多层螺旋CT导向下经皮肾穿刺硬化治疗肾囊肿的临床价值

目的：探讨多层螺旋CT（MSCT）导向下经皮肾穿刺硬化治疗肾囊肿的方法及疗效。方法：经MSCT或MRI诊断的91例107个肾囊肿在MSCT导向下经皮穿刺抽吸、冲洗后注入无水乙醇（99.7%）,注入量为抽出囊液量的25%~30%。须多次抽吸冲洗,直至抽出液清亮。术后螺旋CT跟踪随访1年,评价其疗效。结果：本组107个囊肿穿刺成功率100%,其中71个囊肿在治疗后消失,34个囊肿较治疗前缩小,2个囊肿未见改变。治疗有效率98.1%。所有病例均未出现严重并发症。结论：MSCT引导下经皮肾穿刺硬化治疗肾囊肿是一种安全有效的治疗方法,有重要的临床应用价值。     

国内超声介入治疗肝脏疾病现状

1肝棘球蚴病肝棘球蚴病经皮穿刺治疗一直被列为禁忌。袁名辉等[1]在治疗肝囊肿、肾囊肿和动物实验的基础上．对167例肝棘球蚴病患者的238个包囊进行了B超引导下经皮肝穿刺硬化治疗。治愈163例，占97．6％；4例2年后复发，占2．4％，远低于手术摘除内囊复发率的12％。1例出现轻度过敏反应。无扩散种植和死亡。刘廷善等”‘治疗120例，202个包囊，随访3～4年，囊肿消失占95．84％，1年以后复发占4．16％，元并发症。治疗时，术前给予10mg地塞米松，术中快速穿刺抽吸减压，囊液吸尽后按比例先后注入过氧化氢、高渗氯化钠液、无水乙醇冲洗囊腔…     

经皮肝、肾、卵巢囊肿穿刺硬化术乙醇注入方法与剂量探讨

目的：探讨经皮穿刺肝，肾，卵巢囊肿硬化术中注入无水乙醇方法与剂量。资料与方法：CT引导下采用“常规治疗法”和“置换注入法”分别对我院1997年2月-2000年7月间154例187个囊肿和2000年8月-2004年12月间183例226个囊肿进行治疗，并对照分析两组病例术后第12月的观察资料。结果：“置换注入法”组穿刺针尖脱出囊肿与“常规治疗法”组对照P〈0．01；“置换注入法”组接受1次治疗病例中Ⅲ级疗效达83．6％。高于“常规治疗法”组64．2％，P〈0．01；两组数据中男女病人数、失访囊肿个数和各组中肝、肾、卵巢囊肿个数P〉0．05，无统计学意义。结论：置换注入法”明显提高手术成功率和囊肿治愈率；囊肿内保留20—30ml70％-75％乙醇不仅安全，而且有利于囊肿的治愈。     

DSA引导下注射高渗葡萄糖及无水乙醇对巨大肝囊肿硬化治疗效果的对照分析

目的 探讨DSA引导下经皮穿刺分别注射高渗葡萄糖及无水乙醇置管引流治疗巨大肝囊肿的3、6和12个月疗效比较.方法 回顾性选择临床资料完整的73例单纯性肝囊肿患者行对照研究,其中27例行高渗葡萄糖硬化治疗(A组),46例行无水乙醇硬化治疗(B组)为对照组.囊肿直径8.3 ～ 15.8 cm.所有病灶均在DSA引导下进行肝囊肿穿刺抽液,置管引流硬化治疗;术后3、6和12个月比较其疗效.结果 73例患者全部顺利完成治疗,肝囊肿穿刺成功率100%,两组3、6和12个月疗效差异无显著性,P值分别为0.526、0.713、0.613(P均＞ 0.05).结论 DSA引导下经皮穿刺置管引流后注射高渗葡萄糖或无水乙醇硬化治疗肝囊肿在3、6和12个月疗效上无明显差异,其中,高渗葡萄糖硬化术后不适症状少,更适合体弱的中老年患者.     

