超声引导下应用聚桂醇和无水乙醇抽吸固化治疗中老年肝肾囊肿的效果

目的观察对比超声引导下应用聚桂醇和无水乙醇抽吸固化治疗中老年肝肾囊肿的效果。方法肝肾囊肿中老年患者324例分为观察组和对照组各162例。患者均行超声引导下抽吸固化治疗。观察组使用聚桂醇,对照组使用无水乙醇,观察两组临床疗效、术后并发症及治疗前后肝肾功能的变化。结果观察组治疗总有效率高于对照组,但差异无统计学意义(P0.05);观察组不良反应发生率明显低于对照组(P0.05)。两组治疗前总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、胆碱酯酶(CHE)差异均无统计学意义(P0.05),治疗后1 w对照组ALT、AST水平明显高于观察组(P0.05)。治疗后6个月两组上述指标差异均无统计学意义(P0.05)。结论超声引导下应用聚桂醇抽吸固化治疗中老年肝肾囊肿的效果与无水乙醇无明显差别,聚桂醇且不良反应低,短期内对患者肝功能影响小。     

超声引导下穿刺注射聚桂醇或无水乙醇治疗肝囊肿患者疗效研究

目的 比较在超声引导下穿刺注射无水乙醇与聚桂醇治疗肝囊肿患者的疗效。方法 2020年6月～2022年10月我院收治的肝囊肿患者62例,其中在30例行在超声引导下穿刺注射无水乙醇治疗,在另32例行在超声引导下穿刺注射聚桂醇治疗,随访6个月。采用化学发光法检测血清淀粉样蛋白A(SAA)和C反应蛋白(CRP),采用放射免疫法检测血清皮质醇(Cor)和肾上腺素(E)。结果 在治疗后6个月末,超声复查发现无水乙醇治疗组治愈率为96.7%,显著高于聚桂醇治疗组的75.0%(P<0.05);术后3 d复查,无水乙醇治疗组血清SAA、CRP、Cor和E水平分别为(20.7±2.3)mg/L、(35.8±3.8)mg/L、(336.4±24.9)nmol/L和(49.4±6.0)ng/L,均显著高于聚桂醇治疗组【分别为(16.5±2.2)mg/L、(21.9±3.2)mg/L、(282.0±25.9)nmol/L和(39.1±5.3)ng/L,P<0.05】;无水乙醇治疗组醉酒样反应、腹痛、发热和消化道症状等不良反应发生率为43.3%,显著高于聚桂醇治疗组的12.5%(P<0.05)。...     

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。     

超声引导下无水乙醇与聚桂醇硬化治疗较大单纯性肝囊肿的临床疗效对比分析

目的对比研究超声引导下无水乙醇与聚桂醇注射液治疗单纯性肝囊肿的临床疗效及不良反应发生情况.方法选取2009-09/2016-09天津医科大学总医院收治的直径≥8 cm单纯性肝囊肿患者112例,根据治疗方法不同分为无水乙醇治疗组(A组,69例)和聚桂醇治疗组(B组,43例),比较两组患者治疗的临床疗效和不良反应发生情况;A组根据囊肿直径分为A组(8-12 cm)、B组(13-16 cm)、C组(17-20 cm),B组根据囊肿直径分为D组(8-12 cm)、E组(13-16 cm)、F组(17-20 cm);分别比较3组之间不良反应发生率及肝功能异常发生情况.结果两组患者的临床治疗总有效率分别为95.7%,95.4%,差异无统计学意义(P0.05);B组的治愈率(67.4%)要优于A组(47.8%);A组不良反应发生率(39.1%)明显高于B组(18.6%),差异有统计学意义(P0.05),且腹痛、腹胀及肝功能异常的发生率A组要明显高于B组(P0.05或P0.01).经无水乙醇治疗的A、B、C三组,不良反应发生率分别为15.4%、43.8%、81.8%,各组间比较差异存在统计学意义(P0.01),C组较A、B组均有明显的统计意义(P0.05或P0.001);其中肝功能异常发生率,3组分别为11.5%,37.5%,81.8%,各组间比较差异存在统计学意义(P0.001),C组较A、B组均有明显的统计意义(P0.05或P0.001).经聚桂醇治疗D、E、F组,不良反应和肝功能异常发生率各组间比较均无统计学意义(P0.05).结论超声引导下无水乙醇与聚桂醇硬化治疗较大肝囊肿的总有效率相当,但聚桂醇治疗的治愈率更高,不良反应发生率低,值得临床推广;无水乙醇治疗期间,肝囊肿的直径越大,患者的不良反应发生率越高,对肝功能的影响越大.     

