介入机器人手术系统的现状与未来

介入医学在心脑血管和肝胆肿瘤等疾病的诊断与治疗中发挥举足轻重的作用,已成为继内科和外科治疗外的第3大类治疗技术。近年来,随着影像学技术及机器人手术系统、人工智能、物联网等领域技术的突破,为介入和（或）微创+机器人带来前所未有的机遇,介入机器人手术系统应运而生。笔者简要介绍目前全世界范围内辨识度较高的介入机器人手术系统,...     

经纤维支气管镜肺活检和选择性支气管造影联合应用的临床意义(附八例分析)

为解决普通 X 线无法定性的肺部阴影的诊断问题,我们自1988～1989年,在 X 线电视导向下经纤维支气管镜作了8例肺活检(Lungbiopsy through fibrooptic bronchoscope 以下简称 LBFB),同时追加选择性支气管造影(Selective bronchography 以下简称 SB),效果较满意,现报告如下。     

经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影的对照研究

目的 对经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影进行对照研究，评价其造影效果及临床应用价值。方法 21例患者（男16例，女5例），原发性肝癌15例，转移性肝癌6例。分别同时行肠系膜上动脉间接门静脉造影和经皮脾穿刺CO2门静脉造影，对造影结果进行统计学分析，并对经皮脾穿刺CO2门静脉造影的安全性进行评估。结果 21例经皮脾穿刺CO2门静脉造影中20例造影成功，图像质量明显优于动脉间接法门静脉造影（t=6．815，P〈0．01）。木中有10例患者（10／21）CO2造影术中有一过性轻度腹部不适，1例术后脾脏出血。结论 经皮细针穿刺脾脏CO2造影可清晰显示门静脉结构，图像质量优于动脉法间接门静脉造影，造影方法简便、创伤小、经济；熟练的操作可以提高其安全性。     

经置留导管溶栓治疗急性下肢动脉栓塞二例

病例1 女性,50岁,以“急性坏死性胰腺炎”于1991年5月21日入院手术治疗。术后第19天晚突感左小腿及足部疼痛,逐渐加剧,左下肢麻木。查:左下肢苍白,冰凉,左足背动脉及股动脉搏动均未触及,诊断“左下肢动脉急性栓塞”,10小时后局麻下右股动脉 Seldinger 穿刺,置入6.5F Cobra 导管,行 DSA 检查。见左髂总动脉距开口约1cm 处完全栓塞,呈杯口状充盈缺损,左髂外动脉始终未显影,明确诊断为“左     

移动式C臂DSA机与CT机的联合导向在介入手术中的应用

目的 探讨移动式C臂DSA机与CT联合导向下行介入治疗的定位、操作方法及意义。方法 将移动式C臂DSA机与CT机组成联合机。先用体表标记尺与CT扫描来确定穿刺点，测量出进针的角度及深度。在C臂机实时透视监视下将穿刺针穿刺达病变部位后，再作CT扫描证实。最后在C臂机实时透视下完成药物注射治疗。共治疗142例，主要包括：经皮肺穿刺活检术，经皮肝穿刺治疗肝肿瘤、腹膜后淋巴结转移，经皮肝脓肿穿刺留置导管引流术，经皮穿刺椎体成形术，经皮穿刺腰椎间盘手术，经皮穿刺椎体骨活检术等。结果 在组合机导向下行介入手术142例共158次操作，成功率100％，无严重并发症发生。结论 移动式C臂DSA机与CT机联合导向操作简便，具有定位准确，实时监视的优点，为介入治疗提供了更加安全的导向方法，扩大了介入放射学的应用范围。     

