房壁瘤病因不明且多见于左心房,发生于右心房者较为罕见.右房壁瘤(Right atrial aneurysm,RAA)最早由Bailey于1955年发现并描述[1] ,以男性较多见,单发为主.多无明显临床症状,部分表现为心悸、气促、肺部感染,严重时可出现猝死、肺栓塞等[2].我院2019年7月影像检查发现并经手术证实1例巨大右房壁瘤合并房间隔缺损患儿,现报道如下.

髂外动脉支架置入术后并发乙状结肠瘘在国内报道罕见,临床以间歇性消化道出血为主要症状.我院2018年6月收治1例右髂外动脉假性动脉瘤支架置入术后6年并发乙状结肠瘘.现报道如下: 1临床资料 患者,男,79岁,因"便血1月余,加重3天"入院.患者1月前无明显诱因出现鲜红色血便,伴下腹痛,排便后可缓解,无恶心、呕吐,予痔疮膏处理后便血仍反复发作.近3天便血增多伴低热、全身乏力,间有胸闷、心悸.查体:贫血貌,腹部见一造瘘口及手术疤痕.血常规:血红蛋白57g/L.

Objective ToinvestigatethefeasibilityofpredictingtheKi-67expressionusing MRandclinicalfeaturesofbreast cancer.Methods 52patientswith56invasivebreastcarcinomawereretrospectivelyinvestigated.Eachsubjectunderwentpresurgical breastMRI,whichincludeddynamiccontrastenhancementandDWI(b=0s/mm2,1000s/mm2).Clinicalcharacteristicsand MR findingswerecollected,includingage,ER ,PR ,HER2,tumorsize,location,number,spiculesign,lobulationsign,margin,TICandADCvalues. Ki-67expressionwasrecordedbyimmunohistochemicalstaining,whichwasdividedintohighexpression(≥20%)andlowexpression (<20%).Leastabsoluteshrinkageandselectionoperator(Lasso)wereperformedtoselectthefeaturesmostassociatedwithKi-67 expression.ThenomogramwasconstructedtopredictKi-67expression,aswellasAUCand95%confidenceinterval(CI)werecalculated.Results TICtypesandADCvaluesassociatedwithKi-67expressionwereidentifiedbyLassoregression.Thenomogram predictedthehigh andlow Ki-67expressionwithanAUCof0.827 (95% CI:0.713-0.940).TheKi-67expressionwasnegativelycorrelatedwiththe ADCvalues(r=-0.430,P=0.003).Ki-67expressionwassignificantlycorrelatedwithTICtype,andTICⅢwasmorelikelytohavehigher expressionofKi-67.Conclusion ThereisindividualandrespectivecorrelationbetweentheexpressionlevelofKi-67andTICtype, ADCvalue.TheexpressionlevelofKi-67canbepredictedtosomeextentbyADCvaluesandTICtypes.

目的 评价Turbohawk定向斑块切除系统联合药物涂层球囊在下肢动脉硬化闭塞症中临床应用价值.方法 对于术前超声以及下肢动脉CTA检查诊断为下肢动脉硬化闭塞症的8例患者,行Turbohawk斑块旋切以及药物涂层球囊治疗,术后行常规抗凝治疗,定期行彩超复查.结果 8例患者下肢动脉均全部再通成功,技术成功率为100％,术后缺血症状明显改善,术后平均踝肱指数为0.78±0.06,高于术前的0.31±0.12(P<0.05).住院期间无并发症发生,随访3～18个月,患者保肢均获得成功.结论 Turbohawk定向机械旋切系统联合药物涂层球囊治疗下肢动脉硬化闭塞症,具有创伤小、 疗效好以及安全性高等优点,值得临床推广使用.

肠系膜血管疾病主要指肠系膜血管阻塞、狭窄或供血不足引起的肠壁营养障碍或运动障碍,从而导致缺血性肠病的发生,目前发病率呈上升趋势,临床上缺乏及时有效的诊断.肠系膜动脉有丰富的侧支循环,即使其中某支动脉出现慢性闭塞,其侧支血管亦有较强的代偿能力以维持正常血供.当血管狭窄闭塞达到一定程度就会出现相应的临床症状,一般多以肠系膜上动脉病变多见,而肠系膜下动脉狭窄闭塞很少会引起缺血性肠病的发生[1].现报道一例经肠系膜下动脉成形术治疗因肠系膜下动脉狭窄所致的缺血性肠病的案例.

