颅内动脉瘤栓塞术的临床分析

目的：用动脉瘤栓塞体积比评价颅内动脉瘤栓基术的治疗效果,观察颅内动脉瘤栓塞术治疗颅内动脉瘤的影响因素及颅内动脉瘤栓塞术的术后情况。方法：选取112例行血管内栓塞治疗的患者为研究对象,按术后动脉瘤栓塞体积比分成VER〉25％和VER〈25％两组,观察不同的栓塞材料（电解可脱弹簧圈、水解可脱弹簧圈）和术中血管的痉挛程度（轻、中、重）对栓塞程度的影响;术后随访106例病人,按动脉瘤栓塞体积比分成VER〉25％和VER〈25％两组,统计两组患者的再出血率和复发率,用动脉瘤栓塞体积比评价栓塞术的预后效果。结果：动脉瘤栓塞体积比VER〉25％和VER〈25％两组间进行比较,不同血管痉挛情况下和使用不同的栓塞材料在两组间均存在显著差异（P〈O．05）,具有统计学意义;术后随访半年,比较VER〉25％和VER〈25％两组的再出血率也有显著差异（P〈O．05）,具有统计学意义。结论：动脉瘤栓塞体积比在评价颅内动脉瘤栓塞术中有重要意义,血管痉挛情况、栓塞材料是影响颅内动脉瘤栓塞术栓塞疗效的主要影响因素;术后随访证实动脉瘤栓塞体积比对评价动脉瘤栓塞术的预后有一定的作用。     

Radio aneurysm coils for noninvasive detection of cerebral embolization failures: a preliminary study

The rupture of a cerebral aneurysm is the most common cause of subarachnoid hemorrhage. Endovascular embolization of the aneurysms by implantation of Guglielmi detachable coils (GDC) has become a major treatment approach in the prevention of a rupture. Implantation of the coils induces formation of tissues over the coils, embolizing the aneurysm. However, blood entry into the coiled aneurysm often occurs due to failures in the embolization process. Current diagnostic methods used for aneurysms, such as X-ray angiography and computer tomography, are ineffective for continuous monitoring of the disease and require extremely expensive equipment. Here we present a novel technique for wireless monitoring of cerebral aneurysms using implanted embolization coils as radiofrequency resonant sensors that detect the blood entry. The experiments show that commonly used embolization coils could be utilized as electrical inductors or antennas. As the blood flows into a coil-implanted aneurysm, parasitic capacitance of the coil is modified because of the difference in permittivity between the blood and the tissues grown around the coil, resulting in a change in the coil's resonant frequency. The resonances of platinum GDC-like coils embedded in aneurysm models are detected to show average responses of 224–819 MHz/ml to saline injected into the models. This preliminary demonstration indicates a new possibility in the use of implanted GDC as a wireless sensor for embolization failures, the first step toward realizing long-term, noninvasive, and cost-effective remote monitoring of cerebral aneurysms treated with coil embolization.     

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。     

Gastroduodenal artery aneurysm: treatment by transcatheter embolization.

Aneurysm of the gastroduodenal artery is a rare but well recognized complication of acute and chronic pancreatitis. It appears to be secondary to the proteolytic action of activated pancreatic enzymes on the arterial wall. A case is reported of massive, life-threatening hemorrhage in a patient with a gastroduodenal artery aneurysm. The aneurysm was diagnosed by angiography and treated by embolization with Gianturco coils, the first successful use of this technique. A review of the literature revealed that bleeding in the upper gastrointestinal tract is a very common clinical presentation and is frequently fatal. Arteriography followed by computerized tomography are the most specific modalities of diagnosis.     

Acute occlusion of an abdominal aortic aneurysm complicated by bilateral lower extremity venous thrombosis: A case report

Acute occlusion of an abdominal aortic aneurysm is a rare phenomenon. Its possible complications include distal spasm followed by arterial thrombosis, ischemia of the distal limbs, distal embolization, acidosis, hyperkalemia, and the development of venous thrombosis of the lower limbs. Surgical correction is often complicated by cardiac decompensation, renal failure, fatal pulmonary embolism, and metabolic derangements related to toxins released from the revascularized limb. Unless contraindicated, immediate systemic heparinization must be undertaken when the diagnosis is first suspected. We present a case of sudden occlusion of an abdominal aortic aneurysm complicated by venous thrombosis involving both lower extremities. After undergoing surgical revascularization, the patient sustained massive fatal pulmonary emboli. Prophylactic interruption of the inferior vena cava may be indicated in patients who present with this complication of abdominal aortic aneurysm.     

