超声定位在小儿颈内静脉穿刺置管中的应用

目的探讨超声定位在小儿颈内静脉穿刺置管中的应用效果。方法选择6月~6岁的先天性心脏病择期手术患儿80例,随机均分为两组:超声定位组(D组):使用便携式B超仪在颈部以二维超声图像确定颈内静脉位置进行穿刺;对照组(C组):以传统的颈内动脉搏动的外侧为标志进行穿刺。记录首次穿刺成功率、总穿刺成功率、穿刺次数、穿刺时间和并发症发生率;观察D组超声图像的颈内静脉走向与同侧乳头的关系。结果 D组首次穿刺成功率、总穿刺成功率显著高于C组(P<0.05),穿刺次数和操作时间显著少于C组(P<0.01),误穿颈动脉并发症显著低于C组(P<0.05)。结论超声定位在小儿颈内静脉穿刺置管中的应用,可以显著提高首次穿刺成功率和总穿刺成功率,明显减少穿刺次数和缩短穿刺时间,降低并发症的发生率。     

超声引导右锁骨下静脉穿刺置管的效果:与体表解剖标志定位法比较

目的 通过与体表解剖标志定位法比较,评价超声引导右锁骨下静脉穿刺置管的效果.方法 选择消化道肿瘤切除术病人120例,ASAⅡ或Ⅲ级,随机分为2组(n=60):体表解剖标志组(AL组)依据体表解剖标志定位,引导右锁骨下静脉穿刺置管;超声组(US组)使用便携式彩超定位,引导右锁骨下静脉穿刺置管.两组均于气管插管前进行穿刺置管.记录穿刺时间、穿刺成功情况和并发症的发生情况.结果 US组全部穿刺成功,AL组有1例穿刺失败.与AL组比较,US组首次穿刺成功率高,穿刺时间短,穿刺部位血肿、气胸和误穿动脉的发生率低(P<0.05).结论 超声引导行右锁骨下静脉穿刺定位准确,成功机率高,并发症少,其效果优于体表解剖标志定位法.     

老年患者超声引导下锁骨下静脉与腋静脉穿刺的比较

目的比较老年患者超声引导下锁骨下静脉与腋静脉穿刺置管的效果。方法需要放置中心静脉导管的患者99例,男68例,女31例,年龄65岁,随机分为两组:锁骨下静脉穿刺组(SV组,n=49)和腋静脉穿刺组(AV组,n=50)。记录锁骨下静脉和腋静脉超声定位时间、静脉深度、静脉最大内径,计算静脉塌陷率。记录深静脉一次穿刺成功、二次穿刺成功、总穿刺成功例数和穿刺时间。记录误穿动脉、气胸等并发症的发生情况。结果与AV组比较,SV组超声定位时间明显缩短(P0.01),静脉深度、静脉最大内径明显增大(P0.01),呼吸塌陷率明显降低(P0.01),一次穿刺成功率和总穿刺成功率明显升高(P0.05)。两组二次穿刺成功率、穿刺时间差异无统计学意义。两组均无误穿动脉、气胸等并发症。结论老年患者超声引导下锁骨下静脉穿刺较腋静脉穿刺成功率高。     

超声引导在患儿颈内静脉穿刺置管中的应用

目的 比较超声引导与传统体表标志定位在患儿颈内静脉穿刺置管中的差异.方法 将53例行心脏外科或消化道手术的患儿(0～36个月)随机分成超声引导组(U组,28例)和体表定位组(L组,25例).前者在超声引导下行颈内静脉置管术,后者使用传统的体表标志定位法行颈内静脉置管术.记录两组成功率、穿刺时间、试穿次数及并发症.结果 U组一次成功率为96.43％,明显高于L组的80％ (P＜0.05);穿刺相关并发症U组仅3.57％,明显低于L组28％(P＜0.01),同时U组穿刺时间明显短于L组(P＜0.05),穿刺次数明显少于L组(P＜0.05).结论 超声引导应用于患儿颈内静脉穿刺置管可提高置管成功率,减少并发症的发生.     

