腹部穿透伤保守治疗30例分析

目的 探讨腹部穿透伤保守治疗指征,总结辅助检查在治疗过程中的价值.方法 回顾性分析同一治疗小组于2006年8月至2010年10月保守治疗30例腹部穿透伤的临床资料.结果 保守治疗成功25例,中转手术5例.所有保守治疗成功病人于入院24～72 h出院.结论 保守治疗应成为腹部穿透伤治疗的手段之一,严格掌握指征、动态观察是...     

Preliminary experience with interactive guided brain biopsies using a vertically opened 0.5-T MR system

The purpose of our study was to evaluate the feasibility and accuracy of brain biopsies performed within a vertically opened MR system. We worked with the interventional 0.5-T MR “SIGNA SP” (General Electric Medical Systems, Milwaukee, Wis.) with an integrated tracking device “Flashpoint Position Encoder” (Image Guided Technologies, USA). As a holding device for this instrument we constructed a special frame. The whole system allows an exact adjustment of an optimum biopsy direction and guidance of the biopsy in a non-stereotactic, interactive mode in near real-time. As biopsy tools we used MR-compatible aspiration and specially made side-cut needles (Daum, Germany; E-Z-EM, USA). We performed a prospective diagnostic brain biopsy study in 18 patients. Guidance of the needle was carried out using gradient-echo single-slice technique. The sample was taken after controlling the exact position of the needle tip on spin-echo images. In 12 cases an exact neuropathological diagnosis was possible. In 6 cases of negative biopsy (4 aspiration biopsies) the samples were not representative. Our results demonstrate the feasibility of interactive MR-guided minimally invasive brain biopsies in an open MR system. The best results were achieved using cut needles for biopsies of contrast-enhancing lesions visible on T1-weighted gradient-echo guidance sequence. Received: 2 February 1998; Revision received: 13 July 1998; Accepted: 2 September 1998     

A comparative analysis of the accuracy, diagnostic uncertainty and cost of imaging modalities in suspected scaphoid fractures

INTRODUCTION: Clinical examination of suspected scaphoid fractures is sensitive, but not specific, and initial plain radiographs lack sensitivity. A variety of second-line imaging techniques have been proposed to improve immediate diagnosis and reduce overtreatment. Different sample populations and methods of reporting test performance have made side-by-side comparison difficult. The aim of this study is to describe the epidemiology of clinically suspected scaphoid fracture and determine the prevalence of true fracture. These data are used to compare second-line imaging techniques in our population. PATIENTS AND METHODS: 200 consecutive patients attending a trauma service with clinically suspected scaphoid fracture were followed through diagnosis to discharge. RESULTS: The prevalence of true fracture was 16% and was associated with male sex and injury playing sport. Magnetic resonance imaging has the best diagnostic performance, with the added benefit of soft tissue evaluation, but was the most expensive option. Ultrasound examination was least effective in detecting true fractures. CONCLUSIONS: Future studies should further evaluate the clinical and economic sequelae of overtreatment of suspected fractures. Clinicians should examine alternatives to "empirical" treatment without definite diagnosis based on their local facilities and patient demographics.     

痛风性关节炎误诊原因分析

痛风性关节炎在20世纪60年代以前,国内只有30例左右的报道,但随着人民生活水平的提高,痛风性关节炎患者逐渐增多,而有些医师临床诊治水平却并未随之提高,出现了不少误诊病例,现就我们近年来接诊的部分误诊病例作一分析。     

