孤立性肠系膜上动脉夹层介入血管腔内治疗的初步体会

目的:评价介入血管腔内治疗孤立性肠系膜上动脉夹层(ISMAD)的安全性和疗效.方法:5例患者均通过腹部CT及血管造影明确诊断ISMAD,本组病例确诊后行介入血管腔内治疗,术后继予抗凝抗血小板治疗,并术后1、3、6个月进行CTA或血管造影随访.结果:5例患者手术成功率100％,其中支架联合弹簧圈栓塞2例,双支架重叠技术3例,无并发症发生.全部患者术后3周内症状逐渐消失;术后3～6个月时肠系膜上动脉CTA及血管造影显示动脉瘤腔不显影,支架腔内血流通畅;随访3～12个月(平均7.8个月)夹层动脉瘤无复发.结论:介入血管腔内治疗是治疗ISMAD的安全有效的方法.     

孤立性肠系膜上动脉夹层介入血管腔内治疗的初步体会

目的:评价介入血管腔内治疗孤立性肠系膜上动脉夹层(ISMAD)的安全性和疗效。方法:5例患者均通过腹部CT及血管造影明确诊断ISMAD,本组病例确诊后行介入血管腔内治疗,术后继予抗凝抗血小板治疗,并术后1、3、6个月进行CTA或血管造影随访。结果:5例患者手术成功率100%,其中支架联合弹簧圈栓塞2例,双支架重叠技术3例,无并发症发生。全部患者术后3周内症状逐渐消失;术后3～6个月时肠系膜上动脉CTA及血管造影显示动脉瘤腔不显影,支架腔内血流通畅;随访3～12个月(平均7.8个月)夹层动脉瘤无复发。结论:介入血管腔内治疗是治疗ISMAD的安全有效的方法。     

血管内栓塞治疗已破裂后交通动脉瘤的临床研究

目的:探讨已破裂后交通动脉瘤的血管内栓塞介入治疗的临床疗效.方法:对73例血管内介入栓塞治疗已破裂后交通动脉瘤患者资料回顾分析,观察临床治疗效果.结果:所有患者均成功栓塞,获100％栓塞35个(47.9％),95％栓塞24个(32.9％),90％栓塞13个(17.8％),80％栓塞1个(1.4％),发生并发症6例(8.2％),术后随访未见复发病例(0.0％).结论:已破裂后交通动脉的血管内介入栓塞治疗是一种微创、安全、有效的方法.     

胆道支架置入联合介入化疗对恶性胆道梗阻患者肝功能及预后的影响

目的:研究胆道支架置入联合介入化疗对恶性胆道梗阻患者肝功能及预后的影响,为临床治疗提供依据。方法:选取2013年2月到2015年2月我院收治的恶性胆道梗阻患者90例,按照随机数字表法将患者分为Ⅰ组、Ⅱ组和Ⅲ组,每组30例,Ⅰ组给予胆道支架置入联合介入化疗,Ⅱ组给予单纯胆道支架置入,Ⅲ组给予保守治疗,比较三组治疗前、后肝功能、并发症、支架通畅率及生存期。结果:治疗前三组谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转移酶(r-GT)比较无统计学意义(P0.05),治疗后Ⅰ组和Ⅱ组AST、ALT和r-GT均显著改善,与治疗前和Ⅲ组比较差异具有统计学意义(P0.05),且I组显著优于Ⅱ组,比较差异具有统计学意义(P0.05),Ⅲ组治疗后AST、ALT和r-GT与治疗前比较差异无统计学意义(P0.05);Ⅰ组、Ⅱ组和Ⅲ组并发症发生率比较无统计学意义(P0.05);Ⅰ组术后3个月、6个月和12个月支架通畅率均显著高于Ⅱ组,比较差异具有统计学意义(P0.05);I组生存期显著高于Ⅱ组和Ⅲ组,Ⅱ组高于Ⅲ组,比较差异具有统计学意义(P0.05)。结论:胆道支架置入联合介入化疗治疗恶性胆道梗阻具有较好效果,能明显改善患者肝功,延长患者生存期。     

