胆道支架置入联合内外放疗治疗恶性阻塞性黄疸的临床观察

对30例恶性阻塞性黄疸病例分别行胆道支架置人＋后装腔内放疗＋适形放疗（综合组，15例）和单纯胆道支架置入治疗（对照组，15例）。两组患者血总胆红素在胆道支架置入后1个月内明显下降，对照组6个月后开始升高，而综合组6个月后继续降低；肿瘤最大径对照组增大，综合组缩小。对照组无完全与部分缓解，综合组肿瘤缓解比例为13／15；综合组0．5年、1年和2年生存比例分别为15／15，14／15，和10／15，高于对照组的15／15，5／15和1／15。     

Enterprise支架辅助栓塞颅内动脉瘤

BACKGROUND We aimed to investigate endovascular treatment of intracranial aneurysms using the method of coil embolization and an Enterprise stent. METHODS Forty patients were treated with Enterprise stent implantation and coil embolization between December 2008 and June 2009 in our hospital. RESULTS The mortality of our patients was 0%. All stents were successfully implanted and there were no surgery-related complications. CONCLUSIONS According to our experience, the Enterprise stent has some advantages to be selected.     

Endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent

Background  Several difficulties can arise from wide-neck cerebral aneurysms when treated with endovascular embolization. We aimed to investigate the effect of endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent.

Methods  Forty patients were treated with coil embolization plus an Enterprise stent between December 2008 and June 2010.

Results  The mortality of patients was 0. All stents were successfully implanted without any surgery-related complication.

Conclusion  The Enterprise stent has some advantages to be selected.

     

99mTc-MIBI门控心肌断层显像在冠状动脉支架术后的临床价值

目的:探讨99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-MPI)在冠状动脉支架术后疗效评价、判断再狭窄以及预后评估的临床价值。方法:78例患者,冠状动脉支架术后3～12个月内均行G-MPI,其中31例有术前对照。33例复查冠状动脉造影(CAG)。随访13～24个月。结果:①31例复查G-MPI24例心肌灌注有改善,改善率为77.4%。②31例术后静息G-MPI所测左室射血分数(LVEF)较术前由(42.6±8.6)%上升至(49.7%±6.4)%,P<0.05;舒张末期容积(EDV)和收缩末期容积(ESV)分别由(158.2±55.3)ml、(92.6±44.9)ml明显下降到(133.9±39.9)ml、(71.2±28.7)ml,P均<0.01。③33例复查CAG患者,G-MPI对再狭窄诊断的敏感性、特异性、准确性为82.3%、85.0%、84.8%。④随访心脏事件发生率术后G-MPI灌注改善组(1.9%)与异常组(28.6%)之间有极显著差异(P<0.01)。结论:G-MPI对冠心病血运重建术后疗效评价、判断再狭窄以及预后评估具有重要的临床价值。     

Very late stent thrombosis due to multiple stent fracture and stent malapposition

Coronary stent fracture (SF) is a rare but potentially serious complication of coronary artery stenting.Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple steut fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation (Firebird,Microport,Shanghai,China). A 43-year-old man with hyperlipidemia and a smoking history was referred for coronary angiography (CAG)following repeated exertion associated chest pain in January 2007.CAG revealed a diffused tortuous stenosis at the proximal segment and a total occlusion at the mid-segment of the left anterior descending (LAD) artery,a 90％ stenosis at the proximal segnent of the left circumflex artery (LCX),and a diffused lesion with a maximal 60％ stenosis of the right coronary artery (RCA).     

单分支支架血管植入技术在急性A型主动脉夹层全弓替换加支架象鼻植入术中的应用

目的 探讨单分支支架血管植入技术简化急性A型主动脉夹层全主动脉弓替换的可行性.方法 2008年6月至2009年9月,福建医科大学附属协和医院心外科23例急性A型主动脉夹层患者接受升主动脉及全主动脉弓人造血管替换和单分支支架血管植入术.当体外循环鼻咽温度降至20℃时,停止下半身灌注,横断左颈总动脉并缝闭其近端开口.于左颈总动脉和无名动脉间横断主动脉弓,将单分支支架血管植入近端胸降主动脉真腔内,并将其分支植入左锁骨下动脉.应用三分支人造血管替换升主动脉和主动脉弓,并与无名动脉、左颈总动脉相连接.结果 术中均能顺利地植入单分支支架血管.平均体外循环时间、心肌阻断时间、下半身停止灌注时间和选择性脑灌注时间分别为( 161±32)、(97±20)、(21 ±4)和(31±6)min.术后无并发症,均痊愈出院.术后3个月电子束CT检查结果示:主干支架血管和分支支架血管通畅,周围无血流,单分支支架血管植入部位的主动脉夹层假腔闭合.结论 应用单分支支架血管直视植入来简化急性A型主动脉夹层全主动脉弓替换是可行的;这种方法避免了常规主动脉弓替换术中较深部位的左锁骨下动脉吻合和左锁骨下动脉远端的远端人造血管-降主动脉吻合.     

