血管运动性鼻炎合并鼻结构异常手术治疗的初步分析

目的 评估内镜下鼻内结构正常化手术对血管运动性鼻炎合并鼻结构异常的治疗效果.方法 对确诊为血管运动性鼻炎合并鼻结构异常的76例患者行常规鼻内镜检查及鼻窦CT扫描,根据患者的手术意愿将其分为微波组及手术组,微波组(41例)接受对双侧下鼻甲及鼻丘黏膜微波处理,手术组(35例)接受内镜下鼻内结构正常化手术.两组分别于术后3、6、12个月时进行随访.结果 微波组术后3、6、12个月时有效率分别为90.2%、46.3%、4.9%,而手术组分别为97.1%、97.1%、88.6%,两组3个月时的疗效无显著差异(P0.05),6、12个月时疗效差异显著(P<0.05).微波组鼻干、鼻腔粘连发生率分别为70.7%、56.1%,手术组鼻腔粘连发生率为22.9%.结论 对常规治疗效果不理想且合并鼻结构异常的血管运动性鼻炎患者,施行内镜下鼻内结构正常化手术可取得较好效果.     

Cypher支架治疗冠心病11例

目的　评价Cypher支架近期效果及远期效果。方法　对我院11例冠心病患者14处病变行经皮冠状动脉介入治疗(PCI)中置入11个Cypher支架的回顾性分析。其中男性8例,女性3例,患者年龄4 2 - 76岁;患者中合并2型糖尿病、高血压和高脂血症患者各为4、6和5例,1例患者急性前壁心肌梗死后4h行急诊PCI术。14处病变弥漫性病变4例,管状病变5例,分叉处病变2例,慢性完全性闭塞3例;使用支架直径2 .5～3.5mm ;所有患者行PCI术前1d服用肠溶性阿司匹林片和氯吡格雷各30 0mg ,置入支架后予低分子肝素钠5 0 0 0U皮下注射,每12h 1次共7d ,术后服用氯吡格雷75mg d ,6个月,术后长期服用肠溶性阿司匹林10 0mg d ;11处病变都经球囊预扩张后置入支架。结果　11处病变选择Cypher支架置入成功,术中术后无主要不良事件发生,所有患者随诊3～2 0个月。有2例患者在术后6个月及12个月行冠脉造影术,未发现支架内再狭窄。结论　只要选材恰当,手术操作规范,PCI术中选用Cypher支架治疗冠心病是安全和有效,降低再狭窄率,特别是对合并糖尿病的患者     

改良术式局麻下治疗慢性硬膜下血肿(附33例报告)

目的:探讨老年合并严重心肺疾患慢性硬膜下血肿患者的简易手术.方法:对33例慢性硬膜下血肿患者在局麻下进行钻孔引流,不进行冲洗.结果:33例患者,1例术后因经济原因放弃治疗,1例因术后疗效不佳改行骨瓣开颅清除血肿治愈,31例术后1个月复查头颅CT,23例硬膜下血肿完全消失;6例少量残留;2例复发,经再次手术治愈.结论:局麻下行慢性硬膜下血肿钻孔引流手术(不冲洗)较传统手术可缩短手术时间,简化手术操作,减少麻醉及手术并发症,且疗效好.     

合并支气管动脉-肺循环瘘大咯血的介入治疗

目的 探讨大咯血患者合并支气管动脉-肺循环瘘介入栓塞治疗策略及临床疗效. 资料与方法 66例大咯血患者经DSA检查显示20例合并支气管动脉-肺循环瘘,采用长效栓塞剂PVA和丝线对靶血管进行栓塞治疗,部分辅以明胶海绵颗粒(条). 结果 16例1周内咯血消失,4例首次治疗无效者均为病变广泛分流量大或主干血管细小扭曲,1例病变血管栓塞不全,3例1～3天复发再次造影显示瘘口完全或部分再通,栓塞后2例仍咯血改行手术治疗.术后5个月及11个月复发各1例,首次治疗有效率80%,1年内复发率26.3%. 结论 介入栓塞治疗合并支气管动脉-肺循环瘘的大咯血安全、有效,但主干血管细小扭曲及病变广泛分流量大者瘘口易早期再通复发咯血.     

