• 【经腋窝入路无气内镜甲状腺切除术:经验30例。】 复制标题 收藏 收藏
    DOI:10.1097/00129689-200608000-00006 复制DOI
    作者列表:Yoon JH,Park CH,Chung WY
    BACKGROUND & AIMS: :Surgery for thyroid disease requires skin incisions that can result in postsurgical problems such as prominent scars, adhesions, hypesthesia, and paresthesia in the neck. To overcome these problems we performed gasless endoscopic thyroidectomy via an axillary approach. Between May 2004 and April 2005, 30 patients underwent gasless endoscopic thyroidectomy via an axillary approach. The mean operating time was 126.8+/-32.4 minutes, and the mean length of hospital stay was 4.3+/-1.1 days. No cases required conversion to open surgery and none involved significant intraoperative complications. Three patients (10.0%) complained of slight hypesthesia or paresthesia in the anterior chest wall, and only 2 patients (6.7%) complained of discomfort while swallowing 4 months after surgery. All patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy via an axillary approach is feasible and safe and provides excellent cosmetic results with a minimal degree of postoperative complaints.
    背景与目标: :甲状腺疾病的手术需要皮肤切口,这可能导致术后问题,例如明显的疤痕,粘连,感觉异常和颈部感觉异常。为了克服这些问题,我们通过腋窝入路进行了无气内镜甲状腺切除术。在2004年5月至2005年4月之间,有30例患者通过腋窝入路行无气内镜甲状腺切除术。平均手术时间为126.8 /-32.4分钟,平均住院时间为4.3 /-1.1天。没有病例需要转换为开放手术,也没有涉及重大的术中并发症。 3例患者(10.0%)抱怨前胸壁轻度感觉异常或感觉异常,而只有2例患者(6.7%)吞咽术后4个月吞咽不适。所有患者对美容效果均满意。通过腋窝入路的无气内镜甲状腺切除术是可行且安全的,并能以极少的术后不适程度提供出色的美容效果。
  • 【视频内镜经肛门直肠肿瘤切除术。】 复制标题 收藏 收藏
    DOI:10.1016/S0002-9610(97)00076-7 复制DOI
    作者列表:Swanstrom LL,Smiley P,Zelko J,Cagle L
    BACKGROUND & AIMS: BACKGROUND:Transanal resection of benign and selected malignant rectal tumors is a well accepted surgical technique. The use of a stereoscopic microsurgical technique, as originally described by Buess et al in 1984, has been shown to improve the results of standard transanal resection by allowing precise, full thickness resections up to 24 cm from the anal verge. Transanal endoscopic microsurgery (TEM) has failed to gain widespread popularity for two reasons: The proprietary instrument set is expensive and complex ($68,000 and 30 components), and the procedure is difficult to master technically. We present our results with a modification of the TEM instrument that incorporates a standard laparoscope and video camera as well as standard laparoscopic instruments.

    METHODS:Four surgeons have been trained to date. Details of the training curriculum are presented. The technique of videoendoscopic transanal tumor resection (VTEM) is described. A prospective data base was maintained of all VTEM cases. This was reviewed for this study to determine indications, operative times, complications and outcomes.

    RESULTS:Four surgeons performed 27 VTEM cases between August 1994 and June 1996. The average age was 69 years and the majority (16) of patients were ASA III. Pre-op diagnosis was benign polyp in 25 patients and adenocarcinoma in 2. Average operating time was 127 minutes (49 to 280 minutes), and was longer during a surgeon's first 5 cases and for lesions more than 16 cm from the anal verge. Operative problems were rare (4%) and post-op complications (incontinence 2, late bleeding 1, adenoma recurrence 1) were seen in 15%.

    CONCLUSIONS:VTEM can be taught successfully to GI and colorectal surgeons using a format similar to that used for advanced laparoscopic courses. The use of already available laparoscopes and instruments decreases the initial costs of the set-up. Results are good, with low rates of complications and recurrence and a very short hospital stay. The patient benefits from an effective, minimally invasive alternative to open surgery.

    背景与目标: 背景:经肛门切除良性和恶性直肠肿瘤是一种广为接受的手术技术。如Buess等人在1984年最初描述的,使用立体显微外科技术已显示可通过允许距肛门边缘长达24 cm的精确,全层切除来改善标准经肛门切除的结果。经肛门内窥镜显微外科手术(TEM)未能获得广泛的普及,其原因有两个:专有的器械套件昂贵且复杂(68,000美元,包含30个组件),并且该过程在技术上难以掌握。我们通过修改TEM仪器(结合标准腹腔镜和摄像机以及标准腹腔镜仪器)展示我们的结果。

    方法:到目前为止,已经培训了四名外科医生。介绍了培训课程的详细信息。描述了视频内镜经肛门肿瘤切除术(VTEM)的技术。保留了所有VTEM病例的前瞻性数据库。

    结果:1994年8月至1996年6月,四名外科医生进行了27例VTEM病例。平均年龄为69岁。年,大多数(16)患者为ASA III。术前诊断为良性息肉25例,腺癌2例。平均手术时间为127分钟(49至280分钟),在外科医生的前5例中以及距肛门边缘16厘米以上的病变中,手术时间更长。手术中很少有手术问题(4%),术后并发症(尿失禁2,晚期出血1,腺瘤复发1)占15%。

    结论:可以教VTEM使用类似于高级腹腔镜课程的格式成功地向胃肠道和结直肠外科医生使用。使用已经可用的腹腔镜和仪器可降低安装的初始成本。结果良好,并发症和复发率低,住院时间很短。患者可以从有效,微创的替代开放手术中受益。

  • 【内镜下注射硬化剂治疗小儿肝内和肝外门静脉阻塞的静脉曲张破裂出血:注射道栓塞术的益处。】 复制标题 收藏 收藏
    DOI:10.7196/samj.6263 复制DOI
    作者列表:Bandika VL,Goddard EA,De Lacey RD,Brown RA
    BACKGROUND & AIMS: BACKGROUND:The outcome of sclerotherapy for bleeding oesophageal varices may be influenced by injection technique. In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection tract was introduced in an attempt to reduce injection-related complications. METHODS:To determine the outcome and effectiveness of injection tract embolisation in reducing injection-related complications, we retrospectively reviewed a series of 59 children who underwent injection sclerotherapy for oesophageal varices (29 for extrahepatic portal vein obstruction (EHPVO) and 30 for intrahepatic disease) in our centre. RESULTS:Sclerotherapy resulted in variceal eradication in only 11.8% of the children (mean follow-up duration: 38.4 months). Variceal eradication with sclerotherapy alone was achieved in 20.7% and 3.3% of EHPVO and intrahepatic disease patients, respectively. Injection tract embolisation was successful in reducing the number of complications and re-bleeding rates. Complications that arose included: transient pyrexia (16.7%); deep oesophageal ulcers (6.7%); stricture formation (3.3%); and re-bleeding before variceal sclerosis (23%). CONCLUSION:Injection sclerotherapy did not eradicate oesophageal varices in most children. Injection tract embolisation by sclerosant was associated with fewer complications and reduced re-bleeding rates.
