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Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.
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Objective To investigate the safety and efficacy of camrelizumab added to second-line therapy after drug- eluting bead transarterial chemoembolization (DTACE) combined with apatinib for unresectable hepatocellular carcinoma (HCC). Methods A retrospective analysis was performed for 89 HCC patients with camrelizumab added to second-line therapy who attended The First Affiliated Hospital of Zhengzhou University from December 2019 to December 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) after the application of camrelizumab, and the secondary endpoints were objective remission rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs). The Kaplan-Meier method was used to plot survival curves, the Log-rank test was used for stratified analysis of subgroups based on baseline characteristics, and the influencing factors for prognosis were analyzed. Results A total of 89 patients were screened and followed up in this study. The patients were followed up to December 2021, with a median follow-up time of 16 months, a median OS time of 17.0 (95% confidence interval [ CI ]: 15.3-18.7) months, and a median PFS time of 7.0 (95% CI : 6.2-7.8) months. There were significant differences in OS and PFS between the patients with different ECOG-PS scores, liver function Child-Pugh classes, portal vein invasion, patterns of progression, times of DTACE treatment, durations of oral administration of apatinib, and durations of application of camrelizumab (all P 4 months had significant improvements in median OS [21.0 (95% CI : 19.1-22.9) months vs 14.0 (95% CI : 10.4-17.6) months, χ 2 =19.399, P 5 months had significant improvements in median OS [22.0 (95% CI : 20.2-23.8) months vs 13.0 (95% CI : 9.3-16.7) months, χ 2 =22.336, P < 0.001] and PFS [9.0 (95% CI : 7.0-11.0) months vs 5.0 (95% CI : 4.1-5.9) months, χ 2 =26.141, P < 0.001]. Post-embolization syndrome was the adverse event after DTACE and resolved after symptomatic treatment. Adverse reactions related to targeted drugs and immunotherapy all resolved after symptomatic supportive treatment, with no grade ≥4 adverse reactions, and no patients withdrew from target-free therapy due to TRAEs. Conclusion As for DTACE combined with apatinib in the treatment of unresectable HCC, camrelizumab added after progression has a marked therapeutic efficacy with safe and controllable TRAEs.
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ObjectiveTo investigate the efficacy and safety of 125I intraluminal irradiation combined with lenvatinib in the treatment of progressive extrahepatic cholangiocarcinoma. MethodsA retrospective analysis was performed for 25 patients with progressive extrahepatic cholangiocarcinoma who attended Department of Interventional Radiology， The First Affiliated Hospital of Zhengzhou University， from January 2018 to November 2021， and according to the treatment modality， they were divided into combination group with 13 patients （125I intraluminal irradiation combined with lenvatinib） and control group （125I intraluminal irradiation alone）. The two groups were compared in terms of technical success rates， changes in liver function， stent patency， survival time， and incidence rates of adverse events. The independent－samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank－sum test was used for comparison of continuous data with skewed distribution between two groups； the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan－Meier method and the log－rank test were used to evaluate survival time and stent patency. ResultsAll patients had successful implantation of biliary stents and 125I particles， with a technical success rate of 100%. After 1 month of treatment， both groups had significant improvements in the serum levels of total bilirubin， direct bilirubin， alanine aminotransferase， and aspartate aminotransferase （all P<0.05）. There were significant differences between the control group and the combination group in the duration of stent patency （7.0 months vs 9.5 months， P=0.022） and median survival time （11.5 months vs 15.6 months， P=0.008）. There were no intolerable adverse events in the combination group during treatment. ConclusionCompared with 125I intraluminal irradiation alone， 125I intraluminal irradiation combined with lenvatinib has better efficacy and is a safe and effective treatment regimen for progressive extrahepatic cholangiocarcinoma.
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Methods:From Jan 2019 to Nov 2021, 20 patients underwent 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the EVAR at the three hospitals. The clinical data patients were collected and analyzed.Results:All the 20 cases underwent 3D printed template assisted pre-fenestration of stent graft according to the data of pre-operative the computed tomographic angiography (CTA). EVAR was successfully performed in all patients(included 2 cases with one fenestration,5 cases with 2 fenestration,10 cases with 3 fenestration and 3 cases with 4 fenestration). Fifty-four reinforced fenestrations (20 in right renal artery, 18 in left renal artery, 13 in superior mesenteric artery and 3 in celiac artery) were performed. During the follow-up period (mean 14.6 months), 1 case died, and the one-stage patency rate of splanchnic artery branch stent was 98.1%. Four patients had endoleak, 1 patient died of intracranial hemorrhage during postoperative period. None of patients had postoperative paraplegia or organ ischemia.Conclusions:3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique is feasible for EVAR in the treatment of complex abdominal aortic aneurysms and dissections. The technique is capable to reinforce the blood supply of visceral arteries with satisfied short-term effectiveness.Ojective:To evaluate 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the endovascular aortic aneurysm repair (EVAR).
