Cutting balloon angioplasty for treatment of coronary in-stent restenosis: immediate results and 6-month outcomes

目的　研究切割球囊对支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊和普通球囊治疗组。切割球囊组 38例。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗塞 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 6 7± 2 3月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组 (15 %VS 38%及 18%VS 4 3%,P均小于0 0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 1 72± 0 5 2mm和 1 15± 0 5 4mm ,而随访终点时切割球囊组的血管直径晚期丢失为 0 2 6± 0 0 5mm(3个月 )及 0 38± 0 0 6mm ,同时的普通球囊组丢失值为 0 78± 0 19mm(3个月 )及 0 89± 0 16mm。对于支架体部狭窄 ,普通球囊难以固定 ,扩张时移动明显 ,而切割球囊较易于固定 ,扩张时罕见移动。结论　切割球囊治疗支架内再狭窄效果可靠 ,安全 ,容易操作。再狭窄率低 ,手术费用相对易于患者接受 ,是一个较有前途的治疗手段。     

Clinical experience with the cordis coronary stent in the Chinese population

ＣｌｉｎｉｃａｌｅｘｐｅｒｉｅｎｃｅｗｉｔｈｔｈｅｃｏｒｄｉｓｃｏｒｏｎａｒｙｓｔｅｎｔｉｎｔｈｅＣｈｉｎｅｓｅｐｏｐｕｌａｔｉｏｎＫ．Ｆａｎ，Ｗ．Ｈ．Ｃｈｏｗ，Ｌ．Ｃｈｏｗ，Ａ．ＹｉｐａｎｄＫ．Ｌ．ＣｈｅｕｎｇＯｂｊｅｃｔｉｖｅＴｏａｓｅｓｔｈｅｓ...     

双导丝球囊在药物涂层球囊治疗股腘动脉硬化闭塞症中的效果分析

目的 探讨应用双导丝球囊预处理病变,是否会对药物涂层球囊(drug coated balloon,DCB)治疗股腘动脉硬化闭塞症的疗效产生影响.方法 回顾性分析于本中心诊疗的股腘动脉硬化闭塞症患者40例的临床资料,其中20例接受普通球囊(plain-balloon-angioplasty,PBA)结合DCB(对照组)治...     

Short-term and long-term benefits of coronary angioplasty in unstable angina pectoris

Primary coronary angioplasty was attempted in 288 patients (206 men and 82 women) who presented with stable (50%) or unstable (50%) angina pectoris. The success rates of angioplasty and the subsequent revascularization requirements in these two angina categories were compared during a one year prospective follow-up. The site and distribution of coronary artery stenoses did not differ between the categories. Three hundred and five dilatations were attempted (149 in 144 patients with unstable angina and 156 in 144 patients with stable angina). Of these procedures, 265 (87%) were technically successful--133 (89%) in 128 patients with unstable angina and 132 (85%) in 120 patients with stable angina. Lower success rates were achieved in 29 attempted dilatations of vessels with chronic total occlusion (19 successful [66%], P = 0.002) and in 19 patients who presented with unstable angina after recent (within two weeks) infarction (10 patients with successful angioplasty, [53%], P less than 0.0001). Subsequent revascularization requirements after an initially successful angioplasty in 57 patients were greater in unstable (36 patients) than in stable angina (21 patients; P = 0.05) and reflected the greater frequency of repeat angioplasty in patients with unstable angina (22 patients) compared with those with stable angina (10 patients; P = 0.04) among patients with recurrent symptoms. At one year, 245 patients (85%)-121 treated for unstable angina and 124 treated for stable angina--experienced no angina during normal daily activities. We conclude that a primary angioplasty success rate of 89% can be achieved in patients with unstable angina pectoris but this rate is significantly lower in patients presenting after recent infarction. Repeat angioplasty for recurrent symptoms after a successful primary procedure is required more frequently in patients presenting with unstable angina.     

