经胸超声心动图在房间隔缺损封堵术中的应用

 目的 评价经胸超声心动图(TTE)在房间隔缺损(ASD)介入治疗中的价值。方法 30例ASD患者应用TTE行术前筛选、术中监测和术后随访。结果用TTE术前检查ASD大小8～36(25.0±6.8)mm,选用Amplatzer封堵器大小为12～40(28.2±7.0)mm。TTE测量ASD大小与封堵器大小相关良好(r=0.94,P＜0.01)。硬缘ASD的封堵器选择比超声所测ASD大1～6mm。软缘ASD通常不考虑摆动较大部分为有效缘而予以去除,封堵器选择比超声所测ASD大7～13mm。随访6个月封堵器牢固,无脱落及残余分流。结论 TTE术前检查及术中指导ASD封堵是一种可行、简便而有效的方法。     

The effect of lower limb occlusion on recovery following sprint exercise in academy rugby players

Objectives

The effects of vascular occlusion on recovery of physiological and neuromuscular markers over 24 h, and hormonal reactivity to subsequent exercise were investigated.

长期应用肝动脉栓塞治疗的肝细胞癌患者的影像分析

本文对４２例ＨＣＣ患者的ＴＡＥ影像资料进行回顾性分析，发现供血动脉主干闭塞率６２％（２６／４２）。主要是由于以下几种因素引起的内皮细胞损伤所致；（１）导管和高压注射造影剂的物理刺激；（２）化疗药物的化学刺激；（３）导管嵌顿和长时间持续性注射化疗药物和栓塞剂所致的缺氧。因此，ＴＡＥ并非根治性、长久的治疗手段，应适时结合手术治疗，其手术切除的最佳时机是初次治疗后的３～５月。     

Nd∶YAG激光解除瞳孔膜闭

ObjectiveTo investigate the effect of Nd∶YAG laser on the occlusion of pupil.MethodsThe pupillary membrane incision was performed in 13 patients (13 eyes) with occlusion of pupil due to anterior uveitis (7 active cases and 6 static cases) by means of Nd∶YAG laser. The incision was started with the superior edge of the pupil. The pupillary membrane was torn by the contraction of the pupillary extensor. The incision was enlarged until the pupillary membrane rolled in the anterior chamber.ResultsThe visual acuity was 0.77±0.11. Four out of 6 patients with abnormal intraocular pressure (IOP) returned to normal one week after laser irradiation. The visual acuity was 0.83±0.15 and all had normal IOP. Active inflammation in 6 patients disappeared one month after operation. One patient recovered 2 months after operation. The complications included localized pit of lens in one patient and transient and slight rising of IOP in 4 patients. All the rest were free from any complications.ConclusionsNd∶YAG laser can relieve the anterior uveitis and its complication, and can also improve the visual acuity in cases in which even the potent mydriatics failed to rip open the pupillary membrane. It's an economical, easy, rapid, accurate, safe and effective therapy which can get twice the result with half the effort.     

TOI支架术在冠脉闭塞病变介入治疗中的应用

目的:探讨完全闭塞难治病变介入治疗技术(TO I)对冠状动脉完全闭塞病变(CTO)介入治疗的成功率和疗效。方法:经冠状动脉造影选择冠状动脉完全闭塞的陈旧性心肌梗死的患者149例进行回顾性分析,其中男性86例,女性63例,平均年龄(61±14)岁,完全闭塞的病变血管中,前降支(LAD)61例,回旋支(CX)31例,右冠状动脉(RCA)57例,根据心肌梗死发生的时间长短分为小于3个月、3~6个月和大于6个月3组,均采用TO I支架植入技术行冠状动脉支架植入血管血运重建术。结果:149例完全闭塞的血管,支架植入血管完全重建134例,成功率89.9%,其中LAD失败7例,CX失败8例,其中钢丝未通过闭塞病变者8例,球囊未通过闭塞病变者6例,血管未充分扩张,支架无法植入1例,均发生在3~6个月和大于6个月组,所有病例术中及术后未发生严重并发症。结论:在冠状动脉完全闭塞血管行经皮冠状动脉介入治疗(PC I)中,采用TO I介入治疗技术可显著提高完全闭塞冠脉的再通率,且并发症未增加;CTO发生的时间和部位不同也影响冠脉血管的再通率。     

大脑中动脉闭塞的超选择性动脉内溶栓治疗

目的 :探讨超选择性动脉内溶栓治疗急性大脑中动脉闭塞的价值。方法 :经股动脉穿刺 ,将微导管超选择插至闭塞血管远端或置于血块内注入尿激酶 (UK)进行溶栓治疗。 12名急性大脑中动脉闭塞患者接受了溶栓治疗。结果 :8例获得大脑中动脉完全再通 ,3例获得部分再通 ,1例没有发生再通。随访 5个月 ,6人生活能完全自理 ,2人生活部分自理 ,3人无法生活自理 ,1人死亡。结论 :超选择性动脉内溶栓治疗可作为急性大脑中动脉闭塞可供选择的治疗方法之一。     

