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81.
目的 评价破裂与未破裂颅内微小动脉瘤(动脉瘤最长径≤3 mm)血管内治疗的可行性和安全性.方法 回顾分析2001年6月至2009年8月北京医院44例48个的颅内微小动脉瘤的临床、影像学、血管内治疗和随访资料.44例患者中,男20例,女24;平均年龄57.8岁;Hunt-Kosnik分级:0、1~2和3~4级的患者分别为11、23和9例,1例无法确定分级.48个动脉瘤中,动脉瘤瘤体最长径均≤3 mm;前交通、大脑中、后交通和颈内动脉动脉瘤依次分别为11、8、14和12个,胼周、椎和小脑后下动脉动脉瘤各1个.39个动脉瘤用弹簧圈行囊内栓塞(其中13个辅以支架,6个栓塞临时使用了球囊),9个动脉瘤仅在载瘤动脉内放置了支架.结果 39个囊内栓塞的动脉瘤中,9个动脉瘤100%栓塞,20个90%,9个80%,1个<80%.术中破裂出血1例;术后一过性轻偏瘫2例,小脑梗塞致共济失调1例.对所有患者临床随访4~90个月无出血,13例在术后4~72个月复查血管造影,未见动脉瘤再生长.结论 破裂与未破裂的颅内微小动脉瘤的血管内治疗技术上可行,操作相对安全,初步结果有效. 相似文献
82.
Daniel Leff Mei Nortley Lucy Melly Rajinder P Bhutiani 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):157-160
BACKGROUND: Laparoscopic cholecystectomy is generally a safe and well-accepted procedure. However, in a small percentage of patients, it is associated with complications, such as bleeding and injury to the bile duct and other viscera. Splenic injury as a result of laparoscopic surgery has been reported only in the context of direct trauma, for example due to retraction in hand-assisted urologic surgery. To date, there have been no reported cases of patients requiring splenectomy following laparoscopic cholecystectomy. We report an unusual case of ruptured spleen presenting less than 28 days following "uncomplicated" laparoscopic cholecystectomy. RESULTS: A 52-year-old female presented to our Accident and Emergency department 3 weeks following "uncomplicated" laparoscopic cholecystectomy, complaining of severe left upper quadrant pain radiating to the left shoulder tip. Clinical examination revealed a patient in hypovolemic shock, with localized left upper quadrant peritonism. Abdominal computed tomography supported a diagnosis of splenic rupture, and the patient required an emergency splenectomy. DISCUSSION: Splenic injury rarely complicates laparoscopic cholecystectomy. We postulate that either congenital or posttraumatic adhesions of the parietal peritoneum to the spleen may have caused the capsule to tear away from the spleen when the pneumoperitoneum was established, resulting in subcapsular hematoma and subsequent rupture in this patient. Videoscopic assessment of the spleen at the end of laparoscopic cholecystectomy might be a worthwhile exercise to aid early recognition and management in such cases. 相似文献
83.
Guenther Felix; von zur Muhlen Constantin; Lohrmann Jens; Bode Christoph; Geibel Annette 《European journal of echocardiography》2008,9(1):186-187
A 32-year-old woman presented to the emergency department afterthe sudden onset of palpitations, dyspnoea and left-sided tinnitus.Echocardiography revealed a ruptured aneurysm of the noncoronarysinus of Valsalva into the right atrium. Due to deteriorationof right heart failure with rapidly progressive decline of systemicblood pressure, the patient underwent immediate surgery witha patch repair of the ruptured aneurysm. A few days later, thepatient was discharged home in good condition. 相似文献
84.
