儿童动静脉畸形病变的血管内治疗

目的 了解儿童颅内动静脉畸形（ＡＶＭ）病变的血管内治疗特点。方法 回顾分析２１例儿童动静脉畸形的临床表现、血管构筑学特点及治疗。结果 手术切除７例,１例不全切除后多次出血,继发颅内感染;单纯栓塞８例,栓塞加ｒ－刀立体放射治疗５例,均治愈。结论 儿童动静脉畸形的临床表现和血管构筑学具有一定的特点,尽早行血管内栓塞治疗或栓塞后合并ｒ－刀治疗效果满意。     

颅内深部小型动静脉畸形的血管内介入治疗

目的探讨颅内深部小型动静脉畸形血管内介入治疗的安全性及临床效果。方法回顾分析12例颅内深部小型动静脉畸形患者采用血管内介入治疗的临床资料,其中畸形位于基底节区6例,丘脑．基底节区4例,小脑上蚓部2例;采用Onyx或NBCA进行栓塞治疗。结果完全栓塞7例（58．3％）,次全栓塞3例（25％）,部分栓塞2例（16．7％）,残余畸形者行伽玛刀治疗,随访3个月至2年,平均12个月,无严重并发症及死亡病例。结论颅内深部小型动静脉畸形根据具体情况采用血管内介入栓塞,能收到满意的效果,但栓塞率和畸形血管构筑、供血动脉多少以及血管条件相关。     

选择性肾动脉栓塞治疗肾脏出血疾病

目的：探讨选择性肾动脉介入栓塞治疗肾脏出血疾病的临床价值。方法：回顾分析11例肾脏出血疾病患者临床资料。其中4例肾动静脉畸形和1例肾外伤引起的出血患者采用超选择性肾动脉介入栓塞治疗，6例中、晚期肾癌出血患者采用化疗＋栓塞治疗。结果：4例肾动静脉畸形患者栓塞治疗1～3d后，肉眼血尿消失，随访9～36个月血尿再无复发。1例肾外伤经保守治疗后继发性出血的患者，栓塞治疗后随访10个月再无出血。6例中、晚期肾癌并出血患者经介入化疗＋栓塞治疗后，其中4例在24～72h内行肾癌根治术，均治愈；1例6个月后复查CT，原发病灶缩小，转移灶未增多；1例并发肺转移，9个月后死亡。11例患者均无严重并发症发生。结论：选择性肾动脉栓塞治疗肾脏出血疾病是安全、有效的方法，尤其是对肾动静脉畸形患者更为有效。     

出血性颅内动脉瘤108例诊治分析

目的回顾性分析和总结已破裂出血的颅内动脉瘤的诊治情况以期提高该病的诊治水平。方法回顾分析108例颅内动脉瘤破裂出血患者的资料。除1例外均经脑血管三维重建(CTA)发现颅内动脉瘤。26例行血管内栓塞动脉瘤介入治疗;42例行动脉瘤手术夹闭术;35例动脉瘤患者为保守治疗或放弃治疗;转院治疗5例。结果介入栓塞治疗26例,治愈25例,继发脑血管痉挛、延迟性脑缺血梗塞死亡1例,手术治疗42例,死亡5例,保守或自动出院病例中5例轻残其余均死亡。结论颅内动脉瘤性破裂出血的治疗重点是病因治疗,个性化的治疗方案、尽早干预是提高脑动脉瘤治愈率的关键。     

颌骨中心性动静脉畸形栓塞与手术治疗的临床研究

目的 总结动脉血管介入栓塞结合手术治疗颌骨动静脉畸形的临床疗效。方法 对10例颌骨中心性动静脉畸形血管永久栓塞。其中8例栓塞后行颌骨病灶刮治。结果 8例栓塞加手术治疗的患者，随访24个月无复发，2例单纯栓塞治疗的病例，随防36个月无复发。结论 颌骨动静脉畸形栓塞加手术治疗是一种新的安伞有效的治疗。     