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Objective:To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH).Methods:From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People′ s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. The general information, postoperative survival rate, the incidence of rebleeding, shunt dysfunction rate, and incidence of hepatic encephalopathy were analyzed.Results:All 13 patients with INCPH completed TIPS successfully with an average age of 45±8 (33 to 59) years. The hepatic venous pressure gradient (HVPG) decreased from 20.0-26.0 (22.6±1.9) mmHg before procedure to 8.0-14.0 (9.4±3.2) mmHg after. The median follow-up time was 44±7 (31 to 53) months. One patient died of liver failure 27 months after TIPS. Hepatic encephalopathy occurred cumulatively in 1 case (1/13), 1 case (1/13) and 1 case (1/13) in 12, 24 and 36 months after TIPS. Stent restenosis occurred cumulatively in 2 cases (2/13), 3 cases (3/13) and 3 cases (3/13) in 12, 24 and 36 months after TIPS. Portal vein thrombosis occurred cumulatively in 2 cases (2/13), and no primary liver cancer developed.Conclusions:TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.
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Objective:To identify the key convergence points in the medical-nursing combined care among literature, and establish a mechanism for medical-nursing combined care integration from the perspective of the synergy theory, for the purpose of promoting the integrated development of such care in China.Methods:Relevant literature on the medical-nursing combined care were retrieved from the CNKI database from September 2013 to September 2021. The search formula used was TI= "the medical-nursing care integration" AND SU=(convergence+ transformation+ coordination+ mechanism), while supplementary searches were made using " pkulaw.com database" and Baidu Scholar database. The method of literature content analysis was used to screen key points of the medical-nursing combined care, and the convergence mechanism was built based on the perspective of the synergy theory.Results:A total of 42 literatures were included in this study, 8 key convergence points of medica-nursing combined care integration were identified. Namely the 4 key horizontal convergence points of medical care, aging care, rehabilitation and nursing, the 3 key vertical convergence points of home care, institution care and community care, and the one key convergence point of institutional medical care. Based on the synergy theory and the 8 key convergence points, the " 431" convergence mechanism of medical-nursing combined care was constructed. This mechanism refered to the horizontal linkage of healthcare, nursing, rehabilitation and aging care, the vertical redirection among home care, institution care and community care modes, and the development mode focusing on institutional aging care.Conclusions:At present, the poor convergence between aging care and nursing care in China is a key roadblock hindering the integrated development of aging and nursing care. Medical-nursing combined care should be conducive to the " 431" convergence development, achieving horizontal linkage, vertical redirection, and resource sharing, for the purpose of high-quality development of China′s aging care system.
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Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.
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Chyluria is characterized by the presence of chyle in the urine. The most common cause of non-parasitic chyluria is the upstream obstruction of the thoracic duct and reflux of the chyle into the renal collecting system. Traditional treatments include dietary modifications and surgery. The recently developed new interventional technique to treat chyluria. Here, we firstly reported one case of chyluria caused by thoracic duct obstruction in China, which was successful treated with intranodal lymphangiography combined by percutaneous balloon plasty. The symptoms of chyluria were completely relieved after our operation, which provides a minimally invasive, safe and effective method for patients with ineffective chyluria after conservative treatment or surgery.
