ObjectiveTo investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound.MethodsThe clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined.ResultsSatisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae.ConclusionPercutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.
ObjectiveTo research the association between the prognostic nutritional index (PNI) and the prognosis of patients with malignant obstructive jaundice (MOJ) after interventional treatment. MethodsThe clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University, from September 2018 to June 2021, were gathered retrospectively. The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment, then the patients were allocated into the high PNI group (PNI was the optimal critical value or more) and low PNI group (PNI was less than the optimal critical value). The clinicopathologic characteristics of the two groups were compared. The Kaplan-Meier method was used to draw survival curve for survival analysis, and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ (the prognostic index was overall survival). ResultsA total of 205 patients were included in this study. The optimal critical value of PNI was 37.5. There were 154 cases in the high PNI group and 51 cases in the low PNI group, respectively. The proportions of the patients with biliary infection, CA19-9 ≥400 kU/L, hemoglobin <120 g/L, albumin <30 g/L, total bilirubin ≥300 μmol/L, and alanine aminotransferase <300 U/L were higher in the low PNI group as compared with the high PNI group (P<0.05). The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months, respectively. The overall survival curve of the former was better than that the latter (χ2=18.514, P<0.001). The median follow-up time of 205 patients was 6.2 months, with a median overall survival of 5.3 months. The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD, with stent implantation, with treatment for primary tumor, without metastasis, and with preoperative PNI ≥37.5 (P<0.05). ConclusionFrom the results of this study, preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment, and it is expected to be used to predict the prognosis of patients with MOJ in the future.
摘要:目的: 探討經子宮動脈介入化療栓塞治療剖宮產切口瘢痕妊娠的應用價值。 方法 :回顧分析本院自2006年7月至2007年12月子宮動脈介入治療的15例剖宮產切口瘢痕妊娠病例資料。 結果 :15例介入治療均成功,其中8例化療及明膠海綿栓塞后加用彈簧圈栓塞,術后陰道流血停止,孕囊明顯縮小,血清人絨毛膜促性腺激素明顯下降。術后清宮無大出血,病理檢查示子宮瘢痕部位絨毛、蛻膜或胎盤組織,有變性、壞死。 結論 :經子宮動脈介入治療剖宮產瘢痕妊娠,能有效預防和控制出血,減小清宮危險,并保留子宮,是剖宮產瘢痕妊娠安全、有效的治療方法之一。 Abstract: Objective: To investigate the value of uterine artery chemotherapy and embolization in the treatment of cesarean scar pregnancy. Methods : Fifteen cases with cesarean scar pregnancy performed with uterine artery interventional therapy were retrospectively analyzed from July, 2006 to December, 2007 in our hospital. Results : All cases were treated successfully by uterine artery chemotherapy and embolism. All cases were embolized with gelatin sponge after chemotherapy, and eight with spring ring additionally. Vaginal bleedings were stopped after uterine artery embolization. Gestation sacculi deflated obviously. Serum human chorionic gonadotrophin descended dramatically. There was no severe vaginal bleeding by curettage after interventional therapy. The villi, decidua, or placental tissues were observed with degeneration and necrosis by pathology. Conclusion : Uterine artery chemotherapy and embolization was proved to be a safe and useful procedure for preventing and controlling vaginal bleeding, diminishing the risk of curettage and avoiding the loss of uterus.
ObjectiveTo explore the rescue value of emergency bronchoscopic interventional therapy in patients with malignant airway stenosis and to share the treatment experience. MethodsThe critical patients with malignant airway stenosis who needed urgent bronchoscopic interventional therapy from January, 2007 to January, 2022 in Beijing Tiantan Hospital Affiliated to Capital Medical University were selected. The demographic and clinical data of intra-and-post the operation were collected. The rescue value and safety of emergency bronchoscopic intervention in the critical patients with malignant airway stenosis were evaluated, and the rescue process was summarized. ResultsForty-three patients were enrolled in the study, including 26 males and 17 females, with an average age of (61.6±11.4) years, including 20 cases of primary lung cancer and 23 cases of other malignant tumors; The main type of stenosis was endogenous (26 cases, 61.90%), followed by external pressure (12 cases, 28.57%) and mixed (4 cases, 9.52%) type. The stenosis site was almost the central airway (41 cases, 95.35%), and the main anesthesia method was general anesthesia (37 cases, 86.05%); Emergency bronchoscopic interventional therapy included local resection in 27 cases (62.79%), stent implantation in 12 cases (27.91%), exploration in 2 cases (4.65%), tumor biopsy in 1 case (2.33%), and adjustment of stent position in 1 case (2.33%); The dyspnea score and the degree of airway stenosis decreased significantly after interventional therapy (P<0.01); intraoperative complications occured in 21 cases and bleeding (19 cases) was the commonest one, short term postoperative complications occurred in 3 cases, including respiratory depression, glottic edema and airway spasm, respectively. ConclusionsEmergency bronchoscopic interventional therapy can quickly and effectively alleviate the severe airway obstruction caused by malignant tumor, and win time for the follow-up comprehensive treatment of tumor, but it needs close team cooperation and standardized rescue process.
ObjectiveTo summarize the treatment and experience of percutaneous transhepatic portal vein recanalization by endovascular approach for treatment of cavernous transformation of the portal vein (CTPV) in a child. MethodThe clinical data of a child with idiopathic CTPV who underwent percutaneous transhepatic portal vein recanalization by endovascular approach were retrospectively analyzed. ResultsWe described a novel percutaneous transhepatic portal vein recanalization approach that had successfully treated a child with idiopathic CTPV following a multidisciplinary team evaluation. The operation time was 1.5 h and blood loss was approximately 1 mL. The child recovered uneventfully at 9-month follow-up, without any clinical evidence of CTPV complications. ConclusionIn light of our successful management, we can envision that the portal vein recanalization is an important therapeutic supplement for treating CTPV and will result in a paradigm change.