细针脾穿刺门脉造影与磁共振和动脉法间接门脉造影的对照研究

目的将三维动态增强磁共振门静脉造影(3DDCEMRP)和动脉法间接门静脉造影(TAP)对照,评价细针脾穿刺CO2门静脉造影(CO2-SP)的临床应用价值。资料与方法35例接受了以上3种方法门静脉造影。对照分析CO2-SP、3DDCEMRP和TAP对门静脉的显示能力,包括:(1)门静脉成像质量;(2)门静脉主干及左、右分支的开放性;(3)侧支循环发生的部位及分布的范围。结果CO2-SP、3DDCEMRP和TAP门静脉显影质量的平均得分分别为6.46±1.68、5.60±1.55、4.77±1.61,方差分析三者之间的差异有统计学意义(F=9.49,P<0.05)。3种方法显示门静脉开放性的差异无统计学意义(卡方检验,P>0.05),不一致主要表现为显示门静脉开放性程度不同。对侧支循环显示率分别为97%、92%和70%,χ2检验三者之间的差异有统计学意义(χ2=14.92,P=0.001)。结论CO2-SP显示门静脉的图像质量优于3DDCEMRP和TAP;CO2-SP能够准确显示门静脉开放性及侧支循环,尤其在门静脉狭窄程度及细小侧支循环方面具有更强的显示能力。     

应用心电脉冲技术降低64层螺旋CT冠状动脉成像的辐射剂量

Objective To evaluate the value of reducing radiation dose with ECG-pulsing and image quality in 64-row multi-alice CT coronary angiography.Methods Fifty-nine consecutive patients whose heart rates were less than 80 beat per minute and cardiac rhythm was regular were randomly divided into two groups from October 26, 2007 to March 12, 2008.Conventional technique of CT coronary angiography was employed in group 1, while ECG-pulsing technique was applied in group 2.CT dose index volume (CTDIvol) and dose length product (DLP) were obtained automatically, and then the corresponding effective dose (ED) were calculated.The quality scores were performed on obtained imaging by using double blind method.Student t-test was applied in the comparison of value of CTDIvol, value of ED and quality of imagiugbetween two groups.Results The value of CTDIvol was (70.0±1.1) and (39.0±2.7) mGy, the value of ED was (16.8±2.0) and (9.5±1.7) rosy in group 1 and group 2, respectively, which reached statistically significant differences between the groups(t=57.675,15.346 ,P <0.01, respectively). The quality scores of coronary images were 3.8±0.2 and 3.8±0.1 in the groups, which did not reach the statistical significance (t=-0.222, P 0.05).Conclusions The proper application of ECG-Pulsing technology in 64-slice spiral CT coronary angiography can reduce radiation dose significantly while having no influence on the quality of the imaging.     

大鼠间充质干细胞超顺磁性氧化铁标记和经脾移植后的MR示踪研究

目的磁粒子标记骨髓间充质干细胞,同种异体移植入急性肝损伤大鼠脾脏,应用1·5TMR仪进行活体成像,为干细胞移植并无创示踪提供实验依据。方法制备Fe2O3-多聚左旋赖氨酸(PLL),标记分离纯化后的大鼠骨髓间充质干细胞(bonemesenchymalstemcells,BMSCs),普鲁士蓝染色显示细胞内铁。12只急性肝损伤大鼠分成实验和对照两组,将标记细胞(实验组,n=6)和未标记细胞(对照组,n=6)同种异体移植入大鼠脾脏,在移植前、移植后3h及3、7、14d应用MR的T2W对肝脏进行活体成像,测量肝脏信噪比(signal-to-noiseratio,SNR),并与肝脏组织切片普鲁士蓝染色对照。结果BMSCs的Fe2O3-PLL标记率近100%,普鲁士蓝染色显示蓝色铁颗粒位于BMSCs胞质内。实验组和对照组注射前、注射后3h及3、7、14d肝脏的SNR分别为19·53±2·30,3·28±1·06,7·34±2·10,10·25±3·96,15·50±3·73;20·20±4·35,21·20±4·43,19·13±2·80,21·43±5·45,19·07±4·80。与注射前比较,实验组3h及3、7d肝脏的SNR下降,差异具有统计学意义(Dunnett检验,t值分别为16·25,12·19,9·29,P值均<0·05),14d时SNR虽仍较低,但差异无统计学意义(Dunnett检验,t=4·03,P>0·05)。对照组移植后各时间点与移植前比较,SNR改变差异无统计学意义(方差分析,F=0·187,P>0·05)。组织学示普鲁士蓝阳性细胞主要分布于肝小叶中央静脉周围病变区。结论Fe2O3-PLL可以有效标记大鼠BMSCs,临床应用型1·5TMR仪可对磁粒子标记的BMSCs经脾植入后进行活体示踪。     

