创伤性肾动静脉瘘的介入治疗

目的 评价用介入技术治疗创伤性肾动静脉瘘(RAVFs)的安全性和疗效。方法 对8例不适宜做外科治疗的RAVFs患者进行了介入治疗，其中外伤性损伤4例，医源性损伤4例。6例行经导管超选择性肾动脉内钢丝圈栓塞术，2例行被覆膜支架置入患侧肾动脉内封闭瘘口。结果 血管造影显示肾内型动静脉瘘4例，累及肾动脉段-亚段级分支；主干(肾外)型动静脉瘘4例。治疗均获成功，治疗结束时复查血管造影显示瘘口被封闭。轻微并发症1例。医源性RAVFs患者术后失血症状迅速改善，肉眼血尿消失；4例术前存在心脏负荷过度症状患者，闭塞动静脉瘘后症状迅速改善，血管杂音消失。术后肾功能测定均属正常范围，其中2例肾动脉被覆膜支架置入患者，同位素肾扫描显示患侧肾脏形态、功能正常。术后随访10～42个月，2例分别于术后10，18个月死于与RAVFs无关的疾病。6例仍然生存，一般情况良好，未再针对RAVFs进行外科或介入治疗。结论 介入技术，包括经导管超选择性肾动脉内栓塞术和被覆膜支架置入术，是治疗创伤性、复杂型RAVFs的安全、有效的方法。     

Transcranial cerebral oximetry and carotid cavernous fistula occlusion

Summary Different methods have been used in the evaluation and monitoring of the cerebral oxygen supply during neuro-interventional therapies. Attenuation of near-infrared light by the chromophores oxyhemoglobin and deoxyhemoglobin have shown to be useful in the study of the cellular oxygen metabolism and oxygen delivery to the brain. Transcranial cerebral oximetry (TCCO) has the advantage of providing real-time information regarding regional brain oxygen saturation (rSO₂) by using wavelengths in the near-infrared range.We present a patient with a carotid cavernous fistula who underwent balloon occulusion and concurrent continuous TCCO monitoring. TCCO was found to be a useful tool providing immediate rSO₂ values during the angiographic and interventional procedures. Initial balloon occlusion of a carotid cavernous fistula resulted in partial occlusion of the internal carotid artery lumen causing an immediate decrease in rSO₂ which correlated with angiographic findings. Subsequent reocclusion of the fistula produced a slower and smaller degree of decrease in rSO₂ with clinical improvement in the patient. Changes in rSO₂ were detected before any adverse clinical event was observed. TCCO was reliable, safe, sensitive, and provided a real-time assessment tool for the monitoring of brain oxygen supply in a patient undergoing a neuroendovascular procedure.     

硬脑膜动脉海绵窦瘘的眼眶CT表现,DSA检查及栓塞治疗

笔者分析了５例硬脑膜动脉海绵窦瘘伴突眼，结膜充血的病例，全部经ＣＴ及ＤＳＡ检查，同时进行了栓塞治疗，经随访７－９个月未见复发，主要ＣＴ表现为：（１）眼球突出，结膜充血；（２）眼上静脉扩张；（３）海绵窦增大；（４）眼外肌增厚：（５）眶尖软组织肿胀。并讨论了诊断鉴别诊断，ＤＳＡ检查及有关治疗问题。     

Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support

The mortality of neonates with oesophageal atresia in the Third World remains high because of delays in presentation and diagnosis. Lack of appropriate intensive care facilities is a further contributing factor. Caudothoracic epidural anaesthesia was used during surgical repair of oesophageal atresia in 35 patients in an attempt to minimise the need for post-operative ventionally support. This group was compared with 36 patients whose surgery was performed under general anaesthesia. The age at the time of referral, sex ratio, and weight were comparable in both groups. Using the Waterson classification, a greater number of poorer prognostic patients were seen in the epidural group (P <0.02). In all Waterson risk categories fewer patients required ventionally support post-operatively, which was statistically significant (P <0.01) when all categories were combined. We are encouraged by our results and believe this technique has a rôle in the management of neonates undergoing major surgery, both where neonatal intensive care exist or is deficient as in many parts of the Third World.     

Thoracotomy in the acute phase of staphylococcal lung disease

Two cases of staphylococcal lung disease in young infants are described. In each instance a life-threatening bronchopleural fistula in the acute phase was successfully managed by thoracotomy and suture repair. Offprint requests to: A. W. Auldist     

复发性甲状舌管囊肿和瘘的外科治疗

29例复发性甲状舌管囊肿和瘘中.男性20例,女性9例。复发次数1～4次,以2年或2年以内复发居多。作者对复发的有关因素进行了讨论,并且提出术中注射亚甲蓝显示瘘管,以利完全切除。     

Primary Adenocarcinoma in the Urethrorectal Fistula

A 60-year-old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996.     

Catheter embolization of pulmonary arteriovenous fistulas in an infant

Summary An infant with pulmonary arteriovenous fistulas is described. Surgical ligation of the fistulas and limited resection of paraenchyma from the right lung was followed at 11 months of age, by successful steel coil embolization of residual fistulas.     

Bile duct injury repair: when? what? who?

Laparoscopic cholecystectomy is associated with a two-to-four times higher risk of bile duct injury (BDI) than open cholecystectomy. BDI can lead to significant morbidity and even mortality. The first priority in BDI is to control peritoneal and biliary sepsis and to convert an acute BDI to a controlled external biliary fistula (EBF) — this can be achieved by endoscopic and/ or radiological intervention in most cases. This should be followed by assessment of the extent of injury — both biliary and vascular. Immediate management of BDI recognized during cholecystectomy depends on the type of injury, the condition of the patient, and the experience of the surgeon. For BDI recognized after cholecystectomy, early repair is not recommended, as the results are poor. The EBF may evolve into a benign biliary stricture (BBS), which should be electively repaired by a Roux-en-Y hepatico-jejunostomy. The use of an endoscopic stent as definitive management of BDI is not recommended. Long-term follow-up is essential after the repair of a BBS, as recurrence can occur several years after repair. Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers.