鼻泪管阻塞的内涵管治疗

目的介绍鼻泪管阻塞的内涵管治疗。方法对9例11只鼻泪管阻塞（鼻泪管与泪囊连接处）置放Song601型内涵管治疗，按Song方法顺行引入导丝，逆行放入内涵管。术前与术后做泪囊造影。结果所有鼻泪管在术后造影均通畅，最长随访日为377天，放内涵管前，所有病例均有Ⅳ～Ⅴ度流泪程度，放内涵管后半年内，10只（91％）流泪明显好转，其中7只完全正常；1只5个月后无效，取出内涵管重新置放，症状消失至今3个月。结论介入治疗界泪管阻塞是一种安全、简单及有效的方法，不影响局部解剖结构。     

恶性胆管梗阻内照射支架植入术的护理体会

目的 探讨恶性胆管梗阻内照射支架植入术后相关护理的辅助价值.方法 12例临床诊断明确的恶性胆管梗阻患者,在进行内照射支架植入术前及术后实施心理护理、饮食护理、穿刺点护理、并发症的观察与护理等方法,确保手术顺利进行及术后患者尽早康复.结果 所有患者术前心态平和;对6例由于缺乏疾病认知而存在紧张焦虑心理的患者采取相应的护理方案,确保了手术顺利进行.对于术后出现的呕吐、发热的患者采取呕吐姿势指导、心理护理,所有患者均未出现感染、胆管穿孔等严重并发症.结论 对于行胆管内照射支架置入的患者,细致的术前心理护理,有效的术后护理对减少并发症、保证手术成功及缩短住院时间具有重要的作用.     

经皮肝途径胆道内支架置入术治疗恶性胆管梗阻(附57报告)

目的：经皮肝穿肝胆管内置入金属支架治疗恶性胆管梗阻并探讨其 点和影响疗效的因素。方法：57例恶性胆管梗阻，采用经皮肝穿刺肝管胆道内金属支架置入术，胆管癌25例，胰头癌9例，肝癌15例，胃癌转移8例。阻塞部位们于胆总管33例；肝门部24例，其中肝总管13例，累有右肝管5例，左、右肝管6例。结果：共置入4种类型金属支架65枚，9例病人置入双内支架。技术操作成功率98．2％。术前血清胆红素162．7－960．4μmol/l，术后53例降至18．3－55．6μmol/l。半年生存率75．4％（43．57），一年生存率47．4％（27／57）。支架置入后半年再 阻塞率43．9％（25／57）。结论：经皮肝穿胆道内支架置入术治疗恶必理管梗阻安全、有效，是临床重要姑息性治疗手段，支架再阻塞是影响远期疗效的重要因素。     

鼻泪管植管治疗婴幼儿先天性鼻泪管阻塞104例

目的观察鼻泪管植管治疗婴幼儿先天性鼻泪管阻塞的临床疗效。方法对104例（118眼）先天性鼻泪管阻塞的婴幼儿用鼻泪管植管治疗进行观察。结果 104例（118眼）先天性鼻泪管阻塞全部治愈,有效率100.00%,治愈率94.06%。结论鼻泪管植管操作方便,对泪道无损伤,治疗婴幼儿先天性鼻泪管阻塞效果良好。     

梗阻性黄疸介入治疗的临床价值（附30例分析）

目的探讨梗阻性黄疸介入治疗的临床价值.方法30例梗阻性黄疸患者在经皮穿刺胆道造影后进行介入治疗,其中PTCD19例,PTCD+胆道内支架11例,共使用金属支架16枚.结果全组技术成功率100%,其中28例(占93.3%)黄疸消退满意,治疗前后血清总胆红素相差的均数±标准误差为205.3±93.4μmol/L,P＜0.01,直接胆红素相差的均数±标准误差为133.8±57.1祄μmol/L,P＜0.01.2例因梗阻复杂及术后胆道感染,效果不满意.全组30天病死率3.3%(1/30).结论经皮胆道内支架置入术和PTCD是姑息性治疗梗阻性黄疸的安全有效方法.     

Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes

Renal artery stenosis is a common, progressive cause of hypertension and renal impairment, and is frequently treated with percutaneous transluminal dilatation and stenting. The outcome of this procedure is still being evaluated. The records of 198 consecutive patients who had stents inserted at the Royal Melbourne Hospital were analysed retrospectively, and adequate follow-up information on 148 (75%), in whom a total of 182 renal arteries had been treated was obtained. Technical success was achieved in 144 patients (97%). Complications occurred in 19 patients (13.3%), with major complications occurring in 10 (7.0%) and one death occurring in relation to the procedure. A fall in average systolic blood pressure of 13.2 mmHg (12.1-14.3 mmHg) was seen and a fall in diastolic blood pressure of 10.1 mmHg (9.3-10.9 mmHg), without an increase in the number of antihypertensive drugs used. Renal function remained stable in the majority of patients, particularly those who had minimal baseline renal impairment. Restenosis was common after 6 months, occurring eventually in 29% of screened patients, but was not shown to affect clinical outcomes. Insertion of renal artery stents is a safe and effective treatment for renal artery stenosis.     

Endovascular treatment of a pulmonary artery pseudoaneurysm with a stent graft: report of two cases

Two patients with hemoptysis secondary to pulmonary artery pseudoaneurysm were treated by endovascular placement of stent grafts. Aneurysms were effectively excluded and hemoptysis stopped. Stent grafts were occluded in both patients. However, endovascular treatment of the pulmonary artery pseudoaneurysm with a stent graft is a safe alternative to coil embolization or surgery.     