NP和GP方案治疗晚期非小细胞肺癌的疗效比较

目的 诺维本加顺铂(NP)和健择加顺铂(GP)方案均是目前治疗晚期非小细胞肺癌的常用方案,本研究对两种方案进行了有效率、存活率和不良反应等方面的比较.方法 自1999～2004年,总共80例晚期非小细胞肺癌(Ⅲb期或Ⅳ期)参与研究,采用NP方案治疗40例、GP方案40例,比较其疗效及不良反应.结果 总有效率NP方案为27.5%,GP方案为22.5%(P＞0.05);平均存活时间NP方案为9.4个月,GP方案为8.6个月(P＞0.05);1年存活率NP方案为10.0%,GP方案为7.5%(P＞0.05).两种方案的主要不良反应均为骨髓抑制,白细胞下降至Ⅲ、Ⅳ度者NP方案为45%,GP方案为40%(P＞0.05);化疗后出现Ⅲ、Ⅳ度便秘者NP方案为25.0%,GP方案为7.5%(P＜0.05).结论 NP方案和GP方案治疗晚期非小细胞肺癌效果确实,且较一致,耐受性均较好,但使用NP方案要注意预防便秘.     

Forgotten urological stent

"Forgotten" Ureteral stent DJ stent related complication is not uncommon even in the era of modern urology in the developed world. In this context we have undertaken a retro-prospective study in relation to its various causes, complications, management and prevention of forgotten stents in a single teaching institute. The study period was from January'04 to December'09. The sample size was 60. The effect of "forgotten stent" in our study reflects mild UTI to various complications including severe renal failure. We had approached all of our cases judiciously using various modalities of minimal access endourological techniques either alone or in combinations with successful outcome. The study concluded that it is vary easy to prevent "forgotten stent" and so its complications. However if we confront such unwanted complications that could be managed successfully with the use of endourological techniques. We did not use other techniques like laparoscopy and open surgery in this study.     

Incidence and predictors of definite stent thrombosis after coronary stent implantation

Background  Coronary stents are widely used in percutaneous coronary intervention (PCI) procedures. We aimed to explore the incidence, predictors and characteristics of stent thrombosis (ST) after coronary stent implantation in routine clinical practice.

Methods  From data of 18 063 consecutive patients who underwent successful stent implantation in Shenyang Northern Hospital from 2004 to 2010, we identified patients with definite ST (n=140) and control patients (n=280) matched on age, diagnosis, sex, current antiplatelet medication and stent type. The incidence, predictors and characteristics of ST after coronary stent implantation were investigated.

Results  The incidence of angiographically confirmed ST was 0.78% (140/18 063). The time distribution of ST was acute in 43 (30.7%), subacute in 50 (35.7%), and late in 47 (33.6%) patients. Binary Logistic regression analysis identified the angiotensin-converting enzyme inhibitor (ACEI) (odds ratio (OR)=0.472, 95% CI: 0.276–0.807, P=0.006) and heparin (OR=0.477, 95% CI: 0.278–0.819, P=0.007) were associated with an reduced risk of cumulative ST. Stent length (OR=1.042, 95% CI: 1.026–1.058, P <0.001), serum creatinine total (OR=1.020, 95% CI: 1.004–1.035, P=0.04), cholesterol (OR=1.267, 95% CI: 1.021–1.573, P=0.032), glucose (OR=1.086, 95% CI: 1.002–1.176, P=0.044), and platelet aggregation (OR=1.113, 95% CI: 1.075–1.154, P <0.001) were associated with an increased risk of cumulative ST.

Conclusion ST is associated with longer stent length and higher level of total cholesterol, glucose and platelet aggregation.

     

Meta-analysis of stent thrombosis after drug-eluting stent implantation: 4-year follow-up

Background Drug-eluting stents （DES） are the most common device used in percutaneous treatment of coronary artery disease. Recently, there has been an increased concern regarding their safety profile, in particular the late and very late stent thrombosis rate compared to bare metal stents （BMS）. The aim of the study was to compare the reported incidence of late and very late stent thrombosis of DES and BMS in patients from published clinical studies with an extended follow-up period to four years.Methods A search strategy was developed to identify publications reporting on late or very late thrombosis of BMS and DES available through MEDLINE and Cochrane Library databases. Two independent reviewers appraised eligible studies and extracted data. Odds ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI）.Results Fourteen randomized controlled trials, which were at least single blinded, were identified. There was no difference in the incidence of late and very late stent thrombosis in patients treated with DES compared with patients treated with BMS （late OR 0.55, 95%Cl 0.23-1.31 and late/very late OR=1.08, 95%CI 0.61-1.91）.Conclusions The safety profile of DES was similar to BMS in terms of stent thrombosis. We found no evidence of increased risk of late and very late thrombosis for DES.     

