Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report

We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.

气冷微波固化与传统微波固化杆温对治疗效应影响的比较研究

背景与目的:高杆温限制了传统微波固化的应用与发展。气冷微波固化在该领域目前有所突破。本研究探讨气冷微波固化与传统微波固化有关杆温的应用比较。方法:动物实验,成年猪2头,分别用传统微波及气冷微波进行超声引导经皮瘤内穿刺固化,比较二者在穿刺点皮肤灼伤程度、引导针表面温度、组织粘附天线情况以及凝固灶形态等方面的不同。临床应用,观察5例接受传统微波固化术的肝癌患者与8例接受气冷微波固化术的肝癌患者在疼痛、皮肤灼伤、碳化组织粘附天线以及局部疗效和复发等方面的差异。结果:动物实验:传统微波固化80W×10min,杆温达到119～160℃之间;穿刺点皮肤严重灼伤;拔针后见天线前端有碳化组织粘附;肝内凝固灶有严重拖尾现象。气冷微波固化80W×10min,杆温28.8～39.9℃之间;穿刺点皮肤无红肿等灼伤表现;拔针后天线前端无碳化组织粘附;凝固灶无明显拖尾现象。临床结果:传统微波固化皮肤灼伤率为60%;天线前端碳化组织粘附率是40%;术后所有病例均中至重度上腹疼痛,延续时间1周至2月;肿瘤完全固化率80%;局部复发率20%。气冷微波固化不会引起穿刺点皮肤灼伤;所有病例拔针后天线前端均未见碳化组织粘附;50%患者术后觉上腹轻度疼痛,均于一周内好转;肿瘤完全固化率100%;无局部复发率。结论:气冷却技术可以?

超声引导下血管缝扎并铜针介入栓塞治疗海绵状血管瘤

目的 更准确、有效地对皮下深部软组织中海绵状血管瘤进行铜针介入栓塞治疗。方法 自 2 0 0 1年 8月～ 2 0 0 3年 3月 ,对 18例深部软组织中弥漫型海绵状血管瘤患者 ,在高频彩色超声引导下行粗大或主干血管缝扎和铜针介入栓塞术治疗 ,术后 1～ 2 0个月随访 ,彩超复查对治疗效果进行判定和检测。结果 该组18例均取得较好疗效 ,总有效率 10 0 %。结论 在非创伤性高频彩超引导下皮下深部软组织弥漫型海绵状血管瘤显示清楚 ,粗大血管缝扎和铜针刺入准确、安全有效 ,具有独到之处。

三维超声测定子宫内膜容积预测IVFET结局

目的:评价三维(3D)超声测定子宫内膜容积在预测体外受精胚胎移植(IVFET)结局中的作用。方法:对124例行IVFET的患者在HCG注射当天进行超声测定子宫内膜的厚度和容积。结果:妊娠组(48例)和未妊娠组(76例)在HCG注射当天测得的子宫内膜厚度、内膜容积、子宫容积两组间无统计学差异(P>0.05)。子宫内膜容积和厚度的ROC曲线下面积分别为0.532和0.523。子宫内膜容积<2.0ml的5例患者,无一例发生妊娠。结论:子宫内膜容积和子宫内膜厚度不能预测IVFET结局。但子宫内膜容积测定可指导是否行ET。

超声监导宫腔镜下切除宫内异物

目的 :探讨超声监导宫腔镜下宫内异物切除术的方法。材料与方法 :48例宫内节育器、胚胎或胎盘残留宫腔的患者 ,在常规清宫术或取环术失败后行宫腔镜手术治疗。采用经腹超声、腹腔镜超声和腹腔镜监视手术过程。结果 :在超声监导下 ,2 7例嵌顿节育器全部经宫腔镜取出 ,合并宫腔粘连 3例。切除残留胎骨和残留胎盘 2 1例 ,7例与子宫壁粘连 ,2例植入。结论 :经腹超声是监视经宫颈切除宫内异物的首选方法。