CT引导下穿刺注射硬化剂治疗卵巢囊肿61例分析

CT引导下的囊肿抽吸和乙醇硬化治疗已成为肝囊肿和。肾囊肿的首选治疗方法,而卵巢囊肿的硬化剂治疗临床报道较少。2010年1月至2012年6月,我科利用CT下引导经皮穿刺注射硬化剂治疗卵巢囊肿患者61例,效果满意,报告如下。     

CT导向下肾囊肿的穿刺硬化治疗

目的 评价CT导向下经皮穿刺无水乙醇注射治疗肾囊肿的临床应用价值。资料与方法 16例24个肾囊肿，其中单纯性肾囊肿10例，肾盂旁囊肿2例，多囊肾4例，在CT导向下行穿刺无水乙醇硬化治疗，分析其并发症，并追踪观察其疗效。结果 16例中，24个囊肿顺利完成穿刺硬化治疗，无严重并发症发生，对18个囊肿术后追踪观察3个月-1年，0-Ⅲ级囊肿疗效个数分别为1（5.6%)，2（11.1%),3(16.7%)和12（66.7%)，临床症状缓解率为81.8%(9/11)。结论 CT导向下经皮肾囊肿穿刺无水乙醇硬化治疗是一种安全有效的治疗方法。     

CT引导经臀内下1／4象限后入路介入治疗子宫后位卵巢囊肿的初步经验

目的:(1)探讨经臀内下1/4象限后入路治疗子宫后位卵巢囊肿疗效;(2)确立在臀内下1/4象限穿刺,经皮经臀大肌、梨状肌入盆腔穿入囊肿治疗路径的安全性和实用性。材料和方法:32例患者,在CT引导下穿刺针经臀大肌,梨状肌入盆腔硬化治疗子宫后位卵巢囊肿。结果:经治的32例子宫后位卵巢囊肿患者,副损伤小,无并发症;6个月内随访,有效率100%,治愈率96.8%。确立后入路安全进针三角区。结论:CT引导经臀内下1/4象限后入路介入治疗子宫后位卵巢囊肿是副损伤小、疗效肯定和安全微创的治疗方法。     

高原地区肺包虫囊肿超声引导穿刺硬化治疗的远期疗效观察

目的评价超声引导穿刺硬化治疗肺包虫囊肿的远期疗效。方法6例6个肺包虫囊肿在超声引导下经皮穿刺硬化治疗,术后超声随访观察8.7年。结果超声引导穿刺成功率100%。穿刺术后未出现过敏、出血、感染,亦未出现气胸、支气管胸膜瘘、囊腔破裂等并发症;经超声及CT检查未发现沿针道种植的任何迹象。显效率83.33%。结论超声引导穿刺硬化治疗肺包虫囊肿安全实用,疗效显著,开辟了一条非开放性手术的新途径。     

CDFI引导套管法穿刺硬化治疗卵巢子宫内膜异位囊肿的临床价值

目的：探讨在彩色多普勒（CDFI）超声引导下套管法穿刺硬化治疗卵巢子宫内膜异位囊肿，以提高治愈率，减少术后不良反应。方法：对47例51个囊肿在CDFI引导下用常规法穿刺并保留无水乙醇或套管法穿刺不保留无水乙醇，经腹（TAS）或经阴道（TVS）穿刺硬化治疗，随访观察治疗效果。结果：51个囊肿，常规法穿刺治疗22个囊肿，消失18个，治愈率81．8％（18／22），术后不良反应出现率45．0％（9／20），套管法穿刺治疗27例，29个囊肿，消失28个，治愈率96．55％（28／29），术后不良反应出现率18．5％（5／27）。结论：CDFI引导套管法穿刺硬化治疗卵巢子宫内膜异位囊肿明显优于常规法，在治愈病灶的同时，保留卵巢功能，提高术后妊娠率，是一种安全、有效的治疗方法。     