颅内动脉瘤急性破裂的早期综合治疗

目的应用早期介入栓塞及显微手术等早期全程综合诊疗方法治疗急性破裂的颅内动脉瘤，以期降低病死率及病残率。方法120例颅内动脉瘤破裂出血患者入院时急诊综合救治及脑血管造影。早期（72h内）介入栓塞或显微手术治疗。术后立即释放血性脑脊液，抗血管痉挛，保持脑灌注，防制并发症。结果良好95例，轻残18例，重残4例，死亡3例。治疗良好率达80％以上。住院期间再出血2例。导致昏迷的严重脑血管痉挛5例。结论对于颅内动脉瘤加强早期全程综合救治，早期介入栓塞或显微手术治疗，注意脑血管痉挛和脑积水防治，可有效减少住院期间再出血，防止或减轻严重脑血管痉挛和脑积水的发生，降低病死率，改善患者预后。     

显微手术治疗胼胝体动静脉畸形8例分析

目的：总结胼胝体动静脉畸形(AVM)的显微手术治疗经验。方法：回顾分析1992年1月至2002年12月治疗8例胼胝体AVM的结果。结果：7例行显徽手术切除．术中1例行术中AVM栓塞加手术切除。全切5例，次全切除2次，无手术死亡。1例拒绝手术，半年后死于再出血。随访5例。平均随访26月，均恢复良好。结论：胼胝体AVM一经诊断明确．应积极行显微手术切除。对难以全切者可行栓塞治疗或栓塞后切除。对深部术后部分残留者，再辅以γ刀治疗，可取得良好的效果。     

脑动静脉畸形出血的显微手术治疗

目的:探讨显微外科手术治疗脑动静脉畸形(AVM)破裂出血的效果.方法:对54例破裂出血的脑AVM患者实施显微手术治疗.结果:手术完全切除病灶46例(85.2%);畸形血管团残留8例(14.8%).按GOS评分,恢复良好31例(57.4%),轻度残疾9例(16.7%),重度残疾8例(14.8%),植物生存4例(7.4%),死亡2例(3.7%).结论:显微外科手术是脑AVM破裂出血的有效治疗手段.     

儿童自发性颅内出血36例临床分析

目的 探讨儿童自发性颅内出血的病因、临床特点及诊断、治疗方法.方法 对1992-2009年收治的36例颅内自发性出血患儿的临床资料进行回顾性分析.主要分析其病因、临床表现、出血部位和影像学检查、其他检查、治疗及预后.结果 儿童自发性颅内出血病因以脑动静脉畸形多,占58.3％ (21/36).临床特点主要表现为头痛、呕吐、意识障碍、抽搐和偏瘫.出血部位多在脑叶,占41.7％(15/36).颅高压症状明显而急诊手术清除血肿7例,脑室外引流术2例.21例脑动静脉畸形中,脑数字减影血管造影同时血管内介入栓塞治愈3例,栓塞后再手术切除2例,显微手术切除畸形血管团16例.1例右后交通动脉瘤经开颅手术夹闭.3例海绵状血管瘤患儿均经开颅清除血肿并显微切除病灶.2例烟雾病患儿采取内科保守治疗痊愈.36例治愈23例,轻残7例,中残4例,死亡2例.结论 脑动静脉畸形是儿童自发性颅内出血的主要原因,CT、MRI和全脑数字减影血管造影检查可辅助诊断,血肿清除加脑动静脉畸形切除是有效的治疗方法.     

康复干预对脑动静脉畸形介入治疗后神经功能恢复的作用

目的：探讨高危出血的脑动静脉畸形的血管内治疗及栓塞术后康复干预的疗效。方法：经脑CT或MRI确认为脑实质内出血的56例出血的高危脑动静脉畸形病例经数字减影血管造影(digital Subtract Angiography，DSA)全脑血管造影证实为脑动静脉畸形(arterioveinous malformation，AVM)。根据AVM病灶的特点，经血管内超选择应用a-氰基丙烯酸正丁酯栓塞或结合放射外科治疗，同时结合康复干预治疗。结果：56例均进行血管内栓塞治疗，其中36例在1-3次栓塞后病灶完全消除；2例因新生和残留的AVM中存留有动脉瘤而分别在随访1年时和在X-刀治疗后3月时再次出血，经2次栓塞后痊愈。经过康复干预治疗后，患者神经功能恢复满意。结论：经血管内栓塞是治疗高危性脑AVM的一种微创、安全、有效的方法，而栓塞后的康复治疗是脑神经功能的康复的必要手段。     

Life-threatening arteriovenous malformation of the maxillomandibular region and treatment outcomes