    背景与目标: 背景:硬化治疗食管静脉曲张破裂出血的结果可能受到注射技术的影响。在我们机构的先前研究中,硬化疗法与高再出血率和食道溃疡相关。为了减少与注射相关的并发症,引入了栓塞栓塞术。
    方法:为了确定注射栓塞栓塞术在减少注射相关并发症方面的效果和有效性,我们回顾性分析了59例接受食管静脉曲张注射硬化治疗的儿童(29例肝外门静脉阻塞(EHPVO)和30例肝内疾病)在我们的中心。
    结果:硬化疗法仅导致11.8%的儿童根除静脉曲张(平均随访时间:38.4个月)。仅EHPVO和肝内疾病患者分别采用硬化疗法根除静脉曲张。注射道栓塞术成功减少了并发症的数量和再出血率。引起的并发症包括:短暂性发热(16.7%);深食道溃疡(6.7%);狭窄形成(3.3%);并在静脉曲张硬化之前再次出血(23%)。
    结论:注射硬化疗法未根除大多数儿童的食管静脉曲张。硬化剂引起的注射道栓塞与较少的并发症和降低的再出血率相关。
  • 【内镜超声引导与常规透壁技术在引流胰腺假性囊肿方面具有可比的治疗效果。】 复制标题 收藏 收藏
    DOI:10.1097/MEG.0b013e32835871eb 复制DOI
    作者列表:Panamonta N,Ngamruengphong S,Kijsirichareanchai K,Nugent K,Rakvit A
    BACKGROUND & AIMS: :We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.
    背景与目标: :我们进行了首次荟萃分析,比较了胰腺假性囊肿的内镜超声引导引流术(EUD)和常规透壁引流术(CTD)的技术成功率和临床结果。我们搜索了PubMed,Embase,Scopus和Cochrane库,以确定相关的前瞻性试验。比较了技术上的成功率,短期(4-6周)成功率和长期(6个月时)症状的成功率以及假性囊肿的放射学分辨率,并发症发生率和死亡率。检索了两项合格的随机对照试验和两项前瞻性研究,其中包括229例患者。 EUD的技术成功率显着高于CTD [风险比(RR)= 12.38,95%置信区间(CI):1.39-110.22]。当CTD由于假性囊肿的非膨隆性而失败时,便与EUD进行了交叉(n = 18),在所有这些情况下均成功进行了交叉。所有患有门静脉高压症和出血倾向的患者均应接受EUD治疗,以避免严重的并发症。就短期成功率(RR = 1.03,95%CI:0.95-1.11)或长期成功率(RR = 0.98,95%CI:0.76-1.25)而言,EUD并不优于CTD。两组的总并发症相似(RR = 0.98,95%CI:0.52-1.86)。最常见的并发症是出血和感染。 CTD后有两人因出血死亡。仅当在特定的临床情况下选择了适当的引流方式时,这两种方法的短期和长期治疗成功率才具有可比性。对于隆起的假性囊肿,可以选择EUD或CTD,而EUD是不隆起的假性囊肿,门脉高压或凝血病的治疗选择。
  • 【产前超声检查与胎儿尸检结果之间的一致性:妊娠中期终止妊娠的回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1325538 复制DOI
    作者列表:Lomax L,Johansson H,Valentin L,Sladkevicius P
    BACKGROUND & AIMS: OBJECTIVES:To estimate the agreement between prenatal ultrasonography observations at 16 - 21 gestational weeks and fetal autopsy findings in pregnancies terminated because of fetal anomalies. STUDY DESIGN:This 4½ year retrospective study includes consecutive fetuses that were terminated because of fetal malformation and/or chromosomal anomaly diagnosed in the second trimester. Only fetuses that had undergone fetal anatomy scanning by an obstetrician trained in fetal ultrasound before the termination and with available fetal autopsy reports were included. The cases were identified through the malformation registry database of our ultrasound unit. The sensitivity and specificity of ultrasound were calculated per organ system. When estimating the agreement between ultrasound results and autopsy findings, the cases were allocated to one of four categories according to the degree of concordance between ultrasound and autopsy findings: full agreement, near match, partial agreement and unconfirmed ultrasound findings. RESULTS:71 of 95 pregnancy terminations due to fetal malformations met the inclusion criteria and constitute our study population. The sensitivity of ultrasonography with regard to malformations in the brain and spine was 100 % (27/27) and with regard to malformations in the internal organ system (including malformations in the urogenital and gastrointestinal systems and in the abdominal wall and diaphragm) was 91 % (30/33). The corresponding figures for malformations in the cardiovascular and skeletal organ systems were 63 % (17/27) and 71 % (25/35), respectively. The specificity was lowest for malformations in the central nervous system and internal organ system (33/38, 87 % and 39/44, 89 %, respectively). There was full agreement between the ultrasound and autopsy findings in 44 % (31/71) of all cases and a near match in 46 % (33/71) of cases. In almost 10 % (7/71) of the pregnancies, the ultrasound findings were only partially confirmed or not confirmed by autopsy. In one case the discrepancy between the ultrasound and autopsy findings suggests that the pregnant woman might have decided to terminate the pregnancy on the basis of incorrect interpretation of ultrasound findings. CONCLUSION:Even though the agreement between ultrasound and autopsy findings was acceptable from a clinical point of view, agreement with regard to the detailed description of malformations was far from perfect. The detection rates were suboptimal for the cardiovascular and skeletal organ systems. :ZIEL:: Bewertung, inwieweit bei Schwangerschaftsabbrüchen aufgrund fetaler Anomalien die Befunde der pränatalen Ultraschalluntersuchung in der 16.