B超引导下注射无水乙醇治疗肝肾囊肿

Ｂ超引导下注射无水乙醇治疗肝肾囊肿温州市第二人民医院Ｂ超室（３２５０００）金丽珍，陈利明我院自１９９１年１０月开始，用硬化剂无水乙醇治疗肝、肾囊肿１９例２４只囊肿，取得了良好效果，现报告如下：临床资料１病例：本组１９例２４只囊肿，肝囊肿７例８只囊肿，...     

超声引导经皮肝穿刺抽液加注射高聚生治疗非寄生虫性肝囊肿的临床观察

自1998年6月～2002年12月，我科采用超声引导下经皮肝囊肿穿刺抽液、囊腔内注入高聚生治疗非寄生虫性肝囊肿32例，取得较好的疗效，现报告如下。     

超声引导介入治疗肝包虫囊肿

外科手术一直是治疗肝囊型包虫病的主要方法〔1〕,其疗效肯定 ,治愈率高〔2～ 5〕,但也存在诸多问题 ,如创伤大、再次手术困难等。近 1 0多年来 ,苯丙咪唑类药物越来越多地应用于临床 ,但由于其吸收差、代谢快 ,血药、肝药及病灶内药物浓度低 ,实际治疗效果并不理想 ,治愈率仅为 30 %左右〔1 ,6〕。 2 0世纪80年代以来 ,随着医学影像学特别是介入治疗的迅速发展 ,人们开始尝试肝囊型包虫病的穿刺治疗〔7～ 9〕。 1 985年Ｍｕｅｌｌｅｒ等〔7〕首次穿刺治疗人类肝囊型包虫病获得成功 ,到目前为止 ,全球穿刺治疗的病例数已逾 2 0 0 0例〔1 0～…     

3D(4D)超声成像技术在肝肾囊肿介入穿刺中的临床应用

目的评价3D（4D）超声成像技术在肝肾囊肿介入穿刺中的临床应用价值。方法分别用动态三维成像（即4D超声成像）、实时动态三维成像（即实时4D冠状面成像）和静态三维成像的条件进行肝肾囊肿的引导穿刺过程。结果①4D超声成像无法达到实时状态,显示的图像落后于针道的步进,图像平均采集时间较长。实时动态4D冠状面成像,引导穿刺过程效果最佳,能达到实时状态;②穿刺针在4D冠状面图像和融合平面上比正常情况要厚一些,这一现象增加了针在穿刺过程中的可视性;③静态3D只能穿刺结束后评价针的最终位置而不能引导穿刺的过程;④实时4D的最佳成像模式为表面质地模式50%和透明最大模式50%混合,动态4D以多平面成像和表面模式成像引导穿刺过程为最佳。结论3D（4D）超声成像技术为超声引导穿刺过程开辟了一条新的途径。     

超声引导穿刺抽液治疗脓肿期浆细胞性乳腺炎的疗效分析

目的 探讨和分析超声引导穿刺抽液治疗脓肿期浆细胞性乳腺炎的临床疗效。方法 选取本院确诊为浆细胞性乳腺炎的患者61例的临床资料,其中对照组31例行负压封闭引流术治疗,实验组30例行超声引导穿刺抽液治疗,观察比较两组患者的手术指标、疼痛情况、术后乳房外观满意度及临床疗效。结果 实验组患者的手术时间、住院时间、术中出血量和切口愈合时间均低于对照组,差异具备统计学意义,P<0.05。实验组和对照组疼痛情况在术前VAS评分和术后1 dVS评分比较差异无统计学意义,P>0.05;而术后7 d的VSA评分比较,发现实验组显著低于对照组,且差异存在统计学意义,P<0.05。在乳房美观上实验组患者的满意度显著高于对照组,差异具备统计学意义,P<0.05。两组患者的临床疗效比较差异不显著,P>0.05。结论 超声引导穿刺抽液治疗脓肿期浆细胞性乳腺炎能够达到和封闭引流术一样的临床疗效,但其可以减少手术相关损伤,减少术后疼痛,且术后更美观。     

