超声介导腹腔神经节去除治疗胰腺癌疼痛的护理

目的探讨超声介导腹腔神经节去除对胰腺癌疼痛患者的治疗作用及护理要点。方法采用B超定位，实时超声动态监测经皮穿刺，于腹腔动脉干根部旁侧注入无水乙醇15ml，对114例胰腺癌疼痛患者实施腹腔神经节去除术。对比观察治疗前后疼痛的视觉模拟评分（VAS）、血清SP水平变化，并对穿刺治疗过程进行严密的护理观察。结果114例中仅1例失败，成功率99．0％，无急性胰腺炎、胰瘘及出血等穿刺并发症；VAS及血清sp较术前明显降低（P〈0．01，P〈0．05）；总有效率88．4％，显效率75．2％，13例无效。结论本微创技术具有很高的安全性，能显著减轻胰腺癌疼痛并提高患者的生存质量。     

CT引导下经皮穿刺卵圆孔行阿霉素阻滞治疗三叉神经痛

目的 探讨CT引导下经皮穿刺卵圆孔注射阿霉素毁损疗法治疗三叉神经痛的技术及临床应用价值。方法 63例三叉神经痛患者，男24例，女39例；年龄43～77岁，平均59岁。右侧疼痛41例，左侧22例。所有患者均有典型的三叉神经支配区域疼痛病史及服用苯妥英钠或卡马西平史，其中27例患者曾接受三叉神经周围分支化学毁损术，7例接受过半月神经节射频热凝毁损术，4例为微血管减压术后复发病例。结果 63例CT引导经皮穿刺卵圆孔全部引导成功。确定针尖在卵圆孔神经节内时，分次缓慢注射阿霉素0．2～0．5ml。治疗后，即刻疼痛完全缓解者61例(96．8％)，明显缓解1例，轻度缓解1例。治疗后行6、12个月随访观察，有效率分别为84．1％，79．4％。并发症少而轻微，无严重并发症。结论 CT引导下经皮穿刺卵圆孔疗法对三叉神经痛具有定位准确，无痛苦，操作简单、安全，并发症少的优点，具有临床推广应用价值。     

CT引导下经皮穿刺卵圆孔阿霉素注射毁损术治疗三叉神经痛

目的：探讨CT引导下经皮穿刺卵圆孔阿霉素注射毁损术治疗三叉神经痛的可行性及临床应用价值。方法：26例患者在CT引导下穿刺到达卵圆孔。注入稀释对比剂观察其分布及弥散范围,注射2％利多卡因0．2ml行试验性治疗,后缓慢分次注入2％阿霉素液,每次0．1ml,共0．3-0．5ml。结果：所有患者均在CT引导下成功穿刺到达卵圆孔。术后即刻疼痛完全缓解率88．5％（23／26）,6个月及12个月有效率分别为80．8％、73．1％。并发症少且较轻。结论：CT引导下经皮穿刺卵圆孔阿霉素注射毁损术治疗具有微创、经济方便、操作相对简单、安全、效果佳及可重复性的优点,不失为临床治疗三叉神经痛的一种有效的可行性治疗方法,具有较好的临床应用价值。     

高强度聚焦超声用于晚期胰腺癌病人的止痛作用研究

目的探讨高强度聚焦超声（HIFU）对晚期胰腺癌止痛的疗效、并发症及安全性。方法应用FEP-BYO1高能聚焦超声肿瘤热疗机对42例晚期胰腺癌患者进行热疗，治疗时采用HIFU治疗病灶及腹腔神经丛的方法，观察治疗前后患者疼痛改变情况。结果42例患者治疗后疼痛消失5例（11．9％），疼痛减轻21例（50．0％），疼痛无改变7例（16．6％），治疗前后均无疼痛9例（21％）。JAMES评分：治疗前后评分差异存在显著意义（P〈0．05）。结论HIFU治疗能有效的缓解晚期胰腺癌患者的疼痛。     

