Palliative treatment of neoplastic strictures by self-expanding nitinol Strecker stent

The purpose of this study was to evaluate technical and clinical results of self-expanding esophageal stent implanted in patients with malignant esophageal strictures and clinically significant dysphagia. From June 1992 to September 1994, 27 patients with inoperable tumors of the esophagus or gastric cardiac were treated by placement of 37 self-expanding nitinol stents. Water-soluble contrast and endoscopy studies were performed after the procedure and during the follow-up period. Successful stenting of the stricture was achieved in 27 patients. The mean dysphagia grade dropped from 2.3 to 1 (SD ± 0.54) immediately after the procedure. After the insertion of the stent, 16 patients died in a period of time ranging from 0 to 13 months (mean 5.6 months), whereas at the end of the study 11 patients were alive 4–15 months after the procedure (mean 8.3 months). No major complications were observed. The results of this study are encouraging because esophageal stent placement was technically easy and clinically effective. Correspondence to: F. Maspes     

老年冠心病慢性闭塞病变的介入治疗探讨

目的探讨老年冠心病患者采用经皮冠状动脉介入(PCI)治疗的中短期疗效。方法对102例住院老年患者采用股动脉穿刺后,行球囊扩张,造影显示扩张满意后植入合适支架。术后随访6-32个月。结果102例患者术后临床症状均完全或基本完全缓解。本组患者有19例多支病变患者至少有一支慢性完全闭塞血管经努力而未能开通,无法植入支架。102例患者通过随访6-32个月,其中32例患者接受了冠脉造影复查,有17例患者分别于术后6个月至16个月又出现胸痛、胸闷症状。超声心动图检查射血分数(EF),心功能术后较术前明显改善,P<0.05。结论对冠状动脉慢性完全闭塞的老年患者,无论核素或超声检查是否存在存活心肌,均应尽量进行闭塞病变的介入治疗,以期改善患者的远期预后。     

药物洗脱支架用于急性心肌梗死的临床观察

目的评价药物涂层支架用于急性心肌梗死的安全性及临床疗效。方法34例发病1周以内的急性心肌梗死患者梗塞相关动脉机械性再灌注治疗时使用药物涂层支架,并于术后3～12个月进行门诊及电话随访,必要时复查冠状动脉造影,观察住院及随访期间心血管事件发生率(死亡、再发急性心肌梗死及血管重建术)。结果37枚药物涂层支架(CYPHER15枚,TAXUS22枚)植入34个梗塞相关动脉(其中3处病变各植入2枚支架),支架长度(22.7±9.0)mm,支架直径(3.1±0.3)mm;10例(29.4%)接受直接经皮冠状动脉介入治疗(PCI),3例(8.8%)为挽救性PCI。支架植入成功率100%。1例(2.9%)支架内急性血栓形成,行急诊血管重建术。平均随访间期(5.9±2.8)个月,2例(5.9%)于随访期间因再发原部位心肌梗死入院治疗,1例因非靶血管病变致心绞痛于术后10个月入院治疗。住院及随访期间无死亡病例发生。结论研究提示药物涂层支架用于急性心肌梗死患者治疗梗塞相关动脉行机械性再灌注安全,可获得与药物涂层支架用于择期的、相对简单的冠状动脉病变的类似疗效。     

冠状动脉支架抗压缩性能的有限元分析

冠状动脉支架作为经皮穿刺冠状动脉成形术中保持病变血管畅通的核心器件。其对病变动脉壁的支撑作用如何是支架植入术成功的先决条件之一。依据冠脉支架抗压缩性能的实际测试原型，建立起对应的有限元模型，并利用此方法系统地研究了专利支架设计，其扩张尺度的不同和筋的尺寸变化对支架抵抗两平面压缩性能的影响。结果显示，随支架扩张直径的增大，其抵抗两平面压缩的作用减小，增加支架筋的宽度或厚度能够提高支架的抗压缩性能，且这两个方向尺寸的增加对提高抗压缩性能的作用相当。模拟与实验结果一致，表明有限元模拟可以在一定程度上替代支架原型测试工作。     

