超声引导多弹头集束电极射频治疗肝海绵状血管瘤

我们自1999- 0 9～2 0 0 3- 0 2利用超声引导多弹头射频治疗肝海绵血管瘤16例,取得了良好的疗效,现报道如下。1　资料与方法1.1　资料:本组男6例,女10例,平均年龄4 6岁。11例系无症状查体发现,5例因有临床症状而确诊。单发14例,多发2例,共2 0个病灶,瘤体最大10cm×9cm ,最小3cm×2cm。B超见为境界清晰,有高回声边带环绕的类圆形病灶,9例均匀强回声,4例混合回声,3例低回声;仅4例>5cm血管瘤周边及其内侧及动脉血流,CT检查均有典型的“早出晚归”征。1.2　方法:采用B超引导经皮经肝穿刺途径及术中超声引导多弹头射频治疗。首先根据CT、MRI…     

甲硝唑液冲洗治疗肛周脓腔58例

1992～1996年,我们对肛周脓肿58例行甲硝唑液冲洗脓腔治疗,效果满意。1　临床资料1.1　一般情况　本组58例,均为本院肛肠科门诊、急诊患者,男39例,女19例;年龄18～49岁,平均32岁;病程3～8d,平均4.5d。初发38例,复发2次或2次以上20例。所有患者均经穿刺,抽出脓液而确诊。最大脓肿约8cm×7cm×6cm,最小约4cm×3cm×2cm,触痛明显,周围有炎性浸润。1.2　治疗方法　取一次性针筒1副,12号针头2只,0.5%甲硝唑液100ml。患者取胸膝卧位,消毒会阴部在脓肿上1/3处,用12号针头穿刺抽出脓液。然后固定针头,用甲硝唑液反复冲冼、抽吸、待吸出液清亮时,再将…     

经皮肝穿置管引流治疗肝脓肿15例

我科自1982年9月～1989年1月共收治细菌性肝脓肿15例，除1例小儿患者外，均采用经皮肝穿刺置管引流治愈，无并发症，现报告如下。一、临床资料本组男10例，女5例，年龄8～56岁，病程9～90d。脓肿位于右肝者14例，左肝者1例。单脓腔14例，多脓腔1例。经皮肝穿刺置管引流脓腔造影显示最大为15cm×8cm，最小为4．5cm×45．cm。首次引流脓液60～1600ml。细菌培养5例有金黄色葡萄球菌生长，10例未培养出细菌。15例均采用X线、A型或B型超声波及同位素肝扫描确诊。其临床表现均为高热（3f）～41．ZoC）、肝区疼痛、肝肿大及白细胞总数升高。二、…     

彩色多普勒超声诊断输尿管囊肿1例

1　临床资料患者男 ,7岁 ,缘于 1年前开始出现小便时排尿中断 ,时有尿频、尿急、尿痛 ,来我院门诊就诊。超声检查使用Acuson SEQUOIA5 12超声诊断仪 ,采用 2 5～ 4 0MHz凸阵探头进行扫查显示 :左肾大小为 7 7cm× 4 2cm ,肾盂分离宽约 1 2cm ,左侧输尿管上段宽 0 6cm ,下段宽 1 1cm ;右肾大小为7 6cm× 4 4cm ,肾盂分离宽约 0 9cm ,右侧输尿管上段宽 0 7cm ,下段宽 1 2cm。然后患者取仰卧位 ,探头置于耻骨联合上方扫查 ,斜冠状切面显示膀胱内三角区处类圆形的液性暗区 ,呈“眼镜状”(图 1) ,左右大小分别为 1 8cm× 1 6cm、2 0…     

腹腔镜下行肝脓肿引流术21例

1993年7月～1996年12月，我们在腹腔镜下行肝脓肿引流术21例，效果满意。1对象和方法1．1一般情况本组男8例，女13例；年龄37～77岁，平均48．5岁。门脉系肝脓肿15例，胆源性肝脓肿6例。伴发疾病：胆囊结石急性胆囊炎4例，慢性胰腺炎1例。右叶肝脓肿14例，左叶肝脓肿7例。多脓腔18例，单脓腔3例。脓肿破溃隔下感染1例。脓腔最大7cm×13cm，最小7cm×5cm。1．2手术方法术前2次以上B超诊断，必要时在B超下穿刺定位。手术在静脉复合麻醉气管插管呼吸机辅助呼吸下进行。制造CO2气腹和建立镜身孔、操作孔、牵拉孔同腹腔镜胆囊切除术（LC），用…     