内照射支架与普通支架治疗晚期食管癌并发症观察——附32例分析

目的 比较分析食管内照射支架与普通支架治疗中晚期食管癌的并发症.方法 中晚期食管癌32例,分为内照射支架置入组15例;普通支架置入组17例.术后定期随访临床并发症,随访内容包括发热、严重胸痛、咳嗽、食管穿孔、肺炎、出血、支架移位及支架再狭窄等.结果 内照射支架组和普通自膨式支架组间在支架置入后,发热、胸痛、食管穿孔、出...     

经皮肝穿刺胆道引流术及胆管内支架植入术在恶性梗阻性黄疸治疗中的应用

目的 评价经皮肝穿刺胆道引流(FTBD)及胆管内支架植入术(PTIBS)治疗恶性梗阻性黄疸的疗效.方法 对56例恶性梗阻性黄疸患者采取PTBD或PTIBS,所有患者均经B超、CT或MRI明确诊断,并确定梗阻部位,其中高位梗阻19例,低位梗阻37例.梗阻原因包括肝癌14例,胆管癌11例,胆囊癌5例,胃癌伴淋巴结转移14例,壶腹部占位1例,胰头癌11例.术中根据造影结果选择合适方案.结果 所有56例均成功完成手术.其中行PTBD 11例,PTIBS 40例,PTBD并PTIBS 5例.TBIL由术前(295.65 ±152.86)μmol/L降至术后(151.05 ± 107.36)μmol/L(P<0.01).术后感染对黄疸消退有影响(P<0.01).梗阻部位与黄疸消退情况比较差异无统计学意义(P=0.063).结论 经皮肝穿刺胆道引流及支架植入术治疗恶性梗阻性黄疸安全有效,可明显减轻黄疸,改善患者生活质量,延长生存期.     

经胆道支架置入放射性粒子条治疗恶性胆道梗阻

目的探讨经胆道支架置入放射性粒子条治疗恶性胆道梗阻的疗效。 方法38例恶性胆道梗阻的患者,应用¹²⁵I粒子,每个¹²⁵I粒子长4.5 mm、直径0.8 mm,送入导管制备粒子条。先行经皮肝穿刺胆道引流（PTCD）术;导丝经皮通过梗阻段,先行球囊导管扩张,后行经皮胆道支架成形术;然后经支架置入8～10F胆道引流管;再将装有粒子条的导管在透视下经胆道引流管送入所需照射部位,包敷固定引流管体外部分或包埋于皮下。 结果38例中36例成功施行经皮胆道支架成形术及放射性粒子条置入术,术后患者的胆红素均降至正常或接近正常（P<0.05）,未出现明显不良反应。 讨论经皮胆道支架成形术后联合放射性粒子条置入术治疗恶性胆道梗阻是一种安全有效的方法。     

Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results

OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy of polyurethane stent placement in adults with nasolacrimal duct obstruction. SUBJECTS AND METHODS: Polyurethane stents were placed under fluoroscopic guidance in 52 eyes of 49 patients (mean age, 43 years) with severe epiphora due to idiopathic nasolacrimal duct obstruction. The obstruction was complete in 44 eyes and partial in eight. Clinical success was defined as complete resolution of or great improvement in the symptoms of epiphora and the patency of the lacrimal system to irrigation. Mean follow-up was 23 months (range, 14-44 months). RESULTS: Stent placement was technically successful in 50 eyes (96%). The mean fluoroscopy screening time was 2.2 min (range, 0.2-5.8 min). Two patients were lost to follow-up. Clinical success was obtained in 33 (69%) of 48 eyes. Lacrimal symptoms developed in 23 (70%) of these 33 eyes at least once during the follow-up, but these patients responded well to topical drug treatment and lacrimal irrigation. External dacryocystorhinostomy was performed in 13 eyes after failure of the stents. At surgery, lacrimal sacs were shrunken, hyperemic, and fragile in all eyes, making it difficult to anastomose with nasal mucosa. Histologic examination showed granulation tissue and chronic inflammation of the sac epithelium. CONCLUSION: The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.     

经皮经肝途径肠道支架植入术治疗恶性输入袢梗阻1例

输入袢梗阻(afferent loop obstruction,ALO) 是胃肠吻合术后的罕见并发症之一[1].肿瘤的复发或转移是恶性ALO 的常见病因[1-2].现报道1 例恶性ALO 患者,行经皮经肝肠道支架植入术治疗,疗效满意.     

Bronchogastric fistula successfully treated with the insertion of a covered bronchial stent

Ohne Zusammenfassung     

Percutaneous transhepatic biliary drainage for malignant biliary obstruction: a report of two cases with five year survival.

We report two cases of malignant biliary obstruction in whom percutaneous transhepatic biliary drainage has contributed to patient survival of more than 5 years. To our knowledge, this represents the first such case report in the literature. Both patients suffered biliary obstruction from poorly differentiated adenocarcinoma, in all likelihood from the head of the pancreas. Morbidity has been low with only two episodes of significant sepsis and one episode of GI haemorrhage in one patient and both patients were able to enjoy an excellent quality of life. These cases demonstrate that percutaneous biliary drainage has a place not only in the short term palliation of patients with malignant biliary obstruction, but in the long term as well.     

MR findings in thyroglossal duct cysts: report of two cases

Two patients with thyroglossal duct cysts have been studied with CT and MR. The typical CT feature of these cystic upper-neck lesions are depicted in literature, conversely MR findings are not well known. The homogeneous high intensity on T1-weighted images, higher than simple cyst or fluid, is the most typical feature of the thyroglossal cyst.     

Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization

Introduction

Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization.

Methods

Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2.

Results

Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases.

Conclusion

Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA.