目的:探究球囊辅助栓塞技术治疗未破裂颅内动脉瘤的有效性和安全性.方法:选择2014年1月～2019年1月在本院介入诊疗科接受介入治疗的540例患者作为研究对象.根据治疗方案分为两组,球囊辅助栓塞组有340例,单纯栓塞组有200例.回顾性分析研究对象的一般资料、临床资料、手术并发症等情况.结果:球囊辅助栓塞组和单纯栓塞组在性别组成、年龄、颅内动脉瘤性质、位置、Hunt-Hess分级等方面,差异不具有统计学意义(P＞0.05);在术后即刻及术后6个月血管造影结果显示,前者栓塞程度明显优于后者,两组差异具有统计学意义(P＜0.05);前者改良Rankin量表评分明显优于后者,两组差异具有统计学意义(P=0.005);前者预后良好率明显高于后者,两组差异具有统计学意义(P＜0.001);手术过程中,球囊辅助栓塞组发生2例破裂出血、2例脑血管痉挛、1例弹簧圈移位,单纯栓塞组发生2例破裂出血、1例栓塞、2例脑血管痉挛、3例弹簧圈移位.前者并发症发生率明显低于后者,两者差异具有统计学意义(P＜0.001).结论:在治疗未破裂颅内动脉瘤方面,球囊辅助栓塞技术的有效性、安全性明显优于单纯栓塞介入治疗,值得临床推广.

目的 研究经颈静脉肝内门体分流术(TIPS)治疗肝硬化门脉高压(PHT)前后调节性T细胞(Treg)/辅助性T细胞17(Th17)比例的变化及TIPS缓解门脉高压性的作用机制.方法 本研究选取行TIPS治疗PHT的9例患者作为治疗组,内科保守治疗的PHT 8例患者作为对照组,分析2组Treg/Th17比例及缺氧诱导因子1α(HIF-1α)的水平变化.结果 2组患者Treg/Th17相关因子比较均无统计学差异(P>0.05),治疗组中叉头蛋白P3(FOXP3)、IL-17A术后3月与术前比较有统计学差异(P<0.05).HIF-1α2组术前比较无统计学差异(P>0.05),术后3月比较有统计学差异(P<0.05),治疗组术后3月与术前比较有统计学差异(P<0.05).结论 TIPS治疗PHT通过降低门脉压力来缓解脾脏及胃肠道微环境的缺氧情况导致Treg/Th17分化改变来起到调控门脉高压相关性炎症反应的作用.

Objective ToexploretheeffectofTIPS+GCVEcombinedwithPSEonhemodynamicsinpatientswithlivercirrhosis,portal hypertensionandsplenomegaly.Methods 56patientswereincludedfromJanuary2015toDecember2016 whounderwentTIPS+GCVEcombinedwithPSE.Patientswerefollowed-upon1month,3months,6monthsand1yearaftersurgery,andstatisticanalysis weredoneonportalveinhemodynamicindex:portalveintrunkdiameter(PVD),portalveinvelocity(PVV),portalvenousbloodflow (PVF),splenicveintrunkdiameter(SVD)andvelocityofbloodflowinsplenicvein(SVV).Results Thereweresignificantdifferencesinportal veinpressurebeforeandafterthebypassinall56patients.PVDandPVV weresignificantlydifferentbetween3and6 monthsafter surgeryandpre-surgery.PVF wassignificantlydifferentcomparing6 monthsand1yearaftersurgery withpre-surgery.SVDand SVV weresignificantlydifferentbetween3 months,6 monthsand1yearaftersurgeryandpre-surgery.Conclusion TIPS+GCVE combinedwithPSEcouldeffectivelyreduceportalveinpressure,improveportalveinandspleenveinbloodflow,increaseportalvenousblood flow,andimprovepatients’liverfunction.

Objective Toinvestigatethemethod,safetyandefficacyoftranscatheterarterialchemoembolization(TACE)combined withargonheliumknifecryoablationintreatmentofadvancedprimaryhepaticcancer.Methods FiftyGfourpatientswithadvanced primaryhepaticcancerunderwentTACEfirstly,andfollowedbytheargonhelium knifecryoablationunderCT/ultrasoundguiding percutaneouspunctureafter1－2weeks.2－3cyclesofcryotherapywereperformedduringtheoperation.Afteroperation,enhanced CT/MRIwasperformedtofollowGup.Results Themediansurvivaltimewas17.6months.The6Gmonthsurvivalratewas100%,the 12Gmonthsurvivalratewas89.34%,thetumorprogressiontimewas9.3 months,andtheshortestsurvivalperiodwas8 months.Recent curativeeffectevaluationshowedCRin9patients,PRin34patients,SDin6patients,PDin5patients(RR＝79.62%,DCR＝90.74%). Conclusion TACEcombinedwithargonheliumknifecryoablationisasafeandeffectivetreatment,whichprovidesanewtreatment planforpatientswithprimaryhepaticcancer.

