选择性肾动脉栓塞治疗肾脏疾病疗效分析

目的:分析选择性肾动脉栓塞治疗肾脏疾病的临床价值。方法:对4例外伤性肾出血患者、7例肾肿瘤患者,采用经皮股动脉穿刺插管行肾动脉数字减影血管造影,根据病变性质行选择性肾动脉栓塞治疗。结果:肾动脉造影明确了出血的部位、程度及相关病变的情况,7例肾出血患者在动脉栓塞后,5例在24h内肉眼血尿消失,2例在栓塞后3d内肉眼血尿消失。4例肾癌患者在栓塞后3～5d左右行肿瘤切除术。结论:选择性肾动脉栓塞治疗肾出血创伤小、并发症少、能最大限度地保护肾功能。肾肿瘤出血栓塞后手术容易剥离,术中出血明显减少,手术时间明显缩短,手术后恢复快,选择性肾动脉栓塞治疗肾出血及肾癌手术前选择性肾动脉栓塞,具有较高临床应用价值。     

超选择性血管内栓塞在鼻咽部纤维血管瘤中的应用

目的:探讨术前超选择性血管内栓塞对鼻咽部纤维血管瘤的疗效和安全性。方法:在术前3~5 d对20例鼻咽部纤维血管瘤进行血管造影(DSA)检查和微导管超选择栓塞肿瘤供血动脉,栓塞的材料主要是PVA颗粒。栓塞后行手术切除肿瘤治疗。结果:主要由颌内动脉的分支血管供血者18例,咽升动脉供血者2例。20例栓塞治疗均成功,其中15例栓塞后肿瘤染色完全消失,5例大部分消失。栓塞治疗3~5 d内手术,肿瘤全切除者15例,大部分切除者3例,部分切除者2例。术中出血明显减少,有10例患者术中出血少于200 mL。结论:鼻咽部血管纤维瘤的术前栓塞有助于减少术中出血、提高手术的全切率和安全性,是一种安全、有效的方法。     

动脉内药物灌注加二步栓塞治疗肾癌的临床应用(附26例报告)

目的 :研究肾癌晚期或术前经导管血管内抗癌药物灌注加无水乙醇—碘化油乳液和明胶海棉栓塞的方法和疗效。方法 :对 2 6例肾癌患者用 Seldinger法 ,将导管插入患者肾动脉 ,以 1∶ 1无水乙醇与碘化油液 10 m L～ 18m L行病变肾动脉基础小血管栓塞和 1mm～ 2 mm宽的小长条明胶海棉混合 2 m L造影剂一起注入栓塞较大的肾血管。其中在栓塞前和二步栓塞中加化疗药物灌注 ,分析其临床表现、血管造影表现和随访结果。结果 :2 6例都成功实施了灌注加二步栓塞治疗术。栓塞后症状减轻 ,肿瘤血管中断 ,体积缩小及肿瘤内碘化油均匀聚集。结论 :肾癌动脉内药物加二步栓塞治疗术对单侧和双侧晚期无手术机会的肾癌是首选的最有效治疗方法 ,肾癌的术前应用可明显减少术中出血和癌细胞的扩散 ,便于手术剥离     

动脉栓塞术治疗急性出血26例报告

目的 探讨介入动脉栓塞治疗在急性出血病变中的应用价值.方法 对26例动脉出血病例进行急诊动脉造影,根据不同的出血部位和出血原因采用动脉栓塞治疗.结果 26例患者血管造影,22例表现为血管破裂,造影剂外溢;血管增粗、迂曲、紊乱、血管截断;肿瘤合并出血见肿瘤染色.动脉栓塞治疗24例,动脉栓塞治疗即时止血率100%,未出现并发症.结论 急性大出血急诊血管造影能明确出血部位同时行栓塞治疗,是安全有效的止血方法,有广泛的临床推广价值.     

硬脑膜动静脉瘘的认识及其血管内栓塞的治疗进展

硬脑膜动静脉瘘是一类在硬脑膜及其大脑镰、小脑幕等附属物发生异常动静脉交通的血管性病变,在其多种治疗方法中,血管内栓塞治疗具有较好的疗效.该文就其发病原因、机制、分型、临床表现、影像学诊断以及血管内栓塞治疗中的栓塞材料和经不同途径栓塞治疗等的最新进展展开综述.     