–21. SSW mit dem Autopsiebefund des Feten übereinstimmen. METHODEN:Diese 4½ jährige retrospektive Studie schließt fortlaufend Feten ein, bei denen im 2. Trimenon ein Schwangerschaftsabbruch (TOP) aufgrund fetaler Fehlbildungen und/oder aufgrund von diagnostizierten Chromosomenanomalien erfolgt ist. Es wurden nur Feten einbezogen, bei denen vor dem Abbruch eine anatomische Untersuchung durch einen in der Fetalsonografie geübten Geburtshelfer durchgeführt wurde und bei denen fetale Autopsiebefunde vorlagen. Die Fälle wurden durch die Datenbank unserer Sonografieabteilung zur „Registrierung von Fehlbildungen“ ermittelt. Die Sensitivität und Spezifität der Sonografie wurde für jedes Organsystem berechnet. Zur Abschätzung der Übereinstimmung von Ultraschall- und Autopsiebefunden wurden die Fälle einer der vier Kategorien zugewiesen, je nach Grad der Übereinstimmung der Befunde: Solche mit völliger, sich fast entsprechender und nur teilweiser Übereinstimmung sowie nicht bestätigte Ultraschallbefunde. ERGEBNISSE:Die Einschlusskriterien erfüllten 71 von 95 Schwangerschaftsabbrüchen aufgrund fetaler Anomalien und bildeten somit unsere Studienpopulation. Die Sensitivität der Sonografie in Bezug auf Malformationen des Gehirns und Wirbelsäule betrug 100 % (27/27) und in Bezug auf Anomalien der inneren Organe (einschließlich der Fehlbildungen des Urogenital- und Magen-Darm-Systems, der Bauchdecke und des Diaphragmas) 91 % (31/33). Die entsprechende Rate für Anomalien des Herz-Kreislauf-Systems betrug 63 % (17/27) und für die des Skelettsystems 71 % (25/35). Die niedrigste Spezifität wurde für Malformationen des zentralen Nervensystems (33/38, 87 %) und der inneren Organe (39/44, 89 %) ermittelt. Eine völlige Übereinstimmung von Ultraschall- und Autopsiebefunden wurde in 44 % (31/71) und eine sich fast entsprechende Übereinstimmung in 46 % (33/71) aller Fälle gefunden. Bei beinahe 10 % (7/71) der Schwangerschaften konnten die Ultraschallbefunde nur teilweise beziehungsweise gar nicht durch die Autopsie bestätigt werden. In einem Fall mit diskrepanten Ultraschall- und Autopsiebefunden kann angenommen werden, dass die Schwangere die Entscheidung für einen Abbruch vermutlich aufgrund der fehlerhaften Interpretation des Ultraschallbefundes fällte. SCHLUSSFOLGERUNG:Obwohl die Übereinstimmung von Ultraschall- und Autopsiebefunden vom klinischen Standpunkt betrachtet akzeptierbar schien, war sie bezüglich der genauen Beschreibung der Fehlbildungen bei weitem nicht perfekt. Die Trefferquoten beim Herz-Kreislauf- und Skelettsystem waren suboptimal.
    背景与目标: 目的:估计在妊娠16〜-21周的产前超声检查结果与因胎儿异常而终止妊娠的胎儿尸检结果之间的一致性。
    研究设计:这项为期4½年的回顾性研究包括由于胎儿畸形和/或在妊娠中期诊断为染色体异常而终止的连续胎儿。仅包括终止前接受过胎儿超声培训的产科医生进行的胎儿解剖学扫描的胎儿,并提供胎儿尸检报告。这些病例是通过我们超声科的畸形登记数据库确定的。超声的灵敏度和特异性是根据每个器官系统计算的。在估计超声结果与尸检结果之间的一致性时,根据超声与尸检结果之间的一致性程度,将病例分为以下四类之一:完全一致,接近匹配,部分一致和未经证实的超声发现。
    结果:因胎儿畸形而终止的95例妊娠中有71例符合纳入标准,构成了我们的研究人群。超声检查对脑和脊柱畸形的敏感性为100%(27/27),对内脏器官系统的畸形(包括泌尿生殖系统和胃肠系统以及腹壁和and肌的畸形)的敏感性为91 %(30/33)。心血管和骨骼器官系统畸形的相应数字分别为63%(17/27)和71%(25/35)。中枢神经系统和内脏器官系统畸形的特异性最低(分别为33 / 38、87%和39 / 44、89%)。在所有病例中,超声检查和尸检结果完全吻合(44%)(31/71),接近匹配率在46%(33/71)中。在几乎10%(7/71)的怀孕中,超声检查结果仅部分被证实或尸检未得到证实。在一种情况下,超声检查与尸检结果之间的差异表明,孕妇可能已基于对超声检查结果的错误解释而决定终止妊娠。
    结论:即使从临床角度来看,超声检查与尸检结果之间的一致性是可以接受的,但就畸形的详细描述而言,一致性还远非完美。对于心血管和骨骼器官系统,检出率不是最理想的。
    :ZIEL :: Bewertung,来自Schwangerschaftsabbrüchen的胎儿异常胎儿在16到21日间因超自然现象丧生。 SSW mit dem Autopsiebefund des Fetenübereinstimmen。
    Methoden:Diese4½jährige具有追溯力的Studieschließtfortlaufend Feten ein,bei denen im 2。 Es wurden nur Feten einbezogen,bei denen vor dem Abbruch eine anatomische Untersuchung durch einen der FetalsonografiegeübtenGeburtshelferdurchgeführtwurde und bei denen fetale Autopsiebefunde vorlagen。 DateFällewurden durch和Datenbank取消注册„ Registrierung von Fehlbildungen“ ermittelt。器官系统的敏感度和敏感度。 ZurAbschätzungderÜbereinstimmungvon Ultraschall- and AutopsiebefundenwürdendieFälleeiner der vier Kategorien zugewiesen,je nach Grad derÜbereinstimmungder Befunde:Solche mitvölligenics undtüstenchänder
    急诊室:死于脑卒中71到95Schwangerschaftsabbrüchenaufgrund胎儿异常和二等体不育的研究人群。百事可乐和Wirbelsäule投注在100%(27/27)和内部器官异常(Einschließlichder Fehlbildungen des Urogenital- und Magen-Darm-Duch-System)中, (31/33)。赫兹-克劳斯劳夫系统异常率达到63%(17/27),而斯凯莱特系统异常率达到71%(25/35)。神经系统神经网络(33/38,87%)和内部有机体(39/44,89%)。 EinevölligeÜbereinstimmungvon Ultraschall- and Autopsiebefunden wurde患病率为44%(31/71),eine sich fast entsprechendeÜbereinstimmung患病率为46%(33/71)。贝纳赫河(Bei beinahe)10%(7/71)从施万格啤酒厂(Ultraschallbefunde nur teilweise beziehungsweise gar nicht durch)进行尸检。在《超常的世界》和《超常的世界》中,施瓦格大帝和德国的企业家之间的关系得到了解释。
