Background: To identify risk factors for loss to follow-up after inferior vena cava (IVC) filter placement in inpatients of other departments (IODs) and to determine whether a quality improvement project launched at our institution in April 2022 improved follow-up and filter retrieval rates in these patients. Methods: Consecutive patients who underwent retrievable filter placement at our institution between March 2021 and March 2023 were included in this study. Patients were divided into preimprovement (before April 2022; n = 81) and postimprovement (after April 2022; n = 77) groups. Risk factors for loss to follow-up were assessed in the preimprovement group, and filter retrieval rates were compared between groups. Results: Acute cerebral hemorrhage (OR = 5.745; 95% CI: 1.471-22.434) and lack of requirement for follow-up by the referring department (OR = 3.435; 95% CI: 1.035-11.398) were identified as independent risk factors for loss to follow-up. The filter retrieval rate was higher in the postimprovement group (94.8%) than in the preimprovement group (69.1%; P < 0.001). The rate of loss to follow-up was lower in the postimprovement group (5.2%) than in the preimprovement group (30.9%; P < 0.001). The preimprovement group had a higher incidence of IVC perforation (9.6%) than the postimprovement group (0; P = 0.019) at the time of filter retrieval. Conclusion: Acute cerebral hemorrhage and lack of requirement for follow-up by the referring department are independent risk factors for loss to follow-up among IODs. The quality improvement project at our institution improved follow-up and IVC filter retrieval rates in IODs.

目的:分析单中心下腔静脉滤器(inferior vena cava filter,IVCF)的使用数据,了解IVCF的使用情况及存在问题.方法:回顾性分析2016年1月—2021年9月南京医科大学附属常州第二人民医院IVCF的使用情况,建立数据库并对数据进行分析.结果:共置入752枚IVCF,均为可回收型,置入适应证包括仅下肢深静脉血栓形成(游离血栓/大量急性血栓)528例(70.2%)、下肢深静脉血栓形成合并肺栓塞(pulmonary embolism,PE)126例(16.8%)、仅症状性PE 98例(13.0%).752枚IVCF中,取出470枚,取出率为62.5%,体内留置时长为15(13,17)d(0～530 d).患者年龄不同、置入年份不同、IVCF品牌不同,取出率差异均具有统计学意义(P＜0.05).未取出的282枚IVCF中,未取出的原因前3位分别是晚期肿瘤(31.2%)、仍存在放置IVCF的适应证(28.7%)和高龄(27.7%).结论:不同年龄段的患者IVCF置入适应证存在差异;IVCF的取出率随置入年份逐年增高;IVCF的低取出率与晚期肿瘤、高龄、IVCF品牌、置入适应证、置入年份相关,应根据不同适应证合理选择IVCF,审慎地评估长期留置IVCF的获益与风险.

患者女，38岁，因“体检发现子宫、附件包块10 d”入院。患者既往体健，有轻度痛经，无阴道不规则出血，12年前行剖宫产。体格检查：左侧附件区可扪及不易推动的包块。腹部超声：左侧附件区囊性团块，约5.0 cm×4.4 cm，边界清，左侧宫旁血管扩张；CTA：左侧附件区异常增粗血管影，考虑为子宫动静脉 畸形（uterine arteriovenous malformation，UAVM），见图1。经多学科讨论后行子宫动脉栓塞（uterine artery embolization，UAE）治疗。术中造影证实为巨大UAVM，使用Glubran胶与碘油混合液以及弹簧圈对靶动脉进行超选择性栓塞（图2, 3）。术后2个月（图4）和2年盆腔CTA：左髂内动脉远段闭塞，UAVM消失。

急性闭塞性肠系膜缺血(Acute Occlusive Mesenteric Ischemia,AOMI)是指血管急性闭塞导致的肠道血液供应突然中断引起的肠缺血性病变,容易引起肠缺血、肠坏死.及时有效的开通闭塞的血管是改善AOMI患者预后的关键.近年来,随着介入器材和技术的快速发展,血管腔内技术已广泛地应用于AOMI的救治,并且取得了显著的疗效.本文汇总分析最新的文献报道,详细的阐述了血管腔内技术在AOMI患者救治中的作用,从而指导临床医生更好的救治AOMI.

下肢动脉栓塞是临床上常见的急症,腔内介入技术可以迅速取出栓子,开通栓塞的动脉,挽救急性缺血的下肢组织.然而大量的血液快速地进入下肢严重缺血的组织后会导致再灌注损伤,进而加重缺血组织的损伤程度.本文报道1例介入技术开通栓塞的股浅动脉后因再灌注损伤导致的下肢局部组织坏死的患者.

