目的 探讨带记忆弹簧圈（MK）补片在无张力修补中、小切口疝中的应用。方法 回顾性分析2005年1月至2007年1月期间我院实施MK补片下置术修补腹壁中、小切口疝25例患者的临床资料，其中初发21例，复发4例。结果 22例一期愈合，3例发生切口皮下积液，经穿刺抽吸处理后治愈。住院7～15 d，均痊愈出院。随访10个月至2年，无复发病例。结论 用MK补片下置术修补腹壁中、小切口疝经济、安全、有效、感染风险降低。
Objective To investigate the technical feasibility and effectiveness of intraoperative sac embolizaion with coils and fibrin glue for preventing type Ⅱ endoleak after endovascular aneurysm repair (EVAR). Methods A patient with abdominal aortic aneurysm (AAA), which had high risk of type Ⅱ endoleaks, was treated with combined packing of coils and fibrin glue in order to prevent type Ⅱ endoleak after EVAR. Percutaneous catheter preset and balloon occlusion were used to ensure accurate packing. Results At the end of the operation, the angiography showed that the blood flow of the stent and distal artery was unobstructed, there was no type Ⅰ and Ⅲ endoleaks, and delayed angiogram showed no collateral circulation of aneurysm. The procedure was successful. The operative duration was 120 min and the blood loss was only 20 mL. No complications such as colonic ischemia and ectopic embolism occurred, and the patient was discharged on 3 days after operation. At 6 months after follow-up, the computerized topographic angiography showed that the aneurysm cavity was completely thrombotic, without type II endoleak, and the diameter and volume of aneurysm were reduced. Conclusions The technique of intraoperative sac embolizaion with coils and fibrin glue during EVAR is safe and effective to prevent postoperative endoleaks, which is simple and feasibility. Intraoperative indwelling catheter and balloon blocking are the key points of successful implementation of this technique.
ObjectiveTo explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery.MethodsThe clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups.ResultsAll 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups.ConclusionCT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.
Objective To summarize the diagnosis and endovascular treatment of middle cerebral artery (MCA) bifurcation aneurysm. Methods Between January 2010 and June 2011, 32 patients with MCA bifurcation aneurysm underwent endovascular treatment. There were 12 males and 20 females, aged 49.5 years on average (range, 35-81 years). All patients had sudden headache, 2 cases had disturbance of consciousness and hemi plegia, and 22 cases had a history ofhypertension. Before operation, 10 cases were classified as Hunt-Hess level I, 15 cases as level II, and 7 cases as level III; 24 cases were classified as Fisher level II and 8 cases as level III. The patients underwent coil embolization using single microcatheter in 16 cases, using double microcatheter in 7 cases, using balloon-assisted in 4 cases, using single stent in 4 cases, and using double stent in 1 case. Results The results of postoperative immediate digital subtraction angiography showed that 30 patients achieved dense embolization, and 2 patients using single microcatheter achieved approximated dense embolization. Among them, 18 cases suffered extensive subarachnoid hemorrhage, thus lumbar puncture continued drainage was performed for 3-7 days; the other 14 cases had l ittle subarachnoid hemorrhage, lumbar puncture released hemorrhagic cerebrospinal fluid discontinuously, and after1 week, head CT demonstrated that subarachnoid hemorrhage was significantly decreased. At 1 day after surgery, 2 patients had local cerebral ischemia; after Nimotop and other drugs were used for 1 week, the symptom was alleviative. All 32 patients were followed up 4 to 17 months. No aneurysm rupture and bleed occurred during follow-up; no other complications or sequelae was observed except for 3 cases of hemiparesis and 1 case of aphasia. The computed tomographic angiography examination showed no re-open of dense embolized aneurysm at 3, 6 months, and 1 year after surgery. Conclusion As long as appropriate intervention treatment method is chosen, endovascular treatment of MCA bifurcation aneurysm is safe and effective.