肝动脉灌注化疗栓塞术(TACE)是无外科切除指征或拒绝行外科切除的原发性肝癌、转移性肝癌患者的首选非根治性治疗方法.在技术方面比较成熟,创伤小、恢复快,对于控制肝癌病灶、缓解患者不适、延长患者生存期疗效显著.但是肝动脉灌注化疗栓塞术亦有其局限性.肝动脉灌注化疗栓塞术为非根治性肝癌治疗方法,为保证疗效,控制病灶,需反复、多次进行.因此,对于肝动脉灌注化疗栓塞术后病灶情况进行准确、有效的评价可及早发现新发病灶或病灶供血血管,达到早诊断,早治疗的目的.现就几种主流影像学方法对肝动脉灌注化疗栓塞术后疗效评价的应用价值进行简要分析.

目的 检测急性缺血性脑卒中患者血清中基质金属蛋白酶(MMP)-2、MMP-9和脂肪细胞因子chemerin的表达,探讨其临床意义.方法 确诊为急性缺血性脑卒中患者血清标本65例为观察组,18例无明显神经系统疾病的成人血清标本为对照组,检测两组血清中MMP-2、MMP-9和chemerin的表达.结果 两组血清中MMP-2、MMP-9和chemerin的表达差异有统计学意义.观察组中MMP-2、MMP-9和chemerin的表达与梗死灶体积密切相关;MMP-2、MMP-9的表达与是否伴有高血压密切相关,chemerin表达与是否伴有糖尿病密切相关.观察组MMP-2和MMP-9之间呈正相关,其他指标间无明显相关性.结论 急性缺血性脑卒中患者血清中MMP-2、MMP-9和chemerin高表达对促进病变的形成有一定价值,MMP-2和MMP-9可能具有协同作用.

黄疸是一种临床常见的疾病症状,病因主要包括肝细胞性、胆汁淤积性、溶血性以及原发非溶血性4种[1].其中胆汁淤积性黄疸即梗阻性黄疽,如在治疗中解除不及时,可能导致患者发生化脓性胆管炎以及肝脏功能衰竭等不良后果,严重威胁患者生命健康[2-3].其中恶性病变包括胆管与胆囊癌、原发性肝癌、壶腹癌、胰头癌、肝门区与胰腺区的转移癌等,造成阻塞性远端胆管扩张.目前临床上行经皮肝穿胆道引流术是缓解梗阻性黄疸最有效的方法之一.[4]外科手术治疗恶性梗阻性黄疸的预后差、成功率低、及病死率高,不但破坏胆道的完整性,还不同程度的改变胆汁的引流方式,使胆道感染风险显著升高,而行经皮肝穿胆道引流术安全性高、创伤小及操作简单,所以现在已经取代了部分外科手术.PTCD术后胆道感染是最主要的并发症,近年来的临床研究也发现PTCD后胆道感染的发生率在14％ ～ 47％之间,并且胆道感染会导致病情进一步恶化,甚至会引起死亡[5-6].

目的:评价覆膜镍钛记忆合金支架在治疗食管瘘中的价值.方法:在X线监视下对20例食管狭窄患者置入覆膜金属食道支架.结果:支架置入成功率100％,术后瘘口得到有效封堵,20例患者治愈出院,治愈率100％.结论:覆膜镍钛记忆合金支架置入治疗食管瘘成功率高、效果好、操作简单、安全、并发症少,宜在临床上推广.

目的:对比分析开颅夹闭手术与介入栓塞治疗颅内动脉瘤的临床疗效、风险及预后.方法:入选病例均经全脑数字减影血管造影(digital subtraction angiography,DSA)明确诊断为颅内动脉瘤.分别行手术或介入治疗,对38例患者病死率、并发症、日常生活能力(activities of daily living,ADL)、平均住院天数、住院费用进行比较.结果:介入治疗组病死率、并发症、平均住院天数等与手术夹闭组比较有显著差异,且疗效好,并发症少,日常生活能力明显提高,病死率显著降低.结论:介入栓塞治疗动脉瘤有手术风险小、适应证范围广、并发症少、住院时间短等优点.

目的:探讨PTCD对梗阻性黄疸的治疗效果及其临床价值。方法:对42例梗阻性黄疸患者行超声引导下PTCD治疗。并对治疗结果进行统计、分析。结果:所有42例病患均一针穿刺成功,穿刺成功率为100%;术后患者的丙氨酸转氨酶、血清总胆红素、r-谷氨酰转移酶、碱性磷酸酶、直接胆红素均呈现显著下降,与手术前比较差异具有统计学意义(P<0.05)。结论:在超声引导下对梗阻性黄疸病患行PTCD治疗,具有操作简单、定位准确、创作小、恢复快、并发症少等优势;同时,还可以在较短时间内有效降低患者体内胆红素水平,效果尤为显著;对保护病患的肝功能以及后续性的治疗具有极高的临床意义。

