颈动脉狭窄在脑保护装置下的支架置入治疗

目的探讨颈动脉狭窄患者支架治疗中的脑保护装置的有效性和安全性及治疗意义。方法对14例颈动脉狭窄患者进行血管内支架治疗。全部应用了脑保护装置(滤网型)。结果14例患者成功地释放了18枚自膨式支架。其中2例发生微栓子脱落轻度卒中,治疗1～3d完全恢复,颈动脉狭窄6例出现短暂性心率减慢和低血压。随访期所有患者均未发生脑梗死。结论在支架治疗中,脑保护装置的应用可减少治疗中的神经并发症,是一种有效和安全的治疗方法。     

蘑菇状覆膜内支架的设计和在食管胃吻合口-胸腔瘘中的应用

目的 设计封堵食管胃吻合口-胸腔瘘的覆膜内支架。方法 根据食管胃吻合口区的特殊解剖结构和吻合口胸腔瘘的病变特点，设计蘑菇状覆膜内支架。透视下，5例吻合口巨大胸腔瘘患者置入6枚蘑菇状覆膜内支架。结果 蘑菇状覆膜内支架能有效封堵食管胃吻合口巨大胸腔瘘，解决了进食问题，改善了营养状况。结论 蘑菇状覆膜内支架结构设计合理，操作简单、安全，近期疗效明显，是一项值得推广的新技术。     

X线、超声联合导向介入治疗布-加氏综合征

目的:探讨X线、超声联合导向下对布 加氏综合征的介入治疗方法和临床应用价值。方法:本组病人 30例,采用X线和超声联合导向。穿刺下腔静脉闭塞或狭窄部位,经球囊扩张后在X线、超声联合定位置入支架 成形。结果:28例成功,占93%。无严重并发症。术后患者症状明显缓解,下腔静脉压基本恢复正常(治疗前 2.8±0.51kPa,治疗后0.7±0.2kPa)。结论:采用X线、超声联合导向介入治疗布 加氏综合征是一种成功率高、 损伤小、效果可靠的治疗方法。     

金属内支架介入治疗恶性输尿管狭窄的临床应用

目的探讨经皮顺行植入输尿管金属内支架治疗恶性输尿管狭窄的效果。方法对14例恶性肿瘤伴输尿管狭窄的患者行经皮顺行植入输尿管金属内支架治疗。术后观察尿量及性状,超声及腹部平片随访。结果14例患者植入输尿管内支架均获成功,输尿管梗阻解除,患者临床症状改善,肾功能好转。结论对恶性输尿管狭窄的患者行顺行植入输尿管金属内支架治疗输尿管狭窄,是一种简便、有效、创伤小的治疗方法。     

多层螺旋CTA:不同重建方法在主动脉瘤腔内隔绝术后的应用评价

目的：探讨多层螺旋CT血管造影不同重建方法在主动脉瘤腔内隔绝术后的临床应用价值。材料与方法：46例主动脉瘤腔内隔绝术后行多层螺旋CT血管造影，采用准直2.5mm，层厚3.0mm，螺距为6，重建方法为容积显示技术（volume rendering，VR）、表面阴影遮盖显示(shade surface display，SSD)及最大密度投影法（maximum intensity projection，MIP），并对三种方法进行比较。结果：46例中有1例术后内支架出现局限性断裂，VR及MIP均清晰显示了内支架的变化，SSD未能显示。1例内支架展开不良，三种重建方法均明确显示；6例术后出现渗漏，VR清晰显示渗漏的部位、形态及内漏量，MIP、SSD仅显示其中的5例，三者中以VR显示最佳。在显示支架内血流情况及瘤周血栓方面，VR能明确支架内有无血栓形成及腔内隔绝术后的转归变化，VR显示1例术后支架内血栓形成SSD及MIP未能显示。结论：多层螺旋CT能在较短时间内进行大范围的扫描，有利于主动脉病变的检查；VR图像优于SSD及MIP，能为术后内支架情况提供更多更准确的信息，VR技术应作为主动脉瘤内支架术后的首选三维重建方法。     

Coronary stenting for coronary artery narrowing in a heart transplant recipient

Transplant atherosclerotic coronary disease remains the leading cause of death in heart transplant recipients. We report the first case of coronary stent implantation in a heart graft for epicardial focal stenosis. Due to the lower rate of restenosis after stenting in the native coronary artery, we suggest that coronary stenting be considered an acceptable, first intention therapeutic option instead of angioplasty alone whenever possible.     

