子宫肌瘤栓塞术后产生疼痛的临床防治

目的 探讨子宫肌瘤栓塞术后产生疼痛的防治措施。方法 56例子宫肌瘤患者栓塞术后均出现疼痛，按对栓塞术后产生疼痛的处理方法不同分为对症组与预防组，分别为3l例和25例。通过观察2组患者术后疼痛的程度和持续时间，评价2种处理方法有无差异。结果 2组患者发生不同程度疼痛的比例无明显差异，但疼痛持续时间预防组显著较短。结论 积极地做好预防处理能有效地减轻子宫肌瘤栓塞术后产生疼痛的程度和持续时间，提高介入治疗的综合效果。     

金属支架、内涵管置入术治疗恶性胆道梗阻的成本-效果分析(多中心研究)

目的比较金属支架与塑料支架(内涵管)置入术治疗恶性胆道梗阻成本-效果比。方法调查广东省三家医院95例实施经皮穿肝胆总管支架置入术的恶性胆道梗阻患者,其中61例置入自膨式金属支架(支架组),34例置入10F 塑料内涵管(内涵管组)。所有患者均回访至死亡或至少术后1年。用 Kaplan-Meier 方法分析比较两组患者的生存及支架开通率,并计算两组的成本-效果比(Cost-effective rations,CER),即 CER_(中位生存期)=总成本/中位生存期,CER_(中位开通期)=总成本/中位开能期。结果两组总成本无差异,分别为53177±3139元和43564±4950(P<0.05)。支架组的 CER_(中位生存期)=237.4元/d、CER_(中位开通期)=231.2元/d,低于内涵管组(分别为 CER_(中位生存期)=452.6元/d、CER_(中位开通期)=472.9元/d。结论金属支架置入术治疗恶性胆道梗阻的成本效果比优于内涵管。     

经皮不同径路肝动脉内植入药盒导管系统的对照研究

探讨肝动脉内植入药盒导管系统的最佳径路。材料与方法２１６例中晚期肝癌,１１８例采取经皮左锁骨下动脉径路肝动脉内植入ＰＣＳ,另外９８例采取经皮股动脉径路植入ＰＣＳ。结果ＬＳＡ组与ＦＡ组植入成功率分别为９１．５％和８８．７％。结论常规采取ＦＡ径路肝动脉内植入ＰＣＳ安全可行。     

肝移植术后多发动脉狭窄的介入治疗一例

患者为男性,23岁,因急性肝功能衰竭、肝昏迷于2010年11月在外院行原位肝移植,术后第3天,丙氨酸转氨酶为337 U/L,天冬氨酸转氨酶为103 U/L,白蛋白为43.1 g/L,胆红素总量为101 μmol/L,直接胆红素为82μmol/L.行320排CT扫描检查,提示腹腔干起始部狭窄,达85%,肝右动脉起始部狭窄,达80%.腹腔动脉造影结果同上,肝动脉吻合口无明显狭窄.     

原位肝移植术后肝窦阻塞综合征一例报道

肝窦阻塞综合征(HSOS)是由于肝窦内皮细胞损伤致肝窦流出道阻塞所引起的肝内窦性门静脉高压症,并以痛性肝肿大、腹水、黄疸为特征,既往称为肝小静脉闭塞病(HVOD).肝移植术后并发HSOS非常罕见,文献报道其发病率约1.9%[1].本病的诊断较为困难,容易造成误诊、误治.我们遇到1例原位肝移植术后并发HSOS者,现将我们的诊治体会报告如下.     

原位肝移植术后肝动脉狭窄导致缺血型胆管损伤的治疗

目的 探讨原位肝移植术后肝动脉狭窄导致缺血型胆管损伤的治疗方法及预后.方法 回顾性分析我院2004年6月至2008年6月,11例肝移植术后肝动脉狭窄导致胆管损伤,接受肝动脉支架成形联合内镜逆行胰胆管造影术(ERCP)和(或)经皮经肝胆管引流(PTCD)处理患者的临床资料.结果11例患者成功植入12枚冠脉支架,5例单独采用胆道ERCP引流,3例采用PTCD,3例ERCP疗效欠佳后改用PTCD.随访4个月至4年,6例死于感染,其中5例1年内死亡,3例再次接受移植,2例生存至今.结论 肝移植术后肝动脉狭窄导致缺血型胆管损伤总体疗效欠佳.肝动脉支架联合胆道长期引流可延长移植物存活期,为再次肝移植提供机会.     