    SCHLUSSFOLGERUNG:Obwohl死于Ultraschall-and Autopsiebefunden vom klinischen Standpunkt betrachtet akzeptierbar schien,战胜了beschüglichder genauen Beschreibung der Fehlbildungen bei weitem nicht。 Die Trefferquoten认为Herz-Kreislauf-和Skelettsystem警告不理想。
  • 【用于经直肠自然孔腔内腔镜手术的新型可拆卸闭塞气囊装置。】 复制标题 收藏 收藏
    DOI:10.3109/13645706.2012.732080 复制DOI
    作者列表:Xu H,Ohdaira T,Nagao Y,Tsutsumi N,Mori M,Uemura M,Toyoda K,Ieiri S,Hashizume M
    BACKGROUND & AIMS: INTRODUCTION:Transrectal natural orifice translumenal endoscopic surgery (NOTES) requires a good endoluminal view and adequate intrarectal bacterial clearance in the working area. We developed a new occlusion balloon unit with an easily detachable inflation device, which allows the surgeon a clear working area distal to the balloon. MATERIAL AND METHODS:The effectiveness of the sealing balloon and the extent of macroscopic and histopathological injury to the bowel wall at the site of balloon placement were examined in 12 pigs. RESULTS:The mean time to place and inflate the balloon unit was 12.0 ± 3.5 min, effective air-tightness lasted for 21.0 ± 12.0 min. There was no leakage of dye (methylene blue) past the balloon when pressure was maintained >6.70 ± 0.08 kPa (6.62-6.78 kPa). After gut irrigation, good visibility was maintained in the working area for six hours, and adequate bacterial clearance was maintained for three hours. There were no macroscopic signs of intestinal wall damage at the site of balloon placement. Histopathological examination showed only patchy mucosal damage and submucosal thrombus at the site of balloon placement. CONCLUSION:This newly-developed occlusion balloon unit helps to establish good visibility and adequate bacterial clearance for endoluminal surgical procedures.
    背景与目标: 简介:经直肠自然孔腔内镜手术(NOTES)需要良好的腔内视野,并在工作区域内有足够的直肠内细菌清除率。我们开发了一种带有易于拆卸的充气装置的新型阻塞球囊装置,使外科医生在球囊远端有一个清晰的工作区域。
    材料与方法:检查了12只猪的密封球囊的有效性以及球囊放置部位肠壁的宏观和组织病理学损伤程度。
    结果:气囊装置的平均放置时间和充气时间为12.0±3.5分钟,有效气密性持续21.0±12.0分钟。当压力保持> 6.70±0.08 kPa(6.62-6.78 kPa)时,没有染料(亚甲蓝)通过球囊泄漏。灌肠后,在工作区域内保持六个小时的良好可见度,并在三个小时内保持足够的细菌清除率。在球囊放置部位没有肉眼可见的肠壁损伤迹象。组织病理学检查仅在球囊放置部位发现斑块状的粘膜损伤和粘膜下的血栓。
    结论:这种新开发的闭塞气囊装置有助于为腔内外科手术建立良好的可见性和足够的细菌清除率。
  • 【一种超声细胞学方案,用于诊断管理皮肤默克尔细胞癌患者子集中的区域性结节。】 复制标题 收藏 收藏
    DOI:10.1111/bjd.12107 复制DOI
    作者列表:Righi A,Asioli S,Caliendo V,Macripò G,Picciotto F,Risio M,Eusebi V,Bussolati G
    BACKGROUND & AIMS: BACKGROUND:The status of regional lymph nodes (LNs) is one of the most consistent predictors of survival in Merkel cell carcinoma (MCC). In cases of clinically localized disease, current practice involves sentinel lymph node (SLN) assessment. OBJECTIVES:To propose ultrasonography (US) followed by fine needle aspiration cytology (FNAC) and immunohistochemistry as a useful diagnostic tool in the pre-surgical management of patients with MCC. METHODS:US of LNs was performed in 75 patients with MCC (22 with stage III tumours; 53 with stage I-II). In patients with US suspected disease, US coupled with FNAC of the LN was performed. Smears were examined by routine cytological staining supplemented with immunohistochemical staining for cytokeratin 20. All patients underwent surgical removal of regional LNs. RESULTS:In all 22 patients with stage III tumours, US was indicative of tumour deposits and FNAC confirmed metastases to LNs. In 11 of 53 patients with localized MCC without clinical evidence of nodal disease, US revealed enlarged, equivocal nodes where FNAC was performed. Ten LNs were cytologically positive for metastases, and one was negative. Upon histological examination, the FNAC-negative case showed a metastasis 5 mm in diameter. In all the other 42 cases with no clinical or US evidence of LN involvement, only SLN biopsy was performed and in six cases small metastatic foci were detected. Ultimately, of the 53 stage I-II MCC, 17 had positive LN involvement. In 10 cases (59%) metastases were detected by FNAC, and in seven cases, were detected by SLN biopsy. CONCLUSIONS:In a selected subset (∼20%) of patients with MCC with clinically localized disease, US followed by FNAC in the suspect LN is a valid alternative to the classical protocol of SLN histological examination.