纤维蛋白原与吸附白蛋白、肝素的新型血管支架材料氧化钛的血液相容性

探索纤维蛋白原(Fibrinogen,FIG)与吸附白蛋白、肝素的新型血管支架材料氧化钛(Titanium Oxide,Ti-O)的血液相容性。(1)研制Ti-O,切割成薄膜;(2)Ti-O薄膜涂层白蛋白和肝素;(3)血小板(platelet,PL)吸附试验;(4)酶联免疫试验测FIG吸附量;(5)动物犬股动脉内植入涂层的Ti-O薄膜与对照试片Ti-O和不锈钢(Stainless steel,SS)薄膜。结果发现:Ti-O完全具有固定白蛋白和肝素的结构与性能,比未涂层的Ti-O能更一步减少PL和FIG的吸附,实验动物体内薄膜6个月后取出扫描电镜观察黏附的PL少,形态无改变,血管内无血栓,优于未涂层的Ti-O,更明显优于SS。Ti-O为N型半导体,不易接受FIG的电荷,并且与血细胞有相似的界面张力,决定生物材料Ti-O有较好的血液相容性。Ti-O对白蛋白、肝素有极好的亲和力是因以化学键相结合,在血中进一步减少FIG和PL被涂层的Ti-O吸附。实验证明涂层的Ti-O有持久和稳定的抗凝血性能。     

镍钛形状记忆合金血管内支架组织相容性实验研究

将锥形记忆合金支架分别植入６只猪右侧髂动脉。用以研究镍钛形状记忆合金血管内支架生物相容性，支架植入前入植入后８个月，观测动物血常规，肝肾功能以及毛发中镍钛元素含量，均无明显变化（Ｐ〉０．０５），支架植入后８个月处死动物，全身重要脏器（肝、脾、肾、肺、心、脑等）病理学检查结构正常，无淋巴细胞和单核细胞浸润，支架植入部位上游血管壁内膜光滑，内皮细胞结构正常，内弹力板完整，支架植入段为完整肉芽组织阻塞，     

宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架或宫内节育器预防宫腔粘连的临床研究

目的对比宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架或宫内节育器预防宫腔粘连的效果。方法选取行宫腔镜下宫腔粘连电切术的60例患者,随机分为两组各30例。观察组术后置入COOK球囊型子宫支架,对照组术后置入宫内节育器。比较两组的术后出血情况以及临床疗效。结果观察组术后48 h的中度、重度出血发生率显著低于对照组,出血量显著少于对照组(P <0.05)。观察组的总有效率为96.67%,显著高于对照组的80.00%(P <0.05)。结论宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架能够减轻术后出血症状,有效预防粘连复发,效果优于置入宫内节育器。     

X线下带膜支架治疗食管气管瘘10例分析

目的　探讨X线下用带膜支架治疗食管气管瘘的方法。方法　在X线监视下以导丝引导 ,用支架推送器将带膜食管支架送入患者有食管气管瘘的食道段内 ,达到堵瘘目的。结果　 10例患者全部一次堵瘘成功 ,当天即可正常进食 ,无 1例出现严重并发症。结论　在X线下带膜支架治疗食管气管瘘是一种很好的方法。     

大承气汤联合自膨式金属支架在左半结直肠恶性梗阻治疗中的应用

目的:探讨大承气汤联合自膨式金属支架(SEMS)在左半结直肠恶性梗阻(MLBO)治疗中的作用及安全性。方法:选取2018年1月—2020年6月天津市人民医院收治的因MLBO行SEMS治疗的患者78例。随机化分为大承气汤组38例,聚乙二醇组40例。两组患者均进行限期手术治疗,在后续治疗时,大承气汤组口服大承气汤(1袋,125 mL/次,2次/d),聚乙二醇组口服聚乙二醇(舒泰清,A剂+B剂各2袋/次,饮用水冲调至125 mL/次,2次/d),比较2组术前准备时间、腹腔镜率、手术时间、并发症发生率、造口率、排气时间、术后住院时间、淋巴结清扫数目及术后病理水肿程度等差异。结果:大承气汤组的术前准备时间为6(5,7) d,低于聚二乙醇组的8(6,9) d,差异有统计学意义(P<0.001)。大承气汤组限期手术的腹腔镜率为65.8%,高于聚乙二醇组的40.0%,差异有统计学意义(P=0.023)。大承气汤组在造口率(21.1% vs 50.0%)及并发症发生率(15.8% vs 40.0%)方面亦优于聚乙二醇组(均P<0.05)。两组的淋巴清扫数目无明显差异(P=0.2),但大承气汤组的病理组织水肿程度比聚乙二醇组轻,差异有统计学意义(P=0.043)。结论:大承气汤可有效提高MLBO放置SEMS后限期手术的肠道准备效率及质量,提高腹腔镜成功率,并明显降低限期手术并发症发生率及造口率。     

A “bridge” technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.