超声引导注射聚桂醇与高渗葡萄糖治疗肝囊肿的疗效对比分析

目的对比分析经超声引导注射聚桂醇与高渗葡萄糖治疗肝囊肿的临床疗效。方法选取2014年3月至2108年3月青海省人民医院收治的单纯性肝囊肿患者100例,按随机数字表法将其分为观察组与对照组,各50例。观察组患者采取超声引导注射聚桂醇硬化剂治疗,对照组患者采取超声引导注射高渗葡萄糖治疗。两组经不同硬化剂治疗3个月后,观察两组患者临床疗效、肝功能及不良反应情况。结果治疗前,两组肝功能指标ALT、AST、TBil水平比较无统计学差异(P 0. 05)。治疗后,两组ALT、AST水平较治疗前明显降低,且观察组ALT、AST水平明显低于对照组(P 0. 01);两组TBiL水平与治疗前比较差异均无统计学意义(P0. 05),且两组比较亦无统计学差异(P0. 05)。观察组临床治疗总有效率为98. 0%,明显高于对照组的70. 0%(P 0. 05)。观察组术中、术后出现纳差、腹痛、腹胀、囊内出血等不良反应总发生率为6. 0%,显著低于对照组的30. 0%(P 0. 05)。结论与超声引导注射高渗葡萄糖治疗比较,超声引导注射聚桂醇治疗肝囊肿临床疗效更加显著,可有效改善肝功能,减少术中、术后不良反应的发生,因此值得临床推广应用。     

超声引导下聚桂醇与无水乙醇硬化治疗单纯性肝囊肿的疗效分析与对比研究

目的对比分析超声引导下经皮穿刺聚桂醇与无水乙醇注射硬化术治疗单纯性肝囊肿的临床疗效,不良反应发生率及术后肝功能、血常规等变化,以评价两种硬化剂治疗单纯性肝囊肿的优劣。方法收集2013年3月-2015年3月上海市浦东新区公利医院消化内科肝囊肿患者62例,随机分为观察组(聚桂醇组)与对照组(无水乙醇组),分别行超声引导下两种硬化剂治疗,比较两组患者术中、术后的不良反应发生率、治愈率及治疗前、后TBil、ALT、AST、胆碱酯酶、ALP的变化和术后24 h血常规等变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果观察组患者不良反应发生率及血乙醇浓度明显低于对照组(P值均0.05)。观察组与对照组患者的治愈率(术后1个月与术后6个月)、术后24 h血常规变化差异无统计学意义(P值均0.05)。单发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-3.680、-5.571,P值分别为0.001、0.001)。多发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-2.156、-4.626,P值分别为0.040、0.001)。结论超声引导下聚桂醇及无水乙醇硬化术治疗单纯性肝囊肿均安全、有效、损伤小、临床治愈率较高,但聚桂醇引起的不良反应明显少于无水乙醇,对肝功能的不良影响也明显较无水乙醇为轻。对于多发性肝囊肿及肝功能储备不佳患者,聚桂醇优势明显,应为首选治疗用硬化剂。     

超声引导下经皮穿刺置管引流联合聚桂醇泡沫硬化治疗单纯性肝囊肿患者疗效研究*

目的 观察在超声引导下经皮穿刺置管引流联合聚桂醇泡沫硬化治疗单纯性肝囊肿(SHC)患者的疗效。方法 将112例SHC患者随机分为观察组56例和对照组56例,采用超声引导下经皮穿刺置管引流,分别注射聚桂醇泡沫硬化或聚桂醇硬化治疗。采用化学发光法检测血清C反应蛋白(CRP)水平,采用磁微粒化学发光法检测血清皮质醇(Cor)水平。结果 在术后半年随访,观察组总有效率为100.0%,与对照组的92.9%比,无统计学差异(P＞0.05);观察组不良反应发生率为5.4%,显著低于对照组的19.6%(P<0.05);术后1 w,两组血清总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、胆碱酯酶、C反应蛋白、皮质醇和血糖水平变化无显著性差异(P>0.05)。结论 在超声引导下经皮穿刺置管引流联合聚桂醇注射硬化治疗单纯性肝囊肿患者疗效肯定,采取聚桂醇泡沫注射可能能减少并发症的发生。     

