超声引导下铜针治疗体表海绵状血管瘤

目的探索操作更安全、疗效更可靠治疗体表海绵状血管瘤的方法。方法在探头频率为70MHZ彩色多普勒超声引导下留置铜针于瘤体内。结果本组26例,其中2例合并蔓状血管瘤,6例为术后复发者,并均位于大血管周围,经该方法治疗未发现术中术后并发症,其中22例随访一年未见复发。结论超声引导下铜针治疗海绵状血管瘤较既往的铜针治疗方法效果更可靠,操作更安全,对于组织深部及位于大主干血管、神经等重要器官周围的海绵状血管瘤尤有独到之处。     

铜针留置术治疗海绵状血管瘤13例

海绵状血管瘤可发生于身体任何部位 ,常漫无边界 ,治疗较棘手。 1995年以来 ,为探讨其治疗方法 ,我们采用铜针留置术治疗此病 13例 ,疗效良好。1　临床资料1 1　一般情况　 13例中 ,男 8例 ,女 5例 ;年龄 5～4 4岁 ,平均 2 2岁。病变位于头颈部 5例 ,躯干 1例 ,四肢 7例。病程 2～ 15年。有手术史但未彻底切除 2例 ,有硬化剂注射史 5例。体位试验均为阳性 ,穿刺均有血性液体。1 2　方法　铜针选用工业用普通漆包铜线 ,将铜线从漆包中缓慢抽出 ,直径约 2mm ,长度依瘤体大小而定 ,使插入后体外留针长度约 2cm。用砂纸磨去铜针表面漆膜 ,一端…     

平阳霉素局部注射治疗婴幼儿真性血管瘤和血管畸形应注意的问题

目的：探讨提高平阳霉素治疗婴幼儿真性血管瘤和血管畸形过程中疗效的方法。方法：在应用平阳霉素治疗婴幼儿真性血管瘤和血管畸形200余例后，对适应证的选择、药物剂量和浓度、注射方法和观察期、注药后注意事项进至了总结。结果：认为婴幼儿真性血管瘤和血管畸形应及早治疗，药物浓度最好控制在1mg/1.5ml以内，药物应注入瘤体实质内，观察周期以3周为妥。结论：使用平阳霉素局部注射治疗婴、幼儿真性血管瘤和血管畸形，应依据病变的分型、年龄、所欲达到的目的等而区别对待，方能获得理想的效果。     

不同波长激光治疗浅表性皮肤血管性疾病临床分析

目的：观察分析比较各种不同的激光疗法治疗皮肤血管性疾病的特点及临床疗效。方法：对应用可变脉宽532nm激光，脉冲染料585nm激光，IPL强光治疗系统及铜蒸气激光光动力学疗法，治疗鲜红斑痣、草莓状血管瘤、葡型性血管瘤、血管角皮瘤、毛细血管扩张、血管痣、充血性增生性瘢痕进行回顾性总结分析。     

浮针治疗腰椎间盘脱出症150例报告

目的：总结推广浮针治疗腰椎间盘脱出症的经验。方法：对150例腰椎问盘脱出患者采用中医浮针疗法进行治疗，1次／d，7d为1个疗程。结果：经1个疗程治疗显效98例(65．3％)，有效44例(29.63％)，无效8例(5．4％)，总有效率94．6％。结论：浮针为特制针具刺激病灶附近结缔组织，达到疏通经络、畅调气血、化瘀止痛效果。其操作简便，奏效迅速，是一种有推广前景的疗法。     

VEGF PCNA在口腔颌面部血管瘤及血管畸形中的表达意义

目的：检测增殖细胞核抗原（PCNA）、血管内皮细胞生长因子（VEGF）在口腔颌面部血管瘤及血管畸形中的表达,探讨PCNA、VEGF与血管瘤发病机制的关系。方法：SP法检测血管瘤27例,血管畸形9例组织中VEGF和PCNA的蛋白表达。结果：PCNA阳性表达于细胞核中,VEGF阳性表达于细胞浆中,两者在增殖期血管瘤中均有阳性表达,而在血管畸形和消退期血管瘤中表达弱（P〈0.05）。结论：PCNA、VEGF在增殖期血管瘤中影响细胞增殖,可能与血管瘤的发生发展以及其消退有密切关系。     