双钢丝球囊在支架内再狭窄中的应用

目的 评价双钢丝球囊在支架内再狭窄治疗中的有效性和安全性。方法 32例支架内再狭窄病人, 共有再狭窄靶病变37处,采用双钢丝球囊对靶病变进行扩张,观察扩张效果并进行临床随访。结果 全部37 处再狭窄病变的双钢丝球囊扩张成功率为100％,术后血管狭窄程度明显减轻[(87.7±8.6)％比(7.7±6.7)％, P<0.001],住院期间无1例发生死亡、未发生Q波性心肌梗死和心力衰竭等严重临床并发症。1处支架外缘受 累的再狭窄病变在扩张后出现轻度内膜撕裂(A型),4处支架外缘受累的再狭窄病变于支架外缘受累血管段补 充置入支架。临床随访3-15(8.0±3.4)个月,2例出现心绞痛复发。结论 双钢丝球囊成形术对支架内再狭 窄是有效、安全的治疗方法。     

Emergency percutaneous transluminal coronary angioplasty in 52 patients with acute myocardial infarction

Ｅｍｅｒｇｅｎｃｙｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｎｇｉｏｐｌａｓｔｙｉｎ５２ｐａｔｉｅｎｔｓｗｉｔｈａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎＬｉｕＹｉｎｇｆｅｎｇ刘映峰，ＱｉａｎＸｕｅｘｉａｎ钱学贤，Ｆｕ...     

切割球囊在处理冠心病分叉病变分支血管中的疗效和安全性分析

目的评价经皮冠状动脉腔内切割球囊成形术（PTCBA）治疗冠脉分叉处分支血管中病变的安全性及疗效。方法46例冠心病患者52个分叉病变主支病变,应用经皮冠状动脉腔内切割球囊成形术（PTCA）预扩张后置入支架,分支病变单行PTCBA而不置入支架,观察其手术过程、手术成功率、并发症和近期随访结果。结果46例患者52个分叉病变中位于前降支/第一对角支占65%,回旋支/钝圆支占27%,右冠脉/后降支或后侧支占8%。对分支血管行PTC-BA后有5例因内膜严重撕裂而置入支架,1例术中出现心包填塞,行心包穿刺引流症状缓解后行心外科急诊手术15 d出院,其余病变残余狭窄为20%-50%。PTCBA成功率达88.5%,无院内死亡、急性心肌梗死（AMI）等严重并发症。对手术成功的40例患者术后临床随访6个月,无死亡及AMI等心脏事件发生。结论PTCBA治疗冠脉分叉处分支血管病变安全、有效,其成功率高,并发症少,近期疗效满意。     

超声消融联合球囊扩张和支架置入对下肢动脉长段闭塞的临床研究

目的：通过与单独球囊扩张和支架植入比较,评价超声消融联合球囊扩张和支架植入治疗下肢动脉长段闭塞的疗效及安全性。方法筛选我院2010年1月～2013年9月下肢动脉闭塞症患者,选取满足条件的40例存在长段动脉闭塞患者。随机分为2组,治疗组采用超声消融联合球囊扩张和支架植入治疗,对照组采用单纯球囊扩张和支架植入治疗。观察治疗组与对照组两组术前、术后2周患者跛行距离、足部皮温及ABI变化。结果 A组与B组中共11例患者下肢溃烂,术后经局部换药后2周内全部愈合。 A组成功率为97．0％,而B组成功率为87．1％．A组和B组术后2周与术前相比,足部皮温、ABI及间歇性跛行距离均得到明显改善,具有统计学意义（P＜0．05）。术后2周A组与B组比较,足部皮温、ABI及间歇性跛行距离改善无统计学意义（P＞0．05）。术后造影A组较B组有更丰富的侧枝循环。手术并发症：A组并发症发生率6．1％,B组并发症发生率19．3％．结论血管内超声消融联合球囊扩张成形和支架植入治疗下肢动脉完全闭塞比单纯球囊扩张和支架植入的成功率高、并发症少。血管内超声消融联合球囊扩张成形和支架植入治疗下肢动脉完全闭塞的长期疗效有待进一步观察。     

药物涂层球囊和普通球囊在自体动静脉内瘘狭窄中的疗效比较

目的比较药物涂层球囊和普通球囊在自体动静脉内瘘狭窄中的疗效。 方法选择42例自体动静脉内瘘狭窄病人为研究对象,根据治疗方式分为药物涂层球囊组(DCB组)20例和普通球囊组(CB组)22例。DCB组病人采用紫杉醇释放高压分流球囊扩张成形术,CB组病人采用普通球囊扩张成形术。比较2组手术成功率和手术前后狭窄处内径、透析血流量,并比较术后1、6、12个月动静脉内瘘初级通畅率和术后1个月内并发症发生情况。 结果2组手术成功率均为100%。2组病人术前狭窄处内径及透析血流量差异均无统计学意义(P>0.05);术后2组狭窄处内径及透析血流量均较术前明显改善(P < 0.01),但2组间差异均无统计学意义(P>0.05)。术后1个月和12个月,2组病人动静脉内瘘初级通畅率差异均无统计学意义(P>0.05);术后6个月,DCB组初级通畅率高于CB组(P < 0.05)。2组病人术后1个月内并发症发生率差异无统计学意义(P>0.05)。 结论与普通球囊血管成形术相比,药物涂层球囊血管成形术在治疗自体动静脉内瘘狭窄病变方面存在一定优势,可作为治疗自体动静脉内瘘狭窄安全、有效的选择之一。     

