动脉粥样硬化所致髂-股动脉狭窄或闭塞的血管腔内介入治疗

目的 探讨动脉粥样硬化所致慢性下肢缺血通过髂-股动脉腔内介入治疗的可行性和疗效.方法 15例患者经多排螺旋CT下肢血管造影证实为动脉硬化性髂.股动脉狭窄或闭塞性病变行经皮腔内成形术(PTA)和支架植入术.通过术后血管造影及临床症状改善等来评价治疗效果.PTA术后病变段血管残余狭窄<30%被认为技术成功;按照Fontaine分型治疗后临床症状改善1级或1级以上被认为临床成功.结果 经同侧逆行PTA及支架植入术5例,共计6段同侧髂动脉血管.包括植入髂动脉支架3枚、3段髂动脉行VFA术;跨主动脉对侧髂.股动脉PTA及支架植入术10例,共计20支病变血管,包括植入髂动脉支架5枚、股浅动脉支架5枚、10支股动脉行PTA术.髂股动脉支架、成形术后重复血管造影证实所有病变段血管血流明显改善,技术成功率为100%,无血管夹层及血栓形成等并发症.临床随访2～24个月,平均11.9个月,术前及术后6个月踝臂指数测定差异具有统计学意义(t=-4.64,P<0.01).术后6个月Fontaine分型提高1、2和3级的患者分别有7、5和3例,所有患者均未施行截肢(趾)术,随访期间临床有效率为100%.结论 动脉粥样硬化性髂-股动脉狭窄或闭塞的腔内介入治疗是一种安全、有效的治疗方法,能够改善患者的生存质量,及早改善下肢外周动脉病患者的血运状况,为中长期保肢提供较好途径.     

锁骨下动脉狭窄或闭塞支架治疗中期疗效评价

目的 评价血管支架治疗锁骨下动脉狭窄或闭塞的中期临床疗效.方法 经彩超、CTA明确诊断的31例锁骨下动脉狭窄或闭塞患者,其中狭窄18例(19条),闭塞13例(13条).导丝开通病变血管后置入支架.术后问诊及彩色多普勒超声进行随访.结果 除4例闭塞血管开通失败外,27例共计28条病变动脉共成功置入28枚支架.术后患者症状、体征均明显改善.术前有锁骨下动脉窃血征象14例,术后12例消失.27例随访6～62个月(平均24.0个月±16.5个月).术后3例患者再狭窄:1例发生于术后9个月,经PTA后随访12个月血管开放良好;1例术后10个月,PTA后随访8个月开放良好;1例术后12个月再狭窄,转为外科搭桥手术.1例大动脉炎术后8个月死于脑出血;1例术后14个月死于脑梗死.余均无症状、体征再发,多普勒超声提示血管通畅.结论 血管支架可安全、有效治疗锁骨下动脉狭窄/闭塞并有良好中期疗效.     

颅内椎基底动脉狭窄的支架成形术治疗

目的　初步总结血管内支架成形术治疗颅内椎基底动脉狭窄的经验 ,探讨治疗的可行性、安全性及有效性 ,分析技术要点和围手术期处理。方法　 2 2例 2 3个颅内椎基底动脉狭窄进行了支架植入扩张成形治疗 ,其中颅内段椎动脉狭窄 10个 ,基底动脉狭窄 13个 ,术前平均狭窄程度 (72 .4±11.3 ) % (5 0 %～ 90 % ) ,平均狭窄长度 (6.8± 3 .1)mm(3～ 12mm) ,植入球囊扩张支架 2 3枚 ,作临床及造影随访。结果　 2 3个狭窄支架植入均成功 ,狭窄率降低到 (9.3± 5 .2 ) % ,无夹层动脉瘤、血管破裂、支架内急性闭塞并发症 ,手术造成缺血性小卒中 1例 (4.5 % ) ,无死亡。临床随访 3～ 2 4个月 ,无脑缺血性事件发生 ,血管造影随访 10例 ,无再狭窄发生。结论　症状性颅内椎基底动脉狭窄的血管内支架成形治疗是一种有效、安全的方法 ,但远期结果仍需要进一步随访     

药物洗脱支架治疗椎基底动脉狭窄

目的总结应用药物洗脱支架治疗椎基底动脉狭窄的经验,探讨其近、中期疗效、安全性及预防再狭窄的作用。方法27例患者均为反复短暂性脑缺血发作(TIA)或脑梗死后恢复良好,狭窄程度在50%以上且常规药物治疗无效。在局麻或全麻下,采用直接支架成形术进行治疗。术后常规给予抗血小板聚集治疗,并定期进行临床和影像学随访。结果27例患者28处脑动脉狭窄采用药物洗脱支架进行治疗,其中27处成功植入药物洗脱支架(Cypher支架24枚,Taxus支架2枚,Firebird支架1枚)。平均狭窄程度从术前(74．5±6．7)%减少到(8．7±4．4)%。2例发生穿支血管闭塞症状。术后临床随访2～14个月,无一例患者出现TIA或卒中复发。14例患者接受血管造影随访,随访时间为3～18个月,1例支架近端狭窄(＜50%),无一例支架内再狭窄。结论短期结果显示应用药物洗脱支架治疗脑供血动脉狭窄是安全和有效的,但长期疗效有待于进一步观察。     

