CT导引下肝肾囊肿抽吸硬化治疗

目的：总结CT导引下肝肾囊肿穿刺抽吸硬化治疗的疗效和操作经验。材料和方法：肝囊肿11，肾囊肿15例，多囊肾1例，囊肿大小为3．5－12cm，均用15cm长20GGreene针穿刺治疗，抽出囊液量为21－550ml，囊液抽净后注入99．7％的无水酒精。结果：治疗后症状均有明显好转或消失，本组随访肝囊肿7例、肾囊肿11例，疗效指数I级1例（多囊肾），Ⅱ级肝肾囊肿各2例，Ⅲ级肝囊肿5例肾囊肿8例。穿刺操作顺利，无严重并发症发生。结论：CT导引下肝肾囊肿抽吸硬化治疗操作简便、创伤小、疗效高可作为替代外科手术的有效的治疗方法，多囊肾的单纯抽吸治疗可明显减轻症状，改善肾功能，是一种较好的治疗手段。     

CT导引下肝肾囊肿抽液硬化治疗

ＣＴ导引下肝肾囊肿抽液硬化治疗初建国王绍武郎志谨肝囊肿、肾囊肿系一种良性病变。有临床症状的巨大肝、肾囊肿要行手术治疗或反复穿刺引流，患者痛苦大，部分病例效果不理想。我院１９９０－０８～１９９２－０８对有临床症状的肝、肾囊肿８例患者行ＣＴ导引下囊肿穿刺...     

CT引导下肾囊肿穿刺硬化剂治疗的评价

目的 :分析影响CT导引下穿刺硬化剂治疗肾囊肿疗效的因素和预防并发症的方法。方法 :对 96例 13 5个肾囊肿行CT导引下无水乙醇 (纯度 99.7% )硬化治疗 ,囊肿直径 2 .8～ 12 .0cm ,用 2 0G抽吸针穿刺 ,抽液后注入无水乙醇 ,注入量为抽出液的 2 5 .0 %。留置 15min后抽出注入的无水乙醇 ,重新注入少量无水乙醇保留。对于囊液大于 3 0 0ml的囊肿则多次冲洗 ,直至抽出液清亮。结果 :该组随访 5 1例 ,有效率 94.1% ,囊肿消失率 84.3 % ,无严重并发症发生。结论 :CT导引下穿刺硬化剂治疗肾囊肿方法简便 ,疗效好 ,并发症少 ,是一种非常有价值的治疗方法。     

CT导引下穿刺注射无水乙醇治疗肾囊肿

目的　评估CT导引经皮穿刺肾囊肿注射无水乙醇治疗的临床经验。方法　 4 4 5例 5 10个肾囊肿于CT导引下经皮穿刺肾囊肿抽液后注射无水乙醇治疗 ,4 4 5例中 385例为单发肾囊肿 ,5 3例多发肾囊肿 ,7例多囊肾。囊肿直径为 1.9～ 13.5cm。用 18～ 2 1G抽吸针穿刺抽吸 ,抽出囊液量为 3～780ml。注入 99.7%乙醇 ,乙醇量以抽出囊液的 2 5 %为合适。结果　本组 396例 (42 7个囊肿 )用CT扫描或超声检查随访 ,随访时间为 3个月到 1年以上 ,单发肾囊肿疗效为 97% ,其中囊腔消失为 82 % ,多发肾囊肿疗效为 95 % ,其中囊腔消失为 79% ,多囊肾疗效为 6 7%。并发症为局部疼痛 (2 8例 ) ,血尿 (4例 ) ,无严重并发症出现。结论　CT导引经皮穿刺肾囊肿乙醇治疗对单发肾囊肿和多发囊肿是一种有价值的治疗方法     