目的探讨早期经血管内栓塞和显微神经外科手术治疗颅内破裂动脉瘤的有效性。方法240例颅内破裂动脉瘤患者,110例在发病后3天内行早期手术治疗,其中选择经血管内栓塞治疗70例,开颅显微神经外科夹闭手术治疗40例。结果110例颅内破裂动脉瘤早期经血管内栓塞治疗70例,完全栓塞59例(84.29%);近全栓塞11例(15.71%),即栓塞率≥85%;治疗后3—6月内随访,56例(80%)完全恢复健康,9例轻度神经功能障碍,5例术后病情恶化,重度神经功能障碍。显微外科手术夹闭40例,完全夹闭36例(90%),不全夹闭或包裹治疗4例(10%),术后3—6月随访示:临床治愈34例(85%),4例轻度神经功能障碍,1例重度偏瘫、语言障碍,1例死亡。结论颅内破裂动脉瘤的早期手术治疗可有效防止动脉瘤再破裂出血和迟发性脑血管痉挛危险因素的发生,可降低其病残率和死亡率。 相似文献
85.
Kawabe T Tenjin H Hayashi Y Kakita K Kubo S 《Clinical neurology and neurosurgery》2006,108(2):163-167
The midterm effects of coil embolization for ruptured aneurysm remain unknown. We investigated the prevention of rebleeding by GDC in ruptured aneurysms. Between March 1998 and April 2003, we treated 38 ruptured aneurysms measuring less than 10 mm in diameter. The patients were followed for a median of 37.3 months. During the follow-up term, aneurysms treated by coil embolization did not develop rebleeding after 1 month. We conclude that an embolized aneurysm measuring 10 mm or less remains quite stable over 3 years. 相似文献
86.
目的 探讨伴破裂囊泡形成的颅内动脉瘤的血管内治疗特点.方法 回顾性分析2年间治疗的此类病例30例,将其分为Ⅰ~Ⅳ4型进行血管内介入治疗.预后采用GOS评分判定,各型间采用x2检验进行比较.并行DSA复查.结果 Ⅰ型及Ⅱ型的19例中,GOS评分5分18例、4分1例.Ⅲ型7例山,GOS评分5分6例、1分1例.Ⅳ型4例,GOS评分5分2例、1分2例.x2检验见预后:Ⅰ及Ⅱ型>Ⅲ型>Ⅳ型.所有病例随访至半年至1年时行DSA复查,未见动脉瘤再通.结论 伴破裂囊泡形成的颅内动脉瘤病例采用血管内治疗多能获得较好疗效.这其中以Ⅳ型的预后最差,Ⅲ型次之,Ⅰ及Ⅱ型最好. 相似文献
87.
Rahul K. Gupta Sanjay Oak Beejal Sanghvi Advait Prakash Mitesh Bachani 《Journal of pediatric surgery》2010,45(7):1538-1541
A newborn boy was brought to us, 2 hours after birth, with a mucosal-lined left hemiperineal lesion associated with classical bladder exstrophy and an anterolaterally displaced anus. Perineal anatomy was restored by excising the mucosa lined lesion. The bladder closure for classical bladder exstrophy was done at the same time. Histologically, gastric, respiratory, and small intestinal epithelia were present in the mucosa. A rectal duplication cyst that had ruptured in utero through the hemiperineum could explain the anomaly. The association of classical bladder exstrophy with ruptured rectal duplication cyst has never previously been described in the literature. 相似文献
88.