介入栓塞治疗内脏动脉瘤的临床研究

目的:探讨介入血管腔内栓塞治疗内脏动脉瘤的方法、疗效及安全性。方法:选择内脏动脉瘤患者23例,包括脾动脉瘤13例,肝动脉瘤2例,胃十二指肠动脉瘤3例,肠系膜上动脉瘤4例,肾动脉瘤1例。其中,9例行远近端动脉栓塞术,4例采用支架辅助弹簧圈瘤体内填塞,3例采用弹簧圈瘤体内填塞加瘤体内注胶栓塞术,4例行弹簧圈瘤体内栓塞术,2例行分支动脉颗粒栓塞术,1例行单纯注胶栓塞术。术后1月、3月、6月行超声、CTA或血管造影复查,以后每年复查一次。结果:本组均成功行介入血管腔内栓塞治疗内脏动脉瘤,栓塞治疗后造影示动脉瘤体和/或载瘤动脉闭塞,动脉瘤体内无明显对比剂显影,脾动脉瘤栓塞患者有3例出现发热,脾区疼痛等脾梗塞症状,未见栓塞术相关严重并发症发生。4例消化道出血患者出血均停止。术后随访3~48个月,未见动脉瘤破裂出血、动脉瘤复发或增大,支架置入者,支架内及分支动脉血流均保持通畅。结论:介入血管腔内栓塞是一种治疗内脏动脉瘤的简便、微创、安全有效的方法。     

血管内支架介入成形术对老年缺血性脑血管病患者的神经功能、动脉血流速度及预后的影响

摘要 目的：探讨血管内支架介入成形术对老年缺血性脑血管病（ICVD）患者的神经功能、动脉血流速度及预后的影响。方法：选取2018年3月~2019年4月期间我院收治的117例老年ICVD患者作为研究对象,根据随机数字表法分为对照组（n=58）和研究组（n=59）,其中对照组患者予以保守药物治疗,研究组患者予以血管内支架介入成形术治疗,比较两组患者疗效、神经功能、动脉血流速度、预后及并发症情况。结果：研究组治疗6个月后的临床总有效率为91.53%（54/59）,高于对照组的72.41%（42/58）（P<0.05）。两组患者治疗后1个月、治疗后3个月、治疗后6个月美国国立卫生研究院卒中量表（NIHSS）评分均下降（P<0.05）,且研究组低于对照组（P<0.05）。两组患者治疗后6个月大脑中动脉、基底动脉、颈内动脉血流速度均升高（P<0.05）,且研究组高于对照组（P<0.05）。两组患者治疗后1个月、治疗后3个月、治疗后6个月改良Rankin量表（mRS）评分呈下降趋势（P<0.05）,且研究组低于对照组（P<0.05）。两组患者并发症发生率对比未见统计学差异（χ²=2.261,P=0.133）。结论：老年ICVD患者经血管内支架介入成形术治疗后的疗效显著,可有效改善患者神经功能、动脉血流速度及预后,且不增加并发症发生率,具有较高的临床应用价值。     

下肢动脉硬化闭塞症血管成形术的疗效观察

目的:探讨血管成形术治疗下肢动脉硬化闭塞症的临床应用价值。方法:对我院78例下肢动脉硬化闭塞患者的临床资料进行回顾性分析。78例患者(98条血管)术前经CTA诊断后,行腔内血管成形术(PTA)和血管支架植入术治疗,治疗后随访1~18个月,分析踝/肱指数(ABI)、血管内径、皮温及足背动脉搏动的变化。结果:成功完成77例(98.7%)患者、97条(99.0%)患肢的PTA和支架植入术,除1例下肢动脉完全闭塞患者导丝未能成功通过病变导致介入失败外,其余病例经介入治疗后均开通,术中所有病例均未发生血肿、血管壁破裂、穿孔或内支架移位,远端血管血栓栓塞等并发症。术后,患者下肢缺血症状消失或明显减轻,踝/肱指数(ABI)由术前(0.39±0.23)恢复至(0.86±0.26),下肢血管内径及足背动脉搏动均明显改善。结论:PTA和血管支架植入术是一种治疗下肢动脉硬化闭塞症安全有效的方法,成功率高,并发症少,再狭窄率低。     