A clinicopathological correlation of 134 stage 1 and 79 non-invasive cutaneous melanomas presenting over a decade (1984–1993) at the Mater Misericordiae Hospital, Dublin

In a study of malignant melanoma during the period 1984–1993, 134 (63 per cent) had invasive melanoma and in 79 (37 per cent) melanoma was confined to the epidermis (in situ). There was female predominance, F: M = 2.4 1, a family history of melanoma in 1.5 per cent, a mean age at diagnosis of 50 yr. Females presented a decade earlier than males on average. Over half of invasive melanomas in females occurred on lower limbs; 40 per cent of lesions in males occurred on the trunk. Almost one third of lesions in males and over two thirds in females occurred in sun exposed area. Sixty per cent of invasive lesions were of the superficial spreading type and half of all lesions were histologically thin [less than 1.5 mm vertical depth]. Surprisingly, median lesion thickness was lower in males, probably reflecting the greater frequency of nodular lesions in females compared to males (36 per cent -v- 24 per cent). The marked increase in the number of invasive melanoma patients presenting in the second half of the decade studied (treble that of the first half) probably reflects an increase in melanoma incidence. Over the decade no change in invasive melanoma type, anatomical site or histological thickness was noted, the latter suggesting a failure to diagnose melanoma at an increasingly earlier stage. An official melanoma public education programme is required, particularly as half of the patients delayed 1 yr or more before seeking medical advice. However it is encouraging that, of the invasive melanomas, 30 per cent were small (<10mm), 50 per cent were histologically thin and that 37 per cent of all melanomas were in situ. The melanoma-in-situ group had a similar gender ratio and mean age at diagnosis to the invasive melanoma patients but lesions were smaller, were predominantly on the head, neck and limbs with lentigo melanoma as the commonest type.     

彩超引导下球囊扩张在血管通路狭窄中的应用

目的研究彩超引导下球囊扩张术与外科重建内瘘术在治疗动静脉内瘘吻合口近心端狭窄（距吻合口2 cm以内）时的疗效是否一致。方法回顾性分析69例动静脉内瘘吻合口近心端狭窄病人,根据手术方式分为经皮腔内血管成形术（PTA）组（A组）36例,外科手术组（B组）33例。随访并比较2组第1、3、6个月的通畅率。结果A组透析时间（4.11±3.06）年,临床成功率97%,技术成功率100%。B组透析时间（3.85±2.81）年,临床成功率94%,技术成功率100%。A组第1、3、6个月的通畅率高于B组（P>0.05）。术后2组并发症发生率差异无统计学意义（P>0.05）。术前及术后1个月的内瘘狭窄处血管内径与肱动脉血流量2组差异均无统计学意义（P>0.05）,2组术后1个月的血管内径和血流量均明显大于术前（P < 0.01）。结论彩超引导下球囊扩张术与外科手术治疗动静脉内瘘吻合口近心端狭窄具有相同的疗效,因为前者具有操作简便,术后即可透析,保存病人血管资源等优势可以推荐作为动静脉内瘘吻合口近心端狭窄首选的治疗方式。     

Coronary stents in the management of coronary artery disease review of first 100 stents

This is a review of the first 100 coronary stents implanted for the indications of PTCA restenosis, acute or threatened closure and De Novo lesions. The success rates were high and complications rates were low. Subacute stent thrombosis rates were low and stenting for De Novo lesions in > 3.0 mm arteries provide the best short and long term results. Six months restenosis rate was low. Stent assisted high pressure balloon angioplasty is an important advance.     

Coronary angioplasty and surgery for coronary artery disease.

