病例资料患者,男,57岁,因右上腹隐痛半年,呕吐伴双下肢浮肿2周.体检:反应迟钝,全身皮肤轻度黄染,双下肢凹陷性水肿.无饮酒及肝炎史.胸片:心脏明显扩大(图1).彩色多普勒检查:肝动脉蛇行纡曲扩张,肝实质内见团片状血管瘤样偏强回声结节.

病例资料 患者,男,47岁,因肝硬化肝癌行肝移植术.术前血清丙氨酸转移酶(alanine transferase,ALT)80U/l,总胆红素(total bilirubin,T-Bil)8μmol/l.

目的:研究肝动脉化疗栓塞治疗肝癌时所使用吡柔比星-碘油乳剂的最佳配比方案方法:多种水溶剂和造影剂溶解吡柔比星后以不同油水比例与碘化油制成7种乳剂.肉眼和显微镜观察各样本物理稳定性.用控制应力流变仪检测样本粘滞度.结果:吡柔比星经生理盐水和非离子型造影剂溶解后与碘化油制成的乳剂(NNTLE)性质稳定,粘滞度较其它乳剂低.油水比2:1的NNTLE稳定性最好,粘滞度适中.结论:油水比2:1的NNTLE是较为理想的吡柔比星-碘油栓塞剂配制方法,利于肝癌的肝动脉化疗栓塞治疗.

目的研究脾下极动脉栓塞(SLPAE)技术的改进及其治疗效果.方法使用不同插管技术和栓塞物对3只犬行部分性脾动脉栓塞,观察术后反应、外周血象和组织病理改变.结果 3种方法栓塞后均有血小板计数显著增高及大网膜对脾下极包裹粘连.脾下极动脉栓塞后仅有较轻不良反应.鱼肝油酸钠脾下极栓塞产生完全凝固性坏死,栓塞区无残存脾组织.结论脾下极动脉栓塞不良反应少,抑制脾功能的效果与传统方法相似.应用微导管和液态硬化剂栓塞更为安全可靠.

Objective To evaluate the method and result of thyroid artery embolization as a new therapy for hyperthyroidism. Methods Twenty two patients with hyperthyroidism underwent selective thyroid artery embolization. Totally 52 thyroid arteries were embolized with microspheres. The indications to this therapy were following: hyperthyroid patients having indications to surgical and 131 I therapy, clinically being difficult to complete the preparation for subtotal thyroidectomy and having high risk for surgical process because of their huge thyroid gland. Results Serum level of thyroid hormones dropped significantly [median T3 from 8 8 nmol/L(4 3～ 43 0 nmol/L) to 4 0 nmol/L(1 1～9 2 nmol/L), median T4 from 206 4 nmol/L(77 4～748 2 nmol/L) to 144 5 nmol/L(25 8～279 9 nmol/L), P 0 01] and symptoms of hyperthyroidism were controlled in 21 patients within 1 month after embolization. The symptoms of twelve patients followed up for more than 6 months were effectively controlled through low dose antithyroid medication. Two patients who were positive in antithyroid antibody recurred 1 month later and underwent second embolization. No hypothyroidism and hypoparathyroidism were observed after the interventional procedure. Severe allergenic reaction of ionic contrast occurred in 1 patient. Conclusion Thyroid artery embolization is an effective alternative for surgical and 131 I treatment of hyperthyroidism. A long term follow up study is still needed.

目的探讨血管造影和动脉栓塞对肢体动静脉畸形的诊断、治疗价值。方法１１例肢体动静脉畸形行选择性动脉造影检查，对５例具有明显动静脉瘘的病人进行了１０次动脉栓塞治疗。栓塞时联合使用了包括鱼肝油酸钠在内的不同种类液态和固体栓塞材料。结果动脉造影明确了病变中静脉畸形和动静脉瘘何者为主，为分类和选择治疗方法提供了依据。２例栓塞后外科手术治疗，术中出血减少。３例单纯栓塞治疗的病变得到有效控制。结论动脉造影和栓塞是肢体动静脉畸形诊断治疗中的重要环节，鱼肝油酸钠可有效地用于动脉栓塞治疗肢体动静脉畸形