    背景与目标: 背景:区域淋巴结(LNs)的状态是默克尔细胞癌(MCC)存活率最一致的预测指标之一。在临床上局部疾病的情况下,当前的实践涉及前哨淋巴结(SLN)评估。
    目的:提出超声检查(US),然后进行细针穿刺细胞学检查(FNAC)和免疫组织化学,作为MCC患者术前治疗的有用诊断工具。
    方法:我们对75例MCC患者(22例为III期肿瘤; 53例为I-II期)进行了LNs检查。在患有US可疑疾病的患者中,进行US联合LN的FNAC。通过常规细胞学染色和细胞角蛋白20的免疫组化染色检查涂片。所有患者均接受了手术切除局部LN。
    结果:在所有22例III期肿瘤患者中,US提示有肿瘤沉积,并且FNAC证实转移至LNs。在53例没有局部淋巴结病临床证据的局部MCC患者中,US显示了进行FNAC的肿大,模棱两可的淋巴结。 10个LN在转移学上在细胞学上均为阳性,而1个为阴性。经组织学检查,FNAC阴性病例显示直径为5毫米的转移灶。在没有临床或美国证据显示LN受累的所有其他42例病例中,仅进行了SLN活检,而在6例中,发现了小的转移灶。最终,在53个I-II期MCC中,有17个LN积极参与。 FNAC检测到10例(59%)转移,SLN活检检测到7例转移。
    结论:在选定的一部分(约20%)患有临床局部疾病的MCC患者中,可疑LN中的US继之以FNAC,是经典SLN组织学检查方案的有效替代方案。
  • 【分化型早期胃癌非治愈性内镜切除的自然过程。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1325676 复制DOI
    作者列表:Ahn JY,Jung HY,Choi JY,Kim MY,Lee JH,Choi KS,Kim DH,Choi KD,Song HJ,Lee GH,Kim JH,Park YS
    BACKGROUND & AIMS: BACKGROUND AND STUDY AIMS:Following noncurative endoscopic resection of early gastric cancer (EGC), the patient should be observed when the underlying disease is severe, the patient is elderly, or the patient refuses further treatment. The aim of this study was to analyze the clinical outcomes of patients with differentiated EGC who underwent noncurative endoscopic resection without additional treatment. PATIENTS AND METHODS:Included patients underwent noncurative endoscopic resection for differentiated EGC without additional treatment at the Asan Medical Center between July 1994 and January 2009. Clinical and oncological outcomes were analyzed. RESULTS:A total of 159 patients were included in the analysis. The median follow-up period was 33 months (interquartile range [IQR] 22 - 52 months). In total, 40 patients died (25.2 %) - 3 due to stomach cancer, 34 due to other causes, and 3 from unknown causes; the median survival time after endoscopic treatment for these patients was 27.5 months (IQR 13.8 - 48.3 months). Multivariate analysis showed that the rates of underlying disease (P < 0.001) and lymphovascular invasion (P = 0.005) were higher among the 40 patients who died than among the 119 survivors. The overall 3-  and 5-year survival rates were 82.9 % and 77.1 %, respectively; the rates of the patients with lymphovascular invasion were 61.9 % and 42.4 %, respectively, and the rates of patients without lymphovascular invasion were 86.1 % and 81.8 %, respectively (P < 0.001). CONCLUSIONS:Additional treatment provides fewer benefits to patients who do not have long life expectancies. Additional surgery can be considered for patients with lymphovascular invasion because of its high mortality rate; however, the benefits and risks of surgery should be considered carefully.
    背景与目标: 背景与研究目的:在早期胃癌(EGC)的非根治性内镜切除术之后,当潜在疾病严重,患者年老或患者拒绝进一步治疗时,应观察患者。这项研究的目的是分析未经治疗的内镜下切除术而无需额外治疗的分化型EGC患者的临床结局。
    患者与方法:1994年7月至2009年1月间,在Asan医疗中心对包括EGC在内镜下进行非根治性内镜切除术的患者进行了分化EGC治疗,无额外治疗。分析了临床和肿瘤学结局。
    结果:总共159例患者被纳入分析。中位随访期为33个月(四分位间距[IQR] 22±52个月)。共有40例患者(25.2 %%)died- 3因胃癌死亡,34因其他原因死亡,3因不明原因死亡;这些患者经内镜治疗后的中位生存时间为27.5个月(IQR 13.8±48.3个月)。多因素分析显示,死亡的40例患者的基础疾病(P(<0.001)和淋巴管浸润(P = 0.005)的发生率高于119名幸存者。 3年和5年总生存率分别为82.9%和77.1%。淋巴管浸润患者的发生率分别为61.9%和42.4%,无淋巴管浸润的患者分别为86.1%和81.8%(P <0.001)。
    结论:额外治疗对没有预期寿命的患者提供的益处较少。由于其高死亡率,可以考虑对淋巴管侵犯的患者进行额外的手术。但是,应仔细考虑手术的益处和风险。
  • 【内镜超声检查评估食管平滑肌瘤。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Massari M,Lattuada E,Zappa MA,Pieri G,Cioffi U,De Simone M,Segalin A,Bonavina L
    BACKGROUND & AIMS: Fourteen patients with suspected leiomyoma of the esophagus were studied by endoscopic ultrasonography, computed tomography, endoscopy and barium swallow. The results were correlated with the histology of the resected specimensin 2 patients with a peduncolated leiomyoma originating from the second echographic layer, endoscopic resection was performed. Endoscopic ultrasonography was superior to other imaging techniques in detection and staging of leiomyoma because it can determine the layer of origin, the direction of the growth and the consistency of the tumor.

    背景与目标: 通过内镜超声检查,计算机断层扫描,内窥镜检查和钡餐检查了14例疑似食管平滑肌瘤的患者。结果与2例来自第二回声层的足钉状平滑肌瘤的切除标本的组织学相关,进行了内窥镜切除。内镜超声检查在平滑肌瘤的检测和分期方面优于其他成像技术,因为它可以确定起源层,生长方向和肿瘤的一致性。

  • 【内镜经乳头内胆囊引流管胆汁细胞学检查对厚壁胆囊的术前诊断和处理。】 复制标题 收藏 收藏
    DOI:10.1016/j.gie.2006.01.024 复制DOI
    作者列表:Itoi T,Sofuni A,Itokawa F,Kurihara T,Tsuchiya T,Moriyasu F,Yamagishi T,Serizawa H
    BACKGROUND & AIMS: BACKGROUND:It is often difficult to distinguish gallbladder cancers (GBC) from benign gallbladder diseases, which show thickened walls. OBJECTIVES:To evaluate the efficacy of bile cytology using endoscopic transpapillary gallbladder drainage (ETGD) and CT. DESIGN:Retrospective study. SETTING:Division of Gastroenterology, Tokyo Medical University, Tokyo, Japan. PATIENTS AND INTERVENTIONS:Eighty-five patients with gallbladder diseases, consisting of 27 GBC and 58 benign gallbladder diseases, were reviewed. A pigtail-type nasobilliary drainage tube was left indwelling in the gallbladder, and through this drainage tube washing cytology was performed with an ETGD tube. MAIN OUTCOME MEASUREMENTS:Diagnostic accuracy of CT and cytology. Complications and outcome were also evaluated. RESULTS:CT and cytology with the ETGD tube had 81% and 81% sensitivity, 91% and 83% specificity, and 88% and 82% accuracy, respectively (P > .05). Looking only at the 71 successful ETGD cases, CT and ETGD cytology had 82% and 100% sensitivity, 92% and 98% specificity, and 89% and 99% accuracy, respectively (P = .036 and .025, respectively). Four patients with GBC in whom CT showed benign findings underwent open cholecystectomy because ETGD cytology revealed malignant findings. In contrast, 4 patients with benign diseases in whom CT suggested malignant finding underwent LC because the findings of ETGD cytology suggested benign disease. CONCLUSIONS:Cytology using an ETGD tube is very useful in the diagnosis and management of gallbladder diseases.
