肠动脉静畸形的诊断和标记定位（附38例报告）

目的 探讨肠道动静脉畸形的诊断及定位。方法 将选择性肠系膜动脉造影用于术前诊断肠动静脉畸形３８例，其中１０例放置导引钢丝或造影导管，作为术中定标记，并即刻或择期手术，结果 本组动脉造影Ｘ线表现为：（１）动静脉瘘和静脉早显２１例；（２）局部染色浓密３０例；（３）局部血管丛异常增多３０例；（４）肠壁内静脉扩张，迂曲２７例，１０例置标记物者，术中顺利寻长并切除病灶；结论 选择性肠系膜动脉造影是诊断肠动静     

肠动静脉畸形诊断和标记定位问题———附38例报告

目的：肠动静脉畸形为消化道出血重要原因。应用肠系膜动脉造影诊断并同时置标记物作为病人手术定位以减少术中盲目性。材料和方法：选择性肠系膜动脉造影，术前诊断３８例小肠动静脉畸形，其中１０例放置导引钢丝或造影导管，作为术中定位标记，并即刻或择期手术。结果：本组动脉造影Ｘ线表现为：（１）动静脉瘘和静脉早显２１例；（２）局部染色浓度３０例，（３）局部异常增多的血管丛３０例；）（４）肠壁内静脉扩张、迂曲２７例     

标记定位在肠血管畸形外科治疗中的应用

目的探讨肠血管畸形的术中定位方法。方法对15例肠血管畸形患者,经选择性肠系膜血管造影证实具体出血动脉后,再进一步对出血分支动脉行超选择性插管,置入导引钢丝或造影导管作为术中定位标记。结果本组肠血管畸形位于空肠6例、回肠5例、空肠加结肠1例、结肠3例。手术时均顺利找到标记物并切除病变肠管,从而获得满意疗效。结论经选择性肠系膜血管造影明确畸形的肠血管后,置入标记物作为术中寻找病变部位的定位标记,是一种非常有效的方法。     

选择性肠系膜血管造影留置导引钢丝定位空回肠血管畸形出血部位

目的 探讨空回肠血管畸形出血部位的术中定位方法.方法 1995年12月至2005年11月,复旦大学中山医院对16例空回肠血管畸形病人,经选择性肠系膜血管造影证实具体出血动脉后,再进一步对出血分支动脉行超选择性插管,置入导引钢丝作为术中定位标记.结果 肠血管畸形位于空肠9例、回肠6例、空肠加结肠1例.手术时均顺利找到标记物并切除病变肠管,从而获得满意疗效.结论 经选择性肠系膜血管造影明确畸形的肠血管后,置入标记物作为术中寻找病变部位的定位标记,是一种非常有效的方法.     

肠系膜上动脉造影并置标记物切除动静脉畸形段小肠

为探讨小肠动脉畸形的诊疗方法，作者首先采用在选择性肠系膜上动脉造影确定小肠动静脉畸形的基础上，进一步对出血动脉分支的超选，并置入一短段导引钢丝作为术中肠切除的定位标记及缓解急性期出血。本组７例治疗效果良好，作者认为该方法准确性高，操作简单易行。     

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我院自1991年5月至2002年5月，采用选择性肠系膜动脉造影确诊12例，并放置标记物，即刻或择期手术，切除病变肠段，获得满意效果。现报告如下：     

下消化道出血的诊断及术中定位方法(附22例报告)

目的 探讨原因不明的下消化道出血的术产主中定位该当。方法 采用选择性腹腔动脉造影对２２例原因不明的肠道出血病例进行术前诊断,并在选择性腹腔动脉诊断的基础上,进一步地出血分支动脉行超选插管,入一小段导引钢丝作为手术定位标记及妥急性出血期因。结果 ２２例病人术前全部得到定性及;定位诊断,并置标记物,其中小肠恶性肿瘤８例、肠道血管畸形１４例,术中均准确找到标记物,从而获得满意的治疗效果。结论 选择性腹腔     

血管畸形

血管畸形包括血管瘤和动静脉畸形。本文回顾血管瘤、动静脉畸形(AVMs)和后天性动静脉(A-V)瘘之间的鉴别诊断,以及手术方法和选择性栓塞疗法。14例血管畸形,男8例,女6例,年龄为2个月～42岁,其中血管瘤5例,动静脉畸形9例。12例术前做过动脉造影。全部病人都经过1次或1次以上手术。局部小病变术后无复发倾向。4例做病变供血动脉结扎的仅1例     