CT导引下聚桂醇硬化治疗肾囊肿

目的 评价CT导引下聚桂醇硬化治疗肾囊肿的临床效果。方法 回顾性分析2019年1月至2021年12月在上海市第六人民医院东院接受CT导引下肾囊肿穿刺硬化治疗的50例（52枚）肾囊肿患者临床资料。术前完善出凝血功能、肝肾功能及增强CT检查，排除禁忌病例，确定治疗体位和聚桂醇用量。术中使用Bard 18 G活检针穿刺抽液，囊液吸净后用0.9%氯化钠溶液40～100 mL冲洗1～2次，注入聚桂醇泡沫硬化剂（氧气和聚桂醇按1∶1配比）。参照WHO实体瘤疗效评价标准评价硬化治疗效果。结果 所有患者肾囊肿穿刺一次成功。囊肿大小范围为4.3～12 cm，抽出囊液40～900 mL，颜色淡黄或清亮。囊肿内注入聚桂醇泡沫剂15～60 mL。抽吸硬化治疗全程顺利，患者均无并发症发生。术后所有患者临床症状明显好转或消失。术后3、6个月随访显示，总显效率、有效率分别为71.15%、98.07%。结论 CT导引下聚桂醇硬化治疗肾囊肿创伤小、操作简单、费用低、住院时间短、效果显著，可替代外科手术治疗。尤其是对肾上极囊肿硬化治疗，CT导引优于超声导引。     

猪尾引流导管在淋巴管畸形硬化治疗中的应用及疗效分析

目的 探讨猪尾引流导管在大囊型及混合型淋巴管畸形硬化治疗中的应用及疗效.方法 回顾性分析2011年1月至2014年1月确诊并接受猪尾引流导管硬化治疗的26例大囊型及混合型淋巴管畸形患儿临床资料.术前彩色超声、CT或MRI检查结合术中穿刺液检查进一步确诊.全身麻醉后在彩色超声引导下置入猪尾引流导管作引流,每日予平阳霉素溶液作冲洗硬化治疗,拔管前囊腔内保留少量平阳霉素溶液;拔管4周未达到治愈标准者,予平阳霉素局部注射治疗,4周后再评估是否继续注射.结果 26例患儿共置入引流导管26次,冲洗硬化治疗105次.20例患儿经1次置管硬化治疗后达治愈标准,拔管后无需平阳霉素局部注射治疗;2例局部注射1次,2例局部注射2次后达治愈标准;2例局部注射2次后达好转标准.术后随访6～36个月,24例临床症状消除,影像学检查未见瘤体或仅有少量残余硬化病灶,无复发;2例瘤体缩小50％以上,影像学检查仍有少量囊性病灶残余,建议继续随访.本组总治愈率为92.3％,有效率达100％.结论 猪尾引流导管应用于硬化治疗大囊型及混合型淋巴管畸形,具有创伤小、治疗周期短、复发率低及安全有效的特点,值得临床推广应用.     

一次CT导引下置双针穿刺硬化治疗双肾多发肾囊肿的应用体会

目的 探讨一次CT导引下于左右两侧肾区分别置针进行穿刺抽吸、注射硬化剂治疗肾囊肿的应用价值.方法 在一次CT导引下分别于脊柱两侧肾区内确定穿刺点、设计穿刺路径,分别给予交替穿刺、抽吸、冲洗、保留乙醇等治疗步骤,对19例多发肾囊肿进行硬化治疗.结果 通过对19例两侧多发肾囊肿患者同时进行硬化治疗的时间统计,最短延长20 ...     

肝囊肿置管硬化后胆汁性引流液的产生原因与处理

目的 :探讨肝囊肿经皮穿刺置管硬化后出现胆汁性引流液的原因及相关处理。方法 :回顾性分析我院2008年1月至2017年6月行经皮穿刺置管引流无水酒精硬化治疗过程中引流液染有胆汁的肝囊肿患者9例,均行囊腔造影,3例引入留置导管后即抽吸出浅绿色黏液样液体,3例抽净囊液后稍加负压即抽出浅绿色液体,2例注射无水酒精15 min后抽出浅绿色浑浊液体,1例置管后持续抽吸出浅绿色黏性液体。结果:5例改变操作技术(抽吸囊液及注射酒精时轻柔缓慢、勿加压)、3例调整导管位置、1例延长留置导管引流时间(10 d)后,胆汁性引流液消失,继续硬化治疗。结论:肝囊肿穿刺置管后出现胆汁性引流液可能与囊内压改变、囊壁损伤和侧孔位置不当有关,应经导管行囊腔造影,确认无胆管显影,通过消除负压吸引、加压注射,调整导管位置及盘曲张力,延长引流,待引流液胆汁消失变清亮,再继续行囊腔硬化治疗。     

