介入放射学在颈部副神经节瘤的临床评价

目的评价介入放射学在颈部副神经节瘤的术前应用。方法分析13例颈部副神经节瘤病例,对6例副神经节瘤行术前栓塞,对9例行球囊阻断试验,了解Willis环功能。结果6例颈部副神经节瘤术前造影及部分供血动脉栓塞均获成功,术中出血明显减少,9例颈动脉阻断(测定Willis环功能)试验全部成功,在术中施行颈动脉结扎术,术中及术后随访未出现新的神经系统症状或体征。结论颈部的副神经节瘤术前栓塞及术前球囊阻断试验安全、可靠,可作为常规术前准备。     

颈动脉体瘤的DSA诊断

目的：加深对颈动脉体瘤DSA表现特点的认识，探讨其诊断及介入治疗价值。方法：由两位有经验的放射学医师按双盲法对12例动脉体瘤的DSA造影资料进行回顾性分析，然后共同讨论并达成一致意见。结果：DSA均能明确诊断。所有患者均见颈动脉分叉角度增大，颈内、外动脉移位；大部分瘤体以颈外动脉供血为主，血供较丰富；6例患者瘤体包绕颈动脉者可见局部血管受侵。2例患者栓塞后造影见肿瘤染色范围缩小，且术中出血明显减少。结论：DSA是颈动脉体瘤的诊断和术前评估的有效手段，术前栓塞有利于减少术中出血。     

膀胱副神经节瘤诊治分析:16例临床报告

目的探讨膀胱副神经节瘤的临床表现及诊断治疗方法。方法回顾性分析2005年3月至2013年12月我院收治的16例膀胱副神经节瘤患者临床资料,总结膀胱副神经节瘤临床表现和诊治要点。结果本组16例患者,11例为功能性肿瘤,主要临床表现为头痛、心悸、多汗、排尿后血压一过性升高;5例为无功能性肿瘤,临床表现为血尿。临床诊断主要结合临床表现、尿儿茶酚胺检测及病理学检查。16例患者中,12例行膀胱肿瘤切除术,4例行膀胱部分切除术,术后随访无1例复发。结论膀胱副神经节瘤临床少见,有其特殊临床表现,行膀胱部分切除或肿瘤切除术效果良好。     

局部穿刺栓塞进展期青少年鼻咽纤维血管瘤

目的 探讨局部直接穿刺栓塞在青少年鼻咽纤维血管瘤(JNA)术前辅助性栓塞治疗中的临床应用价值.方法 29例JNA患者均行颈动脉造影明确肿瘤供血动脉.然后经皮直接穿刺到肿瘤内,注射组织胶栓塞瘤腔.结果 29例患者造影显示由颈内、颈外动脉双重供血.经局部直接穿刺栓塞后造影显示肿瘤血管染色明显减少,供血动脉远端未见明显显示.所有患者在栓塞后1周内行手术切除,术中出血明显减少,出血量150～500 ml,平均350ml.结论 直接穿刺肿瘤栓塞(DPTE)技术安全,能有效栓塞瘤腔,明显减少术中出血.     

颈静脉球瘤术前血管内治疗的应用价值

目的 评价颈静脉球瘤术前造影及栓塞的应用价值.方法 14例颈静脉球瘤经CT和MRI及五官科详细检查评价,所有患者于术前行双侧颈动脉及患侧椎动脉造影,栓塞供血动脉及瘤巢,7例患者行患侧颈内动脉球囊阻断试验以了解Willis环功能,栓塞后48 h手术切除颈静脉球瘤.结果 14例颈静脉球瘤术前造影和供血动脉及瘤巢栓塞均获成功,肿瘤切除术中出血明显减少,7例颈动脉球囊阻断试验均获成功,3例术中施行颈内动脉结扎术,术后及随访期未出现新的神经系统症状或体征.结论 颈静脉球瘤术前行供血动脉和瘤巢栓塞及颈内动脉球囊阻断试验安全可靠,可作为常规的术前准备.     

腹膜后巨大神经源性肿瘤外科切除术前载瘤血管栓塞的初步体会

目的 探讨腹膜后巨大神经源性肿瘤外科切除术前载瘤血管栓塞的初步经验.方法 回顾性分析2006-08-2007-05腹膜后巨大神经神经源性肿瘤外科切除术前介入栓塞病例5例,介入术中数字减影血管造影,明确载瘤动脉支后均行血管栓塞,择期外科手术切除.结果 5例患者外科术前血管造影及载瘤动脉支栓塞成功,外科术中输血0～400 ml;其中完整切除4例,部分切除1例.结论 腹膜后巨大神经源性肿瘤外科切除术前载瘤血管栓塞完全可以达到减少术中出血的目的,栓塞程度应该个体化.     