超声引导下穿刺抽脓及药物联合治疗小儿细菌性肝脓肿

本文报道采用超声引导、肝脓肿穿刺或置管引流、全身及局部药物联合治疗小儿细菌性肝脓肿１４例，其中１次穿刺治疗１１例，２例置管引流，总有效率９２．９％，未出现严重并发症．我们认为，本法具有操作简单、并发症少、住院时间短、疗效确实可靠的优点，是一种安全可行的治疗方法．     

超声引导下穿刺抽脓及药物联合治疗小儿细胞性肝脓肿

本文报道采用超声引导、肝脓肿穿刺或置管引流，全身及局部药物联合治疗小儿细菌性肝脓肿１４例，其中１次穿刺治疗１１例，２例置管引流，总有９２．９％，未出现严重并发症，我们认为，本法具有操作简单，并发症少、住院时间短，疗效确定可靠的优点，是一种安全可行的治疗方法。     

超声引导下微创治疗乳腺单纯性囊肿的临床研究

目的探讨三苯氧胺联合超声引导穿刺注入无水乙醇治疗乳腺单纯性囊肿的临床价值。方法将经超声诊断为乳腺单纯性囊肿的患者随机分为2组,观察组采用超声引导穿刺抽液后囊腔注入无水乙醇,对照组采用超声引导穿刺抽液。抽液后均服用三苯氧胺并随访,观察治疗效果。结果观察组总有效率98.18%,对照组总有效率77.89%,差异有统计学意义(P<0.05)。结论三苯氧胺联合超声引导穿刺注入无水乙醇治疗乳腺单纯性囊肿,疗效确切,具有微创、定位准确、复发率低、费用少、不良反应轻微等优点,值得临床推广应用。     

超声引导下穿刺注入50%葡萄糖治疗肝肾单纯性囊肿

目的探讨超声引导下经皮穿刺使用不同方法注入高渗葡萄糖治疗肝肾囊肿的疗效的可靠性。方法回顾性分析于我院接受超声引导下肝肾囊肿高渗葡萄糖（50％葡萄糖）注入治疗的53例患者（54个囊肿）的资料,根据注入高渗葡萄糖的不同方法进行分组,其中I组24例24个囊肿,使用传统的方法注入高渗葡萄糖进行囊肿治疗,即抽出囊液后注入的葡萄糖的量为抽出囊液量的1／3,Ⅱ组29例30个囊肿,使用改良的高渗葡萄糖注入法,一次或多次注入高渗葡萄糖,使囊肿内葡萄糖的浓度尽量达到50％的高渗环境,并对两组疗效进行对比分析。对所有患者随访6个月及12个月。结果53例均为一次穿刺治疗成功。6个月时I组、Ⅱ组有效率分别为75．00％（18／24）和86．67％（26／30）,全部治疗总有效率为81．48％（44／54）;12个月时I组、Ⅱ组有效率分别为58．33％（14／24）和76．67％（23／30）,全部治疗总有效率为68．52％（37／54）。两组患者治疗前的囊肿平均直径和容积差异均无统计学意义,但6个月与12个月的治疗有效率差异均有统计学意义（P均do．05）。结论超声引导下经皮穿刺注入高渗葡萄糖治疗肝肾囊肿时,提高囊内葡萄糖的浓度是保证疗效的关键;且此方法操作简便,安全,尤其适宜老年患者。     

超声引导下介入治疗卵巢巧克力囊肿疗效观察

在妇科疾病中．超声介入治疗越来越受到重视及推广。本院从2000年6月至2004年12月．应用介入性超声技术对41例卵巢巧克力囊肿经阴道超声下囊肿穿刺抽液．并注入99．9％乙醇固定术治疗。术后随访．疗效确定，现将结果总结报告如下。     

腹腔镜下肝肾囊肿开窗去顶术的临床应用

目的:探讨腹腔镜治疗肝肾囊肿的方法和效果。方法: 1994至2004年于腹腔镜下为68例肝肾囊肿患者行开窗去顶术,其中肝囊肿56例,肾囊肿12例,并注入无水酒精灌洗残留粘膜。结果: 68例手术全部成功,无中转开腹。手术时间30~70min,随访时间6个月~10年, 1例复发。结论:腹腔镜治疗肝肾囊肿安全可行,在严格掌握适应证的条件下值得推广应用。     

Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

OBJECTIVE: To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts. PATIENTS AND METHODS: Sixty patients with 64 symptomatic simple renal cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of 95% ethanol (31 men and 29 women, mean age 46 years, SD 22). The main presentation was renal pain in 34 patients, renal mass in nine, hypertension in 11 and haematuria in six; 24 cysts were on the right, 32 on the left and four bilateral. Patients were evaluated after 1 month and then every 6 months by clinical assessment, US and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume with the resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume and/or persistent symptoms. RESULTS: After aspiration and ethanol sclerotherapy, there was microscopic haematuria in two patients and low-grade fever (<38.3 degrees C) in two, but no major complications. During a mean (range) follow-up of 19 (14-40) months there was complete cyst ablation in 54 cysts and partial resolution in 10. Pain disappeared or was much improved in all patients. After cyst ablation hypertension was well controlled with no medication in all 11 hypertensive patients and haematuria disappeared in all six affected patients. CONCLUSIONS: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive and highly effective. We recommend it as the first therapeutic option in these patients.     

腹腔镜胆囊切除联合肝肾囊肿手术的应用

目的 :探讨腹腔镜胆囊切除 (LC)联合肝囊肿或肾囊肿部分切除减压术的疗效及适用性。方法 :回顾分析 15例LC联合肝囊肿或肾囊肿部分切除减压术的临床资料。结果 :15例LC联合肝、肾囊肿手术均获成功。手术时间 6 0～ 12 0min ,术后未发生严重并发症 ,康复顺利 ,平均住院 3～ 5d。随访 2～ 10月无复发。结论 :LC联合肝囊肿或肾囊肿部分切除减压术疗效肯定 ,操作方便 ,术中视野显露良好 ,患者创伤小 ,康复快 ,术后住院时间短 ,是兼患肝或肾囊肿的胆囊疾病患者最佳的手术方法     

Simple renal cysts in children

Although renal cysts occur in children less frequently than adults, they are not as rare as once believed. Eight children with simple renal cysts are reviewed. The diagnostic and radiographic studies in each patient showed characteristic findings. A nonoperative diagnosis of simple renal cyst in a child usually can be made with confidence and surgical confirmation is not necessary.     

Hyaluronidase aspiration vs surgical excision of ganglion cysts: a randomized controlled trial

Surgical treatment of a ganglion cyst is commonly performed but excision is associated with high recurrence rates. Some authors have reported alternative, less invasive treatment regimens such as aspiration using dissolving substances. The aim of this prospective randomized controlled trial was to investigate whether injecting ganglion cysts with hyaluronidase followed by aspiration was as effective as surgical excision. In one group of patients, 150 units of hyaluronidase (HD) were injected in each ganglion cyst by a 15 gauge needle followed by a 15 min equilibration period. The contents were then aspirated with constant suction by a 20 ml syringe. In the surgical group, the ganglion cyst was dissected down its neck and excised under local anesthetics. Pain sensation was evaluated by a visual analogue scale (VAS) at various time points. A total of 38 patients were enrolled in the study. However, only 32 patients were available for analysis (HD group: 20. surgery: 12). Seventeen of the 20 patients treated with HD demonstrated recurrent disease during follow-up. In contrast, following excision only 3 out of 12 patients demonstrated recurrent disease (p<0.05). Pain during motion following surgical excision was not reduced postoperatively compared to preoperative values. HD-assisted aspiration of ganglion cysts is not effective. Surgical excision is fairly successful although some degree of pain usually persists. An observation period is indicated prior to invasive treatment since a portion of ganglion cysts resolve spontaneously.     

肝囊肿腹腔镜开窗引流术后复发原因的探讨

目的探讨肝囊肿腹腔镜开窗引流术后复发的原因. 方法回顾性总结1998年6月～2003年8月54例肝囊肿腹腔镜下开窗引流术的临床资料. 结果 52例随访1～6年,5例复发,复发率9.6%(5/52).3例由于囊肿位置特殊开窗过小,1例由于多发囊肿之间的透明隔未予切开,1例系多囊肝术后复发. 结论适应证选择不当、囊肿开窗过小、遗漏多发囊肿以及黏膜处理不当是导致复发的主要原因.     

On the pathogenesis of simple renal cysts in the adult

Summary The simple cyst in the adult seems to be mainly an acquired disorder. Microdissection of the nephron in the adult kidney points to the presence of diverticula on the distal tubule as the starting point of the affection. A degree of obstruction in the urinary tract together with normal involutional phenomena of the basal membrane, both typical of the aging process, are believed to be precipitating factors.     

Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts

Objective: To assess the effectiveness and long-term results of two repeated ethanol injections in the treatment of symptomatic renal cysts. Methods: Sixty-eight patients 47to 75 years old with 77 large (6.3–14.8 cm; mean 8.62 cm)symptomatic cysts were included in this study. Of the 68patients, in 4 cases there were renal cysts associated with renal calculi. An 8FR Pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of cystic fluid. Two repeated ethanol 95% injections were performed every 24 hours. Patients were followed-up by ultrasonography for a period of 12–48 months (mean 30). Results: In two patients the cyst puncture was not feasible because of poor visualization of puncture site while in one patient there was communication of cystic cavity with the pelvocaliceal system. In these patients surgical resection of cysts was performed. Complete and partial regression rates were 57/68 (83.82%) and 8/68 (11.76%)respectively. In four patients with renal stones and renal cysts, extracorporeal shock wave lithotripsy (ESWL) was successfully executed 1 month after sclerotherapy. Conclusion: Our results suggest that percutaneous aspiration followed by two repeated ethanol injections is highly effective on reducing recurrence of simple renal cysts. This revised version was published online in September 2006 with corrections to the Cover Date.     

SonixGPS影像穿刺定位系统在经皮肾镜取石术中应用的早期经验

目的 探讨SonixGPS影像穿刺定位系统在PCNL中应用的可行性及安全性.方法 选取2012年5月上尿路结石患者15例,男8例,女7例.年龄33 ～ 72岁,平均43岁.患者术前均行KUB、彩色多普勒超声、CT和(或)IVU等检查.其中11例伴有不同程度的肾积水;合并尿路感染4例,术前给予积极抗炎治疗;孤立肾2例.肾多发性结石7例,鹿角形结石3例,输尿管上段结石3例,肾结石合并输尿管上段结石2例.手术均采用全麻,取俯卧位,在SonixGPS影像穿刺定位系统的引导下,采用系统自带的16G穿刺针穿刺目标肾盏并扩张建立24 F标准皮肾通道,置入肾镜后应用EMS第四代气压弹道联合超声碎石清石系统进行碎石并吸出体外.结果 本组15例均一次穿刺成功并行一期碎石,手术时间30～ 115 min,平均45 min,经皮肾穿刺时间2～ 10 min,平均4 min.术中术后未出现大出血、肠道损伤、气胸等并发症.术后复查KUB,一期清石率为93％ (14/15),1例有残余结石患者行ESWL治疗效果良好.结论 SonixGPS影像穿刺定位系统在PCNL穿刺前可预判和设计穿刺路径及角度,穿刺中可精准地看到穿刺针在组织中的穿刺轨迹,实时记录针尖位置,及时调整穿刺针的角度与深度,缩短了经皮肾穿刺技术的学习曲线.     

Fine needle aspiration in the management of benign thyroid cysts

Background: Resolution of cystic thyroid lesions after aspiration occurs in 8?45% of cases, the remainder require treatment for residual tumour or recurrent cysts. The aim of this study was to identify patient characteristics that predict cyst recurrence to enable these patients to undergo early surgery. Methods: A retrospective analysis of 123 patients with benign thyroid cysts that were suitable for conservative management was undertaken. Demographic, clinical, ultrasound and fine needle aspiration cytology data were collated for patients who underwent surgery or were managed conservatively. Univariate and multivariate analyses were performed to identify factors predictive of cyst recurrence. Results: Of the 123 patients, 43 underwent surgery consequent on cyst recurrence or persistent symptoms after aspiration, and 80 were treated by aspiration alone. There were 17 males and 106 females, of mean age 45.5 years. The mean cyst size was 27 mm. Those undergoing surgery had a significantly greater mean cyst size (P = 0.001). The only factor predicting cyst recurrence on univariate analysis was absence of follicular cells on initial aspiration (P = 0.005). Multivariate analysis confirmed absence of follicular cells as an independent characteristic predicting recurrence, the odds ratios for recurrence was 3.18 (95%CI 1.39?7.29). Conclusion: The present study suggests consideration of early surgery for patients with thyroid cysts with absence of follicular cells on initial cytology.