神经导航系统引导穿刺抽吸与CT定位穿刺抽吸治疗高血压性脑出血疗效比较

目的：比较神经导航系统引导多靶点穿刺与CT定位单靶点穿刺两种手术方法治疗高血压性脑出血的疗效。方法98例患者按就诊顺序随机分成两组。神经导航系统组46例,多靶点穿刺抽吸脑内血肿;CT定位组52例,根据CT片直接穿刺、抽吸血肿。术后随访3个月,行格拉斯哥预后评分（GOS）判断疗效。结果两组患者手术持续时间、引流天数、术中血肿抽吸率、住院天数和GOS评分差异均有统计学意义（P〈0.05﹚。结论神经导航多靶点技术微创穿刺抽吸手术治疗高血压脑出血较CT定位单靶点穿刺安全、有效。     

CT引导经皮椎体成形术治疗骨质疏松性压缩骨折疗效观察

目的探讨CT引导下经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析行CT引导经皮椎体成形术治疗骨质疏松性椎体压缩骨折106例患者的临床资料。结果106例手术均获成功,术后视觉模拟评分（visualanaloguescale,VAS）（（2．31±0．75）分）较术前（（7．62±0．62）分）明显降低（P〈O．05）,治疗优良率72％,有效率97％;术后患者疼痛症状明显缓解或消失,无肺栓塞、神经损伤等并发症。结论CT引导经皮椎体成形术治疗骨质疏松性压缩骨折疗效确切,具有微创、安全等优点。     

CT引导下经皮肺穿刺活检在肺部占位病变中的诊断价值

目的探讨CT引导下经皮肺穿刺活检对肺部占位病变的诊断价值。方法CT扫描确定最佳的穿刺点、局麻后CT引导下组织切割针经皮刺入到病灶,切割组织行病理检查。结果56例肺占位病变行CT引导下经皮肺穿刺活检,53例得到确诊,阳性率为94.6%。并发症包括少量气胸11例,肺出血9例,少量咯血5例,均不需特殊处理。结论CT引导下经皮肺穿刺活检对肺占位病变的诊断阳性率高、并发症轻,值得临床推广。     

Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome

AIM:To determine the feasibility of performingcomputed tomography(CT)-guided transpulmonaryradiofrequency ablation(RFA)for hepatocellularcarcinoma(HCC)located in the hepatic dome.METHODS:A total of seven patients with HCCcomprising seven nodules located in the hepatic domewere treated from April 2004 to December 2004.CT-guided transpulmonary RFA was performed using acool-tip type electrode(Radionics Company)based ona standardized energy protocol.All tumors located inthe hepatic dome were not detectable by the usualultrasound(US)methods.The lesion diameters rangedfrom 15 to 27 mm.RESULTS:RFA was technically feasible in all thepatients.The puncture procedure was performed twiceor less and the total average performance time was40.6 min.Local tumor control was achieved in all thepatients.The necrosis diameter ranged from 25 to35 mm.The mean follow-up period was 9.6(7-14 mo)mo.There was no local recurrence at the follow-uppoints.Pneumothorax requiring pleural drainage was themain complication,which was observed in two of theseven patients(28.6%).However,it improved with chestdrainage tube,and the tube could be removed within2-3 d.No other major complications were observed. CONCLUSION:CT-guided puncture is useful for thetreatment of tumors located in the hepatic dome whichare hardly detectable by US,even though pneumothoraxsometimes may occur as a complication.In the caseswith adhesion in the pleura for which artificial pleuraleffusion methods are not appropriate,CT-guided RFA isthus considered to be an alternative treatment for HCClocated in the hepatic dome.     

CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique

PURPOSES: To assess the safety of CT-guided brachytherapy of lung malignancies and to evaluate the initial therapeutic response. PATIENTS AND METHODS: Fifteen patients with 30 lung malignancies were included in this prospective phase I trial (metastases, 28; non-small cell lung cancers, 2). Pre-interventionally two patients had a vital capacity of < 80% (39% and 63%). These two patients, and one other, had FEV1 values of < 80% predicted (17%, 48%, and 64%). Tumors with a maximum diameter of 4 cm were treated with a single brachytherapy catheter that was positioned under CT-fluoroscopy. In two tumors with tumor diameters of 5.5 and 6.5 cm, two applicators were used. In one patient with an 11-cm irregularly shaped tumor, nine catheters were inserted. Treatment planning for 192Ir brachytherapy was performed using three-dimensional CT data that were acquired after percutaneous applicator positioning. All procedures were performed under local anesthesia. A follow-up CT was performed 6 weeks later and every 3 months pos-tintervention. RESULTS: The mean diameter of the 30 lung tumors was 2 cm (range, 0.6 to 11 cm; median diameter, 1.5 cm). The minimal dose within the tumor margin was 20 Gy in all 30 tumors treated. Except for nausea in one patient and focal hemorrhage detected on CT in two patients, no acute adverse events were recorded. One patient developed an abscess at the previous tumor location 9 months after treatment, which proved to be a local tumor recurrence. The median follow-up period was 5+ months with a local tumor control of 97%. CONCLUSION: The novel technique of CT-guided interstitial brachytherapy was safe for the treatment of lung tumors and yielded a very low complication rate. The initial data on therapeutic response are promising.     

采用Max-Core活检枪经皮肺活检诊断肺周边及弥漫性病变38例临床研究

目的探讨采用Max-Core活检枪在螺旋CT引导下经皮肺活检诊断肺周边及弥漫性病变的价值。方法在螺旋CT引导下,采用Max-Core活检枪对中国武警医学院附属医院2002-02~2005-01收治的38例肺周围结节性和弥漫性病变进行肺活检。结果检出肺癌30例,其中肺腺癌28例,低分化鳞癌1例,细支气管肺泡癌1例。余8例中,肺结核2例,炎性假瘤2例,特殊表现肺炎2例,肺间质纤维化1例,未获得有意义结果1例。38例肺周边及弥漫性病变经Max-Core活检枪经皮肺活检获阳性结果37例,阳性率为97·36%。手术病人31例,活检枪病理结果与术后病理相符率为100%。副反应轻微,短期内均痊愈。结论螺旋CT引导下采用Max-Core活检枪经皮肺活检是一项简捷、高效、准确和安全的诊断技术,对于肺周围结节性和弥漫性病变的定性具有非常重要的意义。     

肺部周围性病变CT引导下经皮肺活检临床分析

目的探讨CT引导经皮活检术对肺部周围性病变的诊断价值。方法对66例肺周围性病变患者进行CT引导下的经皮肺活检术。结果CT引导下的经皮肺活检术对肺周围性病变确诊率为93．94％,气胸与出血的发生率为16．67％。结论CT引导下经皮肺活检是一种安全有效可靠的方法,可为肺部周围性病变患者提供可靠的病理标本。     

CT引导下经皮肺穿刺活检在肺部占位性病变诊断中的诊断价值

目的探讨cT引导下经皮肺穿刺活检在肺部占位性病变诊断价值。方法分析62例CT引导下经皮肺穿刺活检术的临床资料,评价其临床应用价值,对并发症进行分析。结果62例肺占位病变中,穿刺病理诊断56例,准确率达90．3％,并发肺出血19．34％,气胸16．13％。结论CT引导下经皮肺穿刺活检是一种微创、安全、准确、简便的获得组织病理的诊断方法,具有重要的临床诊断意义。     

多种肺穿刺活检术对老年疑似Ⅰ～ⅢA期肺癌的诊断运用评价

目的评价多种肺穿刺活检术对老年疑似Ⅰ～ⅢA期肺癌中的诊断价值。方法对疑似Ⅰ～ⅢA期151例肺癌老年患者分别采取经纤维支气管镜肺活检(TBLB)、CT或彩色多普勒超声(CDU)引导下经皮肺穿刺活检并进行临床诊断,所得结果与病理结果进行对照。结果联合3种活检方法诊断率与单一活检方法诊断率比较,差异有统计学意义(P<0.05)。结论多种肺穿刺活检术联合应用可明显提高对老年疑似Ⅰ～ⅢA期肺癌的诊断率。     

CT导引下肺部穿刺150例临床应用体会

目的研究CT导引下肺部穿刺在临床的应用价值。方法对150例肺部肿块患者在CT下精确定位,穿刺,活检。结果150例患者穿刺成功率100%,确诊率90%,并发症8%。结论穿刺活检可获得病理学依据,为患者的治疗指明了方向,有利于医生为患者的病情制定出准确的治疗方案,此技术对于临床应用具有很大价值。