计算机辅助CT引导经皮肺结节穿刺活检临床应用

目的评价CT引导下肺结节病变经皮穿刺术的技术要点及临床应用价值。方法本组78例CT诊断肺结节患者,病灶直径为1～3 cm,平均(1.9±0.7)cm。采用计算机辅助多平面重组精确三维定位后,行经皮肺穿刺术,所取组织同时作细胞学和组织学检查。病例经手术病理证实或经临床随访而明确结果。结果 78例中恶性49例,良性病变29例,总穿刺敏感性94.2%,特异性100%,符合率96.1%,阳性预测值100%,阴性预测值89.6%。9例并发气胸,11例肺内少量渗血,1例咯血,1例胸腔大量出血,并发症发生率28.21%(22/78),经处理后均治愈。结论计算机辅助CT引导肺结节病变经皮穿刺术活检对肺结节的定性有重要价值。     

Pressure sensors for the monitoring of diseases in surgical care

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.     

Auditory Neurotoxicity and Hepatotoxicity After MSMA (Monosodium Methanarsenate) High Dose Oral Intake

Context.?Human butyrylcholinesterase (huBuChE) has potential utility as a post-exposure therapy following percutaneous nerve agent poisoning as there is a slower absorption of agent by this route and hence a later onset of poisoning. Methods.?We used surgically implanted radiotelemetry devices to monitor heart rate, EEG, body temperature and locomotor activity in guinea pigs challenged with VX via the percutaneous route. Results.?Treatment with huBuChE (24.2 mg/kg, i.m.) at 30 or 120 min following percutaneous VX (~2.5 × LD₅₀) protected 9 out of 10 animals from lethality. When i.m. huBuChE administration was delayed until the onset of observable signs of systemic cholinergic poisoning, only one out of six animals survived to 7 days. Survival increased to 50% when the same dose of huBuChE was given intravenously at the onset of signs of poisoning. This dose represents approximately 1/10th the stoichiometric equivalent of the dose of VX administered (0.74 mg/kg). Intramuscular administration of huBuChE (24.2 mg/kg) alone did not produce any changes in heart rate, brain electrical activity, temperature or locomotion compared to saline control. Survival following VX and huBuChE treatment was associated with minimal incapacitation and observable signs of poisoning, and the mitigation or prevention of detrimental physiological changes (e.g. seizure, bradycardia and hypothermia) observed in VX + saline-treated animals. At 7 days, cholinesterase activity in the erythrocytes and most brain areas of guinea pigs that received huBuChE at either 18 h prior to or 30 min following VX was not significantly different from that of naïve, weight-matched control animals. Conclusion.?Percutaneous VX poisoning was successfully treated using post-exposure therapy with huBuChE bioscavenger. The opportunity for post-exposure treatment may have particular relevance in civilian settings, and this is a promising indication for the use of huBuChE.     

Percutaneous endovascular treatment of aortic aneurysms: Clinical evaluation and literature results

Abstract

In this study we aimed to evaluate the efficiency of percutaneous endovascular aortic aneurysm repair (p-EVAR). Anatomically selected patients treated with a single 10Fr Perclose Prostar XL vascular closure device (VCD) were examined. Primary success rate and common femoral artery (CFA) open conversion (OC) requirement per sheath size used were recorded. A literature review on p-EVAR results was also performed. One-hundred patients were enrolled. Successful p-EVAR was achieved in 183 of the 196 CFA access sites (93.4%), and was specifically 85.9% and 98.3% for sheaths ≥20Fr and ≤18Fr respectively. There were 13 periprocedural complications (bleeding = 10, arterial dissection and thrombosis = 1, pseudoaneurysm = 2) all leading to OC. Use of ≥20Fr sheaths had significantly higher OC rate (P < .05). Reconstruction was achieved with primary repair (N = 11) and patch angioplasty (N = 2). Mean hospital stay was 1.8 days. The literature review (vascular closure of 2921 CFA access sites) revealed an overall technical success rate of 92.3%. Device related- were more common than patient related-OCs (P < .05). p-EVAR procedures are safe and feasible. Sheath size is a significant predictor of OC rate and more OCs might be expected with very large (≥20Fr) sheath sizes.     

CT引导经皮穿刺微波消融肺部恶性肿瘤的临床观察

目的 探讨CT引导经皮穿刺微波消融（PMAT）治疗肺部恶性肿瘤的临床疗效及应用价值。方法 2010年3月至2012年10月我科收治的23例周围型肺癌患者行CT引导经皮肺穿刺微波消融治疗,共31个病灶。微波频率2450MHz、功率50～70W,根据肿瘤大小、形状选择1点或2点加热。结果 23例患者均完成治疗,手术时间为5～12 min,平均8min。微波消融后即刻CT表现为病灶密度减低及CT值降低,由术前的均数52.60Hu降低为26.12Hu。获完全缓解6例,部分缓解12例,稳定3例,进展2例,有效率为78.3％。3例气胸,2例胸腔积液,15例发热,无1例针道转移。随访至2012年12月,17例患者存活,1年局部控制率为65.2％,中位无进展生存时间为14.6个月,1年、2年生存率分别为91.3％、82.6％。结论 CT引导下PMAT治疗肺肿瘤微创、安全、有效,可以提高患者的生活质量并延长生存时间。     

内镜介入治疗晚期梗阻性食道癌

 晚期梗阻性食道癌患者23例,其中7例为晚期转移不能手术者,16例手术后复发,放疗后又复发者.22例均首先采用扩张术,7例不能手术者中2例患食道支气管瘘,其中1例放支架后采用放疗,另1例放支架后采用化疗,其余5例无食道支气管瘘者-律放支架解除梗阻后进行放疗,16例多次治疗复发者,除扩张外,分别采用微波、局部化疗及合并症出血治疗,止血成功率达67%以上,扩张后消化道梗阻解除率达100%.内镜局部化疗肿瘤缓解率90%以上达PR.     

