医源性动脉出血的介入栓塞治疗

目的探讨介入栓塞治疗医源性动脉出血的临床应用价值。方法回顾性分析我科35例医源性动脉出血、接受介入栓塞治疗患者的临床及影像资料,观察介入栓塞治疗医源性动脉出血的疗效。结果对35例外科术后动脉出血患者均成功进行介入栓塞治疗。5例肠道术后出血DSA示局部血管紊乱,其中3例见少量对比剂外漏进入肠管,给予适量明胶海绵颗粒进行栓塞;余30例DSA均可见对比剂外漏,其中17例伴假性动脉瘤形成,均采用微弹簧圈予以栓塞。随访10～15天,33例出血停止,2例肠道术后出血患者仍有持续性少量便血,进行再次手术止血治疗。所有患者均未发生器官缺血坏死等严重并发症。结论介入栓塞治疗医源性动脉出血具有一定优势;对于外科术后导致动脉出血、尤其是病情危重的患者,采取介入栓塞治疗具有较好的临床应用价值。     

肝细胞癌右膈下动脉供血的CT评价

目的　评价肝细胞癌 (HCC)右膈下动脉 (RIPA)供血的CT表现。方法　选择做过螺旋CT检查及血管造影的HCC患者共 195例 ,发现其中 15例由RIPA供血 ,测定CT动脉期图像上这 15例的RIPA、左膈下动脉、HCC的大小 ,记录RIPA的起源及HCC的位置 ,并与血管造影图像对照。结果全部病例RIPA在CT图像上于右侧膈肌脚呈高密度影 ,11例见到其起源 ,RIPA直径达 (3 1±1 1)mm ,比左膈下动脉 [(1 3± 0 4 )mm]要宽 (t=6 17,P <0 0 5 )。HCC全部位于肝右叶 ,平均直径为 (4 8± 1 3)cm。结论　CT上显示出RIPA非对称性扩大 ,直径超过 2 5mm者 ,应提示有RIPA供血到HCC。     

甲状颈干栓塞术在外周血管介入中的临床意义

目的观察甲状颈干参与肿瘤及咯血供血的表现,评价栓塞甲状颈干的安全性和疗效。 方法2年间用介入技术治疗外周疾病（肿瘤及咯血）术中经血管造影证实甲状颈干参与病变咯血供血13例,其中纵隔肿瘤2例、肺部咯血性疾病11例,包括：肺部恶性肿瘤3例、支气管扩张6例、肺结核2例。年龄25～69岁,平均年龄44.5岁。对参与供血的甲状颈干进行了超选择性栓塞术,栓塞剂用聚乙烯醇微球（PVA,500～700μm）、明胶海绵颗粒和微型钢丝圈。观察甲状颈干参与病变供血的特点,评价栓塞甲状颈干的安全性和临床意义。 结果选择性造影均显示甲状颈干管径增粗、分支增多紊乱和不同程度的新生血管形成,伴有肿瘤血管和肿瘤染色者5例次、咯血患者中由甲状颈干供血区对比剂外溢4例次、非特异性片状对比剂染色4例。本组患者均行供血甲状颈干的栓塞术,同时栓塞胸廓内动脉9例、肋间动脉8例、膈下动脉3例、支气管动脉7例,术后咯血停止;随访2个月～2年,11例未再咯血。纵隔肿瘤患者介入治疗后行外科切除,术中出血仅100 ml。 结论甲状颈干可参与纵隔肿瘤及咯血的供血,如发现甲状颈干参与纵隔肿瘤及咯血供血,补充栓塞甲状颈干安全有效。     

