Interventional embolization

介入栓塞
  • 文章类型: Journal Article
    这项研究旨在评估肝硬化患者的安全性和有效性的介入栓塞与大量自发性门体分流(SPSS)相关的难治性肝性脑病(HE)。采用治疗加权的逆概率(IPTW)来最小化潜在偏差。本研究共纳入123例患者(栓塞组34例,对照组89例)。在未经调整的队列中,栓塞组表现出明显更好的肝功能,较大的SPSS总面积,血清氨水平>60µmol/L且存在肝细胞癌(HCC)的患者比例较高(均P<0.05)。在IPTW队列中,两组基线特征具有可比性(均P>0.05)。在未调整队列和IPTW队列中,与对照组相比,栓塞组患者的无HE生存期明显更长(均P<0.05)。随后的亚组分析表明,血清氨水平>60μmol/L的患者,门静脉主干内的肝血流,孤立的SPSS的存在,基线HE等级为II级,基线时未出现HCC,栓塞治疗具有统计学意义(均P<0.05)。栓塞组未出现早期手术并发症。术后远期并发症发生率与对照组相当(均P>0.05)。因此,对于伴有大SPSS的难治性HE的肝硬化患者,介入栓塞似乎是一种安全有效的治疗方式。然而,栓塞的益处仅在特定的患者亚组中可见.
    This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.
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  • 文章类型: Case Reports
    背景:血管畸形(VMs)是由于血管生成过程中的错误而产生的,通常在出生时就存在,但直到出生后才会变得明显。然而,头部和面部的巨型VM并不常见,报告的病例很少,和他们的手术干预的预后尚不清楚。
    方法:一名12岁女孩因右侧颞叶头皮增大而入院。入院后,脑动脉的计算机断层扫描(CT)血管造影显示右咬合间隙和右颞动脉静脉畸形。此外,脑血管造影显示右颞叶VM有多个血管供血。患者接受手术以移除畸形血管和侵蚀的头骨。手术后两小时,病人的右瞳孔扩大了,颅骨的紧急CT扫描显示切口下右侧硬膜下血肿,被第二次手术紧急移除。手术后,我们连续给予抗生素抗感染治疗,病人恢复良好,两周后出院。
    结论:手术切除巨大血管瘤是有风险的,应做好术前(包括介入栓塞)和术中准备。
    BACKGROUND: Vascular malformations (VMs) arise as a result of errors in the process of angiogenesis and are usually present at birth, but may not become apparent until after birth. However, giant VMs of the head and face are uncommon, with few reported cases, and the prognosis for their surgical intervention is unclear.
    METHODS: A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp. After admission, computed tomography (CT) angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation. Furthermore, cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood. The patient underwent surgery to remove the malformed vessels and the eroded skull. Two hours after the surgery, the patient\'s right pupil was dilated, and an urgent CT scan of the skull showed a right subdural haematoma under the incision, which was urgently removed by a second operation. After surgery, we gave continuous antibiotic anti-infection treatment, and the patient recovered well and was discharged two weeks later.
    CONCLUSIONS: Surgical removal of giant haemangiomas is risky and adequate preoperative (including interventional embolisation) and intraoperative preparations should be made.
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  • 文章类型: Journal Article
    背景:慢性硬膜下血肿(CSDH)患者中脑膜中动脉栓塞(MMAE)被认为安全的中线移位(MLS)量尚未确定。MMAE是否可以用作单侧大CSDH患者的早期治疗,MLS显著(>1cm)尚未报道。
    目的:探讨MMAE对MLS>1cm的单侧大CSDH患者的疗效和安全性。
    方法:在2021年5月1日至2022年8月31日期间,11名精心挑选的轻度或中度症状和显著MLS>1cm的CSDH患者被纳入研究。所有患者均使用聚乙烯醇(PVA)颗粒进行MMAE治疗。临床评估结果并在随访时进行间隔成像研究。
    结果:所有19例MMA(3例患者单侧栓塞,8例患者双侧栓塞)均成功栓塞。所有11名患者均接受了随后几个月的随访,并且没有CSDH的复发和扩大。程序性不良事件,死亡率,或未观察到并发症。MLS减少50%的平均时间约为四周,而花了大约八周的时间才能使最大体积减少50%。所有11例患者在术后3天神经系统症状均有改善,包括四名偏瘫患者。
    结论:MMAE可能在精心选择的具有明显中线移位(MLS>1cm)的CSDH患者中显示出安全性,特别是那些不适合手术的人,从而提供了一种潜在的替代方法。
    BACKGROUND: The amount of midline shift (MLS) considered safe for middle meningeal artery embolization (MMAE) in patients with chronic subdural hematoma (CSDH) has not been established. Whether MMAE could be used as upfront treatment for unilateral large CSDH patients with significant MLS (>1 cm) has not been reported.
