目的阐明数字减影血管造影（DSA）监控在区域性置管栓塞化疗治疗肝癌中的重要性。方法比较152例肝癌区域性置管中DSA监控置管与注射美蓝指导下置管的导管位置准确性； 并对术后发生与置管有关的并发症进行分析。结果DSA监控置管准确率肝动脉及门静脉均为100%，注射美蓝指导下置管肝动脉和门静脉的导管位置准确率分别为70.2%和76.1%，两组比较差异有显著性意义（P＜0.01)。术后有导管移位、肝动脉胆管瘘、导管阻塞、药液外漏、硬化性胆管炎等并发症。结论DSA指导下置管准确，又能保证血管内介入治疗的彻底性； 术后行DSA监控，以指导下一步的治疗，并可防止并发症的发生。
Abstract： Objective To analyze the manifestation, treatment，outcome and potentially predisposing risk factors of perioperative thromboembolism after cavo-pulmonary connection, and to assess the effects of our prophylactic antithrombotic strategy. Methods Clinical data of 264 cases of bidirectional Glenn and 224 cases of total cavopulmonary connection （TCPC） operations undertaken from September 2005 to December 2010 in Fu wai hospital were retrospectively analyzed. Perioperative thromboembolic complications occurred in 9 patients. 5 of them were after bidirectional Glenn, 4 were after TCPC. Most of the 9 patients had at least one thrombi-related risk factor. The routine prophylactic antithrombotic therapy after these operations were intravenous infusion of heparin 10 U/（kg·h） initially, followed with oral aspirin 1-3 mg/（kg·d）. Results Thromboembolic events occurred within 7 days after the operation in 6 cases, appeared 2 to 4 weeks after the surgery in 3 cases. All 9 patients received anticoagulation with heparin. One patient also undertook take-down operation. 3 （33%） patients died, accounting for 33% （1/3）, and 18% （2/11） of the early deaths after bidirectional Glenn and TCPC operations. Clinical symptoms improved or disappeared in the remaining 6 patients. Conclusion The mortality of perioperative thromboembolic complications after cavo-pulmonary connection is high, consisting of the important cause of early deaths after these procedures. Our prophylactic anticoagulation strategy proved to be effective, though some thrombi-relatedrisk factors still need to be avoided.
Objective To evaluate the safety and effectiveness of interventional therapy for hyperthyroidism. Methods From 1995 to 2000, 38 cases underwent bilateral super-selective superior thyroid arteries embolization with brown-algae microballs.Results There was no misembolization and mortality. Hyperthyroidism crisis developed in 2 cases. Thirty eight cases were followed-up for 0.5～5 years (the median time was 2.2 years). Medications were needed only in one patient because of relapse and the others were cured. Conclusion This procedure features miniinvasive trauma, less complications and quick recovery. It may be a safe and rational treatment for hyperthyroidism.
Objective To investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital to enrich the epidemiological data of chronic thromboembolic pulmonary hypertension (CTEPH) in China.Methods We conducted a retrospective study to investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital from 2008 to 2012. Results The incidence of CTEPH was 5.24% . About 62.90% of venous thromboembolism/pulmonary embolism (VTE/PE) patients were unprovoked, and about 53.85% of CTEPH patients was unprovoked. About 38% of CTEPH patients had no history of VTE, and 62% of CTEPH patients had no history of acute pulmonary embolism. None of the CTEPH patients was treated by pulmonary thromboendarterctom (PTE) , and about 53.85% of patients were only given anticoagulant monotherapy. Conclusions The incidence of CTEPH is higher in our hospital than reported. This phenomenon may be related to the lack of awareness of risk factors of CTEPH and the insufficient thrombolytic and anticoagulant therapy to acute pulmonary embolism. It’s very urgent to standardize the diagnosis and management of CTEPH in pulmonologists.
Objective To explore the ocular clinical features in patients with cranial venous sinus thrombosis (CVST). Methods The clinical data from 118 inpatients with CVST diagnosed by digital subtraction angiography (DSA).The patients included 53 males and 65 females with the sexual rate of1 :1.2. The initial onset age of the patients ranged from 15 to 67; 20-45 are the most common onset ages, and 30-40 reached the peak. The CVST patients were divided into 3 groups a c cording to the onset styles, including acute onset (within 2 days), subacute ons et (2 days to 1 month), and chronic onset (more than 1 month). The features of o cular and systemic manifestations was analyzed. A total of 58 out of 118 patient s with CVST were followed up for about 1 year after the diagnosis and treatment. Results Among the 118 patients with CVST, 25 (21.2%) had the ocular symptoms as the initial onset, 36 (305%) had ocular syndrome with other symptoms, and 57 (48.3%) had non ocular symptoms. There was no statistical significance among each group. The most common chief complains were the blurred and decreased vision (in 61 eyes, occupying 85.9% of all the chief complains). The most common symptom was papilloedema (in 57 eyes, accounting for 48.3% of all the patients with CVST). In 58 follow-up patients, 13 (22.4%) had serious visual decrease due to the optic atrophy. All the ocular manifestations related to the intracranial hyper tension caused by CVST. Conclusions In patients with CVST, 1/3 have ocular symptoms, and 1/5 have ocular symptoms as the initial manifestation. Visual decrease and papilloedema are the common symptoms in patients with CVST. We should especially advert to the patients with intracranial hypertension with unknown origins. (Chin J Ocul Fundus,dis,2006,22:373-375)
Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
ObjectiveTo explore the risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.MethodsThe clinical data of 240 patients with intracranial aneurysms treated by interventional embolization in Department of Neurosurgery, Renmin Hospital of Wuhan University between January 2015 and December 2019 were collected retrospectively. According to whether cerebral thrombosis occurred after embolization, the patients were divided into the cerebral thrombosis group and the non-cerebral thrombosis group. Univariate analyses and multivariate logistic regression analysis were used to analyze the independent risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.ResultsOf the 240 patients, 55 (22.9%) had postoperative cerebral thrombosis confirmed by MRI, and 15 (6.2%) had neurological symptoms. There were significant differences in age, hypertension, hyperlipidemia, operative duration, and procedure methods (simple coiling, balloon or stent-assisted coiling) between the cerebral thrombosis group and the non-cerebral thrombosis group after embolization of intracranial aneurysms (P<0.05). Multivariate logistic regression analysis showed that only operative duration [odds ratio=1.036, 95% confidence interval (1.018, 1.054), P<0.001] was the independent risk factor for cerebral thrombosis after interventional embolization of aneurysms.ConclusionsOperative duration is the independent and adjustable risk factor for cerebral thrombosis after embolization of intracranial aneurysms. Improving the surgical skills of neurointerventional surgeons and shortening the procedure time will be helpful to reduce the occurrence of cerebral thrombosis after interventional treatment of aneurysms and improve the prognosis of patients.
