Role of radiology in the treatment of malignant hilar biliary strictures 2: 10 years of single‐institution experience with percutaneous treatment

We reviewed the results of percutaneous intervention of hilar biliary malignancy over a 10‐year period at a single institution: the Royal Melbourne Hospital. Ninety‐nine patients (100 treated in total) were included. Information was retrieved by retrospective examination of patient notes and radiology, combined with interviews with family and relevant physicians. Sixty‐nine patients were treated with insertion of semipermanent stents, 19 had external drain tubes, and 25 received percutaneous access for Iridium brachytherapy. Adequate drainage was achieved in 87% of the patients stented, and percutaneous access was successful in 96% of patients planned for brachytherapy. Of those patients undergoing endoprosthesis insertion, early complications occurred in 39% and late complications in 23%. Average survival for the entire patient population was 227.3 days, with a median of 167 days. Longer survival times (213 vs 142 days) and lower complication rates (44 vs 64%) are observed with metal stents in comparison with plastic stents. Percutaneous intervention is an important treatment option in hilar biliary malignancy, particularly in patients unfit for surgery. Reasonable survival with good palliation is the most common outcome, and most patients do not require further intervention.     

应用冷循环集束电极射频治疗晚期肝癌的疗效观察

[目的]观察冷循环集束电极射频治疗晚期肝癌的效果。[方法]冷循环集束电极射频治疗38例晚期肝癌，术后每月复查CT观察病变区液化坏死和病灶缩小情况以及增强扫描是否强化、患者生存质量及AFP变化。[结果]术后1个月CT显示全部病灶均出现部分液化坏死及CT扫描不强化，3个月后CT扫描5例患者肿瘤完全坏死。其余大部分坏死。全部患者术后1个月KPS评分均提高10分以上。随访AFP变化与肿瘤毁损情况一致。术后CT复查病灶液化坏死范围大或病灶缩小明显的病例AFP下降显著。[结论]冷循环集束电极射频治疗是一种安全、有效、耐受性好的晚期肝癌治疗技术。初步结果显示该治疗能够提高患者生存质量、延长生存期，值得深入研究并推广。     

肝癌介入治疗方法的回顾与展望

介入治疗被认为是肝癌非手术疗法中的首选方法。肝癌介入治疗方法可分为经皮经血管治疗技术和经皮非血管治疗技术。单纯动脉内灌注抗癌药效果差，各种肝动脉栓塞术尤其是使用同轴导管作超选节段性治疗是介入治疗的主流；一些非血管介入方法如经皮无水乙醇注射治疗、经皮射频消融治疗等以及合理的综合治疗也是治疗肝癌的有效武器。     

四种小儿动脉导管未闭堵闭术的临床应用:附127例报告

本文采用四种不同的介入治疗方法堵闭动脉导管共127例,成功率海绵塞法为92％(23/25例),双面伞器法为98.6％(66/67例),钮扣式补片法为100％(26/26例),弹簧圈器法为100％(9/9例)。海绵塞法和弹簧圈器无残余分流;术后6个月双面伞器法残余分流为7％(5/67例),钮扣式补片法为15％(4/26例)。钮扣式补片法和弹簧圈器法无并发症,海绵塞法为24％(6/25例),双面伞器法为4％(3/67例)。我们认为,钮扣式补片法及弹簧圈器法在小儿动脉导管未闭的介入治疗中具有较大的应用价值。     

Aortic Stenosis and Patent Ductus Arteriosus: Pressure Gradients Pre- and Posttranscatheter Ductal Occlusion

Three patients with patent ductus arteriosus and moderate aortic stenosis had a marked reduction in aortic valve gradient following transcatheter ductal occlusion. The hemodynamic effects of an aortopulmonary shunt on the severity of left ventricular outflow obstruction and the implications on intervention are discussed.     

清肝解毒散结汤配合介入治疗用于原发性肝癌的远期疗效观察

目的 观察中药清肝解毒散结汤配合介入治疗原发性肝癌的远期疗效。方法 将110例原发性肝癌住院患者随机分为治疗组（60例）与对照组（50例）。两组均采用Seldinger’s技术行肝动脉栓塞化疗，治疗组同时加用中药清肝解毒散结汤治疗。观察两组的远期生存率及生存质量。结果 治疗后0．5年、1年、2年、3年生存率治疗组分别为88．33％、78．33％、51．67％、31．67％；对照组分别为84．00％、68．00％、30．00％、16．00％，2、3年生存率治疗组优于对照组（P〈0．05），卡氏评分及体重变化方面来评价患者生存质量，两组比较差异均有显著意义（P〈0．05）。结论 中药清肝解毒散结汤配合介入治疗原发性肝癌，可以提高远期生存率和患者生存质量。     

Percutaneous Placement of Self-expandable Metallic Biliary Stents in Malignant Extrahepatic Strictures: Indications of Transpapillary and Suprapapillary Methods

Objective

To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied.

Materials and Methods

Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared.

Results

Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62).

Conclusion

For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.     

血管内介入诊疗技术在脑动静脉畸形中的应用

目的　探讨血管内介入诊疗技术在脑动静脉畸形诊疗中的价值。方法　回顾性分析 98例脑动静脉畸形的血管内介入诊疗资料。结果　DSA能明确诊断 ,显示供血动脉、畸形血管团及引流静脉的情况。 5 2例栓塞治疗的技术成功率为 1 0 0 %,单纯真丝线段栓塞 36例 ,真丝线段和α-氰基丙烯酸正丁酯 (NBCA)联合栓塞 1 6例。栓塞程度 :畸形血管团完全消失者 1 2例 ,畸形血管团减少 75 %以上者 2 1例 ,畸形血管团减少在 5 0 %～ 75 %者 1 1例 ,畸形血管团缩小不足 5 0 %者 8例。结论　DSA检查是脑动静脉畸形合理而可靠的诊断方法 ,有利于估计其预后并制订治疗方案 ,血管内栓塞治疗是其安全有效的治疗手段。     

泪囊黏液囊肿的鼻泪管支架植入治疗观察

目的 评价鼻湘管支架植入术在治疗泪囊黏肿中的应用价值。方法 对21例（21眼）泪囊黏滚囊肿患者行鼻泪管支架植入术，逆行扩张鼻泪道后植入特制的鼻泪管支架，术前术后行数字减影泪道造影检查，分析其疗效。结果 21眼均成功植入鼻泪管支架，手术成功率为100%，术后随访2—43个月，有效率为100%。无严重并发症的发生。结论 鼻泪管支架植入术治疗泪囊黏液囊肿操作简便，具有良好的临床效果，值得推广。     

肝癌合并高血压或冠心病TACE围手术期处理

[目的]探讨围手术期处理在肝癌合并高血压或冠心病经导管动脉内化疗栓塞(TACE)中的重要性.[方法]对45例合并高血压或冠心病的肝癌患者行TACE围手术期处理进行回顾性分析.[结果]合理应用降压药、硝酸酯类药物及化疗药的患者均平稳度过围手术期,有2例因处理不当死亡.[结论]加强TACE围手术期处理是确保肝癌并高血压或冠心病患者手术成功、减少并发症的重要保障.