介入栓塞治疗肾动静脉畸形(瘘)11例报道并文献复习

目的通过分析肾动静脉畸形影像学征象并通过介入栓塞治疗,提高肾动静脉畸形的诊断和治疗水平。方法回顾性分析2004年4月至2014年12月期间在南京大学医学院附属鼓楼医院行肾动脉造影和选择性栓塞治疗的11例肾动静脉畸形患者的临床资料。通过呈现典型的栓塞前后影像特点,对常见栓塞方法及疗效进行讨论。结果 11例肾动静脉畸形患者的影像特点可分为2类:1一个或多个小动脉和一个或多个引流静脉之间成迂曲血管团状病灶,共6例;2单个动脉和扩张静脉间交通,肾动静脉之间直接形成瘘而无畸形血管团,5例。其中治疗后1例患者在栓塞8d后复发,行肾切除后血尿消失,对侧肾功能代偿正常;1例患者在栓塞1d复发后加用无水乙醇,随访6年无复发。结论选择性肾动脉造影和栓塞术是肾动静脉畸形主要的诊断和治疗方法,组合使用栓塞材料较使用单一栓塞材料临床效果更好,但仍需要密切随访。     

肾动静脉瘘的选择性血管造影与栓塞治疗(附20例报告)

目的 提高肾动静脉瘘介入诊断和治疗水平。方法 20例患者均有反复间歇性全程肉眼血尿，曾行超声、KUB、IVU、CT、泌尿系内镜检查，未能明确病因。行选择性肾动脉造影或(和)超选择性肾段动脉造影确诊为肾动静脉多瘘，采用明胶海绵加鱼肝油酸钠／无水乙醇、聚乙烯醇(PVA)微粒、TH胶、钢圈等对病变血管选择性栓塞。对肾动脉造影的征象和选择性栓塞治疗资料进行分析。结果 20例按影像特点分3类：(1)肾内畸形血管团及动静脉分流现象，共11例；(2)肾动静脉大分支之间高流量的分流而无畸形血管团，共4例；(3)肾动脉主干造影末显示畸形血管团和显著分流，超选择肾段动脉造影或应用气体造影剂则显示微小分流病变，共5例。20例均采用超选择性栓塞供血动脉治疗，栓塞当天肉眼血尿即消失，24～72h后镜下血尿阴转。术后72h内术侧腰部均出现酸痛，尚有发热、腹胀、恶心等症状。结论 选择性肾动脉造影和栓塞术是肾动静脉瘘主要的诊断和治疗方法。CO2造影有助于隐匿型肾动静脉瘘的诊断。     

Usefulness of three-dimensional digital subtraction angiography in endovascular treatment of a spinal dural arteriovenous fistula

The use of 3D digital subtraction (DS) angiography provides a better understanding of spinal vascular lesion architecture. The authors report on 2 cases involving a spinal dural arteriovenous fistula (DAVF) and demonstrate the usefulness of 3D DS angiography for endovascular treatment of these spinal DAVFs. In both cases, middle-aged male patients suffered from bilateral leg hypesthesia, gait disturbance, and urinary dysfunction several months before treatment. Spinal angiography revealed DAVFs that were fed by a radicular artery branching from the intercostal artery and draining veins proceeding superiorly along the perimedullary veins. Endovascular embolization was performed in both cases. Selective 3D DS angiography of the intercostal artery clearly demonstrated the tortuous course of the feeder and the relationship among the feeding artery, fistula point, and draining veins in each case. This information was very useful in selecting a working angle for manipulating the microcatheter and for glue injection. In addition, the maximum intensity projection image from rotational DS angiography data clearly showed the fistula point at the dural sleeve and feeder entering the spinal canal via the intervertebral foramen and the relationship with the bone structure. Successful obliteration of the fistulae was achieved in both cases. Selective spinal 3D DS angiography was very useful in understanding the complex spinal vascular architecture and in choosing the best working angle and therapeutic strategy for endovascular treatment of spinal DAVFs.     