带膜支架治疗6例颅内动脉瘤的临床分析

目的 探讨应用带膜支架治疗颅内动脉瘤的效果.方法 根据靶血管的直径和病变的长度,选择合适带膜支架行病变隔绝术,共治疗椎动脉颅内段动脉瘤3 例、颈内动脉动脉瘤3 例. 结果 在6例患者带膜支架被成功释放于靶动脉,动脉瘤消失,并保持载瘤动脉畅通,临床效果满意.支架放置后6个月造影随访病例载瘤动脉畅通. 结论 带膜支架是采用血管内治疗技术处理部分颅内动脉瘤的有效手段.     

带膜支架治疗6例颅内动脉瘤的临床分析

目的探讨应用带膜支架治疗颅内动脉瘤的效果。方法根据靶血管的直径和病变的长度,选择合适带膜支架行病变隔绝术,共治疗椎动脉颅内段动脉瘤3例、颈内动脉动脉瘤3例。结果在6例患者带膜支架被成功释放于靶动脉,动脉瘤消失,并保持载瘤动脉畅通,临床效果满意。支架放置后6个月造影随访病例载瘤动脉畅通。结论带膜支架是采用血管内治疗技术处理部分颅内动脉瘤的有效手段。     

Late stent thrombosis: a not negligible issue after drug-eluting stent implantation

Drug-eluting stent （DES） has markedly reduced restenosis and the need for target lesion revascularization （TLR）. The safety profile of DES does not seem to differ from that of bare metal stent in the acute and subacute phases following coronary intervention. However, at World Congress of Cardiology 2006 a meta-analysis of randomized trials suggested that there was a small but significant increase in risk of death or Q-wave myocardial infarction throughout a period of 3 years after implantation of a Cypher stent possible due to late stent thrombosis） The study received wide attention and since then the long-term safety of DES has been questioned by the physicians, patients and societies.     

Subclavian artery stent fracture

We report a case of a 52 year-old dentist who had stent implantation for a left subclavian artery stenosis. However, this was later complicated by a stent fracture within one week of stent placement. A chest radiograph showed two pieces of the fractured stent, which was confirmed by computed tomographic angiogram (CTA) of the affected artery. We then discuss the occurrence of stent fractures, which are not uncommon but serious complications of endovascular therapy.     

涂层支架的研究进展

经皮冠状动脉内气囊血管成形术后常产生支架内再狭窄的问题，目前采用不同涂层技术研制各种涂层支架以对抗支架内再狭窄。     

Coronary aneurysm and very late stent thrombosis formation associated with sirolimus-eluting stent implantation

Since drug-eluting stents （DES） can significantly reduce the risk of instant restenosis compared with bare-metal stents, they have been widely used in interventional therapy for coronary heart disease. With bare-metal stents being rapidly replaced by DES there is a great concern about the safety of DES due to stent thrombosis.Very late stent thrombosis （VLST） has been categorized as occurring beyond 1 year.3 Coronary aneurysm formation induced stent malapposition is a rare but potentially fatal cause of VLST. We report a case of coronary aneurysm with VLST formation 35 months after sirolimus-eluting stent （SES） implantation.     

Comparison of drug-eluting stent and bare-mental stent in the complex small vessel intervention

Nowadays, coronary intervention has been dramatically improved in the drug-eluting stent era. The drug-eluting stent represents the dominant percutaneous coronary intervention modality beacause it significantly reduces the restenosis rate compared with bare mental stent. Such benefit was initially demonstrated in coronary vessels 3 mm or more in diameter.1,2 However, restenosis after coronary stent implantation is influenced by vessel size and length, and stent occlusion is more frequent in sm…     

国产雷帕霉素洗脱支架和进口紫杉醇洗脱支架的3年临床随访

目的 比较国产雷帕霉素洗脱支架(Firebird)和紫杉醇洗脱支架(Taxus)的长期临床效果.方法 回顾性分析从2004年4月至2005年4月阜外医院连续置入Firebird支架(F组:88例)和Taxus支架(T组226例)共314例患者.结果 基线上T组包括的复杂病变比率、病变狭窄程度、球囊预扩张的比率以及置入支架的长度均明显大于F组,两组介入成功率均为100%.主要心脏不良事件(MACE)发生率F组明显低于T组(8.O%、21.7%,P=0.005),其中心源性死亡、非致死性心肌梗死(MI)两组差异无统计学意义;(O%、1.8%)和(1.1%、3.5%);(P=0.580,P=0.453),靶血管重建率(TVR)F组明显低于T组(6.8%、16.4%,P=0.028).支架内血栓发生率两组差异无统计学意义(1.1%、3.5%,P=0.453),早、晚期和晚晚期支架内血栓发生率两组差异无统计学意义.造影随访F组支架内和血管段再狭窄率均明显低于T组(0%、21%;P=0.002和0%、24%,P=0.001).F组支架内和血管段的晚期丢失均明显小于T组[(0.11±0.07)mm、(0.53±0.38)mm,P=0.000和(0.05±0.03)mm、(0.38±0.19)mm,P=0.000)].结论 Taxas和Firebird支架有良好的长期临床效果,Firebird在降低再狭窄方面有优势.