平阳霉素碘油乳剂栓塞治疗肝血管瘤

目的：评价平阳霉素碘油乳剂拴塞治疗肝血管瘤的疗效。方法：采用Seldinger技术股动脉插管，将导管超选择肿瘤供血动脉后，注入平阳霉素碘油乳剂栓塞。术后6—12个月随访CT观察肿瘤直径大小变化及碘化油充填情况。结果：21例患者肿瘤体积均明显缩小。5例直径超过8CM血管瘤一次栓塞后缩小的肿瘤内仍有血管瘤结构，经再次栓塞后显示瘤体内碘化油充填良好，随访6个月肿瘤无增大趋势。无1例发生严重并发症。结论：平阳霉素碘油乳剂动脉栓塞肝血管瘤疗效良好，微创、安全、副作用小，可作为首选治疗方案。     

介入治疗肝血管瘤的临床研究

目的：探讨平阳霉素碘油乳剂超选择栓塞治疗肝血管瘤的临床疗效和治疗体会。方法：对23例肝血管瘤患者,采用平阳霉索碘油乳剂超选择性动脉插管行栓塞治疗,观察治疗前和治疗后6个月、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症。结果：所有患者在术后6个月和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘化油聚积征象。术前血管瘤直径为（8．1±2．2）cm,术后6个月血管瘤直径为（5．4±1．3）cm,术后12个月血管瘤直径为（3．4±1．2）cm。治疗前有临床症状者治疗后缓解或消失。术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生。结论：超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大肝血管瘤是一种疗效肯定、相对安全较为理想的治疗方法。     

选择性肝动脉造影联合栓塞治疗肝血管瘤

目的 探讨肝血管瘤的选择性肝动脉造影表现及栓塞的治疗效果.方法　对49例肝血管瘤患者采用平阳霉素-超液化碘油乳剂行超选择性动脉插管行栓塞治疗,观察治疗前和治疗后6、12个月时患者临床症状、血管瘤大小的变化以及出现的并发症.结果 所有患者在术后6、12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘油聚集征象.血管瘤直径由术前为(9.3+2.2)cm到术后6、12个月时分别为(4.2+1.5)cm和(2.0+1.3)cm.治疗前的临床症状治疗后均获缓解或消失.术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症.结论 超选择肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大肝血管瘤是一种疗效肯定、相对安全较为理想的治疗方法.     

平阳霉素碘油乳剂超选择硬化性栓塞治疗肝血管瘤

目的 总结平阳霉素碘油乳剂行肝动脉硬化栓塞术(TAE)治疗的肝血管瘤的疗效和优缺点.方法 对150例肝血管瘤患者,采用平阳霉素碘油乳剂超选择性动脉插管行硬化栓塞治疗,观察治疗前和治疗后 3、6个月时患者临床症状、肿瘤大小的变化以及出现的并发症.结果 所有患者在术后3、6个月复查 CT,见瘤体血供消失,其内碘油沉积良好,...     

超选择性动脉栓塞治疗巨大肝血管瘤

目的 评价超选择性动脉插管栓塞治疗肝血和瘤的应用价值。方法 本组２０例,男８例,女１２例。肝血管瘤体最大直径５ｃｍ～２３ｃｍ,将导管超选择插入血管瘤供体血动脉,一次或分次输注平阳霉不和超液化碘油乳剂。最后用明胶海绵颗粒栓塞供血动脉。术后定期复查。结果 介入手术成功率９０．５％总胶有效率９０％（１８／２０）,并发症少,术后复发率低。结论 超选择动脉插管栓塞是治疗肝血管瘤的很有价值的方法,可作为首选。     

肝海绵状血管瘤的肝动脉栓塞治疗及并发症分析

目的　评价和分析肝动脉栓塞治疗肝海绵状血管瘤的疗效及并发症。方法　治疗肝血管瘤 34例 ,瘤体大小为 2 .5cm× 2 .0cm～ 9.0cm× 12 .0cm ,采用Seldinger技术股动脉插管 ,导管超选择插至肝血管瘤供血动脉后 ,灌注平阳霉素碘化油乳剂。所有病例术后随访 6～ 18个月。结果　肝动脉栓塞后肝血管瘤瘤体内碘油沉积良好 ,32例 (94 .1% )血管瘤瘤体有不同程度缩小 ,1例发生肝坏死及肝内胆管毁损性并发症 ,5例发生胆囊炎 ,并发症发生率为 17.6 % (6 34)。结论　肝动脉灌注平阳霉素碘化油乳剂治疗肝海绵状血管瘤并不是一种”无损伤”的治疗方法 ,必须严格掌握其适应证。     