Heart disease remains the most common cause of morbidity and mortality in the United States. During the 1970s until the early 1980s, patients with angina pectoris refractory to medical therapy could only consider bypass surgery to relieve their symptoms. Beginning in the early 1980s, coronary balloon angioplasty became an alternative to bypass surgery in those with single vessel coronary artery disease and failure to medical therapy. In the mid-1980s, patients with multi-vessel coronary artery disease also were seen to benefit from balloon angioplasty. Now in the 1990s, balloon angioplasty's success is being compared to coronary bypass with prospective randomized trials. While balloon angioplasty has become relatively easy to perform due to advances in balloon, wire, and guiding catheter technology, many new interventional devices such as atherectomy and laser, are now available. The explosion in technology reflects our inability to prevent atherosclerotic disease and also reveals that while we can improve a patient's lifestyle and in some situations improve mortality rate, atherosclerotic disease remains a disease for which we have no cure.     

SIA治疗膝下动脉硬化闭塞性病变的疗效分析

目的探讨内膜下血管成形术（Subintimal Angioplasty,SIA）治疗膝下动脉闭塞性病变（Infrapopliteal Arterial Atherosclerotic Occlusion,IPASO）的有效性和安全性。方法回顾分析2006年4月-2010年4月31例患者,31条患肢经SIA治疗的IPASO患者的一般资料、技术成功率、临床成功率及并发症发生率。结果手术技术成功率为80.6%,并发症发生率为6.45%,2例患者发生动脉穿孔,球囊扩张后消失,1例患者发生动脉远端血栓形成,经导管溶栓和球囊扩张后消失。平均踝肱指数由术前0.48±0.30提高至术后0.86±0.12（P〈0.05）。平均随访（17.85±11.33）个月,15例间歇性跛行患者跛行距离增加,8例静息痛者疼痛消失,5例足趾溃疡者换药1个月后溃疡愈合,3例足趾坏死者行截趾术后,创面一期愈合。结论 SIA是治疗IPASO安全有效的方法。     

Cook宫颈扩张球囊引产成功率与宫颈长度的研究

目的：探讨Cook 宫颈扩张球囊应用于妊娠晚期人工引产方法终止妊娠的有效性。方法：选择2010年8月-2012年8月在本院住院,妊娠42周前而未临产,或妊娠晚期由于母亲或胎儿原因,需要通过人工的引产方法终止妊娠,宫颈评分2~6分,自愿选择应用Cook宫颈扩张球囊的妊娠晚期初产妇患者100例,其中宫颈长度小于1 cm的50例为A组,宫颈长度大于1 cm的50例为B组。比较两组产妇引产情况及产痛情况。结果：两组取囊时宫颈扩张到1~2 cm、2~3 cm例数、临产时间、第一产程潜伏期、活跃期比较差异均有统计学意义（P〈0.05）;第二产程、第三产程及失败例数比较差异均无统计学意义（P〉0.05）;以长海痛尺为标准,两组产妇疼痛情况比较差异有统计学意义（P〈0.05）。球囊引产成功率与引产术宫颈管长度呈负相关（r=-0.36, P〈0.001）,与取囊时宫颈扩张情况呈正相关（r=0.52,P〈0.001）。结论：Cook宫颈扩张球囊的置入可缩短产程,减轻产妇的产痛,尤其对宫颈长度小于1 cm的产妇效果更好。     

Clinical outcome of patients with left anterior descending artery ostial lesions treated with percutaneous coronary intervention: case-matched comparison with bypass surgery

Objective To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention.Methods Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and reguiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method).Results In the catheter-based angioplasty group, the patients’ mean age was 63±8 years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein Ⅱb/Ⅲa antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2.90±0.48 mm. The minimum lumen diameter increased from 1.05±0.30 mm to 2.40±0.45 mm, and the diameter stenosis decreased from 64%±7% to 8%±13%. During the follow-up period, adverse events reguiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42±0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant.Conclusions Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery.     