We report on cases of life-threatening maxillomandibular arteriovenous malformations (AVM) whereby patients had successful endovascular treatment with good outcomes. Out of a total 93 facial AVMs treated endovascularly between 1991 and 2009, five patients (5.4%) had maxillomandibular AVMs. All presented with uncontrolled dental bleeding. Endovascular procedure was the primary treatment of choice in all cases, either transfemoral approach with arterial feeder embolization or transosseous puncture, depending on the accessible route in each patient. NBCA (glue) was the only embolic agent used. Tooth extraction and dental care were performed after bleeding was controlled. All five patients (8-18 years) with a mean age of 12.4 years presented with massive dental bleeding following loosening of teeth, dental extraction and/or cheek trauma. The plain films and CT scans of four patients with AVMs of mandibles and one of maxilla, revealed expansile osteolytic lesions. The mean follow-up period was 6.6 years (ranging between one and 19 years). Three cases developed recurrent bleeding between two weeks to three months after first embolization, resulting from residual AVM and infection. Late complications occurred in two patients from chronic localized infection and osteonecrosis, which were successfully eradicated with antibiotic therapy and bony curettage. Complications occurring in two patients which included soft tissue infection, osteomyelitis and osteonecrosis were successfully treated with antibiotics, curettage and bone resection. No patient had a recurrence of bleeding after the disease had cured Initial glue embolization is recommended as the effective treatment of dental AVMs for emergent bleeding control, with the aim to complete eradicate the intraosseous venous pouches either by means of transarterial superselection or direct transosseous puncture. Patient care by a multidisciplinary team approach is important for sustained treatment results.     

胰十二指肠切除术后大出血的处理

目的：探讨胰十二指肠切除术(PDT)后急性大出血的处理原则与方法。方法：总结我院1991—2001年期间PDT术后急性大出血6例的诊治经验井复习文献，就临床表现、出血原因、处理方法与结果进行分析。结果：上腹部胀痛与腹腔引流管内或周围出血是所有病例的主要临床表现，2例合并上消化道出血症状，均有术后胰瘘。所有病例均进行血管造影检查，来自胃十二指肠动脉出血3例，胰十二指肠下动脉2例，胰腺残端后缘1例。前3例施行肝动脉血管造影与栓塞，未再出血。后3例再次行手术止血，1例术后5d死于反复再出血致多器官衰竭。加用健脾行气中药可促进肠功能恢复。结论：出血后应给予必要的准备，及时进行血管造影检查明确出血来源，根据出血的部位选择肝动脉栓塞或手术止血。     

闭合性肾损伤148例临床分析

目的：总结148例闭合性肾损伤的诊断及治疗方法,提高闭合性。肾损伤的诊治水平。方法：本组B超、静脉肾盂造影（IVU）、CT检查阳性发现率分别为73．6％、52．4％、100％。非手术治疗122例;手术探查16例,其中肾切除10例,肾修补6例;选择性肾动脉栓塞治疗10例。结果：死亡5例（死亡率3．4％）;143例治愈（治愈率96．6％）。结论：B超检查便捷、无损伤,可作为闭合性肾损伤首选检查方法;CT检查是闭合性肾损伤准确诊断及选择治疗方法的重要依据,Ⅳ级以下闭合性肾损伤尽可能采用非手术治疗。     

Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer

N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.     

Uterine arteriovenous malformations: from diagnosis to treatment.

OBJECTIVE: The purpose of this study was to describe the sonographic features of uterine arteriovenous malformations (AVMs) and to describe the role and clinical outcome after transcatheter arterial embolization of symptomatic uterine AVMs. METHODS: In our institution, over a 4-year period, symptomatic uterine AVMs were diagnosed in 21 women. Endovaginal sonography with gray scale, color, and spectral Doppler imaging was performed on all patients. Fourteen patients required therapeutic angiography/embolization to control bleeding. These 14 patients had follow-up endovaginal sonography 24 hours after the procedure. RESULTS: The sonographic gray scale findings of uterine AVMs were nonspecific. The most common finding was subtle myometrial heterogeneity (n = 14), whereas other patients had small anechoic spaces in the myometrium (n = 7). Color Doppler sonography showed a tangle of vessels with multidirectional high-velocity flow that produced a "color mosaic" pattern. Spectral Doppler analysis showed arteriovenous shunting with high-velocity, low-resistance flow. Fourteen patients required transcatheter arterial embolization to control bleeding. Thirteen of 14 patients had no sonographic evidence of a residual AVM 24 hours after the procedure. One of 14 patients had a residual AVM requiring additional embolization. One patient had recurrent bleeding at 4 months and required further embolization. The remaining 7 patients were treated conservatively. CONCLUSIONS: Endovaginal sonography is the imaging modality of choice in patients with abnormal uterine bleeding. Routine use of color and spectral Doppler sonography allows one to confidently make the correct diagnosis. Transcatheter arterial embolization is an excellent treatment option. Endovaginal sonography should be used to monitor postembolization outcomes.     