超声定位与实时引导右颈内静脉穿刺置管用于急诊血液透析的价值

目的：通过与体表解剖法比较、探讨术前超声定位与术中动态引导右颈内静脉穿刺置管用于急诊血液透析患者的价值。方法：拟行急诊血液透析患者90例,ASAⅡ～Ⅳ级,随机分为3组,（n=30）,所有患者均去枕平卧,头左偏30°体位,于环状软骨平面穿刺。A组：体表解剖法组,依据体表解剖标志定位,行右颈内静脉中路法穿刺置管。B组：超声定位组,术前超声定位,并标记右颈内静脉,穿刺置管。C组：超声动态引导组,使用便携式彩超定位,全程引导右颈内静脉穿刺置管。分别记录穿刺次数及一次穿刺成功率,操作时间,早期穿刺并发症等情况。结果：C组1例失败,B组有2例失败,A组5例失败。与A组比较,C组穿刺次数少（P〈0.05）,一次穿刺成功率、一次置管成功率高（P〈0.01）,无误穿动脉（P〈0.05）,但穿刺时间最长（P〈0.05）。与B组比较,C组操作时间更长（P〈0.05）。结论：急诊血液透析患者右颈内静脉穿刺前常规超声定位,有利于提高一次穿刺置管成功率,缩短穿刺时间,减少并发症发生。对于解剖变异或穿刺困难者宜采用超声实时引导。     

不同超声引导平面技术在颈内静脉穿刺置管术中的临床应用

目的比较长轴平面、短轴平面和斜轴平面超声引导下颈内静脉穿刺置管的临床效果,探讨最佳的穿刺引导平面。方法选择昆明医科大学第一附属医院急救医学部EICU收治的患者180例,男94例,女86例,年龄34~82岁,按前瞻性随机试验方法分为短轴平面组、长轴平面组和斜轴平面组,每组60例。在超声引导下使用三种不同的引导平面行颈内静脉置管术,记录三组刺入目标血管时间、总穿刺时间、穿刺针进针改变方向的次数、穿刺点数量和置管成功率。记录三组颈内静脉置管的并发症(气胸、血肿和误穿动脉)。结果三组患者均顺利完成超声引导下颈内静脉穿刺置管术。短轴平面组和斜轴平面组刺入目标血管时间和总穿刺时间明显短于长轴平面组,斜轴平面组刺入目标血管时间和总穿刺时间明显短于短轴平面组(P0.05);三组穿刺点数量差异无统计学意义;短轴平面组进针改变方向次数最多,斜轴平面组进针改变方向次数最少(P0.05);斜轴平面组误穿动脉发生率明显低于长轴平面组和短轴平面组(P0.05),三组均未发生气胸、血胸。结论与长轴平面和短轴平面比较,使用斜轴平面行颈内静脉穿刺置管术可降低危重患者行颈内静脉穿刺置管术中误穿颈总动脉的风险和缩短穿刺时间,是安全而有效的超声引导下颈内静脉穿刺路径。     

超声引导下经皮右颈内静脉穿刺中心静脉置管术35例体会

目的总结超声引导下经皮右颈内静脉穿刺中心静脉置管术的体会。方法将70例拟行经皮右颈内静脉穿刺中心静脉置管术的患者随机分为2组,每组35例。观察组在超声引导下置管,对照组行传统体表定位穿刺置管。观察2组穿刺置管成功率、完成穿刺置管操作时间及误穿动脉、血肿形成和引起气胸等并发症发生率。结果观察组一次性和总穿刺置管成功率均高于对照组,穿刺置管操作时间短于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论超声引导下经皮右颈内静脉穿刺中心静脉置管术,成功率高,并发症少,安全性高。     