超声引导穿刺置管引流治疗肝脓肿的临床应用及护理

目的:探讨了超声引导经皮穿刺置管引流冲洗与直接冲洗治疗肝脓肿的临床应用价值及护理。方法:对52例肝脓肿患者,63个病灶行超声引导经皮穿刺,小于5cm的脓肿直接穿刺抽吸治疗,大于5cm的肝脓肿置管引流。同时做好术前准备,全身支持营养,心理护理。临床应用效果良好。结果:52例患者的63个病灶完全治愈,穿刺术后24小时无不良反应,4周治愈率达到78%,8周治愈率达到83%,6个月治愈率达到100%,无护理并发症。结论:超声引导经皮穿刺置管引流抽吸冲洗治疗肝脓肿,方法简单,安全有效,创伤小,可取代外科手术治疗肝脓肿。细致周到的护理是治疗成功的重要保证。     

背阔肌肌皮瓣转移治疗腋部放射性溃疡12例

放射性溃疡一旦形成 ,经久难愈 ,溃疡面越来越深大 ,非手术治疗难以奏效 ,须行清创、肌皮瓣转移覆盖修复。 1980年 1月～ 2 0 0 0年 12月 ,我们采用背阔肌肌皮瓣转移治疗腋部放射性溃疡 12例 ,疗效较好。1　临床资料1 1　一般情况　 12例均为女性 ,年龄 34～ 5 2岁 ,平均 4 7岁。因乳腺癌根治术局部放疗后出现水疱溃破 5例 ,局部搔痒抓破 4例 ,洗澡时局部擦伤 2例 ,跌倒碰伤 1例。病程 :3个月 5例 ,4～ 6个月 4例 ,7～ 12个月 2例 ,1年以上 1例。溃疡大小 :3cm× 4cm× 4cm 5例 ,4cm× 5cm× 4cm 4例 ,6cm× 7cm× 4cm 3例。局部组织涂片未…     

肝癌合并肝脓肿一例

患者　男 ,6 0岁。上腹部不适半年 ,食欲减退 ,进行性消瘦 ,近来发热、腹胀加重 3天入院。体检 :慢性病容 ,全身皮肤轻度黄染 ,右中上腹可扪及 4cm× 5 cm大小肿块 ,质硬无活动 ,触痛明显 ,双下肢轻度浮肿。体温 38.2℃ ,脉搏 10 0次 /分 ,血压 16 /10 k Pa。实验室检查 :白细胞 2 1.3× 10 9/ L ,中性粒细胞 0 .87,红细胞 3.6× 10 1 2 / L ,血红蛋白 13g/ dl,血沉 80 mm/ h,甲胎蛋白17.2。 B超检查 :肝癌合并肝脓肿 ,脾脏增大 ,少量腹水。CT表现 :肝脏外形增大 ,肝内胆管中度扩张 ,肝左叶内段可见 9cm× 6 cm× 6 cm不规则形等、低密度…     

CT引导下经皮穿刺肝脓肿引流术的临床应用

目的：探讨CT引导下经皮穿刺肝脓肿引流术的临床应用。方法：对27例肝脓肿患者行CT引导下经皮穿刺引流术，通过CT扫描确定脓肿的位置、穿刺途径、角度及深度后，进行穿刺直接抽吸或置管引流，其中7例行穿刺直接抽吸脓液1—3次，20例行放置引流管持续引流。结果：27例行穿刺37次，穿刺成功率100％。穿刺路径包括腹前壁18例(25次)、侧壁4例(7次)、后壁5例(5次)。共放置引流管21根。随访13—46天，症状明显好转、病灶缩小或消失26例，治愈率96．3％(26／27)。1例引流15天后转入手术治疗。并发症：置管过程中脓肿破入腹腔1例，无其他严重并发症。结论：CT引导下经皮穿刺肝脓肿引流术，可大大缩短病程，创伤小，操作简单，只要掌握好适应症和技术要领，成功率、治愈率高，并发症少而轻，值得推广应用。     

CT引导下经皮穿刺引流治疗阑尾周围脓肿

目的 评价CT引导下经皮穿刺引流阑尾周围脓肿的安全性和效果. 资料与方法 38例阑尾周围脓肿患者接受CT导向下经皮穿刺引流.回顾性分析患者的临床资料、置管数目、引流量、带管时间、并发症和随访结果. 结果 对5例脓肿＜4 cm者行细针单独抽吸,另33例各经皮置入一根引流管;引流脓液25～270 ml,平均80 ml;带管6～24天,平均9天;无严重并发症发生;随访31例,2例复发给予抗生素治愈. 结论 对液化完全且局限的阑尾周围脓肿,CT引导下经皮穿刺引流安全有效.     

Biliary-jejunal drainage for failed biliary-duodenal drainage

Percutaneous biliary drainage, as palliation for malignant biliary obstruction, is subject to complications, particularly blockage of the drainage tube. Blockage may occur because of duodenal tumour involvement. In nine patients with blockage of the biliary-duodenal drainage tube, conversion to biliary-jejunal drainage allowed continued internal drainage of bile.     

