机械可脱性螺旋圈栓塞治疗颅内动脉瘤

目的 探讨颅内动脉瘤血管内治疗的理想方法。方法 采用机械可脱性螺旋圈（ＭＤＳ）血管内栓塞治疗颅内动脉瘤７例。结果 ７例中５例栓塞成功,２例未成功。无死亡及永久性并发症,其中１例动脉瘤患一过性双目失明,经及时有效抢救治疗,１天后恢复正常。结论 颅内动脉瘤的栓塞治疗,是目前比较理想的治疗方法,但其远期疗效有待随访观察。     

磁控血管内磁性微球栓塞实验研究

将三种不同粒径聚甲基丙烯酸甲酯磁性微球分别注入磁场控制的股动脉、进行血管内磁性微球栓塞研究，术后Ｘ片、股动脉造影及病理检查显示，磁控时间５ｍｉｎ，不能形成稳固磁栓，磁控时间１５ｍｉｎ，３０－５０μｍ磁性微球组有稳固磁栓形成；磁控时间３０ｍｉｎ，则均能形成稳固磁栓。     

血管内置铂金圈栓塞脑动脉瘤的护理配合探讨

目的探讨脑动脉瘤栓塞术的护理配合。方法对20例脑动脉瘤做好介入治疗术前护理准备,术中护理紧密配合,通过股动脉穿刺途径,插入微导丝、微导管至脑动脉瘤腔内,置入铂金圈。结果经医生精心操作,护理紧密配合,分别在20例脑动脉瘤顺利置入2×2cm、2×4cm、2×6cm、2×8cm、6×8cm、6×10cm、7×15cm铂金圈,无出现介入引起的并发症。结论充分做好各项术前护理准备,术中紧密配合,密切观察并及时处理患者出现的病情变化是确保脑动脉瘤置铂金圈顺利完成的重要环节。     

机械钨丝可脱性螺旋圈栓塞治疗颅内动脉瘤的护理

颅内动脉瘤是一种病死率和致残率都很高的疾病 ,外科手术难度大 ,术后易出现严重并发症或导致死亡。目前 ,神经外科领域多采用电解铂金可脱螺旋圈 (GDC)栓塞治疗动脉瘤 ,被不少学者认为是更安全和可靠的方法[1] ,但由于价格昂贵 ,患者及家属常常难以承担其昂贵的手术费用 ,因此临床上推广受限。我科于 1999年 8月～ 2 0 0 1年 9月 ,采用法国BALT公司生产的机械钨丝可脱性螺旋圈 (MDS N)治疗 16例颅内动脉瘤取得了同等的临床效果 ,MDS N价格合理、安全、有效、术后恢复快、并发症少、病人易于接受 ,同时精心的护理与严密的病情观察 ,对…     

甲氨蝶呤明胶微球末梢栓塞效果的实验研究

本文通过肝动脉灌注的实验研究旨在证明国内首创的甲氨蝶呤明胶微球（ＭＴＸ－ｍｓ）的末梢栓塞作用，为临床介入治疗肝癌提供一种新型的化疗栓塞剂。经大白鼠肝动脉灌注ＭＴＸ＿ｍｓ后即刻及１０－５０天行随访肝动脉造影，显示ＭＴＸ－ｍｓ能在小动脉 效地阻断肝动脉血流，小剂量的微球不会引起明显的肝组织损害。ＭＴＸ－ｍｓ的降解时间约在３０－４０天左右。大白鼠肝动脉完全阻断后仍可产生侧枝循环，但多为不完全性肝动脉再通     

肺动脉栓塞术的实验性研究

用７只健康成兔进行碘化油线段选择性肺动脉栓塞术（ＰＡＥ），目的是观察其影像表现及组织学变化。结果显示栓塞区的树枝状影的肺动脉末稍呈絮状或斑片状影，影像放第八周末近於全消退。组织学改变为栓塞区小血管扩张、外周炎性细胞浸润、血栓形成，无组织坏死。实验证明用碘油线段做兔ＰＡＥ易放影像观察，存留时间长，安全可行。     

磁性微球血管栓塞的实验研究

本文以磁性微球（ＭＧ－ｍｓ）为栓塞剂进行了实验研究。通过加磁场与不加磁场情况下行兔耳静脉注入￣（９９）ＴＣ标记的ＭＧ－ｍｓ试验、经导管犬肾动脉注入磁微粒（粒径＜１μｍ）和犬肝动脉注入１０～３０μｍＭＧ－ｍｓ的对比研究，显示磁微粒及磁微球有良好的体内磁应性。对１２只犬在加磁场与不加磁场下行肾动脉栓塞，结果有明显差异。对４只犬在加磁场的情况行１０～３０μｍＭＧ－ｍｓ肝动脉栓塞，效果满意。     

