食管覆膜支架置入术和球囊扩张术在治疗中晚期食管癌中的临床价值探讨

目的:探究中晚期食道癌应用食管覆膜支架置入和球囊扩张术治疗的临床应用价值。方法:对我院收治中晚期食道癌患者110例进行回顾性分析,治疗前本组病例均有病理活检,患者均为不能手术或拒绝手术的患者。所有患者术前均行X线检查,确定病变部位、狭窄长度及与周围组织关系,本组病例均有在术前或术后配合化疗或放射治疗的情况。对110例患者分组,30例患者置入覆膜支架,对30例患者进行球囊扩张,对50例患者不分先后做了食管覆膜支架置入术和球囊扩张术。以术后狭窄扩张效果、生存质量及相关并发症进行比较分析。结果:支架置入成功率100%,平均生存期12个月,食道球囊扩张均经1~3次扩张达到预期效果,成功率70%,生存率9个月,食管覆膜支架置入术联合球囊扩张术治疗中晚期食道癌,总有效率100%,生存期平均16个月。结论:食管覆膜支架置入术联合球囊扩张术,在治疗中晚期食管癌能相对延长患者生存时间、提高生存质量方面明显优于单纯食道食管覆膜支架置入术及单纯球囊扩张术,患者疗效更高,具有理想的临床价值。     

Safety and efficacy of balloon angioplasty in symptomatic intracranial stenosis: A systematic review and meta-analysis

Background and purposeEndovascular treatment is offered for symptomatic intracranial stenosis (ICS) when medical therapy fails. The purpose of this meta-analysis is to evaluate the risks and effectiveness of balloon angioplasty (BA) alone.Materials and methodsSystematic review and meta-analysis of all available articles on BA for symptomatic ICS was conducted. Data was analyzed separately for > 70% (Group 1) and > 50% (Group 2) stenosis. The results of the Group 1 were compared with those of SAMMPRIS study to the extent possible.ResultsA total of 25 studies comprising 674 patients were included. The cumulative incidence of periprocedural (within 30 days) stroke and death were 16.3% (Group 1), 7.6% (Group 2) and 11.5% (all studies). Incidence rates of ischemic stroke in the qualifying artery territory during follow-up (per 100 patient-years) were 2.0, 2.4 and 2.3, any stroke and death during follow-up were 4.4, 7.4 and 6.9, restenosis rates were 4.9, 11.5 and 8.9 respectively.While comparison of cumulative incidences of periprocedural ischemic stroke between Group 1 (13.0%) and the medical arm from SAMMPRIS study(4.4%) showed a significant difference (P = 0.008), there was no significant difference between the Group 1 and the stenting arm from SAMMPRIS study(10.7%) in the same variable.ConclusionBalloon angioplasty for stenosis of more than 70% is likely to have similar outcome comparable to the stenting arm in the SAMMPRIS study, however it presents lower rates of late ischemic events and restenosis. These data may help deciding on the endovascular method of choice in case of medical therapy failure.     

唑来膦酸联合椎体后凸成形治疗骨质疏松性压缩骨折：提高骨密度、预防椎体再骨折、远期疗效评价的Meta分析

文题释义：椎体后凸成形：采用椎体内置入气囊的方法通过扩张使椎体复位,在椎体内部形成空隙,减小骨水泥注入所需的推力,使骨水泥在椎体内不易流动,可有效解除或缓解疼痛、恢复病椎高度,但临床发现仍存在骨水泥渗漏等风险。 唑来膦酸：椎体后凸成形已被广泛应用于骨质疏松性压缩骨折的治疗,临床疗效显著,然而如何有效改善骨质疏松状况成为临床面临的重要问题。唑来膦酸是双膦酸盐类药物,可有效抑制骨吸收,降低再发骨折风险,改善骨折患者的功能评分。 背景：临床应用唑来膦酸治疗骨质疏松症缺乏系统的科学评价和循证学依据,因此目前对于唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的临床疗效尚无明确定论。 目的：系统评价唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的临床疗效。 方法：应用计算机检索公开发表在CNKI、万方、维普等中文数据库及CBM、PubMed、Cochrane等英文数据库中,有关唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的随机对照试验,试验组治疗方式为唑来膦酸联合椎体后凸成形,对照组治疗方式为椎体后凸成形,时间截止至2019年9月。由2位研究员独立进行文献筛选、数据提取,按Cochrane协作网标准对纳入随机对照试验逐个进行质量评价,采用RevMan 5.3软件对符合纳入标准的研究进行统计分析。 结果与结论：①最终纳入5篇文献,均为随机对照研究,试验组患者175例,对照组患者184例;②统计分析结果显示：试验组治疗后12个月的骨密度高于对照组[MD=0.12,95%CI(0.08,0.17),P < 0.000 01],治疗后6,12个月的目测类比评分低于对照组[MD=0.46,95%CI(0.18,0.75),P=0.002;MD=0.85,95%CI(0.20,1.50),P=0.01],治疗后1年的Oswestry功能障碍指数评分低于对照组[MD=6.59,95%CI(4.77,8.41),P < 0.000 01],骨水泥渗漏率、椎体骨折再发率低于对照组[OR=0.22,95%CI(0.08,0.59),P=0.003;OR=0.18,95%CI(0.07,0.50),P=0.000 8];两组椎体高度恢复、椎体后凸Cobb角比较差异无显著性意义[MD=0.65,95%CI(-0.27,1.56),P=0.16;MD=-0.60,95%CI(-2.45,1.25),P=0.53];③结果表明与单独应用椎体后凸成形相比,唑来膦酸联合椎体后凸成形在提高骨密度值、减少椎体骨折再发率、改善患者远期临床症状、预防骨水泥骨水泥渗漏等并发症方面具有显著优势,但后期仍需大量高质量的多中心随机对照研究提供更充足的证据。 ORCID: 0000-0001-8871-3539(李凯明) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