Biliary drainage: conversion of external to internal drainage

A percutaneously inserted biliary drainage catheter was converted from external to internal drainage with the use of an additional catheter advanced through the gastrostomy opening. This technique was successful in one patient with unresectable cancer of the head of the pancreas, in whom it was performed to overcome the various disadvantages of external biliary drainage.     

The utility of a drainage needle for percutaneous abscess drainage

OBJECTIVE: In this article, I describe a percutaneous drainage needle that consists of six side holes in its cannula. The needle is specially designed for effective evacuation of complex abscess collections consisting of internal solid components, including floating debris, that tend to block the needle aperture during aspiration. The characteristic features of the needle and its performance in both in vitro and in vivo environments are described. MATERIALS AND METHODS: An in vitro experiment was performed with the use of a model of a fluid collection containing floating sheets of gelatin sponge to mimic a complex body collection consisting of floating fibrinous strands. Five radiologists were asked to perform aspiration from two collections of normal saline and 5% methylcellulose of two different volumes using an ordinary aspiration needle and the drainage needle. The needle was evaluated in a prospective in vivo study of 30 postoperative abdominal collections in 29 consecutive patients that were drained by a single radiologist. Complete evacuation was attempted initially with a conventional aspiration needle. When there was sonographic evidence of residual fluid collection, a repeat aspiration using a drainage needle was performed during the same session. RESULTS: In the in vitro experiment, the median percentage of fluid aspirated with the conventional needle from the 10- and 15-mL collections of saline was 10% and 15% and from the 10 mL and 15 mL of methylcellulose solution was 20% and 26.67%, respectively, whereas the drainage needle was able to remove 100% of fluid in all attempts. In the in vivo study, the conventional needle was able to remove all drainable fluid from the 12 simple collections. For the 18 complex collections, the drainage needle was always able to remove some residual fluid from the collection after aspiration with the conventional needle. The median percentage of fluid volume aspirated with the conventional needle was 55.6%, whereas that aspirated with both the conventional and drainage needles was 95.5%, with a significant difference by Wilcoxon's signed rank test (p < 0.001). CONCLUSION: This drainage needle was effective in evacuating fluid from complex abdominal collections that could not be drained with conventional end-hole needles.     

The effect of drainage tube size on adequacy of percutaneous abscess drainage

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter sideholes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonouscollections and cavities with fistulous connection to bowel. This study was presented as a Scientific Paper (#177) at the 69th Scientific Assembly and Annual Meeting of the Radiologic Society of North America in Chicago, Illinois, November 14, 1983.     

Percutaneous abscess drainage

Literature published in the past year has focused on controversy over the indications for percutaneous abscess drainage, particularly drainage of hepatic, splenic, and renal abscesses. Percutaneous abscess drainage for intra-abdominal abscesses with enteric communication, perivascular abscesses, infected abdominal tumors, tuboovarian abscesses, and pancreatic collections is also reviewed.     

Appendiceal abscess drainage

Appendicitis is the most common abdominal inflammatory process in children, and the most frequent indication for abdominal drainage encountered in pediatric interventional radiology. Imaging in the diagnosis of appendicitis is evolving with CT becoming more common, although the incidence of perforation is not definitely improving. Tailored CT techniques for the diagnosis of acute appendicitis are designed to expedite care, but are not optimal in the diagnosis or characterization of abscesses. In the appropriate clinical setting the CT study needs to be altered for appropriate therapeutic planning. Drainage of appendiceal abscesses utilizes multiple techniques, some of which are more useful in children than adults. Image-guided drainage can facilitate a more limited surgery and can avoid repeat surgery from postoperative abscesses. Radiation doses must be minimized due to the increased risk in children. This article will discuss imaging in children with suspected appendiceal abscesses and drainage techniques.     

锥孔与钻孔引流手术治疗慢性硬脑膜下血肿的临床应用比较

目的对慢性硬脑膜下血肿的锥孔引流和传统钻孔引流术疗效进行回顾性比较,以明确两种手术方法的优缺点,找出治疗慢性硬脑膜下血肿的最佳方法。方法锥孔组86例患者采用床边直接锥孔冲洗引流,钻孔组82例患者采用传统钻孔引流术。两组患者术后2～3 d复查头颅CT,对手术时间、术后并发症、症状改善、平均住院日、痊愈率及复发情况进行对比研究。结果两组患者均痊愈。两组患者住院期间主诉改善、术后继发血肿及复发情况等比较,差异无统计学意义(P>0.05)。锥孔组平均手术时间(35±5)min,少于钻孔组的(60±8)min;锥孔组平均住院日(6.5±0.5)d,少于钻孔组的(10.5±1.0)d;锥孔组颅内积气发生率明显少于钻孔组,两组对比差异均有统计学意义(P<0.05)。结论锥孔引流手术有创伤小、操作简便、手术时间及平均住院日短等优点。