再次手术治疗瓣周漏28例临床分析

目的 研究因瓣周漏(PVL)行再次心脏手术的患者的疗效及中远期生存情况.方法 回顾性分析1998年10月-2015年10月因人工瓣膜瓣周漏在解放军总医院行手术治疗的28例患者的临床资料,其中男22例,女6例,年龄15～67(55.4±11.6)岁.28例患者中二尖瓣置换术后瓣周漏18例,主动脉瓣置换术后瓣周漏4例,二尖瓣、主动脉瓣置换术后二尖瓣瓣周漏4例,双瓣置换合并左室隧道内隔膜切除术后双瓣瓣周漏1例,法洛三联症根治合并三尖瓣置换术后三尖瓣瓣周漏1例.其中2例起因为感染性心内膜炎.再次手术前心功能分级(NYHA)Ⅱ级11例、Ⅲ级10例、Ⅳ级7例.结果 术后早期死亡2例,分别死于感染性休克和多脏器衰竭.术后出现缺血缺氧性脑病1例,再次开胸2例,少量瓣周漏复发1例.26例出院患者中22例获随访,随访率84.6％,随访时间12～219个月,平均76.2个月.1例于术后31个月死于重症胰腺炎;1例术后7个月再次出现瓣周漏复发,目前心功能Ⅲ级;其余患者恢复良好,心功能Ⅱ级.结论 对于超声诊断明确的中重度瓣周漏患者积极行外科手术是切实有效的治疗方法.     

门静脉支架联合125I粒子条植入治疗门脉癌栓12例

目的 介绍用门静脉支架联合125I粒子条对合并门脉癌栓的肝癌患者的综合治疗方法.方法 汇集自2014年以来中国医科大学附属盛京医院放射科收治的肝癌合并门脉癌栓的患者12例,分析其临床、影像、实验室检查资料,完成经皮经肝门静脉穿刺及支架联合125I粒子条植入术,统计手术的可行性、安全性及并发症,讨论支架的通畅情况及患者的生存情况.结果 手术成功12例(100％),2例支架未开通,其中1例并发穿刺点出血,1例并发呕血.10例患者接受随访,平均随访时间8.0个月(2～15个月),平均生存时间8.0个月(2～15个月).术后3、6和9个月及1年生存率分别为7/9、7/9、5/8和3/6.门脉支架平均通畅时间7.5个月(0～15个月).术后3、6和9个月、1年门静脉通畅率分别为7/9、6/9、5/8和3/6.随访期内共8例患者行后续TACE治疗,共行TACE 18例次,术后肝功能稳定.结论 门静脉支架联合125I粒子条植入可以降低癌栓分级、维持支架通畅、保证门脉供血、扩大TACE适应证,对合并门脉癌栓的肝细胞癌患者具有较大的综合治疗价值.     

胆囊切除术中意外胆囊癌的临床诊治分析

目的:胆囊切除术中发现的意外胆囊癌(unsuspected gallbladder carcinoma,UGC)的临床诊断及处理并对pT1b期的两种手术方式的生存率进行分析.方法回顾性分析我院在2006年3月～2013年4月经胆囊切除术中、术后发现的29例UGC患者的临床资料.结果29例患者术后均获得随访,随访时间2～60个月,平均24个月.其中术中发现20例,术后发现9例,6例pT1a期均行单纯胆囊切除术,中位生存期40(5～60)个月;11例pT1b期中的6例行胆囊癌根治术,中位生存期25(4～36)个月;5例行单纯胆囊切除术,中位生存期18(3～30)个月,两种术式术后生存期比较差异有统计学意义(P＜0.05);8例PT2期行胆囊癌根治术,中位生存期20(3～26)个月;3例PT3行胆囊癌根治术,中位生存期9(4～15)个月;1例PT4期行单纯胆总管引流,术后3月死亡.结论胆囊癌的恶性程度较高,手术切除率低,对于UGC病例要根据分期采取适宜的手术方式,对于胆囊癌pT1b期的手术方式选择目前仍存在争议,本研究认为行胆囊癌根治术可以明显提高患者的生存率.     

