要的应用价值。     

Successful treatment of spontaneous rupture of the internal carotid artery in an acute promyelocytic leukemia patient using ultrasound-guided thrombin injection

Spontaneous rupture and bleeding from the carotid artery in acute promyelocytic leukemia (APL) patients leading to pseudoaneurysm (PSA) formation has not been reported.We first successfully treated an APL patient with left internal carotid artery rupture during chemotherapy leading to PSA using ultrasound-guided thrombin injection (UGTI).A 10-year-old girl,who was diagnosed with APL,suddenly experienced left neck swelling,which expanded gradually and was not associated with pain,dizziness,palpitations,or labored breathing 2 days after the third session of chemotherapy (mitoxantrone + cytarabine) in a local hospital.She had no history of injury.     

Factors influencing discomfort during anterior ultrasound-guided injection for hip arthrography

BackgroundAlthough ultrasound (US)-guided injection techniques for magnetic resonance arthrography of the hip have been used with increasing frequency to diagnose internal joint derangements, little is known about patient tolerance, which is relevant information for patients. The objective of this study was to evaluate prospectively the association between possible influencing factors and discomfort felt during the performance of anterior US-guided injection techniques targeting the femoral head–neck junction during hip arthrography.MethodsForty-four consecutive patients (21 women and 23 men; mean age, 41 years) undergoing magnetic resonance hip arthrography were sequentially assigned to receive injection alternating between fixed and freehand US-guided injection. Discomfort was assessed using a visual analog scale and relative ratings. Patient body mass index, extra-articular contrast leakage, the duration of the procedure, the needle advancement distance, and the fixed trajectory of the needle were assessed. Pearson’s correlation coefficients and multiple logistic regression analysis were used to determine the association.ResultsPuncture was successfully accomplished in all cases, and no relevant complications were reported. The only significant relationships were between discomfort and the time required for needle manipulation (r = 0.8) and fixed US-guided injection (r = 0.6; p < 0.001). Compared with the freehand technique, the fixed technique resulted in significantly less pain and took significantly less time to perform (p < 0.001). The procedure time during needle manipulation in the fixed US-guided injections (4.0 ± 0.9 seconds) was significantly less than that in the freehand US-guided injections (19.4 ± 17.6 seconds; p < 0.001). No significant relationships were found between discomfort and other parameters (r < 0.3, p > 0.05).ConclusionThe procedure time appears to be the most important factor influencing patient discomfort. Fixed US-guided injection is a time-saving technique that alleviates procedure-related discomfort.     

尿激酶灌注在B超引导穿刺引流治疗肾周血肿中的观察

目的：探索肾周血肿的理想治疗方法.方法：将30例肾周血肿患者随机分成对照组及观察组,每组各15例.观察组采用B超引导穿刺引流联合尿激酶灌注治疗,对照组采用单纯B超引导穿刺引流治疗,比较2组患者的治疗效果.结果：观察组患者术后住院时间、引流管留置时间均短于对照组（P＜0.05）,肾功能损害、血肿残留比例均小于对照组（P＜0.05）.结论：B超引导穿刺引流联合尿激酶灌注治疗肾周血肿疗效确切,是治疗肾周血肿的一种理想方法.     

超声引导下颈部肿块穿刺活检术的护理配合

目的探讨超声引导下颈部肿块自动活检枪穿刺活检术的护理配合。方法对28例超声引导下颈部肿块自动活检枪穿刺活检术的护理配合进行回顾性分析。结果本组患者均能正确配合并顺利完成穿刺,仅2例患者主诉穿刺点疼痛,给予心理护理后好转,未使用止痛剂;1例患者出现小血肿,经及时处理后血肿消退。结论及时有效的护理配合对减少患者的痛苦、保证穿刺的顺利进行起着重要的作用。     

B超引导下持续循环胸腔热灌注治疗恶性胸腔积液的可行性及临床疗效初探

目的评价B超引导下持续循环胸腔热灌注（continuous circularory intrapleural perfusion hyperthermia,CCIPH）治疗各种恶性肿瘤引起的恶性胸腔积液的可行性、临床疗效及毒副反应。方法选取13例恶性肿瘤合并胸膜转移、胸腔积液患者,经胸片或胸部CT明确存在中一大量胸腔积液,且胸腔积液经细胞学检查明确可查见癌细胞。本组13例患者均在B超引导定位下行胸腔穿刺置管术,分别留置灌注管和排液管,所有操作均在局麻下进行。灌注液为蒸馏水,总量约2500～3500ml,灌注速度300～400ml／min,灌注时间60min,治疗温度（48±0．2）℃,每例灌注2～3次,两次治疗之间时间间隔为48h。结果所有13例患者均顺利进行B超引导下CCIPH,人体温度为（48．00±0．20）℃,出体温度为（44．98±0．22）℃。患者均耐受良好。9例患者胸腔积液完全缓解,4例部分缓解。CCIPH后1个月左右复查胸部CT,发现肺部原发灶缩小者6例,基本不变者7例。患者KPS评分上升均在10分以上,肿瘤标志物不同程度下降,无严重副作用。结论B超引导下CCIPH治疗恶性胸腔积液安全性高,患者耐受良好,方法简便易行,近期疗效满意。     

超声引导下经皮肺穿刺活检在肺周围性病变中的诊断价值

目的探讨彩色多普勒超声引导下经皮肺穿刺活检在肺周围型病变临床诊断中的应用价值。方法对贴近胸壁及超声能显示的肺周围型病灶48例,先观察二维图像及血流分布,再行彩超引导下经皮肺穿刺活检。结果一次穿刺成功率为95.8%（46/48）;穿刺组织用于病理诊断满意率93.8%（45/48）;并发症发生率6.3%（3/48）。结论对超声能显示的肺周围型病变行彩超引导下穿刺活检术,取材成功率高,是一种安全、有效的活检方法。     

B超引导下可调控套管腹腔灌洗治疗重症急性胰腺炎的临床观察

目的 探讨B超引导下可调控套管腹腔灌洗在重症急性胰腺炎治疗的安全性及疗效.方法 对21例重症急性胰腺炎患者除采用常规非手术综合治疗外均行B超引导下可调控套管腹腔灌洗.结果 该组21例患者中,治愈18例,死亡3例,治愈率为85.7%.全组患者均无导管脱落、腹腔空腔脏器损伤等并发症.结论 B超引导下可调控套管腹腔透析液腹腔灌洗治疗重症急性胰腺炎安全有效,为重症急性胰腺炎治疗方法的一种新的探索.     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。