锁骨下静脉穿刺心脏介入通路的解剖学基础

目的：为锁骨下静脉穿刺的心脏介入通路提供提供解剖学依据。方法：采用３５具成人尸体、４套成人躯干连续横断层和１套连续矢状断层标本,观测相关参数。结果：锁骨下静脉、头臂静脉和上腔静脉的长度与外径值,与其它路径相比,右侧锁骨上皮经锁骨下静脉穿刺的介入通路具有路径短、弯曲小的优点。穿刺点选在锁骨上缘上、内１／３交界处的上方,针尖指向胸锁关节稍外侧。结论：首选右侧锁骨上经皮锁骨下静脉穿刺的心脏介入通路。     

Amplatzer封堵器经导管治疗动脉导管未闭20例

目的　应用 Amplatzer封堵器经导管治疗动脉导管未闭并对其即刻和近期疗效进行评价 .方法　全组 2 0例 ,年龄 2 0± 17( 0 .8～ 5 1)岁 ,体质量 37± 2 0 ( 6～ 70 ) kg,动脉导管未闭最窄处直径为 5 .1± 1.8( 2 .9～ 10 .0 ) mm.经 6或 7F导管置入 Amplatzer封堵器 ,术后 10 min行侧位降主动脉造影 ,术后 1d及 1mo行超声心动图检查观察有无残余分流及动脉导管未闭再通 .结果　全组技术成功率为 10 0 % ,术后 10 min降主动脉造影示 ,6例有微 -少量残余分流 ,术后 2 4h,术后 1mo超声心动图未见残余分流及再通 .结论　应用 Amplatzer封堵器治疗直径达 10 mm的动脉导管未闭是一种安全有效的介入方法 ,操作简便 ,成功率高 ,近期疗效可靠 ,中远期疗效尚待进一步观察     

Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz goose-neck snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential. Correspondence to: R. D. Edwards     

介入化疗栓塞治疗32例宫颈癌合并出血的临床疗效分析

目的探讨介入化疗栓塞治疗宫颈癌合并出血的临床意义。方法对３２例宫颈癌合并出血的患者采用子宫动脉灌注５－氟尿嘧啶（５－Ｆｕ）、顺铂（ＰＤＤ）、丝裂霉素（ＭＭＣ）加碘油行子宫动脉化疗栓塞,再用明胶海绵栓塞止血。结果①盆腔动脉造影能清楚显示肿瘤血管及范围,明确出血部位,经化疗栓塞后全部病例得以止血。②介入治疗能够短时间内控制巨大肿瘤,但难以使肿瘤完全坏死。结论介入化疗栓塞能够取得满意的止血效果,是其他治疗手段不可比拟的。介入治疗能够提高宫颈癌的近期疗效,但单纯用介入治疗难以根治,必须配合手术治疗或放射治疗。     

心血管疾病介入诊治术患者心理状态调查分析

对８６２例心血管疾病介入诊治术患者术前分别采用心理护理（ｎ＝４３１）和非心理护理（ｎ＝４３１）前后比较心理状态差别观察。结果显示：手术前所有患者均有严重焦虑心理,经采用心理宣教、心理护理后,患者焦虑程度大大降低（Ｐ＜０．００１）,处于接受手术的最佳心理状态,保证手术顺利进行,并减少了术前、中、后并发症的发生。而未行心理宣教及心理护理的患者的焦虑程度几乎没有变化（Ｐ＞０．０５）,有的甚至提高。通过对照观察、心理宣教及心理护理的有效实施,对消除患者的焦虑、恐惧心理有较满意的效果,并能达到仅靠操作技术难以获得的效果,起到良好的助手作用。     

Ultrasound-guided percutaneous laser ablation of liver tissue in a rabbit model

The present report evaluates the efficacy and safety of percutaneous interstitial laser tissue ablation of the liver in nine New Zealand rabbits. A Nd: YAG laser was coupled to a quartz fibreoptic guide (600 m) with a flat tip. The fibre and a thermocouple were placed in the lumen of two Chiba needles (18G) and these were inserted into the liver 10 mm apart under ultrasound guidance. The laser was fired for 5 min at 1, 3 and 5 W power, respectively, in three groups of rabbits. There were no acute complications and all the rabbits except one survived until the established time of sacrifice. The procedure induced a cavity surrounded by a zone (about 10 mm) of coagulative necrosis. After 2 weeks a strong peripheral inflammatory response was evident and after 4 weeks a capsule of connective tissue enclosed the lesions. Our study seems to offer a safe and rapid technique producing a guaranteed kill radius for the treatment of small hepatic neoplasms. Correspondence to: C. M. Pacella     