超声引导下穿刺硬化治疗肝肾囊肿患者临床疗效研究*

目的 探讨超声引导下穿刺硬化治疗肝肾囊肿患者的临床疗效。方法 2019年1月～2020年12月我院收治的肝肾囊肿患者72例,其中36例在超声引导下穿刺注射无水乙醇治疗,另36例注射聚桂醇治疗。比较两组临床疗效、囊肿体积缩小率和不良反应发生率。结果 在术后6个月超声复查,聚桂醇治疗组囊肿消失或明显缩小发生率为94.4%,与无水乙醇治疗组的91.7%比,无显著性差异(P>0.05);在术后1 m、3 m和6 m,聚桂醇治疗组囊肿体积缩小率分别为(67.5±8.1)%、(81.6±5.5)%和(95.2±4.9)%,显著高于乙醇治疗组【分别为(53.9±6.4)%、(73.2±4.7)%和(85.6±3.5)%,P＜0.05】;聚桂醇治疗组术后发热、醉酒样反应和恶性呕吐等不良反应发生率为8.3%,显著低于无水乙醇治疗组的27.8%(P＜0.05)。结论 在超声引导下穿刺注射聚桂醇或无水乙醇硬化治疗肝肾囊肿患者疗效较好,但注射聚桂醇可提高囊肿体积缩小率,减少不良反应的发生。     

超声引导下囊液抽吸联合聚桂醇注射治疗甲状舌骨囊肿的疗效及安全性分析

目的探讨超声引导下囊液抽吸联合聚桂醇注射治疗甲状舌骨囊肿的疗效及安全性。方法选取2017年6月至2019年6月本院甲状舌骨囊肿80例,依据随机表分为超声组(n=40)和切除组(n=40),超声组给予超声引导下囊液抽吸联合聚桂醇注射治疗,切除组给予传统切除治疗,比较两组疗效及安全性。结果超声组术后1、2、3个月囊肿体积明显低于术前,差异有统计学意义(P0.05),超声组和切除组治疗有效率比较差异无统计学意义(P0.05);超声组和切除组术后6个月均无复发病例;超声组切口长度、术中出血量、手术时间、住院时间明显低于切除组,差异有统计学意义(P0.05);超声组并发症发生率明显低于切除组,差异有统计学意义(P0.05)。结论与传统切除治疗比较,超声引导下囊液抽吸联合聚桂醇注射治疗甲状舌骨囊肿也具有良好的疗效,且可有效减少患者手术创伤及并发症,有利于术后康复,值得临床推广。     

超声引导下聚桂醇硬化治疗单纯性肝囊肿初步研究

目的 探讨超声引导下行聚桂醇硬化治疗单纯性肝囊肿患者的疗效及安全性。方法 2012年3月~2016年10月我院收治的经B超、CT或MRI检查诊断的单纯性肝囊肿患者83例,随机将其分成聚桂醇注射治疗组（n=41）和乙醇注射治疗组（n=42）,分别采用1%聚桂醇或99.7%无水乙醇囊内注射硬化治疗,比较两组术后不良反应、生化指标变化和疗效。结果 聚桂醇和乙醇注射组在年龄、性别、囊肿直径和病程等一般临床资料方面比较,差异无统计学意义（P>0.05）。术后6 m行超声检查,聚桂醇注射治疗组囊肿消失率为39.0%,囊肿缩小率为58.5%,乙醇注射治疗组分别为38.1%和52.4%,两组差异无统计学意义（P>0.05）;聚桂醇注射治疗组术前血清谷丙转氨酶水平为（42.2± 8.1） U/L,术后6月为（34.8± 6.9） U/L,术后较术前有所降低（P<0.05）;乙醇组术前血清谷丙转氨酶水平为（43.4± 9.1） U/L,术后为（35.1± 7.0） U/L,术后较术前同样有所降低（P<0.05）,但两组治疗前后谷丙转氨酶水平和及其肝功能指标差异均无统计学意义（P>0.05）;聚桂醇注射治疗组无醉酒样不良反应发生,而乙醇注射治疗组有6例患者出现醉酒样不良反应,发生率较聚桂醇高（x2=23.11,P<0.01）;聚桂醇注射治疗组腹胀和腹痛发生率为7.3%,显著低于乙醇注射治疗组的23.8%（x2=4.27,P<0.05）;聚桂醇组有4例患者出现发热,3例患者出现恶心呕吐,乙醇组有4例患者出现发热,5例患者出现恶心呕吐,两组在发热和恶心呕吐不良反应发生率方面,差异无统计学意义（P>0.05）。结论 在超声引导下行聚桂醇囊腔内注射能有效治疗单纯性肝囊肿,且与无水乙醇注射比,具有相同的疗效和更少的副作用。作者单位：810007 西宁市 青海省人民医院超声科第一作者：王有全,男,44岁,大学本科,主治医师。主要从事超声疑难病诊断及介入治疗。E-mail： 282424179@qq.com     