CT引导下经腹前壁途径腹神经丛阻滞术治疗癌性疼痛

目的：评价CT引导下经腹前壁途径腹腔神经丛阻滞术（NCPB）治疗上腹部及后背癌性疼痛的疗效和安全性。方法：回顾性分析了24例接受了CT引导下经腹前壁穿刺无水酒精腹腔神经丛阻滞治疗癌性疼痛的中、晚期胰腺癌和其它恶性肿瘤患者的临床资料。结果：短期疗效（＜2周）的有效率为91．7％,完全缓解率为45．8％,长期疗效（＞3个月）的有效率为71．4％,完全缓解率为14．3％。无1例严重并发症。结论：T导腹前壁穿刺腹腔丛阻滞术是一种简便、安全、有效的治疗上腹部及后背癌性疼痛的方法。     

B超引导下经皮肾穿刺活检围手术期的护理

目的：探讨B超引导下经皮肾穿刺活检术前、术中、术后的护理措施。方法：对30例狼疮性肾炎患者行B超下肾穿刺活检，在术前、术中及术后各期进行相应的护理。结果：术后极少部分出现并发症，经相应的对症治疗、护理后，均痊愈。结论：B超引导下的经皮肾穿刺活检术是一种安全准确的诊断技术，但细致周到的护理工作也是穿刺成功的重要保证。     

放射性^125I粒子植入术治疗原发性中晚期肝癌的观察与护理

目的：探讨B超引导下经皮穿刺组织间植入^125I放射性粒子治疗原发性中晚期肝癌的的护理方法。方法对31例行B超引导下^125I放射性粒子植入治疗的患者进行全面的护理,包括术前护理、物品准备、术中配合、术后并发症的护理和放射防护等。结果所有患者能够积极配合治疗和护理,并取得了较为满意的疗效,其主要并发症为术中及术后短期穿刺部位疼痛、麻木,但经过适当的护理均可减轻或消除。结论 B超引导下经皮穿刺125I放射性粒子植入是一种安全、有效的治疗中晚期肝癌的微创介入法,我们通过及时有效的护理措施可确保治疗成功。     

B型超声引导125I粒子植入治疗溶骨性骨转移瘤18例

目的观察B型超声（B超）引导下经皮穿刺125I粒子植入姑息性治疗溶骨性骨转移瘤的疗效。方法对2011年2月至2013年12月收治的18例晚期肿瘤患者的溶骨性骨转移瘤采用B超实时引导经皮穿刺植入125I粒子,术前、术后3 d以及术后1个月根据视觉模拟评分法（VAS）对疼痛评分。所有治疗病灶术后1个月复查CT检测肿瘤大小变化,观察粒子分布情况,必要时重复治疗。根据CT结果,按实体瘤的疗效评价标准（RECIST）评价疗效。结果18例患者进行33次手术,术后3 d局部疼痛较术前已有明显改善,与术前VAS比较P=0.000,差异有统计学意义。术后1个月疼痛仍能较好控制,P=0.000,差异有显著统计学意义。末次手术后1个月与基线相比观察疗效：CR 0例（0%）,PR 11例（61.1%）,SD 6例（33.3%）,PD 1例（5.6%）,局部控制率（CR+PR）61.1%。无严重的放疗并发症。结论 B超引导简便,可重复性好,能安全、有效地引导经皮穿刺125I粒子植入近距离放射治疗溶骨性骨转移瘤,在不采用治疗计划系统（TPS）的情况下,也能获得较好的局部控制率,疼痛缓解显著。     