    背景与目标: 背景:通常很难将胆囊癌(GBC)与良性胆囊疾病相鉴别,后者显示壁增厚。
    目的:通过内镜经乳头胆囊引流术(ETGD)和CT评估胆汁细胞学的疗效。
    设计:回顾性研究。
    单位:日本东京医科大学胃肠病学系。
    病人与干预措施:对包括27例GBC和58例良性胆囊疾病的85例胆囊疾病患者进行了回顾。一根猪尾型鼻腔引流管留在胆囊中,并通过该引流管用ETGD管进行洗涤细胞学检查。
    主要观察指标:CT和细胞学检查的诊断准确性。并发症和结局也进行了评估。
    结果:ETGD管的CT和细胞学检查分别具有81%和81%的敏感性,91%和83%的特异性以及88%和82%的准确性(P> 0.05)。仅查看71例成功的ETGD患者,CT和ETGD细胞学检查分别具有82%和100%的敏感性,92%和98%的特异性以及89%和99%的准确性(分别为P = .036和.025)。因为ETGD细胞学检查显示恶性,所以4例CT表现为良性病变的GBC患者接受了开腹胆囊切除术。相比之下,有4例CT提示有恶性发现的良性疾病患者进行了LC检查,因为ETGD细胞学检查结果表明存在良性疾病。
    结论:使用ETGD管进行细胞学检查对胆囊疾病的诊断和治疗非常有用。
  • 【内镜排空,立体定向抽吸和开颅手术治疗幕上高血压性脑出血的比较:一项随机对照试验的研究方案。】 复制标题 收藏 收藏
    DOI:10.1186/s13063-017-2041-1 复制DOI
    作者列表:Xu X,Zheng Y,Chen X,Li F,Zhang H,Ge X
    BACKGROUND & AIMS: BACKGROUND:Hypertensive intracerebral haemorrhage (HICH) is the most common form of haemorrhagic stroke with the highest morbidity and mortality of all stroke types. The choice of surgical or conservative treatment for patients with HICH remains controversial. In recent years, minimally invasive surgeries, such as endoscopic evacuation and stereotactic aspiration, have been attempted for haematoma removal and offer promise. However, research evidence on the benefits of endoscopic evacuation or stereotactic aspiration is still insufficient. METHODS/DESIGN:A multicentre, randomised controlled trial will be conducted to compare the efficacy of endoscopic evacuation, stereotactic aspiration and craniotomy in the treatment of supratentorial HICH. About 1350 eligible patients from 10 neurosurgical centres will be randomly assigned to an endoscopic group, a stereotactic group and a craniotomy group at a 1:1:1 ratio. Randomisation is undertaken using a 24-h randomisation service accessed by telephone or the Internet. All patients will receive the corresponding surgery based on their grouping. They will be followed-up at 1, 3 and 6 months after surgery. The primary outcome is the modified Rankin Scale at 6-month follow-up. Secondary outcomes include: haematoma clearance rate; Glasgow Coma Scale 7 days after surgery; rebleeding rate; intracranial infection rate; hospitalisation time; mortality at 1 month and 3 months after surgery; the Barthel Index and the WHO quality of life at 3 months and 6 months after surgery. DISCUSSION:The trial aims to investigate whether endoscopic evacuation and stereotactic aspiration could improve the outcome of supratentorial HICH compared with craniotomy. The trial will help to determine the best surgical method for the treatment of supratentorial HICH. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT02811614 . Registered on 20 June 2016.
    背景与目标: 背景:高血压脑出血(HICH)是出血性中风的最常见形式,在所有中风类型中发病率和死亡率最高。对于HICH患者,手术或保守治疗的选择仍存在争议。近年来,已经尝试了微创手术,例如内窥镜排空和立体定向抽吸术,以去除血肿并提供了希望。但是,关于内窥镜排空或立体定向抽吸术的益处的研究证据仍然不足。
    方法/设计:将进行一项多中心,随机对照试验,以比较内镜排空,立体定向抽吸和开颅手术治疗幕上HICH的疗效。来自10个神经外科中心的约1350名合格患者将以1:1:1的比例随机分配到内窥镜组,立体定位组和颅骨切开术组。随机化是通过电话或互联网访问的24小时随机化服务进行的。所有患者将根据其分组接受相应的手术。他们将在手术后的1、3和6个月进行随访。主要结果是修订后的6个月随访中的Rankin量表。次要结果包括:血肿清除率;手术后7天的格拉斯哥昏迷量表;再出血率颅内感染率;住院时间;术后1个月和3个月的死亡率;术后3个月和6个月的Barthel指数和WHO的生活质量。
    讨论:该试验旨在研究内镜腔内抽空和立体定向抽吸术是否比开颅手术能改善幕上HICH的预后。该试验将有助于确定治疗幕上HICH的最佳手术方法。
    试用注册:ClinicalTrials.gov,ID:NCT02811614。 2016年6月20日注册。
  • 12 Results of endoscopic plantar fascia release. 复制标题 收藏 收藏

    【内镜下足底筋膜释放的结果。】 复制标题 收藏 收藏
    DOI:10.3113/FAI.2007.0549 复制DOI
    作者列表:Bazaz R,Ferkel RD
    BACKGROUND & AIMS: BACKGROUND:Conservative treatment for plantar fasciitis usually provides improvement, but some patients progress to surgery. Open release is most commonly performed but is associated with prolonged recovery and complications. Endoscopic plantar fascia release (EPFR) has become popular recently. We present our results. METHODS:Twenty patients (23 feet) had EPFR. Sixteen patients (19 feet) were available for followup after at least 1 year. Ten were women and 6 were men, with an average age of 44.7 (range 28 to 70) years. The average followup was 47 months. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Maryland Foot Score were used for evaluation. Gender, obesity, severity, length of preoperative symptoms, and workers compensation (WC) status were studied. RESULTS:The average AOFAS and Maryland scores improved postoperatively (66 to 88, p<0.05; 62 to 83, p<0.05, respectively). Women improved 25 (AOFAS) and 23 points (Maryland) points. Men improved 16 (AOFAS) and 17 points (Maryland) points. Obese patients improved 38 and 28 points, respectively. Normal weight patients improved 16 and 19 points, respectively. Postoperative scores for patients with high preoperative severity improved from 58 to 81 (AOFAS) and from 52 to 73 (Maryland). Patients with moderate preoperative severity achieved scores from 72 to 93 and from 70 to 91. Patients who had symptoms longer than 2 years before EPFR had lower postoperative scores. Non-WC patients improved 25 (AOFAS) and 24 (Maryland) points. WC patients improved 18 and 16 points, respectively. CONCLUSIONS:EPFR provides significantly improved patient outcomes. Patients with more severe symptoms before EPFR and those with symptoms for longer than 2 years had worse results. Obesity had no negative effect on outcome. WC patients had inferior results compared to non-WC patients. Women achieved better results than men. This finding may be biased because most WC patients were men.