导航辅助脊柱胸腰段椎弓根钉植入的临床应用

目的探讨临床运用计算机影像导航技术引导脊柱胸腰段椎弓根钉植入的准确性。方法2003年5月-2007年5月,29例患者接受116枚计算机影像导航技术引导脊柱胸腰段椎弓根钉植入手术治疗,T10-T1250枚胸椎弓根钉,L1-L3 66枚腰椎弓根钉。术中记录椎弓根钉植入所需时间及C-臂透视工作次数,椎弓根钉植入完成后,即行C-臂正侧位摄片并与导航路径进行比较测量。术后CT进行椎弓根层面扫描,根据椎弓根钉与椎弓根皮质问关系分为四级：A=在椎弓根内;B=突破皮质,〈2mm;C=突破皮质,2-4mm;C=突破皮质,〉4mm。结果术后CT椎弓根位置扫描显示：A级101枚（87．07％）;B级10枚（8．62％）;C级2枚（1．72％）;D级3枚（2．59％）。1枚椎弓根钉植入平均所需时间：2．73±0．64min（1．15～4．02min）。下胸椎9枚（7．75％）胸椎弓根钉突破皮质,上腰椎6枚（5．17％）腰椎弓根钉突破皮质,且临床观察未发现与椎弓根钉突破皮质相关的神经血管等并发症。植入的椎弓根钉C-臂正侧位摄片与导航路径吻合比较,进钉点均差2．6mm（最大3．1mm）,角度均差3．3°（最大5．4°）。结论计算机影像导航辅助脊柱胸腰段椎弓根钉植入,提供二维、多平面实时显示,保证了脊柱胸腰段椎弓根钉植入的准确性及安全性,明显减少放射线的暴露强度。     

肾上腺肿瘤的影像学诊断与临床治疗(附117例报告)

目的总结肾上腺肿瘤的影像学诊断及外科治疗经验.方法应用比较影像学方法,对117例患者的各种影像学检查方法的定位、定性诊断正确率及治疗结果进行分析.结果B超、CT、MRI定位准确率分别为84.6%、90.6%、98.1%,术前定性准确率为39.2%、69.6%、79.6%.综合影像检查定位、定性准确率100.0%及87.5%.手术切除107例,其中巨大肿瘤(体积＞10cm×5cm×4cm)30例.9例肾上腺转移癌采取超声引导下穿刺硬化或介入性治疗.1例未手术.结论肾上腺肿瘤影像学检查B超可作为筛选手段,CT、MRI定位准确率高,定性准确率MRI略高于CT.综合影像学检查可发挥互补作用.正确的手术切口选择是手术成功的要素之一.围手术期充分准备是减少并发症的保证.腹腔镜B超技术具有术中诊断作用并可指导手术方案的制定和修改.     

诊断性腹腔镜的临床应用

目的:探讨诊断性腹腔镜的临床应用价值。方法:2001年9月至2008年7月为70例有临床症状,但诊断不明确的患者进行了腹腔镜探查。可疑组织送病理检查。结果:腹腔镜手术探查阳性61例,阳性率87.1%。其中不明原因腹水52例,46例确诊(88.5%);慢性腹痛4例,3例确诊(75%);腹腔肿块4例,3例确诊(75%);肠梗阻3例和急腹症5例,均得到确诊(100%);其他2例,明确诊断1例。结论:腹腔镜探查是一种安全有效的诊断方法,通过镜下观察及活检组织的病理检查基本可以明确病因。     

老年人原发性腹膜后肿瘤73例诊治分析

目的探讨老年人腹膜后肿瘤的诊断及治疗方法。方法回顾性分析我院1990年1月～2002年12月经手术治疗的73例老年人原发性腹膜后肿瘤的临床资料。结果术前CT扫描、MRI诊断PRPT的准确率为100%。本组良性肿瘤12例,完整切除11例;恶性肿瘤61例,完整切除38例。全组合并脏器切除60例次,因复发再次手术17例。全组无手术死亡病例。结论CT、MRI是重要的辅助检查手段。只要充分做好术前准备,高龄并不是手术的禁忌证。对于术后复发者可再次手术。     

剖宫产瘢痕妊娠的影像学诊治进展

目的剖宫产瘢痕妊娠是发病率低、风险极高的异位妊娠,临床症状和体征多样,易误诊为早孕、难免流产等。影像学检查技术在剖宫产瘢痕妊娠的早期诊断及治疗中均发挥着重要作用,本文就此进行综述。