CT引导下射频热凝治疗原发性三叉神经痛的临床疗效

目的 探讨运用CT引导下射频热凝治疗原发性三叉神经痛的临床效果.方法 选取原发性三叉神经痛患者165例作为研究对象,所有患者采用随机抽签法分成射频热凝组和药物毁损组,射频热凝组患者83例,药物毁损组患者82例.射频热凝组采用CT引导下射频热凝治疗三叉神经痛,药物毁损组采用CT引导下经皮穿刺卵圆孔表阿霉素化学毁损治疗三叉神经痛,于治疗后3个月、6个月、1年、3年进行随访,观察两组患者的VAS评分变化、治疗总有效率及并发症发生率指标.结果 射频热凝组优良率明显优于药物毁损组,两组差异有统计学意义(P＜0.05);两组并发症发生率比较,射频热凝组明显更低,差异有统计学意义(P＜0.05);两组随访期VAS疼痛评分比较,观察组更低,且远期疼痛情况稳定,总体治疗效果突出.结论 采用CT引导下射频热凝治疗原发性三叉神经痛的临床效果显著,值得推广应用.     

硬膜外靶向阻滞治疗腰椎间盘突出症术后疼痛效果观察

目的：对比观察硬膜外靶向阻滞与常规穿刺阻滞治疗腰椎间盘突出症胶原酶溶解术后疼痛的效果。方法：选择腰椎间盘突出症胶原酶溶解术后疼痛加重108例,随机分为硬膜外靶向阻滞治疗组（观察组）58例和常规穿刺阻滞治疗组（对照组）50例,分别于阻滞治疗3天后采用视觉模拟评分（VAS）评分进行疗效评定。结果：观察组优30例,占51．7％;良23例,占39．7％;差5例,占8．6％;总优良率91．4％。对照组优19例,占38．0％;良18例,占36．0％;差13例,占26．0％;总优良率74．0％。两组总优良率比较,差异显著（P〈0．05）。结论：采用硬膜外靶向阻滞治疗腰椎间盘突出症术后疼痛效果优于常规穿刺阻滞。     

床旁纤维支气管镜引导经鼻气管插管抢救慢性阻塞性肺部疾病呼吸衰竭的临床应用

目的：探讨床边纤维支气管镜（简称纤支镜）引导下经鼻气管插管抢救慢性阻塞性肺部疾病（COPD）呼吸衰竭的临床价值。方法：总结48例喉镜经口插管和床旁纤维支气管镜引导经鼻气管插管所需时间、对生命体征影响、插管成功率、插管结束后并发症。结果：A组和B组插管所需时间差异无显著性（P〉0．05）。A组和B组插管结束后并发症（P〈0．01）。A组和B组插管成功率差异无显著性（P〉0．05）。A组和B组插管前后呼吸频率增加（P〈0．05）。A组和B组插管前后心率增加差异有非常显著性（P〈0．01）。A组和B组插管前后血压增加差异有显著性（P〈0．05）。A组和B组插管前后SPO2降低差异有非常显著性（P〈0．01）。结论：纤维支气管镜引导下经鼻气管插管抢救COPD呼吸衰竭，操作简单、快速、准确、安全，值得临床推广应用。     

Evaluation by ultrasound of traumatic rib fractures missed by radiography

Rib fractures are the most common (25%) injuries resulting from blunt chest trauma, and are usually revealed on radiographs. Radiography sometimes cannot show fractures, especially those in costal cartilages, except for densely calcified ones. Several authors have recently investigated the role of ultrasound in the detection of rib fractures. We conducted this study to investigate possible rib fractures with ultrasound, determine those overlooked on chest x-ray, and analyze the possible clinical predictors of these insidious rib fractures in minor or mild blunt chest trauma. A total of 20 patients with minor mild blunt chest trauma were enrolled into this study. All radiographs were reviewed by two radiologists who noted rib fractures or other complications. Ultrasonography was performed in the radiology department using a linear transducer by one radiologist. The costal cartilage normally appears relatively hypoechoic compared with the osseous rib. Fractures of the rib, costochondral junction, and costal cartilage were denoted by a clear disruption of the anterior echogenic margin. A total of 20 patients with normal radiological findings, but continuing symptoms were evaluated by ultrasound. The most common etiology of trauma was a fall, as seen in 60% of the patients. None of the rib fractures were identified radiographically. Sonography detected 26 rib fractures in 18 of 20 subjects at presentation. Sonography reveals more fractures than radiography and will reveal fractures in most patients presenting with suspected rib fracture.     

