血管内乳头状内皮增生的高频超声表现

目的探讨血管内乳头状内皮增生（IPEH）的高频超声（包括二维及彩色多普勒血流）成像特征,帮助该病的诊断及鉴别诊断。 方法收集2014年1月至2019年11月于南京医科大学第一附属医院经穿刺或手术病理证实的IPEH患者21例,回顾性分析患者的年龄、性别和临床病史。其中8例患者（年龄17~63岁,平均44.8岁,女性4例,男性4例）进行了术前高频超声检查,包括二维及彩色多普勒血流成像检查。2名肌肉骨骼超声医师对该8例IPEH患者的超声表现进行回顾性分析,包括病变位置、形状、大小、内部回声、异质性、血管分布,分析超声特征与病理的关系。 结果8例IPEH灰阶超声表现为单发,平均大小23.5 mm,从皮下脂肪层至深筋膜层均可发生,呈边界清晰的不均质低回声,1例（12.5%）内部结构呈洋葱圈样改变,1例（12.5%）呈筛网状改变;彩色多普勒血流成像显示肿块内血流分级0级7例,仅1例（12.5%）肿块内可见血管穿行。病理诊断8例IPEH均为单纯型,均可见扩张血管腔内机化的血栓;典型病理表现为纤维血管轴心玻璃样变的乳头状内皮增生。所有患者均未复发。 结论IPEH（单纯型）多为孤立性肿块,其超声表现为体积较小、椭圆形、边界清晰、不均匀低回声、不伴钙化、内部可有穿支血管、质偏软。检测到的起源血管的存在可能有助于区分IPEH和其他软组织肿块。高频超声成像检查可作为IPEH首选的检查方法。     

Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt

Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high‐risk patients. Although the success rate of endoscopic gallbladder stenting is 79%–100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035‐inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7‐Fr 12‐cm double‐pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.     

左锁骨下动脉闭塞行腔内再通术中医源性B型主动脉夹层1例

<正>患者男,51岁,半月前出现左上肢无力,活动后头晕;既往无特殊病史。查体:左挠动脉、肱动脉搏动明显减弱,双上肢收缩压差45 mmHg。经颅多普勒检查:左椎动脉血流反向;CTA:左锁骨下动脉起始部闭塞伴明显纡曲,闭塞段长约14mm(图1)。入院后双联抗血小板治疗3天后,经股动脉穿刺入路行闭塞段开通、球囊扩张及支架成形术。将8F导引导     

血管内支架成形术治疗有症状大脑中动脉狭窄

目的：探讨血管内支架成形术在有症状大脑中动脉狭窄治疗中的应用。方法：对3例临床诊断脑梗死和3例短暂性脑缺血发作患者行全脑血管造影术，发现大脑中动脉M1段存在不同程度狭窄，对狭窄段大脑中动脉行颅内支架成形术。结果：6例大脑中动脉支架成形术均获得成功。大脑中动脉M1段平均直径狭窄程度从92．8％降至6％（P〈0．01）。1例患者在支架置入10min后出现急性血栓形成，术中经微导管注入尿激酶接触性溶栓，25min后血栓溶解。术后随访6个月，所有患者均无脑缺血事件发生。结论：采用血管内支架成形术治疗有症状大脑中动脉狭窄可行。     

Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial. DIrect Stenting of COronary Arteries.

AIMS: To assess the safety of direct coronary stenting, its influence on costs, duration of the procedure, radiation exposure, clinical outcome and angiographic restenosis. METHODS AND RESULTS: We randomized 416 patients (446 lesions) to direct stent implant or stent implant following balloon pre-dilation. Patients >75 years old, heavily calcified lesions, bifurcations, total occlusions, left main lesions and very tortuous vessels were excluded. Direct stenting was successful in 217/224 lesions (96.8%). No single loss or embolization of the stent occurred. All stents in the group with pre-dilation were effectively deployed. The immediate post-procedure angiographic results were similar with both techniques. Fluoroscopy and procedural time were significantly lower in direct stenting (6.4+/-0.3 and 21+/-0.9 min) than in pre-dilated stenting (9.1+/-0.4 and 27.5+/-1.1 min) (P>0.001). Major adverse cardiac events during hospitalization were one in direct and four in pre-dilated stenting (P=0.05) but there were no significant differences at follow-ups at 1, 6 and 12 months between the two groups. Angiographic reevaluation at 6 months was performed in 94% of the cases. Restenosis rate was 16.5% in direct stenting and 14.3% in pre-dilated stenting (P=ns). CONCLUSIONS: Direct stenting is as safe as pre-dilated stenting in selected coronary lesions. Acute angiographic results are similar but procedural costs, duration of the procedure and radiation exposure are lower in direct stenting. Overall success rate, mid-term clinical outcome and restenosis are similar with both techniques.     