超声引导下两种硬化剂药物治疗单纯性肝囊肿的疗效及并发症观察研究

背景近年来,超声介入技术发展迅速,超声引导下注射硬化剂治疗单纯性肝囊肿具有创伤小、并发症少、操作简便、疗效显著等优点,越来越受到临床重视,并成为单纯性肝囊肿的首选治疗手段.而其临床治疗效果与所使用的硬化剂种类密切相关.目的探讨超声引导下注射不同药物治疗单纯性肝囊肿的效果及其临床应用价值.方法回顾性分析我院收治的126例单纯性肝囊肿患者(共126个单纯性肝囊肿)的临床资料,按硬化剂药物不同分为聚桂醇组(63例,超声引导下注射聚桂醇治疗)和高渗葡萄糖组(63例,超声引导下注射高渗葡萄糖治疗),比较两组术中、术后1 mo的并发症情况以及术后3 mo的临床疗效.结果聚桂醇组治疗总有效率(98.41%)明显高于高渗葡萄糖组(73.02%),差异有统计学意义(P<0.05);聚桂醇组术后并发症总发生率(7.94%)明显低于高渗葡萄糖组(22.22%),差异有统计学意义(P<0.05).结论超声引导下注射硬化剂治疗单纯性肝囊肿疗效确切,而注射聚桂醇的疗效及安全性优于高渗葡萄糖,值得临床推广应用.     

超声引导下聚桂醇硬化术治疗良性甲状腺囊肿的疗效及安全性分析

目的探讨超声引导下聚桂醇硬化术治疗良性甲状腺囊肿(BTC)的疗效及安全性。方法选取2017年6月至2019年6月本月BTC患者180例,按随机数字表分为聚硬组(n=80)和乙硬组(n=80),聚硬组给予超声引导下聚桂醇硬化术,乙硬组给予超声引导下无水乙醇硬化术,比较两组囊腔体积、治疗疗效、并发症、不良反应。结果聚硬组和乙硬组术后1、3、6个月囊腔体积明显低于术前,差异有统计学意义(P0.05),聚硬组和乙硬组术后1、3、6个月囊腔体积比较差异无统计学意义(P0.05);聚硬组和乙硬组治疗有效率、并发症率比较差异无统计学意义(P0.05);聚硬组不良反应率明显低于乙硬组,差异有统计学意义(P0.05)。结论与无水乙醇比较,超声引导下聚桂醇硬化术也可有效缩小BTC患者囊腔体积,具有良好的疗效及安全性,可减轻患者不良反应,值得临床推广。     

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。     

Sclerotherapy of simple hepatic cysts by repeated aspiration and alcohol instillation

Background/aims: The efficacy and safety of traditional alcohol sclerotherapy procedures are controversial in the management of large simple hepatic cysts. In this study, we aimed to develop and evaluate a novel alcohol sclerotherapy procedure, termed repeated aspiration and alcohol instillation sclerotherapy, for the treatment of simple hepatic cysts. Materials and Methods: A prospective, double-blind, randomized study was performed. Sixty-seven patients with large simple hepatic cysts were randomized into two groups to receive either single-session alcohol retention sclerotherapy (alcohol was instilled into the cyst cavity, kept for 20 minutes and aspirated) or repeated aspiration and alcohol instillation sclerotherapy (instillation of 30-70 ml of alcohol and immediate aspiration with repetition 3 to 6 times until the estimated alcohol concentration exceeded 80%). The cyst volume reduction was calculated to compare the efficacy of the two procedures. We evaluated the safety of the procedure by monitoring side effects and assaying blood alcohol concentrations at 0, 0.5, 1, 2 and 3 hours after sclerotherapy. Results: The cyst volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy was significantly higher than that in those receiving alcoholretention sclerotherapy. The concentration of alcohol in the last aspirated cyst fluid was correlated with the mean volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy but not in the alcohol-retention group. Only minor side effects occurred in both groups. Although elevated blood alcohol concentration was noted in all patients, it declined to normal levels within 2-3 hours after treatment. There were no significant differences in blood alcohol concentration between the two groups. Conclusions: Repeated aspiration and alcohol instillation sclerotherapy is superior to single-session alcohol-retention sclerotherapy in the management of large simple hepatic cysts.     