超声监导:宫腔镜子宫成形术

目的:用超声法代替腹腔镜监视宫腔镜子宫成形术。材料与方法:在宫腔镜手术中将膨宫液导入子宫腔并向膀胱内注入生理盐水形成双项对比。在超声监导下经宫颈切除中隔或解除宫腔粘连。结果:切除子宫中隔24例,其中9例已妊娠并生育。5例宫腔粘连患者术后周期性腹痛消失。结论:超声监导宫腔镜子宫成形术,手术时间短、安全、且不需要同时做腹腔镜。

超声对离体前列腺的定量研究

目的 探讨超声如何准确地对前列腺作出定量诊断。方法 ①超声应用三种不同的测量方法 ,即 :测量点从前列腺包膜内、包膜外、包膜内至外 ,分别对其左右径、前后径、上下径进行测量。②实际测量离体前列腺的大小、体积、重量。③应用两种常用公式 :V =π/6×L×W×H、V =4/3π×R1×R2 ×R3,分别对三种不同测量方法的结果进行计算。结果 三种不同测量方法与实际测量结果比较准确性分别为 :包膜内 85 17%、包膜外80 36 %、包膜内至外 96 93 % ,两种公式计算结果无差异。结论 超声对前列腺的测量采用从包膜内至外的方法最为准确。

Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract

AIM:To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.METHODS:A cohort of 1019 patients with suspected malignant lesions adjacent to the gastrointestinal tract received EUS-FNA after a standardized multidisciplinary team evaluation(MTE)and were divided into 4 groups according to their specific malignant risk score(MRS).Patients with a MRS of 0(without detectable risk of malignancy)received only EUS without FNA.For patients with a MRS score ranging from 1(low risk)-through 2(intermediate risk)-to 3(high risk),EUS-FNA cytology of the lesion was planned for a different time and was prioritized for those patients at higher risk for cancer.The accuracy,efficiency and quality assessment for the early detection of patients with potentially curable malignant lesions were evaluated for the whole cohort and in the different classes of MRSs.The time to definitive cytological diagnosis(TDCD),accuracy,sensitivity,specificity,positive and negative predictive values,and the rate of inconclusive tests were calculated for all patients and for each MRS group.RESULTS:A total of 1019 patients with suspected malignant lesions were evaluated by EUS-FNA.In 515patients of 616 with true malignant lesions the tumor was diagnosed by EUS-FNA;421 patients with resectable lesions received early surgical treatment,and 94patients received chemo-radiotherapy.The overall diagnostic accuracy for the 1019 lesions in which a final diagnosis was obtained by EUS-FNA was 0.95.When patients were stratified by MTE into 4 classes of MRSs,a higher rate of patients in the group with higher cancer risk(MRS-3)received early treatment and EUSFNA showed the highest level of accuracy(1.0).TDCD was also shorter in the MRS-3 group.The number of patients who received surgical treatment or chemo-radiotherapy was significantly higher in the MRS-3 patient group(36.3%in MRS-3,10.7%in MRS-2,and 3.5%in MRS-1).CONCLUSION:EUS-FNA can effectively detect a curable malignant lesions at an earlier time and at a higher rate in patients with a higher cancer risk that were evaluated using MTE.

彩色多谱勒超声对正常人眼动脉血流速度的测定

应用美国Ａｃｕｓｏｎ－１２８型彩色多谱勒声像仪，对正常人各年龄组１２３例（２４６只眼）的眼动脉血流速度进行测定。发现眼动脉收缩期峰值速度：右眼为３６．４４±８．３５ｃｍ／ｓ，左眼为３６．９４±１１．３０ｃｍ／ｓ。右、左眼及性别之间差异无显著性。各年龄组间，４１岁以上各组与以下各组间差异有显著性。提示４１岁可能是全身小血管老化过程的开始，为抗衰老提供参考。同时对急性闭角型青光眼发作期的１８只眼、临床前期１５只眼的眼动脉血流速度进行了检测。