目的 探讨TACE联合放射性125I粒子植入与TACE联合经皮射频消融(RFA)治疗乏血供肝癌的临床疗效.方法 回顾性分析46例乏血供肝癌患者资料,其中25例(30个病灶)接受TACE联合放射性125 I粒子植入治疗(A组),21例(27个病灶)接受TACE联合RFA治疗(B组).比较两组疗效及并发症情况.结果 治疗后3个月,B组临床有效率(RR)为96.30％(26/27),明显高于A组[86.67％(26/30),x2=8.694,P＜0.05];直径≤3 cm的病灶中,A、B组的RR均为100％ (8/8、10/10);在直径＞3～5 cm的病灶中,A、B组的RR分别为81.82％ (18/22)、94.12％ (16/17),差异无统计学意义(x2=5.837,P＞0.05).治疗后6个月,A、B组的RR分别为93.33％(28/30)、96.30％(26/27),差异无统计学意义(x2 =3.422,P＞0.05);直径≤3 cm的病灶中,A、B组的RR均为100％(8/8、10/10);直径＞3～5 cm的病灶中,A、B组的RR分别为90.91％(20/22)、94.12％(16/17),差异无统计学意义(x2=2.716,P＞0.05).两组术后并发症差异无统计学意义(P均＞0.05),均未出现严重并发症.结论 TACE联合放射性125I粒子植入与TACE联合RFA均为乏血供肝癌安全、有效的治疗方法,TACE联合RFA相对近期疗效更优.

大隐静脉高位结扎剥脱术是治疗下肢浅静脉曲张成熟、有效的手术方法之一[1]，术中将毗邻的股浅动脉当做大隐静脉予以高位离断、结扎是极为罕见和严重的手术失误。现将我院收治的1例因左大隐静脉曲张行大隐静脉高位结扎剥脱术治疗，术中误扎股浅动脉后经人工血管移植术+左下肢动脉置管溶栓术复合手术治疗成功重建左股浅动脉，保全左下肢，现将诊治体会报道如下。

目的 通过应用奥马哈系统对下肢动脉硬化闭塞症(ASO)介入治疗护理干预的评估,制定完整的临床护理管理体系,提升护理质量.方法 82例下肢ASO患者分为观察组42例和对照组40例,2组患者均给予介入治疗,对照组患者给予常规专科护理措施,观察组患者在给予常规专科护理措施的基础上应用奥马哈系统,并制定完整的护理管理体系;术后3个月比较2组患者的治疗效果.结果 所有患者术后下肢血管残余狭窄均＜30％,无严重并发症发生.2组患者术前Likea评分比较差异无统计学意义(P＞0.05).术后3个月,观察组患者疼痛、神经-肌肉-骨骼功能、皮肤温度减低、皮肤溃疡坏死、精神健康、营养、睡眠、个人自理、药物治疗及家庭照顾评分均显著低于对照组(P＜0.05),但2组患者排便及泌尿功能评分比较差异无统计学意义(P＞0.05).结论 奥马哈系统在下肢ASO介入治疗患者护理中的应用具有可操作性,可进一步提升护理质量,显著改善患者的临床症状和预后.

Objective To discuss the safety and clinical effect of fine needle single-step centesis in percutaneous endoscopic nephrolithotomy for renal staghorn calculi. Methods Percutaneous endoscopic nephrolithotomy with fine needle single-step centesis was employed in 75 patients (single-step group) with renal staghorn calculi, and percutaneous endoscopic nephrolithotomy with two-step centesis was adopted in other 75 patients with renal staghorn calculi (two-step group). The clinical effect and the incidence of complications were compared between the two groups. Results The placement of drainage catheter was successfully accomplished in all 150 patients. In single-step group the operation time was 18-45 minutes with a mean of 36 minutes; the mean blood loss during the procedure was about 5 ml. After the treatment, massive bleeding occurred in 3 cases that needed blood transfusion, and residual stone was observed in 6 cases. In two-step group the operation time was 16-42 minutes with a mean of 34 minutes; the mean blood loss during the procedure was about 7 ml. After the treatment, massive bleeding occurred in 7 cases that needed blood transfusion; one of them had renal pseudoaneurysm and the bleeding was stopped after renal artery embolization treatment; and residual stone was observed in 7 cases. No procedure-related perirenal organ injury was seen in single-step group, while in two-step group pneumothorax (n=1) and injury of splenic flexure of colon (n=1)were found. Conclusion In performing percutaneous endoscopic nephrolithotomy, fine needle single-step centesis is more safe and effective than conventional two-step centesis.

Objective To investigate the features of MR DWI with different b values, changes of ADC value, correlation of ADC value with Ki-67 expression in early breast cancer. Methods 35 patients with early breast cancer underwent MR DWI scanning with different b values, including 500s/mm2、800s/mm2、1000s/mm2.The ADC values of the tumor lesions were measured after scanning with different b values. The DWI signal features of the tumor lesions were analyzed. The differences of the ADC Values were statistically compared, and the correlations of ADC values of the lesions with Ki-67 expressions were statistically analyzed. Results All of the patients were early breast invasive ductal carcinoma. All of the tumor lesions showed obviously high signal in DWI. There were statistically significant differences(P<0.05) between the mean values of the group of b-value 500s/mm2 (group of b-500) with group of b-value 800s/mm2 (group of b-800), Group of b-500 with group of b-value 1000s/mm2 (group of b-1000),respectively. However, there was no statistically significant difference(P>0.05) between the group of b-800 and group of b-1000.The mean ADC values were 1.1416×10-3mm2/s(group of b-500), 0.9258×10-3mm2/s (group of b-800), 0.8668×10-3mm2/s(group of b-1000),respectively. The correlations between the ADC values of the three different b-value groups and the Ki-67 expressions were not statistically different(P>0.05). Conclusion There are certain differences between the ADC values measured after DWI scanning with different b values in early breast cancer. It is more suitable to select b-value 800s/mm2 for DWI scanning in breast cancer. It is possible to diagnose early breast cancer when the ADC value is less than 0.9258×10-3mm2/s.The ADC value of early breast cancer was not obviously correlative with Ki-67 expression.

Objective To explore the technique and clinical effect of Fogarty catheter in treatment of acute limb arterial embol-ism.Methods Eight cases of acute limb arterial embolism treated by Fogarty catheter were analyzed retrospectively.The technique of thrombectomy,curative effect,complications,prognosis,and 6-24 months follow-up results were assessed to evaluate the safe-ty,effectiveness and operative skills.Results Seven cases were cured,and 1 case was efficacious.The endangium injury and vaso-spasm was occurred in 1 case,respectively.During follow-up from 6 to 24 months,6 cases recovered activity,1 case was hemiplegia because of cerebral infarction after 12 months,and 1 case died of respiratory function failure after 6 months.Conclusion Fogarty catheter is safe and effective in treatment of acute limb arterial embolism.

目的探讨身心化护理模式在急性下肢动脉栓塞溶栓术后护理中的重要性。方法选择我院收治的急性下肢动脉栓塞经介入治疗的患者88例，随机分为一般护理组和干预组，分析两组护理对于患者疗效与并发症的影响。结果 <br>　　身心护理是一种个性化的新型的护理模式，是一种温馨和谐的医患沟通方式，消除了心理上的不良状态，树立了治疗信心，赢得了患者的信任，减少了并发症的发生，使患者得到最佳治疗。干预组无论从患者的焦虑度，并发症以及满意度与一般组相比，均具有显著性的效果（p＜0．05）。结论身心化护理模式在急性下肢动脉栓塞溶栓治疗护理中具有显而易见的重要性，值得推广应用。 <br>　　以提高治疗效率。

