门脉海绵样变性一例报告

患者,女,36岁。因上腹闷痛2月,发现腹块半月入院。外院曾作穿刺活检诊断肝细胞肝癌。体查:巩膜无黄染,剑突下触及6×6cm质硬结节状肿块,脾未触及,移动性浊音(—)。实验室:肝功正常,AFP400ug/L。B超示左肝占位病变拟肝癌,脾不大。 肝动脉造影见肝门部10×8cm肿瘤染色,门脉早显并有主干瘤栓。肠系膜上动脉间接门脉造影见门脉主干瘤栓闭塞,仅有小支入肝,其右下方有粗大之异常静脉分成多支进入右肝。行肝动脉碘油化疗药乳剂及明胶海     

肝癌化疗栓塞致脑碘油栓塞一例

肝动脉化疗肝癌致脑碘油栓塞是一种罕见的介入治疗并发症,我们遇见1例,现报告如下。 患者,男性,51岁。因上腹部疼痛伴消瘦二月余,B超发现右肝占位性病变而住院治疗。实验室检查AFP 352μg/L,CT增强检查发现右肝肿块(5×5.5×4.5cm)呈轻度不均匀强化,CT值40-60HU,无腹水,腹膜后未见肿大淋巴结,胆囊、胰腺、脾脏均无异常CT征象(图1)。经临床、生化、B超、CT诊断为肝癌,遂行肝动脉灌注化疗碘油栓塞治疗。 治疗方案:常规插管至肝动脉造影示肝右叶肿块明显染色,可见粗大、紊乱的肿瘤血管、经导管灌注5     

肝血管瘤碘油栓塞术致肺栓塞一例

患者 ,女性 ,5 8岁 ,因肝大血管瘤碘油栓塞术致碘油肺栓塞两个月于2 0 0 2年 11月 18日在我院再次行肝血管瘤栓塞术。腹部CT显示 :肝右叶后段一巨大类圆形高低混发密度影、边界清 ,前方及肝顶分别可见小圆形低密度影、边界清。常规消毒局麻醉穿刺右股动脉 ,并注入地塞米松 10mg ,造影示原栓塞动脉未再通 ,碘油沉积量无明显减少 ,右膈动脉及右肝动脉均有肿瘤供血 ,分别超选进入右膈动脉及右肝动脉并注入乙碘油 10ml、 6ml,栓塞后再行造影血管瘤血管完全闭塞 ,无对比剂进入瘤区 ,手术进行顺利。于术后第 3天晨起翻身时突然出现胸闷、喘憋伴大…     

原发性肝癌并下腔静脉-右心房癌栓的DSA表现及临床意义

目的探讨原发性肝癌并下腔静脉-右心房癌栓的DSA表现及其在经动脉化疗栓塞中的临床意义。方法 12例肝癌并下腔静脉-右心房癌栓患者,行动脉造影确定肿瘤供血动脉并化疗栓塞治疗;同时行下腔静脉造影评价下腔静脉及右心房狭窄情况和周围侧支循环情况。结果下腔静脉-右心房癌栓供血动脉包括肝右动脉(7/12)、肝左动脉(6/12)、右膈下动脉(5/12)、左膈下动脉(1/12)、胃左动脉(1/12)及肋间动脉(1/12),8例造影表现为典型的"条纹征";下腔静脉狭窄程度85%~100%;周围可见丰富的侧支循环,右心房内可见典型的充盈缺损。结论动脉造影可以及时准确地评价下腔静脉-右心房癌栓的供血情况,肝外侧支血管在癌栓的供血中意义重大。     

选择性肾动脉栓塞术治疗肾外伤性出血三例报告

患者,例1,男58岁。左腹部撞在铁样杆小时,肉眼血尿急诊入院。B超示“脾破裂,左肾挫裂伤,肾周血肿”。IVP检查左肾未见显影。13天后继发左肾反复大出血,手术因左肾粘连固定未能切除左肾及有效止血。左肾动脉插管造影显示左肾破裂出血(图1),行左肾动脉主干栓塞术(图2)。例2,男41岁,车祸右腰部受伤伴肉眼血尿4小时入院。B超示“右肾挫裂伤”,CT示“右肾裂伤伴包膜下血肿”。肾动脉造影示     