    OBJECTIVE: To investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.
    METHODS: Eleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.
    RESULTS: All 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.
    CONCLUSIONS: MMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.
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  • 文章类型: Case Reports
    先天性肝内门体分流是一种极为罕见的血管畸形,其异常分流道连接肝内门静脉与肝静脉或下腔静脉,导致部分血液绕过肝脏直接进入体循环从而引发高氨血症、高半乳糖血症等,严重者并发肝肺综合征、肺动脉高压、肝性脑病,治疗较为棘手。现报道1例以肝肺综合征为首发表现的先天性肝内门体分流V型患儿,应用Amplatzer血管塞Ⅱ型成功介入栓塞的案例,术后1d复查血氨降至正常,术后6个月患儿缺氧症状消失,临床指标改善。以期加深对该病的认识,提示介入治疗可作为部分患儿的首选治疗方案。.
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  • 文章类型: Journal Article
    UNASSIGNED: To analyzes the changes in serum levels of matrix metalloproteinase-9 (MMP-9), neuroenolase (NSE), myeloperoxidase (MPO) and prognostic factors in patients with intracranial aneurysm (IA) undergoing interventional embolization at different treatment times.
    UNASSIGNED: A retrospective analysis was made of 200 IA patients admitted to our department from January 2018 to June 2021 was performed. All patients underwent interventional embolization. According to the timing of surgery, the patients were divided into an early group (n=120, onset to surgery ≤72 h) and a delayed group (n=80, onset to surgery >72 h). The effect of embolization, complications and neurological deficit scale (NDS) scores were compared between the two groups. Serum MMP-9, NSE and MPO levels were compared before and after surgery, and the prognosis of all patients within 2 years after surgery was assessed by the Glasgow outcome scale (GOS) and divided accordingly into the good prognosis group (n=147) and the poor prognosis group (n=53) accordingly, and the prognostic factors influencing the patients were analyzed univariately and multifactorially.
    UNASSIGNED: Cilj je bio da se analiziraju promene u serumskim nivoima matriks metaloproteinaze-9 (MMP-9), neuroenolaze (NSE), mijeloperoksidaze (MPO) i prognostičkih faktora kod pacijenata sa intrakranijalnom aneurizmom (IA) koji su podvrgnuti interventnoj embolizaciji u različitim vremenima lečenja.
    UNASSIGNED: Urađena je retrospektivna analiza 200 pacijenata sa IA koji su primljeni na naše odeljenje od januara 2018. do juna 2021. godine. Svi pacijenti su podvrgnuti interventnoj embolizaciji. Prema vremenu operacije, pacijenti su podeljeni u ranu grupu (n=120, početak operacije ≤72 h) i odloženu grupu (n=80, početak operacije >72 h). Efekat embolizacije, komplikacije i rezultati skale neurološkog deficita (NDS) su upoređeni između dve grupe. Nivoi MMP-9, NSE i MPO u serumu su upoređeni pre i posle operacije, a prognoza svih pacijenata u roku od 2 godine nakon operacije procenjena je Glasgov skalom ishoda (GOS) i prema tome podeljena u grupu sa dobrom prognozom (n=147) i grupa sa lošom prognozom (n=53) shodno tome, a prognostički faktori koji utiču na pacijente analizirani su univarijantno i multifaktorski.
    UNASSIGNED: Nakon operacije, stopa potpune embolije bila je veća u ranoj grupi nego u odloženoj grupi (P<0,05). Nakon operacije, nije bilo statističke značajnosti u poređenju pojedinačnih stopa komplikacija u obe grupe (P>0,05). U 3d, 1 mesec i 6 meseci nakon operacije, rezultati NDS pacijenata u obe grupe su bili niži od onih pre operacije, a poređenje NDS rezultata pacijenata u obe grupe u različitim vremenskim tačkama je bilo statistički značajno ( P<0,05). Posle operacije, nivoi MMP-9, NSE i MPO u serumu su bili niži u obe grupe nego pre operacije, a bili su niži u ranoj grupi nego u odloženoj grupi (P<0,05). Rezultati GOS-a su pokazali da je u roku od 2 godine nakon operacije bilo 97 i 23 slučaja sa dobrom i lošom prognozom u ranoj grupi i 54 i 26 slučajeva sa dobrom i lošom prognozom u odloženoj grupi, respektivno, a stopa dobre prognoze u ranoj grupi grupa je bila veća od one u odloženoj grupi (P<0,05). Multifaktorska analiza je pokazala da su odložena operacija, aneurizma u zadnjoj cirkulaciji, širina vrata aneurizme >4,5 mm, stepen III-IV po Fisheru, stepen III-IV Hunt-Hess i hipertenzija nezavisni faktori rizika za lošu prognozu nakon interventne embolizacije IA (P <0,05).
