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Clinical Analysis of 156 Old Patients with Severe Acute Cholangitis Treated by PTCD under Ultrasonic Guidance

目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。

微创胸膜腔置管注入尿激酶治疗结核性胸腔积液

【摘要】 目的 探讨微创胸膜腔置入中心静脉导管(简称导管)注入尿激酶治疗结核性包裹性胸腔积液(简称积液)的临床价值。方法 2008年6月-2009年8月在正规抗结核治疗基础上,选取确诊积液患者72例,按数字随机法分为治疗组和对照组,治疗组36例经超声引导导管置入胸膜腔并注入生理盐水50 mL加尿激酶10万 U,对照组36例多次穿刺抽液,比较两组疗效及积液引流量、胸膜厚度、积液吸收时间等。结果 治疗组28例显效,5例好转,3例无效;对照组10例显效,13例好转,13例无效,两组疗效差异具有统计学意义(Plt;0.05)。治疗组与对照组平均积液引流量分别为1 421 mL和756 mL,胸膜厚度分别为(1.9±0.4) mm和(3.7±1.2) mm,积液吸收时间分别为(13.3±1.2)d和(17.3±1.6)d,两组间比较差异均有统计学意义(Plt;0.05)。结论 超声引导导管置入胸膜腔并注入尿激酶治疗结核性包裹性胸腔积液疗效显著,可增加引流量,减轻胸膜肥厚,改善肺功能,减少穿刺机会。

CLINICAL OBSERVATION OF PERCUTANEOUS ACETIC ACID INJECTION AND PERCUTANEOUS ETHANOL INJECTION IN THE TREATMENT OF PRIMARY HEPATIC CARCINOMA

Objective To study the efficiency of percutaneous acetic acid injection (PAI) or percutaneous ethanol injection (PEI) in the treatment of primary hepatic carcinoma (PHC). Methods Seventeen and 24 patients with PHC were treated, respectively by PAI or by PEI in our hospital. According to hepatic function test, soluble intereukin-2 receptor (sIL-2R), AFP, biopsy and size of tumor, the evaluation was made.Results Effective rate was 88.2% in PAI group and 87.5% in PEI group, respectively. There was no obvious influence to sIL-2R in serum in the two groups (Ｐ＞0.05). Obvious differences in impairment of hepatic functions between PAI and PEI groups were found (Ｐ＜0.01), it also showed that smaller amounts of acetic acid and less puncture frequency were required for the treatment than that of ethanol. Conclusion PAI is superior to PEI in the treatment of those patients who are complicated with cirrhosis or other vital disease.

超声引导在 125I 放射性粒子植入治疗近膈处肝癌中的安全性分析

目的 总结超声引导下经皮 125I 放射性粒子组织间植入治疗近膈处肝癌的临床安全性及优势。 方法 回顾性分析 2014 年 3 月至 2016 年 2 月期间于笔者所在医院接受超声引导下经皮 125I 放射性粒子植入治疗的 10 例近膈处肝癌患者的临床资料。 结果 10 例患者均按计划行粒子植入，植入 125I 粒子 19～108 枚，平均植入 58.1 枚。植入过程顺利，手术时间 30～90 min，平均 57 min。术后质量验证示粒子分布满意，无补种情况发生。2 例患者术后出现发热，经抗炎及对症治疗后痊愈。1 例患者出现穿刺部位疼痛，给予止痛治疗后好转。10 例患者术后复查均未发现腹腔出血及积液，无血、气胸等肺部并发症发生，无胆汁漏、肝功能衰竭等严重并发症发生。10 例患者均顺利出院。术后 10 例患者均获访，随访时间为 6～43 个月，中位数为 18.5 个月。随访期间，2 例出现粒子移位，未出现严重后果，未予处理；未发现其他远期并发症发生。 结论 超声引导下经皮 125I 放射性粒子植入治疗近膈处肝癌的并发症少，安全可靠，具有其优势。

ltrasoundguided Interstitial Implant Brachytherapy for Moderately Advanced and Advanced Cervical Carcinoma

摘要:目的：探讨超声引导下组织间插植内照射治疗中晚期宫颈癌的意义和效果。方法:回顾性分析32例中晚期宫颈癌患者,采用超声引导下肿瘤组织间插植内照射+外照射。结果：有23例肿瘤脱落,宫颈原形出现,其余7例肿瘤缩小50%以上,持续时间均≥1个月,另有2例肿块缩小＜50%,即CR为719%,PR为218%,NC为63%,PD为0%。结论：超声引导下插植内照射是一种治疗中晚期宫颈癌的安全有效的近距离放疗技术。Abstract: Objective: To evaluate the efficacies of interstitial implant brachytherapy by ultrasoundguided for moderately advanced and advanced cervical carcinoma. Methods: Thirytwo patients with cervical cancer ⅡbⅣ who received interstitial implant brachytherapy by ultrasoundguided and routine irradiation. Results: 719% cases achieved complete remission (CR), 219% cases partial remission (PR), 63% cases no change(NC),0% case progressed disease（PD）. Conclusion: Interstitial implant brachytherapy by ultrasoundguided is an effective method for cervical tumor.

Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study

ObjectiveTo explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of avascular necrosis of the femoral head.MethodsWe retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received 4 injections at one-week intervals. The Visual Analogue Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Harris Hip Joint Function Scale (HHS) were evaluated before treatment and 1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance; the non-normally distributed data were presented as median (lower quartile, upper quartile), and analyzed by Friedman test.ResultsA total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and 1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0 (5.5, 8.0), 4.0 (3.0, 5.0), 3.0 (2.0, 3.0), and 3.0 (2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0 (40.0, 64.0), 71.0 (57.5, 75.0), 78.0 (68.0, 80.5), and 78.0 (64.0, 80.0), respectively. The time effects in VAS (χ2=65.423, P<0.001), WOMAC (F=46.710, P<0.001), and HHS (χ2=66.347, P<0.001) were all statistically significant. There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant difference in each index between the value 1 month after treatment and that 3 months after treatment (P<0.05). There was no significant difference in any indicator between the value 6 months after treatment and that 3 months after treatment (P>0.05). Significant difference was shown between the value 6 months after treatment and that 1 month after treatment in WOMAC (P=0.016), but not in VAS or HHS (P>0.05). No obvious adverse event was reported during the follow-up period.ConclusionsUltrasound-guided intra-articular PRP injection can effectively alleviate the pain and improve the hip joint function of patients with femoral head necrosis for at least 6 months. However, randomized controlled studies with a larger sample size and longer-term follow-up are needed in the future to confirm the efficacy and safety of PRP injection in femoral head necrosis.

超声引导下老年单纯性肾囊肿穿刺的护理配合

目的　讨论超声引导下单纯性肾囊肿穿刺治疗术的护理配合措施。 方法　对2009年6月－2010年6月120例单纯性肾囊肿老年患者行超声引导下穿刺治疗的方法及护理配合措施进行回顾性分析。 结果　120例患者全部手术成功，无并发症发生，经6个月随访，无效1例，显效7例，效果明显112例。 结论　单纯性肾囊肿老年患者行超声引导下穿刺治疗术，其护理配合是顺利完成治疗，避免并发症发生的关键。

超声引导下改良塞丁格技术在高龄患者中的应用

A retrospective study of the effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of knee osteoarthritis

ObjectiveTo explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of patients with different stages of knee osteoarthritis.MethodsWe retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification (K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded.ResultsA total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3rd and 6th month follow-up (P<0.05). VAS and WOMAC scores of the three groups at the 3rd and 6th month after the treatment were significantly improved compared with those before the treatment (P<0.05). There was no significant difference in VAS score at the 3rd or 6th month after the treatment three groups (P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3rd or 6th month after the treatment (P>0.05). However, the WOMAC scores at the 3rd month after the treatment were better than those at the 6th month in K&L Ⅱ and Ⅲ groups (P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group (P>0.05).ConclusionThe ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.

Treatment for Benign Thyroid Cystic Mass in Elderly Patients by Ultrasound Guided Percutaneous Aspiration and Pure Ethanol Injection——Experience from Primary Hospital

目的　总结穿刺抽液及无水乙醇局部注射在老年良性甲状腺囊性疾病患者中的应用方法及效果。方法　回顾性分析2008年1月至2011年6月期间在我院行穿刺抽液及无水乙醇注射治疗的老年良性甲状腺囊性疾病患者的临床资料。结果　共84例患者接受穿刺抽液及无水乙醇注射，男11例，女73例；年龄（69±6.4）岁（60～82岁）。术前彩超检查包块均为囊性，直径（4.8±1.7） cm。术前所有患者均主诉吞咽或活动时颈部不适感。54例患者注射无水乙醇后出现面色潮红、局部皮肤发红等症状，在1～2d内消失。无感染、死亡等发生。术前、术后甲状腺功能比较无变化。术后半年复查彩超，包块直径缩小为（1.9±1.2） cm。术后患者主诉颈部不适感症状减轻或消失。结论　对于老年良性甲状腺囊性疾病患者行穿刺抽液及无水乙醇注射安全，可有效缓解患者局部压迫不适，其远期疗效还有待长期观察。