原发性肝癌肝动脉栓塞后切除2例报告

自1989年11月至1990年10月我院经皮穿刺肝动脉栓塞术(TAE)治疗原发性肝癌46例,其中栓塞术后切除2例,现报告如下。例1 男性,30岁。因右季肋部不适、闷痛2个月于1989年11月14日入院,无肝炎病史。体检:巩膜不黄,浅表淋巴结不大,肝肋下1cm,质中,脾肋下未触及,无腹水征。化验检查:AFP<25μg/L,A/G1.54:1,SGPT正常,HBsAg阳性。腹部CT检查肝右叶9.2×6.6cm低密度区,提示肝癌。1989年11月30日经皮股动脉穿刺从右肝动脉注入阿霉素50mg、丝裂霉素C12mg,超化碘油10ml混合液,见整个肿瘤积聚药物。40天后CT复查,右肝9.3×6.7cm肿块,内有大片高密度碘油存留。栓塞术后2个月剖腹探查发现肝硬化,肝右叶肿块侵及膈肌及右侧腹壁,作不     

原发性肝癌肝动脉化疗栓塞术后的侧枝供血

目的:探讨原发性肝癌化疗栓塞术后肿瘤的侧枝供血。材料与方法:连续观察200例经病理证实的原发性肝癌患者,常规行经导管动脉化疗栓塞术,重复治疗中,根据影像学资料进行相关动脉造影,对造影结果进行分析。结果:200例中有21例出现侧枝循环供血于肿瘤,其中14例来自肝外,分别是右膈下动脉3例,左右共干的膈下动脉2例,左膈下动脉1例,胃左动脉3例,胃十二指肠动脉2例,右侧内乳动脉2例,胆囊动脉1例;7例来自肝内,其中肝左动脉供应肝右页病灶4例,肝右动脉供应肝左叶病灶3例。总共17例出现在第三次治疗及以后。结论:肝癌经导管化疗栓塞术后肿瘤侧枝供血存在于部分患者,这一现象在临床工作中应得到重视。     

碘油肝动脉造影诊断肝肿瘤的作用

肝动脉注射碘油抗癌药乳剂诊断和治疗肝癌已广泛用于临床,并有大量文献报道;但碘油肝动脉造影对其他肝肿瘤诊断及临床诊断的作用报道甚少。为了进一步探讨碘油肝动脉造影在诊断肝肿瘤和肝癌与其它肝肿瘤鉴别上的作用,笔者收集了240例证实的肝肿瘤碘油肝动脉造影资料进行分析,结果如下。     

大鼠种植性肝癌的活体影像学及病理对照

目的 探讨大鼠Walker-256种植性肝癌的活体影学表现,并与病理对照,以便更好地应用这一经典的大鼠肝癌模型。方法 种植瘤大鼠15只,10只行门静脉插管,5只行肝脉插管,所有动物均行MRI平扫检查,CT平扫及动态增强扫描,DSA血管造影,活体下缓慢注入超液化碘油,新鲜肝脏软X线钼靶摄片并行病理检查,结果 （1）种植瘤的MRI表现与人肝癌相似;肿瘤经门脉CT增强及DSA造影为少血型,而经肝动脉CT增强及DSA为多血型,经门静脉注入碘油后新鲜肝脏软X线摄片显示2只肿瘤边缘内侧可见碘油,经肝动脉注入碘油后肿瘤内可见较多斑点状碘沿 。（2）光镜下经门静脉注入碘油后肿瘤中央不见碘油,但7只肿瘤边缘内侧可见碘油,经肝动脉注入碘油后肿瘤中央及边缘均可见较多油滴,光镜下15只大鼠中9只发现门脉癌栓,癌栓内的碘油来自肝动脉,结论 大鼠Walker-256种植性肝癌在肝内呈膨胀性和浸润性生长,活体状态下以肝动脉供血为主,门静脉对肿瘤边缘有供血,种植瘤易发生门脉癌栓,癌栓主要由肝动脉供血。     

肝脏结节坏死一例

1　病例资料女 ,66岁。因右上腹痛 1个月 ,加重 1周就诊。门诊B超及CT检查示肝右叶占位性病变 ,肝癌可能性大 ,以肝癌待除外收入院。自发病以来 ,饮食、睡眠较差 ,大小便正常。既往有高血压、冠心病、糖尿病病史。查体 :体温 3 6℃ ,脉搏 80 /min ,呼吸 18/min ,血压 12 0 /70mmHg。腹平软 ,右上腹轻度压痛 ,无反跳痛及肌紧张。肝肋下 2cm ,脾未触及。肝功能正常。在局麻下行肝动脉造影后肝动脉灌注化疗加栓塞术。肝动脉造影示肝右叶内可见片状浅淡染色灶 ,未见明确的肿瘤血管及动静脉瘘。将导管置于肝固有动脉内 ,灌注化疗药后 ,以超液化…     

肱动脉流量介导的舒张功能与冠心病的关系

目的探讨肱动脉流量介导的舒张功能(FMD)与冠心病的关系.方法受试者98人,分为冠心病组(52人)和有冠心病倾向的对照组(46人).用高分辨率超声心动图仪检测所有受检者的肱动脉FMD.结果冠心病组患者FMD 0.05±0.01,对照组为0.09±0.04,二组间差异有显著性意义(P=0.01).FMD与冠状动脉病变程度不相关(P>0.05).当把FMD临界点定为10%时,诊断冠心病的敏感性为88%,特异性为71%.结论超声检测FMD是监测冠心病的一项重要指标.     