经导管盆腔动脉栓塞术的临床应用

本文报告18例经导管单侧或双侧髂内动脉栓塞。其中外伤出血8例，盆腔肿瘤8例，骶骨肿瘤2例。经髂内动脉栓塞后，外伤出血均得到控制，膀胱肿瘤的顽固性血尿停止，全身情况好转，肿瘤缩小。骶骨肿瘤术中出血较同类手术明显减少。文内对盆腔动脉栓塞的适应证，止血效果，晚期盆腔肿瘤的姑息治疗，栓塞材料及并发症等作了讨论。     

鸦胆子油动脉栓塞的动物实验研究

目的 通过动物实验的方法探讨中药抗癌刑——鸦胆子油的动脉栓塞效果。方法 4组日本大耳白兔行单侧肾动脉栓塞，分别于栓塞后1天、3天、1周及4周处死，观察栓塞肾改变情况。结果 栓塞后肾动脉内血栓形成，肾实质坏死、机化，复查血管造影无再通。4周后栓塞肾明显缩小并与周围组织粘连。结论 鸦胆子油具有良好的动脉栓塞效果，可用于肿瘤的动脉内治疗，同时起到抗癌及栓塞的双重治疗作用，     

Matrix微弹簧圈血管内栓塞治疗颅内动脉瘤

目的探讨M atrix微弹簧圈血管内栓塞治疗颅内动脉瘤的疗效。方法采用M atrix微弹簧圈血管内栓塞治疗颅内动脉瘤26例28个动脉瘤,回顾性分析其疗效,评价此种栓塞材料的特点。结果全组无手术死亡病例。随访3~15个月,复查全脑血管DSA,治疗的28个动脉瘤中,完全栓塞26个,次全栓塞2个。临床结果23例很好,2例良好,1例较差。结论M atrix微弹簧圈是血管内栓塞治疗颅内动脉瘤的良好栓塞材料。     

血管栓塞术在颌面及耳鼻喉疾病的临床治疗效果分析

目的探讨血管栓塞术在颌面及耳鼻喉疾病的临床治疗效果。方法本组资料共有患者18例,所有患者均行局部麻醉,采用Seldinger's法经过皮股动脉做穿刺插管,在透视情况下将Simons导管超选择性送入病变部位供血动脉进行栓塞。对观察血管内栓塞治疗效果。结果 18例患者均治愈出院,4例颌面部进行性增大患者经过栓塞后有2例患者肿物消失,其余2例栓塞后病灶缩小,后经过手术切除治愈。外伤性鼻腔出血患者3例均行血管内栓塞止血,后痊愈出院。其余11例患者先行血管内栓塞,后进行病灶切除手术治愈。结论血管内栓塞术在治疗颌面及耳鼻喉疾病中疗效好,安全性高,可重复治疗,在临床中有很高的应用价值。     

支气管动脉栓塞术临床疗效影响因素的相关分析

目的探讨BAE临床疗效的相关影响因素。方法选取我科行BAE治疗患者72例,按随机方式平分为实验组和对照组各36例,实验组咯血患者在行BAE治疗过程中栓塞病变血管时,先选用300~500μm的明胶海绵颗粒栓塞远端血管,再用700~1000μm的明胶海绵颗粒栓塞病变血管主干。对照组采用常规的700~1000μm的明胶海绵颗粒栓塞病变血管。分别计算两组咯血患者行BAE术治疗的有效率。结果实验组36例中,有31例术后立即止血,4例于术后12h内继续内科治疗后方止血,1例对BAE治疗无效,有效率为92.7%;对照组36例中,30例术后立即止血,6例对BAE治疗无效,有效率为83.3%;两组有效率有差别,有统计学意义。结论 BAE是治疗咯血最有效的方法,应用大小不同的明胶海绵颗粒栓塞为栓塞剂并遵循动脉逐级密实栓塞的原则,安全、有效且临床疗效显著。     

Sevelamer arsenite nanoparticle as a Pi-responsive drug carrier and embolic agent for chemoembolization

Arsenic trioxide (As₂O₃, ATO) has limited therapeutic benefit to treat solid tumors, whether used alone or in combination. Nanoscale drug delivery vehicles have great potential to overcome the limitation of the utility of ATO by rapid renal clearance and dose-limiting toxicity. Polymeric materials ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) were developed for vascular embolic or chemoembolic applications. Recently, we have introduced sevelamer, an oral phosphate binder, as a new polymeric embolic for vascular interventional therapy. In this paper, sevelamer arsenite nanoparticle with a polygonal shape and a size of 50–300 nm, synthesized by anionic exchange from sevelamer chloride, was developed as a Pi-responsive bifunctional drug carrier and embolic agent for chemoembolization therapy. At the same arsenic dosage, sevelamer arsenite-induced severer tumor necrosis than ATO on the VX2 cancer model. In vitro tests evidenced that Pi deprivation by sevelamer could enhance ATO’s anticancer effect. The results showed that ATO in Pi starvation reduced cell viability, induced more apoptosis, and diminished the mitochondrial membrane potential (Δψm) of cells since Pi starvation helps ATO to further down-regulate Bcl-2 expression, up-regulate Bax expression, enhance the activation of caspase-3 and increase the release of cytochrome c, and the production of excessive reactive oxygen species (ROS). Sevelamer arsenite not only plays a Pi-activated nano-drug delivery system but also integrated anticancer drug with embolic for interventional therapy. Therefore, our results presented a new administration route of ATO as well as an alternative chemoembolization therapy.     