ObjectiveTo investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention.MethodsA retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.ResultsAll patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened.ConclusionSCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.
Objective To explore the effectiveness of primary interventional revascularization combined with secondary perforator composite flap in the treatment of peripheral arterial disease (PAD) accompanied by soft tissue defects around the ankle. Methods Between January 2022 and January 2025, 12 patients with PAD and soft tissue defects around the ankle were admitted. Among them, there were 9 males and 3 females; their ages ranged from 52 to 82 years, with an average of 68.9 years. The causes of injury included 4 cases of traffic accident, 5 cases of falls, 1 case of falling from height, 1 case of foreign body puncture injury, and 1 case of electric shock injury. The infection duration ranged from 1 month to 35 years, with a median duration of 3.5 months. The wound size ranged from 5.5 cm×3.0 cm to 15.0 cm×9.0 cm. The ankle-brachial index (ABI) was 0.32±0.12. The visual analogue scale (VAS) score for pain was 3.3±0.5. Preoperative vascular stenosis assessment was performed in all patients, with primary intervention to dredge large and medium-sized arteries, followed by secondary repair of the wound using a perforator composite flap. The flap size ranged from 6.5 cm×4.0 cm to 16.0 cm×10.0 cm. The donor sites were sutured directly or repaired with skin grafts. After two stages of treatment, the effectiveness was evaluated by measuring ABI, observing flap survival and wound healing, assessing VAS scores, and American Orthopedic Foot and Ankle Society (AOFAS) scores. Results All 12 cases completed two stages of treatment; all patients were followed up after the second-stage treatment, with a follow-up period ranging from 7 to 28 months, with an average of 16.8 months. After the first-stage treatment, the skin temperature around the ankle was significantly higher than that before treatment, and the ABI increased to 0.71±0.07, with a significant difference (t=9.918, P<0.001). After the second-stage treatment, the blisters on the distal end of the skin flap occurred in 3 cases. The flaps survived and the wounds healed, with a healing time ranging from 10 to 14 days (mean, 11.8 days). The incisions at the donor site healed by first intention, and the skin grafts survived. The VAS score was 0.5±0.5 at 3 weeks, which was significantly lower than that before treatment (t=13.675, P<0.001). No infection recurrence occurred during follow-up. At 6 months after the second-stage treatment, the AOFAS score of the ankle joint ranged from 92 to 97, with an average of 94.7, all reaching excellent. Conclusion Interventional revascularization combined with perforator composite flap for staged treatment of PAD with ankle soft tissue defects can obtain good effectiveness, by unclogging the main blood vessels, improving lower limb blood supply, and improving the survival rate of the skin flap.
Objective To establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). MethodsA retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital from December 2017 to June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at the Xuzhou Cancer Hospital were included as an external validation set to assess the reliability of the model. ResultsAmong the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. ConclusionsThe risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.
ObjectiveTo investigate treatment methods and effect of endovascular interventional therapy for visceral artery aneurysms.MethodsThe clinical data of 32 patients with visceral artery aneurysms, who were treated in the No. 960 Hospital of PLA from February 2011 to April 2018, were retrospectively analyzed. It was proveded by the CT or digital subtraction angiography before the interventional therapy. The implantation of covered stent, coil embolization together with stent implantation, double stents placement or pure coil embolization were performed. The postoperative antithrombotic therapy was adopted in the patients accepted the stent implantation. The CT angiography was performed on the month of 1, 6, 12, 24 or the patient was uncomfortable after the treatment to evaluate the obstruction condition of the aneurysms, stent blood flow, and branches arteries, etc..ResultsThe success rate of the endovascular interventional therapy was 100%. In the 11 patients underwent the implantation of covered stent, the postoperative angiography showed that the stent lumen was patent and the aneurysm was not visualized. In the 9 patients underwent the coil embolization together with stent implantation and 3 patients underwent the double stents placement, the postoperative angiography results of the aneurysm showed that it was faintly visualized and the branch arteries were not involved. In the 9 patients underwent the pure coil embolization, the postoperative angiography showed that the aneurysm was not visualized. No perioperative mortality or procedure related complications occurred. No case was lost during the follow-up of a median period of 25.5 (6–48) months. During the follow-up, one patient developed the mild abdominal pain in one month, which disappeared after the symptomatic medication management. Except for 1 patient developed the mild stent stenosis (<30%) on the 12th month after the procedure, the stent and the branch arteries of the other patients were completely patent, and no aneurysms recurred.ConclusionFor treatment of visceral artery aneurysms, endovascular interventional therapy is safe and effective and shows an excellent short-term and mid-term effects.
ObjectiveTo evaluate the occupational exposures and protective condition of medical staff in operating room for interventional therapy. MethodsFrom September to November in 2014, 46 medical staff in the operating room for interventional therapy were adopted to complete the occupational exposures and protection situation survey. After that, we analyzed and scored all the questionnaires. ResultsThe awareness of the medical staff about occupational exposures and occupational protection in the operating room was low; the awareness rates of doctors, nurses, and radiology technicians were 74.2%, 63.0% and 66.7%, respectively. The general condition of implement of occupational protection measures of the medical staff was bad, and the average rate of the doctors, nurses and radiology technicians was 51.3%, 43.9%, and 15.2%. ConclusionThe implement rates of occupational protection measures of the medical staff in Operating Room for interventional therapy differ much from the awareness rates. The rates in doctors and nurses are higher than that in radiology technicians. We should strengthen the education of radiation damage and protection measures in doctors, and enhance the training of iatrogenic injuries related knowledge in clinical radiology technicians to reduce occupational hazards.