Endovascular stent implantation in patients with stenotic aortoarteriopathies: early and medium-term results.

Data regarding stent implantation for stenotic aortoarteriopathy (SAA) are incomplete. We report on nine patients with this rare syndrome who underwent arterial stent implantation. Indications, results, and complications for patients with SAA were reviewed. Nine patients underwent 11 procedures. Twenty-two stents were implanted in the aorta or brachiocephalic vessels. Five patients had diffuse stenoses, three patients had middle aortic syndrome, and one patient had thoracic and abdominal coarctation. Associated diagnoses included Williams syndrome (2), neurofibromatosis (2), Takayasu's (1), and congenital rubella (1). Median gradient was 60 mm Hg (20-140 mm Hg). Poststent gradient was 15 mm Hg (0-60 mm Hg; P < 0.001). Additional stents were implanted in two patients and five underwent stent redilation. Two patients (22%) were found to have aneurysm formation. Stent implantation effectively provides gradient relief in SAA. Gradient reduction persists or is amenable to redilation. Importantly, however, uncomplicated stent implantation does not preclude aneurysm formation and may be more common than in traditional patient groups.     

Endoscopic sphincterotomy for common bile duct stones: Impact of recent technical advances

Technical improvements, such as mechanical lithotripsy, stenting or nasobiliary drainage, and wire-guided cannulation, have reduced the risk of complications in endoscopic sphincterotomy. To determine the extent of this reduction in risk, we assessed the medical records of 1352 patients with common bile duct stones in whom the procedure was conducted. Complications examined were: acute cholangitis and pancreatitis. Stone clearance was achieved in 1256 patients (92.8%), with an overall morbidity rate of 7.7% and a mortality rate of 0.15%. One hundred and forty-two patients had stones with a diameter greater than 20mm; 97 of these patients did not undergo lithotripsy. Cholangitis occurred in 10 of these 97 patients (10.3%), whereas, in the 45 patients who underwent lithotripsy, there were no cases of cholangitis (P=0.02). Stone removal was not immediately accomplished or attempted in 396 patients. In 82 of these patients in whom a stent or a nasobiliary drain was placed in the common bile duct, the incidence of cholangitis was 1.2%, significantly less (P=0.045) than the incidence of 6.4% in the other 314 patients given no stenting or nasobiliary drain. To overcome difficult cannulation, precut sphincterotomy was conducted in 134 patients and wireguided sphincterotomy, a recently introduced procedure, was conducted in 55 patients. When the precutting technique was used, the incidence of acute pancreatitis was significantly higher (8/134; 6.0%) than that in the patients in whom the standard procedure was conducted, i.e., neither the precut technique nor wire-guided ES was used (23/1218; 1.9%) (P=0.008). There were no cases of pancreatitis in the 55 patients in whom wire-guided sphincterotomy was performed, although the difference was not statistically significant because of the small number of patients (P=0.06). Based on these findings, we conclude that improved technologies have led to a significant reduction of complications in endoscopic sphincterotomy.     

内支架结合放疗治疗晚期食管癌18例临床分析

目的　通过被覆支架治疗晚期食管癌恶性狭窄 ,并行术后放射治疗 ,以提高生活质量 ,延长生存期。方法　晚期食管癌恶性食管狭窄 18例 ,狭窄直径均在 2 .5mm以下 ,其中 3例呈梗阻状 ,4例合并有食管瘘 ,1例出现肝部转移。经口置入镍钛合金被覆支架 2 0枚 ,于 2周后行外照射 ,肿瘤试剂照射剂量 (DT) :6 0～ 70Gy。结果　所有患者均一次顺利完成支架置入 ,患者进普食顺利 ,疗效满意。 2周后均顺利接受放射治疗 ,未出现并发症。经随访复查 ,支架未发生移位及出现再狭窄改变 ,食管通畅 ,患者进食顺利 ,生存期延长 ,平均 11个月。结论　被覆支架治疗晚期食管癌恶性食管狭窄及术后结合放疗 ,能有效地抑制肿瘤生长 ,提高生活质量 ,延长生存期 ,是治疗晚期食管癌患者的一种安全有效的治疗方法。     

Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis

Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined with endoscopic biliary stent placement seems to offer a minimally invasive palliation. Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively. Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention; there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%) patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain oral intake during the remaining survival time. Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional result while impairing the quality of life only to a minimal extent. Received: 7 May 1996/Accepted: 12 December 1996