铜离子电化学治疗与药物治疗内痔效果比较

目的 探讨铜离子电化学治疗内痔的优势。方法选择二-四度内痔脱出的患者共计446例,分为铜离子电化学治疗组146例,药物治疗组300例,药物治疗选用口服消脱止和外用复方角菜脂栓7天。结果铜离子电化学治疗组术后1个月出血及脱出症状明显改善。二度78例占97．8％（78／80）,三度41例,占100．0％（41-41）。结论铜离子电化学治疗术对痔病的出血及脱出疗效显著,止血效果迅速。     

鼻咽癌药物荧光成像诊断和定位的研究

目的：探讨1341nmNd:YAP激光照射切除耳鼻咽喉-头颈部血管瘤和血管畸形的临床应用和疗效。方法：采用1341nm激光接触式和非接触式凝固汽化照射，翻瓣光凝术（组织间照射），激光窥镜手术等方法，切除耳鼻咽喉头颈部血管瘤和血管畸形123例。结果：经过2-4a的随访观察。本组123例中，有100例治愈（81.30%)。显效23例（18.70%)，临床治疗效果满意。结论：1341nm激光手术方法安全可靠，是目前治疗耳鼻咽喉-头颈部血管瘤和血管畸形最为有效的手段之一。值得推广应用。     

四肢血管瘤的MRI表现与病理对照及临床意义

目的：探讨四肢软组织血管瘤的MRI表现与病理组织学关系，评价四肢血管瘤MRI表现的临床意义。方法：收集经手术病理证实的四肢软组织血管瘤33例，分析其在MRI上的形态、内部结构及信号特点，并与手术病理结果进行比较。结果：33例四肢血管瘤的MRI形态上可分为三大类型：Ⅰ型：血窦细密型血管瘤，12例，血窦细小、排列紧密，MRI图像不能分辨单个血窦，瘤体内可有或无结缔组织间隔，畸形血管组织可被分割成畸形巢状改变，在T2WI上为高信号，肿块边界清楚，其病理结果5例为毛细血管瘤，3例为肉芽组织型血管瘤，4例为海绵状血管瘤。Ⅱ型：血窦疏松型血管瘤，6例，血窦粗大，排列疏松，血窦间隙较宽，边缘不规则，边界不清，在T2WI上血窦呈均匀高信号，血窦间隙规则，沿血管分布，手术病理结果均为大血管血管瘤。Ⅲ型：弥漫型血管瘤，15例，其中8例血管瘤主要位于骨胳肌内，3例血管瘤局限于骨胳肌内，另4例血管瘤以侵犯皮下脂肪为主。畸形血管在T2WI上呈弥漫线样、斑点状、小斑片状高信号，畸形血管组织之间有大量混杂信号，受累骨胳肌外形可增粗，也可萎缩缩小。手术病理结果：11例为肌内血管瘤，4例为脂肪血管瘤。结论：四肢软组织血管瘤在MRI上具有特征性表现，与其病理组织学类型有较高的对应关系，术前MRI检查对临床治疗有一定的指导意义。     

16层螺旋CT双期脑血管成像诊断脑静脉血管瘤的价值

目的：探讨16层螺旋CT双期脑血管成像对脑静脉血管瘤的临床诊断价值。方法：回顾性分析15例脑静脉血管瘤的16层螺旋CTA及CTV表现。结果：动脉期CT血管造影5例未发现明显异常，10例病灶仅部分显示，且密度淡。静脉期脑CT血管造影15例均清晰显示放射状排列的髓静脉及中央静脉，整个形态似海蛇头。结论：16层螺旋CT双期血管造影能清晰显示脑静脉血管瘤的影像特征，是诊断本病的可靠方法。     

改良注射核素骨显像剂的拔针方法可提高图像质量

目的 探讨改良注射核素骨显像剂的拔针方法对全身骨显像图像质量的影响.方法 静脉注射核素骨显像剂后用两种方法拔针.常规组117例,拔针方法以一根棉签按压穿刺点迅速拔出针头,按压片刻.改良组117例,拔针方法以两根棉签置于针头进皮肤及血管两点,拔出针头同时按压两个进针点5min以上.2h后行SPECT全身骨骼平面显像.结果 常规组注射部位显像剂浓聚的发生率为16.24%,改良组为2.56%.结论 改良注射核素骨显像剂的拔针方法使注射部位显像剂浓聚的发生率明显下降,可以提高全身骨显像图像质量.     