The importance of the conus artery in patients with obstructive coronary artery disease

It is well-known that collateral circulation is important in preserving ventricular functions, especially in coronary artery disease with total occlusion. The conus branch is distinct in having notable capacity of angiogenesis and arteriogenesis. We intend to emphasize the clinical importance of the conus branch by presenting two cases in which it supplied the distal regions of total occlusion.     

Aneurysms of the pancreaticoduodenal artery associated with occlusion of the celiac artery

Aneurysms of the pancreaticoduodenal artery are rare and may be associated with celiac artery stenosis or occlusion. Twenty-eight patients are reported in the literature. The diagnostic findings and therapeutic alternatives of four additional patients form the basis of this report. One patient with ruptured pancreaticoduodenal aneurysm was successfully treated by transcatheter embolization, and one patient was treated surgically; both patients had an uneventful recovery. In the remaining two patients, the aneurysms were left untreated. One patient died 1 year later of an unrelated cause, and the other patient is symptomfree after 2 years.     

Compression of the brachial artery in vivo

Stiffening of the brachial artery is implicated in pseudo-hypertension. To date, a reliable clinical predictor of the condition has not been developed. This paper describes the development of prototype instrumentation and methodology for measurement of the brachial artery transmural pressure/cross-sectional area relationship in vivo. The methodology has been validated using a model of an arm and a thin-walled rubber tube. Application of the technique to a healthy subject shows that the technique is viable and gives good reproducibility. Closure of the brachial artery with reducing transmural pressure is observed and recorded. The new technique has some important advantages over existing methodologies.     

经桡动脉与股动脉 2 种途径行冠状动脉介入术的效果比较及护理

目的探讨经桡动脉与股动脉2种途径行冠状动脉介入术诊治冠心病的利弊,以及针对不同的途径采取相应的护理措施。方法将645例冠心病患者按介入途径不同分为桡动脉组510例和股动脉组135例,比较2组患者手术并发症和主观不适等发生率。结果桡动脉组患者术后卧床时间、住院时间短于股动脉组,迷走神经反射、患者主观不适、皮下血肿、假性动脉瘤、排便困难、术后低血压的发生率均低于股动脉组。结论2种穿刺途径行冠状动脉介入诊疗均安全、可行。经桡动脉穿刺不良反应发生率低,术后护理相对简单,可提高护理人员工作效率,患者更易接受。     

经胸超声心动图诊断左冠状动脉异常起源于肺动脉的初步探讨

目的总结左冠状动脉异常起源于肺动脉（ALCAPA）的经胸超声心动图（TTE）特征及诊断思路。方法 回顾性分析我院经手术证实的8例ALCAPA患者的临床及影像学资料，总结其TTE特征。结果8例ALCAPA患者左室收缩功能均正常，其中婴儿型1例，早期出现肺炎、ST改变和心影增大；成人型7例，多无明显症状，因发现心脏杂音首次就诊。8例患者首诊超声仅确诊1例，高年资医师复诊检查确诊6例，1例误诊冠状动脉-肺动脉瘘。ALCAPA的典型TTE特征表现为左室增大，右冠状动脉增宽，心肌侧支血流丰富，肺动脉内见来自左冠状动脉的异常血流信号。结论 婴儿期发现心力衰竭、ST改变、心影增大；儿童或成人期发现冠状动脉侧支血流丰富、右冠状动脉增宽，均需警惕ALCAPA，应仔细扫查左冠状动脉的起源和血流方向，有助于提高TTE对ALCAPA的早期诊断。     

Coronary artery disease in the elderly

Clearly, management of heart disease is quite different in the elderly than in younger patients, and it represents a significant problem in light of the increasing numbers of elderly patients. For physicians, the challenges are to recognize the many cardiac entities, to avoid the problems that can result from prescribing drugs in dosages similar to those given to younger patients, and to acquire a better understanding of cardiac anatomy and physiology associated with the aging process.     

Coronary artery disease in the elderly

Elderly patients with coronary artery disease (CAD) present special opportunities and challenges for nurses. The astute nurse is aware of changes in the aging cardiovascular system and possible alterations in the presenting signs and symptoms of CAD. Risk factor reduction may need to be approached more selectively in the elderly. Older patients who are treated surgically may experience more complications. Implications for nursing care are reviewed.