肠道血管畸形的诊断和治疗

目的：探讨肠道血管畸形的诊断和治疗方法。方法：对29例肠道血管畸形的临床资料进行回顾性分析。结果：本组以反复性，间歇性血便为主要临床表现，17例患经19例次选择性肠系膜血管造影，7次经纤维结肠镜、2例经单光子发射电子计算机断层扫描（ECT），3例行剖腹探查得以确诊。5例非手术治疗，24例行手术治疗。手术患无死亡，亦未发生术后并发症，随访20例（69．0％），再出血4例，其中非手术组3例，手术组1例，结论：（1）选择性肠系膜血管造影是诊断本病的最佳方法；（2）外科手术是治疗肠道血管畸形出血的最有效方法；（3）术前和术中的准确定位是手术成功的关键。     

Selective mesenteric vein catheterization and plasma serotonin determination in patients with carcinoid tumors

Selective abdominal vein catheterization with blood sampling for serotonin determination was evaluated regarding its use in the diagnosis, location, and characterization of carcinoids. Serotonin was determined in a platelet-poor plasma fraction (PPP) by an enzymatic procedure. In 5 normal subjects the concentration of serotonin in PPP in the celiac artery, the hepatic vein, and different intestinal and pancreatic veins ranged from 1.2 to 5.4 ng/ ml. In 10 patients with carcinoid tumors, the concentration of serotonin in tumor-draining veins was clearly elevated and ranged from 10 ng/ml to 88 ng/ml PPP. 5-HIAA urine levels were false-negative in 4 cases, liver scintiscan was false-negative in 3 cases, and the angiograms were not conclusive in 2 cases. The technique with plasma serotonin determination in combination with selective catheterization is a useful complement to other investigative techniques in the diagnosis, location, and follow-up of patients with carcinoid tumors.     

脾切除后肠系膜静脉血栓性肠梗阻的诊治

目的：探讨肠系膜静脉血栓性肠梗阻的诊断及治疗方法。方法：对8例肠系膜静脉血栓性肠梗阻进行回顾性分析。结果：8例均有腹痛，全腹压痛，后期均出现腹膜刺激症，腹部x线片均见肠胀气和小气液平。周围血Hb＞150g／L 2例，血小板升高6例。6例行部分小肠切除吻合术，静脉切开取栓术和对症处理各l例。4例死亡。结果表明，病因为脾切除术后血液高凝状态；发病常不典型，应综合临床检查及早诊断，B超检查及血管造影具有重要诊断价值；治疗以手术为主，可获良好结果。结论：对各种原因的脾切除，尤其是肝硬化、门脉高压症的脾切除后出现腹痛等症状，进一步检查术前可获确诊，及时手术可获良好预后。     

CT Venography and CT Angiography of the Pulmonary Arteries in Acute Pulmonary Embolism

OBJECTIVES: To determine the diagnostic value of CT venography after CT angiography of the pulmonary arteries using multislice helical CT in the diagnosis of acute pulmonary embolism. METHODS: Between September 1999 and April 2001 252 patients with clinically suspected pulmonary embolism were examined. CT angiography of the pulmonary arteries was followed by CT venography of the inferior vena cava, the iliac veins and the proximal femoral veins; after April 2000 the popliteal veins and the proximal lower leg veins were additionally investigated. The examinations were performed with a double detector and a multidetector scanner (Elscint Twin and GE Lightspeed). RESULTS: Pulmonary embolism was found in 79/252 patients (40 central and 39 segmental/subsegmental PE). In 38/40 patients with central PE and in 22/39 patients with segmental/subsegmental PE in CT venography a deep venous thrombosis was detected, in 1/79 patient a doubled inferior vena cava could be found. In 5 patients with thrombosis of the inferior vena cava a transjugular cava filter placement was performed. In 13/173 patients without pulmonary embolism CT venography showed deep venous thrombosis. CONCLUSION: CT venography of the lower extremities is a practical and efficient additional examination to CT angiography in clinical suspected pulmonary embolism. It can detect the causing venous thrombosis with a high sensitivity.     