    UNASSIGNED: Rana interventna embolizacija kod pacijenata sa IA može poboljšati njihovu potpunu stopu embolizacije i smanjiti nivoe MMP-9, NSE i MPO u serumu; odložena operacija, aneurizma u zadnjoj cirkulaciji, širina vrata aneurizme >4,5 mm, Fisher stepen III-IV, Hunt-Hess stepen III-IV i hipertenzija su snažno povezani sa lošom prognozom nakon interventne embolizacije kod pacijenata sa IA.
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  • 文章类型: Journal Article
    本研究探讨医用粘合剂在周围型假性动脉瘤血管内栓塞治疗中的临床应用价值。
    这是一项对2021年7月至2023年7月在石河子大学第一附属医院接受医用粘合剂血管内栓塞治疗的31例周围假性动脉瘤患者的回顾性研究。随访3~6个月,观察医用胶粘剂栓塞治疗的临床疗效及术后并发症。
    在31例周围假性动脉瘤患者中共栓塞了32个假性动脉瘤。所有假性动脉瘤均起源于内脏动脉。其中,仅使用医用粘合剂栓塞29个假性动脉瘤,用线圈辅助医用粘合剂栓塞三个假性动脉瘤。用医用粘合剂进行血管内栓塞后,所有假性动脉瘤均成功栓塞.技术成功100%。所有患者使用医用粘合剂进行血管内栓塞后出血停止,术后无严重并发症。临床成功率为100%。在后续期间,2例患者经历了复发性出血,但未观察到假性动脉瘤复发.
    血管内药物粘连栓塞是治疗假性动脉瘤的一种安全有效的方法,具有高止血效率和栓塞后假性动脉瘤的永久闭塞,值得临床推广应用。
    UNASSIGNED: This study explores the clinical application value of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm.
    UNASSIGNED: This was a retrospective review on 31 patients with peripheral pseudoaneurysm treated with medical adhesive endovascular embolization at the First Affiliated Hospital of Shihezi University from July 2021 to July 2023. Follow-up for 3-6 months was to observe the clinical efficacy and postoperative complications of medical adhesive embolization treatment.
    UNASSIGNED: A total of 32 pseudoaneurysms were embolized in 31 patients with peripheral pseudoaneurysms. All pseudoaneurysms originated from visceral arteries. Among them, 29 pseudoaneurysms were embolized with medical adhesive alone, and three pseudoaneurysms were embolized with coil-assisted medical adhesive. After endovascular embolization with medical adhesive, all pseudoaneurysms were successfully embolized. Technical success was 100%. All patients experienced cessation of bleeding after endovascular embolization with medical adhesive, and there were no serious post-operative complications. Clinical success was 100%. During the follow-up period, two patients experienced recurrent bleeding but no pseudoaneurysm recurrence was observed.
    UNASSIGNED: Endovascular medical adhesive embolization is a safe and effective method for treating pseudoaneurysm, with high hemostatic efficiency and permanent occlusion of the pseudoaneurysm after embolization, which is worthy of clinical promotion and application.
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  • 文章类型: Journal Article
    探讨介入栓塞治疗前循环动脉瘤的临床疗效及安全性。
    对2019年6月至2021年12月乐山市人民医院收治的80例前循环动脉瘤患者进行回顾性分析。根据手术方式的不同,分为观察组和对照组。观察组患者给予介入栓塞治疗,对照组给予开颅夹闭。手术疗效,术后神经功能和生活质量,比较两组患者的手术预后及手术并发症。
    观察组术中出血量、住院时间均低于对照组(p<0.05)。观察组术后3个月的Hunt-Hess评分和改良Rankin量表评分均显著低于对照组(p<0.05)。观察组预后良好率高于对照组(p<0.05)。此外,观察组并发症发生率为12.50%,显著低于对照组的32.50%(p<0.05)。
    介入栓塞术显示了微创手术的优势,例如更短的手术时间和更短的住院时间。能显著改善患者的神经功能和生活质量,具有较好的临床安全性,改善患者的预后,减少并发症的发生。
    UNASSIGNED: To investigate the clinical efficacy and safety of interventional embolization in the treatment of anterior circulation aneurysms.
    UNASSIGNED: Eighty patients with anterior circulation aneurysms admitted to People\'s Hospital of Leshan from June 2019 to December 2021 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups: the observation group and the control group. Patients in the observation group were given interventional embolization, while those in the control group were given craniotomy clipping. The surgical efficacy, postoperative neurological function and quality of life, surgical prognosis and surgical complications of the two groups were compared.