血液透析患者中心静脉狭窄的介入治疗

目的探讨血液透析患者中心静脉狭窄介入治疗的方法及疗效。方法 2010年5月至2011年11月共收治20例发生中心静脉狭窄的血液透析患者,所有患者均具有中心静脉狭窄的临床症状、体征,并行MRA或CTA明确诊断,经静脉造影明确病变长度、范围和程度,行血管球囊扩张成形术(PTA)对病变部位进行治疗,成形术失败时,行血管支架植入术。术后随访患者的临床症状、MRA、超声等影像学检查。结果所有患者均成功行静脉造影,成功处理了20例患者共17条狭窄静脉,其中成功进行PTA 15例,支架植入成功2例,术后狭窄静脉血管通畅,侧支循环消失。首次PTA后再狭窄发生率为11.8%,再次行P1A。所有手术成功病例随访至今未出现再狭窄。结论血液透析患者中心静脉狭窄的介入治疗安全、有效,静脉通畅率良好。     

介入治疗急性髂总动脉和肢体动脉栓塞的临床研究

目的：探讨急性髂总动脉和肢体动脉栓塞血管内治疗的方法和疗效。方法：采用血管内尿激酶溶栓术11例，8例腘动脉狭窄9段，3例髂外动脉狭窄6段；经皮穿刺血管成形术(PTA)8例，2例髂总动脉狭窄3段，6例股动脉狭窄10段。支架置入1例为髂外动脉狭窄。共治疗患者20例28段。男16例，女4例，年龄30～83岁，平均56岁。结果：溶栓治疗成功率66．67％(10／15段)，PTA治疗成功率92．31％(12／13段)，支架置入术成功1例(1／1)。结论：采用血管内局部溶栓和PTA、支架置入是治疗急性髂总动脉和肢体动脉栓塞安全、有效的方法。     

血管支架成形术治疗症状性大脑中动脉狭窄

目的研究血管内支架成形术治疗症状性大脑中动脉狭窄的疗效及安全性。方法对27例症状性大脑中动脉狭窄患者行血管腔内成形术。结果27例患者中,24例成功置入冠脉支架,术后即刻造影显示狭窄程度为(8±4)%,较术前(80±19)%改善明显。2例因支架置入困难改行经皮血管腔内成形术(PTA)。平均随访18个月。25例患者术后短暂性脑缺血发作均未发生。无责任血管区新发脑梗死。1例支架置入后3h发生再灌注性脑出血。1例支架脱落后于颈内动脉虹吸部,后用抓捕器取出。1例支架置入术后6个月发生再狭窄。结论经皮血管内支架成形术是治疗症状性大脑中动脉狭窄的一种较安全有效的方法。长期疗效有待于进一步观察。     

血管内支架成形术治疗颅内动脉狭窄

目的:探讨颅内动脉狭窄血管内球囊支架成形术的可行性、安全性及其疗效。方法:17例患者术前3天给予阿司匹林300mg/天和噻氯吡啶250mg/天,6F(Envoy)导引导管放置到颈内动脉远段或椎动脉近颅底段,造影获得工作位,评价血管狭窄程度:狭窄率=(1-狭窄处管径/狭窄远端管径)×100%,微导丝在路途导引下通过颅内动脉狭窄段,向远端直至P2或M2段,确保足够的支撑力。选择支架大小的依据为狭窄远端正常血管的直径,导丝引导下支架通过狭窄部位,造影确定支架位置正确,充盈球囊至5～6大气压,支架释放后造影确认展开良好,回撤球囊,无并发症,操作完毕。随访3～10月。结果:17例患者颅内动脉狭窄处植入支架,技术成功100%,造影显示狭窄由术前(78.3±12.9)%降至术后(6.8±7.3)%,狭窄的动脉管径恢复,短期随访(3～10个月)显示很好临床效果。术中出现一例蛛网膜下腔少量出血(SAH),对症治疗痊愈。6例随访造影未见血管再狭窄。结论:颅内动脉狭窄支架植入增加血管内径,改善血流量,减轻临床症状,是一种安全、可行有效的治疗方法。     

肾移植急性动脉狭窄的影像学表现及介入治疗

目的探讨肾移植急性动脉狭窄的影像学表现及介入治疗的价值。资料与方法 15例肾移植动脉狭窄患者均有高血压和肾功能不良。均采用股动脉插管造影,明确诊断后行球囊扩张(PTA)和/或置入支架。结果15例中,6例行PTA治疗,9例行支架置入,操作全部成功。6例PTA治疗者中2例术后1个月出现再狭窄,行支架置入;9例支架置入者1年内有1例出现再狭窄。15例肾移植动脉狭窄患者介入治疗后均有血压下降和肾功能改善。结论肾移植动脉狭窄分为受体动脉狭窄、供体肾动脉狭窄和吻合口狭窄。血管造影是诊断肾移植动脉狭窄的金指标。介入治疗应作为肾移植急性动脉狭窄的首选疗法。     

腹腔动脉狭窄的介入治疗

目的报道用介入方法治疗2例腹腔动脉(CA)狭窄的疗效。方法2例患者有长期进餐后腹痛、伴有体重下降和上腹部血管杂音,Doppler超声提示CA狭窄,经腹主动脉造影证实。1例CA狭窄为典型膈肌中脚综合征(MALs),另1例狭窄为动脉粥样硬化所致。介入技术包括常规经皮经腔血管成型(PTA)和支架置入术。结果腹主动脉造影显示2例均为重度CA狭窄,狭窄程度大于90％。术中做PTA和支架置入,1例用球囊扩张式Palmaz支架、1例用Wallstents,术后造影显示CA血流通畅。Dopplex。超声随访提示CA血流速度正常。术后3个月随访,患者症状消失、体重增加;分别随访16、26个月,无再狭窄证据。结论PTA和支架置入是治疗CA狭窄的安全、有效方法。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控通路以及与肿瘤发生发展关系的研究进展作一综述.     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.