超声引导下注射聚桂醇联合无水乙醇治疗良性甲状腺囊肿的疗效观察

目的探讨超声引导下注射聚桂醇联合无水乙醇治疗良性甲状腺囊肿(BTC)的疗效。方法选取2015年6月～2017年6月治疗的120例BTC患者,随机分为乙醇组和联醇组,每组各60例,乙醇组给予超声引导下注射无水乙醇治疗,联醇组在此基础上给予超声引导下注射聚桂醇治疗,治疗后比较两组疗效。结果联醇组治疗有效率明显高于乙醇组,差异有统计学意义(P0.05);两组并发症率和不良反应率比较,差异无统计学意义(P0.05);联醇组1年总复发率明显低于乙醇组,差异有统计学意义(P0.05)。结论超声引导下注射聚桂醇联合无水乙醇治疗可有效提高BTC患者的近远期疗效,且安全性好,值得临床推广。     

介入超声下聚桂醇硬化剂对肝囊肿患者肝功能与安全性的影响

目的研究介入超声下聚桂醇硬化剂对肝囊肿患者肝功能与安全性的影响。方法收集2018年11月至2019年10月收治的94例肝囊肿患者,按照随机数字表法分为对照组和观察组各47例。对照组实施超声介入穿刺注射无水乙醇硬化剂治疗,观察组实施超声介入穿刺注射聚桂醇硬化剂治疗。将两组的临床效果、治疗相关指标、囊肿体积、症状积分、肝功能指标、不良反应发生情况进行对比。结果观察组患者的临床总有效率高于对照组,差异均有统计学意义(P<0.05);观察组患者的治疗时间、治疗后住院时间短于对照组,液体抽取量多于对照组,治疗费用少于对照组,治疗后3个月、6个月时的囊肿体积小于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后的症状积分、不良反应发生率低于对照组,差异有统计学意义(P<0.05);观察组患者治疗后的ALB高于对照组,治疗后的TBIL、ALT、AST、ALP水平均低于对照组,差异有统计学意义(P<0.05)。结论对肝囊肿患者实施超声介入穿刺注射聚桂醇硬化剂治疗具有较高的有效性和安全性,能有效缩小囊肿体积,促进临床症状和肝功能改善,适合在临床中推广应用。     

超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿患者疗效研究*

目的 探讨在超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿患者的疗效。方法 2018年1月～2020年12月我院诊治的巨大单纯性肝囊肿患者73例,随机分为对照组36例和观察组37例,两组均采用在超声引导下穿刺抽液,在对照组注射无水乙醇硬化治疗,在观察组注射聚桂醇置换冲洗硬化治疗。随访6个月。采用化学发光法检测血清C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)水平,采用磁微粒化学发光法检测血清皮质醇(Cor)水平。结果 在术后6个月复查,观察组临床总有效率为97.3%,显著高于对照组的80.6%(P＜0.05);治疗前后,两组血清肝功能指标无显著性差异(P＞0.05);在术后1周,观察组血清CRP、Cor和SAA水平分别为(15.7±3.6)mg/L、(283.6±10.3)nmol/L和(13.5±2.4)ng/mL,显著低于对照组【分别为(21.1±4.5)mg/L、(312.3±10.7)nmol/L和(19.8±3.7)ng/mL,P＜0.05】。结论 在超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿有良好的临床治疗效果,且对肝功能的影响小。     