三维数字减影血管造影在颅内动脉瘤诊疗中的应用价值

目的：探讨3D—DSA在颅内动脉瘤诊断和治疗中的应用价值。方法：对蛛网膜下腔出血患者常规行DSA检查，发现病变或可疑病变后行3D—DSA检查。结果：26例颅内动脉瘤中检出动脉瘤31枚，其中后交通9枚，C1段3枚，C2段5枚，C3段3枚，前交通6枚，大脑中3枚。椎动脉动2枚。3例2D—DSA未见病变3D—DSA确诊，5例因血管重叠3D—DSA排除了动脉瘤。6枚GDC栓塞，5枚手术夹闭，2枚颈内动脉可脱性球囊封阻术。结论：3D—DSA极大提高了脑血管造影检查的准确性和可靠性，为动脉瘤的介入治疗和手术夹闭提供了可靠保障，在临床诊疗中具有很高的应用价值。     

经胸超声心动图监测经导管Amplatzer封堵器介入治疗房间隔缺损的临床价值

 目的探讨经胸超声心动图(Transthoracic echocardiography,TTE)监测经导管引导Amplatzer封堵器介入治疗房间隔缺损(Atrial septal defect,ASD)的临床应用价值.方法选择经TTE检查确诊ASD适合做封堵术的9例患者,术前多个切面综合测量ASD的直径,然后在术中监测经导管引导Amplatzer封堵器治疗ASD的全过程,封堵术后即刻、1周内、1个月、3个月、6个月、1 a随访TTE,观察封堵效果、封堵器周边有无分流.结果9例ASD患者,除2例因缺损口过大(最大伸展径大于38 mm),选用最大的封堵器无效而放弃封堵外,其余7例均成功封堵,术后TTE未见残余分流.结论TTE对ASD封堵术前病例的选择,封堵术中监测及封堵术后疗效评价等均有一定的临床应用价值.     

Intentional occlusion of a transjugular intrahepatic portosystemic shunt

The transjugular intrahepatic portosystemic shunt (TIPS) procedure is a well-described means of treating portal hypertension and its complications. Occasionally, the consequences of this shunt prompt the desire for its subsequent obliteration. We report one unsuccessful and one successful method of TIPS occlusion. Key words: TIPS, complications-Occlusion-Thrombosis-Balloon occlusion catheter-Amplatz spi-der-Embolization coil     

Preliminary findings of recanalization and stenting for symptomatic vertebrobasilar artery occlusion lasting more than 24 h: A retrospective analysis of 21 cases

Purpose

To evaluate the technical feasibility, safety and short-term treatment effects of recanalization and stenting for intracranial symptomatic vertebrobasilar artery occlusion (VBAO) lasting more than 24 h.

Methods and materials

Twenty-one consecutive patients with VBAO refractory to aggressive medical treatment were enrolled into this study and underwent recanalization and stenting. The rate of recanalization was evaluated radiographically and the functional outcome was examined using modified Rankin Scale (mRS) scores.

Results

Median time between imaging-documented occlusion and endovascular recanalization was 10.5 days (IR, Interquartile Range: 6.5–18); technique success ratio of recanalization was 95.2%. There were 3 periprocedural complications. Median mRS score was 4 (IR, 2.5–5) prior to procedure and 4 (IR, 1–5) at discharge (P < 0.05). One stroke and one death occurred within 30 days after recanalization. Mean duration of clinical follow-up was 15.5 months. One transient ischemic attack, one stroke and one death occurred beyond 30-day window. Mean angiographic follow-up was 10.6 months in 10 patients. Four patients developed in-stent restenosis or occlusion, and two of them were symptomatic. Subgroup analyses revealed better functional recovery (lower mRS) in patients with vertebral artery occlusion (VAO) (P < 0.05).

Conclusions

Endovascular recanalization and stenting for symptomatic VBAO lasting more than 24 h were technically feasible and patients with VAO benefited from the treatment with significant functional recovery. However, the complexity of the procedure and high risk of complication should prompt extreme caution.     

A dual-balloon technique for nonoperative removal of retained biliary stones

Retained intrahepatic biliary stones were dislodged with and crushed between two occlusion balloon catheters. Standard angiographic catheters and guide wires with exchange for occlusion balloon catheters can be used in situations where a stone basket cannot, and have certain advantages over Fogarty biliary balloon catheters.     