CT导向下无水乙醇硬化治疗肝囊肿

目的评价在CT导向下经皮穿刺硬化治疗肝囊肿的临床价值。方法63例肝囊肿患者,其中41例单发,22例多发,均任CT导向下经皮穿刺注射无水乙醇行硬化治疗。结果63例患者随访3～15个月,疗效指数0级4例(6.3%),Ⅰ级8例(12.7%),Ⅱ级23例(36.5%),Ⅲ级28例(44.4%)。硬化治疗总有效率为93.6%。未出现严重的并发症。结论无水乙醇硬化治疗肝囊肿安全、经济、简单、有效。     

Sclerotherapy of renal cysts using acetic acid: a comparison with ethanol sclerotherapy

This study compared percutaneous sclerotherapy using 50% acetic acid with that using 99% ethanol for patients with simple renal cysts. The study included 72 simple renal cysts in 64 patients (male/female ratio = 31/33; age range, 31-75 years). Under fluoroscopic guidance, the cyst fluid was aspirated completely. Sclerotherapy was then performed using 50% acetic acid for 32 cysts and 99% ethanol for 40 cysts. The volumes of each renal cyst before and after sclerotherapy were compared using ultrasonography or CT. Medical records were reviewed to analyse any complications. The mean follow-up period was 21.5 months (range, 3-75 months). The mean remnant volume of the cyst after sclerotherapy was 2.6% of the initial volume in the acetic acid group and 14.0% in the ethanol group. The rates of complete remission, partial remission and treatment failure were 90.6%, 9.4% and 0%, respectively, in the acetic acid group, and 60.0%, 30.0% and 10.0%, respectively, in the ethanol group. There were no complications related to sclerotherapy in either group. In conclusion, acetic acid is a safe and effective sclerosing agent, with clinical results superior to those of ethanol, and is an alternative to ethanol for sclerotherapy of renal cysts.     

One-year Results of Single-session Sclerotherapy with Bleomycin in Simple Renal Cysts

PurposeTo evaluate the efficacy and safety of single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy for the treatment of simple renal cysts.Materials and MethodsA total of 66 renal cysts in 53 patients were treated by single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy under computed tomography (CT) guidance. Symptomatic (n = 31) and asymptomatic cysts (n = 22) with maximum diameters greater than 5 cm were treated. As much liquid content of each cyst was aspirated as possible, and bleomycin was injected and remained in the cyst. Follow-up was performed with ultrasonography or CT every 3 months until 1 year, and cyst volume was calculated before and after sclerotherapy. Therapeutic response was assessed by cyst volume reduction rate (VRR) and classified as complete regression (CR; ie, invisible), near-CR (ie, VRR>85%), partial regression (PR; ie, VRR of 50%–85%), or no response (NR; ie, VRR<50%). Medical records were reviewed to analyze complications.ResultsCysts refilled partially in the initial stage after sclerotherapy and decreased gradually in size over the entire follow-up period. At 1-year follow-up, the overall response rate was 98.5% (65 of 66), with CR in 31 cysts (47.0%), near-CR in 24 cysts (36.4%), PR in 10 cysts (15.1%), and NR in one cyst (1.5%). No major complications were encountered.ConclusionsSingle-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy is a simple, safe, effective, well tolerated alternative technique for management of simple renal cysts.     

超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿

目的评价超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿的效果。方法46例单纯性肾囊肿患者(男性26例,女性20例,平均年龄65岁)均经超声引导经皮穿刺抽吸和注射无水乙醇硬化治疗。全部操作是在局部麻醉下完成的。治疗后,全部病人经超声或CT随访1至6个月。囊肿与治疗前比较,减小2/3以上为有效,完全消失为治愈。结果46个囊肿中,2个囊肿抽出液蛋白定性试验阴性,抽液后未注入无水乙醇,其余44个囊肿于治后1,3,6个月呈进行性缩小,6个月时复查有效率为100%,治愈率为90.6%。结论超声引导经皮穿刺抽吸和注射无水乙醇是治疗单纯性肾囊肿的一种操作简单、痛苦小、费用低、安全有效的方法,值得临床推广应用。     