创伤性颈动脉海绵窦瘘的可脱性球囊栓塞治疗技术

目的探讨创伤性颈动脉海绵窦瘘的临床表现和血管内介入栓塞治疗效果。方法回顾性分析本组共32例创伤性颈动脉海绵窦瘘的临床表现,采用可脱性球囊微导管技术经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果28例一次性治愈;4例术后16~48h因球囊发生早泄移位复发,经再次以可脱性球囊栓塞后治愈。本组有28例(87.5%)闭塞了瘘口,颈内动脉主干保持通畅;4例同时闭塞了瘘口及颈内动脉主干。27例获随访(术后6个月~5.2年),无复发。结论采用可脱性球囊栓塞技术是治疗创伤性颈动脉海绵窦瘘的首选方法。     

Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine

We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.     

经皮球囊扩张椎体后凸成形术的临床应用

目的总结经皮球囊扩张椎体后凸成形术治疗胸腰椎疾病的临床特点和疗效。方法胸腰椎疾病28例,其中男性9例,女性19例;年龄56～84岁,平均年龄65岁;骨质疏松性椎体压缩骨折(OVCF)24例,椎体血管瘤(VH)4例。应用经皮球囊扩张椎体后凸成形术进行治疗,观察术后症状改善情况。结果 28例患者手术均顺利完成。患者术后疼痛症状均即刻消失,术后次日即下床活动。术后平均随访10个月,28例患者均恢复发病前生活方式,无疼痛;影像学检查,病椎高度无明显丢失,无并发症发生。结论经皮球囊扩张椎体后凸成形术是治疗胸腰椎疾病安全有效的一种方法。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的初步探讨应用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法应用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折患者24例28个椎体，并随访4～11个月，平均8个月。结果所有患者手术均获成功，无脊髓神经损伤，病椎疼痛缓解，后凸畸形平均矫正20°，随访期间，疗效满意，无病椎高度丢失。结论应用经皮椎体成形术治疗骨质疏松性椎体压缩骨折能明显改善患者疼痛症状，恢复椎体高度，矫正后凸畸形，是一种安全的微创方法。     

直肠大息肉黏膜剥离术后穿孔保守治疗的护理

总结了1例直肠大息肉患者行内镜下黏膜刺离术发生穿孔后的护理经验.对患者采取了钛夹夹闭的方法,并用气囊压迫瘘口上方肠壁使瘘口旷置愈合.在保守治疗过程中,气囊的护理是保证穿孔瘘口痊愈的关键,指导患者禁食和静脉营养是重要的护理措施.     

液电碎石球囊扩张术中B超在治疗复杂肝内胆管结石中的应用研究

目的探讨手术联合液电碎石、胆道球囊扩张、术中B超在治疗复杂性肝内胆管结石的应用价值。方法选择2006年8月至2009年1月50例多发性肝内结石并胆管狭窄手术患者（观察组）作为研究对象。主要观察该治疗方法所需的手术时间、术中出血量、术后并发症、住院时间和费用、残留结石、结石复发、优良率等指标,与2005年以前50例采用多术式单纯联合纤维胆道镜治疗该病（对照组）的疗效进行对比分析。结果对比2组结果,除手术时间和住院时间（P〉0.05）无明显差异外,观察组术中出血量、术后并发症、残留结石、结石复发、住院费用等均低于对照组（P〈0.05）,优良率高于对照组（均P〈0.05）,均有明显差异。结论胆道镜配合液电碎石球囊扩张和术中超声治疗复杂肝内胆管结石,安全有效,可以明显降低结石残留,提高优良率。