颅内动脉瘤栓塞术的临床分析*

摘要目的：用动脉瘤栓塞体积比评价颅内动脉瘤栓塞术的治疗效果,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<0.05),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<0.05),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。     

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。     

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。     

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。     

颅内动脉瘤夹闭术、血管内栓塞术治疗颅内动脉瘤的疗效及安全性研究

目的:探讨颅内动脉瘤夹闭术、血管内栓塞术治疗颅内动脉瘤的疗效及安全性。方法:回顾性分析2016年9月-2019年1月接受手术治疗的76例颅内动脉瘤患者的临床资料,根据手术方式的不同分为接受颅内动脉瘤夹闭术治疗的A组40例和接受血管内栓塞术治疗的B组36例。对比两组患者的动脉瘤完全闭合率、住院费用及血清炎性因子[C反应蛋白(CRP)、白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、脑氧饱和度水平及日常生活能力量表(ADL)评分值,记录并发症发生情况。结果:两组患者的动脉瘤完全闭合率比较差异无统计学意义(x~2=0.515,P=0.473)。A组患者的住院费用低于B组患者(t=17.732,P=0.000);A组患者术后血清中CRP、IL-1β、IL-6、TNF-α的水平高于B组(t=10.580、12.904、9.355、19.176,P均=0.000);A组患者术后脑氧饱和度水平低于B组(t=2.113,P=0.019),两组ADL评分值的差异无统计学意义(t=1.211,P=0.115);A组术中再破裂、脑血管痉挛发生率高于B组患者(x~2=4.817、5.383,P=0.028、0.020)。结论:颅内动脉瘤夹闭术应用于颅内动脉瘤患者,动脉瘤完全闭合率与血管内栓塞术无明显差异,住院费用更低,但对目标血管的刺激较大,可能存在术中再破裂、脑血管痉挛等风险。     

血管内介入术可有效治疗颅内后循环动脉瘤

针对颅内动脉瘤的发病特征,血管内介入术的治疗效果及相应并发症,讨论其安全性及有效性。回顾并分析南华大学附属第二医院在2013年1月至2016年9月期间治疗的71例后循环颅内动脉瘤患者临床数据及相关资料,其中包括糖尿病史、高血压病史、饮酒史、吸烟史等既往史;性别、年龄、民族;头痛、恶心、头晕、意识障碍、呕吐等临床症状;入院检查Hunt-Hess等级,改良的Fisher等级、动脉瘤数目、动脉瘤部位、动脉瘤形态、入、出院的mRS预后评估等级、造影复查及手术后动脉瘤栓塞的程度Raymond等级等,对以上相关资料进行相应统计分析。研究发现,出院时mRS评分值在0~2分之间的患者占总数的87.4%,入/出院时mRS的评分值存在明显差异(χ~2=12.06;p=0.001);后循环颅内动脉瘤的治疗过程中栓塞术具有有效性(χ~2=8.15;p=0.017)。颅内后循环能达到完全栓塞效果,能有效的降低术后再次出血及复发率,因此血管内治疗颅内动脉瘤是一种相对安全又有疗效的治疗手段。与介入并发症相关的因素包括术中药物的选择、术中血压血、管内操作时间以及脑组织缺血时间等。     

栓塞和夹闭治疗对颅内动脉瘤患者认知功能的影响

目的:评估血管内栓塞治疗和显微手术夹闭两种治疗方法对颅内动脉瘤患者认知功能的影响。方法:选取2014年3月至2015年9月重庆市中医院神经外科收治的颅内动脉瘤患者80例,按随机数字表法分为对照组和实验组各40例,对照组采用显微手术夹闭治疗,实验组采用血管内栓塞治疗。应用简易精神状态检查量表(MMSE)评估术后认知功能,并对比两组住院时间、院内死亡率和1年死亡率以及术后不良反应发生率。结果:实验组MMSE总分为(26.78±0.85)分,高于对照组的(22.25±0.63)分(P0.05);实验组认知功能障碍率为37.50%,低于对照组的55.00%(P0.05);实验组住院时间为(6.7±3.9)天,低于对照组的(9.6±4.5)天(P0.05),两组院内死亡率和1年死亡率比较无统计学差异(P0.05);两组术后不良反应发生率比较无统计学差异(P0.05)。结论:血管内介入治疗可改善颅内动脉瘤患者治疗后的认知功能,缩短住院时间。     

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。     

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。     

颅内动脉瘤患者介入栓塞手术时机探讨及其预后的影响因素分析

目的:探讨颅内动脉瘤患者介入栓塞的手术时机及其预后的影响因素。方法:纳入安徽医科大学附属阜阳医院和安徽医科大学第一附属医院2015年5月～2017年5月收治的颅内动脉瘤患者130例,均行介入栓塞术治疗。根据手术时机分成早期组(n=78)、延期组(n=52)。早期组在发病芨3 d行手术,延期组在发病3 d行手术。比较两组术后动脉栓塞程度、并发症与2年内预后情况。根据预后分成良好组和不良组,采用多因素Logistic回归分析患者预后的影响因素。结果:早期组完全栓塞率为88.46%,高于延期组的73.08%,差异有统计学意义(P0.05)。两组动脉瘤出血、肢体障碍、意识障碍、穿刺处感染、脑积水、电解质紊乱发生率比较无显著差异(P0.05)。早期组预后良好率为79.49%,显著高于延期组的63.46%(P0.05)。不良组术前格拉斯哥预后评分(GOS)≤3分、延迟期手术、瘤体位于后循环、高血压、糖尿病、Hunt-Hess 3～5级、FisherⅢ～Ⅳ级占比显著高于良好组(P0.05)。多因素Logistic回归分析结果提示术前GOS评分≤3分、延迟期手术、瘤位置在后循环、高血压、糖尿病、Hunt-Hess3～5级、FisherⅢ～Ⅳ级是患者预后的危险因素(P0.05)。结论:颅内动脉瘤患者早期行介入栓塞术,能提高完全栓塞率,改善预后,患者预后不良主要与术前GOS评分、手术时机、瘤位置、高血压、糖尿病、Hunt-Hess分级、Fisher分级有关。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418