11 例锁骨下动脉瘤腔内介入治疗体会

目的：总结锁骨下动脉瘤腔内介入治疗的经验。方法：11 例锁骨下动脉瘤,其中7 例真性动脉瘤4 例假性动脉瘤,均采用覆 膜支架腔内隔绝术进行治疗。结果：本组11 例患者腔内介入治疗成功率100%,共置入覆膜支架12 枚,无严重并发症发生,均痊 愈出院。经平均32.5 个月随访,全部患者无明显内漏发生,无动脉瘤复发,除3 例患者出现覆膜支架内轻度狭窄（<30%）外,余介 入治疗患者的锁骨下动脉血流均通畅。结论：腔内覆膜支架隔绝术治疗锁骨下动脉瘤是一种安全、有效的治疗手段。     

肠镜下置入支架治疗左半结肠癌性梗阻的临床疗效分析

目的:探讨肠镜下置入支架治疗左半结肠癌性梗阻的应用价值。方法:对我院54例左半结肠癌性梗阻的患者行肠镜下支架置入术,恢复肠道通畅性。结果:24例患者永久性植入结肠内支架以姑息的治疗,30例患者暂时植入结肠支架,并行肠道准备,择期外科手术。术后患者无死亡,无相关并发症的发生,均痊愈出院。结论:肠镜下置入支架在治疗左半结肠癌性梗阻中有临床应用价值,既可作为姑息疗法,也可作为术前准备的一部分。     

血管内支架成形术治疗大脑中动脉狭窄

目的:探讨血管内支架成形术治疗大脑中动脉狭窄的疗效及安全性.方法:对22例大脑中动脉狭窄患者行血管内支架成形术,回顾性分析其临床特点、疗效及治疗经验.结果:22例患者共植入22枚支架,均获得成功.术后即刻造影狭窄率为(11.2±4.5)%,较术前(79±15)%明显改善.术后残余狭窄程度均小于20%.临床随访无TIA发作或脑卒中再发,DSA随访除1例外均无再狭窄发生.结论:血管内支架成形术治疗大脑中动脉狭窄安全有效,但远期疗效还需进一步观察.     

良性中心气道狭窄支气管镜介入治疗术后近远期再狭窄相关因素分析

目的探讨良性中心气道狭窄支气管镜介入治疗术后近远期再狭窄相关因素。方法对2011年2月~2015年2月我院收治的60例良性中心气道狭窄患者经支气管镜下介入治疗,治疗方式包括高频电刀、冷冻、球囊扩张、金属覆膜支架置入等。治疗后对患者的治疗时机、局部感染情况、治疗方法、气道狭窄病因、年龄、性别、基础疾病等情况进行分析,随访观察评估术后疗效、出现再狭窄的时间,探讨近远期再狭窄的危险因素。结果 Cox回归分析表明,患有基础疾病(高血压、糖尿病)、球囊扩张、支架置入、治疗时机不当(溃疡坏死增值阶段)、局部感染是良性气管狭窄支气管镜下腔内介入治疗术后近期再狭窄的相关危险因素,其对再狭窄影响的风险比(OR值)依次为6.715、2.197、5.820、6.914、5.345。支架置入和治疗时机不当(溃疡坏死增值阶段)是良性气管狭窄支气管镜下腔内介入治疗术后远期再狭窄的相关危险因素,其对再狭窄影响的风险比(OR值)分别为6.706,7.154。结论良性中心气道狭窄患者支气管镜下腔内介入治疗术后近期再狭窄的危险因素是基础疾病、球囊扩张、支架置入、局部感染、治疗时机不当,远期再狭窄危险因素是支架置入和治疗时机不当。     