    背景与目标: 背景:足底筋膜炎的保守治疗通常可以改善病情,但有些患者可以接受手术治疗。公开释放最常执行,但与恢复时间延长和并发症相关。内窥镜足底筋膜释放术(EPFR)最近变得很流行。我们介绍我们的结果。
    方法:20名患者(23英尺)患有EPFR。至少1年后可对16例患者(19英尺)进行随访。女性10名,男性6名,平均年龄为44.7岁(28至70岁)。平均随访47个月。使用美国骨科足踝协会(AOFAS)的踝部-足部评分表和马里兰州的足部评分进行评估。研究者对性别,肥胖,严重程度,术前症状持续时间和工人补偿(WC)状况进行了研究。
    结果:术后AOFAS和马里兰州的平均评分有所改善(分别为66至88,p <0.05; 62至83,p <0.05)。妇女提高了25分(AOFAS)和23分(马里兰)。男子提高16(AOFAS)和17点(马里兰)。肥胖患者分别改善了38点和28点。体重正常的患者分别改善了16点和19点。术前严重程度高的患者的术后评分从58分(81)(AOFAS)和52分(73)(马里兰州)提高。术前轻度中度的患者得分分别为72分至93分和70分至70分。症状出现时间超过EPFR前2年的患者术后得分较低。非WC患者提高了25(AOFAS)和24(Maryland)点。 WC患者分别改善了18点和16点。
    结论:EPFR可显着改善患者预后。 EPFR前症状较重的患者和症状超过2年的患者的病情较差。肥胖对结局没有负面影响。与非WC患者相比,WC患者的结果较差。妇女取得了比男子更好的结果。由于大多数WC患者是男性,因此该发现可能有偏见。
  • 【实时超声与计算机断层扫描的图像融合:影响肝脏局灶性病变的配准误差和运动的因素。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2017.01.027 复制DOI
    作者列表:Lee MW,Park HJ,Kang TW,Ryu J,Bang WC,Lee B,Lee ES,Choi BI
    BACKGROUND & AIMS: :Factors affecting the registration error (RE) and motion of focal hepatic lesions (FHLs) in image fusion of real-time ultrasonography (US) with computed tomography (CT) images were prospectively assessed by focusing on respiratory movement and FHL location. Real-time US and pre-acquired CT images at end-inspiration were fused with FHLs for 103 patients. Three-dimensional US data containing FHLs were obtained during end-inspiratory/expiratory phases. Multivariate analysis revealed that diaphragm motion (p < 0.001), chronic liver disease (p = 0.02) and the absolute difference in distance between the FHL and the central portal vein (CPV) during respiration (p = 0.03) were the independent factors that revealed the maximum effect on RE. In contrast, diaphragm motion (p < 0.001) and distance between the FHL and CPV at inspiration (p = 0.036) revealed the maximum effect on FHL motion. In conclusion, RE and FHL motion are affected by the degree of respiratory movement and the location of the FHL. Therefore, image fusion with CT images should be used with caution if the degree of respiratory motion is significant or if the FHL is located at the periphery of the liver.
    背景与目标: :前瞻性评估了实时超声检查(US)与计算机断层扫描(CT)图像融合中影响配准误差(RE)和局灶性肝病灶(FHLs)运动的因素,重点在于呼吸运动和FHL位置。吸气时将实时美国超声和预先采集的CT图像与FHL融合在一起,治疗103例患者。在吸气/呼气末期获得包含FHL的三维US数据。多因素分析表明,呼吸过程中diaphragm肌运动(p <0.001),慢性肝病(p = 0.02)和FHL与门静脉中央静脉(CPV)之间的绝对距离差(p = 0.03)是揭示这些因素的独立因素。对RE的最大影响。相反,隔膜运动(p <0.001)和吸气时FHL与CPV之间的距离(p = 0.036)揭示了对FHL运动的最大影响。总之,RE和FHL运动受呼吸运动程度和FHL位置的影响。因此,如果呼吸运动的程度很明显或者FHL位于肝脏的周围,则应谨慎使用CT图像融合。
  • 【胆道闭锁的瞬时弹性成像测定结缔组织生长因子与肝硬度的相关性。】 复制标题 收藏 收藏
    DOI:10.1111/hepr.12015 复制DOI
    作者列表:Honsawek S,Udomsinprasert W,Chirathaworn C,Anomasiri W,Vejchapipat P,Poovorawan Y
    BACKGROUND & AIMS: AIM:Biliary atresia (BA) is a neonatal liver disease defined as chronic progressive fibrotic obliteration of extrahepatic bile ducts. The objective of this study was to determine the association of serum connective tissue growth factor (CTGF) with clinical outcome and liver stiffness measurement. METHODS:Eighty-two BA patients post-Kasai operation and 28 healthy controls were recruited. BA patients were categorized into two groups based on their portal hypertension (PH) status. Serum CTGF levels were determined by enzyme-linked immunosorbent assay. Liver stiffness scores were measured by transient elastography. RESULTS:BA patients had greater CTGF levels (905.9 ± 57.7 vs 238.3 ± 23.5 pg/mL, P < 0.001) and higher liver stiffness values than controls (28.2 ± 2.6 vs 5.0 ± 0.5 kPa, P < 0.001). Serum CTGF levels were remarkably elevated in BA patients with PH compared to those without PH (1092.4 ± 73.9 vs 582.6 ± 45.7 pg/mL, P < 0.001). Furthermore, BA patients with PH had significantly higher liver stiffness values compared to those without PH (37.3 ± 3.0 vs 10.6 ± 1.1 kPa, P < 0.001). Additionally, serum CTGF was positively correlated with liver stiffness (r = 0.875, P < 0.001) and total bilirubin (r = 0.462, P < 0.001). There was an inverse correlation between serum CTGF and serum albumin (r = -0.579, P < 0.001). CONCLUSION:High serum CTGF was associated with a poor outcome in BA patients. Accordingly, serum CTGF and transient elastography may serve as non-invasive biomarkers reflecting the disease severity in postoperative BA patients.