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Objective:To explore the safety and efficacy of Castor branched stent-graft exclusion in the treatment of aortic dissection and aneurysm involving left subclavian artery.Methods:The clinical and imaging data of 88 patients with aortic dissection or aneurysm involving left subclavian artery diagnosed by CTA or DSA in our hospital from December 2017 to December 2019 were collected retrospectively, including 67 aorta dissections, 7 thoracic aortic aneurysms and 14 aorta penetrating ulcer. All patients were treated with branched stent-graft under the guidance of DSA. The postoperative curative effect and complications were observed. The paired t test was used to compare the maximum aortic diameter of the lesion before and 6 months after the operation. Results:Eighty-eight patients were successfully treated with integrated stent, the success rate of operation was 100%, and the disease-related symptoms of all patients were basically or completely relieved. The mortality rate within 1 month after the operation was 2.7% (2/88). The two deaths were complicated with other serious diseases before the operation, and the cause of death was not related the operation. All patients were followed up except 4 patients who lost contact after discharge. During the follow-up, there were 1 case of retrograde type A dissection, 1 case of new aneurysm of aortic arch, 2 cases of in-stent stenosis of left subclavian artery branch, 3 cases of mild stroke, no persistent endoleak and no death or other serious complications. The mean maximum aortic diameter at 6 months after operation [(34±4)mm] was significantly lower than that before operation [(38±6 mm)] ( t=6.63, P<0.05). Conclusion:Castor branched stent-graft is simple, mini-invasive and effective in the treatment of aortic dissection and aneurysms involving the left subclavian artery.
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Objective To investigate the cost-effect of transarterial chemoembolization (TACE) with CalliSpheres beads loaded with arsenic trioxide (ATO) (CBATO) versus ATO iodized oil emulsion (conventional TACE, cTACE) in the treatment of unresectable liver cancer. Methods A total of 100 patients with advanced liver cancer who attended The First Affiliated Hospital of Zhengzhou University from May 2017 to December 2018 were enrolled and divided into CBATO group( n =45) and cTACE group( n =55) according to the treatment regimen. Progression-free survival (PFS) was used to evaluate the efficacy of quality-adjusted life year (QALY), and European Quality of Life-5 Dimensions (EQ-5D) index was used to evaluate quality of life. The t -test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; the number of surgeries, length of hospital stay, treatment cost, and incremental cost-effectiveness ratio (ICER) were calculated for the two groups, and then a cost-effect analysis was performed. Results Within the PFS time, the per capita hospital cost was 96 446 yuan in the CBATO group and 91 230.43 yuan in the cTACE group. There were significant differences between the two groups in the mean number of surgeries (2.5±0.7 vs 3.4±0.8, t =16.911, P < 0.01) and mean hospital stay (5.8±1.2 days vs 7.5±1.8 days, t =12.459, P < 0.01). The CBATO group had a significantly higher QALY than the cTACE group (0.804 vs 0.512). Compared with the cTACE group, the CBATO group had an ICER of 17 861.53 yuan/QALY for unresectable liver cancer. Conclusion Although CBATO has a higher surgery cost than cTACE, CBATO has a better clinical effect than cTACE and can reduce the number of surgeries and length of hospital stay, with a better postoperative quality of life than cTACE, suggesting that CBATO has marked cost-effect advantages.
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Objective:To observe the short-term efficacy and safety of bronchial arterial chemoembolization (BACE) combined with anlotinib for treatment of advanced non-small cell lung cancer (NSCLC).Methods:The clinical data of 14 patients with advanced NSCLC in the First Affiliated Hospital of Zhengzhou University from June 2018 to March 2019 were retrospectively analyzed. The short-term efficacy and adverse reactions of BACE combined with anlotinib hydrochloride were evaluated.Results:All patients successfully received BACE treatment twice. The median follow-up time was 19 months (8-26 months). The objective response rate (ORR) of patients at 1, 3 and 6 months after the first treatment was 100.0% (14/14), 71.4% (10/14) and 57.1% (8/14), and the disease control rate (DCR) was 100.0% (14/14), 92.8% (13/14) and 78.6% (11/14), respectively. The median progression-free survival (PFS) time was 9.5 months (95% CI 9.0-17.3 months), and the 6-month and 12-month PFS rates were 78.6% and 28.6%, respectively. The median overall survival (OS) time was 19.0 months (95% CI 18.4-23.1 months), and the 6-month and 12-month OS rates were 100.0% and 85.7%, respectively. Anlotinib hydrochloride-related adverse reactions included hand-foot syndrome [42.9% (6/14)], fatigue [35.7% (5/14)], hypertension [35.7% (5/14)], oral mucositis [28.6% (4/14)], hemoptysis [28.6% (4/14)], elevated aminotransferases [21.4% (3/14)] and diarrhea [14.3% (2/14)]. There were no grade ≥3 adverse reactions. Conclusion:BACE combined with anlotinib is safe and effective for treatment of advanced NSCLC, and the short-term clinical efficacy is satisfactory.