超声引导下老年肝肾囊肿抽吸固化治疗效果观察

目的探讨超声引导下应用聚桂醇和无水乙醇抽吸固化治疗老年肝肾囊肿的效果。方法选取2013年1月至2014年12月濮阳市中医院超声介入科收治的老年肝肾囊肿患者116例,按照固化治疗方法分为聚桂醇组和无水乙醇组,各58例,聚桂醇组在超声引导下实施囊肿积液抽吸和聚桂醇固化治疗,无水乙醇组在超声引导下实施囊肿积液抽吸和无水乙醇固化治疗,比较两组患者住院时间、治疗效果和不良反应。结果聚桂醇组住院时间(5.78±0.89)d,治疗有效率89.66%(52例),无水乙醇组住院时间(6.16±1.45)d,治疗有效率94.83%(55例)),两组间差异无统计学意义(P0.05)。聚桂醇组发生不良反应2例,无水乙醇组9例,两组比较差异有统计学意义(P0.05)。结论超声引导下应用聚桂醇和无水乙醇抽吸固化治疗老年肝肾囊肿,均具有疗效确切、操作简便的特点,但应用聚桂醇不良反应发生率较无水乙醇明显降低,可作为老年肝肾囊肿抽吸固化治疗的首选。     

Diagnosis and treatment of hepatic echinococcosis: an overview

BACKGROUND: Surgery has long been considered the first-choice treatment in patients with echinococcosis of the liver. The poorly predictable outcome of older studies using mebendazole or albendazole confirmed this belief. Since the introduction of a percutaneous technique (PAIR; puncture, aspiration, injection, reaspiration) treatment policy is changing. The actual question is which treatment is preferred in which patients. METHODS: Review of recent literature. RESULTS: Laparoscopic treatment of anteriorly located hepatic cysts is a new surgical technique with high success rates (77%-100%) and low complication (0%-17%) and recurrence rates (0%-9%). Albendazole is superior to mebendazole treatment. Degenerative changes were found in 82% of patients treated with albendazole and in 56% of those treated with mebendazole. The main problem is the high relapse rate: 25% mostly within 2 years. PAIR proved to be superior to albendazole treatment (88% versus 18%) and equally effective as surgery (86% versus 76%). A combined injection of alcohol with polidocanol is a simple alternative to PAIR. Percutaneous evacuation of cyst content (PEVAC) made percutaneous treatment accessible to patients with complicated cysts. CONCLUSIONS: Albendazole is the first-choice treatment in patients with univesicular cysts. PAIR or combined injection of alcohol with polidocanol is indicated when pain is intractable or albendazole fails. In patients with multivesicular cysts, PEVAC is a better choice. Surgery is the first-choice treatment only when the expertise of percutaneous treatment is not available or when percutaneous treatment fails.     

胸膜腔注入尿激酶治疗结核性多房性胸腔积液价值

目的探讨超声引导胸膜腔内注射尿激酶治疗结核性多房性胸腔积液的临床应用价值。方法将40例结核性多房性胸腔积液患者随机分为研究组和对照组。研究组在超声引导定位下向胸腔内穿刺抽液后,注射尿激酶10万U治疗;对照组给予胸膜腔穿刺抽液治疗。结果 1.研究组患者胸腔积液消失时间要短于对照组,胸膜肥厚度小于对照组,肺功能中FEV1%、FVC%高于对照组,其差异均具有统计学意义(P<0.05);2.研究组患者总有效率为95%;对照组患者总有效率65%,差异具有统计学意义(P<0.05)。结论超声引导胸膜腔内注射尿激酶治疗结核性多房性胸腔积液是一种安全、可靠、有效的治疗方法,值得临床推广应用。     

B超引导下硬化剂注射治疗肝囊肿

本文报道了19例共34个肝囊肿应用 B 超引导装置硬化剂(无水乙醇或四环素注射液)注射治疗的效果。结果表明:单纯性囊肿治愈率89.5%,有效率100%,囊肿越小,效果越好,治愈时间越短;多囊肝治疗也取得了满意的效果;一次穿刺成功率100%。本法简单、易行,无严重并发症,是非手术治疗肝囊肿的首选方法,值得临床推广应用。     

Nd:YAG laser versus polidocanol injection for palliation of esophageal malignancy: a prospective, randomized study

Palliation is often the only treatment that can be offered to patients affected by esophageal malignancy. This prospective study was carried out in order to compare two endoscopic palliative treatments: Nd:YAG laser and local injection of 3% polidocanol. We randomized 34 patients with inoperable malignancies to one of the two treatments. After the first course, 88.8% of the patients in the laser group and 81.5% in the polidocanol group were able to swallow a normal oral caloric intake. Only one major complication (esophageal perforation) was observed (polidocanol group) and was successfully treated with endoscopic placement of a prosthesis. We believe that both techniques are safe and effective for the palliation of esophageal malignant strictures but that polidocanol injection is cheap, simple, and more widely available.     