肠系膜上动脉栓塞(superior mesentery artery embolism,SMAE)是引起急性肠缺血的常见病因.外源性的栓子多来源于心脏,常见于心房颤动、风湿性心脏病等.SMAE具有发病急、病死率高的特点.本文总结1例反复发生SMAE患者的救治体会,以进一步提高对此类患者的管理与救治效率.

1 病例资料 患者,女,82岁.因"突发右下腹肿块两小时"入院.患者既往有长期口服阿司匹林(国药准字J 20080078 , 100 mg/片,每日一片)药物史;2个月前由于右侧股骨头骨折在外院行空心钉置入治疗,术后恢复良好;患者1天前在外院穿刺右侧股动脉行血气分析,穿刺结束后出现右侧腹股沟部位皮下淤血,但患者否认穿刺部位出现肿块.

临床资料 患者52 岁，男.因"左侧腰痛半月"入院，患者半月前因左侧输尿管结石在外院行3 次体外冲击波碎石（具体治疗方案、治疗适应证等信息不详）.此次入院后行腹部CT 检查，发现左侧输尿管部位结石，左侧腰大肌前方低密度灶（图1），考虑输尿管损伤，伴局部尿液渗漏，输尿管可能并未完全离断.

化脓性胆囊炎是临床上常见的危重病，可以引起多种并发症，但由其引起的胆囊十二指肠瘘较少见。本文报道了1例成功经胆囊穿刺外引流治疗的因化脓性胆囊炎引起的胆囊十二指肠瘘患者的临床资料，并结合文献复习总结了该病的特点。

一、病例资料 患者,男性,62岁,因"确诊转移性肝癌2周"入院.患者半年前因胰腺神经内分泌肿瘤在外院进行治疗,2周前肝脏磁共振成像(magnetic resonance imaging,MRI)检查提示:肝内6枚转移灶,肝右叶5枚,肝左叶1枚(图1A),直径0.5～5 cm不等;美国东部肿瘤协作组评分(Eastern Cooperative Oncology Group,ECOG)为0分;肝功能Child-Pugh分级为A级.

Gallbladder-duodenal fistula is a rare disease in clinical practice, and difficult to diagnosis. One patient with high suspicion of gallbladder-duodenal fistula in preoperative examination was performed with percutaneous transhepatic gallbladder drainage due to could not tolerate surgical operation, and gallbladder-duodenal fistula was diagnosed with the gastric and intestinal fluids extracted from the drainage tube. In the later of fistula repair and the patient′s nutritional support management, the jejunal nutrition tube is inserted through the bile duct, and then the nutrition support was performed through this jejunal nutrition tube. This patients was recovered well.

Purpose: To investigate the safety and effectiveness of primary conservative therapy for patients with symptomatic isolated mesenteric artery dissection (IMAD) with a severely compressed true lumen and/or a large dissecting aneurysm. Materials and Methods: A total of 35 consecutive patients (all men; median age. 53 y) with symptomatic IMAD with a severely compressed true lumen andior a large dissecting aneurysm hut without intestinal necrosis or arterial rupture who were treated with primary conservative therapy between November 2018 and February 2020 were assessed. A severely compressed true lumen was defined as luminal stenosis > 70%. A large dissecting aneurysm was defined as dissecting aneurysm diameter >= 1.5 nines larger than the normal mesenteric artery diameter. Results: There was a strong positive relationship among abdominal pain, degree of luminal stenosis, and length of dissection (R = 0.811; P < .001). Conservative treatment was successful in all patients. Abdominal pain was eliminated within 4.7 d +/- 4.8 (range, 2-31 d) in all patients, within 3.6 d +/- 1.2 (range, 2-6) in the 31 patients with minor or moderate abdominal pain, and within 13.3 d +/- 11.9 (range, 6-31 d) in the 4 patients with severe abdominal pain. Complete or partial remodeling of the mesenteric artery was achieved in 6 (17.1%) and 29 (82.9%) patients, respectively. during 8.6 mo +/- 4.3 of follow-up. Conclusions: Primary conservative therapy can he used safely and effectively in patients with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture

目的:探讨在失能患者介入术后实施“医养融合”管理模式.方法:分析在我院接受介入手术治疗的39例失能患者的临床资料,这些患者在术后接受“医养融合”模式进行管理,观察住院时间、并发症发生率、满意度.结果:39例失能患者均在我院本部成功进行介入治疗,在我院本部平均住院时间为5.1天,无介入手术相关的并发症,转入实施“医养整合”管理模式的金东方院区进行延续疗护.39例患者的总满意度均为100％,其中满意36例(92.3％),一般3例(7.7％).结论:“医养融合”管理模式在失能患者介入术后的管理中发挥积极作用,可以缓解3级综合医院的医疗压力,避免并发症的发生,提高患者的满意度,可以作为失能患者介入术后的一种新型管理模式.