两种迷你中线导管置管方法的效果比较

目的 探讨提高一次穿刺成功率、减少并发症的迷你中线导管置管方法。方法 将130例拟行迷你中线导管穿刺的患者随机分为对照组和观察组各65例。对照组采用盲穿置管法,导管留置于前臂浅静脉。观察组在超声引导下进行迷你中线导管置管,导管留置于上臂静脉。观察并比较两组患者一次穿刺成功率、置管操作时间、并发症发生率及导管留置时间。结果 对照组64例、观察组63例完成研究。观察组患者一次穿刺成功率(96.83%)显著高于对照组(85.94%);静脉炎发生率显著低于对照组,置管操作时间、导管留置时间显著长于对照组(均P<0.05)。结论 采用超声引导下迷你中线导管置管可以提高一次穿刺成功率,降低静脉炎发生率,延长导管留置时间。     

床旁超声引导右锁骨下静脉置管在急诊科的应用

【摘要】 目的 观察急诊休克病人在床旁超声引导下行右锁骨下静脉穿刺置管的应用。方法〓72例急诊休克患者中,采用床旁彩超引导下的右锁骨下静脉穿刺38例(观察组)和传统体表定位组34例(对比组)。比较两分组的穿刺成功率、穿刺次数、穿刺时间及穿刺并发症。结果〓观察组的首次成功率92.1%,优于对比组61.7%(P<0.05)|观察组穿刺次数、穿刺时间均少于对比组(P<0.01)|两分组穿刺相关并发症差异无统计学意义(P>0.05)。结论〓急诊休克病人在床旁彩超引导下行右锁骨下静脉穿刺置管成功率提高明显,缩短穿刺时间,减少穿刺次数。     

超声引导技术在婴幼儿深静脉穿刺置管术中的临床应用

目的对比分析超声引导技术和常规解剖定位技术在婴幼儿深静脉穿刺置管术中的成功率和并发症。方法随机将100例接受择期行手术治疗的婴幼儿分为2组,每组50例。对照组采用超声引导技术行深静脉穿刺置管术,研究组采用常规解剖定位技术进行深静脉穿刺置管术。记录2组患儿的穿刺时间、一次穿刺成功率、总穿刺成功率和误伤动脉、穿刺部位血肿、置管困难、血胸及气胸等并发症发生率。结果与对照组比较,研究组穿刺时间明显缩短(P0.05)。研究组穿刺总成功率、一次性成功率亦明显高于对照组(P0.05)。对照组有10例误伤动脉,8例有穿刺部位血肿,7例有置管困难,而研究组仅有1例误伤动脉,研究组穿刺并发症的总发生率明显低于对照组(P0.05)。2组差异均有统计学意义。结论超声引导技术应用于婴幼儿深静脉术,有助于提高穿刺置管成功率,且穿刺时间较短,可避免多次穿刺,降低并发症的发生率。     

非典型性局限性肺切除术

目的探讨非典型性局限性肺切除术的临床应用价值。方法总结１９８９年至１９９６年３５例４６次非典型性局限性肺切除术（应用超声刀）的经验,随访０．５～７年（平均２９．３个月）。结果无手术及近期死亡。肺良性病变１６例,无复发及远期合并症。原发性肺癌５例,术后２年和１．５年死亡２例,余３例生存至今（分别超过４、２．５和１．５年）。肺转移瘤１４例（其中１０例为两肺多发性转移瘤）,手术２４次,共切除病变２１６个;１、３、５年生存率分别为７８５％、５０％和２１４％。结论非典型性局限性肺切除术的优点在于既能切除肺组织深部病变和多发病变,又能保存更多的肺组织,可作为常规肺切除术的补充,扩大肺外科的治疗范围     

输尿管结石的B超诊断（附2568例报告）

为了提高输尿管结石的确诊率，１９８５年６月～１９９５年１２月应用Ｂ超诊断输尿管结石２５６８例。结果显示：结石位于上下两段占９３５％；无积水者占２１３％，且多为下段结石。认为肾绞痛发作是扫描最佳时机，下段扫描须降低仪器增益，膀胱以不影响探头加压的良好充盈为宜，寻找结石可以自上而下或自下而上。超声检出输尿管结石诊断可以确立，未检出结石不能否定其存在。     