综合手术救治方舱内应用栓塞剂救治血管损伤的体会

目的探讨综合手术救治方舱内应用不同栓塞剂开展院前急救不同类型血管损伤的有效性和可行性。方法在综合手术救治方舱内制造不同类型血管损伤动物模型,应用不同栓塞剂,包括明胶海绵、海藻酸钠-壳聚糖微球、弹簧圈,进行介入救治手术实验,记录手术时间、手术效果、影像清晰度及设备可操控性,探讨其救治效果。结果共对10只实验动物分别应用明胶海绵、海藻酸钠-壳聚糖微球、电解可脱性弹簧圈实施损伤血管介入栓塞手术,成功10例,成功率100%,死亡0例。手术过程中数字化减影(DSA)成像性能及设备可操作性良好,可有效保障介入诊治顺利进行。结论灾难现场或战场一线在综合手术救治方舱内恰当选择不同栓塞剂介入救治不同类型血管损伤有效可行。     

Embolic agents used for bronchial artery embolisation in massive haemoptysis

Massive haemoptysis is a life-threatening disorder that is associated with a high mortality rate. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolisation is now considered to be the treatment of choice for acute massive haemoptysis. The safety and effectiveness of bronchial artery embolisation for massive haemoptysis has been proved since its first use in 1973. Currently, polyvinyl alcohol (PVA) particles are the most commonly used embolic agent for bronchial artery embolisation worldwide. PVA particles are biocompatible and nonbiodegradable and are considered to be a permanent embolic agent. Gelatin sponge is a temporary embolic agent and can be used as a supplementary agent after initial embolisation with PVA particles. Stainless steel coils are not recommended for embolisation of bronchial artery, although they may be used in the embolisation of internal mammary artery to preserve the normal vascular territory. Recently, the interest in the use of new embolic agents for bronchial artery embolisation is emerging because of inherent limitations of PVA particles as an intravascular embolic agent. Tris-acryl gelatin microspheres are a new embolic agent that is increasingly used for uterine fibroid embolisation. Tris-acryl gelatin microspheres have characteristics that make it an attractive alternative to PVA particles for bronchial artery embolisation. Clinical trials and experimental studies should be performed to explore the safety and efficacy of microspheres for bronchial artery embolisation.     

Embolic agents used for bronchial artery embolisation in massive haemoptysis

Massive haemoptysis is a life-threatening disorder that is associated with a high mortality rate. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolisation is now considered to be the treatment of choice for acute massive haemoptysis. The safety and effectiveness of bronchial artery embolisation for massive haemoptysis has been proved since its first use in 1973. Currently, polyvinyl alcohol (PVA) particles are the most commonly used embolic agent for bronchial artery embolisation worldwide. PVA particles are biocompatible and nonbiodegradable and are considered to be a permanent embolic agent. Gelatin sponge is a temporary embolic agent and can be used as a supplementary agent after initial embolisation with PVA particles. Stainless steel coils are not recommended for embolisation of bronchial artery, although they may be used in the embolisation of internal mammary artery to preserve the normal vascular territory. Recently, the interest in the use of new embolic agents for bronchial artery embolisation is emerging because of inherent limitations of PVA particles as an intravascular embolic agent. Tris-acryl gelatin microspheres are a new embolic agent that is increasingly used for uterine fibroid embolisation. Tris-acryl gelatin microspheres have characteristics that make it an attractive alternative to PVA particles for bronchial artery embolisation. Clinical trials and experimental studies should be performed to explore the safety and efficacy of microspheres for bronchial artery embolisation.     