弥漫性轴索损伤大鼠易损区微结构损伤7.0T MRI定量研究

目的 探讨弥漫性轴索损伤(diffuse axonal injury,DAI)大鼠脑组织微结构损伤的空间分布特征,定量评估易损区轴索损伤的程度.方法使用7.0 T MRI对DAI组(20只)和假损伤对照组(15只)大鼠进行扫描,合成弥散张量成像(diffusion tensor imaging,DTI)参数图并计算各易损区的参数值.免疫组化染色检测各易损区β-APP的表达情况,使用IPP软件定量评估轴索损伤的严重程度.结果与对照组大鼠比较,DAI大鼠部分各向异性(fractional anisotropy,FA)、轴向弥散系数(axial diffusivity,AD)图可见胼胝体局部信号缺损或减低;脑干、胼胝体FA值和AD值显著性降低(P＜0.05);各易损区免疫组化染色的累积吸光度(IOD)值均显著性增高(P＜0.01),最高为脑干(P＜0.05);各易损区标化后FA、AD、表观弥散系数(apparent diffusion coefficient,ADC)与IOD呈负相关关系(P＜0.05).结论 DTI能够检测DAI易损区微结构的非可视病变,活体、定量地早期评估轴索损伤程度.

Abstract：

Objective To observe the spatiotemporal characteristics of the micro-structural injury in a rat model of diffuse axonal injury (DAI) and quantitatively assess the axonal injury severity in the vulnerable areas. Methods The 7.0 T MRI was performed in rats in DAI group (n =20) and control group ( n = 15 ) to synthesize the diffusion tensor imaging ( DTI) parameter map and calculate the parameter value of the vulnerable areas. Immunohistochemistry was used to detect β-APP expression in the vulnerable areas and the IPP software to quantitatively assess the axonal injury severity. Results Compared with the control group, FA and AD maps showed local signal defection or reduction in the corpus callosum and their values decreased significantly in the brain stem and corpus callosum in the DAI group (P ＜0.01 ). The integrated optical density (IOD) value of the vulnerable areas in the DAI group was significantly higher than that of the control group ( P ＜ 0. 01 ) , with the highest level in the brain stem (P＜0.05). The normalized FA, AD and ADC in the vulnerable areas were correlated negatively with the IOD (P ＜ 0.05). Conclusion DTI can detect invisible micro-structural injury in the vulnerable areas and quantitatively assess the axonal injury severity in vivo in the early stage.     

咯血的多层螺旋CT血管成像诊断

目的 评价64层MSCT血管成像对咯血的诊断及指导治疗作用.方法 22例因反复大量咯血的患者行胸部64层MSCT血管成像.结果 咯血相关血管表现为无支气管动脉供血型3例、单支或多支支气管动脉供血型15例、支气管动脉与非支气管动脉共同供血型3例以及直接异常体循环动脉供血型1例.结论 64层MSCT血管成像对支气管动脉DSA插管及栓塞治疗大咯血有明显的指导作用.

Abstract：

Objective To evaluate the nse of CT angiography in the diagnosis of hemoptysis and guiding the treatment of it with 64-slice spiral CT.Methods Twenty-two patients with repeated and massive hemoptysis underwent chest CT angiography.Results The blood supply of hemoptysis was nonbronchial systemic arteries in 3 patients,single or multiple bronchial arteries in 15 patients,mixed arteries of nonbronchial systemic and bronchial arteries in 3 patients and abnormal systemic arteries in 1 patient.Conclusion With 64-slice spiral CT,CT angiography provided useful information for the treatment of hemoptysis by guiding bronchial arterial embolization.