冠状动脉瘘介入治疗的若干问题探讨

目的探讨冠状动脉瘘介入治疗的临床指征及方法。方法总结经导管介入治疗(介入组)冠状动脉瘘17例,其中应用Cook公司非可控弹簧圈11例,可控弹簧圈2例;Pfm可控弹簧圈1例,AGA公司Amplatzer Duct-Occluder 3例;外科手术(手术组)修补术26例。结果介入组除早期3例因所选弹簧圈太小,而且为非可控,导致术后弹簧圈移位,2例经导管术取出,1例行外科手术修补并取出弹簧圈,其余病例均获成功,平均随访3年。均无残余分流及其他并发症。手术组均获成功,无死亡病例。结论冠状动脉瘘经合理的治疗可取得良好的临床疗效,随着介入器材的不断更新与完善,经导管介入治疗冠状动脉瘘创伤小、住院时间短、临床疗效及安全性好,但必须严格掌握手术适应证。     

HydroCoil occlusion for treatment of traumatic carotid-cavernous fistula: preliminary experience

Objective

To summarize our preliminary experiences regarding HydroCoil occlusion for the treatment of carotid-cavernous fistula (CCF), and to evaluate the effectiveness of this treatment.

Methods

From January 2006 to June 2007, 15 patients with traumatic CCF who were treated using HydroCoil occlusion were included in this study. All the patients presented with symptoms such as intracranial pulsatile noise, bulbar conjunctival hyperemia, and pulsatile exophthalmia. Cerebral angiography revealed that the fistula was located in the right internal carotid-cavernous segment in 6 cases, in the left internal carotid-cavernous segment in 8 cases, and on both sides in 1 case.

Results

After CCF procedure, in 15 patients, the fistula was no longer visualized, the internal carotid artery on the affected side remained patent, and intracranial noise disappeared immediately. The preoperative symptoms exophthalmia, bulbar conjunctival hyperemia, etc., returned to normal 1 week after the operation. Vision recovered to varying extents. In the 9 patients who underwent 1-3 months of follow-up cerebral angiography, CCF recurrences and neurological complications were not observed.

Conclusion

Intravascular occlusion has been widely used for CCF treatment, and detachable balloon embolization remains the preferred treatment. In the case of failure of detachable balloon embolization because the patient cannot tolerate the procedure or internal carotid artery occlusion on the affected side is contraindicated, HydroCoil occlusion is a safe and effective though expensive alternative and a stable method of maintaining high carotid artery patency.     

经不同动脉入路治疗完全闭塞型自体动静脉内瘘的疗效及安全性观察

目的探讨经股动脉及肱动脉入路腔内血管成形术（percutaneous trans1uminal angioplasty,PTA）联合置管溶栓治疗完全闭塞型自体动静脉内瘘（arteriovenous fistula,AVF）的疗效、安全性及AVF远期通畅状况。 方法回顾性分析我院2016年3月至2018年6月期间收治的53例AVF闭塞且经动脉入路行PTA联合置管溶栓治疗的病例。分析患者基线资料、手术结局、并发症、射线暴露时间及剂量,随访观察患者AVF的通畅时间及通畅率。 结果经过治疗的53例AVF闭塞的患者中,成功48例,失败5例,总体技术成功率为90.6%;肱动脉入路组成功率优于股动脉入路组,两组之间差异有统计学意义（其中P<0.05）;两组之间并发症差异（P=0.234）及初级通畅率差异（P=0.278）无统计学意义;在统计手术射线暴露时间时发现,股动脉入路组射线暴露时间为（2 601.5±1 803.9）s,远长于肱动脉入路的（1 191.8±844.5）s,差异有统计学意义（P<0.05）;肱动脉入路组射线的暴露剂量为（25.15±26.06）mGy,明显小于股动脉入路组的剂量（97.58±69.85）mGy,差异有统计学意义（P<0.05）。 结论经股动脉及肱动脉入路PTA联合置管溶栓可以有效治疗完全闭塞型AVF,且术后的AVF在持续随访中有较好的远期通畅性;但在手术时射线暴露时间及剂量方面,肱动脉入路组明显优于股动脉入路组。     

大鼠上矢状窦后1／3夹闭对其回流区组织的影响──自由基、脑水肿及病理改变

外伤后上矢状窦闭塞的死亡率很高．通过大鼠上矢状窦后１／３夹闭实验，观察了其回流区域皮层组织脑水含量、组织超氧化物歧化酶（ＳＯＤ）和病理学的改变，探讨其回流区域所受影响．结果提示，夹闭４小时后开始出现脑水肿，８～１２小时达到高峰，以后逐渐减轻．结扎后矢状窦旁皮层组织ＳＯＤ含量明显低于颞叶皮层组织．光镜下２４小时窦旁皮层神经元细胞出现核固缩．电镜观察，２小时窦旁皮层神经细胞线粒体肿胀，４小时线粒体脊破坏．由此表明，矢状窦后１／３的急性梗阻导致的损害局限于窦旁皮层组织，不可逆损害发生于结扎后２～４小时．     