山莨菪碱对大鼠颈总动脉吻合术后血流动力学的影响

目的研究山莨菪碱对血管吻合后血流动力学的影响。方法取ＳＤ大鼠９６只，切断左侧颈总动脉作端端吻合后，随机分成术后６、１２、２４、４８、７２和１２０小时共６个时间组。各时间组再分成实验组和对照组，每组８只大鼠。实验组用２％氢溴酸山莨菪碱（３０ｍｇ／ｋｇ）作腹腔注射，对照组则注射等体积生理盐水，给药１０分钟后用彩色多普勒血流仪检测颈总动脉吻合口前、吻合口、吻合口后动脉收缩期平均最高血流速度，并计算吻合口横截面积。结果术后１２、２４、４８、７２和１２０小时组，颈总动脉吻合口前的血流速度比对照组明显增加（Ｐ＜０．０５），平均增加３１．５％。术后６和２４小时组，实验组吻合口狭窄程度比对照组明显减轻（Ｐ＜０．０１，０．０５）。术后１２０小时组，山莨菪碱能够明显增加吻合口后的血流速度，实验组和对照组相比有显著性差异（Ｐ＜０．０５）。结论山莨菪碱能够提高大鼠颈总动脉吻合后，血管吻合口前及吻合口的血流速度，术后２４小时内用药能够减少吻合口的狭窄程度。     

Percutaneous implantation of a catheter with subcutaneous reservoir for intraarterial regional chemotherapy: Technique and preliminary results

Purpose: We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic and extrahepatic tumors. Methods: Two hundred patients with primary or secondary hepatic neoplasms, pelvic, pancreatic, renal, lingual, and breast cancer underwent the procedure. The access was the left axillary artery (188 patients) and the femoral artery (12 patients). The catheter tip was placed in the hepatic (170 patients), hypogastric (18), splenic (4), internal thoracic (2), gastroduodenal (3), renal (2) or the external carotid artery (1). The catheter was connected to a subcutaneous reservoir and filled with heparin; chemotherapeutic infusion was subsequently started. Results: One hundred percent immediate technical success was obtained. Forty-three of 200 (21.5%) patients had a complication: 29 patients had a catheter dislodgment, nine had arterial thrombosis, three had a pseudoaneurysm of the left axillary artery and two had a port pocket hematoma. Most complications (37/43, 86%) were treated percutaneously without interruption of chemotherapy. In only six cases (3% of the total population) was chemotherapy discontinued due to the complication itself. The mean duration of catheter patency was 7.2 months. Conclusion: Percutaneous placement of an intraarterial catheter is feasible and causes less discomfort to the patient than the surgical approach. The technique has an acceptable complication rate (21.5%), similar to that for surgical implantation (17.8%), with the advantage that in most cases the complications can be resolved percutaneously. This technique represents an alternative to surgical implantation in the treatment of liver metastases from colorectal cancer and opens new therapeutic possibilities for the local prolonged treatment of other kinds of tumor, though its clinical efficacy must be assessed in selected trials.     

跟腱区动脉血供的三维可视化研究

目的通过数字化技术构建跟腱区动脉血供的三维可视化图像,研究跟腱区的动脉血供。方法新鲜人小腿标本三只,用30％明胶、10％朱砂、10％淀粉按比例配制的灌注液灌注,冷藏后CT扫描获得DICOM格式数据,Mimics 10．01软件处理。结果获得小腿跟腱区皮肤、骨骼、动脉、跟腱的三维可视化图像。结论跟腱区三维可视化图像可为临床提供形态学资料,虚拟手术有助于最佳手术方案的选择。     

能谱CT最佳单能量技术优化腹部恶性肿瘤供血动脉血管成像图像质量的研究

目的 探讨能谱CT单能量技术对腹部恶性肿瘤细小供血动脉CTA图像质量优化的价值.方法 回顾性分析行能谱CT检查的32例腹部恶性肿瘤患者资料,采用能谱CT扫描技术行腹部平扫及3期动态增强扫描,分别采用140 kVp混合能量、66 keV单能量和最佳单能量3组模式重建显示肿瘤微小供血动脉.数据采集完成后直接获得140 kVp和70 keV单能量图像,再通过AW4.5工作站GSI Viewer软件得到66 keV和最佳单能量图,比较140 kVp混合能量、66 keV单能量和最佳单能量3组肿瘤供血动脉的对比噪声比(CNR)、信噪比(SNR)及其图像质量评分,并采用单因素方差分析进行比较.结果 最佳单能量组、66 keV单能量组、140 kVp混合能量组肿瘤细小供血动脉的CNR分别是21.70±9.74、16.63±7.60和9.85 ±6.76,SNR分别为35.05±17.75、26.77±11.51和16.32±9.50,图像质量评分分别为4.58±0.40、3.55±0.57和2.75±0.46,差异均有统计学意义(F值分别为17.11、15.73和116.01,P值均＜0.01),两两比较差异也均有统计学意义(P值均＜0.05),最佳单能量组CNR、SNR和主观评分优于66 keV单能量组和140 kVp混合能量组.结论 能谱CT最佳单能量技术能够优化腹部恶性肿瘤细小供血动脉的CTA质量.     