经皮椎体成形术中斜面针应用效果观察

目的探讨斜面穿刺针和菱形穿刺针在经皮椎体成形手术中的应用方法和优势.方法解离成人25~40岁尸体腰椎1~5椎节(L1~5),共计10×5节,完成各椎节骨含量检测,符合骨含量减少或轻度骨质疏松标准.分别应用斜面穿刺针和菱形穿刺针完成在尸椎上经皮椎体成形术手术模拟操作.手术后行椎体正侧位拍片,使用简易的学生用角度尺和直尺测量穿刺针道偏转数据;观察CT断层扫描下骨水泥在椎体内的分布特点.针道偏转计量数据应用统计软件完成统计分析.结果斜面穿刺针在椎体骨质内发生背向斜面的偏转,偏转角度为(1.83±0.2)°至(3.30±0.3)°.菱形穿刺针在椎体内未发生针道偏转.骨密度值与修正后偏转角度经Pearson相关分析结果显示:2者存在负相关关系,r=-0.991,P=0.001.CT断层扫描显示:自斜面穿刺针之斜面溢出的骨水泥团分布呈现为偏向分布的类椭圆体,随着针体旋转调整,可控制骨水泥注射方向和分布区域;骨水泥自菱形穿刺针顶端溢出后,直接冲向针尖远端,成为类球形体,旋转针体后,不能调整骨水泥注射方向和分布区域.结论实验观察表明,应用斜面穿刺针具实施经皮椎体成形手术,可以在进针和注射过程中充分发挥其所具有天然的设计优势,获得精确的进针路径控制和骨水泥在靶区内的填充控制效果.     

CT引导下经皮椎体病变穿刺活检的临床研究

目的评价CT引导下经皮椎体病变穿刺活检的成功率、诊断正确性及临床应用价值。方法85例椎体病变患者经皮穿刺活检,病变位于颈椎3例,胸椎26例,腰椎37例和骶椎19例。影像学上表现57例为溶骨性病变,19例成骨性病变,9例溶骨性与成骨性病变共存。穿刺标本行细胞学及组织学检查。临床怀疑感染性病变时行细菌学检查。对穿刺标本进行诊断的正确性分析。结果CT证实85例穿刺活检针均位于病灶内,81例取得病变组织,活检成功率95%。活检标本包括29例骨组织标本,5例软组织标本,47例骨组织与软组织混合标本,4例未取得标本;病理结果包括44例转移瘤,17例原发性骨肿瘤,18例感染性病变,2例正常椎体组织。79例诊断正确,诊断正确性97.5%。结论CT引导下经皮椎体病变穿刺活检是对椎体病变作出正确诊断的重要手段,为临床提供了可靠的组织学依据,且穿刺部位正确、三维定向好、损伤小,可以作为诊断不明确的溶骨性及溶骨与成骨混合性椎体病变拟行椎体成形术术前常规。     

髂-股动脉阻塞性病变的介入治疗及临床疗效随访

目的 探讨动脉硬化性髂-股动脉狭窄或闭塞性病变的介入治疗和临床疗效. 资料与方法 52例动脉硬化性髂-股动脉狭窄或闭塞性病变患者行血管腔内成形术(PTA)/支架置入术,对其临床症状(按Fontaine分型和踝/肱指数)的变化进行随访. 结果 52例共计112支病变血管,74支进行PTA及支架置入术,24支仅行PTA,14支未行处理,共置入87枚支架,支架均成功置入于髂/股动脉内,技术成功率为100%.临床随访1～24月,Fontaine分型提高1、2和3级的例数分别是21、22和2例,5例无变化,1例下降1级(1例因1周后行膝下截肢术,不计入临床症状的随访);踝/肱指数术前为0.57±0.14,术后1、6、12和24个月分别为0.91±0.21、0.90±0.04、0.87±0.08和0.86±0.16,与术前比较差异有统计学意义(P＜0.05). 结论 介入治疗动脉硬化性髂-股动脉狭窄或闭塞性病变是一种安全、有效的治疗方法,其近期临床疗效确切.     

经皮椎体成形术治疗老年骨质疏松症椎体压缩性骨折54例

目的:评价经皮椎体成形术(PVP)治疗老年骨质疏松症椎体压缩性骨折的临床应用价值。方法:回顾性分析老年骨质疏松症椎体压缩性骨折54例经皮椎体成形术治疗后患者的疗效,其中男4例,女50例,1个椎体15例,2个椎体29例,3个椎体10例(胸椎48个,其中Th1120个,Th1228个;腰椎55个,其中L1和L2各15例,L310例,L45例,L510例)。结果:54例患者,根据WHO疼痛评价标准,术前疼痛分级Ⅱ级14例,Ⅲ级40例。术后数小时完全缓解45例,术后1周及数周后部分缓解9例。随访半年54例患者手术操作椎体均无复发,患者未发生明显不良反应及并发症。结论:经皮椎体成形术骨水泥治疗老年性骨质疏松症椎体压缩性骨折是一种安全有效的治疗方法。