目的：探讨双能量 CT 血管造影（DE - CTA）与二维数字减影血管造影（2D - DSA）、三维数字减影血管造影（3D - DSA）诊断脑动脉瘤的临床应用价值。方法收集因蛛网膜下腔出血（SAH）疑诊为脑动脉瘤的患者52例，按瘤体大小分两组：A 组，瘤体〉3 mm，B 组，瘤体≤3 mm；对比分析 DE - CTA 与2D - DSA、3D - DSA 诊断颅内动脉瘤的差异。结果（1）对脑动脉瘤检出情况，DE - CTA 与2D - DSA 对两组诊断之间比较差异无统计学意义（P 〉0.05）；（2）对检出动脉瘤瘤颈与邻近载瘤动脉空间结构的显示情况，DE - CTA 与2D - DSA 对 A 组诊断的差异有统计学意义（P 〈0.05）；对于 B 组患者，3D - CTA 与2D - DSA 之间差异无统计学意义（P 〉0.05）；对于两组患者，3D - DSA 与 DE - CTA 及2D - DSA 间比较均差异有统计学意义（P 〈0.05）。（3）在动脉瘤瘤体长径及短径测量上，DE - CTA 与2D - DSA 测量的差异无统计学意义（P 〉0.05），但2D - DSA 分别与 DE - CTA、3D -DSA 在动脉瘤瘤颈横径测量的差异有统计学意义（P 〈0.05）。结论在瘤颈与邻近载瘤动脉空间结构显示方面，3D - DSA 要明显优于 DE - CTA 及2D - DSA；DE - CTA 对于瘤体较大患者要优于2D - DSA；在瘤颈横径的测量上3D - DSA 及 DE - CTA 要优于2D - DSA。

目的：探讨内膨胀水凝胶弹簧圈在颅内动脉瘤栓塞中的使用安全性及临床疗效。方法回顾性分析30例行铂金弹簧圈联合内膨胀水凝胶弹簧圈栓塞治疗的颅内动脉瘤病人的临床资料,评价内膨胀水凝胶弹簧圈在颅内动脉瘤栓塞中的安全性、有效性。结果完全栓塞26个,次全栓塞4个。共使用铂金弹簧圈127枚,水凝胶弹簧圈63枚。术中发生动脉瘤破裂1例,急性血管栓塞1例,脑血管痉挛1例,术后脑血管痉挛2例；未发现术后再次出血。术后 GOS 评定结果示：5分26例,4分4例。随访30例,时间6~12个月,未见瘤体残留,瘤颈残留1例。结论内膨胀水凝胶弹簧圈治疗颅内动脉瘤是安全有效的。

目的：探讨应用320排动态容积CT行肾脏灌注成像时两种不同造影剂注射速度对正常肾脏血液动力学的影响。方法：采用320排动态容积CT对22例经SPECT检查双肾功能正常的患者行肾脏CT灌注成像，比较不同造影剂注射速度的两组间灌注参数值的差异。结果：5 mL/s组肾皮质BF、BV和Clreance分别为（262．2±4．9）mL/（min·100 mL）、（52．8±2．8）mL/100 mL和（10．6±0．3）mL/（min·100 mL），肾髓质BF、BV和Clreance分别为（118．0±4．2）mL/（min·100 mL）、（13．7±0．7）mL/100 mL和（11．4±0．4）mL/（min·100 mL）；7 mL/s组肾皮质BF、BV和Clreance分别为（295．4±7．2）mL/（min·100 mL）、（46．7±3．2）mL/100 mL和（13．2±0．4）mL/（min·100 mL），肾髓质BF、BV和Clreance分别为（131．0±3．9）mL/（min·100 mL）、（17．8±2．1）mL/100 mL和（15．6±1．5）/（min·100 mL）。7 mL/s组肾皮质的Clearance高于5 mL/s组，差异有统计学意义（P＜0．05），而肾皮质的BF、BV值及肾髓质各灌注参数两组间比较差异均无统计学意义（P＞0．05）。结论：320排动态容积CT灌注成像能对正常的肾脏皮髓质灌注进行定量分析。在临床应用中，造影剂注射速度采用5 mL/s比7 mL/s更安全有效。

目的 探讨支架辅助弹簧圈栓塞在治疗急诊治疗颅内破裂宽颈微小动脉瘤(最大径≤3 mm)中的操作技巧及临床疗效.方法 回顾急诊支架辅助弹簧圈栓塞治疗的7例颅内破裂宽颈微小动脉瘤患者资料,分析治疗方法、疗效、并发症、预后及6～12个月随访结果,评价支架技术的安全性、有效性及操作技巧.结果 术后即刻造影显示,完全栓塞5例,次全栓塞1例,单纯植入支架1例;未发生破裂出血及血栓栓塞事件.术后3个月改良式格拉斯哥预后评分(GOS)结果显示,6例恢复正常,1例恢复良好.6～12个月随访未发现动脉瘤再破裂出血.结论 支架辅助弹簧圈急诊栓塞治疗颅内破裂宽颈微小动脉瘤安全有效.

