不透视腹主动脉低位阻断在凶险型前置胎盘剖宫产中的应用

目的探索无X线引导定位球囊置入腹主动脉低位阻断术在凶险性前置胎盘(PPP)剖宫产术中的应用价值。方法对术前诊断为PPP、不愿X射线照射的14例孕妇及1例术中发生大出血的孕妇,利用解剖标志和手法定位将球囊置入腹主动脉行低位阻断术。结果15例腹主动脉低位阻断术均成功,14例术前置入球囊者,术中出血量为200~900ml,平均(670±247)ml,术后仅1例因术前贫血伴出血者接受输血,7例行子宫动脉栓塞术;均未切除子宫;另1例术中大出血后紧急抢救置入球囊者顺利完成次全子宫切除术。全部病例均无并发症发生。结论无X线引导定位实施球囊置入行腹主动脉低位阻断对手术的顺利实施有一定价值。     

Rapid bedside coronary angiography with a portable fluoroscopic imaging system

The ability to perform coronary angiography rapidly at the bedside has multiple potential applications. This study was designed to determine whether a novel portable angiographic system (OEC Medical Systems, series 9600, Salt Lake City, Utah) is capable of producing high-quality angiograms. In 29 patients (70 vessels) undergoing elective catheterization in a conventional fixed laboratory (Siemens HICOR, Erlangen, Germany), we compared images obtained with the portable system to those from conventional fixed system. The portable system was 100% accurate in detecting both insignificant narrowing as well as significant stenoses (|l750% narrowing). There was complete concordance between systems for lesion location, TIMI flow, and collaterals. Thirty-two stenoses were analyzed in detail. Both quantitative and qualitative percent stenosis demonstrated similar value for lesion severity with both systems (R = 0.95, Kappa = 0.77, P l8 0.001, respectively). Accuracy of lesion morphology by the portable system was similar to the fixed system (calcification 80%, eccentricity 92%). These findings demonstrate that a portable imaging system can produce high-quality coronary angiograms. Cathet. Cardiovasc. Diagn. 41:449–455, 1997. © 1997 Wiley-Liss, Inc.     

Radiation exposure to children during coil occlusion of the patent ductus arteriosus

The risks of excessive exposure to ionizing radiation are well described and measures are routinely taken to limit such exposure to both patient and personnel in the catheterization laboratory. Coil occlusion of the patent ductus arteriosus (PDA) as well as other more complex pediatric interventions has raised concern regarding radiation exposure, particularly as minimally invasive surgical techniques are being developed which lack such exposure risk. In eight consecutive patients, aged 0.7–7 years (median, 2.3 years), coil occlusion of a PDA was performed and surface entrance radiation dose determined by thermoluminescent dosimetry (TD). Total cumulative doses (PA + lateral dose) were also calculated for each patient. Entrance and cumulative dose was likewise measured in 12 patients undergoing standard diagnostic catheterization (DC) and in 5 consecutive patients undergoing pulmonary balloon valvuloplasty (PBV). The groups were comparable in age, weight, and body surface area (BSA). Total cumulative dose in the PDA patients was 97 ± 25 mGy (mean ± SE). There was no significant difference between the three groups in entrance dose absorbed at each location or in total cumulative dose. The mean total fluoroscopy time in the PDA occlusion group was significantly less than that of the PBV group (10.1 ± 1.81 min vs. 19.3 ± 2.29 min, P < 0.05) but was comparable to the DC group (13.2 ± 1.5 min, P = NS). When the subjects were analyzed collectively, no correlation between fluoroscopy time and measured entrance dose was observed. The strongest correlates of total cumulative dose were patient weight (r = 0.67, P < 0.001) and BSA (r = 0.62, P = 0.001). Patients undergoing coil occlusion of a PDA are not exposed to increased radiation entrance dose compared to those undergoing standard DC and PBV. Furthermore, surface entrance radiation dose as determined by TD varies according to patient size for a given fluoroscopy time. Cathet. Cardiovasc. Intervent. 47:449–454, 1999. © 1999 Wiley-Liss, Inc.     

Patient radiation dose and fluoroscopy time during ERCP: a single-center,retrospective study of influencing factors

Objectives: Recently, both the number and the complexity with associated increased technical difficulty of therapeutic ERCP procedures have significantly increased resulting in longer procedural and fluoroscopy times. During ERCP, the patient is exposed to ionizing radiation and the consequent radiation dose depends on multiple factors. The aim of this study was to identify factors affecting fluoroscopy time and radiation dose in patients undergoing ERCP.