急性椎基底动脉闭塞的介入治疗

目的 探讨急性椎基底动脉闭塞动脉内溶栓治疗,溶栓后血管狭窄的处理问题.方法 收集我院2001年1月至2006年7月急性椎基底动脉闭塞患者67例.全脑血管造影后,责任动脉内泵入尿激酶,复查造影,溶栓后动脉残余重度狭窄者置入支架.结果 溶栓后血管完全再通17例(25.4%),血管部分再通41例(61.2%),血管未通9例(13.4%).临床症状恢复良好19例,轻度伤残23例,重度伤残8例,死亡17例.结论 急性椎基底动脉闭塞溶栓治疗是有效的,时间窗应强调个体化,溶栓后血管残余狭窄可行支架置入术.     

儿童先天性冠状动脉瘘——介入治疗和结果

目的探讨儿童先天性冠状动脉瘘介入治疗指征、方法学和并发症预防。方法19例先天性冠状动脉瘘患儿接受了经导管应用弹簧圈或Amplatzer动脉导管未闭(PDA)封堵器或Amplatzer无聚酯纤维栓子(Amplatzer plug)的介入治疗。其中1例为冠状动脉瘘术后残余漏合并PDA。结果19例冠状动脉瘘患儿瘘口最窄处平均直径(3．7±1．6)mm(2．5～8．2 mm)。右冠状动脉瘘11例,左冠状动脉前降支或回旋支瘘8例。与右心室交通14例,与右房交通5例。肺动脉平均压力为(28．0±5．0)mmHg(25．0～67．0 mmHg),肺动脉与体循环血流比值为1．6±0．8(1．0～2．3)。10例植入1枚Gianturco弹簧圈,3例植入2～4枚Gianturco弹簧圈,应用Duct-Occlud弹簧圈3例。另有2例应用Amplatzer PDA封堵器,应用Amplatzer plug 1例。1例冠状动脉瘘外科术后残余漏并合并PDA者,同时封堵PDA成功。即刻封堵率为55．6%(10/18),术后1个月及1年封堵率分别为88．9%(16/18),100%(18/18);1例右冠状动脉右室瘘,在封堵后即刻发生弹簧圈漂移至左肺小动脉,用异物钳取出后再行外科手术。随访3个月～11年无再通和封堵器移位。结论介入治疗先天性冠状动脉瘘经济,安全、有效。     

胰源性门静脉系节段性阻塞的螺旋CT表现

目的 探讨胰源性门静脉系节段性阻塞（ＰＳＯＰＳ）的ＣＴ征象。材料与方法 回顾性分析３３例ＰＳＯＰＳ患者的螺旋ＣＴ表现,同时以２０例无门静脉系阻塞的病例作对照。３３例ＰＳＯＰＳ中,包括脾静脉阻塞（ＳＶＯ）２７例和肠系膜上静脉阻塞（ＳＭＶＯ）６例。结果 在ＳＶＯ中,胃左静脉、胃短静脉、胃网膜一胸脉、胃结肠干曲张或扩张的比例分别为７０％、７８％、８３％、５６％。在ＳＭＶＯ中,胃结肠干、结肠右上静脉扩张比     

肝总动脉瓣膜性狭窄闭塞的初步研究

目的:探讨介入并发症肝总动脉瓣膜狭窄闭塞的原因以及CTA对其的预防价值。方法:回顾性分析DSA证实存在肝总动脉瓣膜狭窄闭塞的原发性肝癌患者8例。所有病例术前均行CTA检查,用VRT、MIP多方位显示感兴趣血管腔的形态、走行以及肝总动脉与上级血管之间的夹角。DSA造影排除解剖变异情况后,判断肝总动脉瓣膜性狭窄闭塞。结果:2例患者CTA示腹腔干及肝总动脉形态正常,而肝总动脉与腹腔干呈夹角狭小。3例术前CTA提示腹腔干起始端重度狭窄;另外3例腹腔动脉明显迂曲延长,肝总动脉起点距离增大,CTA与DSA所见一致。结论:肝总动脉瓣膜性狭窄闭塞是一种罕见的介入治疗并发症,多次介入操作以及解剖变异是可能的诱因,术前CTA能发现这些危险因素,术中选择合适器材轻柔操作是降低其发生率的关键。