超声乳化联合人工晶体植入术治疗白内障合并高度近视临床研究

 目的 观察超声乳化联合低度数人工晶体植入术治疗白内障合并高度近视的疗效.方法 42例56眼白内障合并高度近视行超声乳化联合人工晶体植入术.观察术前、术后1周、1个月、3个月、6个月裸眼及矫正视力 .结果 术后1周裸眼视力超过0.5以上者49眼占87.5%,术后1个月裸眼视力低于术后3个月视力,两者差异显著﹙(P＜0.05).结论 超声乳化联合低度数人工晶体植入术治疗白内障合并高度近视能明显提高患者视力.     

动脉粥样硬化所致髂-股动脉狭窄或闭塞的血管腔内介入治疗

目的 探讨动脉粥样硬化所致慢性下肢缺血通过髂-股动脉腔内介入治疗的可行性和疗效.方法 15例患者经多排螺旋CT下肢血管造影证实为动脉硬化性髂.股动脉狭窄或闭塞性病变行经皮腔内成形术(PTA)和支架植入术.通过术后血管造影及临床症状改善等来评价治疗效果.PTA术后病变段血管残余狭窄<30%被认为技术成功;按照Fontaine分型治疗后临床症状改善1级或1级以上被认为临床成功.结果 经同侧逆行PTA及支架植入术5例,共计6段同侧髂动脉血管.包括植入髂动脉支架3枚、3段髂动脉行VFA术;跨主动脉对侧髂.股动脉PTA及支架植入术10例,共计20支病变血管,包括植入髂动脉支架5枚、股浅动脉支架5枚、10支股动脉行PTA术.髂股动脉支架、成形术后重复血管造影证实所有病变段血管血流明显改善,技术成功率为100%,无血管夹层及血栓形成等并发症.临床随访2～24个月,平均11.9个月,术前及术后6个月踝臂指数测定差异具有统计学意义(t=-4.64,P<0.01).术后6个月Fontaine分型提高1、2和3级的患者分别有7、5和3例,所有患者均未施行截肢(趾)术,随访期间临床有效率为100%.结论 动脉粥样硬化性髂-股动脉狭窄或闭塞的腔内介入治疗是一种安全、有效的治疗方法,能够改善患者的生存质量,及早改善下肢外周动脉病患者的血运状况,为中长期保肢提供较好途径.     

透视下经皮胆管抽吸术在胆管存积物清除中的应用价值

目的 探讨经皮胆管抽吸术(PBA)在胆管存积物清除中的应用价值.方法 8例梗阻性黄疸患者,男6例,女2例,年龄39～ 68岁,平均54岁.肝移植术后2例,肝细胞癌3例,胆管细胞癌1例,外科取石术后胆管仍存残留结石2例.其中3例合并胆管感染.先行经皮肝胆管引流术,2周后总胆红素下降不到原来的1/2且经引流管行胆管造影显示胆管内仍有大量的充盈缺损,即在双导丝技术辅助下行PBA术.对比抽吸前后胆管造影表现,统计技术成功率、临床成功率和并发症,对胆管抽吸物进行病理分析.结果 8例患者均成功完成PBA术.8例患者的PBA术共进行了21次抽吸.其中2例胆管结石患者进行8次抽吸(1例3次,另1例5次),1例胆管细胞癌患者行3次抽吸,2例肝移植术后和3例肝细胞癌患者均行2次抽吸.术后再置放胆管引流管并行胆管造影示胆管内充盈缺损显著减少.术后1～2周再次复查总胆红素7例患者均下降原来的1/2以上,1个月后下降到正常范围,另1例无明显下降.3例合并胆管感染者症状明显好转.胆管抽吸物主要为胆泥、胶冻状物质、泥沙样或小结石和无结构的坏死物质.所有患者在抽吸过程中均未发现胆管出血等手术相关性并发症.结论 PBA术是一项安全、有效的清除胆管存积物的技术方法.     