Diagnosis and management of visceral artery aneurysms: report of 24 cases

During the past 30 years 24 patients were treated for visceral artery aneurysms in our hospital. There were 12 hepatic, 7 gastroduodenopancreatic, 3 splenic, and 2 superior mesenteric artery aneurysms. Perilous ruptures occurred in 20 patients, among them 13 ruptured into the biliary tract, 4 into the upper gastrointestinal tract, and 3 into the abdominal cavity. Correct preoperative diagnosis was often difficult. Selective celiac and superior mesenteric angiography was most valuable, and 14 patients were correctly diagnosed preoperatively by the procedure. Nineteen underwent emergent surgery and 8 died. Prognosis depended on the anatomic location of the aneurysms and the general condition of the patients.     

Budd-chiari综合征血管造影诊断及分型

目的 通过造影表现,探讨Budd-chiari综合征的诊断及造影分型.方法 分别经下腔静脉双向插管造影、经下腔静脉肝静脉造影及经皮肝穿肝静脉造影对患者进行造影诊断.结果 在所有342例经造影证实的Budd-chiari综合征病例中,下腔静脉病变207例,占60.5%,其中下腔静脉膜性病变142例,占41.5%,阶段性病...     

腹腔镜保留直肠上动脉的D3淋巴结清扫术在降结肠、近段乙状结肠癌根治术中的临床应用

目的:探讨降结肠及近段乙状结肠癌行腹腔镜辅助左半结肠D3淋巴结清扫术中保留直肠上动脉的安全性与可行性。方法:回顾分析2013年12月至2015年12月为13例患者行保留直肠上动脉的腹腔镜辅助左半结肠D3淋巴结清扫术的临床资料,其中近段乙状结肠癌8例,降结肠癌5例,2例合并完全性梗阻,经内镜支架置入缓解并充分肠道准备一周后手术。术中应用超声刀全程裸化肠系膜下动脉根部,沿血管鞘向远端分离、结扎左结肠动脉及若干支乙状结肠动脉,保留直肠上动脉;肠系膜下静脉于脾静脉汇合点前结扎切断。结果:术中发现左结肠动脉缺失1例;左结肠动脉发自乙状结肠动脉1例;Riolan弓缺失2例。手术均顺利完成,无一例中转开腹,手术时间平均(148.1±15.5)min,实际淋巴结清扫时间(自系膜切开至D3淋巴结清扫完成)平均(44.9±11.8)min,术中失血量平均(40.0±17.3)ml,淋巴结清扫数量平均(21.9±4.5)枚;吻合口均位于乙状结肠中下段,无吻合口瘘发生。无一例发生与淋巴清扫相关的副损伤、意外出血及死亡。1例患者于术后1周出现高位小肠梗阻,经禁食、胃肠减压后缓解;1例乳糜漏,经保守治疗后痊愈。结论:腹腔镜下保留直肠上动脉的肠系膜下动脉根部D3淋巴结清扫术治疗降结肠、近段乙状结肠癌是安全、可行的,可避免不必要的远端乙状结肠的过多切除。     

腹腔镜技术在肠道血管畸形急性出血中的应用体会

目的:探讨腹腔镜技术诊治肠道血管畸形急性出血的临床价值。方法:回顾分析为13例保守治疗无效的小肠血管畸形急性出血患者行腹腔镜辅助手术的临床资料。结果:13例患者术前选择性行肠系膜数字减影血管造影(digital sub-traction angiography,DSA)。造影定位下行腹腔镜辅助小肠部分切除吻合术10例,回盲部切除末端回肠造口术1例;术中造影无法明确,内镜协助探查明确出血部位,腹腔镜辅助下行小肠切除吻合1例;导管造影及内镜协助探查均无法明确出血部位,行小肠双口造瘘观察1例。12例痊愈出院,1例死亡。结论:DSA及术中造影是诊断小肠出血并准确定位的有效方法,为外科手术提供了正确的定位。DSA及术中造影准确定位后行腹腔镜辅助手术切除病变肠段安全、有效。     

Arteriovenous malformation of the ileum with chronic intestinal bleeding

A 47 year old man had a ten year history of intestinal bleeding due to arteriovenous malformation of the distal ileum. Selective angiography is the most reliable technique for the diagnosis of the lesion and a correct diagnosis was not made until the selective superior mesenteric arteriography was done after repetitive laparotomy and intestinal resection. Transcatheter embolization was transiently successful. This case seemed to belong to type 2 according to Moore’s classification and was probably of congenital origin.