预处理对减少依托咪酯所致肌阵挛120例临床观察

目的：观察通过预处理对依托咪酯全麻诱导时肌阵挛的影响。方法：120例择期全麻患者随机分为3组：雷米芬太尼组、维库溴铵组和对照组,每组40例。观察各组全麻诱导时依托咪酯引起肌阵挛的例数,并记录肌阵挛的发生程度。结果：雷米芬太尼组出现3例肌阵挛（7.5%）,其中轻度1例,中度2例;维库溴铵组出现2例轻度肌阵挛（5.0%）;对照组出现30例肌阵挛（75.0%）,其中轻度15例、中度12例、重度3例。雷米芬太尼组和维库溴铵组肌阵挛发生率明显低于对照组（P〈0.01）,而雷米芬太尼组和维库溴铵组间比较差异无统计学意义。结论：通过雷米芬太尼和维库溴铵预处理均可减少依托咪酯全麻诱导所致的肌阵挛,而因二者对心血管系统的影响不同,使用维库溴铵预处理更利于心血管系统功能降低的患者。     

双神经弓式双端侧吻合治疗痛性指固有神经瘤

目的介绍一种治疗痛性指固有神经瘤的手术方法。方法2005年2月-2011年3月,巢湖紫晨手外科医院手外科中心采用双端侧吻合治疗指固有神经瘤11例11指。术中将神经瘤彻底切除直至正常神经束,对远、近端尺桡侧指固有神经分别进行远与远、近与近端一端吻合,形成远、近2条神经弓;测量两神经弓间距,取直径相近的前臂外侧皮神经,平分为两段,分别于神经弓的尺、桡侧开窗式端侧吻合。结果随访24．5—52个月,平均（38±2．5）个月。9例指疼痛完全消失,2年后未见复发;2例指自发性疼痛消失,但仍有轻度触痛,参照Burchiel疗效评定标准：优9指,良2指;优良率100％。感觉测定指标为s3～s4级,两点分辨觉为4．5—6．5mm。结论双神经弓式双端侧吻合的方法可有效治疗痛性指固有神经瘤,消除患指疼痛、恢复指腹灵敏性。     

Ilizarov外固定架分步延长法治疗儿童尺骨骨干续连症的疗效

 目的 探讨一种应用Ilizarov外固定架治疗儿童尺骨骨干续连症的方法及其疗效。方法 2009-02至2015-10,采用Ilizarov外固定架分步延长法,对29例尺骨骨干续连症患儿进行了矫治。通过定期门诊复查及拍摄患肢X线片,评估术后患肢畸形及功能改善情况。结果 患儿术后平均随访38个月,尺骨平均延长3.2 cm;1例延长过程中出现骨不连,通过调整延长速度后逐渐愈合;1例拆除外架后发生尺骨骨折,石膏固定后自行愈合。术后患儿腕关节、肘关节及前臂功能均得到改善。 结论 应用Ilizarov外固定架分步延长法治疗儿童尺骨骨干续连症效果明显,但术中要注意熟练操作,避免副损伤的发生,延长过程中要注意控制延长速度,做好各项并发症的预防。     