CT引导下介入治疗肾囊肿的临床应用

目的探讨CT引导下穿刺硬化剂治疗肾囊肿的方法及疗效。方法经B超或CT诊断的78例84个肾囊肿在CT定位下经皮穿刺抽吸,行无水乙醇反复冲洗法硬化剂治疗,用18~22 G穿刺针抽吸,注入99.7%无水乙醇,注射量为抽出囊液量的25%~30%。术后每隔3个月复查,随访其疗效。结果其中79个囊肿一次穿刺成功,随访3个月~1年,复查见51例54个囊肿消失,22例24个囊肿缩小,4例4个囊肿未见缩小。有效率95.2%,消失率64.2%,无严重并发症。结论CT引导下经皮穿刺硬化剂治疗肾囊肿是一种安全、有效的治疗方法,具有较高的临床实用价值。     

CT导引下置猪尾导管硬化治疗巨大肝肾囊肿疗效观察

目的探讨CT导引下穿刺置猪尾引流管硬化巨大肝肾囊肿安全性及疗效。方法CT导引下对17例巨大肝肾囊肿患者,穿刺置入7F猪尾导管引流,并且每日注射无水乙醇或乙酸1次。对于囊液<500ml者,每次注入硬化剂后夹闭引流管,24h后再开放引流。囊液大于500ml者,硬化后立即开放引流。所有患者24h引流量<10ml时,再次硬化后拔除引流管。其中肝囊肿平均拔管时间40d;肾囊肿10d。结果本组硬化治疗后6个月,复查B超示治愈17例,治愈率100%。无一例出血、感染及出现心脑血管并发症。结论CT导引下置猪尾巴管硬化治疗巨大肝肾囊肿简单安全、疗效满意。     

Percutaneous aspiration and ethanol sclerotherapy of symptomatic hepatic cysts

Nineteen patients with 49 symptomatic non-neoplastic non-parasitic simple hepatic cysts were subjected to ultrasonographically guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. Small cysts were treated twice, the large ones three times at the same sitting. The volume of alcohol per injection varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one ethanol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. Forty-seven of the 49 cysts could be treated adequately, and did not recur during a follow-up period af 12–40 months. The results indicate that aspiration an and ethanol sclerotherapy is the treatment of choice in patients with symptomatic non-neoplastic simple hepatic cysts or polycystic liver disease. Correspondence to: A. Leinonen     

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.     

Efficacy of Single-Session Percutaneous Drainage and 50% Acetic Acid Sclerotherapy for Treatment of Simple Renal Cysts

Purpose To evaluate the efficacy and long-term results of single-session 50% acetic acid sclerotherapy for the treatment of simple renal cysts, and to compare the therapeutic results of 5 and 20 min sclerosant dwell techniques. Methods During the past 9 years, 50% acetic acid sclerotherapy was performed on 67 cysts in 66 patients. An acetic acid volume corresponding to a mean of 23% of the aspirated cyst volume was injected into the cysts. A 20 min dwell time with position changes was performed in 32 cysts (31 patients; group I) and 8% of volume for a 5 min dwell time in 35 cysts (35 patients; group II). Three- and 6-month sonographic or CT follow-up was performed for a minimum of 1 year. Complete regression was defined as no remaining cyst measurable on sonography with or without a scar at the renal cortex. Partial regression was defined as a decreased cyst volume compared with that before sclerotherapy. The Mann-Whitney U-test was used to compare the therapeutic results between the two groups. Results For 67 simple renal cysts, complete regression on follow-up was observed in 21 of 32 cysts (66%; group I) and 22 of 35 cysts (63%; group II); the remaining 24 cysts all showed partial regression. The partial reduction rate of the cyst’s volume was 97.4% (91.3–99.4%) in group I and 96.9% (90.8–99.5 %) in group II. There were no procedure-related major complications, and no statistically significant differences in the complete regression and partial volume reduction rates between the two groups (p > 0.05). Conclusion Fifty percent acetic acid is an effective and safe sclerosing agent for simple renal cysts. Fifty percent acetic acid sclerotherapy with a 5 min sclerosant dwell time, using a volume of about 10% of the aspirated volume, is sufficient for satisfactory results of simple renal cyst sclerotherapy.     