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ObjectiveTo investigate the effect of arsenic trioxide-loaded CalliSpheres beads (CBATO) in transarterial chemoembolization (TACE) in the treatment of rabbits with VX2 liver tumor. MethodsA total of 120 tumor-bearing rabbits were divided into control group, CalliSpheres beads (CB) group (blank beads for TACE), CBATO group, and conventional TACE (cTACE) group (arsenic trioxide lipiodol for TACE) using a random number table, with 30 rabbits in each group. Five rabbits in each group were sacrificed at 12 hours and on days 3, 7, and 14 after TACE, and immunohistochemistry was used to measure the proliferation index and apoptosis percentage of tumor cells in the residual tumor area. The tumor necrotic volume was measure on day 7 after TACE, and the growth rate and necrosis rate of tumor cells were calculated. Ten rabbits were randomly selected from each group for the observation of survival time. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kaplan-Meier survival analysis was used to evaluate survival time, and the log-rank test was used for comparison. ResultsOn day 7 after TACE, the CBATO group had a significantly lower growth rate and a significantly higher necrosis rate of tumor cells than the cTACE group, the CB group, and the control group (all P＜0.05). At each time point after TACE, there were significant differences in the proliferation index and apoptosis percentage of tumor cells between the CBATO group and the other three groups (all P＜0.05). The median survival time was 26 days in the CBATO group, 18.5 days in the CB group, 22 days in the cTACE group, and 15.5 days in the control group, and the CBATO group had a significantly longer survival time than the other three groups (χ2=3.95, 8.99, and 13.47, P=0.049, P=0.003, and P＜0.01). ConclusionCBATO has a better effect than cTACE and CB in the treatment of rabbits with VX2 liver tumor and can significantly improve tumor necrosis rate, promote the apoptosis of tumor cells, and prolong the survival time of experimental animals.
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This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy, resulting in urinary fistula, which seriously affected the quality of life. Referring to the treatment experience of visicovaginal fistula, the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.
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Objective@#To explore the therapeutic value of interventional methods for hemorrhage caused by mandibular arteriovenous malformations.@*Methods@#The clinical data of 7 patients (3 males and 4 females) with mandibular arteriovenous malformations treated by interventional therapy from January 2012 to January 2018 in the First Affiliated Hospital, Zhengzhou University were retrospectively analyzed. Of all patients, 4 patients suffered from sudden massive hemorrhage and 3 patients suffered from spontaneous repeated bleeding. The age ranged from 8.0 to 13.0 (10.6±1.7) years. Of the 7 patients, 3 underwent interventional embolization via arteries and veins, and 4 underwent embolization only via arteries. The embolic materials were polyvinyl alcohol granules and coils. The follow-up period was 9—18 months and the curative effect was observed.@*Results@#Among the 7 patients, 4 cases of acute massive hemorrhage were effectively controlled after interventional operation, 3 cases of chronic bleeding disappeared after interventional operation. No recurrence of bleeding occurred during the follow-up period, only 1 patient presented with oral infection and gingival swelling and hyperplasia. The symptoms were effectively controlled after anti-infection and debridement. No severe complications occurred in all patients.@*Conclusion@#Interventional therapy for ateriovenous malformation with hemorrhage is effective, safe and feasible, which is worthy of clinical application.
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This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy,resulting in urinary fistula,which seriously affected the quality of life.Referring to the treatment experience of visicovaginal fistula,the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.
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Objective:To investigate the morphological feature and clinical significance of MRI around tumor after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) of primary hepatocellular carcinoma.Methods:We reviewed and analyzed the data of hepatocellular carcinoma patients admitted from January 2017 to December 2018 in the Department of Radiological Intervention of the First Affiliated Hospital of Zhengzhou University. A total of 42 patients were enrolled, including 35 males and 7 females, aged (57.0±11.9) years. For the first time after operation, MRI enhancement showed peri-tumor margin enhancement as the starting point of follow-up. Follow-up and measure enhanced edge thickness, delayed enhancement, progression or remission data.Results:A total of 49 tumors and 84 peritumoral enhancement margins were included in 42 patients, with 30 sharp type , 40 rough type and 14 nodular type. The thickness of sharp type is less than that of rough type and nsodular type, and the differences were statistically significant (all P<0.05). The sharp type is the majority of the tumors with maximum diameter <5 cm, rough type and nodule type are the majority of tumors with maximum diameter ≥5 cm. Most of the sharp type are continuously enhanced, while the rough type and nodular type are not. Most sharp type relief (93.3%, 28/30), while rough type (80.0%, 32/40) and nodular type ( n=12) are mostly of deterioration, the differences are statistically significant (all P<0.05). Conclusion:Compared with the rough type and nodular type, the sharp type usually occurs in smaller tumors and more prone to local mitigation in the enhanced morphology around MRI after DEB-TACE in primary hepatocellular carcinoma.
