颅脑,颌面部肿瘤及血管畸形的栓塞治疗

４８例颅脑、凳面部肿瘤及血管畸形经栓塞治疗。这些病例主要包括血管畸形、血管瘤、脑膜瘤以及鼻咽血管纤维瘤。经选择和超选择靶动脉栓塞达到满意临床效果。本文讨论了有关技术栓塞物以及并发症。     

经导管栓塞治疗肢体血管畸形

评价经动脉血管造影和栓塞治疗肢体血管畸形的临床应用价值.材料和方法：24例肢体血管畸形行选择性动脉造影,对难以手术切除、伴有畸形血管的病变行经导管动脉内栓塞治疗。栓塞材料分别选用明胶海绵、碘油及不锈圈,并 联合应用血管硬化剂平阳霉素。结果：经动脉血管造影明确诊断18例,6例（25％）不能进行明确分类。对9例肢体血管畸形（5例海绵状血管瘤,2例K－T综合征和2例KTPW综合征）行栓塞治疗,治疗后症状缓解,无严重并发症.随访7例,平均随访3．7年,其中5例复发,行多次治疗病变得到有效控制。结论：栓塞治疗可作为肢体血管畸形的姑息性治疗手段。     

口腔颌面部血管瘤或血管畸形介入治疗的效果评价

目的：评价口腔颌面部血管瘤介入治疗的效果。方法：对20例口腔颌面部血管瘤经DSA和栓塞后观察其即刻效果和1年后效果。结果：本组栓塞后即刻有效率为95％，栓塞后1年有效率为90％。结论：栓塞治疗口腔颌面部血管瘤是非常有效的方法之一．但一定要选好适应症。     

头颈部血管性疾病的经导管动脉栓塞治疗

复习了头颈部血管性肿瘤（嗜铬细胞瘤、青年血管纤维瘤、血管瘤和血管周皮细胞瘤）、鼻出血和血管畸形的血管栓塞治疗的技术方法，并介绍了肿瘤侵犯颈内动脉的外科手术前介入处理方法即颈内动脉球囊闭塞试验的技术要点。     

经导管肾动脉节段性栓塞治疗肾动静脉畸形

目的：探讨经导管肾动脉节段性栓塞治疗肾动静脉畸形的栓塞材料及其效果。方法：9例因肾动静脉畸形（先天性者8例，获得性者1例）引起大量血尿患者，施行经导管肾动脉节段性栓塞治疗10次，栓塞材料为无水乙醇、聚乙烯醇颗粒、异丁基-2-氰基丙烯酸酯和弹簧圈。9例患者术后随访观察10-56个月。结果：9例患者栓塞术后肾动脉造影显示畸形血管完全闭塞，3d内血尿消失。随访期间，9例患者中，只有1例单纯应用弹簧圈栓塞患者术后6个月血尿复发，血管造影证实为侧支血管形成导致畸形血管再通，改行无水乙醇及弹簧圈栓塞，术后18个月血尿未再复发。9例患者均无严重并发症发生。结论：经导管肾动脉节段性栓塞是治疗肾动静脉畸形的安全有效的方法，栓塞材料以无水乙醇和弹簧 圈联合栓塞为最佳。     

外生型肝癌经导管动脉化疗栓塞治疗前后血供特点研究

目的 探讨外生型肝癌(P-HCC)经导管动脉化疗栓塞(TACE)治疗前后血供特点.方法 回顾性分析39例P-HCC患者TACE治疗前后血管造影表现,总结其血供特点.结果 39例TACE术前血管造影发现有70支动脉参与供血,以39支(56.0％)肿瘤所在肝叶动脉供血为主,23例(59.0％)伴有31支(44.0％)肝外寄生性血管.TACE治疗前有无寄生性血管和肿瘤直径有相关性(x2=164.00,P＜0.001),与部位无相关性(x2=7.358,P=0.061).TACE治疗后所有血管造影发现有131支动脉参与供血,31例(79.5％)伴有肝外寄生性血管;其中肝内动脉53支(40.5％),肝外寄生性血管78支(59.5％),新增寄生性血管47支,呈逐渐增多(x2 =4.278,P=0.039).TACE术后肿瘤易由近邻血管获得寄生性供血.结论 P-HCC肿瘤TACE治疗前后血供以肝动脉为主,肝外寄生性血管为辅.寄生性血管与肿瘤大小密切相关,其血供丰富,来源以就近为原则.TACE治疗后易形成新的寄生性血管.     

经导管动脉栓塞术治疗支气管动脉瘤

目的:探讨经导管动脉栓塞术(TAE)治疗支气管动脉瘤(BAA)的价值。方法:搜集经支气管动脉造影证实的BAA 2例,根据形态及部位不同,行不同方式TAE治疗,并临床随访。结果:囊状动脉瘤1例(微导管能顺利到达并通过),其远端实施球形PVA微颗粒栓塞止血,输出端及输入端分别用弹簧圈阻断血流,复查造影示支气管动脉远端血流阻断,BAA未见显示;梭形动脉瘤1例(距离支气管动脉起始部较远),其远端行球形PVA微颗粒栓塞,近端加注明胶海绵颗粒栓塞,复查造影BAA未见显示。结论:TAE是一种治疗BAA的微创、高效、可靠方法,不同形态及部位的BAA应选择不同方式的TAE。     