    背景与目标: 目的:胆道闭锁(BA)是一种新生儿肝病,定义为肝外胆管的慢性进行性纤维化闭塞症。这项研究的目的是确定血清结缔组织生长因子(CTGF)与临床结局和肝硬度测量之间的关系。
    方法:招募Kasai手术后的82例BA患者和28例健康对照者。根据门脉高压(PH)的状态,将BA患者分为两类。通过酶联免疫吸附测定法测定血清CTGF水平。肝硬度评分通过瞬时弹性成像法测量。
    结果:BA患者的CTGF水平较高(905.9±57.7 vs 238.3±23.5μpg/ mL,P <0.001),肝硬度值高于对照组(28.2±2.6和5.0±0.5 kPa,P 0.001)。与没有PH的BA患者相比,患有PH的BA患者的血清CTGF水平显着升高(1092.4±±73.9 vs 582.6±±45.7μpg/ mL,P <0.001)。此外,患有PH的BA患者的肝脏僵硬度值明显高于没有PH的患者(37.3±±3.0 kPa与10.6±±1.1±kPa,P <0.001)。另外,血清CTGF与肝硬度(r = 0.875,P <0.001)和总胆红素(r = 0.462,P <0.001)呈正相关。血清CTGF与血清白蛋白呈负相关(r = -0.579,P <0.001)。
    结论:BA患者血清CTGF高与预后不良有关。因此,血清CTGF和瞬时弹性成像可以作为非侵入性生物标志物,反映术后BA患者的疾病严重程度。
  • 【超声在肝细胞癌相关动静脉瘘的诊治中的应用。】 复制标题 收藏 收藏
    DOI:10.1111/j.1478-3231.2007.01520.x 复制DOI
    作者列表:Li YY,Duan YY,Yan GZ,Lv FQ,Cao W,Cao TS,Yuan LJ
    BACKGROUND & AIMS: OBJECTIVE:Hepatic arteriovenous fistula (HAVF) can be caused by trauma, hepatic biopsy, bile duct radiology, etc. Small intrahepatic HAVF can be found in lesions of carcinoma and hepatocirrhosis. Accurate detection of HAVF was magnitude in the process to take appropriate treatment in clinic. The aim of this article is to evaluate the imaging diagnostic value on HAVF and to study the imaging character of HAVF in patients with hepatocellular carcinoma (HCC), and to evaluate the role of ultrasonographic and radiological techniques in the diagnosis and management of developmental intrahepatic shunts so as to assess the imaging diagnostic evaluation in a follow-up study. METHODS:Seventy-eight patients diagnosed with HCC were enrolled in this study, and retrospective analysis of ultrasonographic and radiological data was carried out on all 78 patients, and 25 patients suspected of having HAVF were selected. The results from ultrasonography were compared with that from digital subtraction angiography (DSA) as a gold standard. The portal and hepatic veins, hepatic arteries and vessels around and inside the tumour patients were detected and the haemodynamic indices were recorded with ultrasonography. Ten patients with HAVF were followed up after the therapy of arterial embolization and the reversal effect of the therapy was observed. Associations of HAVF with clinical and ultrasonographic features were evaluated by stepwise logistic regression analysis. RESULTS:Twenty-five of 78 HAVF patients were detected by ultrasonography and other imaging methods. Ultrasonographic parameters made excellent predictions for the patients with HAVF; sensitivity (SE) 83.3%, specificity (SP) 90.7%, positive predictive value (pPV, 80.0%), negative predictive value (nPV) 92.5% and accuracy 88.5%. Among the 25 HAVF patients, 16 were central hepatic artery-portal vein fistulae, seven were peri-hepatic artery-portal vein fistulae and two were hepatic artery-vein shunts. Characteristic ultrasonographic methods of hepatic artery-portal vein fistulae were as follows: 10 patients with hepatic artery-portal vein fistula were followed up after embolization. Compared with that of preembolization, seven cases returned to normal and in three patients abnormalities were still detected. CONCLUSION:Ultrasonographic evaluation of HAVF is easy to perform, reproducible and, when present, gives a high degree of certainty for the diagnosis of HAVF. Ultrasonography is a valuable method for the diagnoses HAVF; it can offer imaging evidence after the treatment of hepatic cell cancer. HAVF in patients with HCC can be detected by ultrasonographic methods, which are characterized by changes of hepatic arteries and veins involved in fistulas. These can be used for diagnosing HAVF and evaluating its arterial embolization effect in patients with HCC.
    背景与目标: 目的:肝外动静脉瘘(HAVF)可能是由外伤,肝活检,胆管放射学等引起的。在肝癌和肝硬化病灶中可以发现小的肝内HAVF。准确检测HAVF是在临床上采取适当治疗的过程中的重要措施。本文旨在评估对肝细胞癌(HAVF)的影像学诊断价值,并研究其对肝细胞癌(HCC)患者的影像学特征,并评估超声和放射学技术在发展性肝内分流术的诊断和管理中的作用。以便在后续研究中评估影像学诊断评估。
    方法:本研究纳入了78例被诊断为HCC的患者,并对所有78例患者的超声和影像学资料进行了回顾性分析,并选择了25例疑似具有HAVF的患者。将超声检查的结果与数字减影血管造影(DSA)的结果作为黄金标准进行了比较。检测肿瘤患者周围和内部的门静脉和肝静脉,肝动脉和血管,并用超声检查记录血流动力学指标。动脉栓塞治疗后,对10例HAVF患者进行了随访,观察到该治疗的逆转作用。 HAVF与临床和超声特征的关联通过逐步逻辑回归分析进行评估。
    结果:超声检查及其他影像学检查方法检测出78例HAVF患者中的25例。超声参数对HAVF患者做出了很好的预测。敏感性(SE)83.3%,特异性(SP)90.7%,阳性预测值(pPV,80.0%),阴性预测值(nPV)92.5%,准确度88.5%。在25例HAVF患者中,有16例是肝中央动脉-门静脉瘘,其中7例是肝周围动脉-门静脉瘘,其中2例是肝动脉-静脉分流。肝动脉门静脉瘘的超声特征检查方法如下:栓塞术后随访10例肝动脉门静脉瘘。与栓塞前相比,有7例恢复正常,其中3例仍发现异常。
    结论:超声检查对HAVF的评价容易,可重复,并且在存在时可为HAVF的诊断提供高度的确定性。超声检查是诊断HAVF的有价值的方法。它可以为肝细胞癌的治疗提供影像学证据。可以通过超声检查方法检测肝癌患者的HAVF,其特征在于涉及瘘管的肝动脉和静脉的变化。这些可用于诊断HAVF并评估其在HCC患者中的动脉栓塞作用。

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