尼莫司汀对复发恶性胶质瘤化疗的临床观察

目的:探讨尼莫司汀在复发胶质瘤化疗的疗效。方法:回顾性分析接受尼莫司汀化疗的13例复发胶质瘤患者的临床治疗效果、生存时间及不良反应。结果:所有患者均接受超过3个周期的化学治疗,平均完成4.6个化疗周期。随访时间5-26个月,平均随访时间16个月。3个月无进展生存率53.8%;6个月无进展生存率30.8%;12月无进展生存率23.1%。2例出现Ⅲ度骨髓抑制,其余不良反应包括恶心呕吐(6例)和疲倦乏力(9例),经积极治疗后均好转。结论:尼莫司汀为主的化疗方案是复发胶质瘤化疗的有效手段之一,可以显著地延长患者的生命,并不伴有严重的并发症,特别是针对前期进行过TMZ化疗的病例,具有价格低廉,疗效相当的优点,是替莫唑胺治疗之外很好的选择。     

三氧化二砷栓塞联合肝动脉介入治疗转移性肝癌的疗效并33例临床观察

目的：观察并探讨三氧化二砷碘油栓塞联合置管介入化疗治疗转移性肝癌的临床效果。方法：选取辽宁省肿瘤医院介入治疗科2008-2010年收治的转移性肝癌患者33例,进行肝动脉造影及间接门脉造影,根据肝动脉造影或门脉造影结果,根据肝动脉供血情况分别采取肝动脉化疗栓塞及肝动脉灌注化疗方法治疗,3．4周为1治疗周期,共完成4个治疗周期,治疗结束后评价患者,陆床有效率,随访半年、1年、2年患者生存率。结果：①介入治疗后,患者,临床症状均改善,KPS得分明显高于化疗前（P〈0．05）,临床总有效率81．82％。②随访半年、1年、2年生存率分别为90．9l％、66．67％、33.33％,肝动脉化疗栓塞组患者中远期生存率明显高于肝动脉灌注化疗的患者。结论：三氧化二砷可从多角度抑制癌细胞,临床应用安全有效;对于不能手术和不适宜手术的转移性肝癌患者,根据肝动脉供血情况和特点选择合适的介入治疗,可获得满意疗效。     

Clinical evaluation of a new two-site assay for CA125 antigen

As appropriate surgery and chemotherapy can improve both quality of life and survival of patients with ovarian adenocarcinoma, there has been a pressing need for "serodiagnostic" assays to enable close patient monitoring. CA 125 antigen has previously been described as a useful tumor marker of ovarian cancer. This is the first clinical evaluation of a radioimmunoassay using two new monoclonal antibodies, B27.1 and B43.13, that react with separate sites on the glycoprotein marker CA 125. Using the new assay, the majority of patients with clinically or radiologically detectable disease had serum CA 125 antigen levels well above the upper limit seen with random apparently healthy donors, while only three patients who were believed free of disease had elevated levels. Disease progression was associated with increasing values of serum CA 125 antigen, while response to therapy was associated with a steady decline in serum CA 125 antigen levels. Seven patients had steadily rising serum CA 125 antigen levels after initially having normal levels. The mean lead time between rise above normal and clinical or radiological evidence of relapse was 5 months (range 2 to 12 months). The merits of further surgical intervention are illustrated by the serial values of two patients followed after chemotherapy. The assay appears to have value in monitoring response to therapy and in detecting disease relapse at a time when appropriate therapeutic intervention is still possible or likely to be beneficial. Furthermore, monitoring CA 125 antigen was shown to be of benefit in assessing response to chemotherapy in a few patients with metastatic adenocarcinoma of unknown primary, and may be useful in this group of patients in determining those likely to benefit from aggressive chemotherapy.     

A randomized trial of chemoimmunotherapy of acute nonlymphocytic leukemia in adults using a protein-bound polysaccharide preparation

Summary The effect of immunotherapy with a protein-bound polysaccharide preparation termed PSK on remission duration and survival of adults with acute nonlymphocytic leukemia (ANLL) was studied in a prospective randomized cooperative trial. After having achieved complete remission and receiving a consolidation therapy, 73 patients were randomized either to maintenance chemotherapy or to maintenance chemotherapy plus immunotherapy with PSK. Ultimately 36 patients in the chemotherapy group and 31 in the chemoimmunotherapy group were evaluable. Six months after the last entry, immunotherapy with PSK showed a borderline beneficial effect on remission duration (P=0.089) and on duration of survival (P=0.062). When the data were analyzed 12, 18, and 24 months after the last entry there were no significant differences in duration of remission and survival between the two groups. However, analysis of the data of patients who had maintained complete remission for more than 270 days revealed that immunotherapy had a suggestive beneficial effect (P=0.105), prolonging the 50% remission period by 418 days (885 vs 467 days). Thus, immunotherapy with PSK seems to be active in the treatment of adult ANLL when used for maintenance therapy in combination with chemotherapy, especially in patients with a good prognosis.     