Successful Resection of a Ruptured Hepatoblastoma Prior to Chemotherapy: Report of a Case 总被引:3,自引:0,他引:3
Iida T Suenaga M Takeuchi Y Kobayashi T Tobinaga J Miwa T Takenaka H Nomura H Hasegawa S Oguma K 《Surgery today》2004,34(8):710-714
A 12-year-old boy was referred to our hospital suffering from severe anemia and liver dysfunction. The laboratory data on admission confirmed severe anemia and an elevated -fetoprotein level. Abdominal ultrasonography revealed a mass measuring 51 × 49mm in size, and abdominal computed tomography showed a low-density mass in S8 of Couinauds segment and a low-density area in S7, thus suggesting bleeding in the tumor. Right subphrenic fluid collection and perirectal fluid collection were also observed. Celiac arteriography showed a faint tumor stain fed by A5–8 but no evidence of any extravasation. A diagnosis of pediatric liver carcinoma was made, and the case was classified as T2 C3 V0 N0 M0 Stage IIIA. Although there was no evidence of bleeding during angiography, because of the high risk of rebleeding, a laparotomy was performed before chemotherapy. At operation, the tumor rupture site and hematoma appeared to be in S7, and a right lobectomy was thus performed. Ascitic fluid cytology was class V. The cut surface of the resected specimen showed a tumor measuring 51 × 49mm located in S8 and a hematoma located in S7. Histologically, the tumor was a well-differentiated hepatoblastoma. The patient was transferred to the pediatric department and treated with six courses of intravenous chemotherapy followed by peripheral blood stem cell transplantation. The outcome has been favorable, with no recurrence as of 25 months after the operation. 相似文献
89.
Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK-432 总被引:2,自引:0,他引:2
Shiratori M Nagashima I Takada T Morofuji S Motomiya H Matsuda K Inaba T Fukushima J Okinaga K 《Journal of Hepato-Biliary-Pancreatic Surgery》2004,11(6):426-429
We report a 51-year-old man with a ruptured hepatocellular carcinoma (HCC). He was admitted to the hospital with abdominal pain and distension. Imaging studies revealed massive ascites, liver cirrhosis, and a 3-cm tumor at the inferior edge of the medial segment of the liver, with adhesions to the greater omentum. Abdominal paracentesis showed bloody ascites, and the patient was diagnosed with a ruptured HCC. OK-432, an immunomodulatory agent prepared from an attenuated strain of Streptococcus pyogenes, was injected (10KE) into the peritoneal cavity four times within 1 week; the massive ascites disappeared, and the serum alpha-fetoprotein (AFP) level decreased to within the normal limits. Afterwards, he underwent a curative operation for HCC. His postoperative course was uneventful and he was discharged from the hospital on the twenty-second postoperative day. He had shown no evidence of recurrence or metastases at the time he died of hepatic failure related to alcohol abuse 9 months after the operation. 相似文献
90.
Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early pregnancy and the use of quantitative measurement of the β-unit of human chorionic gonadotropin have revolutionized the management of this condition. These diagnostic modalities allow its early detection and, in many cases, treatment before rupture occurs. There is an ever increasing body of evidence supporting expectant, medical, and surgical management of ectopic pregnancy according to certain criteria. The indications and criteria for the different management options are described in the literature and in clear guidelines from institutions such as the Royal College of Obstetricians and Gynaecologists. Methotrexate, in a single dose protocol, is widely used in the medical management of ectopic pregnancy. Surgical therapy can be either laparoscopic or via laparotomy. Be that as it may, ruptured ectopic pregnancy will continue to present as a gynecologic emergency requiring prompt and appropriate care. Resuscitation of these patients should be an organized, systematic, and rapid process with the ultimate goal of getting them to the operating theatre in the best possible hemodynamic status. The aim of surgery should be to stop active bleeding by the most expedient method. The use of autotransfusion is well established in cardiac surgery, vascular surgery, orthopedic surgery, and trauma. Using autologous blood should be considered also in the treatment of ruptured extrauterine pregnancy when faced with massive bleeding and a need for transfusion. Advanced abdominal pregnancy is a rare condition with high perinatal and maternal morbidity and mortality. Placental management at delivery remains a dilemma. The risk of massive bleeding upon removal must be balanced against the risk of infection and other complications during the long time needed for resorption of the placenta if left in situ. Despite a reduction in maternal mortality due to ectopic pregnancy in the developed world during the preceding period, it would appear that no further inroads have been made in the last two decades. In developing countries, the problem is far greater, and problems with resources and infrastructure persist. It remains a challenge to all practitioners caring for women to apply available resources and use the published evidence-based guidelines to manage these women effectively and safely. 相似文献