甲氨蝶呤明胶微球末梢栓塞效果的实验研究

本文通过肝动脉灌注的实验研究旨在证明国内首创的甲氨蝶呤明胶微球（ＭＴＸ－ｍｓ）的末梢栓塞作用，为临床介入治疗肝癌提供一种新型的化疗栓塞剂。经大白鼠肝动脉油注ＭＴＸ－ｍｓ后即刻及１０—５０天行随访肝动脉造影，显示ＭＴＸ－ｍｓ能在小动脉水平有效地阻断肝动脉血流，小剂量的微球不会引起明显的肝组织损害。ＭＴＸ－ｍｓ的降解时间约在３０～４０天左右。大白鼠肝动脉完全阻断后仍可产生侧枝循环，但多为不完全性肝动脉再通。结果揭示ＭＴＸ－ｍｓ具有明显的末梢栓塞作用。在初步的临床应用中已取得了明显的疗效。     

自制被覆聚氨酯膜与非覆膜不锈钢支架在动脉系统应用的实验对照研究

目的　探讨自制覆膜与非覆膜Z型不锈钢支架在动脉系统中应用的可行性。方法　本实验共用 9条健康杂种犬 ,按观察时间随机分为 3组 (3条 /组 )。应用介入放射学方法分别将自制Z SSS支架 9枚和PU SSS支架 11枚置入犬的腹主动脉。实验动物分别于支架置入后 2周、4周、12周行血管造影复查。处死实验动物 ,行组织学检查并进行统计学分析。结果　 9枚Z SSS和 10枚PU SSS成功置入靶血管。Z SSS和PU SSS的管腔开通率分别为 :10 0 %和 2 7.2 7% ,两者具有显著的统计学差异 (P =0 .0 0 1)。支架置入 4周时 ,两种支架表面内皮化基本完成。PU SSS引起的局部血栓形成、炎性反应和平滑肌细胞增生明显。 2周、4周、12周时 ,两种支架新生内膜厚度分别为 (3 5 9.2 3± 5 0 .15 ) μm、(4 4 0 .87± 5 8.3 8)μm、(5 81.2 8± 12 1.2 5 ) μm和 (178.49± 14 .67) μm、(12 0 2 .79± 42 1.0 5 ) μm、(14 66.0 6± 463 .19) μm ,两者具有显著差异 (P <0 .0 1)。 4周时 ,平滑肌细胞增殖细胞核抗原 (PCNA)阳性细胞率分别为 :(4 6.0 7± 14 .73 ) %和 (85 .2 3± 18.2 5 ) % ,两者具有显著的差异 (P <0 .0 1)。扫描电镜 :12周时支架表面内皮细胞成熟。置入 12周的支架金属丝表面光洁 ,未见腐蚀现象。结论　①Z SSS具有良好     

Coil embolization of a solitary congenital intrahepatic hepatoportal fistula

Congenital hepatic artery-to-portal vein fistula, a rare type of arteriovenous malformation that may be intrahepatic or extrahepatic, is an uncommon cause of severe infantile portal hypertension. Many researchers believe that acquired intrahepatic arterioportal fistulas are best treated by embolization and that extrahepatic arterioportal fistulas require surgical intervention. The experience with congenital intrahepatic arterioportal fistulas is very limited and has required both embolization and surgical intervention. We report a case of solitary congenital arterioportal fistula successfully treated with coil embolization. Received: 16 May 2000/Accepted: 14 June 2000     

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

BACKGROUNDMost intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children.CASE SUMMARYWe report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula.CONCLUSIONThis was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.     

