心包穿刺留置导管术首选穿刺部位的探讨

心包穿刺部位有8处之多,但多主张首选剑突下,但其是否应作为心包穿刺留置导管的首选穿刺部位,我们进行了探讨,现报道如下。对象与方法1.对象:1999年1月~2005年12月我院因心包积液住院者86例,男63例,女23例,年龄34~74岁,平均年龄52.15岁±15.35岁。按穿刺点不同分组:胸骨左缘第3     

超声心动图引导心包穿刺导管留置及穿刺点选择

心包穿刺的部位有 8处之多 ,最常用部位多认为是剑突与左肋弓缘交界处 ,其次为左第 5肋间心浊音界内侧 1～ 2ｃｍ处〔1〕。根据我院 1 995年 1 0月～ 2 0 0 1年 6月 ,对 47例心包积液患者在二维超声心动图 (2 ＤＥ)引导下 ,行心包穿刺留置导管的临床实践及体会认为 :选用胸骨左缘第 3、4肋间 ,经2 ＤＥ定位 ,积液量最多 ,距胸壁距离最近处为穿刺点 ,具有更多的优越性 ,报告如下。1 　 对象与方法1 .1 　 对象经 2 ＤＥ检查确诊的心包积液患者 47例 ,在 2 ＤＥ引导下行心包穿刺留置导管术时 ,选用剑突与左肋弓缘交界处为穿刺点的有 1 2例…     

心电图监测下心包腔内留置导管的临床应用

目的　本文对 12例心包积液合并心包填塞者 ,施行床边非X线透视指导下经皮心包穿刺置管引流 ,以缓解心包填塞症状。方法　心电图监测指导操作过程。结果　 12例留置导管均获成功。平均操作时间 (9 6±3 5 )min ,导管留置心包腔内深度为 (5 6± 1 5 )cm ,导管保留时间为 (8 7± 2 4 )d。对提高操作成功率、防止并发症及操作适应症 ,进行了讨论     

经皮穿刺留置中心静脉导管引流治疗自发性气胸31例报告

2003年4月-2006年4月,我们采用经皮穿刺胸腔留置单腔中心静脉导管引流治疗自发性气胸31例,疗效颇佳。现报告如下。     

经皮肝穿刺门静脉灌注TNF治疗肝癌门静脉癌栓的临床意义

肝癌预后的主要影响因素有：根治性切除、肿瘤大小、门静脉癌栓(PVTT)、肝功能等。PVTT是原发性肝细胞癌(HCC)的重要生物学特性，其发生率可高达50％～90％，常引起肝内广泛转移或／和加重门静脉高压导致急性上消化道出血等严重后果，已成为目前临床治疗的一个主要难点。针对这个问题，我们2002-08／2004-10采用B超引导下经皮肝穿刺门静脉灌注肿瘤坏死因子(TNF)治疗PVTT研究，取得了满意效果。现总结报告如下。     

超声引导经皮穿刺胆管引流术的临床应用

目的 探讨超声引导下经皮经肝穿刺胆管引流术(PTCD)的临床应用价值。方法 1995-05/2003-05在我院就诊的梗阻性黄疸32例，在超声引导下经皮经肝穿刺胆管置管引流。结果 超声引导下经皮经肝穿刺胆管1次性成功率为78．1％(25／32)2次性成功率为93．7％，3次性成功率为96．9％。PTCD置管成功为27例，置管成功率为84．4％，仅1例出现并发症，术后出血，经充分引流，使用止血药物后消失。结论 超声引导下经皮经肝穿刺引流术胆管准确率高、成功率高、是一种准确、安全、有效、简便治疗的方法，对解除梗阻性黄疸有较高价值。     

血透患者锁骨下静脉穿刺留置导管异位经验总结

以往的研究报道了各种深静脉穿刺留置导管的优缺点及常见的并发症，临床工作中作发现发生锁骨下静脉穿刺留置导管异位的并不少见，现将解放军总医院第一附属医院2002--2004年346例锁骨下静脉穿刺的病例资料总结如下。     

经皮穿刺留置中心静脉导管治疗顽固性胸腔积液36例

自2000年4月以来．我们采用经皮穿刺留置单腔中心静脉导管间断引流的方法治疗顽固性胸腔积液36例，取得满意效果。现报告如下。     

超声引导下经皮穿刺治疗肝囊肿

目的探讨超声引导下经皮穿刺治疗肝囊肿治疗方法及疗效。方法在B超引导下对19例肝囊肿患者经皮穿刺抽出囊液后注入无水酒精,其中2例囊内感染者在冲洗后注入庆大霉素8万单位,并静脉应用抗感染治疗。结果19例患者20个囊腔,在治疗后随访6个月~10年。结果疗效指数无0级病例,Ⅰ级为1个囊肿,Ⅱ级为9个囊肿,Ⅲ级为12个囊肿,其中囊腔消失5个。有1例多囊肝和3例患者进行了第2次治疗。出现黄疸及肝功能明显异常2例,均在治疗后很快恢复正常。1例出现术后明显的腹痛。结论超声引导下经皮穿刺治疗肝囊肿是一种相对安全、有效的方法。     