超选择子宫动脉栓塞治疗子宫肌瘤

目的探讨超选择子宫动脉栓塞治疗子宫肌瘤的方法及疗效。方法子宫肌瘤65例采用Seldinger技术经皮股动脉插管至双侧髂内动脉,造影了解肿瘤的血供来源后,超选至两侧子宫动脉,缓慢注入平阳霉素碘油乳剂或PVA微粒栓塞治疗。结果患者症状缓解率为93．2％,月经增多,痛经,尿频、尿急,贫血等1-3个月内恢复正常。并发症：除栓塞综合征外,可见阴道不规则流血,腰腿痛,可自行恢复。治疗后3-6个月肌瘤缩小率在30％-68％之间。中短期疗效较稳定,末见复发。治疗前后性激素水平变化无明显差异。结论子宫动脉栓塞术治疗子宫肌瘤操作简单安全,疗效好。超选择子宫动脉插管其分支栓塞,并发症少,具有较大的临床应用价值。     

手术夹闭与介入栓塞治疗对前交通动脉瘤患者认知功能的影响

目的:探讨前交通动脉瘤手术夹闭与介入栓塞两种治疗方法对前交通动脉瘤患者认知功能的影响。方法:采用简易精神状态量表(MMSE)对206例前交通动脉瘤患者进行分析对照,其中开颅动脉瘤夹闭患者125例,介入栓塞患者81例,另取正常组40例作为对照组。结果:前交通动脉瘤患者术前即有认知功能障碍发生,术后患者认知功能障碍发生率增高(P<0.01)。患者组的术后认知功能障碍发生率明显高于对照组,而患者组中的介入组的术后认知功能障碍发生率明显小于手术夹闭组(P<0.05)。结论:前交通动脉瘤患者术前既有认知功能障碍发生,两种治疗手段对术前即出现的认知功能障碍无改善作用,并且可能增加认知功能障碍的发生率及加重认知功能障碍的程度,而介入栓塞术在认知障碍的发生率及出现认知功能障碍的程度方面都优于开颅动脉瘤夹闭术。     

早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后分析

目的:研究分析早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后。方法:选取我院2011年至2014年期间收治的脑动脉瘤破裂患者96例作为研究对象。根据数字法随机分成观察组及对照组各48例,观察组患者在入院3d之内实施微弹簧圈栓塞形式介入治疗,对照组治疗时间为入院3 d后。对比两组患者临床治疗疗效、并发症发生情况、以及术后6个月的改良Rankin量表(m RS)、改良型日常生活能力(MBI)评分。结果:观察组的栓塞效果显著好于对照组,差异有统计学意义(P0.05)。观察组术后6个月的m RS评分显著低于对照组,且MBI评分显著高于对照组,差异均有统计学意义(均P0.05)。观察组的并发症发生率均显著低于对照组,差异均有统计学意义(均P0.05)。结论:入院3d之内利用微弹簧圈栓塞对脑动脉瘤破裂实施早期介入治疗,具有较好的疗效及预后,值得临床重视。     

The Management of Vertebrobasilar Dissecting Aneurysm Using Endovascular Embolization

To explore the imaging features of the vertebrobasilar artery dissecting aneurysm (VBA-DA) and to evaluate the effect of endovascular treatments. Five patients with VBA-DA undergoing endovascular treatments were retrospectively studied. Stent-alone technique was used to treat two of the patients, stent-assisted coil embolization of aneurysm in one patient, coil embolization of parent artery in the other patient, and stent-assisted coil embolization of parent artery in the last patient. Postoperative angiography revealed complete occlusion of aneurysm in two patients and delayed image development in three patients. One patient suffered postoperative cerebral hemorrhage without any neurological deficits. Five patients achieved favorable outcomes on both the imaging results and clinical recovery during a mean follow-up of 20.2 months (range 6–90?months). The string sign pearl and string sign and double-lumen sign are typical imaging features of VBA-DA. Treatment modality is determined by the imaging results. Endovascular embolization is a minimally-invasive, safe, effective, and reliable intervention for managing VBA-DA.     