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Objective:To evaluate the curative effect, safety and feasibility of percutaneous transhepatic cholangio drainage(PTCD) combined with balloon dilatation in treating benign biliary-enteric anastomosis stricture(BBES).Methods:The clinical data of 33 patients with benign biliary-enteric anastomosis stricture, who were admitted to the First Affiliated Hospital of Zhengzhou University during the period from January 2013 to May 2019, were retrospectively analyzed. There were 23 cases of benign etiology and 10 cases of malignant etiology, benign strictures of which 15 cases were located in the hepatic hilum and of which 18 cases outside of it. All patients were considered as benign stenosis by at least two imaging examinations of magnetic resonance imaging of pancreatic or enhanced MRI or enhanced CT, laboratory examinations of tumor markers and other clinical data before operation. 10 cases of malignant etiology were confirmed by intraoperative biopsy and pathology. All patients were treated with balloon dilatation at an interval of 1 to 4 weeks after PTCD. The changes of clinical symptoms, bilirubin and liver function before and after operation were compared and analyzed, and the postoperative complications and anastomotic patency rate were followed up.Results:PTCD combined with balloon dilatation was performed successfully in all patients, and the success rate was 100%. After operation, the benign biliary-enteric anastomosis stricture was significantly improved in all patients, and the clinical symptoms were improved obviously. The liver function and bilirubin decreased significantly in all patients after operation, and there was significant statistical significance ( P<0.05). There is no serious complications such as biliary bleeding and biliary fistula were found after operation. At 3 months, 6 months, 12 months, 24 months and 36 months after operation, the anastomotic patency rates of all patients were 90.9%(30/33), 72.7%(24/33), 63.6%(21/33), 63.6%(21/33), 60.6%(20/33), respectively. During the whole follow-up period, anastomotic restenosis happened in 13 patients, of which 9 cases with restenosis, the benign stenosis site of the anastomosis was the hepatic hilum and of which 4 cases located on the outside of the hepatic hilum. After treatment, the incidence of benign restenosis of the anastomosis at the hepatic hilum (60.0%, 9/15) was higher than that at outside of the hepatic hilum (22.2%, 4/18) and it's statistically significant ( P<0.05). Among the 13 patients with recurrence of BBES, 4 cases underwent choledochojejunostomy for malignant causes and 9 cases with benign causes. The recurrence rates after the first balloon dilatation were 40.0% (4/10) and 39.1% (9/23), respectively, and the average recurrence time was 5.8 months and 6.8 months respectively, the difference was not statistically significant( P>0.05). Conclusion:For the treatment of benign biliary-enteric anastomosis stricture, percutaneous transhepatic cholangio drainage combined with balloon dilatation with reliable curative effect, with high safety and less trauma, with less operative complications, and with repeatability, so it is worth applying in clinic.
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Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.
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Objective:To explore the therapeutic value of interventional methods for hemorrhage caused by mandibular arteriovenous malformations.Methods:The clinical data of 7 patients (3 males and 4 females) with mandibular arteriovenous malformations treated by interventional therapy from January 2012 to January 2018 in the First Affiliated Hospital, Zhengzhou University were retrospectively analyzed. Of all patients, 4 patients suffered from sudden massive hemorrhage and 3 patients suffered from spontaneous repeated bleeding. The age ranged from 8.0 to 13.0 (10.6±1.7) years. Of the 7 patients, 3 underwent interventional embolization via arteries and veins, and 4 underwent embolization only via arteries. The embolic materials were polyvinyl alcohol granules and coils. The follow-up period was 9—18 months and the curative effect was observed.Results:Among the 7 patients, 4 cases of acute massive hemorrhage were effectively controlled after interventional operation, 3 cases of chronic bleeding disappeared after interventional operation. No recurrence of bleeding occurred during the follow-up period, only 1 patient presented with oral infection and gingival swelling and hyperplasia. The symptoms were effectively controlled after anti-infection and debridement. No severe complications occurred in all patients.Conclusion:Interventional therapy for ateriovenous malformation with hemorrhage is effective, safe and feasible, which is worthy of clinical application.
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Objective:To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP).Methods:Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed.Results:All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml ( P>0.05), the time of uterine curettage were (37±20), (42±19) minutes ( P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days ( P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion:Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.