外伤性支气管断裂的诊断与治疗

目的：笔者报告８例外伤性支气管断裂患者的诊断与治疗，旨在评价外伤性支气管断裂早期诊断和手术治疗效果以及延误诊断造成的后果。方法：本组４例于伤后５小时以内，１例于伤后６天内施行支气管修复手术。结果：本组８例中５例手术后痊愈。３例延误诊断３～６月，其中１例死亡，另２例合并肺部感染和脓胸未治愈。结论：早期诊断和手术治疗可减少肺和胸腔感染的机会，及时挽救患者生命和恢复呼吸功能。     

Chemoembolization of liver metastasis from breast carcinoma

Chemoembolization was performed in eight patients with liver metastasis from breast carcinoma. Five of eight patients had some radiographic regression of the liver tumors, one had stable liver disease, and two had disease progression. Two of four patients with pain showed clinical improvement of their symptoms. Only one patient with radiographic response or disease stabilization subsequently had intrahepatic progression (at 3 months). Five patients developed other metastasis, particularly brain metastasis, at a mean of 4.6 months after first chemoembolization (range, 2-12 months). All patients died within 13 months of treatment, with a mean survival of 49 months from primary diagnosis, 20 months from liver metastasis diagnosis, and 6 months from first chemoembolization.     

Haemangiopericytoma--Queensland Radium Institute experience and a review of the literature.

We report the presenting clinical characteristics, management, relapse patterns and survival of 17 patients with haemangiopericytoma treated at the Queensland Radium Institute, Australia from 1962 to 1989. Twelve patients were referred at the time of first diagnosis and were treated with curative intent. Three patients were treated with palliative intent when referred following initial diagnosis, and the remaining two patients were referred at the time of relapse. Disease was metastatic at presentation in 4 patients. Radiotherapy was used as a component of primary treatment of disease in 11 patients, in both patients referred for management of local relapse of haemangiopericytoma, and for palliation of metastatic disease developing in 3 patients. One patient received chemotherapy as part of initial treatment. Nine patients have died with survival from first treatment ranging from 3 to 139 months. All 8 surviving patients remain free of disease at 6 to 94 months from first treatment.     

小儿外伤性迟发性脑内血肿

目的 探讨小儿外伤性迟发性脑内血肿的临床特点，诊断和治疗。方法 回顾性分析我院1987年1月-1998年12月收治的27例小儿外伤性迟发性脑内血肿。结果 27例小儿外伤性迟发性脑内血肿中，行血肿清除术13例，颅骨钻孔血肿内置管 增强尿激酶外引流术6例，非手术治疗8例，26例治愈，1例死亡，死亡率3.70%。结论 进行性意识障碍，头痛，呕吐，贫血加重和生命体征不稳定是小儿迟发性脑内血肿的基本临床特征，高度警惕本病的发生，及时再次CF扫描有利于早期诊断，掌握好手术和非手术治疗的指征，是治愈本病的关键。     

一期前路病灶清除钛网植骨后路内固定治疗胸腰椎结核并后凸畸形66例疗效观察

目的观察一期前路病灶清除钛网植骨后路内固定术治疗胸腰椎结核并后凸畸形的临床疗效。方法对66例胸腰椎结核并后凸畸形患者在术前进行至少3周正规抗结核药物治疗后行病灶清除、椎间植骨及后路内固定术,根据术后后凸畸形的矫正角度及Frankel分级评价效果。结果对66例患者随访9~18(12±2)个月,所有患者无局部复发及窦道形成,术前术后Cobb角差异有统计学意义(P<0.05),Frankel分级与术前比较均有1~3级恢复。结论一期前路病灶清除、钛网植骨、后路内固定手术具有病灶清除彻底,植骨融合内固定可靠,畸形矫正理想等优点。     