经皮穿刺留置中心静脉导管治疗恶性胸腔积液

目的介绍一种简单、安全、有效的治疗恶性胸腔积液的方法。方法本组共46例，其中肺癌30例，乳腺癌7例，食管癌5例，肠癌4例。所有患者胸腔积液中均找到恶性细胞。经皮穿刺留置中心静脉导管（ARROW）管行胸腔积液引流术。结果46例患者中，CR22例（47．8％），PR17例（37．0％），NC7例（15．2％），总有效率为84．8％。3例出现导管堵塞，经处理后再通。出现发热35例，胸痛24例，经对症处理后恢复，无一例导管脱滑，元气胸、肺水肿的发生。结论经皮穿刺留置ARROW管行胸腔积液外引流，是简单、方便、经济的治疗方法，能改善恶性肿瘤患者的生活质量，适用于各级医院推广应用。     

经皮经肝介入门静脉血栓溶栓治疗

目的评价经皮经肝门静脉穿刺置管介入溶栓术的安全性和疗效。方法3例患者中,男性2例,女性1例,年龄分别为56岁,62岁,70岁。肝炎肝硬化2例,1例腹痛原因待查(后经手术证实为肠间脓肿)。3例患者均经彩色多普勒和CT检查发现门静脉血栓。3例患者均在B超引导下进行经皮经肝门静脉穿刺,置入5F CobraⅠ型导丝及导管鞘,经导管输注20万单位尿激酶后,继以每日30万单位持续注入,连续3天~5天行溶栓治疗,术后抗凝治疗。结果3例患者经皮经肝门静脉穿刺均一次成功,在置管造影及溶栓过程中均无不良反应;拔管前复查造影显示2例患者门静脉100%再通,1例80%再通;3例患者治疗后临床症状好转,腹水消退,肝功能改善,其中2例肝硬化患者食管静脉曲张程度减轻。1例腹痛原因待查患者溶栓后腹痛减轻但未完全缓解,体温较前下降但未正常,于溶栓后2周行剖腹探查,术中证实右下腹肠间包裹性脓肿,行脓肿切开引流,脓液培养为大肠杆菌,继续抗炎治疗2周后,体温降至正常,腹痛完全缓解。结论经皮经肝门静脉穿刺置管介入溶栓术是治疗门静脉血栓的安全、有效方法。     

肝硬化门静脉血栓形成的临床分析

目的　探讨肝硬化 (LC)门静脉血栓 (PVT)形成对LC病程发展的影响。方法　检索我院自 1 995至 2 0 0 2年肝硬化PVT形成患者 ,血栓诊断依据彩色多普勒和 (或 )CT。 4 8例肝硬化PVT形成患者入选血栓组 ;同阶段LC门脉高压症的非血栓病例中选择 5 2例作为对照组。对两组患者的肝功能Child Pugh分级、凝血功能、门静脉、脾静脉宽度及脾脏面积、厚度进行比较。行t检验 ,χ2 检验 ,Logistic回归分析。结果　肝硬化PVT形成除继发于脾切除等手术后 ,75 .0 %隐匿发病 ,85 .4 %的血栓发生于门静脉主干 ,脾脏增大与门静脉增宽是PVT形成的危险因素 (P =0 .0 0 3、0 .0 1 0 )。血栓组门静脉及脾静脉宽度分别为 (1 .4 8± 0 .2 6 )cm ,(1 .2 3± 0 .38)cm ,与对照组比较差异有显著性 [(1 .37± 0 .2 2 )cm ,(1 .0 5± 0 .30 )cm ,P =0 .0 37,0 .0 31 ]。血栓组脾面积平均值为 (96 .6 4± 33.4 )cm2 ,脾厚径为 (6 .0 7± 1 .2 0 )cm ,分别大于对照组的 (80 .81± 2 8.9)cm2 ,(5 .2 3± 1 .0 8)cm(P =0 .0 36 ,0 .0 0 1 )。血栓组食管胃底静脉曲张程度重于非血栓组 ,大出血、大量腹水比例高 (P <0 .0 5 )。血栓形成后 1年内死亡率为1 6 .6 % ,较非血栓组增高 (P =0 .0 2 3)。两组肝功能Child Pugh分级、凝血功能、血小板计     

Hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis

Hydatid cyst disease is a zoonosis caused by the parasite Echinococcus. It may infest any organ of the body, but it most frequently involves the liver, lungs, and nervous system. Portal vein involvement by hydatid cyst disease is extremely rare with only five cases published in the English literature to our knowledge. We present the ultrasonography (US) and computed tomography (CT) findings of a 77-year-old male with hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis. Colour Doppler US confirmed the lack of blood flow within the portal vein and stigmata of cavernomatosis. CT clearly demonstrated a communication between the multiloculated lesion and the portal vein and the multiple daughter vesicles obstructing the portal vein. The consideration of this complication will make it possible to distinguish this entity from portal vein thrombosis and, thus, the management of the patients with hydatid cyst disease particulary in endemic regions.     