胃底静脉曲张破裂出血的栓塞治疗

[目的]探讨胃冠状静脉,胃短静脉栓塞术以及联合部分脾栓术治疗胃底静脉出血的价值.[方法]35例患者行经皮经肝穿刺胃冠状静脉,胃短静脉栓塞治疗.1周后,对其中19例合并脾亢者行部分脾动脉栓塞治疗.[结果]34例栓塞成功,随访12个月,6个月内再出血5人,再出血率14.3%,死亡1人;另有3人死于肝功能衰竭.[结论]胃底静脉栓塞术及联合部分脾栓塞术是治疗胃底静脉曲张大出血的有效方法.     

显微外科手术和血管内栓塞治疗脑动静脉畸形的Meta分析

目的 使用Meta分析的方法评价显微外科手术和血管内栓塞治疗脑动静脉畸形（AVM）的疗效.方法 检索Medline、EMBase、Cochran图书馆、CNKI、万方、维普等文献数据库,根据临床和统计标准进行合并分析.结果 （1）共纳入24个符合要求的研究,包括脑AVM患者2397例.（2） Meta分析结果显示显微外科手术组和血管内栓塞组治疗脑AVM全切率或完全栓塞率的OR（95％ CI）合并值为40.63（24.20,68.20）,两组差异有统计学意义（P＜0.01）;显微外科手术组和血管内栓塞组治疗脑AVM术后优良率的OR（95％ CI）合并值为1.37（0.85,2.21）,两组差异无统计学意义（P=0.19）;显微外科手术组和血管内栓塞组治疗脑AVM术后死亡率的OR（95％ CI）合并值为0.96（0.50,1.81）,两组差异无统计学意义（P=0.89）;显微外科手术组和血管内栓塞组治疗脑AVM术后病残率的OR（95％ CI）合并值为0.56（0.32,0.98）,两组差异有统计学意义（P=0.04）;显微外科手术组和血管内栓塞组治疗脑AVM术后再出血率的OR（95％ CI）合并值为0.18（0.04,0.74）,两组差异有统计学意义（P=0.02）.结论 显微外科手术治疗脑AVM能保持较高的全切率及较低的再出血率,并且与单纯血管内栓塞治疗相比术后病残率低.     

动脉灌注化疗及栓塞治疗宫颈癌膀胱癌大出血

目的探讨晚期官颈癌及膀胱癌大出血时经动脉介入化疗栓塞治疗的临床效果。方法对37例晚期宫颈癌、膀胱癌急、慢性大出血行双侧髂内动脉栓塞术，术中经导管灌注化疗药。结果37例中32例术后12h出血即明显减少，3—5天出血停止，追踪4—12个月无复发；5例止血效果不佳者均为宫颈癌盆腔脏器广泛转移，其中3例于2周后再次行栓塞手术成功，1例放弃治疗，1例于3周后死亡，35例（94．6％）患者除症状改善外，1个月后CT检查肿瘤范围明显缩小。结论采用动脉灌注化疗及栓塞治疗晚期官颈癌、膀胱癌大出血，安全显效。不良反应轻微，值得推广应用。     

数字减影血管造影及介入治疗在急性动脉出血中的应用价值

目的：探讨数字减影血管造影（ digital subtraction angiography ,DSA）及介入治疗在急性动脉出血中的应用价值。方法总结26例急性动脉出血患者的DSA表现及动脉栓塞、药物灌注的治疗经验。结果本组患者26例,包括胃肠道出血15例,泌尿系出血3例,盆腔出血3例,大咯血3例,外科术后出血2例。所有患者DSA检查结果均呈阳性,表现为对比剂外溢、动脉瘤、畸形血管团等。25例患者经栓塞或药物灌注治疗后出血立即停止,其中1例患者灌注止血后,因腹膜炎并发多器官功能衰竭死亡,其余患者未见严重并发症。结论 DSA对急性动脉出血的定位、定性有重要价值,选择性动脉栓塞及药物灌注止血安全有效。