子宫颈浸润癌介入、手术、再介入治疗30例临床探讨

目的　根据女性盆腔血管解剖学和生理学特点以及介入放射学理论 ,子宫颈癌对化疗药物的敏感性 ,应用介入、手术、再介入的方法治疗子宫颈浸润癌 ,观察其消长变化 ,评价该治疗方案在临床上的应用价值。方法　子宫颈浸润癌Ⅰb -Ⅲ期患者 30例 ,术前常规行盆腔介入治疗。介入后 1 4d左右 ,行子宫颈癌根治术 ,术后根据临床分期分别再介入 3～ 6次。结果　治疗后追踪随访 1～ 6年 ,全部未见复发征象。结论　本组临床观察结果初步肯定介入、手术、再介入方法在治疗子宫颈浸润癌方面是有前途的     

局部动脉内灌注化疗治疗晚期恶性骨肿瘤的近期疗效观察

目的　评价晚期恶性骨肿瘤局部动脉内灌注化疗 (TAI)的临床价值。方法　 43例均采用Seldinger技术经皮穿刺股动脉 ,插入4～ 5F导管至肿瘤局部供血动脉内行化疗药物的灌注术 ,并对术前、术后 2周内病人疼痛的VAS评分 (视觉模拟量表或视觉模拟评分法 ) ,入院、出院病人生活质量的Karnofsky评分 (卡莫夫斯基机能评分 )和ECOG(东方肿瘤协作组 )评分 ,以及WHO对骨原发及骨转移瘤近期治疗效果的评价标准等进行综合比较。结果　TAI术后病人疼痛的VAS评分明显少于术前 ;病人出院的Karnofsky评分、ECOG评分明显优于入院 ,CR PR近期有效率为 48 8%。结论　TAI为治疗晚期恶性骨肿瘤的一种有效方法 ,它能明显缓解病人疼痛 ,改善生存质量。     

Role of radiology in the treatment of malignant hilar biliary strictures 2: 10 years of single‐institution experience with percutaneous treatment

We reviewed the results of percutaneous intervention of hilar biliary malignancy over a 10‐year period at a single institution: the Royal Melbourne Hospital. Ninety‐nine patients (100 treated in total) were included. Information was retrieved by retrospective examination of patient notes and radiology, combined with interviews with family and relevant physicians. Sixty‐nine patients were treated with insertion of semipermanent stents, 19 had external drain tubes, and 25 received percutaneous access for Iridium brachytherapy. Adequate drainage was achieved in 87% of the patients stented, and percutaneous access was successful in 96% of patients planned for brachytherapy. Of those patients undergoing endoprosthesis insertion, early complications occurred in 39% and late complications in 23%. Average survival for the entire patient population was 227.3 days, with a median of 167 days. Longer survival times (213 vs 142 days) and lower complication rates (44 vs 64%) are observed with metal stents in comparison with plastic stents. Percutaneous intervention is an important treatment option in hilar biliary malignancy, particularly in patients unfit for surgery. Reasonable survival with good palliation is the most common outcome, and most patients do not require further intervention.     

应用冷循环集束电极射频治疗晚期肝癌的疗效观察

[目的]观察冷循环集束电极射频治疗晚期肝癌的效果。[方法]冷循环集束电极射频治疗38例晚期肝癌，术后每月复查CT观察病变区液化坏死和病灶缩小情况以及增强扫描是否强化、患者生存质量及AFP变化。[结果]术后1个月CT显示全部病灶均出现部分液化坏死及CT扫描不强化，3个月后CT扫描5例患者肿瘤完全坏死。其余大部分坏死。全部患者术后1个月KPS评分均提高10分以上。随访AFP变化与肿瘤毁损情况一致。术后CT复查病灶液化坏死范围大或病灶缩小明显的病例AFP下降显著。[结论]冷循环集束电极射频治疗是一种安全、有效、耐受性好的晚期肝癌治疗技术。初步结果显示该治疗能够提高患者生存质量、延长生存期，值得深入研究并推广。