肝硬化患者门静脉系统血栓形成29例分析

目的提高对肝硬化患者门静脉系统血栓（PVT）形成的认识及诊治水平。方法收集我院2007年3月至2009年8月收治的肝硬化合并PVT患者29例进行回顾性分析。结果肝硬化合并PVT临床表现多样且缺乏特异性;D-二聚体及血小板水平的升高或相对升高是肝硬化患者发生PVT的独立危险因素;PVT诊断主要依赖影像学检查;在患者条件允许的前提下,及时、合理地选择各种方法进行抗凝、溶栓是治疗的关键。结论提高对肝硬化合并PVT的认识,及时诊断、合理选择治疗方案是决定本病预后的关键。     

原发性肝癌合并门静脉癌栓的外科治疗

肝癌是常见恶性肿瘤之一，其发病率和病死率居我国恶性肿瘤第二位。门静脉侵犯是肝癌重要的生物学特性。肝癌倾向于侵袭门静脉，并继而形成癌栓。临床报道肝癌门静脉癌栓（PVTT）发生率为44．0％～62．2％。肝癌侵袭门静脉是肝内播散及根治性切除术后早期复发的根源。此外，癌栓阻塞门静脉，门静脉高压加剧，继而引发食道胃底静脉破裂出血，甚至导致肝功能衰竭。因此，肝癌合并PVTT患者总体预后差，中位生存时间仅2．7个月。     

Comparison of percutaneous transhepatic portal vein embolization and unilateral portal vein ligation

AIM: To compare the effect of percutaneous transhepatic portal vein embolization (PTPE) and unilateral portal vein ligation (PVL) on hepatic hemodynamics and right hepatic lobe (RHL) atrophy.METHODS: Between March 2005 and March 2009, 13 cases were selected for PTPE (n = 9) and PVL (n = 4) in the RHL. The PTPE group included hilar bile duct carcinoma (n = 2), intrahepatic cholangiocarcinoma (n = 2), hepatocellular carcinoma (n = 2) and liver metastasis (n = 3). The PVL group included hepatocellular carcinoma (n = 2) and liver metastasis (n = 2). In addition, observation of postoperative hepatic hemodynamics obtained from computed tomography and Doppler ultrasonography was compared between the two groups.RESULTS: Mean ages in the two groups were 58.9 ± 2.9 years (PVL group) vs 69.7 ± 3.2 years (PTPE group), which was a significant difference (P = 0.0002). Among the indicators of liver function, including serum albumin, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, platelets and indocyanine green retention rate at 15 min, no significant differences were observed between the two groups. Preoperative RHL volumes in the PTPE and PVL groups were estimated to be 804.9 ± 181.1 mL and 813.3 ± 129.7 mL, respectively, with volume rates of 68.9% ± 2.8% and 69.2% ± 4.2%, respectively. There were no significant differences in RHL volumes (P = 0.83) and RHL volume rates (P = 0.94), respectively. At 1 mo after PTPE or PVL, postoperative RHL volumes in the PTPE and PVL groups were estimated to be 638.4 ± 153.6 mL and 749.8 ± 121.9 mL, respectively, with no significant difference (P = 0.14). Postoperative RHL volume rates in the PTPE and PVL groups were estimated to be 54.6% ± 4.2% and 63.7% ± 3.9%, respectively, which was a significant difference (P = 0.0056). At 1 mo after the operation, the liver volume atrophy rate was 14.3% ± 2.3% in the PTPE group and 5.4% ± 1.6% in the PVL group, which was a significant difference (P = 0.0061).CONCLUSION: PTPE is a more effective procedure than PVL because PTPE is able to occlude completely the portal branch throughout the right peripheral vein.     

肝硬化并发门静脉血栓研究进展

肝硬化并发门静脉血栓（Portal vein thrombosis,PVT）将增加肝硬化并发症的发生率。由于PVT可与上消化道出血同时发生,增加了治疗的难度。PVT形成的主要原因是门静脉血流速度降低。目前,治疗PVT仍以药物为主,研究表明抗凝治疗并不增加消化道出血的风险,因此对于有适应症的患者,在食管胃静脉曲张经治疗消失后,应及时针对PVT进行治疗。部分脾动脉栓塞患者,在治疗后常规给予抗凝处理可减少门静脉血栓的发生。在治疗过程中,早期诊断、抗凝治疗的监测指标、肝素用量、预防复发方面仍有较多问题等待解决。     

Effective treatment strategies other than sorafenib for the patients with advanced hepatocellular carcinoma invading portal vein

Patients with hepatocellular carcinoma(HCC) accompanying portal vein tumor thrombosis(PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelonaclinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival(OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization(TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent metaanalysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization(TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resectionbased multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.