Objective To determine the clinical value of Interventional treatment for hepatic alveolar echi- nococcosis with obstructive jaundice. Methods The 17 patients with hepatic alveolar echinococcosis and ob- structive jaundice received PTCD, the serum levels of total bilirubin, Alanine transaminase and alkaline phosphatase were determined before the treatments and on postoperative 1 week and 1 month. Results The serum levels of total bilirubin, Alanine transaminase and alkaline phosphataseobviously decreased in all the patients at 1 mouth after PTCD,such as in the serum levels of total bilirubin on postoperative 1 week in all the patients. The serum levels of Alanine transaminaseand alkaline phosphatase indistinctively decreased in all the patients at 1 week after PTCD. Conclusions Interventional treatment can improve liver function and reduce icteric index in patients with hepatic alveolar echinococcosis and obstructive jaundice, strive opportu- nity for drugs and surgical treatment.

目的通过监测介入术后降钙素原(PCT)水平,评估PCT对介入术后患者院内感染的预测作用。方法纳入年龄大于21岁介入手术后患者21例。监测PCT水平及院内感染情况。结果 PCT≥0.05ng/ml预测介入术后患者院内感染的敏感度为98%,特异度75%。结论对介入术后患者进行PCT监测,有助于早期发现院内感染高危患者,可指导临床抗生素治疗。

碘-125(125I)消化道放疗支架的应用,既能解决患者的进食,又能治疗局部肿瘤,延长生存期.我们于2004年11月至2005年5月,采用该方法治疗10例晚期食管癌患者,疗效较好,报告如下.

Objective To explore the efficacy of esophageal stent on benign and malignant esophageal stricture and its possible complications and the corresponding treatments.Methods Esophageal stents were put into 98 esophageal stenosis patients selected from Jiangsu Cancer Hospital from Jan.2005 to Dec.2011 according to their pathological changes,and the dysphagia symptoms improvement after implant and complications and treatment were observed.Results In 98 patients,95 cases were one time successful with accurate location.2 cases were lower positioned,which was adjusted to the correct position.1 case was removed and re-implanted.11 cases could not have routine placement of the guiding wire,but all were implanted successfully after positive treatment.10 cases of restenosis after implantation occurred.3 patients had esophageal fistula,stents in 5 cases moved down.Dysphagia were improved significantly one week after surgery(P < 0.05).Conclusion Endoscopic esophageal stent implantation is simple,with good short-term effect and fewer complications,but attention should be paid to the prevention and treatment of serious complications.

Objective To investigate the best therapeutic way for hepatic hemangioma(HHE) and the different ways of embolic methods were compared. Methods 49 cases of HHE were randomly divided into two groups,18 cases in group A were embolized by pingyangmycin and lipiodol. 31 cases in group B were embolized by pingyangmycin,lipiodol and gelfoam. The efficiency of two groups were compared. Results All the cases were performed CT after six months later of the embolization,In group A,7 cases were stabilized and 8 cases was recreased,but 3 cases were inefficient;In group B,stabilized was 9 cases and recreased was 24,the inefficient case was zero.Statistical analysis of the two groups were different in obviously(P 0.05). Conclusion The pingyangmycin is efficiency for the treatment of the HHE,and the combination methods of embolization is the better.

介入性动脉灌注化疗及栓塞是治疗肝癌的常用方法,而转移性肝癌由于其原发灶的病变范围、病理分级及临床分期的不同,其治疗方法也不同,有的选择了单纯性动脉灌注化疗,有的选择了动脉灌注化疗加栓塞的治疗方法.Groen等[1]报道仅有约20%的转移性肝癌患者可选择手术切除,而大部分患者则需要综合性治疗,其中包括介入性治疗.因此,探索并研究单纯性动脉灌注化疗(TAI)及动脉灌注化疗加栓塞(TAE)对转移性肝癌的治疗效果、并发症及生存期具有重要的临床意义.

目的:探索肝血管瘤的最佳栓塞治疗方案,分析比较不同栓塞方法的疗效;方法:45例肝血管瘤患者被分为两组,A组16例,用平阳霉素碘化油乳剂进行栓塞,B组29例,用平阳霉素碘化油乳剂加明胶海绵微粒进行栓塞,比较两组治疗效果;结果:所有病人经栓塞治疗后6个月开始行CT扫描检查,A组中瘤体缩小5例,保持稳定11例,B组中瘤体缩小20例,保持稳定9例,两组统计学检验差别有显著性(P＜0.05);结论:平阳霉素乳剂治疗肝血管瘤有效,而平阳霉素乳剂加明胶海绵微粒的混合性栓塞效果更好.

原发性肝癌在我国是发病率居第3位的恶性肿瘤,年患者达11万之多,预后甚差[1].是最难治疗的恶性肿瘤之一,未经治疗者其生存期仅为2月～6月,早期可手术治疗,但大多数患者就诊时已失去手术机会,介入放射治疗已经被国内外公认为一种最有效的非手术疗法[2],使肝癌患者的生存期明显延长.现将我院1996年-1999年有完整资料的40例经介入治疗患者观察结果总结如下.