目的 总结前交通动脉瘤栓塞治疗的经验。 方法 2008年1月－2011年8月，23例前交通动脉瘤患者均在全身麻醉下行动脉瘤内栓塞治疗。其中4例在导丝或导管保护动脉瘤颈情况下行栓塞治疗；1例术中导丝刺破动脉瘤，继续快速填塞至动脉瘤完全栓塞；1例栓塞后弹簧圈突入载瘤动脉，行A1-A2段支架后置入。 结果 23例患者手术技术成功率100%。术后即刻造影，动脉瘤完全栓塞11例，＞90%栓塞8例，＜90%栓塞4例。支架后置入患者术后出现脑梗死，经治疗1个月后康复出院。所有患者临床随访6～24个月，未见再出血。16例患者行全脑血管数字减影血管成像复查，动脉瘤未见复发，其中3例＞90%栓塞、2例＜90%栓塞患者动脉瘤完全闭塞。 结论 弹簧圈栓塞治疗前交通动脉瘤是一种安全、有效的治疗方式。但其技术难度相对较大，需要细致操作。
目的：探讨血管内Neuroform支架置入联合弹簧圈栓塞治疗颅内复杂动脉瘤的疗效、技术要点、安全性及并发症防治。方法: 研究对象为20例颅内复杂动脉瘤患者，其中颈内动脉海绵窦段4例，眼动脉段3例，后交通动脉段7例，脉络膜前动脉起始部1例，大脑中动脉M1段1例，椎动脉颅内段4例。首先将微导管置入瘤腔，然后跨瘤颈释放支架，栓塞弹簧圈。结果: 所有病例栓塞操作均顺利完成。其中致密栓塞13例，大部分栓塞7例;术后脑梗塞1例，1个月后恢复;2例弹簧圈尾端疝入载瘤动脉，均未引起相应的临床症状。随访3～24个月，平均13个月，无再出血及血栓栓塞症状。结论: 血管内支架植入联合弹簧圈治疗颅内复杂动脉瘤安全有效。
Objective To summarize the diagnosis and treatment of spontaneous rupture of bronchial artery aneurysm in mediastinum.Methods Two cases diagnosed as bronchial artery aneurysmby methods of enhanced-CT plus independent post-procedure techniques and bronchial artery selective angiography were cured by different intervention surgeries in our hospital. The clinical data of these two patients and different interventional treatments were summarized.Results Case 1 was a 38-year old male.He was given coils and PVC micro-particles, and bronchial artery selective angiography showed distal vascular occlusion and aneurysmsize decreased. Case 2 was a 59-year old female. She was also given coils, but digital subtraction angiography showed bleeding of bronchial artery whose opening was near to the aorta.Then a stent was implanted in the descending aorta to isolate the bleeding bronchial artery, and bronchial artery selective angiography showed blood flow was completely blocked. Conclusions Enhanced-CT plus vascular three-dimensional reconstruction and bronchial artery selective angiography is a chief method to diagnose bronchial artery aneurysm. Bronchial artery embolization and/ or isolating surgery with covered stent are minimally invasive, efficient, trustworthy treatment for spontaneous rupture of bronchial-artery aneurysmin mediastinum. Different techniques of interventional treatment are selected depending on lesion.
Objective To explore the diagnostic and treatment value of computed tomography (CT)-guided embolization coil localization of pulmonary nodules accurately resected under the thoracoscope. Methods Between October 2015 and October 2016, 40 patients with undiagnosed nodules of 15 mm or less were randomly divided into a no localization group (n=20, 11 males and 9 females with an average age of 60.50±8.27 years) or preoperative coil localization group (n=20, 12 males and 8 females with an average age of 61.35±8.47 years). Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface with subsequent visualization by video-assisted thoracoscopic (VATS). Nodules were removed by VATS wedge excision using endo staplers. The tissue was sent for rapid pathological examination, and the pulmonary nodules with definitive pathology found at the first time could be defined as the exact excision. Results The age, sex, forced expiratory volume in the first second of expiration, nodule size/depth were similar between two groups. The coil group had a higher rate of accurate resection (100.00% vs. 70.00%, P=0.008), less operation time to nodule excision (35.65±3.38 minvs. 44.38±11.53 min,P=0.003), and reduced stapler firings (3.25±0.85vs. 4.44±1.26,P=0.002) with no difference in total costs. Conclusion Preoperative CT-guided coil localization increases the rate of accurate resection.