Objective To explore the risk factors for bleeding at the puncture site after femoral artery puncture intervention.Methods A computerized retrieval of observation studies,including cross-sectional studies,case-control studies,and cohort studies,about the risk factors for bleeding at the puncture site after femoral artery puncture intervention from the databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,China Biomedical Literature Service(CBM),PubMed,Medline,The Cochrane Library,EMbase and Web of Science was conducted.The retrieval time period was from the establishment of the database to December 31,2022.Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the included studies,and RevMan5.3 software was used to make meta-analysis of the literature data.Results A total of 8 articles with a total sample size of 35 250 patients were included in this analysis.There were 1 410 patients in the postoperative bleeding group and 33 840 patients in the non-bleeding group.The results of the meta-analysis showed that the aged(OR=2.71,95％ CI=2.17-3.38),female(OR=4.26,95％ CI=1.08-16.89),hypertension(OR=2.48,95％CI=1.69-3.63),obesity(OR=2.33,95％ CI=1.59-3.42),use of thrombolytic agents,anticoagulants or platelet antagonists(OR=2.95,95％ CI=2.24-3.89),manual compression(OR=6.78,95％ CI=1.34-34.43)were the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.Conclusion The aged,female,hypertension,obesity,use of thrombolytic agents,anticoagulants or platelet antagonists,and manual compression are the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.(J Intervent Radiol,2024,33:314-320)
Purpose:Evaluating the clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty (MWA + PO group) versus percutaneous osteoplasty (PO group) for the treatment of flat bone metastases. Methods:Patients with flat bone metastases and intractable pain who underwent PO and/or MWA from January 2016 to January 2023 in our hospital were included, with 36 cases in the MWA+PO group and 21 cases in the PO group. Changes in the visual analog scale (VAS), Oswestry Disability Index (ODI), and quality of life assessment scale(QOL) were evaluated regularly. Postoperative complications and target lesion tumor treatment responses were also observed. Results:The VAS and ODI in both the MWA+PO group and the PO group significantly decreased at 1 week, 1 month, and 3 months postoperatively, The VAS and ODI in the MWA+PO group were lower than those in the PO group postoperatively. The QOL in both the MWA+PO group and the PO group significantly increased at 1 week, 1 month, and 3 months postoperatively, with the QOL in the MWA+PO group being higher than that in the PO group postoperatively. According to the mRECIST criteria (target lesion tumor treatment response), the ORR in the MWA+PO group and PO group was 52.8% and 9.5%, respectively, while the DCR was 94.4% and 57.1%, respectively (P <0.001 and<0.001). Different degrees of bone cement extravasation were observed in both the PO group (38.1%) and MWA+PO group(19.4%)(χ²=2.38, P=0.12), but none of the patients developed clinical symptoms related to bone cement extravasation. The average cost of surgery was ¥10,480.43 higher in the MWA+PO group than in the PO group. Conclusion:The MWA+PO treatment is more effective in relieving patients' local pain, improving local dysfunction, and enhancing quality of life, and can effectively improve target lesion tumor ORR and DCR, but it is also more costly.
目的 建立经尾动脉途径肝癌大鼠经导管肝动脉化疗栓塞术(TACE)模型,并探讨其可行性、有效性和安全性.方法 0.01％二乙基亚硝胺(DEN)溶液连续诱导大鼠12周建立肝癌模型,12周后通过MRI明确肿瘤大小.当最大肿瘤长径＞5 mm时,在DSA引导下经尾动脉插管,并将微导管置于肝固有动脉进行TACE,治疗后复查CT了解瘤内碘油沉积.观察大鼠术后1周生存率及相关并发症情况.检测术前及术后3、7 d大鼠ALT、AST、TBil及CRE水平.术后7 d行肝、肺、双肾及脾脏组织病理学检查.结果 TACE模型成功建立,尾动脉置管用时(6.9±1.4)min.造影显示大鼠肝内肿瘤染色明显,术后CT显示瘤内碘油沉积密实,组织病理学结果显示肿瘤大面积坏死,坏死区周缘Caspase3、HIF-1 alpha表达水平明显升高.肺、肾、脾脏大体标本未发现明显异位栓塞.所有大鼠行为无异常.术后3 d大鼠ALT、AST、TBil较术前明显上升(P＜0.05),术后7 d明显下降,但仍高于术前(P＜0.05),手术前后CRE水平无明显差异(P＞0.05).结论 经尾动脉入路可以安全、有效地完成对大鼠原发性肝癌的TACE治疗.
目的 分析双极激光定位导航仪在深部肺结节经皮穿刺活检中的应用效果.方法 选择2020年1月至2022年8月溧阳市人民医院因深部肺结节行经皮穿刺活检的患者120例,按1∶1交错法配对分为激光引导组60例和常规方法组60例.比较两组穿刺过程中的一次性穿刺到位率、穿刺次数、CT扫描次数、操作时间、并发症发生率.以操作时间和穿刺次数为学习曲线评价指标,比较两组的学习曲线.结果 与常规方法组相比,激光引导组的一次性穿刺到位率高(100％比15％)、穿刺次数少[(1.00±0.00)次比(3.15±0.68)次]、CT扫描次数少[(3.00±0.00)次比(5.15±0.68)次]、操作时间短[(19.30±2.38)min比(25.72±2.46)min],气胸率发生低(11.7％比30.0％)、出血率低(6.7％比21.7％),差异均有统计学意义(均P＜0.05).激光引导组均一次性穿刺到位,从第6例开始操作时间明显缩短并稳定,常规方法组从第20例开始操作时间和穿刺次数逐渐下降并稳定.结论 双极激光定位导航仪在深部肺结节行经皮穿刺活检中一次性穿刺成功率高,稳定性高,并发症少,学习曲线低易于掌握,有较高的临床应用价值.
目的 分析子宫动脉预栓塞术(pUAE)辅助凶险性前置胎盘(PPP)剖宫产的临床效果及其可能的影响因素.方法 回顾性分析 2017 年 1 月至 2021 年 12 月苏州大学附属第一医院和新疆克孜勒苏柯尔克孜自治州人民医院收治的PPP孕产妇临床和影像资料.以完成靶血管插管和栓塞为技术成功,以孕产妇和新生儿生命安全且不切除子宫为临床成功.以术中出血 1000 mL为限,分为高出血组和低出血组,比较两组间年龄、孕次、产次、孕周、胎盘前置范围、胎盘植入程度的差异.根据胎盘植入程度,分为植入组(胎盘植入、胎盘穿透)和非植入组(胎盘粘连),比较两组间供血类型差异.结果 共纳入孕产妇40 例,技术成功率 100%,临床成功率 95%.随访期间,无死亡及其他介入相关并发症发生,新生儿生长发育和智力均正常.术中中位出血量为 1000(300～6000)mL.高出血组 25 例,低出血组 15 例,两组间仅胎盘植入程度差异有统计学意义(P=0.001).植入组 18 例,非植入组 22 例,植入组中伴有其他动脉供血比例高于非植入组(8/18 比 3/22,P=0.04).结论 pUAE是辅助PPP剖宫产的安全有效措施,胎盘植入程度是影响出血量的关键因素.伴有胎盘植入的孕产妇出现子宫动脉外血供概率增加,术中出血量也较多.