Materials and methods: Data related to patient demographics, procedural characteristics and radiation exposure in ERCP procedures (n?=?638) performed between August 2013 and August 2015 was retrospectively reviewed and analyzed. Statistically significant factors identified by univariate analyses were included in multivariate analysis with fluoroscopy time (FT) and dose area product (DAP) as dependent variables. Effective dose (ED) was estimated from DAP measurements using conversion coefficient.

Results: The factors independently associated with increased DAP during ERCP were age, gender, radiographer, complexity level of ERCP, cannulation difficulty grade, bile duct injury and biliary stent placement. In multivariate analysis the endoscopist, the complexity level of ERCP, cannulation difficulty grade, pancreatic duct leakage, bile duct dilatation and brushing were identified as predictors for a longer FT. The mean DAP, FT, number of acquired images and ED for all ERCP procedures were 2.33 Gy·cm², 1.84?min, 3 and 0.61 mSv, respectively.

Conclusions: Multiple factors had an effect on DAP and FT in ERCP. The awareness of these factors may help to predict possible prolonged procedures causing a higher radiation dose to the patient and thus facilitate the use of appropriate precautions.     

导引通道辅助经皮置钉治疗无神经损伤胸腰椎骨折

目的 分析新型导引通道辅助经皮椎弓根置钉治疗无神经损伤胸腰椎骨折的手术时间、射线暴露时间及置钉准确性.方法 收集2010年7月至2012年10月采用新型导引通道辅助经皮椎弓根置钉技术治疗的35例无神经损伤胸腰椎骨折患者临床资料,同一术者共完成178枚椎弓根螺钉置钉.记录分析每枚椎弓根螺钉置人时间及术者射线暴露时间,根据术后连续2次手术节段CT扫描结果,对置钉准确性进行分级和评估.结果 本组置钉技术成功率为100％.单枚椎弓根螺钉平均置钉时间为(11.35±2.82) min,平均射线暴露时间为(8.06±2.15)s;156枚(87.64％)螺钉评定为A级,20枚螺钉(11.24％)为B级,1枚螺钉(0.56％)为C级,l枚螺钉(0.56％)为D级.结论 新型导引通道有助于辅助经皮椎弓根置钉过程中定位穿刺点,提高置钉准确性,明显减少置钉时间及射线暴露时间.     

食道钡剂造影在评价鼻咽癌放疗后吞咽功能障碍中的运用

背景与目的：鼻咽癌放疗后吞咽功能障碍评价方法多为主观的问卷调查,缺乏有效的客观检测方法,本研究旨在探索鼻咽癌放疗后吞咽功能障碍的评价方法,了解鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。方法：连续选取2013年10月—2013年12月门诊复查的128例鼻咽癌放疗后患者,其中调强放疗(intensity modulated radiation therapy,IMRT)组患者89例,常规放疗(conventional radiotherapy,CRT)组患者39例。采用食道钡剂造影方法,评价吞咽功能障碍情况。每位患者吞食3种不同浓度的钡剂,并在X线透视下动态观察不同浓度钡剂在通过口腔、咽部和食道时是否存在以下问题：①在口腔受阻无法下咽;②分流至声门或气管;③潴留在梨状窝和舌会厌隙;④舌骨、会厌活动受限;⑤通过咽部不畅,时间延长;⑥通过食道入口处速度减慢。结果：在128例患者中,食道钡剂造影检测出吞咽功能障碍总发生率为60.2%,调强组和常规组分别为52.8%和76.9%(P=0.018);放疗后1年内、1~2年和2年后发病率分别为63.1%、33.3%和69.0%(P=0.019)。结论：鼻咽癌放疗后吞咽功能障碍较多见,采用IMRT的患者其发生率较低。食道钡剂造影可以客观的评价鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。     

X线定位基准线在透视定位穿刺中的应用研究

目的:研究将X线作为透视定位穿刺基准线的可行性,探讨该基准线的实际应用价值。方法:在手术C臂X线机透视下,通过塑料、带皮猪肉块模型实验,利用X线直线传播的特性,找到X线定位基准线后,在该线方向上,进行穿刺实验,将穿刺到位成功率进行统计学处理。结果:用X线定位基准线进行穿刺成功率96.7%和90%,不用X线定位基准线进行穿刺成功率16.7%和6.7%。u检验u=6.25和6.45,u>2.58,P<0.01,表明用与不用X线定位基准线进行穿刺,其成功率差异有极显著意义。又经30例临床验证,表明了使用X线定位基准线进行定位穿刺,是简单、有效的方法。结论:利用X线作为定位基准线,只需一根穿刺针,加上"三点成一线"的瞄准方法,就可实现透视下准确的定位穿刺。