高强度体外聚焦超声治疗腹腔和盆腔恶性肿瘤140例初步报告

目的　了解FEP BY0 1恶性肿瘤热治疗机治疗腹腔和盆腔恶性实体肿瘤的效果及安全性。方法　应用FEP BY0 1恶性肿瘤热治疗机治疗腹腔和盆腔各种进展期实体恶性肿瘤 140例 ,并将其分成空腔脏器恶性肿瘤和实质脏器恶性肿瘤两组。结果　空腔脏器恶性肿瘤 41例 ,恶性肿瘤完全消失率为 6 6 % (2 2 /4 1)、恶性肿瘤部分消失率为 34% (14/4 1) ;实质脏器恶性肿瘤 99例 ,显效率2 2 % (2 2 /99) ,有效率 75 % (74/99) ,无效率 3% (3/99)。全组治疗时无疼痛 ,无皮肤烧伤、穿孔、大出血等并发症。结论　高强度体外聚焦超声 (FEP)技术对治疗腹腔和盆腔进展期恶性肿瘤 ,是一项效果明显又十分安全的新型局部治疗技术。     

胸骨上小切口甲状腺切除术

目的探讨胸骨上小切口甲状腺切除术的可行性。方法对15例结节性甲状腺肿使用超声刀行胸骨上小切口（2.5-3.5 cm）甲状腺切除术。结果15例手术均顺利完成,行单侧甲状腺部分切除术4例,单侧甲状腺次全切除术2例,双侧甲状腺次全切除术9例。手术切口平均长度3.2 cm（2.5-3.5 cm）,平均手术时间46 min（30-65 min）,术中出血量除1例为25 ml外,其余均〈10 ml。2例切口处皮肤浅Ⅱ度烧伤,未出现其他并发症。术后平均住院时间1.8 d（1-3 d）。术后随访8-10个月,未见病变复发。结论胸骨上小切口甲状腺切除术是可行的、安全的,而且具有一定的美容效果。     

带外鞘超声探头在吸脂术中的应用

目的：探讨带有外鞘的超声探头吸脂术的安全笥和有效性。方法：１９９７年～１９９８年对１１０例局部脂肪堆积的患者进行带有外鞘的超声探头吸脂，术中通过进行持续同步冷生理盐水灌注，降低了超声探头和组织的温度，外鞘可以避免超声探头直接与周围组织接触。结果：减少了超声吸脂的并发症，获得了满意的临床效果。结论：利用外鞘可以冷却探头并将探头与外周组织隔离，增加超声吸脂的安全性。     

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目的 研究应用超声及其它腔内微创治疗技术对下肢深静脉血栓形成在静脉再通中的作用。方法 对2000—2002年收治的下肢深静脉血栓形成行以超声消融为主的腔内微创技术和配合导管取栓、球囊扩张、置入支架等其它微创技术治疗。结果 52例病人中，47例(48条肢体)超声治疗获成功，5例属深静脉血栓后遗症超声治疗失败中途改变术式。47例超声微创治疗病人随访1—18个月，平均10个月，自觉症状基本消失。死亡2例分别为术后2—6个月，死于原发病，与超声微创治疗无直接关系。结论 腔内超声消融配合其它腔内微创技术是治疗下肢深静脉血栓形成的最佳选择。     

Ultrasonic-mediated laparoscopic liver transection

Parenchymal liver transection represents a fundamental phase of liver surgery. Several devices have been described for safe and careful dissection of the liver parenchyma during laparoscopic liver surgery, but the ideal technique has not yet been defined. This report describes the combined use of ultrasonic dissector and the ultrasonic coagulating cutter for laparoscopic liver resection. The ultrasonic dissector is used to fracture the parenchyma along the line of proposed division, and the uncovered bridging structures are sealed using the ultrasonic coagulating cutter. The combined use of ultrasonic dissector and harmonic scalpel allows liver resection to be safely performed, with the advantage of minimal surgical complication and low blood losses.     

