The Significance of Anatomical Variations of Hepatic Artery and Multiple Arterial Supplies in Embolization of Liver Tumors

(胡国栋)(李小明)(黄志程)(胡道予)ＴｈｅＳｉｇｎｉｆｉｃａｎｃｅｏｆＡｎａｔｏｍｉｃａｌＶａｒｉａｔｉｏｎｓｏｆＨｅｐａｔｉｃＡｒｔｅｒｙａｎｄＭｕｌｔｉｐｌｅＡｒｔｅｒｉａｌＳｕｐｐｌｉｅｓｉｎＥｍｂｏｌｉｚａｔｉｏｎｏｆＬｉｖｅｒＴｕｍｏｒｓ￥ＨＵ...     

脑血管母细胞瘤的外科治疗(附38例报告)

目的总结、探讨脑血管母细胞瘤的外科治疗。方法对38例脑血管母细胞瘤的临床表现、手术治疗进行回顾分析。结果30例囊性肿瘤均行瘤结节全切除术;随防3～20年,未复发29例。8例实体性肿瘤中,4例先行血管内栓塞后行全切除术,另4例因术中大出血行大部分和部分切除;随访3～12年,全切除的4例未复发,非全切除者1例无变化,1例增大,2例死亡。结论囊性血管母细胞瘤外科治疗易做到全切除,疗效好。实体性血管网状细胞瘤外科治疗因血管丰富,可先行血管内栓塞,减少术中出血量,提高切除率。     

术前选择性血管栓塞减少脊柱转移瘤术中出血

目的:改变脊柱转移瘤治疗长期以来采用的姑息、保守的治疗方法。手术切除脊柱肿瘤后,给予坚强的内固定,辅以术后放化疗,可延长病人的生命,使病人无痛生存,提高了病人的生活质量。但由于脊柱转移瘤切除术中出血异常多,使手术切除肿瘤椎管减压内固定较难进行,为解决这一问题我们于1991年始用下述方法治疗脊柱转移瘤。方法:应用术前选择性脊柱血管栓塞,肿瘤切除椎管减压,内固定器材固定治疗脊柱转移瘤16例,取得了满意的效果。16例病人均为胸腰段转移瘤,均在术前48h行相应脊柱血管,胸段选择相应肋间动脉,腰段选择相应腰动脉进行栓塞,然后行胸段、胸腰段、腰段前路或后路肿瘤切除,椎管减压、内固定术。结果:16例病人术中出血平均900ml,出血量最少者仅600ml,出血量较未行血管栓塞病例明显减少,术野更为清晰、使术者更易操作;术后病人脊髓及神经根受压症状明显减轻,16例脊髓及脊神经根受压症状明显减轻,16例病人中8例脊髓及脊神经受压症状完全解除。结论:术前脊柱血管栓塞,手术切除肿瘤椎管减压内固定明显减少了术中出血、降低了手术风险、缩短了手术时间,是治疗脊柱转移瘤的安全有效的方法。     

经皮血管内栓塞颅内动静脉畸形（附38例治疗效果观察）

经皮血管内采用氰基丙烯酸异丁脂（ＩＢＣＡ）栓塞治疗３８例颅内动静脉畸形（ＡＶＭ）病人。其中８例达到１００％完全栓塞，栓塞面积大于７５％的１０例，大于５０％者１１例；余下９例栓塞面积小于５０％，１９例以出血为首发症状，１１例以癫痫为首发症状，６例神经功能障碍，２例以头痛为主要症状。栓塞术后发生并发症５例，占１３％，无死亡病例。本文讨论了超选插管技术问题、Ａｍｙｔａｌ试验假阴性、导管粘连及正常灌注压突破。     

介入神经放射治疗43例

１９８５～１９９３年对４３例脑血管病及脑肿瘤患者应用介入神经放射治疗方法进行了５１次治疗，包括外伤性颈内动脉海绵窦瘘的球囊栓塞治疗８例；脑、脊髓血管畸形的栓塞治疗１７例；各种脑肿瘤术前栓塞７例；经皮穿刺血管内成型治疗脑供血动脉狭窄３例和脑胶质瘤超选择化疗８例，效果良好，介入神经放射治疗已成为重要的临床治疗手段，是某些脑血管疾病的首选治疗方法。     

肝移植术后血管胆道并发症的介入治疗

目的:评价介入治疗对肝移植后胆道、血管并发症的价值。材料和方法:18例肝移植患者接受了介入治疗。其中肝动脉狭窄8例,行肝动脉造影及溶栓治疗;下腔静脉及肝静脉狭窄2例,行内支架置入术;胆瘘及胆道狭窄8例,行PTCD治疗。结果:胆道并发症8例,PTCD治疗后症状消失;肝动脉狭窄8例,溶栓后肝动脉完全开放6例,1例血流部分开放,1例肝动脉血流未恢复再次肝移植治疗;下腔静脉及肝静脉狭窄2例内支架置入术后下腔静脉梗阻及肝肿大症状消失。结论:介入治疗是治疗肝移植后胆道血管并发症的有效方法。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

血管内覆膜支架置入治疗降主动脉夹层动脉瘤

目的 :介绍血管内覆膜支架置入治疗降主动脉夹层动脉瘤的初步经验。材料与方法 :本组 6例 Debakey 型的慢性降主动脉夹层动脉瘤患者行血管内覆膜支架置入治疗。经股动脉将 Talent覆膜支架置于夹层动脉瘤裂口处 ,支架张开使覆膜支架固定于裂口附近的主动脉壁上将裂口封闭并阻断血流。结果 :6例病人均获得成功 ,手术和临床成功率 10 0 %。 1例患者术中出现内漏 ,置入第二枚支架后漏口封闭。平均随访 7个月 ,所有患者内膜裂口全部完全封闭 ,假腔内血栓形成无内漏 ,假腔均明显缩小。结论 :血管内覆膜支架置入治疗主动脉夹层动脉瘤具有安全可靠 ,患者术后恢复快的优点     

未破裂期输卵管妊娠介入治疗术的护理配合

目的 :根据 14例未破裂期输卵管妊娠病人在介入治疗过程中的护理配合 ,提出术前、术中、术后的护理配合是介入治疗成功的重要环节。方法 :14例病人中 ,7例采用经阴道输卵管孕囊内药物注射方式 ,7例采用经健侧股动脉穿刺子宫动脉内插管灌注栓塞方式。结果 :全部病例均获得满意的疗效。结论 :随着介入技术的应用和普及 ,对护理工作提出了更高的要求 ,总结经验、完善新技术条件下的护理配合 ,是摆在护理工作者面前的一项新任务     

经肝动脉介入治疗并发胆囊坏死(2例报告并文献复习)

目的 :探讨经肝动脉介入治疗并发胆囊坏死的发生原因和防治措施。方法 :报告 2例经肝动脉介入治疗并发胆囊坏死的病例 ,均经手术病理证实。并结合文献资料分析这一并发症发生的机率、原因 ,以及为了减少并发症的发生需要注意的一些问题。结果 :近 8年来我院共做经肝动脉介入治疗 6 80例次 ,并发胆囊坏死 2例 (0 3% )。其发生原因是多方面的。超选择插管不到位是该并发症发生的主要原因。结论 :胆囊坏死是经肝动脉介入治疗比较常见的严重并发症之一 ,在今后工作中应引起足够的重视 ,尤其对肝血管瘤的介入治疗更应慎重 ,使这一并发症的发生率降至最低限度。