CT介入肾囊肿反复冲洗法硬化治疗

目的　对比CT导引下肾囊肿单次和反复冲洗法硬化治疗的疗效。方法　选 96例单发肾囊肿采用经皮穿刺硬化治疗。其中 45例 (A组 )采用常规单次法 ,即抽出囊液后立即注入 99.7%无水乙醇 ,保留后再抽出。 5 1例 (B组 )采用反复冲洗法 ,反复冲洗至少 1～ 2次 ,保留后再抽出。结果　本组全部经B超或CT随访 ,随访时间为 3～ 6个月 ,A组治疗有效率为 91.1% ,治愈率为62 .2 %。B组治疗有效率为 98.8% ,治愈率为 80 .4%。A、B 2组治愈率对比有差异 (Ρ <0 .0 5 )。结论　CT导引下经皮穿刺抽吸硬化剂治疗肾囊肿具有疗效高、并发症低、创伤小的特点 ,采用反复冲洗法能提高治愈率、降低复发率。     

CT引导下肾囊肿、卵巢囊肿穿刺硬化治疗的临床应用

目的探讨CT引导下肾囊肿、卵巢囊肿穿刺硬化治疗的临床应用价值。方法在CT引导下经皮穿刺肾囊肿、卵巢囊肿,根据预定方案针尖位于最佳位置后,开始抽吸囊液,抽尽囊液后,按抽出量的25%注入无水乙醇3~5 m in后再抽取囊液,重复此操作3~4次,据囊肿大小注入3~15 m l无水乙醇保留于囊腔,拔针,CT扫描穿刺部位观察有无特殊改变,术后嘱患者辗转体位3~5次使无水乙醇充分接触囊壁。结果32例患者手术后,30例完全消失,2例缩小达85%,有效率100%。结论CT引导下肾囊肿、卵巢囊肿穿刺硬化剂治疗方法简便、创伤小、痛苦小、恢复快、费用低、疗效高、并发症少,是一种非常有价值的治疗方法。     

Percutaneous treatment of simple renal cysts with sclerotherapy and extended drainage

PURPOSE: To present the long-term results of sclerotherapy of symptomatic simple renal cysts with alcohol and aethoxysclerol followed by protracted seven-day drainage and to compare the efficacy of the two sclerosing agents used in the therapy. MATERIALS AND METHODS: Sixty-six symptomatic patients underwent percutaneous treatment with drainage and sclerotherapy of 72 simple renal cysts in a day hospital setting. The cysts were divided into two groups according to size (Group I and Group II with cyst volume smaller or larger than 600 ml respectively) for a better comparison of the results. The cysts were punctured directly under local anaesthesia with a 7 French Trocar catheter using the 'one-shot' technique and ultrasound guidance; a pig tail catheter was then left in the cyst for the complete evacuation of the cyst fluid. Sclerotherapy was performed by injection of 95% alcohol or 3% aethoxysclerol for 40 minutes, followed by seven-day drainage. On the basis of dimensional criteria, response to treatment was defined as: recovery, partial recurrence or recurrence. RESULTS: The procedure was successful in 97.2% of the cases with regard to cyst drainage, with clinical recovery in 95.3% of the cases. Group I had 14 recoveries and no complete recurrence after either alcohol or aethoxysclerol, 2 partial recurrences with alcohol and 4 partial recurrences with aethoxysclerol; Group II had 15 recoveries, 14 partial recurrences and one complete recurrence with alcohol, and 5 recoveries, 8 partial recurrences and 2 complete recurrences with aethoxysclerol. CONCLUSIONS: The one-shot technique under ultrasound guidance prevents the risk of major complications, reduces the likelihood of failure and is inexpensive; furthermore, it significantly reduces procedure time and is better tolerated by patients. On the basis of the clinical and dimensional results obtained, percutaneous sclerotherapy of renal cysts can be recommended as the treatment of choice and as a valid alternative to laparoscopy. As for the comparison between the two sclerosing agents, alcohol has a higher cost and negative side effects, but is more effective for the treatment of larger cysts. Aethoxysclerol is less expensive and has no side effects, but tends to lead to septic complications. On the basis of our experience, we therefore recommend the use of aethoxysclerol for sclerotherapy of smaller cysts followed by a 4-day drainage. For larger cysts, we recommend repeated alcoholization and the removal of the drainage catheter after seven days.     

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.     

Percutaneous sclerotherapy of a giant benign renal cyst with alcohol.

We report a case of giant, benign renal cyst that was treated with percutaneous aspiration and sclerotherapy using 95% alcohol. A seven French catheter was inserted into the cyst under ultrasonographic and fluoroscopic guidance, and was then left in place to drain the cyst contents. Approximately 4 l of fluid was drained the first day. The following day, a gravity sinogram was obtained, which showed there were no connections between the cyst and the collecting system. The alcohol treatment involved repeated injections of decreasing amounts of alcohol, with volumes selected in accordance with follow-up sinograms. The patient's symptoms resolved and cyst drainage stopped after 3 successive days of therapy. Totally 600 ml alcohol has given. Follow-up ultrasound (US) and computed tomography (CT) studies showed no recurrent disease; with only a small remnant of the cyst wall. We encountered no major complications during follow-up.     