Superselective embolization of arterial bleeding as a late complication 3 months after nephron sparing surgery for renal cell carcinoma

To our knowledge, this is the first case of an arterial bleeding as a late complication 3 months after nephron sparing surgery of renal cell cancer, presumably originating from an arteriocalyceal fistula. Superselective embolization of the feeding arterial branch was chosen for treatment of the hemorrhage and proved successful. The high efficacy of superselective embolization as a minimally invasive procedure in this and other cases of bleeding Vessels should be the preferred method instead of open surgery.     

栓塞治疗颅内动脉瘤的并发症及处理方法分析

目的:分析栓塞治疗颅内动脉瘤过程中并发症的发生原因及处理方法。方法:回顾性分析微弹簧圈栓塞治疗的97例颅内动脉瘤患者的临床资料,包括性别、年龄、Hunt-Hess分级,对住院患者进行术前整体状况评估。影像学检查主要记录动脉瘤的位置、瘤体长度和瘤颈宽度,测量其长宽比例。血管内介入手术治疗观察各种介入治疗方法以及相关并发症。结果:本组97例颅内动脉瘤患者中,男44例、女53例,男性平均年龄51.3岁,女性平均年龄46.7岁,男女共同平均年龄48.7岁。颈内动脉-后交通支及其附近动脉瘤51个,前交通动脉和大脑前动脉29个,大脑中动脉11个,椎-基底动脉系统6个,所用到的栓塞材料包括各种弹簧圈、颅内支架、不可脱球囊等。97例中15例出现并发症(15.5%),动脉瘤破裂出血4例,术中发生血管痉挛3例,血栓形成或血栓性栓塞5例,3例死亡。结论:栓塞治疗颅内动脉瘤过程中最主要并发症包括动脉瘤破裂、栓塞和血栓形成、血管痉挛等,术前评估、术中谨慎操作以及正确及时的处理能够降低栓塞治疗颅内动脉瘤的并发症。     

An inelastic multi-mechanism constitutive equation for cerebral arterial tissue

Intracranial aneurysms (ICA) are abnormal saccular dilations of cerebral arteries, commonly found at apices of arterial bifurcations and outer walls of curved arterial segments. Histological evidence suggests the stages in ICA development include the deformation of a segment of arterial wall into a “bleb” with no identifiable neck region followed by the development of an aneurysm with a clear neck. Afterwards, the aneurysm may undergo further enlargement, possibly with significant biological response including calcification and thrombosis. Past studies of the biomechanics of cerebral aneurysm tissue have been directed at modeling elastic deformations of pre-existing aneurysms. Taking this approach, the aneurysm wall is treated as a different entity than the arterial tissue from which it developed. In the current work, a nonlinear, inelastic, dual-mechanism constitutive equation for cerebral arterial tissue is developed. It is the first to model the recruitment of collagen fibers and degradation of the internal elastic lamina, two important characteristics of early stage aneurysm formation.     

肝癌破裂出血行肝动脉栓塞治疗的护理

目的:探讨肝癌自发性破裂出血行急诊肝动脉栓塞治疗手术前后的护理方法。方法:回顾性分析17例原发性肝癌自发性破裂出血患者的急救及护理措施的临床资料。结果:17例患者入院后均有失血性休克表现,经肝动脉栓塞治疗后,治愈出院14例,死亡1例,放弃治疗2例,治疗总有效率为82.4%,死亡率为5.9%。结论:急诊肝动脉栓塞治疗肝癌破裂出血简单、有效,手术前后的护理非常重要,术前应密切注意患者病情变化,做好术前准备,术后常规止血、止吐,加强支持护理,及时观察手术并发症及疗效,积极预防和治疗各种并发症,是降低患者死亡率的关键。     

