子宫动脉栓塞术预防和治疗子宫大出血的临床效果

目的探讨子宫动脉栓塞术预防和治疗子宫大出血的临床效果。资料与方法对12例人工流产大出血、胎盘植入性大出血和宫颈妊娠为主要表现的患者用明胶海绵颗粒进行双侧子宫动脉栓塞术,观察治疗效果。结果 12例患者全部栓塞成功,随访2～5个月无再次大出血,无严重并发症。结论子宫动脉栓塞术预防和治疗子宫大出血是一种安全、微创和有效的治疗方法,而且可以保留患者的子宫和生育功能,值得临床推广应用。     

子宫及宫旁动静脉畸形的影像学诊断及介入治疗进展

子宫及宫旁动静脉畸形是导致阴道大出血少见却严重的原因之一,影像学在此病的诊断、治疗中有重要的作用.综述目前此病影像学诊断及介入治疗的新进展.     

急诊动脉栓塞治疗产后子宫大出血的临床应用

目的 :探讨产后子宫大出血急诊动脉栓塞的应用价值。方法 :本组 13例产后子宫大出血患者平均出血量2 2 0 0ml ,采用Seldinger法先行腹主动脉造影 ,明确出血动脉后 ,选择或超选择性插管 ,经导管注入明胶海绵颗粒和真丝线段栓塞。结果 :13例子宫大出血患者全部栓塞成功 ,随访 3个月仍无复发。结论 :急诊动脉栓塞治疗产后子宫大出血既安全、有效 ,又无严重并发症发生 ,值得临床推广使用。     

超选择子宫动脉栓塞治疗产科出血性疾病

2例产科出血性疾患(剖腹产术后子宫出血,宫颈妊娠子宫出血备1例),行子宫动脉栓塞术,成功地控制了出血。宫颈妊娠的病例,双侧子宫动脉栓塞后,并成功的进行了剖宫手术,为宫颈妊娠的治疗开创了新的途径.我们认为动脉栓塞术安全.可靠.对产科出血性疾患可作为首选治疗方法.本文还对超选择子宫动脉栓塞的意义进行了探讨.     

子宫动脉血管内介入操作的技术分析

近年来,国内外已熟练开展利用子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤,且已取得良好的临床治疗效果.但是盆腔空间相对狭窄,血管分支多,各血管分支易前后重叠,子宫动脉开口起源复杂,走行迂曲,髂内动脉与髂总动脉之间的夹角变化大,因此,子宫动脉起源、开口的清晰显示,熟练的子宫动脉内插管操作及适度的栓塞是该项技术治疗成功的关键.     

子宫及宫旁动静脉畸形的影像学诊断及介入治疗进展

子宫及宫旁动静脉畸形是导致阴道大出血少见却严重的原因之一，影像学在此病的诊断、治疗中有重要的作用。综述目前此病影像学诊断及介入治疗的新进展。     

微导管在原发性肝癌介入治疗中的应用价值

目的:探讨微导管在原发性肝癌化疗性栓塞中的应用价值。方法:应用微导管对29例原发性肝癌患者行供血动脉超选择化疗栓塞术。结果:本组29例共行化疗性栓塞41次,术后血清AFP下降大于50%者24例(82.8%),肿瘤缩小>50%者6例(20.7%),肿瘤缩小在25%～50%者16例(55.2%),其余患者肿瘤体积无明显变化。术后肝功能损害轻微,无严重并发症。结论:微导管超选择插管治疗肝癌操作简单、方便,超选择成功率高,疗效好,术后并发症少,具有十分重要的临床应用价值。     

人造动静脉内瘘血栓后介入治疗的疗效分析

目的:探讨经肱动脉顺行介入置管溶栓在开通血液透析造瘘管阻塞中的疗效价值。材料和方法:经患侧肱动脉顺行插管,先行导丝、导管松解、碎裂血栓,再行造瘘管置管溶栓,术中团注10万U尿激酶,再以微泵2万U/h维持溶栓,狭窄处行球囊成形术,并分析不同时期血栓介入开通的疗效。结果:23例经介入置管溶栓及球囊成形后22例开通,开通率达95.6%,血栓形成时间<48h者21例,24h内溶通21例(100%),尿激酶用量在(22～70)万U;血栓形成时间>48h者2例,1例部分溶通,以球囊扩张后开通,1例溶栓超过48h后出现肌间血肿,放弃溶栓。结论:经肱动脉介入顺行碎栓、溶栓在维持血透管通畅方面安全、有效、简便而且微创。尤其在血栓形成时间<48h中疗效肯定。     