Successful aspiration and ethanol sclerosis of a large,symptomatic, simple liver cyst： Case presentation and review of the literature

Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver cysts are predominantly large (> 4 cm), right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts (> 4 cm) may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.     

Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms.

PURPOSE: To compare in a randomized prospective study the treatment of femoral pseudoaneurysms with ultrasound-guided thrombin injection versus ultrasound-guided compression. METHODS: Thirty consecutive patients (22 men; mean age 67+/-8 years, range 53-82) with iatrogenic femoral pseudoaneurysms were randomized to treatment with either ultrasound-guided compression (n=15) or injection of bovine thrombin (n=15). The primary outcome measure was thrombosis of the pseudoaneurysm within 24 hours. Secondary outcome measures were complications and hospitalization time (LOS). RESULTS: Thrombosis within 24 hours was achieved in 15 (100%) patients given thrombin versus 2 (13%) in the compression group (p<0.001). Of 13 pseudoaneurysms failing the initial compression treatment, 7 were retreated, 4 successfully. Thus, only 6 (40%) lesions were thrombosed within 48 hours after 1 or 2 compression sessions. The other 9 cases were successfully treated with thrombin injection. LOS was 2.8+/-1.5 days and 3.5+/-2.4 days in the thrombin and compression groups, respectively (p>0.05). No complications were noted in either group. CONCLUSIONS: Ultrasound-guided thrombin injection induces a fast, effective, and safe thrombosis of postcatheterization pseudoaneurysms. The technique is clearly superior to compression treatment and is recommended as the therapy of choice.     

Local therapeutic injection in bleeding peptic ulcer: a comparison of adrenaline to adrenaline plus a sclerosing agent.

OBJECTIVE: a) To analyse the probability of haemodynamic changes in patients with non-variceal upper gastrointestinal bleeding (NV-UGB), as well as the risk of bleeding in cases of peptic ulcer; and b) to compare an injection of epinephrine alone with epinephrine plus an sclerosing agent in ulcers with a high risk of persistent or recurrent bleeding. METHODS: We studied 500 consecutive patients (295 males/205 females) who were admitted because of an NV-UGB episode. Haemodynamic evaluation and upper endoscopy were performed in all patients. They were randomised to receive an injection of epinephrine 1:10.000 or epinephrine plus 2% polidocanol in case of active bleeding, visible vessel or unstable clot. RESULTS: 263/500 (52.6%) were taking NSAIDs before the acute bleeding. 70/96 (72.9%) patients with red haematemesis showed haemodynamic changes vs 15/107 (14%) with dark haematemesis and melena, and 29/281 (10.3%) with melena alone, p < 0.01, OR = 20. Duodenal ulcer was the cause of NV-UGB in 206 cases (40.6%) and gastric ulcer in 134 (27.2%). However, an endoscopic therapy was performed in 85 patients, 58 with gastric ulcers (19 with active bleeding, 33 with visible vessel and 6 with unstable clot) vs 27 with duodenal ulcers (6 with active bleeding, 19 with visible vessel and 2 with unstable clot), p < 0.01, OR = 4.7. 15/85 patients developed recurrent bleeding after injection therapy: 3 with a non-bleeding visible vessel and 10 with active bleeding (10 were treated with epinephrine and 2 with epinephrine plus 2% polidocanol, p < 0.04, OR = 8). A multivariate logistic regression analysis showed that age, active bleeding and type of injected agent were the only independent variables associated with failure of treatment and recurrent bleeding. CONCLUSIONS: a) 52.6% of patients with NV-UGB were taking NSAIDs before acute bleeding; b) epinephrine injection followed by a sclerosing agent is more effective in case of active bleeding; however, there is no difference in case of visible vessel or unstable clot; and c) age, active bleeding and type of treatment were the only independent variables associated with recurrent bleeding.