瑞芬太尼复合七氟醚在颅内动脉瘤栓塞术中的临床观察

目的：探讨瑞芬太尼复合七氟醚在颅内动脉瘤栓塞术中的临床效果。方法：回顾性分析在我院行择期颅脑动脉瘤栓塞术的70例患者的临床资料,按照随机序号的方式将其分为观察组和对照组各35例,观察组患者采用瑞芬太尼复合七氟醚麻醉,对照组采用瑞芬太尼复合异丙酚麻醉,对两组麻醉诱导前1min（T1）、麻醉诱导后1min（T2）、插管时（T3）、手术开始后30min（T4）以及拔管时（T5）患者的血压、心率变化及清醒后拔管时间进行记录和分析。结果：两组患者在T2时收缩压（Systolic blood pressure,SBP）、舒张压（Diastolic blood pressure,DBP）和心率（HeartRate,HR）均较T1明显下降,比较差异均有统计学意义（P〈0．05）;观察组患者的清醒时间（5．1±1．5）min及拔管时间（15．5±7．5）min均明显短于对照组,两组比较差异有统计学意义（P〈0．05o结论：在进行颅内动脉瘤栓塞术时,选择使用瑞芬太尼复合七氟醚的麻醉方式,可使患者血流动力学较为稳定,术后苏醒较快,值得在临床推广应用。     

Risk Evaluation of Selective Renal Arterial Embolization in the Treatment of Delayed Hemorrhage from Renal Artery Pseudoaneurysm After Partial Nephrectomy

Renal-artery pseudoaneurysm (RAP) is a well-described complication of partial nephrectomy. We aimed to evaluate the occurrence rate of delayed hemorrhage from RAP after partial nephrectomy, and to investigate the efficacy and safety of selective renal arterial embolization. Between January 2000 and December 2010, 426 partial nephrectomies were performed at our institution for treatment of small renal mass (SRMs). A retrospective review of these cases revealed that 14 patients developed a postoperative RAP (3.29 % incidence). We compared the clinical characteristics between the 14 patients with delayed renal hemorrhage and other 412 patients. RAP was diagnosed by renal angiography in 12 patients with delayed renal hemorrhage. Of the 12 patients, 10 patients were successfully treated with selective renal arterial embolization after presenting with symptoms postoperatively, 1 patient was treated with open surgery, and 1 patient was treated with nephrectomy. The other two patients showed no abnormalities in renal angiography, and the symptoms relieved by transfusion and hemostasis treatment. We found that tumor type, tumor size, tumor location, and surgical approach were significantly different between the 14 patients and other 412 patients. RAP showed a low incidence. The risk factors of RAP included renal cell carcinoma, tumor with large size, and tumor location. Most patients with delayed renal hemorrhage from RAP were successfully cured by selective renal arterial embolization. Therefore, selective renal arterial embolization can be used as the preferential therapy for RAP.     

老年蛛网膜下腔出血的治疗方法和预后分析

目的:探讨70岁以上老年蛛网膜下腔出血患者的治疗方法和预后。方法:回顾性分析我院2006-2012年收治的49例老年蛛网膜下腔出血患者的临床资料及其预后。结果:49例患者入院时Hunt-Hess分级:Ⅰ级14例,Ⅱ级8例,Ⅲ级6例,Ⅳ级6例,Ⅴ级15例,其中14例采用开颅动脉瘤夹闭术,10例采用血管内介入栓塞术,25例采用内科保守治疗。治疗后6月,根据ADL量表评价预后(ADL≥60分为预后良好):内科保守治疗者仅3例预后良好,手术及栓塞术者17例预后良好。结论:对于老年蛛网膜下腔出血患者而言,影响患者预后的原因主要是出血导致的脑损伤和症状性脑血管痉挛,通过手术或栓塞术积极治疗破裂动脉瘤是预后良好的重要因素。     