动脉栓塞微球的研究进展

动脉栓塞是指将栓塞剂选择性地注入病变靶区供血动脉,有效阻断血流,以达到预定治疗目的的技术,治疗恶性肿瘤效果显著。微球作为栓塞剂的治疗结果更加安全有效,它具有独特的球形外观和良好的栓塞性能,是目前最常用的栓塞剂。现按照基质的不同对栓塞微球进行分类,对动脉栓塞微球研究进展进行总结,着重介绍了各类栓塞微球的基础研究和临床应用状况,并探讨了栓塞微球的发展趋势。     

Yashiro导管用于髂动脉插管治疗盆腔疾病的临床探讨

目的探讨常用于肝脏介入治疗的Yashiro导管在同侧髂内外动脉插管治疗盆腔肿瘤及子宫出血病变的临床应用价值。方法回顾性分析近年来在我院经股动脉穿刺插管血管介入治疗盆腔肿瘤及子宫出血病变共26例,分为两组,其中应用Yashiro导管行穿刺侧髂外动脉成功插入同侧髂内动脉治疗盆腔肿瘤及子宫出血病变14例为A组（研究组）,应用单弯或Cobora导管长襻技术行双侧穿刺髂内外动脉分支交换插管12例为B组（对照组）;比较两组的操作方法、步骤、出血量、所耗时间及手术风险。结果应用肝导管（Yashiro管）短襻技术在同侧髂动脉插管治疗盆腔肿瘤及子宫出血病变操作简便、可节省大量的时间、降低手术风险。结论利用肝导管在同侧髂动脉分支插管介入治疗盆腔肿瘤或出血病变具有重要意义。     

Development of cisplatin-loaded hydrogels for trans-portal vein chemoembolization in an orthotopic liver cancer mouse model

Transarterial chemoembolization is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). This study evaluated the anti-tumor effect of the semi-interpenetrating network (IPN) hydrogel as a novel embolic material for trans-portal vein chemoembolization (TPVE) in vivo. A nude mice orthotopic HCC model was established, followed by TPVE using IPN hydrogel loaded with or without cisplatin. Portal vein blockade was visualized by MRI and the development of tumor was monitored by IVIS Spectrum Imaging. Tumor proliferation and angiogenesis were evaluated by Ki67 and CD34 staining respectively. Intra-tumor caspase 3, Akt, ERK1/2, and VEGF activation were detected by Western Blot. ¹⁸F-FMISO uptake was evaluated by microPET-MRI scanning. IPN hydrogel first embolized the left branch of portal vein within 24 hours and further integrated into the intra-tumor vessels during 2 weeks after the treatment. Mice treated with cisplatin-loaded hydrogels exhibited a significant decrease in tumor growth, along with lower plasma AFP levels as compared to hydrogel-treated and untreated tumor-bearing mice. By Ki67 and CD34 staining, the TPVE with IPN hydrogel suppressed tumor proliferation and angiogenesis. In addition, increased tumor apoptosis shown by up-regulation of caspase 3 with decreased expressions of tumor cell survival indicators Akt and ERK1/2 were observed in the treatment groups. Consistent with the decreased expression of VEGF after TPVE, hypoxia level in the tumor was also reduced as indicated by ¹⁸F-FMISO uptake level. IPN hydrogel-based TPVE significantly suppressed the tumor development by regulating intra-tumor angiogenesis and cell survival in an orthotopic HCC mouse model, suggesting a viable embolic agent for transarterial chemoembolization.     

Subungual glomus tumor: surgical and histopathologic evaluation

Glomus tumor is a rare and benign vascular tumor, arising from neuromyoarterial glomus bodies. It is generally localized on the hand and especially the nail bed and is usually solitary. Pain, tenderness, and temperature sensitivity are the classic triad of symptoms of a glomus tumor. Owing to the small lesions and absence of specific skin features in the nail bed and nail matrix localizations, glomus tumor may not be taken into consideration. In particular, presentation of patients to practitioners of different disciplines for treatment of pain may cause diagnostic delays. Surgical excision is the most effective treatment approach and provides histopathologic diagnosis and rapid improvement of symptoms. This article describes a patient with a subungual glomus tumor for which surgical excision was performed.     

Subungual glomus tumor: surgical and histopathologic evaluation

Glomus tumor is a rare and benign vascular tumor, arising from neuromyoarterial glomus bodies. It is generally localized on the hand and especially the nail bed and is usually solitary. Pain, tenderness, and temperature sensitivity are the classic triad of symptoms of a glomus tumor. Owing to the small lesions and absence of specific skin features in the nail bed and nail matrix localizations, glomus tumor may not be taken into consideration. In particular, presentation of patients to practitioners of different disciplines for treatment of pain may cause diagnostic delays. Surgical excision is the most effective treatment approach and provides histopathologic diagnosis and rapid improvement of symptoms. This article describes a patient with a subungual glomus tumor for which surgical excision was performed.