超声造影新技术对胆囊良恶性疾病的鉴别诊断价值

Objective To investigate the clinical value of contrast-enhanced ultrasound in differ-entiation between benign and malignant gallbladder diseases. Methods Contrast-enhanced ultrasound was performed in eighty patients who were suspicious of gallbladder cancer by conventional ultra-sound. Final diagnosis proved that it was gallbladder cancers 33 patients and benign gallbladder disease in 47. Contrast agent SonoVue and low mechanical index imaging mode were applied. The contrast en-hancement characteristics of the initial enhancement time, the enhancement pattern and the integrality of gallbladder wall adjacent to lesions were analyzed. Meanwhile, the ability of differentiating diagno-sis between benign and malignant gallbladder diseases with contrast-enhanced ultrasound was investi-gated. Results The percentages of those lesions that exhibited hyper-enhancement or iso-enhancement in the early phase and turned to hypo-enhancement within 35s after contrast agent administration were 96.8 % (30/31) in gallbladder cancers and 19.5 % (8/41) in benign lesions(P<0. 001), and the mean time to be hypo-enhancement was (29.5 ± 9.8) s in gallbladder cancers and (58. 8±13.9) s in benign lesions (P<0. 001). Inhomogeneous enhancement was found in 26 (78. 8% ,26/33) gallbladder carci-nomas and 13 (27.6% ,13/47) benign lesions (P<0. 001). Destruction of the integrality of gallblad-der wall was found in 28 (84. 8% ,28/33) gallbladder carcinomas and none (0. 0% ,0/47) of benign le-sions (P<0. 001). The accuracies for differential diagnosis between malignant and benign gallbladder diseases were 72. 5% (58/80) for conventional ultrasound and 93. 8% (75/80) for contrast-enhanced ultrasound (P<0. 001). Conclusion Contrast-enhanced ultrasound can significantly improve the abili-ty of differentiating diagnosis between benign and malignant gallbladder diseases compared with con-ventional ultrasound. The method is deserved to be popularized in clinical practice.     

A Prospective Evaluation of Laparoscopic Versus Open Left Lateral Hepatic Sectionectomy

Background Left lateral sectionectomy is one of the most commonly performed laparoscopic liver resections, but limited clinical data are actually available to support the advantage of laparoscopic versus open-liver surgery. The present study compared the short-term outcomes of laparoscopic versus open surgery in a case-matched analysis. Materials and Methods Surgical outcome of 20 patients who underwent left lateral sectionectomy by laparoscopic approach (LHR group) from September 2005 to January 2007 were compared in a case-control analysis with those of 20 patients who underwent open left lateral sectionectomy (OHR group). Both groups were similar for: tumor size, preoperative laboratory data, presence of cirrhosis, and histology of the lesion. Surgical procedures were performed in both groups combining the ultrasonic dissector and the ultrasonic coagulating cutter without portal clamping. Results Compared with OHR, the LHR group had a decreased blood loss (165 mL versus 214 mL, P = 0.001), and earlier postoperative recovery (4.5 versus 5.8 days, P = 0.003). There were no significant differences in terms of surgical margin and operative time. Morbidity was comparable between the two groups, but two cases of postoperative ascites were recorded in two cirrhotic patients in the OHR. Major complications were not observed in either groups. Conclusions Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance and operative time comparable with open surgery. Laparoscopic liver surgery may be considered the approach of choice for tumors located in the left hepatic lobe.     

Ultrasonic dissection

Following its development for cataract surgery, and gaining widespread use in neurosurgery and liver resection, ultrasonic dissection has been adapted for laparoscopic use. The turbulence, heat, and pressure generated by imploding bubbles disrupts tissues high in water content. This phenomenon is called cavitation and is the principal means by which ultrasonic dissection is accomplished.A randomized, prospective trial demonstrated the utility of the device for laparoscopic cholecystectomy. It was particularly effective in the presence of acute periportal inflammation or fat. Additional experience with a wide range of laparoscopic procedures is being accumulated by several investigators around the world.The laparoscopic use of ultrasonic dissection will be most valuable whenever selective, precise, and, therefore, safe dissection is desired.