平阳霉素+碘油乳剂栓塞治疗肝海绵状血管瘤的疗效观察

目的 评价平阳霉素碘油乳剂栓塞肝海绵状血管瘤的临床疗效。方法 对18例患者采用Seldinger技术股动脉插管,将导管超选择至肿瘤供血动脉,缓慢注入利多卡因5-10 m1及平阳霉素碘油乳剂5-20 ml。栓塞前常规肌内注射杜冷丁50-100 mg;病变巨大、多支血供、病人年龄>60岁者,分次介入治疗。术后3-48个月CT、B超随访观察栓塞前后肿瘤直径大小变化、临床症状缓解情况及并发症。结果 18例肝海绵状血管瘤均见平阳霉素碘油完全充填。病灶完全消失9例,缩小50％以上7例,病灶缩小25％-50％2例。其中6例血管造影复查见病灶血管完全消失,载瘤动脉闭塞。临床症状好转率89％,无严重并发症。结论 平阳霉素碘油乳剂动脉栓塞肝海绵状血管瘤疗效良好,微创、安全、副作用少,可作为首选的治疗方法。     

肝脏巨大海绵状血管瘤的介入治疗(附20例分析)

目的：探讨肝脏巨大海绵状血管瘤(HHCH)的介入治疗方法与疗效。方法：20例肝海绵状血管瘤患者经导管肝动脉注入平阳霉素和超液化碘油混合乳剂，然后用明胶海绵或PVA适量栓塞肿瘤供血动脉。结果：所有病例术前肝动脉造影均显示“爆米花样染色”“早出晚归”的异常血管湖样改变。术后20例肿瘤血供中断，瘤体缩小及碘油在肿瘤内均匀沉积。结论：采用超液化碘油和平阳霉素加适量明胶海绵微粒联合栓塞是一种微创、安全简便、切实可行且疗效显著的治疗方法。     

双途径注药术治疗肝海绵状血管瘤的疗效评价

目的探讨经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤的疗效和价值。资料与方法采用Seldinger技术行肝动脉插管至血管瘤供血动脉,对32例肝海绵状血管瘤注入平阳霉素碘油乳剂(PLE)至血管瘤体大部分充填,用明胶海绵颗粒栓塞供血动脉;对碘油空虚区域再行经皮瘤体内直接注射PLE。定期观察瘤体碘油充填情况,瘤体大小和并发症。结果经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤后,碘油沉积好,血管瘤体积明显缩小,无严重并发症。结论经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤具有疗效好,并发症少等优点。     

经肝动脉平阳霉素碘油乳剂介入治疗肝海绵状血管瘤

目的 :评价平阳霉素碘油乳剂肝动脉栓塞治疗肝海绵状血管瘤的临床疗效。方法 :对 2 1例肝海绵状血管瘤患者 ,经导管肝动脉内注入平阳霉素碘油乳剂 5～ 2 0ml ,然后用明胶海绵或聚乙烯醇 (PVA)颗粒适量栓塞肿瘤供血动脉。结果 :所有病例术前肝动脉造影均显示典型的肝海绵状血管瘤血管造影征象 :“爆米花样染色”、“早出晚归”的异常血管湖样改变。所有病例均成功实施了栓塞治疗 ,栓后肿瘤血供中断 ,瘤体缩小 ,临床症状减轻或消失。结论 :采用介入方法经导管注入平阳霉素碘油乳剂加适量明胶海绵或PVA颗粒治疗肝血管瘤 ,是一种微创、安全、简便可行且疗效显著的治疗方法。     

腹腔镜胆囊切除术胆管损伤分析

目的：探讨腹腔镜胆囊切除术(LC)中胆管损伤的预防和处理。方法：回顾性分析2001年3月至2005年3月LC 510例临床资料。结果：510例中，胆管损伤2例(0．39％)，其中：副肝管损伤1例，行胆管对端吻合；肝总管横断伤1例，行胆肠Roux-en-Y吻合术，术后恢复良好。结论：良好显露胆囊三角，认清胆囊三角解剖关系，可避免损伤肝外胆管。根据损伤的情况和术后时间选择不同的处理方法。     

Intraoperative bile duct sonography during laparoscopic cholecystectomy: experience with a 12.5-MHz catheter-based US probe.

During elective laparoscopic cholecystectomy, 20 patients underwent intraoperative evaluation of the biliary tract with a commercial 6.2-F, 12.5-MHz catheter-based ultrasound (US) probe. The study tested the feasibility of this technology for mapping the anatomy of the hepatoduodenal ligament and Calot triangle, assessing bile duct integrity, and detecting choledocholithiasis. The duct was studied with a transmural approach, the catheter being placed parallel to, but remaining outside, the bile duct. The common hepatic duct and common bile duct in the vicinity of the cystic duct were seen in all 20 patients; the junction of the cystic duct with the common hepatic duct was seen in nine patients (45%). After the cystic duct was clamped, no sonographic evidence to suggest bile duct injury was noted in any patient. The transmural imaging approach was tested in four pigs in whose common bile duct a single human calculus had been placed. In all instances the size and location of the calculus were accurately detected. Intraoperative US with a catheter-based system is a safe and effective means for interrogation of the extrahepatic biliary tree during laparoscopic cholecystectomy.     