肝癌原位肝移植术后肿瘤复发的多层螺旋CT和MRI影像学诊断

Objective To investigate the manifestation and diagnostic value of multislice spiral CT (MSCT)and MRI imaging in detection of tumor recurrence after liver transplantation for bepatocellular carcinoma(HCC).Methods The clinical data of 161 consecutive HCC patients who underwent orthotopic liver transplantation were retrospectively reviewed.Twenty-nine HCC patients were classified by pTNM according to the "Pittsburgh criteria".MSCT and MRI findings of tumor recurrence after liver transplantation were evaluated retrospectively in 29 stage Ⅱ-Ⅳ b HCC patients.The recurrence site and relapse interval between liver transplantation and recurrence were analyzed.Results Lung tumor recurrence were found in 21 cases,presented as cotton-like lesions in a diameter of 2-3 cm,with a clear margin and homogeneous density.Pleural tumor recurrence was detected in 4 cases.Liver tumor recurrence were found in 9 cases,which can be divided into four subtypes:multinodular in 4 cases,diffuse lesion in 2 cases,huge mass in 2 cases,and uninodular in 1 case.Two cases showed tumor thrombus in the inferior vena cava and portal vein.Lymph node tumor recurrence was found in 9 cases,presented as multiple nodules at hepatic hilum,lesser peritoneal sac,posterior mediastinum,retroperitoneum,or around pancreatic head,and accompanied with merging and necrosis in one case.Bone tumor recurrence were found as osteolytie destruction in 4 cases,and accompanied with adjacent soft-tissue mass in 2 cases.The recurrence sites of the 29 cases were as following:lung(21 cases,72.4%),liver(9 cases,31.0%),lymph nodes(9 cases,31.0%),bone (4 cases,13.8%)and other sites(3 cases,10.3%).Lung tumor recurrence was found in all the 10 stage Ⅳb patients with tumor recurrence after liver transplantation,significantly more frequent than that in stage Ⅳ a patients(P = 0.023).After liver transplantation,all 25 patients with stage Ⅲ～Ⅳ b HCC developed recurrence within one year,but in the 4 cases with stage Ⅱ HCC at one year later(P = 0.009).Conclusion The results of our study show that in hepatoceUular carcinoma patients after liver transplantation,the lung and pleura are the most fequent site of recurrence,followed by liver,lymph node and bone as the second and third sites.The Stage Ⅳ b hapatocellular carcinoma should be regarded as a contradiction for liver transplantation due to rapid recurrence.Tumor recurrence occurs later in stage Ⅱ HCC than in stage Ⅲ～Ⅳb patients.MSCT and MRI are of significant importance in diagnosis and formulating operation plan in HCC patients with recurrence after liver transplantation.     

子宫动脉栓塞治疗子宫肌瘤的生命质量评价

目的　评价子宫动脉栓塞治疗子宫肌瘤的生命质量变化 ,并与手术治疗相比较。方法按照完全随机对照研究方法 ,将子宫肌瘤患者分为子宫动脉栓塞组和手术治疗组 ,术前和术后 6个月进行生命质量问卷调查 ,分析治疗前后 2组患者生命质量的变化。结果　 2 79例症状性子宫肌瘤患者符合标准进入本研究 ,其中栓塞组 1 39例 ,手术组 1 4 0例。 2 1 8例患者 (栓塞组 1 1 8例 ,手术组1 0 0例 )完成术后 6个月的生命质量问卷。栓塞组术后的生命质量各因子评分均较术前明显提高 ,差异均有非常显著性意义 (P <0 0 0 1 ) ,而手术组术后除性生活评分与术前比较差异无显著性意义外 ,其他因子评分与术前相比差异均有非常显著性意义 (P <0 0 0 1 ) ;治疗前后生命质量评分差值两组患者相比较 ,术后性生活、一般健康状况、精力、情感职能和精神健康和健康变化等因子评分差值两组差异均有显著性意义 (P <0 0 0 1 ) ,栓塞组高于手术组。结论　子宫动脉栓塞比手术治疗更能提高子宫肌瘤患者的术后生命质量     

经子宫动脉途径介入治疗输卵管妊娠

目的：探讨经子宫动脉途径治疗输卵管妊娠的可行性和临床疗效。方法：采用介入方法治疗34例输卵管妊娠患者,以4．1－5．0F导管行超选择性子宫动脉内灌注MTX（氨甲喋呤）50－100mg,灌注后用明胶海绵栓塞子宫动脉。术前、术后观察临床症状,体征、尿β-hCG(人绒毛膜促性腺激素）值及肿块大小变化。结果：34例中31例获得成功,成功率达91％。无不良反应发生。40支子宫动脉造影,显示输卵管动脉37支,显示率为92．5％;卵巢染色27例次,发现率达68％。6例显示孕囊染色,显示率为18％。结论：子宫动是输卵管的主要供血动脉,经子宫动脉途径介入治疗输卵管妊娠安全有效,并要预防和控制破裂大出血。