改良注射核素骨显像剂的拔针方法可提高图像质量

目的 探讨改良注射核素骨显像剂的拔针方法对全身骨显像图像质量的影响。方法 静脉注射核素骨显像剂后用两种方法拔针。常规组117例,拔针方法以一根棉签按压穿刺点迅速拔出针头,按压片刻。改良组117例,拔针方法以两根棉签置于针头进皮肤及血管两点,拔出针头同时按压两个进针点5min以上。2h后行SPECT全身骨骼平面显像。结果 常规组注射部位显像剂浓聚的发生率为16.24%,改良组为2.56%。结论 改良注射核素骨显像剂的拔针方法使注射部位显像剂浓聚的发生率明显下降,可以提高全身骨显像图像质量。     

皮肤针联合疤痕平治疗烧伤后增生性瘢痕的临床研究

目的:探讨皮肤针联合疤痕平治疗烧伤后瘢痕增生的临床效果。方法:选择烧伤创面愈合后1-3个月成对且情况相似的增生性瘢痕患者12例共40处,随机分组,试验组用皮肤针联合疤痕平治疗,对照组仅用疤痕平治疗。比较两组在治疗后1、3、6个月时的疗效。结果:试验组与对照组在治疗后1个月时的总有效率分别为65％、25％(P<0.05),3个月时的显效率分别为80％、40％(P<0.01)。结论:皮肤针对增生性瘢痕有一定治疗价值;皮肤针联合疤痕平治疗增生性瘢痕较单用疤痕平治疗效果更好。     

自制同径不同针型组织活检细针取材效果的实验研究

用自制同径21G 24种不同针型活检细针,对离体猪肝尸体肝脏以常规穿刺法和提插穿刺法穿刺取材作定量研究,并作组织切片染色,显微镜下观察肝组织结构。优选取材量多及镜下肝组织结构完整的细针,穿刺人体手术肿瘤标本与大体标本同样切片染色,对比其病理学诊断的符合率。结果表明,同径不同针型各针取材量及两种穿刺方法取材量均有显著差异;但用同一针型同一穿刺方法对猪肝及尸体肝的取材量无明显差异。用优选针型穿刺肿瘤标本与大体标本的病理学诊断符合率为100%。其中,三叉、双斜面、双叉等针型,不仅取材量最多,肝组织镜下结构最完整,且针锋利,容易制造,将其制成新型连动式活检针,用于临床经皮穿刺活检。有推广价值。     

Evaluation of vascular puncture needles with specific modifications for enhanced ultrasound visibility: In vitro study

AIM:To determine which modification to a vascular puncture needle results in increased visualization during ultrasound(US)-guided vascular puncture.METHODS:We evaluated US images of a phantom made of degassed gelatin and each of the following four modified versions of a commercially available vascular puncture needle(18 G):re-cut needle,dimple needle,rough-surface needle(rough over the sections of needle located 3-6 mm from the tip),and a needle with four side holes(side holes covered by the sheath).An unmodified commercially available puncture needle was used as a control.Five interventional radiologists evaluated image quality according to the following classification grade:Ⅰ,invisible;Ⅱ,poor;Ⅲ,moderate;Ⅳ,good;Ⅴ,excellent.RESULTS:The highest score for needle visualization was obtained for the needle with four side holes.The re-cut needle scored the same as the control.Multiple comparisons were conducted using overall evaluation scores among the commercially available needle,dimple needle,rough-surface needle(3-6 mm),and the needle with four side holes.A significantly higher score was obtained for the needle with four side holes(P < 0.05/6).CONCLUSION:The needle with four side holes was prominently visualized and gained a significantly higher score(compared with the other needles) in a phantom evaluation.     

MEBO治疗血管瘤破溃伴感染的临床观察

目的：减少血管瘤破溃伴感染的患儿的痛苦，加速感染创面的愈合。方法：用3％过氧化氢清创，生理盐水清洗创面，0．5％安多福消毒创面及周围皮肤，用无菌干棉球吸干创面水分，将美宝湿润烧伤膏挤在创面上，用无菌棉签抹均匀，厚度3mm左右，盖上8～10层无菌纱布，包扎固定，视创面程度确定换药时间。结果：本组20例患儿经NEBO治疗后全部治愈。结论：用NEBO治疗血管瘤破溃伴感染的创面，患儿无疼痛，不出血，疗程短。     