腹腔镜胆囊切除术中胆管损伤预防和处理的经验与教训

目的总结腹腔镜胆囊切除术中胆管损伤的预防和处理的经验与教训。方法分析腹腔镜胆囊切除术中胆管损伤常见原因、预防措施及处理方式。结果胆总管损伤3例行修补术加胆总管T管引流,肝总管损伤1例,外院腹腔镜胆囊切除术胆总管横断损伤转入1例及1例右侧副肝管行胆肠吻合术,l例为外院胆总管损伤初次修复术后出现胆总管梗阻再次行胆肠RouxY吻合术。结论术中辨认清楚胆囊三角和胆囊管、胆总管、肝总管、胆囊壶腹结构及“三管、一壶”关系极重要,手术时如解剖不清严重粘连应及时中转开腹手术。     

多支胆管梗阻的介入性引流技术

目的 探讨多支胆管梗阻介入性引流的方法及疗效。方法 ２１例多支胆管梗阻的患者根据不同情况,分别采用左右肝管同时植入支架内引流（１３例）、左右肝管间植入支架经右肝管外引流（３例）、右肝管支架内引流并左肝管外引流（３例）和右前叶肝管支架内引流并右后叶肝管外引流及左肝管内引流或外引流（２例）等内外引流技术进行治疗。结果 ２１例患者共植入胆道内支架３６枚,其中３５枚支架起到良好的内引流作用,１枚因位置不良     

Percutaneous treatment of biliary stones: sphincteroplasty and occlusion balloon for the clearance of bile duct calculi

OBJECTIVE: Our study describes the percutaneous expulsion of bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. SUBJECTS AND METHODS. Patients (n = 212; 101 men and 111 women; mean age, 73 years; range, 31-95 years) had their calculi (single, 131; multiple, 81) percutaneously expelled into the duodenum in 73 patients via an indwelling T tube, and in 139 via transhepatic or transcystic duct route. Stone expulsion was facilitated with an occlusion balloon after balloon sphincteroplasty and with prior mechanical fragmentation in only 37 patients. After the expulsion of the calculi into the duodenum, drainage of the main bile duct to the exterior was maintained for 2-8 days. RESULTS: Technical success was initially 90.4%, increasing to 93% at the second attempt. There were 13 failures due to the large size of the calculi in nine patients, excessive tortuosity of the T tube (Kher tube) in one, and breaches of the established protocol in two. Residual lithiasis was resolved in 98.6% of cases, decreasing to 92% in the group of native, or nonresidual, lithiasis. There were 10 major complications (hemobilia) with three cases of poor clinical outcome: hepatic necrosis, multiorgan failure, or death. CONCLUSION: Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.     

经导管肝动脉化疗栓塞术后胆管损伤的临床意义

目的 观察经导管肝动脉化疗栓塞术（TACE）治疗肝脏恶性肿瘤后继发胆管损伤的发生率、影响因素和临床过程.方法 对1240例患者做TACE 2 680次,术前影像学检查均无明确胆系异常表现,18例于术后3周～3个月出现胆管损伤并发症.采用回顾性调查,观察TACE术后胆管损伤的发生率、临床表现、转归以及影响因素.结果肝转移性肿瘤TACE后胆管损伤的发生率为8.8%（13/148）,肝细胞性肝癌（HCC）组为0.5%（5/1092）.胆管损伤的影像学表现有局灶性胆管扩张4例、多发性肝内胆管扩张8例、囊性病灶或胆汁瘤6例.3例多灶胆管损伤表现为轻度黄疸,2例对保守治疗反应良好,1例于出现黄疸后2周死于肝功能衰竭.4例胆汁瘤合并感染,3例采取经皮穿刺置管引流和抗生素治疗,其中2例死于感染囊腔破入腹腔、继发化脓性腹膜炎,1例治愈;1例仅用抗生素治愈.与胆管损有关的病死率为16.7%（3/18）.其余11例无相关症状.统计学分析显示：无肝硬变背景的肝转移瘤患者TACE术后胆管损伤发生率明显高于有肝硬变的HCC患者（P〈0.01）;其他高危因素有肿瘤为少血供型（P〈0.01）和用铂类制剂与碘油乳化后做超选择性栓塞（P〈0.01）.结论 认识TACE后继发胆管损伤的影像学表现可避免误诊,特别是肿瘤复发.对存在胆管损伤高危因素患者,适当减少碘油乳化的化疗剂（特别是铂类）剂量,有可能降低胆系缺血损伤并发症.     

