CT引导下经皮微波消融治疗周围型肺癌的临床研究

目的探讨CT引导经皮穿刺微波消融治疗肺部恶性肿瘤的临床疗效及应用价值。方法选取2014年10月-2016年12月医院收治的60例周围型肺癌患者资料进行分析,将患者随机双盲法分为化疗组和微波消融组,每组30例。化疗组采用GP化疗方案治疗,微波消融组采用CT引导下经皮微波消融法治疗,比较两组临床疗效。结果两组患者治疗前Karnofsky评分差异不具有统计学意义(P0.05);微波消融组治疗后近期总有效率为60.0%,显著高于化疗组的33.3%(P0.05);微波消融组治疗后1个月、治疗后3个月Karnofsky评分,显著高于化疗组(P0.05);微波消融组不良反应发生率为16.7%,显著低于化疗组40%(P0.05)。结论与单纯化疗方案相比,采用CT引导下经皮微波消融法治疗周围型肺癌效果更佳,创伤小、安全性高,值得推广应用。     

脾动脉罕见解剖变异一例

患者　男,57岁。乙肝病史10年,肝区疼痛、肝功能持续异常6个月。Ｂ超及ＣＴ检查诊断为原发性肝癌。住院施行介图1　腹腔动脉干、肝总动脉及其分支显示,未见脾动脉显影　图2　脾动脉起自肠系膜上动脉主干作者单位:230031合肥市,解放军105医院放射科ＤＳＡ室入治疗。血管造影:经股动脉行腹腔动脉干造影,可见肝总动脉及其分支显示,未见脾动脉显影(图1)。将导管选择至肠系膜上动脉造影,可见由其发出脾动脉主干和分支(图2)。讨论　脾动脉一般是腹腔动脉干最粗大的分支,可直接变异于腹主动脉,但起自肠系膜上动脉实属罕见,主要是由于腹腔动脉干及肠…     

自体骨髓干细胞移植治疗失代偿期肝硬化

Objective To investigate the therapeutic effects of bone marrow stem cells for the treatment of decompensated liver cirrhosis. Methods The clinical data of 28 patients with decompensated liver cirrhosis who were admitted to the No. 105 Hospital of PLA from July 2009 to March 2010 were retrospectively analyzed. Bone mesenchymal stem cells (BMSCs) were separated and purified from the bone marrow cells of the patients in vitro,and then they were transplanted into the liver of the patients through proper hepatic artery. The clinical symptoms and physical signs of the patients were monitored, and the biochemical indexes of the liver were measured at the 2nd, 4th, 8th and 12th weeks after operation. All data were analyzed using the analysis of variance, LSD test or Dunnett's test. Results The appetite and physical strength of 26 patients were apparently improved one week after operation. The ascites of 23 patients were reduced at the end of the 4th week. At the end of the 12th week,the level of alanine aminotransferase was decreased from (99 ± 36)U/L to (48 ± 26 )U/L, aspartate aminotransferase was decreased from (86 ±36)U/L to (46 ±22)U/L, total bilirubin was decreased from (38 ± 16)μmol/L to (18 ± 13)μmol/L, albumin was increased from (29 ± 4)g/L to (35 ± 5 )g/L, and the prothrombin time was decreased from ( 19 ±4)s to ( 13±4) s. There were significant differences in the biochemical indexes of the liver after operation when compared to those before operation ( F =267. 35, 143. 52, 218. 74, 125. 57, 331.25, P <0.05). No fever, rash or allergic reaction was detected. Hematoma was detected in the incision site of the posterior superior iliac spine in one patient, and it disappeared one week later; one patient had discomfort in the liver area during the process of the BMSCs transplantation, and the discomfort disappeared at the end of the process; one patient died of hemorrhage of the upper gastrointestinal tract at the end of the 3rd month after operation. Conclusion The short term outcome of the autologous BMSCs transplantation for the treatment of decompensated liver cirrhosis is satisfactory, while its long term effect needs to be further investigated.     