目的 比较16层螺旋CT双期脑血管成像3种不同软件减影法(Subtraction,Object editor及Neuro DSA)的图像质量与便捷性及临床应用差异.方法 60例双期脑血管成像随机分成A组(同步扫描)与B组(非同步扫描);分别用3种软件减影,计算后处理时间及图像质量评分(1～8分),比较3种软件减影组内及组间的差异.其中行DSA检查15例,对比3种减影显示病变的差异并采用统计学t检验.结果 3种软件减影时间,手工修饰时间及图像评分两组组内比较:Object editor减影时间[A组(2.52±0.37) min,B组(2.47 ±0.39) min]均最短(P＜0.05);Subtraction与Neuro DSA差异不显著.Subtraction减影手工修饰时间[A组(10.71 ±4.16) min,B组(14.34±3.75)min]均最长(P＜0.05),动、静脉期图像评分(A组5.67 ±0.92,5.60±1.16;B组3.30±1.75,4.03±1.69)均最低(P＜0.05),Object editor与Neuro DSA差异不显著.3种减影组间比较:A组Subtraction减影动、静脉图像评分高于B组,手工修饰时间短于B组(P＜0.05),其余两组组间比较均无显著差异.对比15例DSA检查,Objecteditor与Neuro DSA减影均能显示诊断所有病变,准确性为100％.Subtraction减影漏诊8处病变,准确性为53％.结论 同步扫描是Subtraction减影成功的关键,对Object editor,Neuro DSA减影无显著意义,后2种减影诊断血管病变能力相当,但Neuro DSA减影操作更自动化,推荐为16层螺旋CT脑血管减影首选.

Objective To evaluate the clinical applications of multi-slice spiral CT bone removal method for splenic artery aneurysm(SAA).Methods Sixteen cases of SAA were analyzed retrospectively.All patients underwent contrast-enhanced MSCT scan and were post-processed with Bone Removal.All patients were divided into two groups:A group was only provided routine axial scan image,B group was provided axial scan image and post-processed image.Detection rates were compared between two groups by?2 test through blind method.The correlation of transverse diameter of aneurysm and its neck was analyzed.Results Of the 16 patients with SAA,there were single lesion(10 patients) and multiple lesions(6 patients).Saccular aneurysms(n=18) and fusiform aneurysms(n=5) were detected.Calcification was showed in 6 aneurysms and thromboses was found in 1 aneurysm.Correlation was noted between the diameter of splenic aneurysm and its neck(r=0.731,p0.001).The detection rates of SAA in A and B group were(34.78%,8/23) and(91.30%,21/23) respectively.Significant differences was found in detection rates between tow groups(P0.001).Conclusion Three-dimensional MSCT Angiography could improve the detection rates of SAA significantly.It has important clinical significance in screening,therapy and follow-up for SAA.

Objective To retrospectively compare and analysis the 51 cerebral aneurysms’ clinical data with endovascular embolization treatment, to evaluate the efifcacy of cerebral aneurysms treated with hydrocoils in combination with platinum coils. Methods Retrospective analysis was performed of 51 cerebral aneurysms treated with endovascular coil occlusion in our hospital from January 2007 to December 2010. 25 aneurysms (Hydrocoil group) embolized using Hydrocoil in combination with platinum coils were compared with 26 volume-shape-matched aneurysms (platinum coils group) treated only with platinum coils.Results (1) The patients’ demographics and the aneurysms’ characteristics between the two group were comparable (P>0.05). No signiifcant difference was found between the complete obliteration of Hydrocoil group and platinum group (76%versus 53.8%,P>0.05). (2) Hydrocoil group had a similar complication rates with platinum group (15.0%versus 15.3%,P>0.05). (3) There was no statistically signiifcant comparing the recurrence rate of Hydrocoil group and platinum group (6.7%versus 21.4%), because of insufifcient sample. Conclusion Endovascular embolization of cerebral aneurysms with hydrocoil combined platinum coils is safe and feasible.Similar complication rates were found in both endovascular treatment of cerebral aneurysms.