经皮插管硬化治疗卵巢囊肿

目的 探讨经皮穿刺插管硬化治疗卵巢囊肿的临床价值。方法 在CT引导下经皮穿刺卵巢囊肿,在同轴套管针内插入4F多侧孔猪尾巴导管,用无水乙醇硬化治疗64例76个卵巢囊肿。其中单纯性囊肿48个、巧克力囊肿28个。结果 64例卵巢囊肿穿刺成功率100％,58例（占90、6％）治愈,6例（占9、4％）疗效显著,总有效率为100％,未发生严重并发症。结论 穿刺插管法硬化治疗卵巢囊肿是硬化彻底、安全实用、疗效可靠的方法。     

One-year Results of Single-session Sclerotherapy with Bleomycin in Simple Renal Cysts

PurposeTo evaluate the efficacy and safety of single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy for the treatment of simple renal cysts.Materials and MethodsA total of 66 renal cysts in 53 patients were treated by single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy under computed tomography (CT) guidance. Symptomatic (n = 31) and asymptomatic cysts (n = 22) with maximum diameters greater than 5 cm were treated. As much liquid content of each cyst was aspirated as possible, and bleomycin was injected and remained in the cyst. Follow-up was performed with ultrasonography or CT every 3 months until 1 year, and cyst volume was calculated before and after sclerotherapy. Therapeutic response was assessed by cyst volume reduction rate (VRR) and classified as complete regression (CR; ie, invisible), near-CR (ie, VRR>85%), partial regression (PR; ie, VRR of 50%–85%), or no response (NR; ie, VRR<50%). Medical records were reviewed to analyze complications.ResultsCysts refilled partially in the initial stage after sclerotherapy and decreased gradually in size over the entire follow-up period. At 1-year follow-up, the overall response rate was 98.5% (65 of 66), with CR in 31 cysts (47.0%), near-CR in 24 cysts (36.4%), PR in 10 cysts (15.1%), and NR in one cyst (1.5%). No major complications were encountered.ConclusionsSingle-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy is a simple, safe, effective, well tolerated alternative technique for management of simple renal cysts.     

Acetic acid as a sclerosing agent for renal cysts: Comparison with ethanol in follow-up results

Purpose: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing agents. Methods: Eighty-one patients underwent sclerotherapy and 58 patients, 23 males, 35 females, aged 6–76 years, having a total of 60 cysts, were included in this study; the others were lost to follow-up. The renal cysts were diagnosed by sonography, computed tomography (CT), or magnetic resonance imaging (MRI). Sclerotherapy was performed using 50% acetic acid for 32 cysts in 31 patients and 99% ethanol for 28 cysts in 27 patients. Under fluoroscopic guidance, cystic fluid was aspirated as completely as possible. After instillation of a sclerosing agent corresponding to 11.7%–25% (4–100 ml) of the aspirated volume, the patient changed position for 20 min and then the agent was removed. Patients were followed up by sonography for a period of 1–49 months. The volume of the renal cyst after sclerotherapy was compared with that of the renal cyst calculated before sclerotherapy. Medical records were reviewed to analyze complications. Results: The mean volume after sclerotherapy of the 17 cysts followed for 3–4 months in the acetic acid group was 5.1% of the initial volume, and for the 14 cysts in the ethanol group it was 10.2%. Complete regression during follow-up was shown in 21 cysts (66%) in the acetic acid group; the mean volume of these cysts before the procedure was 245 ml. The mean volume of the nine (32%) completely regressed cysts in the ethanol group was 184 ml. Mild flank pain, which occurred in three patients in each group, was the only complication and resolved the next day. Conclusion: Acetic acid was an effective and safe sclerosing agent for renal cysts, tending to induce faster and more complete regression than ethanol.     

