64层螺旋CT在冠状动脉支架置入术后评估中的价值

目的:评价64层螺旋CT在冠状动脉支架置入术后复查中的临床价值。方法:采用64层螺旋CT对27例冠状动脉支架置入术后的患者(共47个支架)进行CT冠状动脉成像。观察支架及其支架血管和非支架血管的通畅性。结果:支架通畅43例,支架内狭窄3个、闭塞1个,支架前后血管狭窄25支(包括两近端狭窄4例),非支架血管狭窄26支。结论:64层螺旋CT比16层螺旋CT观察冠状动脉内支架优越,可作为冠状动脉支架置入术后效果随访观察和了解原有冠心病进展情况的重要手段。     

自制多孔平行双支架管在尿道下裂手术中的应用

目的 探讨提高各型尿道下裂修复手术成功率的方法.方法 220例尿道下裂患者,均采用一期尿道成形术.阴茎伸直后,用带蒂包皮内板尿道成形术(Duckett术)195例;阴囊中隔+带蒂包皮内板联合成形术20例;膀胱黏膜游离移植尿道成形术5例.用自制带有多个侧孔的平行双硅胶管作为尿道下裂修复手术中新形成的尿道支架管.结果 术后随访1～8年,208例一期手术成功,排尿通畅;2例术后出现尿瘘;6例手术1个月后出现尿道吻合口狭窄,4例术后1个月尿道外口狭窄.结论 本组一期手术成功率达94.5%,自制带有多侧孔的平行双硅胶管作为尿道支架管,具有通畅引流、利于冲洗等优点,可减少感染、尿瘘、狭窄的发生率.     

B超引导下经皮肝穿刺肝静脉成形术 在布-加综合征介入治疗中的应用

目的 探讨B超引导下经皮肝穿刺肝静脉成形术在布-加综合征的介入治疗中的应用价值和疗效。方法 对7例下腔静脉狭窄同时合并肝静脉狭窄或闭塞的布-加综合征患者，在施行下腔静脉成形术后，采用B超引导下经皮肝静脉穿刺的方法，实施肝静脉球囊扩张术或支架植入术。结果 7例患者在单独实施下腔静脉成形术效果不显著的情况下，在B超引导下实施肝静脉成形术，2例单纯球囊扩张，5例植入支架，无严重并发症，术后腹水、下肢水肿等症状有不同程度改善。结论 B超引导下的经皮肝静脉穿刺肝静脉成形术，定位准确，实施快捷，对合并肝静脉狭窄或梗阻的布-加综合征患者症状的缓解有明显效果。     

金属支架治疗大气道狭窄

目的　探讨气管支架成形术缓解大气道狭窄的方法、安全性和疗效。资料与方法　气管狭窄患者 32例 ,其中气管切开或插管后局部组织过度增生 7例 ,转移性肿瘤压迫气管 12例 ,多发性软骨炎引起气管塌陷 1例 ,肺癌 12例 ;单纯气管狭窄 2 8例 ,主支气管狭窄 1例 ,气管支气管同时有狭窄者 3例。术前均经CT检查及气管体层片证实气管、支气管狭窄。 13例术前用的卡因喷喉麻醉 ,19例在全身麻醉下置入支架。结果　 32例共放置 37枚气管支架 ,均一次置入成功 ,无操作失败 ,通气全部得到改善 ,手术成功率 10 0 %。 2例气管狭窄经置入支架后复发狭窄再次置入支架。 33枚置于气管 ,4枚置于主支气管。 1例狭窄严重仅容 4F导管通过 ,用球囊导管扩张至 12mm后置入支架 ;其余均直接置入支架。术后通气功能明显改善 ,无需吸氧 ,无明显胸痛、咯血等并发症。 1周后X线复查无支架移位 ,可见支架进一步扩张。 1例甲状腺癌支架置入术后 2周复发呼吸困难 ,CT扫描示支架内有新生物 ,经支架内放射治疗后症状消失。结论　气管内支架成形术方法简单、安全 ,缓解呼吸困难疗效迅速、确实 ,适合良恶性气道狭窄姑息治疗     

不同材料双J管对兔输尿管的影响

目的：观察不同材料双J管对兔输尿管的影响。方法：本实验通过三种双J管置于15例（每一种双J管5例）正常兔的输尿管内,6周后观察其对输尿管上皮的损伤,输尿管的反应变化,双J管长壳的程度,置管前后肾盂压力的变化,结果：三种双J管均产生上皮细胞的损伤,二种国产双J管所引起的输尿管反应性较小。而进口双J管较重,与之相反,国产双J管长结古石的程度远较进口双J管严重（P＜0．05）,置管6周后与管前比较肾盂压力无明显变化（P＜0．05）,结论：国产双J管有较严重的长结石的倾向,但输尿管的反应性变化较小,适合于短时间置管,进口双J管的输尿管反应性变化较重,便有较长长结石倾向,比较适合于篚置管,尽管这些为动物实验所得结果,但也可能与临床有关系。     

Use of VA ECMO and percutaneous palliation of ductal dependent coarctation in a neonate with trisomy 21 and COVID-19 pneumonia

We present a case of a neonate with trisomy 21, ductal-dependent aortic coarctation, and severe respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. The neonate was managed with venoarterial extracorporeal membrane oxygenation (VA ECMO), palliative stenting of the coarctation, and a vascular plug occlusion of a large patent ductus arteriosus. The patient was successfully weaned off extracorporeal membrane oxygenation (ECMO). The patient is currently awaiting a definitive surgical repair in the near future.     