Basic and Clinical Research on the Therapeutic Effect of Intervention in Primary Liver Cancer by Targeted Intra-Arterial Verapamil Infusion

The aim of this study was assess the therapeutic effect of targeted intra-arterial verapamil infusion in liver cancer patients and its side-effects in a dog model. The blood verapamil levels in dogs were determined after one-off intra-arterial infusion (0.7 mg/kg). Blood pressure, breathing state, and II-lead electrocardiogram were measured. Primary liver cancer patients (100) were randomly assigned into two groups. Controls (50) were treated with targeted intra-arterial infusion, and every patient received once-a-month interventional therapy, twice. Treatment group (50) received chemotherapeutics plus verapamil. Therapeutic and toxic side effects were evaluated. Control (41) and treatment group (45) patients were further treated with a second round of targeted intra-arterial infusion of chemotherapeutics plus verapamil, in 30 days after the 2-time interventional therapy. Every patient accepted interventional therapy 4–5 times during the 6 months after the first confirmed diagnosis. Following verapamil infusion, verapamil in dog liver was tenfold higher than in blood and was 4- to 20-fold higher than that needed for reversing carcinoma drug resistance. After interventional therapy, there were no significant changes in iconographic evaluation indices between the groups. Average activities of aminotransferases were 332 and 178 U/l in the treatment and control groups (P < 0.05). The imaging parameters of the treatment group were significantly better than those of control group. No side effects were found among the 91 patients who accepted verapamil infusion. After verapamil infusion, verapamil levels in dog hepatic tissue exceeded the effective concentration that reverses carcinoma multidrug resistance without any visible changes in the vital signs. Targeted intra-arterial verapamil infusion could improve the chemotherapy for the primary liver cancer patients without any side effects.     

Helicobacter pylori–Positive Duodenal Ulcer: A Long-Term Double-Blind Randomized Study in Patients Healed with H2-Receptor Antagonists

Background. The NIH Consensus Conference in 1994 (1) concluded that all patients with peptic ulcr disease should be tested and treated for Helicobacter pylori and that further evaluation was needed for patients in remission.
Materials and Methods. We evaluated in a double blind randomization 30 patients whose duodenal ulcers had been healed with H₂-receptor antagonists and who remained in remission on maintenance therapy. After ulcer healing and the presence of H. pylori had been confirmed, these patients were randomized to receive eradication therapy or placebo and were followed for a mean period of 23 months.
Results. Almost all patients receiving placebo had ulcer recurrence, whereas the patients treated with antibiotics demonstrate a low recurrence rate.
Conclusion. These data suggest, for the first time to our knowledge, the importance of treating with antibiotics duodenal ulcer patients whose disease is in remission.     

Comprehensive treatment of malignant mesothelioma patients after the failure of systemic chemotherapy

Malignant mesothelioma (MM) is an aggressive neoplasm usually arising from the mesothelial surfaces of the pleural or peritoneal cavity. Currently, no standard therapy is available. The most commonly used therapy is cytoreductive surgery combined with systematic chemotherapy, but the median overall survival (OS) is less than 12 months; moreover, treatments are lacking for patients in whom chemotherapy has failed and/or who cannot withstand surgery. We investigated multiple minimally invasive therapies (cryosurgery, photodynamic therapy and intracavity chemotherapy) for the treatment of MM patients in whom systemic chemotherapy had failed. Twenty-seven patients were divided into comprehensive (combination of the three therapies) and palliative (intracavity chemotherapy only) treatment groups. The OS of patients who received comprehensive treatment was significantly longer than that of those who received palliative treatment (median OS: 64 vs. 9 months, P < 0.001). This interesting result was not associated with treatment timing, but was closely associated with repeated treatments.