一站式治疗重症缺血性糖尿病足感染15例

目的 总结重症缺血性糖尿病足感染创面的一站式治疗经验.方法 回顾性分析2015年6月至2016年4月收治的15例重症缺血性糖尿病足坏疽患者(15条患肢)临床资料.对所有患者采用腔内修复术(EVR)开通闭塞段血管、手术清创及创面封闭负压引流(NPWT)、抗菌保湿伤口敷料进行一站式序贯治疗,评价感染创面愈合率及患肢保肢率.结果 15例患者中下肢动脉造影显示下肢多节段病变13例,单纯小腿病变2例;泛大西洋学会联盟(TASC)Ⅱ分级D级小腿动脉病变13条,C级病变2条.EVR术后,14条患肢至少开通1支小腿流出道;足底动脉环路(PPL)呈完整弓6例,半弓7例,无弓2例;清创后应用带自制冲洗设备NPWT,创面感染控制时间为(7.85±2.84)d.出院后每3～4日随访,并以抗菌保湿的磺胺嘧啶银脂质水胶伤口敷料换药,结果显示创面愈合12例,平均愈合时间(3.70±0.87)个月,3例未愈合,其中2例小腿截肢(13.3％,足部均为PPL无弓),1例死于心血管事件;创面愈合组PPL病变情况与未愈合组比较,差异有显著统计学意义(P=0.006 7).结论 重症缺血性糖尿病足感染治疗较复杂.EVR、带自制冲洗设备NPWT及抗菌保湿创面敷料一站式联合治疗,可作为首选方法有效增加患肢血供,缩短感染控制时间,降低截肢率.     

Hepatocellular carcinoma with indeterminate or false-negative findings at initial MR imaging: effect on eligibility for curative treatment initial observations

PURPOSE: To retrospectively evaluate the effect of indeterminate or false-negative findings at magnetic resonance (MR) imaging on eligibility for curative treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This HIPAA-compliant retrospective study was approved by the institutional review board; the need for informed consent was waived. Of 166 patients with cirrhosis in whom HCC was detected with MR imaging, 21 (13 men, eight women; mean age, 60 years) had 33 proved HCCs that were not detected on previous MR images obtained 6-24 months earlier. MR imaging included T1-weighted, T2-weighted, and dynamic contrast material-enhanced T1-weighted imaging. Serial MR images and treatment records were reviewed to evaluate nodule growth and the effect of delayed diagnosis on treatment eligibility. RESULTS: Of 33 HCCs in 21 patients, 24 corresponding nodules (73%) were described on previous MR images as benign or indeterminate. Five additional nodules were visible at retrospective evaluation, but only on arterial phase images. The diameters of these 29 visible but indeterminate nodules were initially 0.6-1.9 cm (mean, 1.1 cm) and increased to 0.9-4.5 cm (mean, 1.9 cm) at HCC diagnosis (mean follow-up, 378 days). The mean doubling time was 856 days for diameter and 285 days for volume. All nine HCCs with a delayed diagnosis of less than 1 year were smaller than 3 cm at diagnosis, and the patients had undergone liver transplantation (n=3) or technically successful ablation or embolization (n=6). All 10 subcentimeter indeterminate nodules were smaller than 2 cm at HCC diagnosis, and none progressed to untreatable HCC. CONCLUSION: Indeterminate nodules smaller than 2 cm did not become untreatable HCC with delayed HCC diagnosis of 6-12 months.     

介入放射学诊疗肝移植后血管并发症的初步探讨

目的：评价介入放射学手在诊断和处理肝移植后血管并发症的价值。方法：对通过介入方法诊断的7例肝移植术后血管并发症病例进行了回顾,对该7例病例相关生化指标,血管造影的表现进行了分析。结果：7例中6例在操作技术上获得了成功。其中3例腔静脉狭窄者术后临床症状和肾功能改善满意,其中1例超过20个月,另2例由于其它死亡原因分别术在术后10d和29d死亡。肝动脉并 介入术后肝功能未得到明显改善,结论：血管造影对肝术后血管并发症的诊断具有重要的价值,下腔静脉狭窄的介入处理效果令人鼓舞,介入处理移植后肝动脉并发首的受到诊时间等多种相关因素的影响,有待进一步探讨。     

Arthroscopic treatment of osteochondral lesions of the talus

A retrospective study of the arthroscopic treatment of transchondral fractures of the talar dome in 18 patients was conducted. Followup ranged from 3 months to 3 years; 10 patients had an average followup of 2 years (Group A) and 8 of 6.5 months (Group B). The 10 male and 8 female patients ranged in age from 14 to 40 years. Thirteen lesions were posteromedial while five were anterolateral. Fourteen of the 18 patients reported an inversion type injury to the ankle from playing various sports on weekends. One patient had a bimalleolar fracture of the ankle sustained in a car accident 18 months prior to referral, while the last patient in the series had a bilateral fracture of the os calcis from a work-related falling incident. All patients underwent conservative care for at least 4 months prior to referral. Arthroscopic treatment consisted of partial synovectomy, debridement of osteochondral lesions with removal of loose fragments, curettage, abrasion, and, in one case, drilling. For analysis of postoperative management, patients were divided into two groups, 10 with the 2 year followup comprising Group A and the 8 with the 6.5 month followup in Group B. Group A was nonweightbearing for 6 weeks while Group B was ambulatory 2 weeks postoperatively. Group A was fully ambulatory when the 6 week nonweightbearing period expired. All patients had a full range of motion at the time of suture removal (1 week to 10 days). Both groups were evaluated objectively and subjectively. Excellent or good results were obtained in 88% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

介入治疗T管引流术后胆道再狭窄的初步探讨

目的 评价介入治疗外科T管引流后胆道再狭窄的疗效、安全性、可行性.方法 回顾性分析2014年6月-2016年3月收治的T管术后胆道再狭窄的25例患者资料,其中胆管癌6例,胆囊癌3例,胆系结石13例,肝癌2例,胃癌外科术后1例.25例中合并胰胆管合流异常4例.经原T管途径行介入治疗22例,经T管造影后再行PTCD治疗3例.所有患者中,行球囊扩张配合胆道引流者21例,行胆道金属支架植入者4例.良性狭窄患者引流管保留2～3个月后给予拔除.患者经门诊或电话随访3～24个月,通过引流管造影评价疗效.结果 介入手术均顺利,无相关并发症发生,技术成功率100％.15例良性胆道狭窄患者经原T管窦道途径行球囊扩张成形术,留置胆道10.2～12 F内外引流管,拔除原T管.随访发现1例胆管癌吻合口狭窄患者术后8个月死于肺部感染.10例恶性狭窄中,3例胆道梗阻位于T管上方,均行PTCD术;其中2例肝癌侵犯胆道患者,癌栓范围较大,行内外引流管植入;黄疸消退后分别于术后1个月、2.2个月死于肝衰竭;1例胆囊癌侵犯胆道行支架植入,术后2.5个月死于肿瘤进展.7例胆道梗阻位于T管下方,经T管窦道途径植入内外引流管4例,植入金属支架3例.其中2例胆囊癌患者分别于术后3.8个月、5个月死于肿瘤进展;5例胆管癌患者中2例术后3个月出现支架再狭窄,给予PTCD处理.3例于术后3.6个月、5.2个月、9个月死于肿瘤进展、多脏器功能衰竭.结论 介入治疗外科T管引流后胆道再狭窄疗效确切,安全可行,可明显改善患者生活质量.