颈动脉体瘤的术前造影和栓塞

目的了解颈动脉体瘤的血供情况及术前栓塞对术中出血、手术全切率和术后疗效的影响.材料与方法18例颈动脉体瘤患者行数字减影血管造影,并经5F造影导管用直径2501000μmIvalon对肿瘤供血动脉进行栓塞处理.结果颈动脉体瘤主要由同侧的颈外动脉分支供血,同侧颈内动脉参与供血的占1/18,椎动脉参与供血的占2/18.供血动脉栓塞后肿瘤染色大部分消失,术中出血明显减少.结论颈动脉体瘤的术前栓塞有助于减少术中出血,增加手术安全性,提高手术全切率和术后疗效.     

副神经节瘤的影像学诊断(附31例分析)

目的：旨在提高副神经节瘤的诊断水平。方法：收集经手术病理证实的副神经节瘤37例，共43个病灶，其中32个病灶为肾上腺髓质嗜铬细胞瘤，10个病灶为肾上腺外副神经节瘤，1个颈部副神经节瘤。36例行CT检查，21例行MRI检查。回顾性分析其CT或MRI征象。结果：肾上腺髓质嗜铬细胞瘤与肾上腺外副神经节瘤肿瘤常大于5．0cm，易发生出血、坏死和囊变。CT表现为中等密渡，MRI表现为T1WI呈类似于肝组织的信号强度，T2WI高于肝组织的信号强度，增强扫描有明显强化。1例颈部副神经节瘤位于颈总动脉分叉处，密度均匀，无坏死囊变，其强化特征是强化程度与颈部血管接近。结论：副神经节瘤的CT和MRI表现具有一定特征，结合临床表现多可明确诊断。     

迷走神经副神经节瘤的MRI诊断(附6例报告及文献复习)

目的 分析迷走神经副神经节瘤的MRI表现。方法 对6例迷走神经副神经节瘤（良性4例，恶性2例）进行回顾性分析，重点分析其部位、信号、大血管移位和转移情况。结果 6例肿瘤中，4例位于上颈部，中、下颈部各1例；右颈部病变4例，左颈部2例；肿瘤类似纺锤形或不规则形；6例信号均欠均匀，其中4例出现“盐和胡椒征”，以“胡椒”表现最为显著；6例病变均有明显强化。对4例病变行MR血管造影，见颈动脉均向前、内移位，颈内静脉向后、外移位。2例恶性肿瘤中，1例破坏颈静脉孔区域骨质并颈部淋巴结和双肺内转移，1例出现颈部淋巴结的转移。结论 迷走神经副神经节瘤有其特定的部位和MRI信号，手术前可以进行定性诊断。     

颈动脉体瘤多层螺旋CT血管造影和DSA对比分析

目的 比较颈动脉体瘤的多层螺旋CT血管造影(MSCTA)及DSA的影像学特征及评估其诊断价值.方法 回顾性分析16例病理证实的颈动脉体瘤,术前16例均行16排CT血管造影,注射速率采用4.0 ml/s获得容积数据进行MIP及VR重建.其中3例行DSA血管造影,对其影像学表现进行比较.结果 16例病变均为单发,左侧10例,右侧6例.16例MSCTA原始图像上均显著强化,CT值均在200 HU以上,中心可见粗大迂曲的血管.MSCTA显示14例位于颈动脉分叉的内后方,使颈内外动脉分叉角度扩大.2例完全骑跨于颈动脉分叉之中.1例破裂出血.3例行DSA显示颈动脉分叉处肿物,明显染色,呈"金杯"征改变.结论 颈动脉体瘤在MSCTA及DSA下有明确的影像特征,在诊断颈动脉体瘤上有各自临床实用价值及优势.     

腰骶椎肿瘤的选择性动脉造影及栓塞治疗

目的 探索造反性动脉造影及化疗栓塞在腰骶肿瘤治疗中的应用价值。方法 搜集９例腰骶椎肿瘤病例，靠拢性腰动脉造影后，７例行明胶海绵栓塞，其中３例栓塞后行手术治疗。结果 选择性动脉造影可清楚显示肿瘤的大小及血供特点，３例栓塞后行手术治疗的病人，术中出血量大大减少，平均出血５６０ｍｌ，１例未栓塞病人出血量约３０００ｍｌ。４例非手术的病人，腰部疼痛明显减轻。结论 选择性动脉造影栓塞术在腰骶椎肿瘤治疗中具有较     

Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32–82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.     

Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions

Preoperative embolization was performed in 39 patients with 44 paragangliomas of the head and neck. Because of their complex vascular supply and their relation to vital structures such as the internal carotid artery and the lower cranial nerves, paragangliomas of the temporal bone represent challenging lesions to both the neuroradiologist and the otoneurosurgeon. Detailed classification by high-resolution CT and recognition of the multi- or monocompartmental vascular composition and of dangerous situations by selective angiography are essential prerequisites for safe and effective devascularization of paragangliomas of the temporal bone. Major complications that may occur if embolic material reaches intraaxial vessels through anastomoses between external carotid artery branches and the internal carotid and/or the vertebral artery can be avoided with the use of specific precautionary techniques. Palsies of the facial and lower cranial nerves can also be avoided if reabsorbable material is used for embolization of vessels supplying cranial nerves in asymptomatic patients. In selected cases with significant supply from the internal carotid artery, special interventional techniques, including embolization of the pericarotid tumor portion through the caroticotympanic artery and pre- or peroperative balloon occlusion of the petrous internal carotid artery, allow radical removal of extensive paragangliomas of the temporal bone. Techniques and selection of materials for embolization of carotid body, vagal body, and other paragangliomas of the head and neck mainly depend on the vascular composition of the tumor and on the specific vascular territory in which the tumor is located. In this series, preoperative embolization significantly improved surgical conditions of paragangliomas of any location in the head and neck and proved to represent an essential prerequisite for successful surgery of extensive paragangliomas of the temporal bone.     

选择性靶动脉栓塞在骶骨肿瘤切除术中的价值

目的 探讨和评估选择性靶动脉栓塞骶骨肿瘤后对外科切除肿瘤的价值和方法。方法 运用Seldinger技术，对9例骶骨肿瘤患者进行肿瘤供血动脉及肿瘤内血管全部彻底栓塞，栓塞材料应用明胶海绵，栓塞后1周内行手术切除术。结果 彻底的术前栓塞手术中失血量明显减少，9例骶骨肿瘤均得到彻底切除，平均失血量为1090ml。术后平均随访15个月，未见肿瘤局部复发。结论 骶骨肿瘤切除术前选择性靶动脉栓塞可有效减少术中出血，有利于肿瘤的彻底切除，为顺利切除骶骨肿瘤提供了有价值的方法。     

选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用

目的 探讨选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用价值。方法 对15例鼻咽纤维血管瘤行数字减影血管造影(DsA)检查和栓塞治疗。供血动脉主要为颈外动脉的颌内动脉和(或)咽升动脉，栓塞材料用明胶海绵。结果15例在选择性颈外动脉栓塞后行手术治疗，13例术中出血量明显减少，2例由颈外动脉，颈内动脉系统同时供血，仅选择性颈外动脉栓塞，术中出血量较多。栓塞后2～5d手术最为理想。结论鼻咽纤维血管瘤供血动脉术前栓塞是临床有效的治疗方法之一。     

颈外动脉栓塞术联合鼻内镜切除富血供鼻咽部血管纤维瘤

目的评价颈外动脉栓塞术联合鼻内镜切除术治疗富血供鼻咽部血管纤维瘤的临床疗效,并与单纯鼻内镜切除术进行对比分析。资料与方法搜集本院收治的富血供鼻咽部血管纤维瘤患者33例,其中采用颈外动脉栓塞术联合鼻内镜切除术治疗20例(A组),单纯鼻内镜切除术治疗13例(B组),回顾性分析两组病例切除术中失血量、手术时间、术后住院时间等差异,对术后1年复发情况进行随访。结果 A组切除术中失血量为(154.5±84.3)ml,手术时间为(75.0±30.9)min,术后住院时间为(3.5±1.3)天,动脉栓塞术后6例发生轻度并发症,经对症治疗后消失,随访1年有1例复发;B组切除术中失血量为(623.1±142.3)ml,手术时间为(100.8±62.2)min,术后住院时间为(5.7±2.1)天,随访1年有1例复发。结论颈外动脉栓塞术联合鼻内镜切除术是治疗富血供鼻咽部血管纤维瘤微创、安全、有效的方法,与单纯鼻内镜切除术相比,具有术中失血量少、手术时间短、术后恢复快的优势。     

Juvenile nasopharyngeal angiofibroma: Comparison of blood loss during removal in embolized group versus nonembolized group

Purpose This retrospective study was performed to assess the beneficial effect of preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) in terms of blood loss during surgery.Methods Intraoperative blood loss in a group of 7 patients who underwent 10 procedures for JNA without preoperative embolization was compared with the blood loss of 13 patients who underwent 16 procedures after embolization of one or both external carotid arteries.Results Mean blood loss was 5380 ml in patients with-out embolization and 1037.5 ml in those with embolization. This difference was not statistically significant because of the high standard deviation in the nonembolized group. However, when data were analyzed by tumor stage, a significant difference was noted between the embolized and the nonembolized patients with high-grade tumors but not between those with low-grade tumors.Conclusion Preoperative embolization of the branches of the external carotid appears to facilitate removal of high grade tumors. The benefit of embolization in those with low-grade tumors is less clear cut, probably because there is less vascularity in low-grade tumors and so removal is easier.     

选择性肾动脉栓塞的临床应用

目的：研究肾动脉栓塞术在肾肿瘤术前和肾血管畸形出血病人中的临床应用。方法：对１６例进行选择性肾动脉栓塞，其中１４例肾肿瘤为术前栓塞，应用明胶海绵碎屑，栓塞程度达肾动脉主干。２例肾动静脉血管畸形出血，采用２ｃｍ长丝线段加明胶海绵碎屑行肾亚段栓塞。结果：（１）术中易剥离，出血少。（２）术野清晰，缩短术时。（３）肾血管畸形者，止血效果显著，并能免于剖腹手术，且不影响患肾功能。结论：选择性血管造影可以鉴别肾良、恶性病变，为肾切除及止血栓塞提供依据。