Sclerotherapy of renal cysts using acetic acid: a comparison with ethanol sclerotherapy

This study compared percutaneous sclerotherapy using 50% acetic acid with that using 99% ethanol for patients with simple renal cysts. The study included 72 simple renal cysts in 64 patients (male/female ratio = 31/33; age range, 31-75 years). Under fluoroscopic guidance, the cyst fluid was aspirated completely. Sclerotherapy was then performed using 50% acetic acid for 32 cysts and 99% ethanol for 40 cysts. The volumes of each renal cyst before and after sclerotherapy were compared using ultrasonography or CT. Medical records were reviewed to analyse any complications. The mean follow-up period was 21.5 months (range, 3-75 months). The mean remnant volume of the cyst after sclerotherapy was 2.6% of the initial volume in the acetic acid group and 14.0% in the ethanol group. The rates of complete remission, partial remission and treatment failure were 90.6%, 9.4% and 0%, respectively, in the acetic acid group, and 60.0%, 30.0% and 10.0%, respectively, in the ethanol group. There were no complications related to sclerotherapy in either group. In conclusion, acetic acid is a safe and effective sclerosing agent, with clinical results superior to those of ethanol, and is an alternative to ethanol for sclerotherapy of renal cysts.     

Sclerotherapy for Simple Cysts with Use of Ethanolamine Oleate: Preliminary Experience

We evaluated the efficacy of ethanolamine oleate (EO) as a sclerosing agent for a symptomatic hepatic or renal cyst. Seven patients with symptomatic hepatic (n = 3) or renal cysts (n = 4) were treated by sclerotherapy with EO. The cyst size in the greater diameter ranged from 6 to 13 cm. The cyst was punctured under ultrasound guidance, and after all of the cyst’s content was aspirated, an iodized contrast agent was injected to check the absence of communication between the cyst and biliary tree, urinary tract, or vessels. Then, the solution of ethanolamine oleate–iopamidol mixture (EOI) of 10% of the volume of the cyst’s content was injected via catheter. After 30 min, the injected EOI was aspirated completely before catheter removal. A follow-up computed tomography scan was performed at 1 and 3 months after treatment. The volume of the cyst and its reduction rate was calculated. In addition, symptoms and complications were assessed. The volume of the cyst ranged from 64 to 636 ml (mean: 328 ml) before treatment. Three months after treatment, it ranged from 2 to 50 ml (mean: 15ml) and the reduction rate of the cyst’s volume was more than 90% on average. Symptoms caused by the cyst disappeared in all cases and no major complication was encountered. Although two patients had a low-grade fever after sclerotherapy, it was easily controlled. It is suggested that the sclerotherapy with EO might be a safe, effective, well-tolerated treatment for symptomatic hepatic or renal cysts.     

DSA引导下注射高渗葡萄糖及无水乙醇对巨大肝囊肿硬化治疗效果的对照分析

目的 探讨DSA引导下经皮穿刺分别注射高渗葡萄糖及无水乙醇置管引流治疗巨大肝囊肿的3、6和12个月疗效比较.方法 回顾性选择临床资料完整的73例单纯性肝囊肿患者行对照研究,其中27例行高渗葡萄糖硬化治疗(A组),46例行无水乙醇硬化治疗(B组)为对照组.囊肿直径8.3 ～ 15.8 cm.所有病灶均在DSA引导下进行肝囊肿穿刺抽液,置管引流硬化治疗;术后3、6和12个月比较其疗效.结果 73例患者全部顺利完成治疗,肝囊肿穿刺成功率100%,两组3、6和12个月疗效差异无显著性,P值分别为0.526、0.713、0.613(P均＞ 0.05).结论 DSA引导下经皮穿刺置管引流后注射高渗葡萄糖或无水乙醇硬化治疗肝囊肿在3、6和12个月疗效上无明显差异,其中,高渗葡萄糖硬化术后不适症状少,更适合体弱的中老年患者.     

CT引导下介入治疗肾囊肿的临床应用

目的探讨CT引导下穿刺硬化剂治疗肾囊肿的方法及疗效。方法经B超或CT诊断的78例84个肾囊肿在CT定位下经皮穿刺抽吸,行无水乙醇反复冲洗法硬化剂治疗,用18~22 G穿刺针抽吸,注入99.7%无水乙醇,注射量为抽出囊液量的25%~30%。术后每隔3个月复查,随访其疗效。结果其中79个囊肿一次穿刺成功,随访3个月~1年,复查见51例54个囊肿消失,22例24个囊肿缩小,4例4个囊肿未见缩小。有效率95.2%,消失率64.2%,无严重并发症。结论CT引导下经皮穿刺硬化剂治疗肾囊肿是一种安全、有效的治疗方法,具有较高的临床实用价值。