经门-体侧支介入性治疗胃底静脉曲张6例

目的：评价经门-体侧支循环介入性治疗6例胃底静脉曲张临床运用的可行性。方法：采用Seldinger技术经皮穿刺股静脉插管至门-体侧支分流道，用球囊导管阻塞分流道并经其缓慢入鱼肝油酸钠栓塞胃底曲张静脉，术后1、3、6、12个月分别行胃镜和增强CT检查进行评估。结果：6例治疗后胃底静脉曲张几乎完全消失。结论：经门-体侧支介入性治疗胃底静脉曲张，创伤小，可重复治疗，是安全可行的技术，对消除胃底静脉曲张有良好效果。     

自体骨髓干细胞移植治疗失代偿期肝硬化

目的 探讨自体骨髓干细胞移植对失代偿期肝硬化患者的疗效.方法 回顾性分析2009年7月至2010年3月解放军第一○五医院收治的28例失代偿期肝硬化患者的临床资料.抽取患者骨髓后,体外分离、纯化骨髓间充质干细胞(BMSCs),经股动脉置管至肝固有动脉,再将BMSCs植入肝脏.自体移植后观察患者临床症状、体征,术前、术后第2、4、8、12周检测肝功能生化指标.组间比较采用单因素方差分析,当方差齐时,组间多重比较采用LSD法分析,若方差不齐则采用Dunnett's法.结果 本组中,26例患者术后1周食欲增加,乏力明显改善;23例术后第4周腹腔积液明显减少或消失.至第12周,患者ALT由(99±36)U/L降至(48±26)U/L,AST由(86±36)U/L降至(46±22)U/L,TBil由(38±16)μmol/L降至(18±13)μmol/L,Alb由(29±4)g/L升至(35±5)g/L,PT由(19±4)s降至(13±4)s.治疗前、后患者各实验室指标比较,差异有统计学意义(F=267.35,143.52,218.74,125.57,331.25,P<0.05).本组患者未见发热、皮疹、过敏反应等并发症,其中1例髂后上棘穿刺点出现血肿,1周后自行消退;1例在施行BMSCs移植过程中出现肝区不适,移植完毕拔管后症状消失;1例于术后3个月因上消化道大出血死亡.结论 BMSCs移植治疗失代偿期肝硬化近期安全有效,远期效果有待进一步观察.     

右颈内静脉血栓致左颈内静脉留置导管不畅1例

正1临床资料患者男性,79岁,因慢性肾功能不全在外院血液透析治疗2年半,治疗效果尚好;其初始治疗经过是先行右颈内静脉插管,随后已分别进行左、右前臂内瘘手术。近期患者因内瘘闭塞临时行股静脉插管透析,现要求建立长期血管通路收住。体温36.8℃,脉搏80次/min,血压140/80 mmHg。营养一般,神     

经导管肝动脉化疗栓塞术联合三维适形放疗治疗巨大原发性肝癌疗效分析

目的 探讨经导管肝动脉化疗栓塞术（TACE）联合三维适形放疗（3D-CRT）治疗巨大原发性肝癌患者的疗效。方法 回顾性分析2009年1月～2015年1月我院诊治的147例无法手术切除的巨大（直径≥10cm）原发性肝癌。根据治疗方案不同,分为TACE联合3D-CRT治疗63例和TACE治疗84例,比较分析两组患者治疗效果,并记录治疗期间不良反应发生情况。结果 TACE联合3D-CRT组有效率为65.1%,显著高于TACE组的40.5%（P＜0.05）;TACE联合3D-CRT组和单纯TACE组6 m、1 a、2 a生存率分别为84.1%、55.6%、27.0%和59.5%、38.1%、19.1%,其中两组6 m和1 a年生存率比较有统计学差异（P＜0.05）;两组不良反应发生率比较无显著差异。结论 TACE联合3D-CRT治疗无法手术切除的巨大原发性肝癌具有良好的临床疗效。     

Abernethy畸形并发下消化道出血1例并文献复习

目的了解先天性肝外门腔静脉分流（Abernethy畸形）的临床特点。方法回顾分析1例Abernethy畸形并下消化道出血患者的临床资料,并进行文献复习。结果本例患者男性,20岁。反复间歇性便血20年。重度贫血貌,外周血WBC 2.0×109/L,RBC 2.6×1012/L,HB41g/L,PLT 125×109/L;粪红色软便,OB（＋＋＋）,血液（＋＋）;经电子胃镜、电子结肠镜、腹部血管彩超、腹部CT血管重建和磁共振成像检查诊断,行结直肠周围血管离断和直肠下段曲张静脉缝扎术,术后恢复良好,随访2年,生活质量好。结论 Abernethy畸形分为Ⅰ型和Ⅱ型,Ⅱ型患者肝外门静脉广泛扩张并导致门腔静脉分流,以下消化道出血为主要临床表现。