Flexible tantalum stents: Effects in the stenotic canine urethra

Purpose Evaluate the effects of flexible tantalum stents (Strecker) implanted into stenotic canine urethras.Methods Eight conditioned, adult, German shepherd dogs, weighing 30–40 kg, were used. Strictures were created surgically in the bulbar urethra just proximal to the os penis. Two months postsurgery, strictures were documented radiographically and then balloon dilated. Following dilatation, a single Strecker stent was placed across the stricture. Stents were 7 mm in expanded diameter and either 2 or 4 cm in length. Retrograde urethrography was performed immediately after stent placement and then biweekly for up to 12 months. Two dogs were sacrificed at 2, 4, 6, and 12 months post-stenting, and necropsy was performed. The urethra was excised, fixed, and examined by scanning electron and light microscopy.Results Clinical success was achieved without complications in all animals. Hyperplasia of the urothelium was noted 4–6 weeks after stent placement and was most pronounced at 4–6 months. Mucosal folds were found between the stent struts. Restenosis occurred at the distal end of the stent in one dog. Histological alterations were noted in the deeper layers of the urethral wall.Conclusion Strecker stents were well tolerated in all animals and seem useful for the treatment of urethral strictures.Presented at CIRSE Annual Meeting and Postgraduate Course, Budapest, June 20–24, 1993     

Measuring arterial strain induced by endovascular stents

Endovascular stents are expandable, fenestrated tubes that are threaded in their collapsed state through an artery to a site of occlusion, plastically enlarged and left as permanent implants to scaffold the artery open. The stent induces large-scale vascular strains that are difficult to measure in vivo and yet can be critical determinants of stent-vessel biology. A method is developed to measure the strain tensor developed on the surface of an artery as a stent is expanded in vivo. Arterial sections are marked with reference points and imaged as the stent is expanded. An axially symmetric parametric model of the artery is determined for each expansion time-point, and these reference points are back-projected onto this surface. The back-projected reference points are grouped and analysed to determine the circumferential, axial and torsional strain tensor components in each arterial subsection. The method is characterised in vitro using bovine artery segments and a latex phantom, and is then tested on rabbits to demonstrate its feasibility in vivo. In vitro experiments on stented bovine arteries show typical post-stenting strains of 0.60, -0.26, and 0.08 mm mm-1 in the circumferential, axial and torsional directions, respectively, sampled every 1 mm along the length of the stented region. Phantom experiments characterise the RMS error of system measurements as 0.1 mm mm-1. The system is shown capable of measuring strains of straight, accessible vessels in the presence of respiratory/cardiac motion and visual glare in vivo.     

PTCA及血管支架治疗急性心肌梗死时机选择与心脏功能关系的研究

目的：研究PTCA及血管支架安装治疗急性心肌梗死的时机选择与心脏功能关系。方法：本组78例,分为两组。A组为6h以内急诊,直接行PTCA血管支架安装的病人29例,男：女为23：6,平均年龄51．6±12．7岁。B组为49例,男：女为38：11,年龄52．3±11．5岁。急性期静脉溶栓（6h内）后于24～72h补救PTCA及血管支架安装的病人。结果：术后1周、4周做超声心动图检查,其左室射血分数（LVEF）情况A组VSB组：第1周0．52±0．07VS0．51±0．07（P＞0．05）,第4周0.58±0.08VS0．52±0．06（P＜0．05）。结论：急性心肌梗死病人在发病6h内行PTCA及支架安装能及时地使血运重建,达到改善心脏功能的作用。     

镍钛合金支架治疗食管良、恶性狭窄(附10例报道)

目的;研究镍钛合金支架在食管良,恶性狭窄治疗中的应用,方法;本组１０例患者,食管癌９例,贲门失弛缓症１例,均采用镍钛合金支架,在Ｘ线监视下,经口腔进行置入术。结果：全组支架均一次置入成功,支架入后,患者吞咽困难明显改善,总有效率为１００％,追踪观察,有３例食管癌患者,肿瘤分别突向支架腔内及支架上,下端生长,再次引起狭窄,其中１例又加置一个支架,使食管狭窄再次开通。结论：采用镍钛合金支架治疗食管良,