骨盆肿瘤术前经导管动脉栓塞治疗的价值

目的　评价骨盆肿瘤术前局部动脉内灌注化疗和栓塞治疗的价值。资料与方法　术前栓塞治疗 4 8例骨盆肿瘤患者 (栓塞组 ) ,观察其临床改善情况 ,计算术中失血量和手术时间 ,并与 16例术前未栓塞骨盆肿瘤患者(对照组 )进行对照。结果　血管造影可清楚显示肿瘤的大小及血供特点 ,栓塞组术中失血量 2 177.1± 96 9.8ml,手术时间 198.9± 97.4min ;对照组术中失血量 4 4 6 2 .5± 1876 .8ml,手术时间 2 86 .4± 14 4 .5min。栓塞组均明显低于对照组 (P <0 .0 1)。手术时机的选择影响栓塞治疗的效果。组织学证实 :肿瘤均有不同程度的坏死、液化和囊性变 ,部分肿瘤有假包膜形成。结论　术前栓塞是骨盆肿瘤手术前最有效的辅助治疗手段 ,并且使手术易于操作。手术时机应选择在栓塞后 6天以内     

脊髓血管畸形栓塞治疗

本详细阐述了脊髓血管畸形分类、病理结构及对脊髓血管畸形的栓塞治疗方法。     

Transcatheter embolization of uterine arteriovenous malformations

A case of congenital arteriovenous malformation of the uterus in a 25-year-old woman with a long-standing history of recurrent menometrorrhagia is reported. Radiological diagnosis was based on hysterographic, computed tomographic, and angiographic findings. Treatment was performed with percutaneous transcatheter embolization.     

Transcatheter embolization of symptomatic hepatic venous malformations

The aim of this study was to evaluate our results in treatment and management of symptomatic hepatic venous malformations using transcatheter embolization therapy. From 1991 to 1997 five venous malformations were embolized in one man and four women ranging in age from 31 to 50 years. All patients presented nonspecific abdominal pain and were assessed in the general surgery unit. Percutaneous embolization was recommended. In all cases polyvinyl alcohol was used to embolize the afferent arterioles. Clinical and echographic control follow-up was carried out on an outpatient basis in our Vascular and Interventional Radiology Unit. Embolization was possible in all cases. No complications developed during the procedure, except in one case where the subject suffered a spasm of the hepatic artery. Mean follow-up time was 42 months (6–73 months). Four patients remained asymptomatic during the entire follow-up period, whereas one patient required reembolization. In our experience, transcatheter embolization of hepatic venous malformations is a noninvasive technique which requires few admissions and presents few complications. With further use, it could become the treatment of choice in symptomatic hepatic venous malformations as an alternative to surgery. Received 7 October 1997; Revision received 12 February 1998; Accepted 16 February 1998     

急性顽固性鼻出血的动脉栓塞治疗

目的 探讨介入治疗在急性顽固性鼻出血的临床应用价值。方法 20例经常规治疗无效的鼻腔大出血者,均采用经导管颌内动脉造影,证实出血部位后用PVA和明胶海绵颗粒栓塞出血动脉,栓塞后立即抽出鼻腔填塞物观察出血是否停止。结果 20例患者均发现出血动脉,栓塞后出血立即停止,未见严重并发症。结论 经导管动脉栓塞术是治疗急性顽固性鼻出血的有效手段,其创伤小疗效肯定。     

脑动静脉畸形的DSA血管构筑学及其栓塞治疗

目的：探讨脑动静脉畸形（AVM）的血管构筑特征及血管内栓塞治疗的疗效。方法：采用Seldinger技术及微导管技术超选择性脑执AVM供血动脉造影及血管内栓塞。结果：脑AVM血管结构上分为终末型供血方式,穿支型供血方式及混合式。可伴有动脉瘤或静脉结构异常。本组栓塞治疗技术成功率97.5%,AVM完全消失,解剖治愈11例,AVM畸形血管团大部分消失,其减少大于80%4例,减少50%～80例,小于50%9例。随访6个月至5年,效果满意。结论：超选择性造影可正确指导栓塞治疗。血管内栓塞治疗脑AVM是一种安全、可靠、有效方法。     

颈外动脉栓塞治疗颌面部血管瘤

目的 探讨颌面部血管瘤动脉栓塞的适应证，栓塞剂选择，造影栓塞方法的运用及并发症的预防，材料和方法，回顾性分析２０例颌面部血管瘤，对１６例行１７次颈外动脉及其分支栓塞，１４例为术前栓塞，２例为根治性栓塞，根治性栓塞和２例颌骨中心性血管瘤用水无乙醇加明胶海绵栓塞，余均用明胶海绵栓塞。结果 根治性栓塞的２例，观察９－１２月未复发，术前栓塞的１４例，术中出血量和输血量比术前未栓塞的４例减少了７５％和７０％     

Transcatheter embolization of an arteriovenous malformation of the scrotum

There are several vascular abnormalities that could affect the scrotum. The commonest is a varicocele, and differentiation between this and other lesions is possible using Doppler ultrasound and pelvic angiography. A patient with a scrotal arteriovenous malformation (AVM) is presented in whom transcatheter embolization was possible.     

Transcatheter arterial embolization for postpartum massive hemorrhage: a case report

A 29-year-old woman suffered uncontrollable massive hemorrhage from a deep vaginal laceration following spontaneous vaginal delivery. Pelvic angiography revealed extravasation from a branch of the right pudendal artery. Transcatheter arterial embolization was successfully performed and quickly achieved hemostasis. When postpartum hemorrhage cannot be controlled with conservative treatment, transcatheter arterial embolization should be considered in order to avoid major surgery in an unstable patient and to maintain reproductive potential.     

合理使用无水乙醇栓塞,提高血管畸形的治愈率

血管畸形发病率较低,临床表现变化万千,从局部的胎记到严重的大出血、甚至心功能衰竭.其发病机制不明,治疗具有挑战性.随着介入放射学的发展、局部穿刺和血管内栓塞经验的积累以及乙醇彻底的血管栓塞作用,无水乙醇栓塞治疗有望成该种复杂难治疾病的首选疗法.