Does primary stenting preserve cardiac function in myocardial infarction? A case-control study

OBJECTIVE—To investigate whether coronary stenting limits myocardial injury and preserves left ventricular function.
DESIGN AND SETTING—Prospective multicentre case-control study of primary percutaneous transluminal coronary angioplasty (PTCA) with and without stenting, performed in seven cardiovascular centres.
SUBJECTS AND METHODS—45 consecutive patients with acute myocardial infarction who were treated with successful primary stenting (Stent group) and did not have restenosis were paired with 45 matched control subjects with acute myocardial infarction treated by successful primary PTCA without stenting, also with no restenosis (POBA group).
RESULTS—In comparison with the POBA group, the Stent group—especially those patients with a left anterior descending coronary artery lesion—had a smaller hypokinesis area (mean (SD): 15.1 (20.0) v 34.4 (24.3) chords), reduced hypokinesis area/risk area (25.2 (31.9)% v 58.8 (40.1)%), and a larger ejection fraction (63.3 (10.2)% v 51.7 (11.7)%) evaluated by quantitative left ventriculography using the centreline method. In the Stent group, the correlation between risk area and hypokinesis area was significantly shifted downward. Multiple logistic regression analysis on infarct size limitation (hypokinesis area/risk area < 50%) identified preinfarction angina in all subjects and preinfarction angina and stenting in patients with left anterior descending coronary artery leasions as explanatory factors.
CONCLUSIONS—Primary PTCA using a coronary stent is effective in preventing myocardial injury and restoring left ventricular function in patients with anterior acute myocardial infarction.


Keywords: acute myocardial infarction; primary stenting; left ventricular function; preinfarction angina     

CDFI与实时组织弹性成像联合监测在肝硬化经颈静脉肝内门体分流术术后疗效的临床价值

目的 探讨CDFI和实时组织弹性成像(RTE)联合监测在肝硬化经颈静脉肝内门体分流术(TIPSS)术后疗效的临床价值.方法 对临床46例肝硬化门脉高压经TIPSS术前、术后进行CDFI和RTE检查.观察门静脉、脾静脉内径和血流变化情况;通过组织弥散定量分析软件分析肝硬化弥散指标变化情况.结果 TIPSS术后门静脉内径变小,门静脉、脾静脉流速增快,与术前比较差异有统计学意义(P＜0.05),脾静脉内径改变不明显,与术前比较差异无统计学意义.TIPSS术后蓝色领域百分比增高,复杂度、峰度、偏度减低,与术前比较差异均有统计学意义(均P＜0.05),TIPSS术前、后应变均值、标准偏差、对比度、均等性、杂乱度、一致性及相关性改变不明显.结论 CDFI技术在观察TIPSS术前后血管内径、血流速方面改变比较明显;RTE能观察到肝硬化TIPSS术后肝硬度的改变情况.二者联合诊断肝硬化TIPSS术后价值更高.     

不同冠状动脉截段定量冠状动脉造影与血管内超声测值的差异与意义

目的评价定量冠状动脉造影(QCA)与血管内超声(IVUS)在冠心病不同冠状动脉截段参考血管直径的测量差异。方法选择2015年12月至2018年10月在导管室同时行冠状动脉造影及IVUS检查的患者共278例,分别测量不同冠状动脉截段病变血管的参考血管直径,并进行比较,寻找相对简单的公式应用于两者内在联系,并随机选择额外300处病变(280例患者)血管进行验证分析。结果不同冠状动脉截段病变血管的参考血管直径QCA和IVUS测值之间存在显著差异,右冠状动脉直径IVUS测值较QCA测值大,旋支直径IVUS测值较QCA测值小,这种差异在血管远端更明显。通过线性回归分析,QCA测量的不同冠状动脉截段参考血管直径由相应公式推算出IVUS测出的直径,并通过额外300处血管病变测量的数值得到相应验证。结论不同冠状动脉截段定量冠状动脉造影与血管内超声测值之差具有规律性,有助于冠状动脉介入治疗中确定血管直径。