目的 探讨置管溶栓(catheter-directed thrombolysis,CDT)治疗下腔静脉血栓的安全性和疗效.方法 回顾性分析21例经CDT治疗的下腔静脉血栓患者的临床及影像资料.结果 21例患者均经静脉造影诊断为下腔静脉血栓,同时伴有下肢深静脉血栓.其中下肢深静脉血栓向上延续导致的下腔静脉血栓18例,下腔静脉滤器导致的下腔静脉血栓3例.21例患者均在下腔静脉滤器的保护下成功进行CDT治疗,其中7例患者伴有髂静脉压迫综合征,给予髂静脉支架治疗.随访3～48个月,1例肿瘤患者CDT术后2周再次出现下肢深静脉血栓,给予加强抗凝治疗后好转,其他患者无血栓复发,所有患者无严重并发症的发生.结论 下肢深静脉血栓和下腔静脉滤器均会导致下腔静脉血栓.在下腔静脉滤器的保护下,CDT治疗下腔静脉血栓是安全有效的方法 .

可回收型滤器已经广泛的用于临床,大部分可回收型滤器可以通过常规方法(圈套器法)取出,但少数需要特殊方法才能取出.对于常规方法取出失败的,应根据取出失败的原因选择合适的特殊取出方法,术者应了解各种取出方法的特点、适应证及优劣势.

临床资料 患者男,64 岁.因"体检发现肾动脉夹层动脉瘤15 d"就诊.患者既往有左侧腘窝搏动性肿块病史.查体见双侧肾区听诊无杂音,双侧下肢皮肤颜色与皮温正常,左侧腘窝可触及搏动性肿块,双侧腘窝部位听诊无杂音.患者否认外伤史.实验室检查无异常, 心电图检查正常, 血压135/85 mmHg(1 mmHg=0.133 kPa).

患者男,50岁,因“膀胱癌术后20年,广泛转移2个月”就诊.患者20年前因膀胱癌于外院接受膀胱部分切除术,4年前因膀胱癌复发于我院接受全膀胱切除十双侧输尿管皮肤造口,2个月前出现尿道口滴血.实验室检查血红蛋白为73 g/L,CT提示阴茎及左侧腹直肌占位(图1A、1B).腹直肌病灶穿刺活检诊断为高级别乳头状尿路上皮癌.行DSA引导下介入栓塞治疗(图1C～1H),以微导管超选至肿瘤供血分支,采用40 mg直径150～350μm明胶海绵颗粒与生理盐水混合物进行栓塞.由于转移灶位于脐平面以下水平,且左侧腹壁下动脉造影见肿瘤染色完整,故仅对双侧腹壁下动脉造影,而未行双侧腹壁上动脉造影.术后即刻患者尿道滴血症状消失,无不良反应;术后3个月再次出现尿道少量渗血,患者拒绝进一步介入治疗.

目的 探讨“并行导丝法”更换“同轴导丝法”失败的肾造瘘管的应用价值.方法 观察“同轴导丝法”更换肾造瘘管失败的成功率.失败的21例患者(33例次)采用并行导丝法.结果 2014年6月—2017年2月,共87例患者进行了262次肾造瘘管更换治疗,其中21例患者33例次因“同轴导丝法”更换造瘘管失败纳入本研究,33例次均使用“并行导丝法”成功更换造瘘管,取得完全成功.结论 经“并行导丝法”可以顺利的完成肾造瘘管的更换,可以用于“同轴导丝法”换管失败的患者.

Objective To investigate the efficacy of gelatin sponge particles(GSP)or polyvinyl alcohol particles (PVA) for hemoptysis secondary to bronchiectasis or pulmonary tuberculosis. Methods The clinical data on 271 patients with bronchiectasis- or tuberculosis-induced hemoptysis were retrospectively analyzed. The efficacy and rates of recurrence and complications were analyzed. Results A total 271 patients were included in this study, 176 of whom suffered from bronchiectasis and the rest 95 had tuberculosis. One-week cure rate was signifi-cantly higher in bronchiectasis group than in tuberculosis group(73.3%vs. 46.3%,P<0.05),and one-year recur-rence rate was significantly lower in bronchiectasis group(17.6%vs. 26.3%,P<0.05). One-year recurrence rate was slightly higher in patients receiving GSP than in those undergoing PVA(bronchiectasis group:22.2%vs. 10.3%, P<0.05;tuberculosis group:28.8%vs. 22.2%,P>0.05). No severe complications occurred. Conclusions In-terventional artery embolization therapy for hemoptysis secondary to bronchiectasis is better than tuberculosis-induced hemoptysis,and PVA is more effective than GSP. Recurrence of massive hemoptysis mostly occurrs within one month ,and most of the patients are complicated with blood supply and have a history of hemoptysis.