经皮椎体成形术和后凸成形术并发症的对比分析

经皮椎体成形术(percutaneous vertebroplasty,PVP)已成为椎体良恶性肿瘤和骨质疏松性椎体压缩骨折的有效治疗手段,其同类技术经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)术的使用也在迅速增加。2001至2002年间,美国的PVP术的病例数从38000上升至48000,增长了28％,PKP的病例数量增长了一倍达到16000例。     

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。     

用自制器械行选择性输卵管造影和再通术

报告用自制器械行子宫输卵管选择性造影及再通术45例,插管成功率95.5%。近端输卵管阻塞再通率80%。随访结果:15例患者正常受孕,受孕率33.3%,其中继发不孕症受孕率50%,原发不孕症受孕率17.4%。近端阻塞再通术后受孕率54.5%,远端积水或阻塞患者受孕率15%。显示选择性输卵管造影及再通术是治疗女性不孕症的有效方法;本手术最佳适应证为继发不孕、近端输卵管阻塞患者;自制器械价廉、安全。     

支架端改型防治食管支架术后再狭窄的临床应用

目的 观察支架端改型对食管支架术后再狭窄的防治作用及其安全性.方法 10例经病理及影像学确诊的食管癌患者,用支架端增加硅胶膜的改型支架进行治疗.术后每月随访吞咽困难程度Stooler分级评分、胸部X线片、CT和食管钡餐,了解支架的位置及有无梗阻;每2个月行胃镜检查以了解支架有无狭窄,随访有无严重胸痛、出血、肺炎、食管气...     

食管支架成形术治疗食管狭窄现状及研究进展

支架置入术是治疗食管良恶性狭窄最常用的方法.目前广泛应用于治疗进展期食管癌性狭窄、顽固性食管良性狭窄、各种食管瘘等.本文就食管支架的临床应用现状及研究进展作一综述.     

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.     

内皮祖细胞MRI示踪研究进展

研究表明内皮祖细胞(endothelial progenitor cells,EPCs)与很多疾病有关,如血管损伤、动脉粥样硬化和肿瘤等,对于诸多疾病的诊断和治疗有着良好的应用前景[1-2].随着研究的进一步深入,EPCs的来源、动员、归巢和分化等生物学行为成为研究EPCs与疾病相互作用机制的主要内容,如何在活体有效地评价EPCs的生物学行为则自然地成为医学影像学而临的一项重要课题.近年来,分子影像学的快速发展使得在细胞和分子水平活体无创地监测疾病过程成为可能,其中的一项重要研究内容是细胞成像[3-4].在MR细胞成像研究中,对EPCs的MRI示踪做了一些初步的探索,简要综述如下……     

APP/PS1转基因阿尔茨海默病小鼠的MR波谱定量分析

Objective To explore changes of metabolites in APP/ PS1 double transgenie mice of Alzbeimer disease (AD) by 1H-MR spectroscopy (1H-MRS) and the application value of in early diagnosis of AD.Methods 1H-MRS was performed in 35 APP/PS1 transgenie mice of AD ( study group) and 20 wild type mice ( control group) at age of 3, 6 and 9 months using a 7.0 T MR system.Sub-peak areas of N-acetyl aspartate (NAA), myo-inositol (mI) and creatine (Cr) in the cerebral cortex and hippocampus were measured, and the NAA/Cr and mI/Cr ratios were calculated.The changes in pathology between the two groups were compared.Using the lower limit of 95% confidence interval (CI) of the ml/Cr ratio and the upper limit of 95% CI of the NAA/Cr ratio of AD mice as the threshold, their influences on sensitivity,specificity and accuracy of various age groups of AD animals were compared.Comparison of the 1H-MRS indexes between study mice and wild type mice at each time point were conducted by a two-sample t test.Results The mean mI/Cr ratios of AD mice were 0.68± 0.03, 0.72± 0.04, and 0.77 ± 0.04 respectively at 3, 6 and 9 months of age; while they were 0.63 ± 0.04, 0.64 ± 0.03, and 0.64 ± 0.04 respoetively in control group, the difference was significant ( t = 2.814, 5.146, 14.437, P < 0.01 ).Compared with the control group, the mI/Cr ratio of the 3-month-old AD mice of the study group was significantly increased,and histological examination showed proliferation and activation of neuroglial cells in the cerebral cortex and hippoeampus.The mean NAA/Cr ratio were 1.17 ±0.08, 1.04 ±0.05, and 0.90 ±0.05 respectively at 3,6 and 9 months of age in study group, while they were 1.18 ±0.07, 1.16 ±0.07, and 1.18 ±0.08respectively in control group.There were no significant difference ( t = 0.752, P > 0.05 ) between the study group and control group at 3 months of age, and the NAA/Cr ratio decreased significantly only at 6 and 9 months of age ( t = - 8.514, - 5.646, P < 0.01 ).The immunohistochemical exam demonstrated the appearance of Aβ plaque.According to threshold of mI/Cr, the sensitivity of AD mice of 3, 6 and 9 months of age was 80% (28/35), 84% ( 26/31 ) and 85% ( 23/27 ), and the specificity was 85% ( 17/20 ),94% (17/18) and 100% ( 16/16), and the accuracy was 82% (45/55), 88% (43/49) and 91% (39/43),respectively.For NAA/Cr, the sensitivity of AD mice of 6 and 9 months of age was 84% (26/31) and 89% (24/27), and the specificity was 89% (16/18) and 100% (16/16), and the accuracy was 86% (42/49) and 93% (40/43), respectively.Conclusions NAA and mI are the most sensitive and specific markers for early assessment of AD, and change of mI is earlier than that of NAA.Quantitative analysis of mI may provide important clues for early diagnosis of AD.     

支架植入对股腘动脉闭塞性病变内膜下成形术后通畅率的影响

目的采用内膜下成形和(或)支架植入治疗股腘动脉闭塞性病变的临床疗效及支架植入对术后通畅率的影响。方法 2007年1月至2009年5月收治下肢股腘动脉闭塞患者43例(43条肢体),其中24例(非支架组)行单纯内膜下成形术,其余19例患者(支架组)在内膜下成形后一期行支架植术。术后行CTA或多普勒超声检查,对部分再狭窄或闭塞病变行再次介入治疗。术后随访1～27个月。结果术后12个月保肢率为98%(42/43),围手术期并发症发生率为7%(3/43),2年死亡率为7%(3/43)。随访期内22例出现再狭窄或闭塞,其中非支架组3例闭塞发生在术后1个月内;共有12条肢体行再次介入治疗。非支架组6、12和24个月的一期通畅率分别为83.3%±7.6%、74.0%±9.2%和56.1%±13.5%;支架组分别为89.5%±7.0%、77.5%±9.9%和32.2%±16.6%。非支架组12、24个月的一期辅助通畅率分别为90.9%±6.1%和64.2%±14.7%;支架组分别为94.4%±5.4%和39.0%±15.9%);支架组和非支架组整体间差异均无统计学意义P>0.05。远端血管通畅数目、股腘动脉闭塞类型和吸烟史对内膜下成形术后2年内一期通畅率有显著影响(r=-4.417,2.502,3.115;Sχ=1.627,0.955,1.523;P=0.007,0.009,0.041)。结论内膜下成形术后不必常规行支架植入;支架植入不会改善术后2年期内的通畅率;2年期内通畅率与周围血管条件密切相关,吸烟也对预后有重要影响。