Interlock可解脱弹簧圈在脾动脉瘤腔内治疗中的应用

目的:探究Interlock可解脱弹簧圈在脾动脉瘤的腔内治疗中的应用价值。方法:回顾性分析2016年2月至2019年2月于本中心使用Interlock可解脱弹簧圈治疗的36例脾动脉瘤患者的临床资料,包括10例男性,26例女性,31例真性动脉瘤,5例假性脾动脉瘤,术前均行超声或CTA明确诊断。术中栓塞后,立即血管造影以明确技术成功率。围手术期及术后2周、3个月和6个月监测血常规、胰淀粉酶和主动脉CTA,观察并发症的发生情况。结果:6例患者弹簧圈栓塞动脉瘤远近端及瘤腔,其余仅栓塞脾动脉瘤瘤腔。术中DSA血管造影提示即刻脾动脉瘤栓塞闭塞率为97%以上,术中共使用128枚Interlock弹簧圈,其中104枚为钻石型,24枚为普通2D型。弹簧圈平均直径为6.3±4.2(2-12)mm,平均长度为16±13.5(3-32)mm,瘤体平均尺寸为40.6±12.5(15-70) mm。围手术期无并发症发生。平均随访10.0±3.2(6-15)个月,1月后2例出现脾梗死,7例发生轻微腹痛及低热等症状,所有病例均未见瘤腔再通和瘤体增大。结论:Interlock可解脱弹簧圈可以安全有效地治疗脾动脉瘤,但其远期疗效需长期随访观察。     

The False Aneurysm

The clinical course of 18 patients with 25 false aneurysms is reviewed. In recent years false aneurysm has been most commonly seen as a complication of arterioplastic procedures in which prosthetic arterial grafts were used. The use of indwelling needles or cannulae, particularly in patients with a wide arterial pulse pressure, can also lead to the formation of false aneurysms. In the groin, a false aneurysm is frequently mistaken for an abscess. Early diagnosis and operative repair are essential to reduce the incidence of further complications.     

支气管动脉灌注化疗与栓塞治疗中晚期肺癌的疗效观察

目的：对比分析支气管动脉灌注化疗与支气管动脉灌注化疗十栓塞术治疗中晚期肺癌的临床疗效。方法：将我院2011年1月-2013年1月期间收治的76例中晚期肺癌患者随机分为两组,即观察组38例,对照组38例。观察组患者行支气管动脉灌注化疗联合栓塞术治疗,对照组患者行单纯支气管动脉灌注化疗治疗。分别对两组患者治疗后的临床治疗效果进行评价,同时观察两组患者治疗后的不良反应及并发症的发生情况。结果：观察组患者临床治疗的总有效率为84．21％,对照组为64．78％．两组比较,差异具有统计学意义（P〈0．05）。两组患者治疗后,观察组患者总不良反应率为23．67％,对照组为21．04％,两组比较．差异无统计学意义（P〉0．05）。且经对症处理后,均得到有效改善。结论：支气管动脉灌注化疗联合栓塞术治疗中晚期肺癌的,临床疗效明显优于单纯支气管动脉灌注化疗,且无明显不良反应及并发症的发生,安全性好,值得临床推广与应用。     

球囊辅助栓塞技术治疗未破裂颅内动脉瘤的有效性及安全性分析

目的:探究球囊辅助栓塞技术治疗未破裂颅内动脉瘤的有效性和安全性。方法:选择2014年1月~2019年1月在本院介入诊疗科接受介入治疗的540例患者作为研究对象。根据治疗方案分为两组,球囊辅助栓塞组有340例,单纯栓塞组有200例。回顾性分析研究对象的一般资料、临床资料、手术并发症等情况。结果:球囊辅助栓塞组和单纯栓塞组在性别组成、年龄、颅内动脉瘤性质、位置、Hunt-Hess分级等方面,差异不具有统计学意义(P>0.05);在术后即刻及术后6个月血管造影结果显示,前者栓塞程度明显优于后者,两组差异具有统计学意义(P<0.05);前者改良Rankin量表评分明显优于后者,两组差异具有统计学意义(P=0.005);前者预后良好率明显高于后者,两组差异具有统计学意义(P<0.001);手术过程中,球囊辅助栓塞组发生2例破裂出血、2例脑血管痉挛、1例弹簧圈移位,单纯栓塞组发生2例破裂出血、1例栓塞、2例脑血管痉挛、3例弹簧圈移位。前者并发症发生率明显低于后者,两者差异具有统计学意义(P<0.001)。结论:在治疗未破裂颅内动脉瘤方面,球囊辅助栓塞技术的有效性、安全性明显优于单纯栓塞介入治疗,值得临床推广。