超选择子宫动脉栓塞治疗症状性子宫肌瘤

目的：探讨超选择子宫动脉栓塞治疗症状性子宫肌瘤的，临床效果。方法：对56例症状性子宫肌瘤患者采用Seldinger技术，经导管超选择栓塞子宫动脉，栓塞术后3个月及6个月复查。结果：56例全部超选择成功，所有患者临床症状明显改善，术后3个月、6个月子宫体积平均缩小40．1％及50．3％；肌瘤体积平均缩小38．8％及60．6％。结论：超选择子宫动脉栓塞治疗症状性子宫肌瘤创伤小、疗效确切，术后并发症发生率低，具有较广泛的，临床应用价值。     

Management of major hemoptysis in patients with cystic fibrosis

Although bronchoscopy remains the best definitive method for localization of the site of hemorrhage in patients who have massive hemopytsis, angiography remains an important adjunct to this localization. When combined with embolization of the bleeding bronchial artery, it is an effective method of therapy for the management of massive hemoptysis in patients with cystic fibrosis.     

晚期肝癌伴门脉癌栓的介入治疗

本文回顾性分析了１９例晚期肝癌伴门脉癌栓病人的介入治疗疗效和肝动脉栓塞的安全性。结果显示１９例中有１３例肿瘤不同程度的缩小，全部是经加用碘油或明胶抽栓塞肝动脉的病例。在抗癌药物加碘油，明胶海棉栓塞的肝动脉组中，９例门脉显像者仅１例ＡＬＴ和ＡＳＴ升高，而３例门脉未显影者全部升高。因此作者认为：对伴有门脉癌栓的晚期肝癌，只要间接门脉造影显示门静脉，亦应加用碘油和明胶海绵栓塞肝动脉，但对门脉未显影者，用     

Ophthalmic Artery Embolization as Pretreatment of Orbital Exenteration for Conjunctival Squamous Cell Carcinoma

The aim of this study is to describe the effect of transarterial embolization from the ophthalmic artery as a pretreatment for orbital exenteration. A 75-year-old Chinese man with a 7-year history of gradual increase of the left eye swelling showed a massive conjunctival tumor growing outwardly from the interpalpebral fissure and had no light perception in the left eye. Magnetic resonance imaging showed orbital invasion of the tumor around the left eyeglobe. The initial surgery for the planned orbital exenteration was discontinued after skin incision around the orbital margin due to massive hemorrhage. The patient underwent transarterial embolization with gelatin sponge (Spongel) of the feeding arteries from the left ophthalmic artery and, the next day, had orbital exenteration with well-controllable bleeding and reconstruction with free vascularized anterolateral thigh cutaneous flap transfer. Pathologically, well-differentiated squamous cell carcinoma proliferated in exophytic, papillary, and nested fashions, arising from the bulbar conjunctiva. Tumor cells were also found in the conjunctival stroma around the vessels. The sclera at the equator had a perforated site with tumor cell invasion, but no intraocular invasion was found. Hematoxylin-positive gelatin sponges were found inside the orbital vessels and large choroidal vessels. In conclusion, transarterial embolization of feeding arteries arising from the ophthalmic artery is a useful pretreatment to control bleeding at orbital exenteration for malignancy.     

扩散峰度成像在肝脏疾病中的应用进展

扩散峰度成像(DKI)序列作为扩散加权成像(DWI)的衍生序列能够显示复杂组织中水分子扩散受限程度,反映组织微观结构信息。其在肝脏主要应用于肝功能储备和肝脏纤维化程度评估、肝内良恶性肿块病变鉴别、及对肝癌经动脉化学栓塞术后复发评估等。就DKI的基本原理、主要技术参数及在肝脏疾病诊断和疗效评估中的研究进展予以综述。     

选择性肾动脉栓塞治疗肾脏疾病的临床应用

目的：评价选择性肾动脉栓塞治疗在肾癌、症状性肾血管平滑肌脂肪瘤和肾创伤出血病人中的应用价值。方法：采用改良Seldinger技术经皮股动脉穿刺插管，对68例进行选择性肾动脉栓塞治疗，其中30例为肾癌术前辅助治疗，应用明胶海绵颗粒栓塞；8例为晚期肾癌姑息性治疗，采用丝裂霉素＋碘油的乳剂行末梢栓塞，然后用明胶海绵行肾动脉主干栓塞；6例症状性肾血管平滑肌脂肪瘤，采用真丝线段栓塞；24例肾创伤出血，采用自身血块、明胶海绵或弹簧钢圈栓塞。结果：肾癌术前栓塞者，术中肿瘤易剥离，手术野清晰，出血量少，手术时间缩短；晚期肾癌姑息治疗和症状性肾血管平滑肌脂肪瘤者，栓塞术后1~3周临床症状显著改善，3个月后肿瘤体积明显缩小，平均缩小65.6%；肾创伤性出血者，止血迅速，不影响肾功能。全部病例在栓塞治疗后无严重并发症发生。结论：选择性肾动脉栓塞术是治疗肾脏疾病的一种微创、安全、有效的方法，并发症少，可用于肾癌术前辅助治疗、晚期肾癌的姑息性治疗及肾血管平滑肌脂肪瘤和肾创伤出血的治疗，值得临床推广应用。     

TACE治疗巨大肝癌60例疗效及预后因素分析

为了研究肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗巨大原发性肝癌的效果及预后因素,对1998年9月～2004年12月TACE治疗的直径≥100mm的60例原发性肝癌患者的临床资料进行回顾分析,log-rank单因素分析影响预后的因素,多因素分析采用cox比例风险模型确定独立的危险因素。结果显示TACE治疗后的1年、2年、3年生存率分别为41.7%、14.7%和7.3%。Child-pugh分级、有无门脉栓子、TACE术后4d白蛋白下降程度是影响预后的独立因素。TACE治疗巨大肝癌的疗效尚不令人满意,应用大剂量碘油不能提高巨大肝癌患者的生存时间,有门静脉栓子和肝脏储备功能差的患者手术后的预后较差。     

创伤性颈动脉海绵窦瘘的血管内栓塞治疗

目的 探讨创伤性颈动脉海绵窦瘘(TCCF)的治疗方法、栓塞技术要点及随访意义。方法 对119例TCCF病人共行128次栓塞。其中,股动脉入路112例,股静脉入路5例,经眼上静脉入路2例;以球囊栓塞瘘口101例,以微弹簧圈栓塞13例,球囊并用弹簧圈2例,干冻硬脑膜3例。术后3月~10年随访110例,其中行影像学复查29例。结果 111例1次栓塞成功,8例于第1次栓塞后球囊泄漏复发,经再次栓塞治愈,总治愈率100%。颈内动脉通畅率90.8%(108/119),无严重并发症,随访显示疗效可靠。结论 TCCF一般经股动脉入路用可脱性球囊栓塞瘘口,小瘘口TCCF选择微弹簧圈栓塞;若颈内动脉结扎或闭塞,可经静脉入路栓塞瘘口。一般情况下海绵窦瘘均表现为良性过程,应力争解剖治愈,不可轻易牺牲颈内动脉。正确选择栓塞途径及栓塞材料是手术成功的关键。     

彩色多普勒超声在肝细胞癌经动脉化疗栓塞术后的应用

对于失去手术机会的肝细胞肝癌,介入治疗是目前比较公认的首选治疗方法,但因其复发、转移率高,故术后寻找一种简便、有效的监测方法客观评价其疗效显得尤其重要。本文综述了彩色多普勒超声在肝细胞肝癌经动脉化疗栓塞术后评价的应用,及与其他影像学方法比较和其优势所在。