磁共振成像中表面线圈的应用研究

为进一步提高表面线圈在MR成像中的应用价值，通过对几种不同规格的线圈在标准模型上成像效果的检测，并就如何合理选择表面线圈的有关问题作了初步探讨。认为，不同机型中各类表面线圈均可根据信噪比──深度曲线以及充分权衡线圈大小、受检部位大小和深度三者间关系，制定出一套适合于各自选择表面线圈的应用规范，以确保MR成像质量。     

微小动脉导管未闭的介入治疗

目的本文主要探讨微小动脉导管未闭介入治疗的方法学和即刻及中期随访结果.方法我们应用pfm公司DUCT-OCCLUD弹簧圈为37例PDA患儿作了堵塞术.PDA平均最小直径为1.1±0.2mm(0.5～1.5mm).结果 37例PDA堵塞术均获成功.堵塞后10min行升主动脉造影无一例有残余分流,即刻堵闭率为100%.平均透视时间为22min(7～32min).住院时间为5天.在平均1.3年(1月～2年)随访中,没有溶血、延迟的弹簧圈漂移、PDA再通、血栓栓塞、细菌性心内膜炎发生;也没有左肺动脉狭窄及主动脉狭窄.结论应用DUCT OCCLUD弹簧圈,通过改良的操作方法,可安全有效地治愈微小动脉导管未闭.     

Rupture of pulmonary artery induced by Swan-Ganz catheter: success of coil embolization

A 75-year-old woman suffered severe haemoptysis after insertion of a Swan-Ganz catheter in an intensive care unit. Control of the pulmonary artery haemorrhage was quickly and successfully achieved with stainless steel coils as the embolic material. Received: 28 May 1996 Accepted: 4 October 1996     

血管腔内超声辅助盘圈关闭婴幼儿动脉导管未闭的临床研究

目的 :本研究旨在评价血管腔内超声辅助盘圈关闭婴幼儿动脉导管未闭术的安全性和可行性。方法 :对 9例动脉导管未闭婴幼儿患者在血管腔内超声辅助下进行盘圈关闭术。结果 :所有 9例患者都成功地进行了血管腔内超声检查 ,无一例发生并发症。血管腔内超声显示动脉导管为一单层中等回声的管状结构 ,管壁厚度均匀。血管腔内超声测量的平均动脉导管最小内径为 3.0 8± 0 .71mm。 8例患者的盘圈关闭术成功 ,一例患者因动脉导管直径太大(5 .6 1mm)而未能成功。术后随访未发现残余分流 ,盘圈移位以及主动脉或肺动脉阻塞。结论 :血管腔内超声能够安全有效地评价婴幼儿动脉导管未闭 ,为盘圈关闭术提供了血管造影和超声心动图所不能得到的信息 ,从而帮助选择大小适宜的盘圈 ,减小盘圈栓塞和移位的危险性 ,提高手术的成功率。     

Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization

Objective

Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications.

Method

We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI).

Result

Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk (P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained.

Conclusion

Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.     

Antimicrobial-coated endotracheal tubes: an experimental study

OBJECTIVE: Antibiotic-resistant bacterial biofilm may quickly form on endotracheal tubes (ETTs) and can enter the lungs, potentially causing pneumonia. In an attempt to prevent bacterial colonization, we developed and tested in an in-vitro study and animal study several antibacterial-coated ETTs (silver sulfadiazine with and without carbon in polyurethane, silver sulfadiazine and chlorhexidine with and without carbon in polyurethane, silver-platinum with and without carbon in polyurethane, chlorhexidine in polyurethane, and rose bengal for UV light). DESIGN, SETTING, ANIMALS, INTERVENTIONS: After preliminary studies, silver sulfadiazine in polyurethane (SSD-ETT) was selected among the coatings to be challenged every 24 h with 10(4)-10(6) Pseudomonas aeruginosa/ml and evaluated at 6 h, 24 h, and 72 h with standard microbiological studies, scanning electron microscopy, and confocal scanning microscopy. Subsequently, eight sheep were randomized to receive either a SSD-ETT or a standard ETT (St-ETT). After 24 h of mechanical ventilation, standard microbiological studies were performed together with scanning electron microscopy and confocal microscopy. MEASUREMENTS AND RESULTS: In the in-vitro study SSD-ETT remained bacteria-free for up to 72 h, whereas St-ETT showed heavy P. aeruginosa growth and biofilm formation (p < 0.01). In sheep, the SSD-ETT group showed no bacterial growth in the ETT, ventilator tubing, and lower respiratory tract, while heavy colonization was found in the St-ETT (p < 0.01), ventilator tubing (p=0.03), and lower respiratory tract (p < 0.01). CONCLUSION: This study describes several effective and durable antibacterial coatings for ETTs. Particularly, SSD-ETT showed prevention against P. aeruginosa biofilm formation in a 72-h in-vitro study and lower respiratory tract colonization in sheep mechanically ventilated for 24 h.