本文报告1例急性Stanford B型夹层合并脑栓塞高危患者在改良的经皮经颈脑栓塞保护装置下行原位开窗主动脉弓上双分支重建的病例，效果满意。

目的 探讨CT影像导引下预穿刺塑形在经颈静脉肝内门体分流术(TIPS)中的应用价值.方法 回顾性分析2019年1月至2021年6月在莆田市第一医院接受TIPS术治疗的56例肝硬化伴上消化道出血患者临床资料.借助术前CT影像显示的肝静脉和门静脉,设计肝静脉穿刺点(A点)、穿刺角度和方向、预期穿刺的门静脉靶点(B点),精确测量A、B点三维距离,并对穿刺针进行塑形.记录术中门静脉穿刺次数,观察术中和术后相关并发症.结果 56例患者穿刺次数为(1.68±1.32)次.穿刺1次成功40例(71.4％),2次成功8例(14.3％),4次成功2例(3.6％),4次仍未成功6例(10.7％),其中4例联合门静脉间接造影后穿刺成功,2例门静脉海绵样变患者结合经皮经肝门静脉穿刺并置入定位导管后穿刺成功.56例手术均取得成功,其中49例(87.5％)联合胃冠状静脉栓塞术.经肝右静脉穿刺50例(89.3％),经肝中静脉穿刺6例(10.7％);穿刺门静脉右支47例(83.9％),穿刺门静脉左支9例(16.1％).门静脉压由术前(39.46±7.09)cmH2O(1 cmH2O=0.098 kPa)改善至术后(24.95±3.41)cmH2O(t=17.726,P<0.01);门体静脉压差由术前(28.25±5.50)cmH2O改善至术后(16.13±4.32)cmH2O(t=20.017,P<0.01).未发生腹腔出血等严重并发症.结论 借助CT影像对TIPS穿刺针进行预穿刺塑形,穿刺成功率较高,值得临床推广应用.

目的 探讨覆膜支架腔内隔绝术治疗Stanford B型主动脉夹层(AD)的临床疗效及术后血管重塑情况.方法 回顾性搜集36例Stanford B型AD患者资料,所有患者均接受覆膜支架腔内隔绝术治疗,观察患者的手术情况及随访结果,比较术前和术后1个月主动脉各部位真假腔短径以评估血管重塑情况.结果 所有手术均取得成功,共植入38枚支架.1例患者术后出现截瘫,6例患者术后出现内漏.随访时间3 ～36个月,1例患者于术后4个月突发主动脉破裂死亡,6例术后残余内漏患者术后6个月复查时均自行封闭.术后1个月时,主动脉峡部段、降主动脉中段、降主动脉远段、腹腔干段真腔短径较术前增大,而假腔短径较术前缩小,差异均具有统计学意义(P＜0.05).结论 覆膜支架腔内隔绝术治疗Stanford B型AD安全、有效,值得临床推广应用.

我科收治1例因上腔静脉畸形,行经股静脉路径联合经皮门静脉逆行穿刺下腔静脉门腔分流术患者报道如下. 临床资料 患者,男,40岁.以“反复排黑便2d,伴呕血1次”为主诉入院.既往“慢性乙型病毒性肝炎”病史20余年,未规律服药治疗,4年前因“突发呕血、排黑便”就诊我院,根据CT及胃镜检查诊断“①食管胃底静脉曲张破裂出血;②乙肝肝硬化失代偿期;③脾功能亢进(脾亢)”,予行“脾切除+贲门周围血管离断术”.体格检查:BP 100/46 mmHg,神志清楚,贫血面容,睑结膜苍白,双下肺闻及湿啰音,余查体未见明显阳性异常体征.入院后急症行胸部+上腹部CT平扫示:①双肺局限性肺气肿;②双肺炎症;③双侧胸腔积液;④上腔静脉走行异常,考虑先天变异;⑤考虑肝硬化,请结合临床;⑥脾脏切除术后改变;⑦考虑胰腺炎;⑧腹腔及腹膜后多发小淋巴结.

Objective To find the clinical plan to improve the prognosis of patients on the basis of depth analysis of value of combined treatment of multiple interventional techniques for paitents with acute lower extremity arterial occlusive dis-ease. Methods 90 cases of patients with acute lower extremity arterial occlusive disease treated in our hospital from September 2013 to September 2015 were randomly selected and divided into experimental group and control group with 45 cases in each, the experimental group chose combined treatment of multiple interventional techniques, the control group chose routine treatment, the prognosis of all patients was analyzed in all directions and its efficiency was compared. Results Of all the patients in this study, the effective rate of the experimental group was 77.78%, and 95.56% of the control group, the comparison was different (P<0.05). Conclusion The choice of plan of combined treatment of multiple interventional tech-niques for patients with acute lower extremity arterial occlusive disease has a prominent effect and it is worth promoting.