ObjectiveTo systematically evaluate the efficiency and safety of interventional embolization versus laparoscopic surgery in the treatment of varicocele. MethodsWe searched the Chinese Journal Full-text Database, Wanfang Medical Journal Database, and VIP Chinese Science and Technology Journal Full-text Database with such keywords as interventional therapy, embolization, laparoscope, and varicocele. For PubMed and Cochrane Library, MESH terms or keywords were interventional embolization, interventional therapy, embolization, laparoscope, laparoscopic surgery, and varicocele. All database were searched up to March 2015. Then we selected trials comparing interventional embolization versus laparoscopic surgery in the treatment of varicocele according to the including criteria. We assessed the quality of the included studies with the Newcastle-Ottawa Scale and conducted meta-analysis with revman 5.2 for the primary outcomes sperm improvement rate, recurrence rate, complication rate, pregnant rate, etc. ResultsWe included 7 trials comparing interventional embolization with laparoscopic surgery, including 1 prospective study and 6 retrospective studies, with a total of 349 patients receiving interventional therapy and 400 patients receiving laparoscopic surgery. Meta analysis of the included studies showed that there were no significant differences for sperm improvement rate[OR=1.17, 95%CI (0.70, 1.96), P=0.54], pregnant rate[OR=0.58, 95%CI (0.29, 1.13), P=0.11], recurrence rate[OR=0.84, 95CI% (0.40, 1.78), P=0.66] or complication rate[OR=0.68, 95%CI (0.34, 1.32), P=0.25] between the two groups. ConclusionPresent evidence shows that there is no significant difference between interventional embolization and laparoscopic surgery for varicocele.
Objective To compare the efficacy of reteplase and ateplase in the treatment of acute massive pulmonary thromboembolism ( PTE) in emergency. Methods From January 2005 to December 2009,42 patients with acute massive PTE were treated by intravenous thrombolysis with reteplase or ateplase. The thrombolysis efficacy, bleeding incidence and mortality were measured. Results In the reteplase group, the emergency thrombolysis effective rate was 88. 9% among 18 patients. Mild bleeding occurred in 3 patients,moderate bleeding in 1 patient, and 2 cases died in hospital. In the ateplase group, the emergency thrombolysis effective rate was 75% among 24 patients. Mild bleeding occurred in 3 patients, moderate bleeding in 2 patients, and 3 cases died in hospital. The thrombolysis effective rate, bleeding incidence and mortality had no significant difference between the two groups. Conclusion Both the reteplase and ateplase thrombolysis therapy are safe and effective in the treatment of acute massive PTE, but reteplase thrombolysis therapy is more convenient in emergency.
摘要:目的： 分析肺动脉血栓栓塞症（PTE）的临床特征、诊断方法及治疗。提高诊断率和治愈率,改善预后。 方法 ：回顾分析我院过去七年间收治的25例PTE患者的危险因素、临床表现、辅助检查、治疗情况等临床资料。 结果 ：PTE的危险因素有深静脉血栓、高龄、心肺疾病、长期卧床等慢性基础疾病以及近期手术、外伤史等。其临床表现各异,D-二聚体、CT肺动脉造影（CTPA）敏感性高。 结论 ：PTE临床表现多样,D-二聚体可作为筛选检查首选;CTPA可作为无创检查之首选。确诊后正确及时治疗可使预后显著改善。Abstract: Objective: to analyze the clinical character\ methods of diagnosis and therapies of pulmonary thrombus embolism, to improve the precisions of diagnosis and therapy, to make prognosis better. Method : 25 patients of pulmonary thrombus embolism admitted in our hospital in the past seven years, were analyzed by risk factors, clinical manifestation accessory examination and therapies. Result : risk factors of pulmonary thrombus embolism included thrombus in venue profound, senility the diseases of heart and lung, keeping in the bed for a long time, above clinic diseases, operation and trauma in the near future their clinical manifestations were different, the sensitivity of dipolymer and CT pulmonary arteriography were high. Conclusion : clinical manifestations of pulmonary thrombus embolism were various, dipolymer may be regarded as the firster to diagnbose pulmonary thrombus embolism, CT pulmonary arteriography may be regarded as the first non-traumatogenic examination to diagnose pulmonary thrombus emboklism. After the diagnosis, correct therapies in time can greatly improver prognosis.