Percutaneous treatment of simple renal cysts with sclerotherapy and extended drainage

PURPOSE: To present the long-term results of sclerotherapy of symptomatic simple renal cysts with alcohol and aethoxysclerol followed by protracted seven-day drainage and to compare the efficacy of the two sclerosing agents used in the therapy. MATERIALS AND METHODS: Sixty-six symptomatic patients underwent percutaneous treatment with drainage and sclerotherapy of 72 simple renal cysts in a day hospital setting. The cysts were divided into two groups according to size (Group I and Group II with cyst volume smaller or larger than 600 ml respectively) for a better comparison of the results. The cysts were punctured directly under local anaesthesia with a 7 French Trocar catheter using the 'one-shot' technique and ultrasound guidance; a pig tail catheter was then left in the cyst for the complete evacuation of the cyst fluid. Sclerotherapy was performed by injection of 95% alcohol or 3% aethoxysclerol for 40 minutes, followed by seven-day drainage. On the basis of dimensional criteria, response to treatment was defined as: recovery, partial recurrence or recurrence. RESULTS: The procedure was successful in 97.2% of the cases with regard to cyst drainage, with clinical recovery in 95.3% of the cases. Group I had 14 recoveries and no complete recurrence after either alcohol or aethoxysclerol, 2 partial recurrences with alcohol and 4 partial recurrences with aethoxysclerol; Group II had 15 recoveries, 14 partial recurrences and one complete recurrence with alcohol, and 5 recoveries, 8 partial recurrences and 2 complete recurrences with aethoxysclerol. CONCLUSIONS: The one-shot technique under ultrasound guidance prevents the risk of major complications, reduces the likelihood of failure and is inexpensive; furthermore, it significantly reduces procedure time and is better tolerated by patients. On the basis of the clinical and dimensional results obtained, percutaneous sclerotherapy of renal cysts can be recommended as the treatment of choice and as a valid alternative to laparoscopy. As for the comparison between the two sclerosing agents, alcohol has a higher cost and negative side effects, but is more effective for the treatment of larger cysts. Aethoxysclerol is less expensive and has no side effects, but tends to lead to septic complications. On the basis of our experience, we therefore recommend the use of aethoxysclerol for sclerotherapy of smaller cysts followed by a 4-day drainage. For larger cysts, we recommend repeated alcoholization and the removal of the drainage catheter after seven days.     

Sonographically guided ethanol sclerotherapy for benign thyroid cysts: results in 22 patients

OBJECTIVE: We evaluate the efficacy and safety of sonographically guided ethanol sclerotherapy for benign thyroid cysts. SUBJECTS AND METHODS: We examined 22 patients with benign thyroid cysts (13 complex cysts and nine pure cysts) confirmed by fine-needle aspiration biopsy. Sonographically guided aspiration of the cystic fluid was followed by instillation of absolute ethanol (99.9%) into the cystic cavity: the injected volume of ethanol was 40-100% of the volume of fluid aspirated. The procedure was performed every 1 or 3 months for one or two sessions (mean, 1.2 sessions). Follow-up sonography was performed 1-10 months after the final session, and we observed patients after ethanol sclerotherapy for complications. RESULTS: The initial volume of the cysts ranged from 3.5 to 42 ml. In 21 patients, the volume of the cyst decreased or the cyst was obliterated. The volume of the cyst was reduced by 50-99% in 13 patients and by 1-49% in six patients, and the cyst was obliterated in two patients. In one patient, the volume of the cyst increased. The volume of ethanol instilled was significantly correlated with the volume reduction rate of the cyst. There was a difference in the volume reduction rate between patients in whom 10 ml or more of initial volume was used and those in whom less than 10 ml of initial volume was used; that is, the volume reduction rate of the group with the initial cyst volume of more than 10 ml was higher than that of the other group. Important long-standing and severe complications were not observed. CONCLUSION: Sonographically guided ethanol sclerotherapy is a safe and effective tool for the therapy of benign thyroid cysts.