MR characterization of blood flow in native and grafted internal mammary arteries

In the postoperative patient with anginal symptoms, differentiation between bypass graft compromise and nonischemic causes has until now been accomplished only by means of x-ray angiography. A noninvasive test is clearly desirable. The authors used a cine phase-contrast (PC) magnetic resonance (MR) imaging technique to characterize blood flow in native and grafted internal mammary arteries (IMAs). Ten volunteers and 15 patients who had recently undergone IMA coronary artery bypass grafting were imaged. Cine PC MR imaging was performed in the transaxial plane at the level of the pulmonary artery bifurcation. Flow in both IMAs was quantified and expressed as a percentage of cardiac output measured in the ascending aorta. In the 15 patients, flow analysis was performed in both the native and grafted IMAs. In the volunteers, IMA blood flow ranged from 2.1% to 4.3% of cardiac output on the left (mean, 3.5%) and 2.1% to 5.1% (mean, 3.5%) on the right. There was considerable intersubject variability, with coefficients of variation of 10.7% for the left and 12.3% for the right IMA. Intrasubject variability was limited, with estimated common standard deviations of 0.45% of cardiac output (range, 0.2%–1.1%) for the left and 0.39% (range, 0.1%–0.6%) for the right IMA. Flow in grafted IMAs was identified in 13 of 15 patients. In one of two patients without demonstrable IMA graft flow, cardiac catheterization confirmed lack of flow. IMA graft flow varied from 28 to 164 mL/min (mean, 80.3 mL/min). This study shows the feasibility of using cine PC MR imaging as a quantitative method of evaluating blood flow in IMA coronary artery bypass grafts.     

DSA在断指再植血管评价中的价值

目的 探讨DSA在评价断指再植血管及血流状况中的价值.方法 12例断指再植患者术后2～4 d行再植指体DSA检查,观察再植指体血管轮廓、吻合口形态、血液动力学改变、有无血管痉挛或血栓及侧支循环建立情况,根据造影结果 确定进一步的处理方案.结果 共27条吻合血管中,DSA全部显示清晰,其中9例23条吻合血管血流通畅,均存活,断指再植指体早期存活诊断符合率为100%(23/23).2例(右手中指和无名指各1例)吻合血管中断,考虑重度血管危象,即行手术探查发现血栓;1例(左手无名指和小指)吻合动脉痉挛变细,提示轻度血管危象,经保守治疗最终存活.DSA对4条吻合血管病变均检出.结论 DSA能够对再植指体血供重建和血液循环情况作出客观、准确的评价,在指导临床对再植指体的进一步处理及预测再植指体早期存活方面具有重要意义.     

3.0T磁共振下肢动脉3D CE-MRA对比剂用量

目的探讨使用3.0TMR仪并行采集快速扫描技术进行腹部至下肢动脉三维对比增强磁共振血管成像（3DCE-MRA）中减少对比剂用量的可行性。方法 30例怀疑下肢动脉狭窄的患者按就诊顺序平均分为A、B两组,使用3.0T磁共振扫描仪行腹部至下肢动脉3DCE-MRA,钆浓度为0.5mmol/ml,A、B两组的使用剂量分别为40ml和20ml。比较两组患者三站图像最大密度投影（MIP）图像质量及原始增强图像末端腹主部动脉、股动脉及腘动脉的信号强度（SI）、信噪比（SNR）和对比噪声比（CNR）。结果 A、B两组所有三站动脉的MIP图像质量均符合诊断要求,差异无统计学意义（P〉0.05）,B组小腿静脉污染比A组略轻,但差异无统计学意义;A、B两组末端腹主部动脉的SI、SNR及CNR差异无统计学意义。A组股动脉及腘动脉的SI、SNR及CNR均略高于B组,差异有统计学意义（P〈0.05）。结论采用3.0TMR仪行腹部至下肢动脉3DCE-MRA,使用20ml钆对比剂获得的图像质量可满足临床诊断。