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。     

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。     

Fine needle sclerotherapy as a new effective therapeutic approach for nonparasitic splenic cysts: A case series

BackgroundNonparasitic splenic cysts are rare. Until now, surgical intervention has been the standard therapy of symptomatic splenic cysts.AimsWe herein present a retrospective analysis of an approach using percutaneous ultrasound-guided fine needle aspiration and sclerotherapy.MethodsOut of 88,151 ultrasound reports, we identified 138 patients who presented with splenic cysts. A single splenic cyst was found in 88% (mean size 28.9 mm). Twelve patients underwent percutaneous therapy of symptomatic splenic cysts. They were younger, had larger splenic cysts and more often cyst internal echoes than the 126 untreated patients (all p < 0.0001).ResultsInitial sclerotherapy was performed with polidocanol 1% in 9 patients and with NaCl 10% in 2 patients. One hemorrhagic cyst was only purged. Serious adverse events were not noted. Eight patients had to undergo 1–11 further percutaneous cyst therapies. 15 of these 30 reinterventions were cyst aspiration therapies, only, and 11 of them were sclerotherapies with NaCl 10%. Four patients were readmitted to hospital for cyst retreatment. After 57 ± 43 months of follow-up, cyst size significantly decreased (p < 0.0001). Only two patients had a complicated course of cyst therapy.ConclusionsPercutaneous ultrasound-guided sclerotherapy is a new approach for symptomatic splenic cysts. In most patients, cyst size and symptoms can be significantly reduced during one hospital stay.     

Alcohol Sclerosis for Polycystic Liver Disease and Obstructive Jaundice: Use of a Nasobiliary Catheter

We report the use of a nasobiliary catheter in the management of a 55-yr-old female with autosomal dominant polycentric kidney disease who developed obstructive jaundice from a hepatic cyst. The patient presented with a 2-wk history of fatigue, jaundice, nausea, vomiting, and abdominal pain. Physical examination was remarkable for tender hepatomegaly. Computerized tomography revealed multiple hepatic cysts and dilated intrahepatic iliary radicles. Endoscopic stent placement failed to relieve the obstruction. Computerized tomography guided percutaneous aspiration of the obstructing hepatic cyst was successful with the aid of a nasobiliary cholangiogram allowing visualization of the biliary tree and identification of the obstructing hepatic cyst. However, the cyst rapidly accumulated fluid, and the obstruction recurred within 1 wk of simple aspiration. Relief of symptoms was maintained only after alcohol sclerosis of the obstructing hepatic cyst. Review of the literature shows that alcohol sclerotherapy is a safe and eftective nonsurgical means of treating symptomatic hepatic cysts.     

Unexpected outcome after sclerotherapy of simple renal cyst

ABSTRACT: BACKGROUND: Simple renal cysts usually have benign clinical features. We report a rare case of papillary renal cell carcinoma (RCC) associated with a large recurrent simple cyst following sclerotherapy. Case Presentation A 47-year-old Japanese woman received minocycline sclerotherapy for a large (9 cm in diameter) simple left renal cyst in May 2005. The cyst regrew, and second-line sclerotherapy with ethanol was performed in November 2005. Three years later, she developed papillary RCC on the wall of the recurrent renal cyst. Radical nephrectomy was performed, but the patient died of metastatic disease 15 months after surgery. CONCLUSION: Malignant transformation from recurrent simple renal cyst to RCC may occur in the years following sclerotherapy, underscoring the need for long-term follow-up. Key words: papillary renal cell carcinoma, simple renal cyst, sclerotherapy, malignant transformation.     

Functional similarities of hepatic cystic and biliary epithelium: studies of fluid constituents and in vivo secretion in response to secretin

Hepatic cysts are a frequent manifestation of autosomal dominant polycystic kidney disease, but little is known about their functional characteristics. The goals of our study were to define the composition of hepatic cyst fluid and to determine whether hepatic cysts secrete in response to intravenously administered secretin. We percutaneously punctured five hepatic cysts and one proximal renal cyst from six subjects with autosomal dominant polycystic kidney disease and one solitary hepatic cyst from a subject without autosomal dominant polycystic kidney disease. Most fluids had an electrolyte composition similar to serum. Fluid from all hepatic cysts had glutamyltranspeptidase concentrations above those found in serum [( cyst]/[serum] = 4.93 +/- 5.92), contained secretory component (the epithelial receptor for polymeric IgA) and had glucose concentrations less than 15 mg/dl. Fluid from both hepatic and renal cysts of subjects with autosomal dominant polycystic kidney disease, but not from the subject with the solitary hepatic cyst, demonstrated extensive changes in the electrophoretic mobility of several serum proteins. Initial intracystic pressures ranged from 16 to 40 cm H2O, were reduced 57% to 97% after aspiration of a portion of cyst fluid and were held constant during the secretion study. Within 8 min of the intravenous administration of secretin, secretion of fluid increased in two of three hepatic cysts and in the renal cyst. The electrolyte composition of cyst fluids was not altered by secretin. These data suggest that hepatic cystic epithelium has functional characteristics of biliary epithelium and that secretion by both hepatic and renal cysts may be hormonally regulated.