肠系膜上动脉供血型肝癌的血管造影分析及介入治疗

目的：研究肠系膜上动脉供血型(即变异肝动脉起源于肠系膜上动脉)肝癌的血管造影表现及插管技术。方法：回顾分析41例肠系膜上动脉供血型肝癌的DSA及介入治疗资料，统计血管解剖变异的发生率，对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。结果：350例肝癌中肠系膜上动脉供血型41例(11．9％)，其中副肝右动脉15例(36．5％)，替代肝右动脉16例(39．0％)，肝总动脉8例(19．5％)，腹腔动脉干起源于肠系膜上动脉2例(5％)。31例肠系膜上动脉发出替代或副肝右动脉者，29例(94．0％)腹腔动脉造影表现为肝右动脉细小或缺如，肝右叶出现无血管区。RH导管超选择性插管成功25例(61％)，未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。结论：肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血，熟忿其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。     

腹腔镜胆囊切除术中转开腹原因分析

目的：了解腹腔镜胆囊切除术中转开腹的原因。方法：对820例腹腔镜胆囊切除术其中16例中转开腹的病例分析。结果：820例腹腔镜胆囊切除术中中转开腹16例，中转手术率1．95％，中转开腹的主要原因为：慢性萎缩性胆囊炎8例(50％)；急性化脓性胆囊炎4例(25％)；胆囊动脉出血2例(12．5％)；与横结肠致密粘连1例(6．25％)；副肝管损伤1例(6．25％)。结论：腹腔镜胆囊切除术中转开腹的主要原因为：腹腔内的严重粘连、急性粘症水肿、坏疽、血管损伤、胆管损伤。     

Percutaneous chemical gallbladder sclerosis after laser-induced cystic duct obliteration: results in an experimental model.

OBJECTIVE. Chemical gallbladder sclerosis has been attempted as a way to defunctionalize the gallbladder in patients who have undergone nonsurgical removal of gallstones and who are unable to undergo surgical/laparoscopic cholecystectomy. The purpose of this investigation was threefold: to study an animal model for chemical sclerosis of the gallbladder with 95% ethanol and 3% sodium tetradecyl sulfate, to attempt chemical sclerosis immediately after percutaneous cystic duct obliteration by laser thermocoagulation, and to assess histopathologic changes in the gallbladder after sclerosis. MATERIALS AND METHODS. Percutaneous cholecystostomy and laser thermocoagulation of the cystic duct was performed in 13 pigs. Eight pigs underwent immediate gallbladder sclerosis with 95% ethanol and 3% sodium tetradecyl sulfate while two pigs received 95% ethanol only. The remaining three pigs served as controls. The cholecystostomy catheter was removed immediately after the procedure. All animals were sacrificed 6 weeks after laser thermocoagulation. Multiple sections through the gallbladder, which included the adjacent liver, the cystic duct, and the common bile duct, were obtained for histologic examination. RESULTS. At autopsy, the gallbladder in all 10 animals who underwent gallbladder sclerosis was reduced in size compared with controls. In all treated animals, the gallbladder mucosa was denuded; however, in nine of 10 cases reepithelialization had occurred. Complete sclerosis without reepithelialization was achieved in one pig who received both ethanol and sodium tetradecyl sulfate. In the two animals who received ethanol only, the depth of wall necrosis around the gallbladder lumen was less than in those pigs who received both ethanol and sodium tetradecyl sulfate. No pigs showed signs of hepatic necrosis or injury to the common bile duct. CONCLUSION. Cystic duct laser thermocoagulation allows immediate gallbladder sclerotherapy without injury to the common bile duct. Sclerosis with ethanol and sodium tetradecyl sulfate results in denudation of the gallbladder mucosa. However, a single therapeutic session with immediate removal of the cholecystostomy catheter was inadequate for gallbladder ablation in this model because of reepithelialization.     

改良向右两弯型导管在肝动脉插管中的应用

本文详细介绍了二种改良向右两弯型导管（ＲＨ１、ＲＨ２）的形状及在肝动脉插管中的应用。其中ＲＨ１型导管由于兼有盘曲型及向右两弯型导管的优点，其肝动脉插管的成功率明显提高至９６％，且可用于其他腹腔内脏动脉的超选择插管，是一种多功能导管，可作为常用导管；而ＲＨ２型导管，由于增加了短臂的长度使得成襻较困难，可是对肝动脉插管的成功率仍很高（９７％）以及本文介绍的新成襻方法，该导管可作为备用导管。