超声引导下注射凝血酶治疗医源性股动脉假性动脉瘤

目的:探讨超声引导下瘤腔内注射凝血酶治疗医源性股动脉假性动脉瘤的方法及其可行性和安全性.方法:6例患者因行股动脉穿刺于术后2～5 d发生6处股动脉假性动脉瘤,均在彩色多普勒超声定位下通过瘤腔内注射凝血酶进行治疗,治疗后即刻超声复查,并定期随访.结果:4例患者4处假性动脉瘤一次性注射凝血酶300～500 U后瘤腔即刻闭合,随访10～90 d,假性动脉瘤无复发.2例患者2处假性动脉瘤瘤体较大,第1次注射后于第3 d复发,行第2次注射后,假性动脉瘤无复发.其中1例患者出现一过性肢体栓塞临床表现,经观察后肢体栓塞临床表现消失,未特殊处理.6例患者均未出现过敏反应等并发症.结论:瘤腔内注射凝血酶治疗医源性股动脉假性动脉瘤是一种创伤小、有效、安全的方法,但操作时需注意瘤体的大小及凝血酶的用量.     

Comparison of SUVs Normalized by Lean Body Mass Determined by CT with Those Normalized by Lean Body Mass Estimated by Predictive Equations in Normal Tissues

Purpose

Standardized uptake values (SUVs) normalized by lean body mass (LBM) determined by CT were compared with those normalized by LBM estimated using predictive equations (PEs) in normal liver, spleen, and aorta using ¹⁸F-FDG PET/CT.

Methods

Fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) was conducted on 453 patients. LBM determined by CT was defined in 3 ways (LBM_CT1-3). Five PEs were used for comparison (LBM_PE1-5). Tissue SUV normalized by LBM (SUL) was calculated using LBM from each method (SUL_CT1-3, SUL_PE1-5). Agreement between methods was assessed by Bland-Altman analysis. Percentage difference and percentage error were also calculated.

Results

For all liver SUL_CTs vs. liver SUL_PEs except liver SUL_PE3, the range of biases, SDs of percentage difference and percentage errors were −0.17-0.24 SUL, 6.15-10.17 %, and 25.07- 38.91 %, respectively. For liver SUL_CTs vs. liver SUL_PE3, the corresponding figures were 0.47-0.69 SUL, 10.90-11.25 %, and 50.85-51.55 %, respectively, showing the largest percentage errors and positive biases. Irrespective of magnitudes of the biases, large percentage errors of 25.07-51.55 % were observed between liver SUL_CT1-3 and liver SUL_PE1-5. The results of spleen and aorta SUL_CTs and SUL_PEs comparison were almost identical to those for liver.

Conclusion

The present study demonstrated substantial errors in individual SUL_PEs compared with SUL_CTs as a reference value. Normalization of SUV by LBM determined by CT rather than PEs may be a useful approach to reduce errors in individual SUL_PEs.     

Chest-wall invasion by carcinoma of the lung: detection by MR imaging

Nineteen patients with bronchogenic carcinoma were studied by MR imaging to determine the presence of chest-wall invasion. All studies were carried out at 1.5 T, and the results were correlated with chest radiographs or CT scans. All MR studies were interpreted before surgery (13 cases) and without knowledge of the results of other radiologic studies. MR findings indicative of chest-wall invasion included a high-signal focus within the chest wall and/or chest-wall thickening with increased signal on spin-echo (SE) images having a repetition time of 2500 msec and an echo time of 50-100 msec (SE 2500/50-100). In one case, noncontour-deforming high-signal intensity within chest-wall musculature (but no other abnormality) was demonstrated on SE 2500/50-100 images. Coronal or sagittal imaging facilitated identification of tumor contiguity with extrathoracic structures in apical lesions. Contrast differences between normal and invaded chest wall on T2-weighted images were the most helpful in assessing chest-wall involvement. These preliminary observations indicate that MR imaging is useful in the evaluation of chest-wall invasion by carcinoma of the lung.     

Treatment of type D dural carotid-cavernous fistula by embolization followed by irradiation

Summary In a patient with dural carotid-cavernous fistula supplied by meningeal branches of both internal and external carotid arteries, particulate embolization of the meningeal branches of only the external carotid artery failed to cure the fistula. Subsequent radiation therapy achieved clinical and anatomical cure of the lesion.