经皮腔内血管成形术结合药物溶栓治疗动静脉内瘘急性血栓形成的疗效观察

目的: 探讨超声或放射监测下经皮腔内血管成型术结合药物溶栓治疗血液透析动静脉内瘘急性血栓形成的效果。方法: 选取2014年10月至2017年10月浙江大学医学院附属邵逸夫医院动静脉内瘘血管经过物理和影像学检查证实存在血栓形成和血流停滞的患者192例,血栓形成时间一般不超过72 h,排除活动性出血、严重凝血功能障碍等溶栓及手术治疗禁忌患者。在超声或放射监测下,采用尿激酶和肝素等渗氯化钠混合液溶栓,狭窄部位行球囊扩张术,使内瘘血流再通并恢复功能。结果: 2014年10月至2017年10月共192例患者施行了274例次内瘘血管急性血栓形成的腔内介入手术,技术成功率为98.2%,临床成功率为93.8%,并发症发生率1.46%。自体动静脉内瘘患者术后3、6、12个月的初级通畅率分别为87.4%、76.7%、63.9%,次级通畅率分别为93.7%、91.6%、83.0%;移植血管动静脉内瘘患者术后3、6、12个月的初级通畅率分别为60.7%、51.5%、43.1%,次级通畅率分别为82.7%、77.1%、70.8%。结论: 腔内介入技术结合药物溶栓是治疗动静脉内瘘急性血栓形成安全、有效的方法,能够延长内瘘的使用寿命,保护患者宝贵的血管资源。     

切割球囊血管成形术对不稳定型心绞痛患者血清IL-6和CRP的影响

目的 :比较切割球囊血管成形术 (CBA)与普通球囊血管成形术 (BA)对血清IL 6和C反应蛋白 (CRP)浓度的影响 .方法 :65例拟行冠脉介入治疗的不稳定型心绞痛患者 ,随机分为 2组 ,分别接受CBA或BA ,球囊扩张后均放置支架 .分别于术前、术后即刻、2h和 6h抽取冠状静脉窦血样测定血清IL 6的浓度 ;另于术前、术后 6,2 4和 4 8h抽取肘静脉血样 ,测定血清CRP的浓度 .血清IL 6和CRP的浓度均以ELESCA双抗体夹心法进行测定 .结果 :两组患者临床特征及靶病变情况无显著差异 .CBA组的球囊最大充盈压及支架置入压力明显低于BA组 (P <0 .0 1) .BA组IL 6浓度在术后即刻开始高于CBA组 ,术后 2h和 6h差异进一步增大 (P <0 .0 1) .BA组的CRP浓度在术后 6,2 4和 4 8h都明显高于CBA组 (P <0 .0 1) .结论 :CBA以及联合支架置入术对不稳定型心绞痛患者血清IL 6和CRP浓度的影响均小于BA或其联合支架置入术 ,这可能是前者通过减轻对炎症反应的影响 ,减少RS及心血管事件发生的机制之一     

Early experiences with laser-assisted thermal angioplasty for peripheral vascular disease

Laser-assisted angioplasty has been used on 47 occasions in 45 patients for the management of atherosclerosis of the superficial femoral and proximal popliteal arteries. Twenty-four procedures were performed to treat disabling intermittent claudication and 23 procedures were performed for a "threatened limb" (rest pain, ischaemic ulceration or digital gangrene). Technical success was achieved in 40 (85%) cases; the mean length of occluded segment was 7.7 cm. The presence of heavily calcified occlusions contributed significantly (P less than 0.001) to technical failure. In 28 (70%) of the successfully treated cases, the recanalized arteries were patent at one month and in 21 (53%) cases they have remained patent during the follow-up period. In five of nine cases with a nine-month follow-up, the arteries still were patent. The mean length of the occluded segments that were treated initially was 7.1 cm in those that remained patent compared with 8.2 cm in those that reoccluded. Thirty-six (77%) patients were discharged from hospital on the day after the procedure. Laser-assisted angioplasty is a promising new technique that is applied best to short-segment, non-calcified occlusions and should reduce the requirement for femoropopliteal arterial bypass surgery.     

腹膜后淋巴结清扫在卵巢上皮癌治疗中的价值

目的探讨卵巢上皮癌腹膜后淋巴结清扫的临床价值。方法对289例卵巢上皮癌患者进行回顾性研究。Log-ranktest进行差异性检验,Cox风险比例模型进行预后多因素回归分析。结果早期卵巢上皮癌行腹膜后淋巴结清扫并不能提高生存率（P〉0．05）;晚期卵巢上皮癌行腹膜后淋巴结清扫能提高患者的生存率（P〈0．05）;卵巢上皮癌腹膜后淋巴结清扫组中残余灶〈2cm的生存率高于残余灶≥2cm的患者（P〈0．05）。多因素分析显示：临床期别、残余灶、腹膜后淋巴清扫和化疗疗程是卵巢癌上皮癌的独立预后因素。结论虽然腹膜后淋巴结清扫可以改善卵巢癌患者生存率,但是建议有选择的进行。对残余灶≥2cm的卵巢上皮癌患者,行腹膜后淋巴结清扫是没有意义的。