CT引导下侧隐窝针联合针刀治疗腰椎手术失败综合征

 目的 观察CT引导下侧隐窝针联合针刀治疗腰椎手术失败综合征(failed back surgery syndrome,FBSS)的临床疗效。方法 将62例FBSS患者随机分为两组,每组31例,其中治疗组采用CT引导下侧隐窝针联合针刀治疗,对照组采用电针治疗。观察两组治疗前、治疗后1、3、6个月VAS和改良ODI评分。结果 两组治疗后1、3、6个月VAS和改良ODI评分逐渐降低,差异有统计学意义(P<0.05);治疗组治疗后1、3、6个月VAS和改良ODI评分较对照组降低明显,差异有统计学意义(P<0.05)。结论 CT引导下侧隐窝针联合针刀治疗FBSS疗效确切。     

Three-dimensional gradient-echo imaging for percutaneous MR-guided laser therapy of liver metastasis

PURPOSE: To evaluate the use of three-dimensional (3D) gradient-echo (GRE) magnetic resonance imaging (MRI) for percutaneous MR-guided catheter placement for laser therapy of liver metastases. MATERIALS AND METHODS: Thirty-four patients were included. A total of 122 MR-guided percutaneous punctures of 67 liver metastases were performed on a 1.5T scanner (Symphony and Sonata; Siemens, Erlangen, Germany) using a 5.5F microcatheter system and titanium needle (Monocath; MeoMedical, Augsburg, Germany). In 88 of 122 procedures, a 2D fast low-angle shot (FLASH) T1-weighted GRE breath-hold sequence was acquired in the axial plane and if necessary in a second plane. Sequences were acquired and reviewed using the panel in the control room. In 34 of 122 procedures a 3D FLASH T1-weighted fat-saturated GRE (volume-interpolated breath-hold examination (VIBE)) sequence was acquired in the axial plane only. Acquisition and 3D review were controlled under sterile conditions with a panel inside the examination room (Syngo; Siemens). RESULTS: The 3D FLASH sequence significantly decreased the mean number of acquisitions needed to place the microcatheter with the titanium needle in the metastasis compared to interventions with the 2D FLASH sequence (2.9 +/- 0.83 vs. 4.4 +/- 1.63). With 2D FLASH imaging, acquisition in a second plane was necessary in 78 instances (20% of acquired 2D sequences) to ensure adequate positioning of the device during the procedure. The artifact caused by the titanium needle was smaller with the 3D FLASH sequence. The conspicuity of liver metastases and morphology (liver edge and vessels) was acceptable with both sequences. The 3D FLASH sequence improved differentiation when two to four titanium needles were inserted, due to smaller susceptibility artifacts caused by the needles. CONCLUSION: 3D GRE imaging with the capability to perform multiplanar reconstruction (MPR) shortens the procedure by reducing the number of sequences needed. Improved visibility of the titanium needles allows more precise insertion of multiple needles into the metastasis.     

肝肿瘤射频消融电极针研究进展

射频消融(RFA)是目前广泛应用于肝肿瘤治疗的微创、有效方法,适用于不愿或不宜外科手术治疗患者.近20余年来RFA技术取得了长足的发展与进步.作为主要治疗工具,射频电极针对RFA疗效具有很大影响.该文就目前临床常用或处于研发阶段的射频电极针,如多针尖可扩展电极针、灌注电极针、内冷却电极针及双电极针等的特点进行总结,比较它们的优势与不足,展望进一步研究方向,以提高RFA治疗肝肿瘤效果.     

System for robotically assisted prostate biopsy and therapy with intraoperative CT guidance

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the work-in-progress prototype of an image-guided, robotic system for accurate and consistent placement of transperineal needles into the prostate with intraoperative image guidance inside the gantry of a computed tomographic (CT) scanner. MATERIALS AND METHODS: The coach-mounted system consists of a seven-degrees-of-freedom, passive mounting arm: a remote-center-of-motion robot; and a motorized, radiolucent needle-insertion device to deliver 17-18-gauge implant and biopsy needles into the prostate with the transperineal route. The robot is registered to the image space with a stereotactic adapter. The surgeon plans and controls the intervention in the CT scanner room with a desktop computer that receives DICOM images from the CT scanner. The complete system fits in a carry-on suitcase, does not need calibration, and does not utilize vendor-specific features of the CT scanner. RESULTS: In open air, the average accuracy was better than 1 mm at a 5-8-cm depth. In various phantoms, the average orientation error was 1.3 degrees, and the average distance between the needle tip and the target was 2 mm. CONCLUSION: Results of preliminary experiments indicate that this robotic system may be suitable for transperineal needle placement into the prostate and shows potential in a variety of other percutaneous clinical applications.