    UNASSIGNED: The intraoperative blood loss and hospitalization time in the observation group were lower than those in the control group (p<0.05). The scores of the Hunt-Hess and modified Rankin scale in the observation group were significantly lower than those in the control group three months after surgery (p<0.05). The good prognosis rate of the observation group was higher than that of the control group (p<0.05). Moreover, the complication rate of the observation group was 12.50%, which was significantly lower than 32.50% in the control group (p<0.05).
    UNASSIGNED: Interventional embolization shows the advantages of minimally invasive procedures such as shorter operative times and shorter hospital stays. It has better clinical safety because it can significantly improve the neurological function and quality of life of patients, improve the prognosis of patients, and reduce the incidence of complications.
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  • 文章类型: Journal Article
    基于无水乙醇的介入栓塞方案通常用于外周动静脉畸形(PAVMs),临床医生往往根据分类选择方案。
    评价不同无水乙醇介入栓塞治疗PAVMs的方案
    回顾性研究河南省人民医院2018年1月至2021年5月165例无水乙醇介入栓塞治疗PAVMs患者。PAVM被分类为II型(n=67),根据Yakes分类系统,III型(n=81)和IV型(n=17),包括123个颌面,13个躯干和29个肢体。栓塞的有效性是基于血管造影的PAVM断流术:100%(总),90%~99%(接近总量),70%~90%(实质性),30%~70%(部分)和0%~30%(失效)。
    PAVM被分类为II型(n=67),根据Yakes分类系统,III型(n=81)和IV型(n=17),其中颌面123人(74.55%),躯干13例(7.88%),四肢29例(17.58%)。不同Yakes分级和不同方法间的血管造影结果差异有统计学意义(P<0.05),不同Yakes分级的故障率差异有统计学意义(P<0.05)。
    PAVM通常出现在颌面部,和II型可以通过弹簧线圈和无水乙醇达到更好的效果,而平阳霉素+碘化油+PVA+无水乙醇和弹簧圈+无水乙醇的III型和IV型效果不理想,分别。两者恰好都是并发症,伤口账户最高。
    UNASSIGNED: Interventional embolization schedules based on absolute ethanol are usually used for peripheral arteriovenous malformations (PAVMs), and clinicians often choose the scheme according to the classification.
    UNASSIGNED: To evaluate different interventional embolization schedules based on absolute ethanol for PAVMs.
    UNASSIGNED: A retrospective study was performed of 165 patients with PAVMs treated with interventional embolization based on absolute ethanol in Henan Provincial People\'s Hospital from January 2018 to May 2021. PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial, 13 trunk and 29 limbs. Effectiveness of embolization was based on PAVM devascularization on angiography: 100% (total), 90%~99% (near-total), 70%~90% (substantial), 30%~70% (partial) and 0%~30% (failure).
    UNASSIGNED: PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial (74.55%), 13 trunk (7.88%) and 29 limbs (17.58%). There are statistical differences in the angiographic outcomes among different Yakes classification and between different methods (P < 0.05), and there was a statistical difference in the failure rates among different Yakes classification (P < 0.05).
    UNASSIGNED: PAVMs occur maxillofacial usually, and Type II can achieve better effect by spring coil and absolute ethanol, while Type III and Type IV have no ideal effect by Pingyangmycin + iodized oil + PVA + absolute ethanol and spring coil + absolute ethanol, respectively. Both the two happen to be complications, and wound accounts the highest.
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  • 文章类型: Journal Article
    UNASSIGNED: To investigate the effect of nursing intervention on patients with intracranial aneurysm subarachnoid hemorrhage who underwent interventional embolization.
    UNASSIGNED: According to the random number table method, 80 patients with subarachnoid hemorrhage caused by intracranial aneurysm who received interventional embolization in our hospital from September 2018 to May 2021 were randomly divided into a control group of 40 cases and an observation group of 40 cases. 40 cases, the two groups were implemented routine nursing and humanized nursing.
    UNASSIGNED: Compared with before nursing, the anxiety score, depression score, compliance rate, complication rate and PSQI score of the observation group were significantly lower than those of the control group after nursing (P < 0.05); Karnofsky Performance Status Scale score, Activity of daily living scale of the observation group and quality of life scores were significantly higher than those in the control group (P < 0.05).
    UNASSIGNED: Humanized nursing can effectively improve the psychological state of patients with subarachnoid hemorrhage caused by intracranial aneurysm during the perioperative period of interventional embolization, enhance their compliance with treatment, reduce complications, and make patients more satisfied with nursing services.
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  • 文章类型: Case Reports
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