α-氰基丙烯酸正丁酯在选择性肝动脉栓塞中的应用

目的:评价应用α-氰基丙烯酸正丁酯(N-butyl 2-cyanoacrylate,NBCA)选择性栓塞肝动脉的安全性和有效性.材料和方法:2008-09～2009-12解放军总医院就诊的20例患者,包括外科术后出血2例、原发性肝癌合并肝动-静脉瘘形成11例、多囊肝7例,男性13例,女性7例;年龄45-65岁,应用NBCA进行选择性肝动脉栓塞.结果:所有选择性栓塞均成功,无严重并发症.2例外科术后出血患者在栓塞结束后出血即停止,分别随访6个月、8个月,均未再发生出血.11例原发性肝癌合并肝动-静脉瘘患者中9例患者瘘口闭合,2例患者瘘口明显缩小.7例多囊肝患者栓塞区囊肿范围均不同程度缩小.结论:应用NBCA进行选择性肝动脉栓塞的近期疗效是安全、可靠的,但其栓塞的远期效果仍有待进一步观察.     

介入治疗下颌骨动静脉畸形出血的疗效分析

目的探讨介入治疗下颌骨动静脉畸形出血的临床价值。方法回顾性分析2012年1月至2018年1月于郑州大学第一附属医院接受介入治疗的7例下颌骨动静脉畸形患者的临床资料。患者男3例、女4例,年龄8.0~13.0(10.6±1.7)岁。4例为突发大出血,3例为自发性反复渗血。3例经动、静脉途径行双介入栓塞治疗,4例单纯经动脉途径栓塞,栓塞材料为聚乙烯醇颗粒及弹簧圈,术后随访9~18个月观察其疗效。结果7例患者,4例急性大出血患者介入术后出血得到有效控制,3例慢性渗血者症状消失,所有患者随访期间未再复发出血;1例出现口腔感染、牙龈肿胀增生,经抗感染、清创术后得到有效控制。所有患者无严重并发症发生。结论介入治疗下颌骨动静脉畸形出血疗效确切、安全可行,值得临床推广应用。     

急诊栓塞在抢救急性大出血患者中的临床应用

目的通过对38例不同部位急性大出血患行急诊栓塞止血的临床观察,评价急诊栓塞在抢救急性大出血患中的价值。方法采用Seldinger技术先行选择性血管造影确定出血血管后,超选择插管至该血管。造影证实不存在共于、动静脉瘘、危险吻合后,以相应的栓塞材料包括无水乙醇、明胶海绵、钢圈、聚乙烯醇颗粒等行栓塞,间断造影至满意为止。结果所有患在栓塞后当即止血,有效率100％,无器官坏死等并发症。结论急性大出血患在行一般内科治疗的同时应尽快行栓塞治疗,其方法简单方便,能很快查明出血原因,明确出血部位,迅速有效止血。     

急诊行髂内动脉栓塞治疗16例骨盆骨折并大出血

目的探讨髂内动脉栓塞治疗骨盆骨折并大出血的临床效果。方法对16例骨盆骨折并大出血患者,经保守治疗无效,急诊行单侧或双侧髂内动脉造影,明确出血部位后,经导管用明胶海绵或弹簧圈栓塞。结果 16例骨盆骨折并大出血患者经髂内动脉栓塞后活动性出血停止,除1例死于术后70h外,绝大多数患者的出血性休克得到明显控制。结论髂内动脉栓塞是治疗骨盆骨折并大出血的一个快速、合理、有效的方法。     

Emergent transcatheter embolization of massive hepatic hemorrhage

Seven cases of blunt trauma to the abdomen are reported with significant hepatic vascular injury, hemoperitoneum, and hypotensive shock. Six patients were involved in motor vehicle accidents, and one patient was assaulted. By computed tomographic imaging, the liver injuries were all grade 3–4, according to the Mirvis classification system (Mirvis SE, et al. Radiology 1989;171:27–32). All seven patients underwent angiography with the identification of an active bleeding site(s). Embolization was performed with Gelfoam pledgets, steel coils, polyvinyl alcohol particles, or a combination of materials. In all seven cases, technical success was achieved, with control of hemorrhage and stabilization of the patient’s shock. One patient later succumbed to multiorgan failure. One patient required a second embolization for hemorrhage at a second site. Transcatheter embolization is an effective method for the control of life-threatening hepatic hemorrhage secondary to blunt abdominal trauma.     

Transcatheter embolization for massive posttraumatic pelvic hemorrhage

The purpose of this study was a retrospective review of patients treated by transcatheter embolization for management of life-treatening pelvic hemorrhage due to trauma. Sixty-one patients with suspected significant pelvic hemorrhage from trauma were referred for arteriography and consideration of embolization. The etiology was blunt trauma in 56 patients (92%) and gunshot wound in 5 patients (8%). Embolization followed selective arteriography in 37 patients (61%). Embolization was performed using coils, coils and Gelfoam, or coils and polyvinyl alcohol sponge particles in all cases.Of the 37 patients embolized, causative arteriographic lesions were identified in 32 patients (86%). In 5 patients, only minor vascular abnormalities were identified, but coupled with clinical findings, empiric treatment was warranted. Thirty-four of 37 patients (92%) stabilized hemodynamically after embolization. Two of the 34 had recurrent hemorrhage, which was permanently arrested by re-embolization. In 3 of 37 patients (8%), exsanguination occurred before embolization was completed. All had significant delays in recognition of pelvic hemorrhage as the source of hemodynamic instability.Transcatheter embolization is safe and effective in our experience. We attribute the three deaths to delay in recognition of pelvic hemorrhage as the cause of hemodynamic instability, not failure of embolization.     

介入止血在鼻咽癌放疗后大出血治疗中的应用

【摘要】　目的　探讨介入止血治疗鼻咽癌放疗后大出血的有效性和安全性。方法　回顾性分析 2015 年至 2021 年湖南省人民医院收治的16例鼻咽癌放疗后大出血患者临床资料。9例患者接受颈外动脉分支栓塞术,2例接受单侧颈内动脉栓塞术,3例接受颈内动脉覆膜支架隔绝术,2例未接受介入止血治疗。结果　14 例患者介入止血治疗后13例为有效止血,1例止血失败。术后随访时间3 d至71个月,其间患者均无再次出血,1例出现脑缺血症状后死亡。结论　鼻咽癌放疗后大出血介入治疗可准确、迅速止血,但对于颈内动脉破裂出血需进一步改进术式,以减少并发症发生概率,提高患者生存率。     

Pleomorphic xanthoastrocytoma presenting with massive intracranial hemorrhage.

A 46-year-old woman presented with massive left temporal lobe intraparenchymal and diffuse subarachnoid hemorrhage on CT. Lack of enhancement excluded intermediate and high-grade primary tumor or metastasis as likely causes. At surgery, a fibrovascular left temporal lobe mass adherent to the dura proved to be a pleomorphic xanthoastrocytoma. The unusual hemorrhagic presentation of this typically benign entity is thought to be related to the meningeal involvement, which itself is characteristic of this neoplasm.     

Cerebral amyloid angiopathy associated with massive intracerebral hemorrhage

Summary Characteristic computed tomographic, clinical and pathologic features are discussed in two patients with cerebral amyloid angiopathy (CAA) associated with massive intracerebral hemorrhage. Amyloid angiopathy should be considered in any elderly patient in whom intracerebral hemorrhage occurs at an atypical site. Cortical involvement, multiplicity of hemorrhages, bilaterality, and repeated episodes should further arouse diagnostic suspicion. Clinical management is confined to prevention of systemic hypertension.     

CT diagnosis of massive hemorrhage from hepatocellular carcinoma

Massive hemorrhage from rupture of hepatocellular carcinoma is uncommon. We report our experience in two cases diagnosed by CT.